"HAWAII ADMINISTRATIVE RULES

TITLE 11

DEPARTMENT OF HEALTH

CHAPTER 96

FREESTANDING ADULT DAY HEALTH CENTERS

§11-96-1 Purpose§11-96-2 Definitions§11-96-3 Licensing§11-96-4 Administrator§11-96-5 Admission requirements§11-96-6 Arrangements for services§11-96-7 Basic program requirements§11-96-8 Client care management§11-96-9 Client's rights§11-96-10 Dietetic services§11-96-11 Discharge planning§11-96-12 Disaster plan§11-96-13 Emergency care of clients§11-96-14 Employee records§11-96-15 Employee requirements§11-96-16 Equipment and supplies§11-96-17 Finances§11-96-18 General policies and procedures§11-96-19 Governing body and management§11-96-20 Housekeeping and maintenance§11-96-21 Infection control§11-96-22 Inservice education§11-96-23 Laundry§11-96-24 Health record system§11-96-25 Nursing service§11-96-26 Occupational therapy services§11-96-27 Physical therapy services§11-96-28 Ownership and financial capability§11-96-29 Pharmaceutical services§11-96-30 Physical plant construction

requirements§11-96-31 Physicians services§11-96-32 Program director§11-96-33 Psychiatric or psychological

services

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§11-96-34 Recreation and social activities§11-96-35 Restraints§11-96-36 Sanitation§11-96-37 Social services§11-96-38 Speech therapy services§11-96-39 Staffing§11-96-40 Transportation safety§11-96-41 Transportation services§11-96-42 Severability

§11-96-1 Purpose. The purpose of thischapter is to establish minimum requirements for theprotection of health, welfare, and safety of clientsand the public in adult day health centers. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-2 Definitions. As used in thischapter:

"Activity coordinator" means a person havingresponsibility for developing and implementing anactivity program in an adult day health center who:

(1) Has two years of experience in a social,recreational, or educational program, oneyear of which was full-time employment in aclient activities program in a health caresetting, mental health setting, or settingfor the care of the handicapped; or

(2) Is an occupational therapist,occupational therapy assistant orrecreational therapist.

"Administrator" means the person havingresponsibility for the operation of an adult dayhealth center.

"Adult day health care" means an organized dayprogram of therapeutic, social, and health servicesprovided to adults with physical, or mentalimpairments, or both, which require nursing oversightor care, for the purpose of restoring or maintaining,to the fullest extent possible, their capacity forremaining in the community.

"Adult day health center" means a facilitywhich provides adult day health care.

"Authorized representative" means a person

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authorized by law, by court order, or by writtenconsent of the client to act on behalf of the client.

"Cardiopulmonary resuscitation" or "CPR" meansan emergency first-aid procedure that consists ofopening and maintaining a client's airway, providingartificial ventilation by means of rescue breathing,and providing artificial circulation by means ofexternal cardiac compression.

"Center" means adult day health center."Client" means any adult who has been admitted

and participates in the services offered by an adultday health center.

"Consultant" means a qualified person whogives professional advice or service, with or withoutremuneration.

"Controlled drugs" has the same meaning asdefined in chapter 329, Hawaii Revised Statutes.

"Dentist" means any person holding a validlicense to practice dentistry in the State of Hawaii,pursuant to chapter 448, Hawaii Revised Statutes.

"Department" means the State of Hawaii,Department of Health.

"Designated representative" means theauthorized representative of the director of health.

"Dietitian" means a person who is registeredby the Commission on Dietetics Registration or iseligible for such registration.

"Direct supervision" means that the supervisorshall be present in the same building as the personbeing supervised and available for consultation andassistance. "Director" means the director of health, Stateof Hawaii.

"Drug administration" means the act in which asingle dose of a prescribed drug or biologicalsubstance is given to a client by an authorized personin accordance with all existing laws and rulesgoverning these acts. The entire act ofadministration entails removing an individual dosefrom a previously dispensed, properly labeledcontainer (unit dose included), verifying the dosagewith the physician's orders, giving the specified doseto the proper client and properly recording the timeand dose given to the client and signing the record.Only a licensed nurse or a physician mayadminister medications.

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"Drug dispensing" means the act which involvesthe interpretation of the physician's order and pursuant to that order, the proper selection,measuring, packaging, labeling, and issuance of thedrug or biological substance for a client.

"Governing body" means the policy makingauthority, whether an individual or a group, which hasoverall authority over the affairs of a center andestablishes policies concerning its operation and thewelfare of the individuals it serves.

"Immediate supervision" means that thesupervisor shall be physically present while a task isbeing performed.

"Individualized plan of care" means a writtenplan of treatment and services provided to a client ofan adult day health center in accordance with thedocumented assessed needs of the client.

"Legal guardian" means a person appointed by acourt to care for another person or that person'sproperty, or both.

"Licensed capacity" means the maximum numberof clients authorized to receive services at any onetime in an adult day health center as specified on thelicense.

"Licensee" means an individual or organizationwithin the State to whom a license to operate an adultday health center has been issued and who isresponsible for the administration and operation ofthe adult day health center. "Licensed nurse" means a person currentlylicensed by the State of Hawaii as a licensedpractical nurse or a registered nurse.

"Licensed practical nurse" means a nursecurrently licensed as such, pursuant to chapter 457,Hawaii Revised Statutes.

"Maintenance" means the upkeep of a buildingand equipment to preserve the original functional andoperational state.

"Medication" means any chemical compound,remedy, or non-infectious biological substance, theaction of which is not solely mechanical, which may beadministered to clients by any route as an aid in thediagnosis, treatment or prevention of disease or othercondition, for relief of pain or suffering, or tocontrol or improve any mental, physiological orpathological condition.

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"Mobile person" means a person who is capableof moving about without human assistance and has thephysical ability to leave a building without theassistance or supervision of any other person.

"Multidisciplinary team" means a group withinthe adult day health center that conducts assessmentsand makes decisions regarding individual admissionplans, treatment services, and discharge of clients;may include but is not limited to, a staff orattending physician, a registered nurse, a socialworker, an occupational therapist, and a physicaltherapist as appropriate to the case.

"Non-ambulatory person" means any personrequiring human assistance or supervision to leave abuilding under any circumstances.

"Nurse's aide" means a person who hassuccessfully completed a nurse aide training courseand works under the supervision of a licensed nurse.

"Occupational therapist" means a personcurrently registered or eligible for registration bythe American Occupational Therapy Association.

"Occupational therapy aide" means a personwho, under the supervision of a registeredoccupational therapist, assists with occupationaltherapy services.

"Occupational therapy assistant" means aperson who is currently registered or eligible forregistration by the American Occupational TherapyAssociation as an occupational therapy assistant.

"Pharmacist" means a person who is currentlylicensed as a pharmacist, pursuant to chapter 461,Hawaii Revised Statutes.

"Physical therapist" means a person who islicensed to practice physical therapy, pursuant tochapter 46lJ, Hawaii Revised Statutes.

"Physical therapy assistant" means a personwho has graduated from a two year college levelprogram approved by the Section on Education of theAmerican Physical Therapy Association.

"Physical therapy aide" means a person who,under the immediate supervision of a registeredphysical therapist, assists with physical therapycare.

"Physician" means any person holding a validlicense to practice medicine and surgery orosteopathy issued by the State of Hawaii, pursuant to

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chapter 453 or 460, Hawaii Revised Statutes. "Program director" means that person having

on-site responsibility for direction and coordinationof the various programs at the adult day healthcenter.

"Provisional license" means a license issuedfor a specified period of time (no longer than oneyear) at the discretion of the director in order toallow the licensee additional time to correctdeficiencies. No more than two consecutiveprovisional licenses shall be issued to a center.

"Psychiatrist" means a person licensed topractice medicine in the State of Hawaii and who iscertified or is eligible to be certified in psychiatryby the American Board of Psychiatry or Neurology.

"Psychiatric nurse" means a person who:(1) Is a registered nurse with a graduate

degree in psychiatric nursing and one yearof psychiatric nursing experience within thepast five years; or

(2) Is a registered nurse with one year ofpsychiatric nursing experience in an acutepsychiatric setting or in a psychiatrichealth facility.

"Psychologist" means a person who is licensedin the practice of psychology pursuant to chapter 465Hawaii Revised Statutes.

"Registered nurse" means a person who iscurrently licensed as a registered nurse, pursuant tochapter 457, Hawaii Revised Statutes.

"Social worker" means a person who has amaster's degree from a school of social workaccredited by the Council on Social Work Education orhas a bachelor's degree from an accredited school ofsocial work, plus two year's experience in a nursingfacility, or some other health care agency.

"Social work assistant" means a staff personwith on the job training who is supervised by means ofconsultation with a qualified social worker.

"Speech therapist" means a person who iscurrently licensed in the State of Hawaii as a speechpathologist or audiologist, pursuant to chapter 468E,Hawaii Revised Statutes.

"Supervision of employee" means to instruct anemployee or subordinate in the employee's duties andto oversee or direct the employee's work, but does not

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necessarily require the immediate presence of thesupervisor.

"Waiver" means an exemption from a specificrule or regulation, which may be granted to a centerfor a specified period of time at the discretion of thedirector. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-3 Licensing. (a) No person, firm, corporation, institution, association, organization,or any other entity, non-profit or for profit, mayoperate a freestanding adult day health center unlessit is licensed by the department.

(b) Any person, firm, corporation,institution, association, organization, or any otherentity, desiring to operate a freestanding adult dayhealth center shall apply to the department for alicense on forms prescribed by the department.

(c) The director shall prescribe the contentand form of the license.

(d) The department shall issue a license ifthe proposed facility meets all of the requirementsunder this chapter and all of the requirements forlicensure under state and county laws, including butnot limited to, the certificate of need law, and fire,zoning, and building codes. The director, in hisdiscretion, may authorize a waiver from a particularrule of this chapter provided that the health andsafety of the clients would not be affected. Theapplicant shall be responsible for securing writtenevidence of compliance with the state and county laws.

(e) A license, when granted, shall beeffective for one year, or a shorter duration of timeas may be decided by the director, unless it issuspended or revoked by the department.

(f) If written application for renewal of alicense is not filed with the department before theexpiration of the license, the license shallautomatically expire as of the expiration datespecified on the license.

(g) Each license shall be issued to a person,group of persons, firm, corporation, institution,association, organization, or other entities, by nameand by the address of a specific physical facility.

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The license may not be transferred from one licensee,or from one physical location, to another.

(h) A provisional license may be issued for aspecified period of time at the discretion of thedepartment for the purpose of giving a centeradditional time to correct deficiencies, or complywith regulations. Not more than two consecutiveprovisional licenses may be issued to a center.

(i) The director or his authorizedrepresentative shall inspect each licensedfreestanding adult day health center at least onceannually. Notice of the approximate time for theannual inspection visits may be given to the center.In addition to annual inspection visits, the directoror his authorized representative, without priornotice, may enter the center at any reasonable timefor the purposes of confirming correction ofdeficiencies, or investigation of complaints, or both.

(j) Following the annual inspection, a listof deficiencies, if any, shall be presented to thefacility. The facility shall return a plan ofcorrection of the deficiencies to the departmentwithin ten days. Facilities shall be allowed areasonable time to implement the plan of correction. Afollow-up survey shall be made by the department todetermine the progress in the plan of correction. Ifthere has not been substantial progress in carryingout the plan of correction, the license shall not berenewed.

(k) The director may suspend, revoke, orrefuse to issue a license for failure to comply withthe requirements of this chapter, or for any causedeemed a hazard to the health and safety of theclients, employees, or the general public. Anyperson, firm, corporation, institution, association,or organization, or other entity affected by thedirector's final decision of denial, suspension, orrevocation may appeal in accordance with chapter 91,Hawaii Revised Statutes.

(l) Penalties, hearings and appeals. Inaddition to any other appropriate action to enforcethis chapter, the director may initiate procedures forinvoking fines as provided in §321-20, Hawaii RevisedStatutes, and to withdraw the license after hearingsheld in accordance with chapter 91, Hawaii RevisedStatutes.

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(m) All centers shall post its currentlicense in a conspicuous place at the center.

(n) No center licensed under the provisionsof this chapter may deny admission to any individualon account of race, religion, sex, ancestry, ornational origin.

(o) All centers shall keep reports of allannual licensing inspections at the center.[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-4 Administrator. (a) Each center

shall have an administrator. The administrator shallhave the responsibility and authority to carry out thepolicies of the center. The center shall notify theDepartment in writing within fourteen working daysfollowing a change of administrator.

(b) The administrator shall make provisionfor continuity of operations, and for assumption ofthe administrator's responsibilities during theadministrator's absence.

(c) Centers with a capacity of fifty or moreclients shall have both an administrator and afull-time program director.

(d) The administrator of two or more licensedfacilities shall not serve as a program director.

(e) An individual may be an administrator ofno more than three centers. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-5 Admission requirements. (a)Requirements for admission to an adult day healthcenter shall include:

(1) Referral from a community or healthagency, physician, or hospital; and

(2) Need for the health, nursing,therapeutic, or social services provided bythe adult day health center in order toreach or maintain the highest degree offunctional status practicable for theclient.

(b) All clients prior to admission, shallprovide the center with the following:

(1)Their physician's full name, address, and

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emergency phone numbers; and(2) A written order from the physician

specifying therapeutic procedures orprograms to be provided by the center asdelineated in §11-96-31.[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-6 Arrangements for services. Wherethe center does not employ a qualified person torender a required or necessary service, it shall havea written agreement or contract with an outside personor provider to provide the needed service.[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-7 Basic program requirements. Theconfiguration of services available to clients will beappropriate to the assessed needs of the clients.Basic program requirements of an adult day healthcenter shall include provisions for medical services,nursing services, dietetic services and plannedtherapeutic and social activities, and, if required byclients, social services, speech therapy, physicaltherapy, occupational therapy, psychiatric orpsychological services. Services provided may includetransportation. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-8 Client care management. (a) Eachcenter shall make available a multidisciplinary team,either through regular staff or contractedarrangement, for the purpose of client assessment anddevelopment of the plan of care.

(b) A written individualized plan of careshall be developed to meet the needs of each clientand shall include but not be limited to:

(1) Days of attendance;(2) Medical diagnosis, including general

functional capacity;(3) Prescribed medications;(4) Specific types of services needed based

on functional capacity;(5) Individualized objectives and therapeutic

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goals;(6) An individualized activity plan designed

to meet the needs of the client for socialand therapeutic recreation activities;

(7) Participation in specific groupactivities;

(8) Transportation;(9) Therapeutic diet requirements, if any;(10) A plan to arrange for any services needed

which are not routinely available at thecenter;

(11) Anticipated date of discharge whenappropriate, and projected services andsupport needs after discharge from theprogram; and

(12) The signature of each member of themultidisciplinary team, including thephysician. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-9 Client's rights. (a) Writtenpolicies regarding the rights and responsibilities ofclients during their stay in the center shall beestablished and shall be made available to the client,to any guardian, next of kin, sponsoring agency orrepresentative payee, and to the public. The center'spolicies and procedures shall provide that eachindividual admitted to the center shall:

(1) Be fully informed, as evidenced by theclient's written signed acknowledgementprior to or at the time of admission, ofthese rights and of all rules governingclient conduct;

(2) Be fully informed, prior to or at thetime of admission and during stay, ofservices available in or through the centerand of related charges, including any chargefor services not covered by the center'sbasic per diem rate;

(3) Be advised that clients have a right tohave their medical condition and treatmentdiscussed with them by a physician of their

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choice, and to be afforded the opportunityto participate in the planning of theirmedical treatment and to refuse toparticipate in experimental research;

(4) Have the right to refuse treatment afterbeing informed of the medical benefits oftreatment, the consequences of refusal, andthe medical alternatives;

(5) Be encouraged and assisted throughouttheir period of stay to exercise theirrights as clients, and to this extent tohave grievances and to recommend changes inpolicies and services to the center's staffand outside representative of their choicefree from restraint, interference, coercion,discrimination, or reprisal;

(6) Not be humiliated, harassed, injured, orintimidated and shall be free from chemicaland physical restraints. Physicalrestraints may be used only in an emergencywhen necessary to protect the client frominjury to the client or others. In such anevent, the client's physician shall benotified as soon as possible and furtherorders obtained; as provided in section 11-96-35;

(7) Be entitled to have their personal andhealth records kept confidential and subjectto release only as provided in section11-96-24;

(8) Be treated with consideration, respect,and in full recognition of their dignity andindividuality, including privacy intreatment and in care as appropriate;

(9) Not be required to perform services forthe center that are not included fortherapeutic purposes in their plan of care;

(10) Have reasonable access to telephones,both to make and receive confidential calls,or to have such calls made for the client,if necessary;

(11) Be allowed to end participation at theadult day health center at any time; and

(12) Be discharged only for medical reasons,or for the client's welfare or that of otherclients, or for non-payment for services,

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and be given reasonable advance notice toensure orderly discharge. Such actionsshall be documented in the client's record.

(b) Each center shall have a formal fairhearing written procedure for any alleged client'srights infractions.

(c) Each adult day health center shall post alist of client's rights in a prominent place in thecenter.

(d) The center shall provide for andencourage each employee to report observations orevidence of abuse. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-10 Dietetic services. (a) Mealsserved in the center shall meet the recommendeddietary allowances of the Food and Nutrition Board ofthe National Research Council, and be adjusted forage, sex, activity and disability.

(b) A minimum of one meal per day shall beprovided in accordance with the following requirementsstated.

(1) Each client who is in the center for fourhours or more shall be served a meal thatwill supply at least one-third of theNational Research Council recommendeddietary allowances;

(2) Each client who is in the center foreight hours or more shall be served a mealand between meal nourishments that willsupply at least half of the NationalResearch Council recommended dietaryallowances;

(3) Each client who is in the center forperiods longer than ten hours shall beserved at least two meals and between mealnourishments that will supply at leasttwo-thirds of the National Research Councilrecommended dietary allowances; and

(4) Any client accepted at 7:00 a.m. orearlier shall be served a breakfast, unlessit has been determined that the client hasreceived a meal prior to arrival.

(c) All diets shall be:

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(1) Prescribed by the client's physician witha record of the diet as ordered kept onfile;

(2) Planned, prepared, and served bypersonnel using the current Hawaii DieteticAssociation manual; and

(3) Reviewed and adjusted as needed by thedietitian.

(d) Therapeutic diets shall be planned by aqualified dietitian, as prescribed by the client'sphysician.

(e) A nutritional assessment and diet planfor each client shall be completed and recorded in thehealth record by the physician or dietitian. Theplan should be incorporated in the overall plan ofcare and reviewed as necessary.

(f) Menus shall be written at least one weekin advance and posted in the kitchen.

(1) Menus shall provide a sufficient varietyof foods served in adequate amounts at eachmeal, and adjusted for seasonal changesalong with clients preferences as much aspossible; and

(2) A different menu shall be followed foreach day of the week. If a cycle menu isused, the cycle menu shall cover a minimumof twoweeks.

(g) All food shall be procured, stored,prepared, distributed, and served under sanitaryconditions.

(1) Dry or staple food items shall be storedabove the floor in a ventilated room notsubject to seepage or waste-water back flow,or contamination by condensation,leakages, rodents, or vermin; and

(2) Perishable foods shall be stored at theproper temperature to conserve nutritivevalues and prevent spoilage.

(h) Food shall be served under sanitaryconditions, and shall be in a form consistent with theneeds of the client and the client's ability toconsume it.

(1) Food shall be served in a form consistentwith the appropriate utensils;

(2) Effective procedures to promptly and

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consistently clean all equipment and workareas shall be enforced;

(3) All personnel handling food shall betrained in and observe appropriate personalhygiene practices;

(4) Hand washing facilities, including hotand cold water, soap, and paper towelsadjacent to the work areas shall beprovided;

(5) Individuals needing special equipment,implements, or utensils to assist them wheneating shall have such items provided by thecenter;

(6) There shall be a sufficient number ofcompetent personnel to fulfill the food andnutrition needs of clients;

(7) If the food service is directed by aperson other than a qualified dietitian,there shall be consultation by a dietitian;

(8) Dietary consultation, training andinservice education shall be appropriate

to staff and client needs and shall bedocumented; and

(9) Provision may be made for food service bycontract with an outside supplier. Themethod of transport, storage,

preparation, and serving of such food as well asthe method of providing prompt appropriate

replacement foods in therapeutic dietsshall be approved by the director prior

to initiating such a service.[Eff ] (Auth: HRS

§321-11)(Imp: HRS §321-11)

§11-96-11 Discharge planning. (a) A planfor discharge of each client shall be based on theassessment of the client by the multidisciplinary teamand shall be reviewed and updated at the time of eachreassessment if discharge planning is appropriate.

(b) As appropriate, each client's healthrecord shall include documentation of the plan fordischarge which shall be completed within fourteendays of the first assessment.

(c) Referral of clients shall be made to

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outside resources by the multidisciplinary team or byan individual team member. Each referral shall berecorded in the client's health record.

(d) Consultation shall be made available to aclient's family prior to any discharge.

(e) If a client decides to terminateparticipation in an adult day health center programprior to the date recommended by the multidisciplinaryteam, the center staff shall, when appropriate,discuss the consequences of such action with theclient, the client's physician, and the client'sauthorized representative, if any, and center staffshall document the discussion in the client's healthrecord. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-12 Disaster plan. (a) Each centershall have a written plan for a fire or disasteroccurring within the center, or a natural disasteroccurring inthe community.

(b) The disaster plan shall be in writing andshall include:

(1) Designation of administrative authorityand employee assignments; and

(2) A plan for evacuation or relocation ofclients, if this is appropriate, including:

(A) Means and routes of evacuation;(B) Transportation of clients when

necessary;(C) Supervision of clients after

evacuation or relocation; (D) Means for contacting local service

agencies, such as fire department, lawenforcement agencies and other disasterauthorities of local government; and

(E) Posting of evacuation routes.(c) Each employee shall be instructed in

assigned duties. Instruction shall include employeeand client practice sessions. New employees shall beinformed immediately of their disaster duties, asrequired in the plan. Records of all training shallbe kept on file in the center.

(d) Facilities licensed under this chaptershall be inspected at least annually by appropriate

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fire authorities for compliance with state and countyfire and life safety rules and ordinances.

(e) Smoking rules shall be adopted. (f) Fire drills shall include the transmission

of a fire alarm signal and be held at least quarterly.Records of all fire drills shall be filed in thecenter. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-13 Emergency care of clients. Theprovider shall establish emergency procedures inwriting. These procedures shall include thefollowing:

(1) An easily located file on each clientlisting the name and telephone number of theclient's physician, treatments ormedications for a client's specialdisabilities, and the name and telephonenumber of a family member, sponsor, orfriend, or case manager, to be notified incase of emergency;

(2) Emergency measures to take in care of theclient, as appropriate;

(3) Procedures to obtain emergencytransportation for treatment and otherappropriate emergency services;

(4) Provision and maintenance of first aidequipment and supplies; and

(5) At least one staff person shall bepresent at all times, who is trained andcertified in CPR and basic first aid. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-14 Employee records. (a) Each centershall maintain an employee record which shall beavailable for review by the director or designatedrepresentative.

(b) Each employee record shall contain atleast the following:

(1) Full name;(2) Date of employment;(3) Credentials and pertinent experience; and

(4)A health record containing a report of the

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following:(A) Tuberculosis clearance pursuant to

section 11-96-19; and(B) Health examination signed by the

examining physician or person lawfullyauthorized to perform such examinationswhich indicates the employee is freefrom any infectious or communicabledisease.

(c) The center shall have a written policyproviding for the health screening of volunteers,including screening for tuberculosis.

(d) All records shall be retained for threeyears following termination of employment. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-15 Employee requirements. (a)Employees shall be sufficient in numbers, qualified,and competent to provide the services for which thecenter is licensed.

(b) Each supervisor shall be at least eighteenyears of age.

(c) Each employee shall have either trainingor related experience in the job assigned.

(d) A planned in service education program,including orientation, skill training, and continuingeducation shall be provided for employees.

(e) Each employee shall be in good mental andphysical health and capable of performing assignedtasks.

(f) No client shall be used as a substitutefor required employees, but may assist employees aspart of the client's program of rehabilitation ortraining. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-16 Equipment and supplies. Medicalequipment and supplies in each center shall be of thequality and in the quantity necessary for care ofclients as ordered or indicated in the plans of care,and shall include standard first aid supplies. Theseshall be provided and properly maintained at alltimes. [Eff ]

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(Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-17 Finances. No adult day healthcenter shall assume responsibility for the funds ofits clients. [Eff ] (Auth: HRS§321-11) (Imp: HRS §321-11)

§11-96-18 General policies and procedures.(a) There shall be written policies and proceduresavailable to staff, clients and the public whichgovern:

(1) All services provided by the center; and(2) Admission and discharge of clients.(b) These policies shall insure that:(1) The center shall not deny admission to

any individual on account of race, sex,religion, color, ancestry, or nationalorigin;

(2) Only those clients are accepted whoseneeds can be met by the center directly or in

cooperation with community resources orother providers of care with which it hasaffiliated or has contracts; and

(3) As changes occur in a clients' physicalor mental condition necessitating adifferent type of service or care which cannotbe adequately provided by the center, itshall be recommended that clients be referredto a facility or service capable ofproviding an appropriate level of care.

[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-19 Governing body and management. (a)

Each licensee shall be responsible for the operationof the center.

(b) The licensee shall exercise generalsupervision over the center, shall establish writtenpolicies concerning the center's operation, and shallmake available these written policies for inspectionby the director.

(c) Each licensee shall have written personnelpolicies and procedures which are available to all

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employees.(1) There shall be written job descriptions

for each position. Each employee shall beinformed of their duties andresponsibilities at the time of employmentand through inservice training sessionsthereafter;

(2) All professional employees shall haveappropriate current licenses as required bylaw;

(3) Ethical standards of professional conductshall apply to all parts of the program;

(4) Written policy shall prohibit misconduct,neglect, or abuse of clients and shallinclude procedures for investigating andreporting any such incidence to the Stateand governing body; and

(5) There shall be documented evidence thatevery employee has a pre-employment and anannual health evaluation by a physician.These evaluations shall be specificallyoriented to determine the presence of anyinfectious disease liable to harm a client.Each health evaluation shall include atuberculin skin test or a chest x-ray;

(A) Skin lesions or diarrhea shall beconsidered presumptive evidence ofinfectious disease. Any employee whodevelops evidence of an infection mustbe immediately excluded from any dutiesrelating to food handling or directclient contact until such time as aphysician certifies it is safe for theemployee to resume such duties;

(B) If the tuberculin skin test ispositive, a standard chest x-ray withappropriate medical follow-up must beobtained, as well as three subsequentyearly chest x-rays. If all threechest x-rays are negative, no furthertuberculin tests shall be required,except that additional chest x-rays maybe required at the discretion of thedirector;

(C) If the tuberculin skin test isnegative, a second skin test shall be

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done after one week, but not later thanthree weeks after the first test. Theresults of the second test shall beconsidered the baseline test and usedto determine appropriate treatment andfollow-up. That is, if the second skintest is positive, then proceed, as insection 11-96-19(c)(5)(B). If the skin test isnegative, a single skin test shall berepeated yearly; and

(D) When a known negative tuberculinskin test on a particular employee orclient converts to a positive test, itshall be considered a new case oftuberculosis infection and shall bereported to the department as requiredin Chapter ll-l64.

[Eff. ] (Auth: HRS §§321-9, 321-11) (Imp: HRS §§321-9, 321-11)

§11-96-20 Housekeeping and maintenance. (a)Each center shall be kept clean, safe, and in goodrepair at all times.

(b) There shall be records that document thatinspection of all devices essential to health andsafety of clients and personnel shall be carried outdaily or at sufficiently frequent intervals to ensureoperational performance. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-21 Infection control. (a) There shallbe appropriate policies and procedures written andimplemented for the prevention and control ofinfectious diseases and management and disposal ofinfectious waste.

(b) Efforts shall be made to promptly returnto their homes those clients who have infectiousconditions. [Eff. ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-22 Inservice education. (a) There

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shall be a staff inservice education program thatincludes:

(1) Orientation for all new employees toacquaint them with the philosophy,organization, program, policies andprocedures, practices, and goals of thecenter;

(2) Training for employees who have notachieved the desired level of competence,and continuing inservice education to updateand improve the skills and competencies ofall employees; and

(3) Annual, or more frequent, training whichshall include, but not be limited to,prevention and control of infections, fireprevention and safety, accident prevention,clients' rights, and problems and needs ofthe aged, ill, and disabled. Provisionshall be made for training appropriatepersonnel in cardiopulmonary resuscitationand appropriate first aid techniques.

(b) Records shall be maintained for allorientation and staff development programs. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-23 Laundry. (a) Where laundry serviceis provided, daily clothing and linen needs shall bemet without delay.

(b) Provisions shall be made for the properhandling, storage, and transportation of soiled andclean laundry and for satisfactory cleaningprocedures. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-24 Health record system. (a) Thereshall be available appropriately qualified staff tofacilitate the accurate processing, checking,indexing, filing, and prompt retrieval of records andrecord data.

(b) The following information shall beobtained and entered in the clients' record at thetime of admission to the center:

(1) Identifying information such as: date ofadmission, date of birth, marital status,social security number or an admission

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number which can be used to identify theclient without use of name when the latteris desirable;

(2) Name and address of next of kin or legalguardian or care taker;

(3) Sex, height, weight, race, languagespoken and understood; and

(4) Admission diagnosis, summary of priormedical care, recent physical examination,toinclude functional, cognitive, tuberculosisstatus, and physician's orders as describedin section 11-96-5.

(c) Records during stay shall also include:(1) Appropriate authorization and consents

for medical procedures;(2) Records of all periods of restraints with

justification and authorization for each;(3) Copies of initial and periodic

examinations and evaluations, as well asprogress notes at appropriate intervals;

(4) Annual review of an overall plan of caresetting forth goals to be accomplishedthrough individually designed activities,therapies, and treatments, and indicatingwhich professional service or individual isresponsible for providing the care orservice;

(5) Entries describing treatments,medications, tests, ancillary servicesrendered; and

(6) Documentation of any injuries oraccidents;

(d) When a client is discharged, there shallbe a discharge summary which shall include:

(1) The reason for discharge; (2) Except in an emergency, documentation to

indicate that the client understood thereason for discharge, or that the guardianand family were notified; and

(3) A summary of current status and care,final diagnosis, and prognosis.

(e) There shall be a master alphabeticalindex of all clients admitted to the center.

(f) All entries in the clients' record shallbe:

(1) Legible, typed, or written in ink;

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(2) Dated; and(3) Authenticated by signature and title of

the individual making the entry.(g) All information contained in a client's

record, including any information contained in anautomated data bank, shall be considered confidential.

(h) The record shall be the property of thecenter, whose responsibility shall be to secure theinformation against loss, destruction, defacement,tampering, or use by unauthorized persons.

(i) There shall be written policies governingaccess to, duplication of, and dissemination ofinformation from the record. Written consent of theclient, if competent, or the guardian if the client isnot competent, shall be required for the release ofinformation to persons not otherwise authorized toreceive it. Consent forms shall include:

(1) Use for which requested information is tobe used;

(2) Sections or elements of information to bereleased and specific periods of time duringwhich the information is to be released; and

(3) Consent of client, or legal guardians,for release of specific health recordinformation.

(j) Records shall be readily accessible andavailable to authorized department personnel for thepurpose of determining compliance with this chapter.

(k) If a client has been absent for thirtydays or more because of illness, there must be awritten statement by a physician that the client iswell enough to be readmitted to the program. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-25 Nursing service. (a) Each programshall have nursing staff sufficient in number andqualifications to meet the needs of the clients.

(b) Nursing services shall be under thesupervision of a registered nurse.

(c) If there are clients admitted who requireskilled nursing, the services will be provided by aregistered nurse or under the direct supervision of aregistered nurse.

(d) Nursing services shall include, but not

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be limited to the following:(1) Nursing assessment of each client and

development of an appropriate plan of careby a registered nurse;

(2) Nursing observations and summaries of theclient's status recorded monthly, or morefrequently if appropriate, by a licensednurse;

(3) Completion of all physician's orders withproper documentation;

(4) Supportive services for all clients toencourage them to participate in appropriatedaily activities;

(5) Physical care to keep clientswell-groomed, clean, comfortable, andprotected from accidents and infections;

(6) Proper care to prevent decubiti,contractures or deformities;

(7) Coordination of an overall plan of carefor each client, consistent with thephysician's medical care plan and developedby the various disciplines involved;

(8) Frequent physical checks to insure thatall clients are present and accounted for;

(9) Restorative and preventive nursing careincluding client and family education asappropriate for each client;

(10) Weighing each client at least monthly; (11) Provision of emergency care, including

arrangements for transportation;(12) Notification of the physician of any

marked changes in the client's condition;and

(13) Administration of medications ormonitoring of self-administration ofmedication by clients.

(e) Nursing service space and beds shall beprovided for the treatment of clients. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-26 Occupational therapy services. (a)Occupational therapy services which utilize purposefulactivity shall be made available in each center asnecessary, and be provided under a physician's order,

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and shall include, but not be limited to, thefollowing:

(1) Assessment of the client and formation ofan individual plan of care in conjunctionwith the multidisciplinary team; and

(2) Progress notes written at least quarterlyin the clients' health record and signed bythe occupational therapist.

(b) The occupational therapy services shallbe under the supervision of an occupational therapist.

(1)An occupational therapy assistant shall workonly under the supervision of anoccupational therapist; and

(2)An occupational therapy aide shall work onlyunder the immediate supervision of anoccupational therapist or an occupationaltherapy assistant.

(c) Adequate space shall be provided foroccupational therapy services and for storage ofequipment. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-27 Physical therapy services. (a)Physical therapy services shall be made available ineach center as necessary, and be provided under aphysician's order, and shall include, but not belimited to, the following:

(1) Provide initial and continuing assessmentof the client by the physical therapist inthe formation of an individual plan of carein conjunction with the multidisciplinaryteam;

(2) Progress notes written at least quarterlyin the client's health record and signed bythe physical therapist; and

(3) Treatment of clients to achieve andmaintain maximum performance using

physical means such as exercises, massage,heat, sound, or water.

(b) Physical therapy services shall be underthe supervision of a physical therapist.

(1)A physical therapy assistant shall work onlyunder the supervision of a physicaltherapist; and

(2)A physical therapy aide shall work only under

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the immediate supervision of a physicaltherapist or a physical therapy assistant.

(c) Adequate space shall be provided fortreating the clients and for storage of equipment.[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-28 Ownership and financial capability.(a) The center shall provide to the director currentinformation in regard to:

(1) The name of each person owning 10 percentor more of the business, either directly orindirectly;

(2) If a corporation, the names of theofficers and directors;

(3) If a partnership, the names of eachpartner; and

(4) The names of each person who is the owner(in whole or in part) of any mortgage, deedor trust, note or other obligation recurred(in whole or in part) by the center.

(b) The financial resources of the ownershall be sufficient to operate and maintain theprogram according to the standards set forth in thechapter. The owner shall provide upon request, suchevidence as deemed necessary by the director toestablish that fact. [Eff ] (Auth:HRS §321-11)(Imp: HRS §321-11)

§11-96-29 Pharmaceutical services. (a) Thecenter shall consult with a licensed pharmacist onmethods and procedures for storage, administration,disposal, and record keeping of drugs and biologicalsubstances.

(b) A pharmacy policy manual shall bedeveloped and kept current by the licensed nursingstaff, consultant pharmacist or a licensed physicianwhich:

(1) Contains appropriate policies andprocedures and defines the functions andresponsibilities relating to pharmacyservices;

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(2) Is revised as necessary to keep up todate with development in overall drug usage;

(3) Specifies the safe administration andhandling of all drugs; and

(4) Includes policies regardingself-administration of drugs.

(c) Medications administered to a clientshall be ordered by the attending physician inwriting.

(1) Where physicians' verbal orders are

directed tothe center,only thefa ci li ty ' s

l i c e n s e dmedical ornursing staffs h a l l

receive suchorders; and

(2) Any verbal or telephone medication ordersshall be recorded and signed by the

person receiving them and must be verified inwriting by the attending physician withinfour days.

(d) Each drug shall be rechecked andidentified prior to administration.

(e) No medication shall be administered to a client by center personnel unless the name, dosage, and frequency of administration of the drugand the name of the prescribing physician are recordedin the client's record.

(f) Only appropriately licensed and trainedstaff shall be allowed to administer drugs and shallbe responsible for proper recording of the medicationincluding the route of administration. Medicationerrors and drug reactions shall be recorded in theclient's health record, reported immediately to theprescribing physician and an incident report prepared.All incident reports shall be kept available forinspection by the director for a period of threeyears.

(g) Drugs shall be stored under proper

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conditions of sanitation, temperature, light,moisture, ventilation, segregation, and security whenplaced in the care of the center.

(1)All drugs shall be kept under lock and keyexcept when authorized personnel are inattendance;

(2)Poisons, drugs used externally, and drugstaken internally shall be stored in locked,well marked separate cabinets, at alllocations;

(3)Medications that are stored in a refrigeratorcontaining things other than drugs shall bekept apart and in a locked container;

(4) Discontinued and out dated drugs,drugsleft by clients who have expired or who havenot visited the center for thirty days,containers with worn, illegible, or missinglabels, shall be returned to the client'sfamily or responsible party for properdisposition. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-30 Physical plant constructionrequirements. (a) The center shall be fullyaccessible to and functional for physicallyhandicapped clients, personnel, and the public.

(b) Each center shall comply with state andlocal building requirements.

(c) Each center shall have a working, listedtelephone on the premises.

(d) Temperature and humidity shall bemaintained within a normal comfort range.

(e) There shall be provisions within thecenter for one or more areas for dining, socialactivities, secluded areas, and therapy areas.

(1)The center shall be equipped with adequatenatural and artificial lighting, tables,chairs, or their equivalent, for the use andcomfort of the client;

(2)Dining areas shall be equipped with tables andchairs. A sufficient number of tables shallbe of proper height to accommodatewheelchair clients;

(3)If a multi-purpose room is used for dining andrecreational activities, there shall be

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sufficient space to accommodate allactivities; and

(4)A secluded area shall be set aside for clientswho require bed rest during the day;

(A) The secluded area shall have chaiselounges or beds in the number necessaryto meet the needs of the clients underwritten order of the staff or attendingphysician; and

(B) Space around sleeping accommodationsshall permit easy passage.

(f) Total area for recreational and diningactivities shall be not less than fifty square feetper client.

(g) Activity, dining and service areas shallbeaccessible to all clients.

(1) There shall be adequate space to allowfree movement of clients using wheelchairs,walkers, canes, and crutches to bed,bathroom, closet, and common hallway areas;and

(2) Areas used for cooking, storage,bathrooms, laundry, and other areas notsuitable for sleeping shall not be used asrest or sleep areas.

(h) There shall be one toilet room for everytwelve clients.

(1) The toilet room shall contain a toiletand lavatory;

(2) Appropriately placed grab bars shall beprovided in designated toilets, bathtubs,and shower enclosures;

(3) Curtains or doors to ensure privacy shallbe provided;

(4) An adequate supply of hot and coldpotable running water must be provided atall times. Temperatures of hot water atplumbing fixture used by clients shall beautomatically regulated and shall bemaintained at a level between 100_ to 110_F;

(5) Each toilet and bath center shall have anauditory call system which permits theclient to signal staff in an emergency;

(6) There shall be at least one bathtub orshower available; and

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(7) Separate toilet facilities shall beprovided for the use of personnel.

(i) Ramps must be designed to permit use byclients in wheelchairs. Ramps shall meet theprovisions of the 1987 Uniform Building Code.

(j) Walls and floors of rooms used by clientsshall be made of materials which shall permit washingor cleaning.

(k) Where appropriate, screening of doors andwindows shall be provided, using screening havingsixteen meshes per inch.

(l) Double acting doors shall be providedwith vision panels of sufficient height to permit useby walkers as well as wheelchair riders.

(m) The minimum clear width of a corridorshall be thirty-six inches except that corridorsserving one or more clients who require the use of awheel chair or walking aids shall be not less thanforty-four inches. Stationary handrails shall beinstalled at least along one side of corridors.

(n) Locked storage space shall be providedfor janitors' supplies and equipment. Storage space,conveniently located, for general and specializedequipment shall be provided.

(o) The water supply shall be in accordancewith Chapter 340E, Hawaii Revised Statutes.

(p) Chapter 11-39 relating to airconditioning and ventilation, shall be followed.

(q) Flashlights shall be in readiness andfunctional at all times.

(r) Open flame types of light shall not beused.

(s) Space for outdoor activities shall beeasily accessible to all clients and protected fromtraffic.

(t) Facilities shall be maintainedin accordance with provisions of state and county firesafety, sanitat ion laws andordinances. [Eff ] (Auth:HRS §321-11)

(Imp: HRS §321-11)

§11-96-31 Physiciansservices. (a) All clients admitted to a center shallbe under the care of a physician selected by the

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client.(b) The physician shall

authorize the client's initial individualized plan ofcare and major revisions thereafter. The plan of careshall be reviewed at least annually.

(c) There shall be astatement from the physician as to the medicalcondition and functional status of the client,prescribed therapies, and any special care orobservations which is required at least annually, withupdates whenever there are changes which significantlyalter the client's medical or functional status.

(d) There shall be astatement from the physician that the client does nothave active tuberculosis.

(e) There shall be directionsfrom the physician as to the procedures to be followedif the physician is not immediately available in theevent of an emergency. [Eff ]

(Auth: HRS §321-11) (Imp: HRS§321-11)

§11-96-32 Program director.(a) Each center shall have a full time programdirector.

(1) The administrator mayserve in this

capacity except as specified in section 11-96-4(d);

(2) The program director shall be present onthe premises and available to clients,employees, and relatives; and

(3) When the program director is temporarilyabsent, another staff member shall bedesignated in writing to serve as the actingprogram director.

(b) The program director shall haveexperience in working with impaired persons and beknowledgeable about their physical, social, and mentalhealth needs.

(c) The duties of the program director shallbe:

(1) Coordinating the development andimplementation of the program, as determinedby the multidisciplinary team; and

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(2) Periodically holding team conferences toevaluate clients and adjust programs asneeded. [Eff ]

(Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-33 Psychiatric or psychologicalservices. (a) Every adult day health center shallhave available appropriate consultant staff trained inpsychiatric care when there is a client in the adultday health center requiring the services while at thecenter.

(b) The consultant shall:(1) Participate in the initial and continuing

assessments for the development of anindividual plan of care by themultidisciplinary team when indicated;

(2) Maintain signed progress records in theclient's health record when providingservices;

(3) Form liaisons with or be advisory toother members of the multidisciplinary team,family members and referral agencies thatmay yield information of value topsychiatric or psychological treatment; and

(4) Provide counseling and other services asappropriate to client needs.

(c) Sufficient space and privacy shall beprovided for individual or group counseling.[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-34 Recreation and social activities.(a) Every adult day health center shall provide aprogram of social and recreatioal activities that issupervised and directed by an activity coordinator tomeet the needs and interests of each client. (b) The activity coordinator's duties shallinclude at least the following:

(1) Participation in initial and continuingassessment of the client's needs for thedevelopment of the individual;

(2) Provision of a signed quarterly progressrecord and individualized activity plan inthe client's health record;

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(3) Posting of a schedule of plannedactivities in a central location readilyaccessible to client, family, guardian, orauthorized representative;

(4) Involvement of clients in the planning ofthe program as appropriate;

(5) Utilization of volunteers as needed toimplement the plan; and

(6) Utilization of the adult day healthcenter's transportation to provideactivities in the community as indicated byclient's needs and interests.

(c) Each client shall engage in activitiessuitable to the client's needs and interests.

(d) The activity coordinator shall be a fulltime employee of the center.

(e) Space shall be provided that:(1) Meets independent and group needs of all

clients;(2) Is accessible to all clients; and(3) Allows adequate storage of equipment and

supplies.(f) Equipment shall be sufficient to meet the

group and independent needs of each client. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-35 Restraints. (a) There shall bewritten policies and procedures governing the use ofrestraints.

(b) Physical restraints shall be used onlyunder physicians' orders for specified and limitedperiods of times and their use shall be documented.

(1) If physical restraints are used in anemergency situation, the attending physicianshall be contacted immediately for orderssupporting or discontinuing the temporaryuse;

(2) Only a staff member so designated in thewritten policy shall have the authority toapply restraints in an emergency situation;

(3) Regular observation and regular releaseof client shall be required while restraintsare in use; and

(4) No restraints with locking devices shall

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be used.(c) Restraints shall be used only under the

following conditions:(1) In emergency conditions to prevent

imminent danger to health or safety by aclient to self or others; and

(2) For temporarily positioning the client toprevent the client from falling out of achair or from a treatment table or bed.

(d) Restraints shall include only clothvests, soft ties, soft cloth mittens, seat belts, orwheelchair trays. Soft ties means soft cloth whichdoes not cause skin abrasion and which does notrestrict blood circulation.

(e) Restraints shall not be used aspunishment or as a convenience to the staff.

(f) Restraints shall be applied in a mannerso that they can be speedily removed in case of fireor other emergency.

(g) Various types of adult chairs referred toas geriatric chairs are not defined as a restraint ifthe type of closing mechanism on the chair and thephysical and mental capability of the specific clientallows for easy removal. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-36 Sanitation. (a) Every center shallbe in compliance with all applicable laws of the State of Hawaii and rules of the department relatingto sanitation.

(b) Reports of annual inspections by state orcounty health authorities and records of action takenin correction of deficiencies and recommendationsshall be kept on file at the facility.

(c) The center shall provide a sufficientnumber of water tight receptacles of metal, or othermaterials acceptable to the department, for rubbish,garbage, refuse and other discarded matter. In kitchenand food preparation areas, receptacles shall be keptclosed by tight fitting covers except in the kitchenduring peak hours of food preparation. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

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§11-96-37 Social services. (a) Every adultday health center shall have available social servicesas appropriate to assist clients and their families tosolve social problems that arise as a result of theclient's disability.

(b) Social services shall consist of thefollowing:

(1) Providing initial and continuingassessment of the client by the socialworker in the formation of an individualplan of care by the multidisciplinary teamas appropriate;

(2) Maintaining signed progress notes in theclients' health record at least quarterly;

(3) Assumption of responsibility forimplementation and coordination of thedischarge plan;

(4) Providing referral to outside resourcesand assisting with counseling whenapplicable;

(5) Providing problem oriented discussiongroups among clients;

(6) Serving as a liaison with the client'sfamily and home; and

(7) Providing referral and follow-up forreferred persons not appropriate for adultday health care.

(c) Social services shall be provided orsupervised by a social worker.

(d) A social work assistant shall providesocial services only under the supervision of a socialworker.

(e) Space to allow privacy shall be providedfor the social worker when counseling clients orfamilies of clients. [Eff ](Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-38 Speech therapy services. (a)Speech therapy services shall be made available ineach center as necessary, and be provided under aphysician's order, and shall include:

(1) Initial and continuing assessment of theclient by the speech therapist in themultidisciplinary team; and

(2) Progress notes, written at least

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quarterly, or more often, if necessary inthe client's health record and signed by thespeech therapist.

(b) The speech therapist shall work thenumber of hours necessary to meet the needs of eachclient as specified in the individualized plan of caredeveloped by the multidisciplinary team.

(c) Space that is free from noise shall beprovided to the extent that such conditions are withinthe reasonable control of the center. [Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-39 Staffing. (a) Staffing shall besufficient to carry out daily activities, nursingservices, physician orders, and individualized plansof care.

(b) The program director of a center whoseaverage daily attendance is twenty or less may alsoserve as the registered nurse, social worker,occupational therapist, physical therapist, activitycoordinator, speech therapist or dietitian providedthat the program director meets the qualifications, inaccordance with 11-96-32, and is not also theadministrator.

(c) Support employees shall include aides,maintenance, food service, and clerical employeessufficient in number to perform the necessary duties.

(d) Volunteers may be utilized in centers,but shall not be used to replace requiredprofessionally qualified employees unless they are soqualified. Each volunteer shall receive orientation,training, and supervision.

(e) When regular employees are absent, thereshall be coverage by employees with suitablequalifications. [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-40 Transportation safety. (a) Everyadult day health center which provides directtransportation services for clients shall meetspecific operational standards. The motor vehicleshall:

(1) Be operated only by drivers who have

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appropriate valid Hawaii drivers license;(2) Be equipped with safety devices to

protect clients during transportation;(3) Be maintained in a safe and reliable

condition and shall meet the provisionsof the current Hawaii Vehicle Code. (b) The center shall develop policiesregarding transportation safety and maintenance ofvehicles.[Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

§11-96-41 Transportation services.Transportation for clients to and from the center maybe provided or arranged by the center.[Eff ] (Auth: HRS §321-11)(Imp: HRS §321-11)

§11-96-42 Severability. If a provision ofthis chapter or the application thereof to any personor circumstances is held invalid, the remainder ofthis chapter or the application of the provisions toother persons or circumstances shall not be affectedthereby." [Eff ] (Auth: HRS §321-11) (Imp: HRS §321-11)

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The Department of Health authorized theadoption of Chapter 96, Title 11, Administrative Ruleson May 31, 1991, following public hearings held on Oahuon May 13, 1991, on Hawaii on May 14, 1991, on Kauaion May 15, 1991, and on Maui on May 17, 1991, afterpublic notice was given in the Honolulu Advertiser onApril 1, 1991, in the Hawaii Tribune Herald on March27, 1991, in the Garden Island on April 1, 1991, andin the Maui News on April 1, 1991.

Chapter 96 of Title 11, Administrative Rulesshall take effect ten days after filing with theOffice of the Lieutenant Governor.

___________________________JOHN C. LEWIN, M.D.DirectorDepartment of Health

APPROVED:

___________________________JOHN WAIHEEGOVERNORSTATE OF HAWAII

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D a t e d :____________________

APPROVED AS TO FORM:

_______________________Deputy Attorney General

F i l e d :_____________________

E f f e c t i v e D a t e :____________

DEPARTMENT OF HEALTH

Adoption of Chapter 11-96Hawaii Administrative Rules

May 31, 1991

1. Chapter 96 of Title 11, HawaiiAdministrative Rules, entitled "Freestanding Adult DayHealth Centers" is adopted to read as follows:

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