PURPOSE: This rule prescribes criteria for admission in all community residential facilities as required by section 630.710, RSMo.

1. (1) Either prior to admission or within thirty
2. (30) days of admission and annually after that, each resident shall have a medical evaluation and an individualized habilitation or treatment plan.
3. (2) The medical evaluation for all residents who are mentally retarded or developmentally disabled shall include a screening for hepatitis B unless the resident has been immunized or by previous screening has been found to be immune.
4. (3) The medical evaluation for all department clients shall include a complete blood count, tuberculin control test and urinalysis; special studies when the index of suspicion is high; vision and hearing tests and routine screening laboratory examinations as recommended by a physician and, at the discretion of the physician, female residents shall have an annual pelvic examination.
5. (4) The facility shall follow its written policies and procedures as approved by the department for the admission of residents. The facility shall describe how its program is especially designed to meet the needs of the residents it admits.
6. (5) The facility shall not admit more residents than its licensed capacity.
7. (6) The facility shall not admit, nor keep in residence, any person whose special needs exceed the facility’s provisions for medical care or for adequate programming as described in the resident’s individualized habilitation or treatment plan.
8. (7) The facility shall not admit any resident unless the facility has adequate fencing around swimming pools, ponds, sewage lagoons, liquefied petroleum gas (LPG) tanks and other potentially hazardous areas.

9. (8) The head of a facility licensed by the Department of Social Services as a residential care facility I shall not admit nor keep in residence any resident unless the facility has evidence supporting the following:

   1. (A) The resident can evacuate the facility without human or mechanical assistance in case of an emergency. In psychiatric group homes, residents needing human or mechanical assistance to evacuate may be placed on the first floor;

   2. (B) The resident has skills in use of hot water above one hundred fifteen degrees Fahrenheit (115°F), use of toxic chemicals and self-administration of medication, which are adequate in consideration of the facility’s policies, procedures and staffing to assure the safety of the resident.

      1. 1. If the record does not document that

a resident can use toxic chemicals, or at least will respect the danger of toxic chemicals, their use and storage is such that residents never have access to them. Procedures require that toxins are always kept locked unless in use. Procedures must include precautions to be utilized when toxins are in use.

1. 2. If the record does not document that

the resident can safely use hot water, hot water at all taps accessible to the resident must be kept below one hundred fifteen degrees Fahrenheit (115°F). Use of hot water includes the ability to know hot faucets from cold faucets, to manipulate faucets and to call for help in emergencies.

1. 3. If residents self-administer medica-

tions, authorization to do so shall be included in the doctor’s orders and approved by those persons participating in the development of the individualized habilitation plan (IHP) or individualized treatment plan (ITP). If the required authorization is not documented in each resident’s record or if, despite the documentation, a facility chooses to distribute or administer medications to residents, the following guidelines apply: 9 CSR 40-3

1. A. The record has doctor’s orders for

all medications being administered except for nonprescription topical medications;

1. B. The same person who prepares the

medication shall also administer it and chart it at the time it is administered; and

1. C. Doctor’s orders shall be reviewed

every ninety (90) days;

1. (C) The resident is ready for training or has required adequate self-care skills including, but not limited to, personal hygiene, grooming, eating skills, telephone use and money management;
2. (D) The resident is capable of competitive employment, employment in a sheltered workshop, a job-training program or training in self-help skills or, if elderly, is capable of participating in leisure time activities and programs;
3. (E) The resident can function safely within the physical environment of the facility; and
4. (F) The resident is at least eighteen (18) years of age or, in psychiatric group homes, seventeen (17) years of age.

1. (9) The head of a facility licensed by the Department of Social Services as a residential care facility II shall not admit nor keep in residence any resident unless the facility has evidence supporting the following:

   1. (A) The resident can evacuate the facility unassisted or with assistive devices;

   2. (B) The resident has skills in the use of hot water above one hundred fifteen degrees Fahrenheit (115°F), use of toxic chemicals and self-administration of medication, which are adequate in consideration of the facility’s policies, procedures and staffing to assure the safety of the resident.

      1. 1. If the record does not document that

a resident can use toxic chemicals, or at least will respect the danger of toxic chemicals, their use and storage is such that residents never have access to them. Procedures require that toxins are always kept locked unless in use. Procedures must include precautions to be utilized when toxins are in use.

1. 2. If the record does not document that

the resident can safely use hot water, hot water at all taps accessible to the resident must be kept below one hundred fifteen degrees Fahrenheit (115°F). Use of hot water includes the ability to know hot faucets from cold faucets, to manipulate faucets and to call for help in emergencies.

1. 3. If residents self-administer medica-

tions, authorization to do so must be included in the doctor’s orders and approved by those persons participating in the development of the IHP or ITP. If the required authorization is not documented in each resident’s record or if, despite the documentation, a facility chooses to distribute or administer medications to residents, the following guidelines apply:

1. A. The record has doctor’s orders for

all medications being administered except for nonprescription topical medications;

1. B. The same person who prepares the

medication shall also administer it and charts it at the time it is administered; and

1. C. Doctor’s orders shall be reviewed

every ninety (90) days;

1. (C) The resident is capable of providing self-care with assistance. Self-care skills shall include, but not be limited to, personal hygiene, grooming, eating and telephone use;
2. (D) The resident is capable of competitive employment, employment in a sheltered workshop, a job-training program or training in self-help skills or, if elderly, is capable of participating in leisure time activities and programs;
3. (E) The resident can function safely within the physical environment of the facility; and
4. (F) The resident is at least eighteen (18) years of age.

1. (10) The head of a facility licensed by the Department of Social Services as an intermediate care facility (ICF) or skilled nursing facility (SNF) shall not admit nor keep in residence any residents unless—

   1. (A) The facility controls the temperature of hot water at all taps accessible to residents by the use of thermostatic mixing valves or by other means, to keep the temperature from exceeding one hundred fifteen degrees Fahrenheit (115°F);
   2. (B) The facility stores and uses toxic compounds so as not to constitute a hazard to residents; and
   3. (C) The resident is at least eighteen (18) years of age.

2. (11) All staff administering medications in a facility licensed by the Department of Social Services as a residential care facility I, residential care facility II, intermediate care facility or skilled nursing facility shall have successfully completed a course on medication administration. This training shall be updated every two (2) years. The initial training and biennial update shall—

   1. (A) Be approved by the regional center or placement office;
   2. (B) Be offered by an instructor who is a licensed practical nurse (LPN) certified by the Division of Aging as an instructor, a registered nurse (RN), a pharmacist or a physician;
   3. (C) Not apply to LPNs, RNs or certified medication technicians with lifetime certificates; and
   4. (D) Be documented in the recipient’s personnel file.

3. (12) The course to update training in medication administration shall address at least the following:

   1. (A) Review of basics.

      1. 1. Medication ordering and storage.

      2. 2. Medication administration.

         1. A. Use of generic drugs.
         2. B. How to pour, chart, administer and

document.

1. C. Information and techniques specif-

ic to the following: inhalers, eye drops, topical medications, insulin injections and suppositories.

1. D. Infection control.
2. 3. Individual rights and refusal of med-

ications and treatment;

1. (B) Issues specific to the facility/program as indicated by the needs of the residents, and the medications and treatments currently being administered.

   1. 1. Emergency response.
   2. 2. Medication allergies.
   3. 3. Corrective actions based on problems

identified by the staff, the trainees or issues identified by regulatory and accrediting bodies, professional consultants or by any other authoritative source; and

1. (C) Updates on new medications or new procedures.

AUTHORITY: sections 630.050 and 630.705, RSMo (1994).* Original rule filed Oct. 13, 1983, effective Jan. 15, 1984. Amended: Filed July 15, 1985, effective Feb. 1, 1986. Amended: Filed Jan. 2, 1990, effective June 11, 1990. Amended: Filed April 1, 1993, effective Dec. 9, 1993. Amended: Filed July 17, 1995, 1995, effective March 30, 1996. *Original authority: 630.050, RSMo (1980), amended 1993, 1995 and 630.705, RSMo (1980), amended 1982, 1984, 1985, 1990.