(f) Residents shall have the right to choose their health care providers, notwithstanding any other agreement to the contrary.

1. (1) The operator shall designate sufficient staff who shall be responsible for monitoring residents on-site.

2. (2) Monitoring shall be provided at any hour of the day or night of the week, and shall include but not be limited to the ability:

   1. (i) to respond to urgent or emergency needs or requests for assistance with appropriate staff; and

   2. (ii) to identify abrupt or progressive changes in behavior, appearance, or in performing basic activities of daily living which may signify the need for re-assessment and changes in service as reflected on the individualized service plan.

      (h) Daily food service.

3. (1) Unless otherwise stated in the resident's residency agreement, the provision of food service shall be dictated by and in compliance with the facility's certification as either an adult home or enriched housing program and provided pursuant to 18 NYCRR Part 487 or Part 488.
4. (2) All food purchasing, storage, preparation and service shall be in compliance with the New York State Sanitary Code Part 14 of this Title and other applicable county and local health codes and the standards for such practices as dictated by the facility's certification as either an adult home or enriched housing program pursuant to 18 NYCRR Part 487 or Part 488.

5. (3) Food services shall be provided in a manner that respects the dietary needs of the residents in relation to health conditions, food allergies and dietary intolerances, religious and ethnic mandates, and that allows for a reasonable variation in taste preferences.

   (i) Case management services.

   In addition to the case management services provided pursuant to 18 NYCRR section 487.7(g) or 488.7(e), the residence shall:

6. (1) identify and evaluate the resident's needs, interests, and strengths and the capability of the facility to meet those needs, prior to admission and then at least once every 12 months, using the personal data and resident evaluation form prescribed by the department;
7. (2) oversee and coordinate a written individualized service plan for each resident, as per the conditions of this paragraph;
8. (3) provide information upon admission including meeting with prospective residents and residents and their representatives and legal representatives, if any, to discuss whether and how the residence can meet the needs of such prospective resident or residents, and to explain the various levels of care and services available in a basic assisted living residence, an enhanced assisted living residence and a special needs assisted living residence;
9. (4) meet with prospective residents and residents, and their representatives and legal representatives to discuss matters described in the residency agreement and disclosures required under article 46-B of the Public Health Law and this Part, including the services that the residence can provide to meet the needs of the prospective resident or residents;
10. (5) provide information and referral on an ongoing basis;
11. (6) coordinate with service providers selected by the residents and with other available resources on an ongoing basis to best address the resident's identified needs and interests;
12. (7) develop a formal mechanism between the case manager and facility staff who serve the resident to identify abrupt or progressive changes in behavior or appearance, which may signify the need for assessment and service; and

13. (8) maintain a complete and accurate personal record for each resident as specified in section 1001.12 of this Part.

    (j) Personal care.

14. (1) Each resident shall be provided such personal care as is necessary to enable the resident to maintain good personal hygiene, to carry out the activities of daily living, to maintain good health, and to participate in the ongoing activities of the residence, as per the resident's individualized service plan developed pursuant to section 1001.7(h) of this Part.
15. (2) Unless otherwise stated in the resident's residency agreement, the provision of personal care shall be dictated by and in compliance with the facility's certification as either an adult home or enriched housing program and provided pursuant to 18 NYCRR Part 487 or Part 488.

16. (3) Personal care service tasks shall be performed by staff, hereafter referred to as resident aides, appropriately trained to perform such tasks pursuant to section 1001.11(c)(2) of this Part.

    (k) Health care services.

17. (1) Pursuant to section 1001.7(k) of this Part, the resident's individualized service plan shall specify any necessary health care services to be provided to the resident, including those provided by a home care services agency licensed pursuant to article 36 of the Public Health Law.
18. (2) Unless approved by the commissioner to provide enhanced or special needs assisted living, the residence shall arrange for any needed health care services to be provided by a home care services agency approved pursuant to article 36 of the Public Health Law. For purposes of this Part, such services shall include: nursing, home health aide services, physical therapy, occupational therapy, speech therapy, respiratory therapy, social work, nutrition, and medical supplies, equipment and appliances.
19. (3) A home care services agency shall not provide in a residence those basic services required to be provided by an adult home or enriched housing program certified pursuant to 18 NYCRR Part 487 or Part 488, including personal care services, unless an assisted living residence operator has contracted with a home care services agency approved pursuant to article 36 of the Public Health Law for the provision of such required services on its behalf, and such services are included in the resident's basic rate. If such home care services agency fails to provide services in compliance with the requirements for the residence as an adult home or enriched housing program, pursuant to such contract, the assisted living residence operator shall continue to be responsible for assuring that such services are provided in accordance with applicable regulations.

20. (4) The receipt of hospice services by a resident of an assisted living residence shall be permitted, and additional certification for enhanced assisted living shall not be required for the resident to receive hospice services within the residence, so long as the following conditions are met:

    1. (i) the ALR, the resident's physician and the hospice determine that, with the provision of hospice services, the resident can be safely cared for in the assisted living residence;
    2. (ii) service responsibilities of the residence and the hospice are specified on the individualized service plan; and

    3. (iii) the operator agrees to retain the resident and to coordinate the care provided by the operator with the hospice.

       (l) Medication management.

21. (1) Medication acquisition, storage and disposal, and assistance with self-administration of medication shall be performed in conformance with the standards for such practice dictated by the facility's certification as either an adult home or enriched housing program, pursuant to 18 NYCRR section 487.7(f) or 488.7(d) respectively, and consistent with any and all operative guidance documents relating to medication services provided to facility residents issued by the department.
22. (2) The operator shall develop policies and procedures for medication management in compliance with the requirements of 8 NYCRR section 29.7(a)(21)(ii)(b), sections 80.5 and 80.6 of this Title, 18 NYCRR section 487.7(f) or 488.7(d) (depending on facility certification).
23. (3) A medication assistance record shall be maintained for each resident to include, at a minimum, the diagnoses of the resident, all medications used by the resident, including both prescribed and over-the-counter medications, the indication for the medications prescribed, labels for medications that are dispensed as generic drugs labeled as such, any special directions for taking or storing medications, known allergies, and a picture of the resident or other electronic means to identify the resident.
24. (4) Medication orders received from the physician of a resident prescribed as PRN shall be reviewed with the physician in terms of the resident's ability to identify the need for medication.
25. (5) The physician's order for all PRN medications, including prescriptions and over-the counter, shall identify those resident behaviors or symptoms warranting consideration of need for the medication(s).
26. (6) Unless at the time that a medication order is issued, the resident's physician has indicated that the resident is able to identify the need for the medication, a resident may not be assisted with any PRN medication, whether prescription or over-the-counter, without observation by or consultation with appropriate licensed nursing or medical providers. The record of assistance with such medications shall include the behavior or symptoms observed as well as the nature of such observation by or consultation with such licensed staff.

27. (7) The use of prescription PRN medications for persons with dementia shall be limited to only those instances where the physician has determined after review with residence staff that there is no alternative to the order.

    (m) Enhanced assisted living.

28. (1) In addition to the services of the assisted living residence provided pursuant to an executed residency agreement, a resident of enhanced assisted living within a residence granted an enhanced assisted living certificate pursuant to section 1001.4 of this Part may receive health care services provided by staff directly employed by the enhanced assisted living residence. The operator may, but is not required to, obtain licensure or certification pursuant to article 36 of the Public Health Law, to provide such health care service.

29. (2) If an enhanced assisted living residence provides health care services that would ordinarily be provided by a home care services agency licensed pursuant to article 36 of the Public Health Law, then the operator of the enhanced assisted living residence shall develop appropriate policies and procedures related to such health care services, to include but not be limited to:

    1. (i) service specific delivery standards consistent with current professional standards of practice, including staff supervision, which are reviewed and revised as necessary;
    2. (ii) documentation of service delivery;
    3. (iii) storage, cleaning and disinfection of medical supplies, equipment and appliances;
    4. (iv) provision of nursing or therapeutic service, procedure or treatment not previously provided by the enhanced assisted living residence;
    5. (v) resident discharge which assures a timely, safe and appropriate transition; and
    6. (vi) appropriate quality assurance and improvement activities.
30. (3) Personal care tasks that exceed the approved scope of tasks in which the resident aide is trained, shall be performed by home health aides trained in such tasks pursuant to section 700.2(b) of this Title.
31. (4) An enhanced assisted living residence shall provide or arrange for nursing services for its residents as necessary. Such services shall include but not be limited to: assessment and evaluations of residents; supervision of aides; and nursing care and treatments.

32. (5) If a resident reaches the point where he or she is in need of 24-hour skilled nursing care or medical care required to be provided by facilities licensed pursuant to article 28 of the Public Health Law or article 19, 31 or 32 of the Mental Hygiene Law, then the resident must be discharged from the residence and the operator shall initiate proceeding for the termination of such residency agreement of such resident in accordance with the provisions of section 461-h of the Social Services Law. Provided, however, a resident may remain at the enhanced assisted living residence if each of the following conditions are met:

    1. (i) the resident in need of 24-hour skilled nursing care or medical care hires appropriate nursing, medical or hospice staff to care for his or her increased needs;
    2. (ii) the resident's physician, home care agency and/or hospice determine that, with the provision of such additional services, the resident can be safely cared for in the residence, and would not require placement in a hospital, nursing home or other health or mental health facility;
    3. (iii) the operator agrees to retain the resident and to coordinate the care provided by the operator and the additional nursing, medical and/or hospice services; and

    4. (iv) the resident is otherwise eligible to reside at the residence.

       (n) Special needs assisted living.

33. (1) In addition to the services of the assisted living residence provided pursuant to an executed residency agreement, a resident of special needs assisted living within a residence granted a special needs assisted living certificate pursuant to section 1001.4 of this Part is entitled to receive the services approved to be offered by the special needs assisted living residence pursuant to the operator's approved special needs plan and consistent with the resident's individualized service plan developed pursuant to section 1001.7(h) of this Part.
34. (2) The operator shall provide a comprehensive and coordinated program to regularly observe and assess the need for services in a professional, respectful, competent, and timely manner.
35. (3) Services provided to a resident of special needs assisted living shall be provided by individuals appropriately trained, experienced and licensed or certified, if applicable, pursuant to section 1001.11 of this Part.
36. (4) The operator shall ensure initial and on-going efforts to establish community-based individual and agency linkages and contacts, specific to serving a special needs population.

37. (5) Supervision in special needs assisted living.

    1. (i) The operator shall maintain knowledge of the general whereabouts of each resident.
    2. (ii) In the event a resident is absent from the residence and the resident's whereabouts are unknown, immediate efforts shall be undertaken to locate the resident, including immediate notification to the appropriate law enforcement agency and the department's regional office. Notification shall also be made immediately to the resident's family and representative, unless a different time frame has been agreed upon pursuant to the residency agreement executed pursuant to section 1001.8(e) of this Part.
    3. (iii) Sufficient staff to supervise residents and respond to their needs must be available on all shifts.
38. (6) Medication assistance in special needs assisted living. When disruptive or aggressive behaviors are exhibited, the operator shall evaluate the special needs assisted living resident, determine precipitating factors, make staff aware of precipitating factors that need to be avoided, and develop a plan to include successful interventions and to promote the highest level of resident function.

39. (7) Case management in special needs assisted living.

    1. (i) In addition to the case management services required by subdivision (i) of this section, the operator shall assist the special needs assisted living resident to maintain family ties by assisting residents' family members and representatives to:

       1. (a) adjust to and remain involved with the resident's initial placement and continued residence in the special needs assisted living residence;
       2. (b) establish, operate, and maintain individual and collective methods or recommendations for change or improvement in residence operations and programs, regarding both individual and congregate resident-related issues;
       3. (c) remain active in the care planning process for the resident; and remain informed in a timely manner about significant issues regarding the resident's care and supervision needs and changes made to the care plan.
    2. (ii) Individualized service plans and case management records shall identify when a resident is periodically resistant to the provision of personal care services by staff of the special needs assisted living residence and include a plan for addressing such services.

40. (8) Activities in special needs assisted living.

    1. (i) The operator shall provide frequent individual and group activities which are geared towards individuals with special needs and which are meaningful to the residents. This programming shall be based on initial and on-going, historical and current, interests, assessments, and observations.
    2. (ii) There shall be sufficient staff to ensure that activities programs are available throughout every day and evening.
    3. (iii) Weather permitting, residents of special needs assisted living residences shall have the opportunity and be encouraged to be outdoors, each day, with appropriate and sufficient supervision.

41. (9) Food service in special needs assisted living.

    1. (i) Food should be offered outside of the usual meal times in a manner acceptable to the special needs assisted living resident and mindful of the resident's functional abilities, preferences and needs. The resident's care plan should reflect these needs and preferences.
    2. (ii) To ensure optimal intake at mealtimes, unless contrary to the physician's orders, prescribed nutritional supplements shall be provided between and not at the same time as scheduled meals.

(g) Monitoring.