(a) The operator will be responsible for the provision of resident services, which will include, at a minimum, supervision, personal care, case management, activities, housekeeping and food service as defined in this section and section 488.8 of this Part.

1. (1) Supervision includes:

   1. (i) knowledge of the general whereabouts of each resident;
   2. (ii) identification of abrupt or progressive changes in behavior or health status of each resident;

   3. (iii) assistance to and encouragement of residents in performing basic activities of daily living including:

      1. (a) appropriate nutritional intake;
      2. (b) personal hygiene;
      3. (c) participation in enriched housing program and community programs; and
      4. (d) basic money management; and
   4. (iv) investigation of incidents involving resident health, safety, injury, occurrences which would constitute a reportable incident, or death.

2. (2) In the event that a resident is absent from the enriched housing program and the resident's whereabouts are unknown, the operator shall initiate efforts to find the resident and, if the absence exceeds 24 hours:

   1. (i) immediately notify the resident's next of kin or representative;
   2. (ii) immediately notify the appropriate law enforcement agency;
   3. (iii) notify the appropriate regional office of the department on the first available working day; and
   4. (iv) send a copy of the incident report (DSS-3123) to the appropriate regional office of the department within five working days.
3. (3) In the event that a resident is unable or unwilling to consume regular meals for two consecutive days, the operator must immediately notify the resident's personal physician, act on the physician's instructions, and note the call and instructions in the resident's record.

4. (4) In the event that a resident requires emergency assistance because of illness or injury, the operator must:

   1. (i) protect the resident's safety and comfort;
   2. (ii) secure necessary emergency medical assistance; and
   3. (iii) if necessary, arrange for the transfer of the resident to an appropriate medical facility.

5. (5) In the event that a resident becomes ill or displays a progressive deterioration of health or behavior, the operator must:

   1. (i) protect the resident's safety and comfort;
   2. (ii) obtain medical evaluation and services; and
   3. (iii) if necessary, arrange for the transfer of the resident to an appropriate medical facility.

6. (6) In the event of illness or injury, the operator must also:

   1. (i) notify the resident's personal physician or, in the event such physician is not available, a qualified alternate;
   2. (ii) notify the resident's representative, or next of kin, if known;
   3. (iii) upon transfer of a resident to a health, mental health or other residential care facility, send an approved transfer form (or a copy of the DSS-3122 and the personal data sheet) and such other information as the receiving facility requests and the operator is required to maintain. In emergency transfers, this information may be telephoned to the receiving facility and written information sent within 72 hours of the transfer; and
   4. (iv) make a notation of the illness or injury and transfer, if any, in the resident's record to include all items applicable in this paragraph. The incident report form may be substituted to record all accidents or illnesses.

7. (7) In the event that a resident exhibits behavior which constitutes a danger to himself/herself or others, the operator must:

   1. (i) arrange for appropriate professional evaluation of the resident's condition;
   2. (ii) if necessary, arrange for the transfer of the individual to a facility providing the proper level of care; and
   3. (iii) notify the resident's representative or next of kin, if known.

8. (8) In the event of the death of a resident, the operator must:

   1. (i) immediately take necessary action to notify the resident's next of kin, or representative, if known;
   2. (ii) immediately take necessary action to notify the appropriate local authorities;
   3. (iii) immediately report the death to the appropriate regional office of the Department of Health by telephone and submit a copy of the incident report (DSS-3123), which must be received by the appropriate regional office of the Department of Health, within 24 hours of the death; and
   4. (iv) immediately following the discovery of the death and submit a written report to the Justice Center, on a form prescribed by the Justice Center, if the resident received services from a mental hygiene service provider within 24 months preceding the date of the death. Such form must be received by the Justice Center within 24 hours of the discovery of the death. Reports by facilities subject to the Justice Center of incidents which would be reportable incidents shall be made pursuant to paragraph (14) of this subdivision and section 488.13 of this Part.

9. (9) If a resident attempts suicide, the operator must:

   1. (i) immediately report the attempted suicide to the appropriate regional office of the Department of Health by telephone and submit a copy of the incident report (DSS-3123), which must be received by the appropriate regional office of the Department of Health, within 24 hours of the attempted suicide; and
   2. (ii) immediately following discovery of the incident, inform the Justice Center of such incident, orally or electronically, as required by the Justice Center, and submit a written report to the Justice Center, on a form prescribed by the Justice Center, if the resident received services from a mental hygiene service provider within 24 months preceding the date of the incident. Such form must be received by the Justice Center within 24 hours of the discovery of the attempted suicide. Reports by facilities subject to the Justice Center of incidents which would be reportable incidents shall be made pursuant to paragraph (14) of this subdivision and section 488.13 of this Part.
10. (10) If it is believed that a felony crime may have been committed by or against a resident, the operator must immediately report the occurrence to the appropriate regional office of the Department of Health by telephone and submit a copy of the incident report (DSS-3123), which must be received by the appropriate regional office of the Department of Health, within 24 hours of the occurrence. The operator also must notify an appropriate law enforcement authority as soon as possible but at least within 24 hours. In addition, the operator must immediately upon discovery of the occurrence, inform the Justice Center of the occurrence, orally or electronically, as required by the Justice Center, an must submit a written report to the Justice Center, on a form prescribed by the Justice Center, if the resident received services from a mental hygiene service provider within the 24 months preceding the date of the occurrence believed to be a felony crime. Such form must be received by the Justice Center within 24 hours of the discovery of the occurrence. Reports by facilities subject to the Justice Center of incidents which would be reportable incidents shall be made pursuant to paragraph (14) of this subdivision and section 488.13 of this Part.

11. (11) The operator must prepare an incident report (DSS-3123) whenever:

    1. (i) a resident's whereabouts have been unknown for more than 24 hours;
    2. (ii) a resident assaults or injures or is assaulted or injured by another resident, staff or others;
    3. (iii) a resident attempts or commits harm to himself/herself;
    4. (iv) there is a complaint or evidence of resident abuse;
    5. (v) a resident dies;
    6. (vi) a resident behaves in a manner that directly impairs the well-being, care or safety of the resident or any other resident or which substantially interferes with the orderly operation of the facility;
    7. (vii) the resident is involved in an accident which requires medical care, attention or services; or
    8. (viii) it is believed that a felony crime may have been committed by or against a resident.

12. (12) The operator must:

    1. (i) place a copy of the incident report (DSS-3123) in the resident's individual record;
    2. (ii) maintain a chronological log or file of all incident reports (DSS-3123) which includes identification of the resident or residents involved and the type of incident; and
    3. (iii) submit a copy of incident reports (DSS-3123) required in paragraph (11) of this subdivision to the appropriate regional office of the department; if the resident is a participant in a service program operated under a cooperative agreement with the operator, to that program, and for all residents who had, at any time received services from a mental hygiene service provider, to the State Commission on Quality of Care for the Mentally Disabled.
13. (13) The operator must include the resident's version of the events leading to an accident or incident involving such resident, unless the resident objects, on all required incident reports (DSS-3123).

14. (14) If the facility falls within the definition of a facility as defined in section 488(4) of the Social Services Law, the operator shall immediately upon discovery, inform the Justice Center, orally or electronically, as required by the Justice Center, of any occurrence constituting a reportable incident, as defined in section 488(1) of the Social Services Law, including the name, title and contact information of every person known to have the same information as the person reporting concerning the reportable incident. Such written report must be received by the Justice Center within 24 hours of the discovery of such occurrence.

    (c) Personal care.

15. (1) Each resident must be provided some assistance with personal care 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 enriched housing program.

16. (2) Personal care functions must include some assistance with:

    1. (i) personal hygiene, including dressing, bathing and grooming; and
    2. (ii) assisting with self-administration of medications, as described in subdivision (d) of this section.
17. (3) Residents must not be confined to their room or bed, except as may be necessary for the treatment of a short-term illness.
18. (4) Commodes, must not be permitted, except as may be necessary for a short-term illness or for night use as a safety measure as confirmed by the written order of a physician.
19. (5) Residents must not be provided tray services except as may be necessary for a short- term illness.
20. (6) Physical restraints, i.e., any apparatus which prevents the free movement of a resident's arms or legs, or which immobilizes a resident and which the resident is unable to remove, must not be used.

21. (7) The operator must establish a system which assures that information regarding incidents or changes in residents' conditions affecting their need for personal care or supervision is available to all staff on an on-going basis.

    (d) Medication assistance.

22. (1) Each resident must be permitted to retain and self-administer medications provided that:

    1. (i) the resident's physician attests, in writing, that the resident is capable of self- administration;
    2. (ii) the resident keeps the operator informed of all medications being taken, including name, route, dosage, frequency, times and any instructions, including any contraindications, indicated by the prescribing physician; and
    3. (iii) the medications, except for those kept by a resident on his/her person for emergency use, are stored in a locked container or area which cannot be removed or entered at will.
23. (2) With the written direction of the resident's physician, an operator may assist a resident in administration of medication by the resident including prompting the resident as to time, identifying the medication for the resident, bringing the medication and any necessary supplies or equipment to the resident, opening the container for the resident, positioning the resident for medication and administration, disposing of used supplies and materials and storing the medication properly.
24. (3) For residents in need of assistance, the operator must establish a system for staff to assist the resident.

25. (4) Recording for medications.

    1. (i) Information on the medication regimen of each resident must be retained on file in a manner which assures both resident privacy and accessibility for assistance or in time of emergency.

    2. (ii) The following information must be maintained for each resident:

       1. (a) the person's name;
       2. (b) identification of each medication used by the resident;
       3. (c) the current dosage, frequency, time and route of each medication;
       4. (d) the physician's name for each prescribed medication;
       5. (e) the dates of each prescription change;
       6. (f) any contraindications noted by the physician; and
       7. (g) the type of assistance, if any, needed by the resident.
26. (5) Staff of an enriched housing program is not permitted to administer injectable medications to a resident, except that staff holding a valid license from the Education Department authorizing them to administer injectable medications may do so, providing that the injectable medication is one which licensed health care providers would customarily train a patient or his/her family to administer.
27. (6) If a resident refuses to take medications or appears unable to independently administer medications, the operator must notify the resident's primary physician.
28. (7) Under no circumstances will staff make a change in the dosage or schedule of administration of medication without the prior written authorization of a physician except that in cases of an emergency, authorization may be by telephone with written confirmation from the physician within seven days.

29. (8) Storage of medications by operators.

    1. (i) Medications stored by operators must be kept in a cabinet which cannot be removed or entered at will and which cannot be opened except by a key.
    2. (ii) Medications for external use must be stored separately from internal and injectable medications.
    3. (iii) Refrigerators used for the storage of pharmaceuticals must not be used for the storage of food or beverages, unless the medications are stored in a separate, locked compartment.
    4. (iv) Medications must not be emptied from one container into another.
    5. (v) Directions on labels must not be changed by anyone other than a physician or pharmacist.
    6. (vi) Stock supplies of prescription medications are prohibited.

    7. (vii) Medications must be disposed of in accordance with the physician's or pharmacist's instructions.

       (e) Case management.

30. (1) Each resident must be provided such case management services as are necessary to support the resident in maintaining independence of function and personal choice.

31. (2) Case management services must include:

    1. (i) evaluating initially and periodically, at least once every 12 months, the needs of a resident and the capability of the program to meet those needs;
    2. (ii) orienting a new resident to the daily routine;
    3. (iii) identifying adjustment problems and assisting the resident to resolve such problems if needed;
    4. (iv) assisting each resident to maintain family and community ties and to develop new ones;
    5. (v) encouraging resident participation in enriched housing and community activities;
    6. (vi) identifying needs and arranging for services and entitlements from public and private sources for income, health, mental health and social services;
    7. (vii) assisting the resident in obtaining and maintaining a primary physician or source of medical care of his/her choice who is responsible for the overall management of the individual's health and mental health needs;
    8. (viii) coordinating the work of other case management and service providers within the enriched housing program;
    9. (ix) assisting residents in need of alternative living arrangements to make and execute sound discharge or transfer plans; and
    10. (x) assisting residents as needed in shopping for personal items such as toiletries, medical supplies, stationery, books and clothing.
32. (3) The operator must establish a system of recordkeeping which documents the case management needs of each resident and records case management activities undertaken to meet those needs.
33. (4) The operator and case management staff within the enriched housing program must utilize and cooperate with external service providers.

34. (5) The operator must:

    1. (i) provide, without charge, space for residents to meet in privacy with service providers;
    2. (ii) not inhibit access to individual residents who request services;
    3. (iii) identify residents in need of services and assist external service providers in establishing a relationship with such residents;
    4. (iv) work with service providers in executing a plan for service for individual residents; and

    5. (v) assist in arranging for transportation, as necessary, to ensure that residents are able to attend required services provided in an external location.

       (f) Activities.

35. (1) The operator must offer an environment conducive to the continuation and strengthening of family ties and friendships as well as the pursuit of intellectual, social and recreational interests.

36. (2) The operator must:

    1. (i) inform the residents of available neighborhood programs and events;
    2. (ii) assist in arranging transportation to such programs and events;
    3. (iii) assist the resident in organizing desired activities;
    4. (iv) directly provide periodic leisure activity programs in which residents are free to participate as desired; and
    5. (v) offer to each resident a monthly schedule of activities which must take into account and reflect the age, sex, physical and mental capabilities, interests and the cultural and social background of the residents.
37. (3) Each activities schedule must be posted, identifying the location, date, time and a program staff contact person knowledgeable about each activity.
38. (4) The monthly schedule of activities, as planned and as implemented, must be maintained for six months.

39. (5) Accommodations and space must be provided for activity and socialization services.

    (g) Housekeeping.

40. (1) The operator must provide housekeeping services necessary to maintain a clean, well-kept, safe and healthy living environment.

41. (2) Housekeeping services must include:

    1. (i) maintenance and cleaning of all individual and congregate space;
    2. (ii) purchase and replacement of household items for common use;
    3. (iii) provision of clean towels and linens at least once a week and more often if needed; and

    4. (iv) provision of and assistance with laundry services including:

       1. (a) laundering of the machine-washable personal clothing of residents although the operator may provide facilities and supplies for residents who choose to launder their own clothing;
       2. (b) assisting residents to maintain nonwashable clothing; and
       3. (c) laundering of blankets, bedspreads, and other furnishings as often as necessary.

(b) Supervision.