(a) An operator shall admit, retain and care for only those individuals who do not require services beyond those the operator is permitted by law and regulation to provide.

1. (1) An operator shall not exclude an individual on the sole basis that such individual is a person who primarily uses a wheelchair for mobility, and shall make reasonable accommodations to the extent necessary to admit such individuals, consistent with the Americans with Disabilities Act of 1990, 42 U.S.C. 12101 et seq. and with the provisions of this section.

(b) An operator shall not accept nor retain any person who:

1. (1) is in need of continual medical or nursing care or supervision as provided by facilities licensed pursuant to article 28 of the Public Health Law or articles 19, 23, 29 and 31 of the Mental Hygiene Law;
2. (2) suffers from a serious and persistent mental disability sufficient to warrant placement in a residential facility licensed pursuant to article 19, 23, 29 or 31 of the Mental Hygiene Law;
3. (3) requires health or mental health services which are not available or cannot be provided safely and effectively by local service agencies or providers;
4. (4) causes, or is likely to cause, danger to himself or others;
5. (5) repeatedly behaves in a manner which directly impairs the well-being, care or safety of the resident or other residents or which substantially interferes with the orderly operation of the home;
6. (6) has a medical condition which is unstable, and which requires continuous skilled observation of symptoms and reactions or accurate recording of such skilled observations for the purposes of reporting to the resident's physician;
7. (7) refuses or is unable to comply with a prescribed treatment program, including but not limited to a prescribed medications regimen when such failure causes, or is likely to cause, in the judgment of a physician, life-threatening danger to the resident or others;
8. (8) is chronically bedfast;
9. (9) chronically requires the physical assistance of another person in order to walk;
10. (10) chronically requires the physical assistance of another person to climb or descend stairs, unless assignment on a floor with ground-level egress can be made;
11. (11) has chronic unmanaged urinary or bowel incontinence;
12. (12) suffers from a communicable disease or health condition which constitutes a danger to other residents and staff;

13. (13) is dependent on medical equipment unless it has been demonstrated that:

    1. (i) the equipment presents no safety hazard;
    2. (ii) use of the equipment does not restrict the individual to his room, impede the individual in the event of evacuation, or inhibit participation in the routine activities of the home;
    3. (iii) use of the equipment does not restrict or impede the activities of other residents;
    4. (iv) the individual is able to use and maintain the equipment with only intermittent or occasional assistance from medical personnel;
    5. (v) such assistance, if needed, is available from approved community resources; and
    6. (vi) each required medical evaluation attests to the individual's ability to use and maintain the equipment;
14. (14) is under 18 years of age;
15. (15) does not provide the operator with the required medical evaluations;
16. (16) refuses or fails to inform the operator on an on-going basis of changes in medications or other elements of the medical evaluation as they occur;
17. (17) engages in alcohol or drug use which results in aggressive or destructive behavior; or
18. (18) is unable to communicate with the operator in a common language.

(e) Such a determination shall be based upon:

1. (1) receipt and consideration of a medical evaluation; and
2. (2) conduct of an interview between the operator and the resident and the resident's representative(s), if any.

(f) The medical evaluation shall be a written, and signed report on a Medical Evaluation (DSS-3122) or approved local equivalent, from the resident's physician which includes:

1. (1) significant medical history and current conditions, the prescribed medication regimen, including information on the applicant's ability to self-administer medications, recommendations for diet, exercise, recreation, frequency of medical examinations and assistance needed in the activities of daily living;
2. (2) a statement that the resident is not medically or mentally unsuited for care in a family-type home;
3. (3) a statement that the resident does not require placement in a hospital or residential health care facility; and
4. (4) a statement that the physician has physically examined the resident within 30 days prior to the date of admission.

(h) During the resident interview the operator shall:

1. (1) explain and discuss the conditions of residency, including but not limited to the admission agreement, resident rights, house rules, and to all who receive Supplemental Security Income or Home Relief, the personal allowance; and

2. (2) ascertain that the home can:

   1. (i) meet the physical needs and personal care needs of the resident, including dietary needs occasioned by cultural or religious practice or preference or medical prescription; and
   2. (ii) meet the psycho-social needs of the resident through the fostering and maintenance of family and community ties and associations;

(i) A resident shall receive, at or prior to the interview:

1. (1) a copy of the admission agreement; and
2. (2) a copy of the statement of resident rights.

(k) Notwithstanding subdivisions (f) and (g) of this section, physical examinations shall not be required for a resident who relies upon or is being furnished treatment by spiritual means through prayer in lieu of medical treatment in accordance with the teachings and practices of a recognized church or religious denomination of which the resident is a member or bona fide adherent. In such cases the operator shall:

1. (1) require documentation of the resident's standing as a member; and
2. (2) adhere to the admission and retention standards set forth in subdivision (b) of this section.

(q) For any residents who cannot be retained in the home due to the conditions set forth in subdivision (b) of this section:

1. (1) the operator must immediately notify the social services district that there is a resident who cannot be retained in a family-type home; and
2. (2) the operator must make persistent efforts to secure an appropriate alternative placement. The social services district must document such efforts in the case record; and
3. (3) when an appropriate alternative placement is not immediately available for a resident who cannot be retained in a family-type home in accordance with subdivision (b) of this section, the operator must arrange for other appropriate services when necessary to assure that the health and safety of the resident are maintained until placement is secured. The social services district must document such efforts in the case record.