(b) The operator of a facility in which at least 25 percent of the resident population or 25 residents, whichever is less, are mentally disabled persons who have been released or discharged from facilities operated or certified by an office of the Department of Mental Hygiene must arrange, by written agreement, with the outpatient or after-care services of the nearest State psychiatric or developmental facility, or alcoholism and substance abuse agency, the local mental health service or a support service provider, for assistance with the assessment of mental health or other service needs, the supervision of general mental health care, including the provision of necessary alcoholism and substance abuse services, and the provision of related case management services for those residents enrolled in these service programs.

1. (1) The agreement developed in satisfaction of subdivision (b) of this section must be reviewed and approved, prior to execution, by the appropriate regional offices of the Department of Social Services and the appropriate office of the Department of Mental Hygiene, including the Office of Alcoholism and Substance Abuse.

2. (2) The agreement must address the role and responsibility, if any, of each party for:

   1. (i) pre- and post-admission assessment and screening, except that final decisions on admission and retention remain the responsibility of the operator;
   2. (ii) the development of service plans and the provision of or arrangements for services;
   3. (iii) securing emergency mental health services and rehospitalization;
   4. (iv) coordination of services within the facility and the exchange of information;
   5. (v) resolving conflicts or disagreements on individual cases.

3. (3) The agreement may not limit or supersede the authority or the responsibilities of either party.

   (d) Resident supervision.

4. (1) Resident supervision services include but are not limited to:

   1. (i) monitoring, guiding, prompting, and encouraging residents to perform basic activities of daily living including:

      1. (a) attendance at meals and maintenance of appropriate nutritional intake;
      2. (b) performance of personal hygiene and grooming activities;
      3. (c) participation in facility and community programs;
      4. (d) performance of basic money management and fulfillment of service needs;
      5. (e) maintenance of personal living space and belonging; and
      6. (f) medication management;
   2. (ii) observing and reporting to case management staff on each resident's performance of the basic activities of daily living;
   3. (iii) observing and reporting to appropriate staff of the facility each resident's functional performance, in order to identify abrupt or progressive changes in behavior or appearance which may signify the need for assessment and service;
   4. (iv) maintaining knowledge of general whereabouts of each resident;
   5. (v) monitoring resident behavior and the degree of progress in attaining the objectives of the individual service plan;
   6. (vi) handling individual emergencies, or need for assistance, including arranging for medical or other services;
   7. (vii) investigation of incidents involving resident endangerment, injury or death.

5. (2) In the event that a resident is absent from the facility and the resident's whereabouts are unknown, the operator must 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 to the appropriate regional office of the department within five working days.

6. (3) In the event that a resident is unable or unwilling to consume regular meals for two consecutive days, the operator must:

   1. (i) immediately notify the resident's personal physician, act on the physician's instruction, and note the call and instructions in the resident's record; and

   2. (ii) notify the resident's mental health service provider, and alcoholism/substance abuse counseling service provider, if any.

      (4)

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

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

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

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

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

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

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

   1. (i) immediately arrange for appropriate professional evaluation of the resident's condition;
   2. (ii) if necessary, arrange for 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. (6) 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) submit a report to the State Commission on Quality of Care for the Mentally Disabled, on a form prescribed by the commission, if the resident had at any time received services from a mental hygiene service provider. Such form must be received by the commission within 24 hours of the death.

9. (7) 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) submit a report to the State Commission on Quality of Care for the Mentally Disabled, on a form prescribed by the commission, if the resident had at any time received services from a mental hygiene service provider. Such form must be received by the commission within 24 hours of the attempted suicide.
10. (8) 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 submit a report to the State Commission on Quality of Care for the Mentally Disabled, on a form prescribed by the commission, if the resident had at any time received services from a mental hygiene service provider. Such form must be received by the commission within 24 hours of the occurrence.

11. (9) 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 another resident, or staff or others or is assaulted or injured by another resident, staff or others;
    3. (iii) a resident attempts or commits suicide;
    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) a resident is involved in an accident on or off the facility grounds which results in such resident requiring medical care, medical attention or services; or
    8. (viii) it is believed that a felony crime may have been committed by or against a resident.

12. (10) The operator must:

    1. (i) place a copy of the incident report in the resident's individual record;
    2. (ii) maintain a chronological log or record of all incident reports prepared which includes identification of the resident or residents involved and the type of incident; and
    3. (iii) submit a copy of the report required in this paragraph to the appropriate regional office; and, if the resident is a participant in a service program operated under a cooperative agreement with the operator, to that program.
13. (11) The operator must establish a system which assures that information regarding incidents and changes in residents' conditions affecting their need for case management or supervision is available on an ongoing basis to all shifts.

14. (12) Assistance with medication management.

    1. (i) Each resident capable of self-administration of medication must be permitted to retain and self-administer medications, provided that:

       1. (a) the resident's physician attests, in writing, that the resident is capable of self- administration; and
       2. (b) 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 physician.

    2. (ii) Residents capable of self-administration are those who are able to:

       1. (a) correctly read the label on the medication container;
       2. (b) correctly interpret the label;
       3. (c) correctly ingest, inject or apply the medication;
       4. (d) correctly follow instructions as to the route, time and dosage, and frequency;
       5. (e) open the container;
       6. (f) measure or prepare medications, including mixing, shaking, and filling syringes; and
       7. (g) safely store the medication.
    3. (iii) Residents who cannot self-administer medications without assistance must be supervised as necessary by the operator or staff in order to carry out the activities listed in subparagraph (ii) of this paragraph.
    4. (iv) For residents in need of supervision of medication compliance, the operator must establish a system for staff to monitor each such resident to ensure that he/she obtains the proper dosage of medication at the designated time.
    5. (v) In any system for supervision, removal of a dose from the container, or measurement or preparation of medications must be performed by the person providing assistance with intake, except that insulin syringes may be prefilled by a licensed nurse.
    6. (vi) Staff may not administer injectable medications to a resident; except that staff holding a valid license from the State of New York Education Department authorizing them, among other things, to administer injectable medications may do so, provided that the injectable medication is one which licensed health care providers would customarily train a patient or his or her family to administer.
    7. (vii) If a resident refuses to take medications or appears unable to independently administer medications, the operator must immediately notify the prescribing physician; and, if different, the primary physician.
    8. (viii) Under no circumstances may staff make a change in the dosage or schedule of administration of medication without the prior written authorization of a physician, or in case of an emergency, by telephone with written confirmation from the physician within seven days.
    9. (ix) If medication is prescribed or discontinued by other than the resident's primary physician, the operator must notify the primary physician within one business day, to advise him or her of the medication and dosage prescribed or discontinued, and note the call or retain a copy of the correspondence in the resident's record.

    10. (x) Storage of medications.

        1. (a) Medication must be kept in a secure storage area at all times whether kept by a resident or kept by the operator for the resident, except when required to be kept by a resident on his or her person for frequent or emergency use.
        2. (b) Secure storage means an area or a cabinet which cannot be removed or entered at will and which cannot be opened except by a key.
        3. (c) An operator retaining controlled substance prescriptions for residents must first obtain a Class 3a controlled substance license as an institutional dispenser, limited from the Department of Health. Standards for storage and recording set forth by the Department of Health are applicable.
        4. (d) Drugs for external use must be stored separately from internal and injectable medication.
        5. (e) Refrigerators used for the storage of pharmaceuticals may not be used for the storage of food or beverages, unless the drugs are stored in a separate, locked compartment.
        6. (f) Medications may not be emptied from one container into another, except when necessary to enable a resident to take medications during temporary absences from the facility.
        7. (g) Directions on labels may not be changed by anyone other than a physician or pharmacist. When a change in dosage or schedule has been made the container must be tagged until the label is corrected. The label must be corrected within 30 days of the change.
        8. (h) Stock supplies of prescription medications are prohibited.
        9. (i) Stock supplies of nonprescription over the counter items for use in self-medication may be maintained.
        10. (j) Prescribed or dated medication must be current.
        11. (k) Any medication which has been prescribed but is no longer in use by a resident must be destroyed or disposed of in accordance with the Public Health Law, unless the resident's physician requests that the medication be discontinued for a specific temporary period.

    11. (xi) Recording for medications.

        1. (a) 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 and supervision or in time of emergency.

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

           1. (1) the person's name;
           2. (2) identification of each medication;
           3. (3) the current dosage, frequency, time and route of each medication;
           4. (4) the prescribing physician's name for each prescribed medication;
           5. (5) the dates of each prescription change;
           6. (6) any contraindications noted by the physician;
           7. (7) the type of supervision and assistance, if any, needed by the resident; and
           8. (8) a record of assistance.

        3. (c) When a resident is assisted in taking medication, the name of the resident, the medication, the staff assisting and the date and time of assistance must be recorded. Recording must occur at the time of assistance to each resident. In no event may recording be done by a person who has not observed the taking of the dose.

           (e) Case management.

15. (1) Case management services include:

    1. (i) initial and periodic evaluation, at least once every twelve months, of the needs of a resident and of the capability of the facility program to meet those needs;
    2. (ii) orienting a new resident and family to the daily routine;
    3. (iii) assisting each resident to adjust to life in the facility;
    4. (iv) developing an individual service plan, as specified in section 490.4 of this Part, with realistic goals toward self-sufficiency and revising the individual service plan and goals at least once every twelve months and more often if necessary.

    5. (v) guiding, prompting, and encouraging each resident to:

       1. (a) engage in activities which will increase his/her independent functioning, in keeping with his/her respective service plan;
       2. (b) pursue realistic vocational and avocational goals;
       3. (c) maintain his/her own personal living space and belongings; and
       4. (d) care for and launder his/her own clothing, and use his/her own clothing;
    6. (vi) assisting each resident to maintain family sand community ties and to develop new ones;
    7. (vii) encouraging resident participation in facility and community activities;
    8. (viii) establishing linkages with and arranging for services from public and private sources for income, health, mental health and social services;
    9. (ix) assisting residents in making application for and maintaining income entitlements and public benefits;
    10. (x) assisting the resident in obtaining and maintaining a primary physician or source of medical care of choice who is responsible for the overall management of the individual's health and mental health needs;

    11. (xi) assisting the resident in making arrangements to obtain services, examinations, and reports needed to maintain or document the maintenance of the resident's health or mental health, including:

        1. (a) health and mental health services;
        2. (b) dental services; and
        3. (c) medications;
    12. (xii) providing information and referral;
    13. (xiii) coordinating the work of other case management and service providers within the facility;
    14. (xiv) assisting residents in need of alternative level of care to make sound discharge or transfer plans;
    15. (xv) assisting in the establishment and operation of a system to enable residents to participate in planning for change or improvement in facility operations and programs and to present grievances and recommendations.
16. (2) Each resident must be provided such case management services as are necessary to support the resident in maintaining independence of function and personal choice.
17. (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.

18. (4) The operator and case management staff within the facility must utilize and cooperate with external service providers.

    (f) Activity services.

19. (1) The operator must have available for residents an organized appropriate activities-socialization program. This program must be available to residents and must emphasize the use of off-site or community-based resources, as well as activity services within the facility.
20. (2) The operator must maintain an organized and diversified program of individual and group activities which will enable each resident to engage in cultural, spiritual, diversional, physical, political, social and intellectual activities within the community and the facility in order to sustain and promote an individual's potential and a sense of usefulness.

21. (3) Activities services include, but are not limited to:

    1. (i) arrangement for resident participation in community-based and community-sponsored activities;
    2. (ii) arrangement for transportation or such other resources as are necessary to enable residents to participate in community activities;
    3. (iii) arrangement for provision of programs and activities within the facility by community groups and service providers;
    4. (iv) direct provision, within the facility, of programs and activities of group and individual participation.
22. (4) Activities must be scheduled during evenings and weekends as well as during the weekday.
23. (5) A monthly schedule of activities must be prepared one week in advance of its proposed implementation and amended to reflect changes as they occur.
24. (6) Activities scheduling must take into account and reflect the age, sex, physical and mental capabilities, the interests, the cultural and social background and the recommendations of residents.

25. (7) Each activities schedule must include:

    1. (i) individual, small group and large group activities;
    2. (ii) facility-based and community activities;
    3. (iii) physical exercise or other physical activities;
    4. (iv) activities which promote self-sufficiency, independence; and
    5. (v) social interaction.
26. (8) Each activities schedule must identify the location, time, the provider of each activity, and a facility staff contact person responsible for or knowledgeable about each activity.
27. (9) The current schedule of activities must be conspicuously posted in a public area accessible to all residents and visitors.
28. (10) A record of the schedule of activities, as planned and as implemented must be maintained for six months.
29. (11) The operator must provide equipment and supplies sufficient to implement the program of activities.

30. (12) Accommodations and space must be provided for activity and socialization services in accordance with section 490.11 of this Part.

    (g) Facility supervision.

31. (1) Supervision of the facility includes but is not limited to:

    1. (i) surveillance of grounds, facility and activities of residents and staff to protect residents and property from harm;
    2. (ii) monitoring emergency call systems within the facility;
    3. (iii) conducting and supervising evacuations and fire and evacuation drills;
    4. (iv) implementation of the disaster and emergency plan.
32. (2) Employees must be trained in the means of rapidly evacuating the building.

33. (3) At least one staff person on duty on each shift must be designated as responsible for the conduct and supervision of any evacuation or implementation of the disaster and emergency plan.

    (h)

34. (1) Housekeeping. The operator must provide housekeeping services necessary to maintain a clean, well-kept and safe living environment. For purposes of this Part, housekeeping services include:

    1. (i) maintaining and cleaning space within the facility;
    2. (ii) purchasing and replacing of household items for common use;
    3. (iii) providing clean towels and linen at least once a week and more often if needed; and
    4. (iv) providing laundry services for blankets, bedspreads, and other furnishings as often as necessary.
35. (2) Housekeeping services do not include light housekeeping or bed-making in a resident's individual living space; however, if a resident is incapable of caring or refuses to care for his/her own personal living space, then the operator is responsible for taking all appropriate action to assure the well-being, care and safety of the resident and other residents.

(c)