11-96

HAWAII 	ADMINISTRATIVE 	RULES
TITLE 	11
DEPARTMENT 	OF 	HEALTH
CHAPTER 	96
FREESTANDING ADULT 	DAY 	HEALTH 	CENTERS
§11-96-1
§11-96-2
§11-96-3
§11-96-4
§11-96-5
§11-96-6
§11-96-7
§11-96-8
§11-96-9
§11-96-10
§11-96-11
§11-96-12
§11-96-13
§11-96-14
§11-96-15
§11-96-16
§11-96-17
§11-96-18
§11-96-19
§11-96-20
§11-96-21
§11-96-22
§11-96-23
§11-96-24
§11-96-25
§11-96-26
§11-96-27
§11-96-28
§11-96-29
§11-96-30
§11-96-31
§11-96-32
§11-96-33
§11-96-34
Purpose
Definitions
Licensing
Administrator
Admission 	requirements
Arrangements 	for 	services
Basic 	program 	requirements
Client 	care management
Client's 	rights
Dietetic 	services
Discharge 	planning
Disaster plan
Emergency 	care 	of 	clients
Employee 	records
Employee 	requirements
Equipment 	and 	supplies
Finances
General 	policies 	and 	procedures
Governing 	body 	and management
Housekeeping 	and 	maintenance
Infection 	control
Inservice 	education
Laundry
Health 	record 	system
Nursing 	service
Occupational 	therapy 	services
Physical 	therapy 	services 	&
ownership 	and 	financial 	capability
Pharmaceutical 	services
Physical 	plant 	construction
requirements
Physicians 	services
Program 	director
Psychiatric 	or psychological
services
Recreation 	and 	social 	activities
96-1
1499

§11-96-1
§11-96-35
§11-96-36
§11-96-37
§11-96-38
§11-96-39
§11-96-40
§11-96-41
§11-96-42
Restraints
Sanitation
Social 	services
Speech 	therapy 	services
Staffing
Transportation 	safety
Transportation 	services
Severability
§11-96-1 	Purpose. 	The 	purpose 	of 	this 	chapter
is 	to 	establish minimum 	requirements 	for 	the
protection 	of 	health, 	welfare, 	and 	safety 	of 	clients
and 	the 	public 	in 	adult 	day 	health 	centers.
[Eff 	NOV 2 2 1991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
§11-96-2 	Definitions. 	As 	used 	in 	this
chapter:
"Activity 	coordinator" 	means 	a 	person 	having
responsibility 	for 	developing 	and 	implementing 	an
activity 	program 	in 	an 	adult 	day 	health 	center who:
(1) 	Has 	two 	years 	of 	experience 	in 	a 	social,
recreational, 	or 	educational 	program, 	one
year 	of which was 	full-time 	employment 	in 	a
client 	activities 	program 	in 	a 	health 	care
setting, 	mental 	health 	setting, 	or 	setting
for 	the 	care 	of 	the 	handicapped; 	or
(2f 	Is 	an 	occupational 	therapist, 	occupational
therapy 	assistant 	or 	recreational
therapist.
"Administrator" 	means 	the 	person having
responsibility 	for 	the 	operation 	of 	an 	adult 	day
health 	center.
"Adult 	day 	health 	care" 	means 	an 	organized day
program 	of 	therapeutic, 	social, 	and 	health 	services
provided 	~o 	adults 	with physical, 	or mental
impairments, 	or 	both, 	which 	require 	nursing 	oversight
or 	care, 	for 	the 	purpose 	of 	restoring 	or maintaining,
to 	the 	fullest 	extent 	possible, 	their 	capacity 	for
remaining 	in 	the 	community.
"Adult 	day 	health 	center" 	means 	a 	facility 	which
provides 	adult 	day 	health 	care.
"Authorized 	representative" 	means 	a 	person
authorized 	by 	law, 	by 	court 	order, 	or by 	written
consent 	of 	the 	client 	to 	act 	on 	behalf 	of 	the 	client.
l.499

§11-96-2
"Cardiopulmonary 	resuscitation" 	or 	"CPR" 	means
an 	emergency 	first-aid 	procedure 	that 	consists 	of
opening 	and 	maintaining 	a 	client's 	airway, 	providing
artificial 	ventilation 	by means 	of 	rescue 	breathing,
and 	providing 	artificial 	circulation 	by means 	of
external 	cardiac 	compression.
"Center" 	means 	adult 	day 	health 	center.
"Client" 	means 	any 	adult who 	has 	been 	admitted
and 	participates 	in 	the 	services 	offered by 	an 	adult
day 	health 	center.
"Consultant" 	means 	a 	qualified 	person who 	gives
professional 	advice 	or 	service, 	with 	or without
remuneration.
"Controlled drugs" 	has 	the 	same meaning 	as
defined 	in 	chapter 	329, 	Hawaii 	Revised 	Statutes.
"Dentist" 	means 	any 	person holding 	a 	valid
license 	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 	the 	authorized
representative 	of 	the 	director 	of 	health.
"Dietitian" 	means 	a 	person who 	is 	registered 	by
the 	Commission 	on 	Dietetics 	Registration 	or 	is
eligible 	for 	such 	registration.
"Direct 	supervision" 	means 	that 	the 	supervisor
shall 	be 	present 	in 	the 	same 	building 	as 	the 	person
being 	supervised 	and 	available 	for 	consultation 	and 	•
assistance.
"Director" 	means 	the 	director 	of 	health, 	State•
of 	Hawaii.
"Drug 	administration" 	means 	the 	act 	in which 	a
single 	dose 	of 	a 	prescribed 	drug 	or biological
substance 	is 	given 	to 	a 	client by 	an 	authorized
person 	in 	accordance 	with 	all 	existing 	laws 	and 	rules
governing 	these 	acts. 	The 	entire 	act 	of
administration 	entails 	removing 	an 	individual 	dose
from 	a 	previously dispensed, 	properly 	labeled 	&
container 	(unit 	dose 	included), 	verifying 	the 	dosage
with 	the 	physician's 	orders, 	giving 	the 	specified
dose 	to 	the 	proper 	client 	and 	properly 	recording 	the
time 	and 	dose 	given 	to 	the 	client and 	signing 	the
record. 	Only 	a 	licensed 	nurse 	or a 	physician may
administer 	medications.
"Drug 	dispensing" 	means 	the 	act 	which 	involves
the 	interpretation 	of 	the 	physician's 	order 	and
pursuant 	to 	that 	order, 	the 	proper 	selection,
96-3
1499

§11-96-2
measuring, 	packaging, 	labeling, 	and 	issuance 	of 	the
drug 	or 	biological 	substance 	for 	a 	client.
"Governing 	body" 	means 	the 	policy making
authority, 	whether 	an 	individual 	or 	a 	group, 	which
has 	overall 	authority 	over the 	affairs 	of 	a 	center
and 	establishes 	policies 	concerning 	its 	operation and
the 	welfare 	of 	the 	individuals 	it 	serves.
"Immediate 	supervision" 	means 	that 	the
supervisor 	shall 	be 	physically present 	while 	a 	task
is 	being performed.
"Individualized plan of 	care" 	means 	a 	written
plan 	of 	treatment 	and 	services 	provided 	to 	a 	client
of 	an 	adult 	day 	health 	center 	in 	accordance 	with 	the
documented 	assessed 	needs 	of 	the 	client.
"Legal 	guardian" 	means 	a 	person 	appointed 	by a
court 	to 	care 	for 	another person 	or 	that 	person's
property, 	or 	both.
"Licensed 	capacity" 	means 	the maximum number 	of
clients 	authorized 	to 	receive 	services 	at 	any 	one
time 	in 	an 	adult 	day 	health 	center 	as 	specified 	on
the 	license.
"Licensee" 	means 	an 	individual 	or 	organization
within 	the 	State 	to whom a 	license 	to 	operate 	an
adult 	day 	health 	center has 	been 	issued 	and who 	is
responsible 	for 	the 	administration 	and 	operation 	of
the 	adult 	day 	health 	center.
"Licensed 	nurse" 	means 	a 	person 	currently
lic,nsed 	by 	the 	State 	of 	Hawaii 	as 	a 	licensed
practical 	nurse 	or 	a 	registered 	nurse.
•~Licensed 	practical 	nurse" 	means 	a 	nurse
currently 	licensed 	as 	such, 	pursuant 	to 	chapter 	457,
Hawaii 	Revised 	Statutes.
"Maintenance" 	means 	the 	upkeep 	of 	a 	building and
equipment 	to 	preserve 	the 	original 	functional 	and
operational 	state.
"Medication" 	means 	any 	chemical 	compound,
remedy, 	or 	non-infectious 	biological 	substance, 	the
action 	of which 	is 	not 	solely mechanical, 	which may
be 	admi~istered 	to 	clients 	by 	any 	route 	as 	an 	aid 	in
the 	diagnosis, 	treatment 	or prevention 	of 	disease 	or
other 	condition, 	for 	relief 	of 	pain 	or 	suffering, 	or
to 	control 	or 	improve 	any mental, 	physiological 	or
pathological 	condition.
"Mobile 	person" 	means 	a 	person who 	is 	capable
of moving 	about 	without 	human 	assistance 	and 	has 	the
physical 	ability 	to 	leave 	a 	building without 	the
assistance 	or 	supervision 	of 	any 	other 	person.
96-4
1499

§11-96-2
"Multidisciplinary team" 	means 	a 	group 	within
the 	adult 	day 	health 	center 	that 	conducts 	assessments
and 	makes 	decisions 	regarding 	individual 	admission
plans, 	treatment 	services, 	and 	discharge 	of 	clients;
may 	include 	but 	is 	not 	limited 	to, 	a 	staff 	or
attending 	physician, 	a 	registered 	nurse, 	a 	social
worker, 	an 	occupational 	therapist, 	and 	a 	physical
therapist 	as 	appropriate 	to 	the 	case.
"Non-ambulatory 	person" 	means 	any person
requiring 	human 	assistance 	or 	supervision 	to 	leave 	a
building 	under 	any 	circumstances.
"Nurse's 	aide" 	means 	a 	person who 	has
successfully 	completed a 	nurse 	aide 	training 	course
and 	works 	under 	the 	supervision 	of 	a 	licensed 	nurse.
"Occupational 	therapist" 	means 	a 	person
currently 	registered 	or 	eligible 	for 	registration 	by
the 	American 	Occupational 	Therapy 	Association.
"Occupational 	therapy 	aide" 	means 	a 	person who,
under 	the 	supervision 	of 	a 	registered 	occupational
therapist, 	assists 	with 	occupational 	therapy
services.
"Occupational 	therapy 	assistant" 	means 	a 	person
who 	is 	currently 	registered 	or 	eligible 	for
registration 	by 	the 	American Occupational 	Therapy
Association 	as 	an 	occupational 	therapy 	assistant.
"Pharmacist" 	means 	a 	person who 	is 	currently
licensed 	as 	a 	pharmacist, 	pursuant 	to 	chapter 	461,
Hawaii 	Revised 	Statutes. 	~
"Physical 	therapist" 	means 	a 	person who 	is
licensed 	to 	practice 	physical 	therapy, 	pursuant 	to 	•
chapter 	461J, 	Hawaii 	Revised 	Statutes.
"Physical 	therapy 	assistant" 	means 	a 	person who
has 	graduated 	from 	a 	two 	year 	college 	level 	program
approved 	by 	the 	Section 	on 	Education 	of 	the 	American
Physical 	Therapy Association.
"Physical 	therapy 	aide" 	means 	a 	person who,
under 	the 	immediate 	supervision 	of 	a 	registered
physical 	therapist, 	assists 	with physical 	therapy
care.
"Physician" 	means 	any 	person holding 	a 	valid
license 	to 	practice medicine 	and 	surgery 	or
osteopathy 	issued by 	the 	State 	of 	Hawaii, 	pursuant 	to
chapter 	453 	or 	460, 	Hawaii 	Revised 	statutes.
"Program director" 	means 	that 	person 	having 	on-
site 	responsibility 	for 	direction 	and 	coordination 	of
the 	various 	programs 	at 	the 	adult 	day health 	center.
96-5
1499

§11-96-2
"Provisional 	license" 	means 	a 	license 	issued 	for
a 	specified period 	of 	time 	(no 	longer 	than 	one 	year)
at 	the 	discretion 	of 	the 	director 	in 	order 	to 	allow
the 	licensee 	additional 	time 	to 	correct deficiencies.
No 	more 	than 	two 	consecutive 	provisional 	licenses
shall 	be 	issued 	to 	a 	center.
"Psychiatrist" 	means 	a 	person 	licensed 	to
practice medicine 	in 	the 	State of Hawaii 	and who 	is
certified 	or 	is 	eligible 	to 	be 	certified 	in
psychiatry by 	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 	year
of 	psychiatric 	nursing 	experience within
the 	past 	five 	years; 	or
(2) 	Is 	a 	registered 	nurse with 	one 	year 	of
psychiatric 	nursing 	experience 	in 	an 	acute
psychiatric 	setting 	or 	in 	a 	psychiatric
health 	facility.
"Psychologist" 	means 	a 	person who 	is 	licensed 	in
the 	practice 	of 	psychology 	pursuant 	to 	chapter 	465
Hawaii 	Revised 	Statutes.
"Registered 	nurse" 	means 	a 	person who 	is
currently 	licensed 	as 	a 	registered 	nurse, 	pursuant 	to
chapter 	457, 	Hawaii 	Revised 	Statutes.
"Social 	worker" 	means 	a 	person who 	has 	a
masti!er's 	degree 	from 	a 	school 	of 	social 	work
accredited 	by 	the 	Council 	on 	Social Work 	Education 	or
has 	a 	~achelor's 	degree 	from 	an 	accredited 	school 	of
social 	work, 	plus 	two 	year's 	experience 	in 	a 	nursing
facility, 	or 	some 	other health 	care 	agency.
"Social 	work 	assistant" 	means 	a 	staff 	person
with 	on 	the 	job 	training who 	is 	supervised 	by means
of 	consultation with 	a 	qualified 	social 	worker.
"Speech 	therapist" 	means 	a 	person who 	is
currently 	licensed 	in 	the 	State 	of Hawaii 	as 	a 	speech
patholog~st 	or 	audiologist, 	pursuant 	to 	chapter 	468E,
Hawaii 	Revised 	Statutes.
"Supervision 	of 	employee" 	means 	to 	instruct 	an
employee 	or 	subordinate 	in 	the 	employee's 	duties 	and
to 	oversee 	or 	direct 	the 	employee's work, 	but 	does
not 	necessarily 	require 	the 	immediate 	presence 	of 	the
supervisor.
"Waiver" 	means 	an 	exemption 	from 	a 	specific 	rule
or 	regulation, 	which may 	be 	granted 	to 	a 	center 	for 	a
t1499

§11-96-2
specified period 	of 	time 	at 	the 	discretion 	of 	the
director. 	[Eff 	NOV 2 21991 	J 	(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, 	may
operate 	a 	freestanding 	adult 	day 	health 	center unless
it 	is 	licensed by 	the 	department.
(b) 	Any 	person, 	firm, 	corporation, 	institution,
association, 	organization, 	or 	any 	other 	entity,
desiring 	to 	operate 	a 	freestanding 	adult 	day 	health
center 	shall 	apply 	to 	the 	department 	for 	a 	license 	on
forms 	prescribed by 	the 	department.
(c) 	The 	director 	shall 	prescribe 	the 	content
and 	form 	of 	the 	license.
(d) 	The 	department 	shall 	issue 	a 	license 	if 	the
proposed 	facility 	meets 	all 	of 	the 	requirements 	under
this 	chapter 	and 	all 	of 	the 	requirements 	for
licensure under 	state 	and 	county 	laws, 	including 	but
not 	limited to, 	the 	certificate 	of 	need 	law, 	and
fire, 	zoning, 	and 	building 	codes. 	The 	director, 	in
his 	discretion, 	may 	authorize 	a 	waiver 	from 	a
particular 	rule 	of 	this 	chapter 	provided 	that 	the
health 	and 	safety 	of 	the 	clients 	would 	not 	be
affected. 	The 	applicant 	shall 	be 	responsible 	for
securing 	written 	evidence 	of 	compliance with 	the
state 	and 	county 	laws.
(e) 	A license, 	when 	granted, 	shall 	be 	effecti~e
for 	one 	year, 	or 	a 	shorter duration 	of 	time 	as 	may 	be
decided 	by 	the 	director, 	unless 	it 	is 	suspended 	or
revoked 	by 	the 	department.
(f) 	If written 	application 	for 	renewal 	of 	a
license 	is 	not 	filed 	with 	the 	department 	before 	the
expiration 	of 	the 	license, 	the 	license 	shall
automatically 	expire 	as 	of 	the 	expiration 	date
specified on 	the 	license. 	,
(g) 	Each 	license 	shall 	be 	issued 	to 	a 	person,
group 	of 	persons, 	firm, 	corporation, 	institution,
association, 	organization, 	or 	other 	entities, 	by 	name
and 	by 	the 	address 	of 	a 	specific 	physical 	facility.
The 	license may 	not 	be 	transferred 	from 	one 	licensee,
or 	from 	one 	physical 	location, 	to 	another.
(h) 	A provisional 	license may 	be 	issued 	for 	a
specified period 	of 	time 	at 	the 	discretion 	of 	the
department 	for 	the 	purpose 	of giving 	a 	center
96-7
1499

§11-96-3
additional 	time 	to 	correct 	deficiencies, 	or 	comply
with 	regulations. 	Not 	more 	than 	two 	consecutive
provisional 	licenses 	may 	be 	issued 	to 	a 	center.
(i) 	The 	director 	or 	his 	authorized
representative 	shall 	inspect 	each 	licensed
freestanding 	adult 	day 	health 	center at 	least 	once
annually. 	Notice 	of 	the 	approximate 	time 	for 	the
annual 	inspection 	visits 	may 	be given 	to 	the 	center.
In 	addition 	to 	annual 	inspection visits, 	the 	director
or 	his 	authorized 	representative, 	without 	prior
notice, 	may 	enter 	the 	center 	at 	any 	reasonable 	time
for 	the 	purposes 	of 	confirming 	correction 	of
deficiencies, 	or 	investigation 	of 	complaints, 	or
both.
(j) 	Following 	the 	annual 	inspection, 	a 	list 	of
deficiencies, 	if 	any, 	shall 	be 	presented 	to 	the
facility. 	The 	facility 	shall 	return 	a 	plan 	of
correction 	of 	the 	deficiencies 	to 	the 	department
within 	ten days. 	Facilities 	shall 	be 	allowed 	a
reasonable 	time 	to 	implement 	the 	plan 	of 	correction.
A follow-up 	survey 	shall 	be made 	by 	the 	department 	to
determine 	the 	progress 	in 	the 	plan 	of 	correction. 	If
there 	has 	not 	been 	substantial 	progress 	in 	carrying
out 	the 	plan 	of 	correction, 	the 	license 	shall 	not 	be
renewed.
(k) 	The 	director may 	suspend, 	revoke, 	or 	refuse
to 	issue 	a 	license 	for 	failure 	to 	comply with 	the
re~irements 	of 	this 	chapter, 	or 	for 	any 	cause 	deemed
a 	hazard 	to 	the 	health 	and 	safety 	of 	the 	clients,
employGes, 	or 	the 	general 	public. 	Any 	person, 	firm,
corporation, 	institution, 	association, 	or
organization, 	or 	other 	entity 	affected 	by 	the
director's 	final 	decision 	of 	denial, 	suspension, 	or
revocation may 	appeal 	in 	accordance with 	chapter 	91,
Hawaii 	Revised 	Statutes.
(1) 	Penalties, 	hearings 	and 	appeals. 	In
addition to 	any 	other 	appropriate 	action 	to 	enforce
this 	chapter, 	the 	director may 	initiate procedures
for 	inv~ing 	fines 	as 	provided 	in 	§321-20, 	Hawaii
Revised Statutes, 	and 	to 	withdraw 	the 	license 	after
hearings 	held 	in 	accordance 	with 	chapter 	91, 	Hawaii
Revised Statutes.
(m) 	All 	centers 	shall 	post 	its 	current 	license
in 	a 	conspicuous 	place 	at 	the 	center.
(n) 	No 	center 	licensed under 	the 	provisions 	of
this 	chapter may deny 	admission 	to 	any 	individual 	on
account 	of 	race, 	religion, 	sex, 	ancestry, 	or 	national
96-8

§11-96-3
origin.
(o) 	All 	centers 	shall 	keep 	reports 	of 	all
annual 	licensing 	inspections 	at 	the 	center.
[Eff 	NnV ? ? l9QI 	] 	(Auth: 	HRS 	§321-11)
(Imp: 	HR's 	s32I-1)
§11-96-4 	Administrator. 	(a) 	Each 	center 	shall
have 	an 	administrator. 	The 	administrator 	shall 	have
the 	responsibility 	and 	authority 	to 	carry 	out 	the
policies 	of 	the 	center. 	The 	center 	shall 	notify 	the
Department 	in writing within 	fourteen 	working 	days
following 	a 	change 	of 	administrator.
(b) 	The 	administrator 	shall 	make 	provision 	for
continuity 	of 	operations, 	and 	for 	assumption 	of 	the
administrator's 	responsibilities 	during 	the
administrator's 	absence.
(c) 	Centers 	with 	a 	capacity 	of 	fifty 	or more
clients 	shall 	have 	both 	an 	administrator 	and 	a 	full-
time 	program director.
(d) 	The 	administrator 	of 	two 	or more 	licensed
facilities 	shall 	not 	serve 	as 	a 	program 	director.
(e) 	An 	individual 	may 	be 	an 	administrator 	of 	no
more 	than 	three 	centers. 	[ Eff 	NOV 2 2 1991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-5 	Admission 	reguirements. 	(a)
Requirements 	for 	admission 	to 	an 	adult 	day 	health
center 	shall 	include: 	~
(1) 	Referral 	from 	a 	community 	or 	health 	agency,
physician, 	or 	hospital; 	and
(2) 	Need 	for 	the 	health, 	nursing, 	therapeutic,
or 	social 	services 	provided by 	the 	adult
day 	health 	center 	in 	order 	to 	reach 	or
maintain 	the 	highest 	degree 	of 	functional
status 	practicable 	for 	the 	client. 	,
(b) 	All 	clients 	prior to 	admission, 	shall
provide 	the 	center with 	the 	following:
(1) 	Their physician's 	full 	name, 	address, 	and
emergency phone 	numbers; 	and
(2) 	A written 	order 	from 	the 	physician
specifying 	therapeutic 	procedures 	or
programs 	to 	be 	provided by 	the 	center 	as
delineated 	in 	§11-96-31.
[Eff 	NOV 2 2 1991 	] 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
96-9
\
1499

§11-96-6
§11-96-6 	Arrangements 	for 	services. 	Where 	the
center 	does 	not 	employ 	a 	qualified 	person 	to 	render 	a
required 	or 	necessary 	service, 	it 	shall 	have 	a
written 	agreement 	or 	contract 	with 	an 	outside 	person
or 	provider 	t~,l?,.~~vide 	the 	needed 	service.
[Eff 	NOV 2 t.. l~~f 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
§11-96-7 	Basic 	program 	requirements. 	The
configuration 	of 	services 	available 	to 	clients 	will
be 	appropriate 	to 	the 	assessed 	needs 	of 	the 	clients.
Basic 	program 	requirements 	of 	an 	adult 	day 	health
center 	shall 	include 	provisions 	for 	medical 	services,
nursing 	services, 	dietetic 	services 	and 	planned
therapeutic 	and 	social 	activities, 	and, 	if 	required
by 	clients, 	social 	services, 	speech therapy, 	physical
therapy, 	occupational 	therapy, 	psychiatric 	or
psychological 	services. 	Services 	provided may
include 	transportation. 	[Eff 	NnV ??1991 	]
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§1!tl-t1j
§11-96-8 	Client 	care management. 	(a) 	Each
center 	shall 	make 	available 	a 	multidisciplinary 	team,
either 	through 	regular 	staff 	or 	contracted
arrilTlgement, 	for 	the 	purpose 	of 	client 	assessment 	and
dev!lopment 	of 	the 	plan 	of 	care.
(ji)) 	A written 	individualized plan 	of 	care 	shall
be 	deyeloped 	to 	meet 	the 	needs 	of 	each 	client 	and
shall 	include 	but 	not 	be 	limited 	to:
(~) 	Days 	of 	attendance;
(2) 	Medical 	diagnosis, 	including general
functional 	capacity;
(3) 	Prescribed medications;
( 4 )1 	Specific 	types 	of 	services 	needed 	based 	on
functional 	capacity;
(5) 	Individualized 	objectives 	and 	therapeutic
goals;
(6) 	An 	individualized 	activity plan 	designed 	to
meet 	the 	needs 	of 	the 	client 	for 	social 	and
therapeutic 	recreation 	activities;
(7) 	Participation 	in 	specific group 	activities;
1499

§11-96-9
(8) 	Transportation;
(9) 	Therapeutic 	diet 	requirements, 	if 	any;
(10) 	A plan 	to 	arrange 	for 	any 	services 	needed
which 	are 	not 	routinely 	available 	at 	the
center;
(11) 	Anticipated 	date 	of 	discharge 	when
appropriate, 	and projected 	services 	and
support 	needs 	after discharge 	from 	the
program; 	and
(12) 	The 	signature 	of 	each member 	of 	the
multidisciplinary team, 	including 	the
~~~~t~i:~s 	§~~f=11)Nq~ik? 1
a~i 	§321-11)
§11-96-9 	Client's 	rights. 	(a) 	Written
policies 	regarding 	the 	rights 	and 	responsibilities 	of
clients 	during 	their 	stay 	in 	the 	center 	shall 	be
established 	and 	shall 	be made 	available 	to 	the
client, 	to 	any 	guardian, 	next 	of 	kin, 	sponsoring
agency 	or 	representative 	payee, 	and 	to 	the 	public.
The 	center's 	policies 	and procedures 	shall 	provide
that 	each 	individual 	admitted 	to 	the 	center 	shall:
(1) 	Be 	fully 	informed, 	as 	evidenced by 	the
client's 	written 	signed 	acknowledgement
prior 	to 	or 	at 	the 	time 	of 	admission, 	of
these 	rights 	and 	of 	all 	rules 	governing
client 	conduct;
(2) 	Be 	fully 	informed, 	prior 	to 	or 	at 	the 	time
of 	admission 	and 	during 	stay, 	of 	services,
available 	in 	or through 	the 	center and 	off
related 	charges, 	including 	any 	charge 	for
services 	not 	covered by 	the 	center's 	basil
per 	diem 	rate;
(3) 	Be 	advised 	that 	clients 	have 	a 	right 	to
have 	their medical 	condition 	and 	treatment
discussed 	with 	them by 	a 	physician 	of,tqBir
choice, 	and 	to 	be 	afforded 	the 	opportuilty
to 	participate 	in 	the 	planning 	of 	their~
medical 	treatment 	and 	to 	refuse 	to
participate 	in 	experimental 	research;
(4) 	Have 	the 	right 	to 	refuse 	treatment 	after
being 	informed 	of 	the medical 	benefits 	of
treatment, 	the 	consequences 	of 	refusal, 	and
the 	medical 	alternatives;
(5) 	Be 	encouraged 	and 	assisted 	throughout 	their
period 	of 	stay to 	exercise 	their 	rights 	as
96-11
14

§11-96-9
clients, 	and 	to 	this 	extent to 	have
grievances 	and 	to 	recommend 	changes 	in
policies 	and 	services 	to 	the 	center's 	staff
and 	outside 	representative 	of 	their 	choice
free 	from 	restraint, 	interference,
coercion, 	discrimination, 	or 	reprisal;
(6) 	Not 	be 	humiliated, 	harassed, 	injured, 	or
intimidated 	and 	shall 	be 	free 	from 	chemical
and physical 	restraints. 	Physical
restraints 	may 	be 	used 	only 	in 	an 	emergency
when 	necessary 	to 	protect 	the 	client 	from
injury 	to 	the 	client 	or 	others. 	In 	such 	an
event, 	the 	client's 	physician 	shall 	be
notified 	as 	soon 	as 	possible 	and 	further
orders 	obtained; 	as 	provided 	in 	section
11-96-35;
(7) 	Be 	entitled 	to 	have 	their personal 	and
health 	records 	kept 	confidential 	and
subject 	to 	release 	only 	as 	provided 	in
section 	11-96-24;
(8) 	Be 	treated with 	consideration, 	respect, 	and
in 	full 	recognition 	of 	their 	dignity 	and
individuality, 	including 	privacy 	in
treatment 	and 	in 	care 	as 	appropriate;
(9) 	Not 	be 	required 	to 	perform 	services 	for 	the
center that 	are 	not 	included 	for
therapeutic 	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;
Be 	allowed 	to 	end 	participation 	at 	the
adult 	day 	health 	center 	at 	any 	time; 	and
(12) 	Be 	discharged 	only 	for 	medical 	reasons, 	or
for 	the 	client's welfare 	or 	that 	of 	other
clients, 	or 	for 	non-payment 	for 	services,
~~d be 	given 	reasonable 	advance 	notice 	to
/)ansure 	orderly 	discharge. 	Such 	actions
~ shall 	be 	documented 	in 	the 	client's 	record.
(b) 	Each 	center 	shall 	have 	a 	formal 	fair
hearing written 	procedure 	for 	any 	alleged 	client's
rights 	infractions.
(c) 	Each 	adult 	day 	health 	center 	shall 	post 	a
list 	of 	client's 	rights 	in 	a 	prominent 	place 	in 	the
center.
(d) 	The 	center 	shall 	provide 	for 	and 	encourage
each 	employee 	to 	report 	observations 	or 	evidence 	of
96-12
l 	9

§11-96-10
abuse. 	[Eff 	NOV 2 2 1991
(Imp: 	HRS 	§321-fiJ
] 	(Auth: 	HRS 	§321-11)
§11-96-10 	Dietetic 	services. 	(a) 	Meals 	served
in 	the 	center 	shall 	meet 	the 	recommended 	dietary
allowances 	of 	the 	Food 	and 	Nutrition 	Board 	of 	the
National 	Research 	Council, 	and be 	adjusted 	for 	age,
sex, 	activity 	and 	disability.
(b) 	A minimum 	of 	one meal 	per day 	shall 	be
provided 	in 	accordance with 	the 	following
requirements 	stated.
(1) 	Each 	client who 	is 	in 	the 	center 	for 	four
hours 	or more 	shall 	be 	served 	a 	meal 	that
will 	supply 	at 	least 	one-third 	of 	the
National 	Research 	Council 	recommended
dietary 	allowances;
(2) 	Each 	client who 	is 	in 	the 	center 	for 	eight
hours 	or more 	shall 	be 	served 	a 	meal 	and
between meal 	nourishments 	that 	will 	supply
at 	least 	half 	of 	the 	National 	Research
Council 	recommended 	dietary 	allowances;
(3) 	Each 	client who 	is 	in 	the 	center 	for
periods 	longer 	than 	ten 	hours 	shall 	be
served 	at 	least 	two meals 	and 	between meal
nourishments 	that will 	supply 	at 	least 	two-
thirds 	of 	the 	National 	Research 	Council
recommended dietary 	allowances; 	and
(4) 	Any 	client 	accepted 	at 	7:00 	a.m. 	or 	earlier
shall 	be 	served 	a 	breakfast, 	unless 	it
been 	determined 	that 	the 	client 	has
received 	a 	meal 	prior 	to 	arrival.
(c) 	All 	diets 	shall 	be:
(1) 	Prescribed by 	the 	client's 	physician with
record 	of 	the 	diet 	as 	ordered 	kept 	on 	file;
(2) 	Planned, 	prepared, 	and 	served 	by 	personnel
using 	the 	current 	Hawaii 	Dietetic
Association manual; 	and 	"/
(3) 	Reviewed 	and 	adjusted 	as 	needed 	by 	th\
dietitian.
(d) 	Therapeutic 	diets 	shall 	be 	planned by 	a
qualified 	dietitian, 	as 	prescribed by 	the 	client's
physician.
(e) 	A nutritional 	assessment 	and 	diet 	plan 	for
each 	client 	shall 	be 	completed and 	recorded 	in 	the
health 	record 	by 	the 	physician 	or dietitian. 	The
plan 	should be 	incorporated 	in 	the 	overall 	plan 	of
96-13
149

§ll-96-lO
care 	and 	reviewed 	as 	necessary.
(f) 	Menus 	shall 	be 	written 	at 	least 	one 	week 	in
advance 	and 	posted 	in 	the 	kitchen.
(1) 	Menus 	shall 	provide 	a 	sufficient variety 	of
foods 	served 	in 	adequate 	amounts 	at 	each
meal, 	and 	adjusted 	for 	seasonal 	changes
along with 	clients 	preferences 	as 	much 	as
possible; 	and
(2) 	A different menu 	shall 	be 	followed 	for 	each
day 	of 	the 	week. 	If 	a 	cycle menu 	is 	used,
the 	cycle menu 	shall 	cover a 	minimum 	of 	two
weeks.
(g) 	All 	food 	shall 	be 	procured, 	stored,
prepared, 	distributed, 	and 	served under 	sanitary
conditions.
(1) 	Dry 	or 	staple 	food 	items 	shall 	be 	stored
above 	the 	floor 	in 	a 	ventilated 	room 	not
subject 	to 	seepage 	or waste-water back
flow, 	or 	contamination by 	condensation,
leakages, 	rodents, 	or vermin; 	and
(2) 	Perishable 	foods 	shall 	be 	stored 	at 	the
proper temperature 	to 	conserve 	nutritive
values 	and prevent 	spoilage.
(h) 	Food 	shall 	be 	served 	under 	sanitary
conditions, 	and 	shall 	be 	in 	a 	form 	consistent 	with
the 	needs 	of 	the 	client 	and 	the 	client's 	ability 	to
consume 	it.
(1) 	Food 	shall 	be 	served 	in 	a 	form 	consistent
with 	the 	appropriate 	utensils;
Effective procedures 	to 	promptly 	and
consistently 	clean 	all 	equipment 	and 	work
areas 	shall 	be 	enforced;
All 	personnel 	handling 	food 	shall 	be
trained 	in 	and 	observe 	appropriate 	personal
hygiene 	practices;
(4) 	Hand washing 	facilities, 	including 	hot 	and
y+. 	.c\old water, 	soap, 	and 	paper towels 	adj a cent
\ the 	work 	areas 	shall 	be 	provided;
(5)~-in'.dividuals 	needing 	special 	equipment,
implements, 	or utensils 	to 	assist 	them when
eating 	shall 	have 	such 	items 	provided 	by
the 	center;
(6) 	There 	shall 	be 	a 	sufficient 	number 	of
competent personnel 	to 	fulfill 	the 	food 	and
nutrition 	needs 	of 	clients;
(7) 	If 	the 	food 	service 	is 	directed 	by 	a 	person
other 	than 	a 	qualified 	dietitian, 	there
96-14
99

§11-96-12
shall 	be 	consultation by 	a 	dietitian;
(8) 	Dietary 	consultation, 	training 	and
inservice 	education 	shall 	be 	appropriate 	to
staff 	and 	client 	needs 	and 	shall 	be
documented; 	and
(9) 	Provision may be made 	for 	food 	service by
contract with 	an 	outside 	supplier. 	The
method 	of 	transport, 	storage, 	preparation,
and 	serving 	of 	such 	food 	as 	well 	as 	the
method 	of 	providing prompt 	appropriate
replacement 	foods 	in 	therapeutic 	diets
shall 	be 	approved by 	the 	director 	prior 	to
initiati~9 	such a 	service.
[Eff 	NOV 2 2 1991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
§11-96-11 	Discharge planning. 	(a) 	A plan 	for
discharge 	of 	each 	client 	shall 	be 	based 	on 	the
assessment 	of 	the 	client by 	the 	multidisciplinary
team 	and 	shall 	be 	reviewed 	and 	updated 	at 	the 	time 	of
each 	reassessment 	if 	discharge 	planning 	is
appropriate.
(b) 	As 	appropriate, 	each 	client's 	health 	record
shall 	include 	documentation 	of 	the 	plan 	for 	discharge
which 	shall 	be 	completed within 	fourteen 	days 	of 	the
first 	assessment.
(c) 	Referral 	of 	clients 	shall 	be made 	to
outside 	resources 	by 	the multidisciplinary 	team 	or by
an 	individual 	team member. 	Each 	referral 	shall 	be
recorded 	in 	the 	client's 	health 	record.
(d) 	Consultation 	shall 	be made 	available 	to 	a
client's 	family 	prior 	to 	any 	discharge.
(e) 	If 	a 	client 	decides 	to 	terminate
participation 	in 	an 	adult 	day health 	center program
prior 	to 	the 	date 	recommended 	by 	the
multidisciplinary 	team, 	the 	center 	staff 	shall, 	yhifn
appropriate, 	discuss 	the 	consequences 	of 	such~/ 	,n
with 	the 	client, 	the 	client's 	physician, 	and 	th~
client's 	authorized 	representative, 	if 	any, 	and
center 	staff 	shall 	document 	the 	discussion 	in 	the
client's 	health 	record. 	[Eff 	NOV 221991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-12 	Disaster plan. 	(a) 	Each 	center 	shall
have 	a 	written 	plan 	for 	a 	fire 	or disaster 	occurring
96-15
l

§11-96-12
within 	the 	center, 	or a 	natural 	disaster 	occurring 	in
the 	community.
(b) 	The 	disaster 	plan 	shall 	be 	in writing 	and
shall 	include:
(1) 	Designation 	of 	administrative 	authority 	and
employee 	assignments; 	and
(2) 	A plan 	for 	evacuation 	or 	relocation 	of
clients, 	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, 	law
enforcement 	agencies 	and 	other
disaster 	authorities 	of 	local
government; 	and
(E) 	Posting 	of 	evacuation 	routes.
(c) 	Each 	employee 	shall 	be 	instructed 	in
assigned 	duties. 	Instruction 	shall 	include 	employee
and 	client 	practice 	sessions. 	New 	employees 	shall 	be
informed 	immediately 	of 	their 	disaster duties, 	as
required 	in 	the 	plan. 	Records 	of 	all 	training 	shall
be 	kept 	on 	file 	in 	the 	center.
(d) 	Facilities 	licensed under 	this 	chapter 	shall
be 	inspected 	at 	least 	annually 	by 	appropriate 	fire
authorities 	for 	compliance with 	state 	and 	county 	fire
ang<life 	safety 	rules 	and 	ordinances.
•• ".J,ta) 	Smoking 	rules 	shall 	be 	adopted.
'\(f) 	Fire 	drills 	shall 	include 	the 	transmission
of 	a \[.ire 	alarm 	signal 	and 	be 	held 	at 	least
quart~fly. 	Records 	of 	all 	fire 	drills 	shall 	be 	filed
in 	the\center. 	[Eff 	\\IQ~ ? 2. \~~, 	J
(Auth: 	HRS 	§321-11) 	(IltfI!). 	ims 	§321-11)
',L''-'
§1~ 	r13 	Emergency 	care 	of 	clients. 	The
provide~ sh~ll 	establish 	emergency 	procedures 	in
writing. 	These 	procedures 	shall 	include 	the
following:
(1) 	An 	easily 	located 	file 	on 	each 	client
listing the 	name 	and 	telephone 	number 	of
the 	client's 	physician, 	treatments 	or
medications 	for 	a 	client's 	special
disabilities, 	and 	the 	name 	and 	telephone
number 	of 	a 	family member, 	sponsor, 	or
96-16
'1 	g

§11-96-15
friend, 	or 	case manager, 	to 	be 	notified 	in
case 	of 	emergency;
(2) 	Emergency measures 	to 	take 	in 	care 	of 	the
client, 	as 	appropriate;
(3) 	Procedures 	to 	obtain 	emergency
transportation 	for 	treatment 	and 	other
appropriate 	emergency 	services;
(4) 	Provision 	and maintenance 	of 	first 	aid
equipment 	and 	supplies; 	and
(5) 	At 	least 	one 	staff person 	shall 	be 	present
at 	all 	times, 	who 	is 	trained 	and 	certified
in 	CPR 	and 	basic 	first 	aid.
[Eff 	NnV 2 2 1991 	] 	(Auth: 	HRS 	§321-11)
(Imp: 	HR~ 	§321-11)
§11-96-14 	Employee 	records. 	(a) 	Each 	center
shall 	maintain 	an 	employee 	record which 	shall 	be
available 	for 	review by 	the 	director 	or designated
representative.
(b) 	Each 	employee 	record 	shall 	contain 	at 	least
the 	following:
(1) 	Full 	name;
(2) 	Date 	of 	employment;
(3) 	Credentials 	and pertinent 	experience; 	and
(4) 	A health 	record 	containing 	a 	report 	of 	the
following:
(A) 	Tuberculosis 	clearance 	pursuant 	to
section 	11-96-19; 	and
(B) 	Health 	examination 	signed by 	the
examining 	physician 	or 	person 	lawful
authorized 	to 	perform 	such
examinations which 	indicates 	the
employee 	is 	free 	from 	any 	infectious
or 	communicable 	disease.
(c) 	The 	center 	shall 	have 	a 	written 	policy
providing 	for 	the 	health 	screening 	of 	volunteers.
including 	screening 	for 	tuberculosis. 	t/
(d) 	All 	records 	shall 	be 	retained 	for 	thre~
years 	following 	termination 	of 	employment.
[Eff 	NOV 2 2 1991 	J 	(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 	the
96-17
1499

§11-96-15
center 	is 	licensed.
(b) 	Each 	supervisor 	shall 	be 	at 	least 	eighteen
years 	of 	age.
(c) 	Each 	employee 	shall 	have 	either training 	or
related 	experience 	in 	the 	job 	assigned.
(d) 	A planned 	in 	service 	education program,
including 	orientation, 	skill 	training, 	and 	continuing
education 	shall 	be 	provided 	for 	employees.
(e) 	Each 	employee 	shall 	be 	in 	good mental 	and
physical 	health 	and 	capable 	of 	performing assigned
tasks.
(f) 	No 	client 	shall 	be 	used 	as 	a 	substitute 	for
required 	employees, 	but may 	assist 	employees 	as 	part
of 	the 	client's 	program 	of 	rehabilitation 	or
training. 	[Eff 	NOV 2 2 1991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-16 	Equipment 	and 	supplies. 	Medical
equipment 	and 	supplies 	in 	each 	center 	shall 	be 	of 	the
quality 	and 	in 	the 	quantity 	necessary 	for 	care 	of
clients 	as 	ordered 	or 	indicated 	in 	the 	plans 	of 	care,
and 	shall 	include 	standard 	first 	aid 	supplies. 	These
shall 	be 	provideQ 	and Eroperly 	maintained 	at 	all
times. 	[Eff 	NuV 2 2 ]991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
fl, 	§11-96-17 	Finances. 	No 	adult 	day health 	center
sha\,' ~ssume 	responsibility 	for 	the 	funds 	of 	its
~i!;\t::Rs 	~~;i-1iMOV 221991 	J 	(Auth: 	HRS 	§321-11)
§ll-96-18 	General 	policies 	and 	procedures. 	(a)
There 	spall 	be 	written 	policies 	and procedures
availabf e,,t:o 	staff, 	clients 	and 	the 	public which
govern: 'i .... )
( ly✓ ''lrll 	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 	national
origin;
(2) 	Only 	those 	clients 	are 	accepted whose 	needs
can be met 	by 	the 	center 	directly 	or 	in
96-18
149

§11-96-19
cooperation with community 	resources 	or
other 	providers 	of 	care with which 	it has
affiliated 	or has 	contracts; 	and
(3) 	As 	changes 	occur 	in 	a 	clients' 	physical 	or
mental 	condition necessitating a 	different
type 	of 	service 	or 	care which 	cannot be
adequately provided by 	the 	center, 	it 	shall
be 	recommended 	that 	clients 	be 	referred 	to
a 	facility 	or 	service 	capable 	of 	providing
an 	appropriate 	level 	of 	care.
[Eff 	NOV 2 2 1991 	J 	(Auth: 	HRS 	§ 	321-11)
(Imp: 	HRS 	§321-11)
§11-96-19 	Governing 	body 	and management. 	(a)
Each 	licensee 	shall 	be 	responsible 	for 	the 	operation
of 	the 	center.
(b) 	The 	licensee 	shall 	exercise 	general
supervision 	over the 	center, 	shall 	establish written
policies 	concerning the 	center's 	operation, 	and 	shall
make 	available 	these written 	policies 	for 	inspection
by 	the 	director.
(c) 	Each 	licensee 	shall 	have 	written 	personnel
policies 	and 	procedures which 	are 	available 	to 	all
employees.
(1) 	There 	shall 	be written 	job 	descriptions 	for
each 	position. 	Each 	employee 	shall 	be
informed 	of 	their 	duties 	and
responsibilities 	at 	the 	time 	of 	employment
and 	through 	inservice 	training 	sessions
thereafter;
(2) 	All 	professional 	employees 	shall 	have
appropriate 	current 	licenses 	as 	required
law;
(3) 	Ethical 	standards 	of 	professional 	conduct
shall 	apply 	to 	all 	parts 	of 	the 	program;
(4) 	Written 	policy 	shall 	prohibit miscondu9t
neglect, 	or 	abuse 	of 	clients 	and 	shal{
include 	procedures 	for 	investigating 	l!tiret,,,;
reporting 	any 	such 	incidence 	to 	the 	State
and 	governing body; 	and
(5) 	There 	shall 	be 	documented 	evidence 	that
every 	employee has 	a 	pre-employment 	and 	an
annual 	health 	evaluation by 	a 	physician.
These 	evaluations 	shall 	be 	specifically
oriented to 	determine 	the 	presence 	of 	any
infectious 	disease 	liable 	to 	harm a 	client.
96-19
1 4

§11-96-19
Each 	health 	evaluation 	shall 	include 	a
tuberculin 	skin 	test 	or 	a 	chest x-ray;
(A) 	Skin 	lesions 	or 	diarrhea 	shall 	be
considered presumptive 	evidence 	of
infectious 	disease. 	Any 	employee 	who
develops 	evidence 	of 	an 	infection must
be 	immediately 	excluded 	from 	any
duties 	relating 	to 	food 	handling 	or
direct 	client 	contact 	until 	such 	time
as 	a 	physician 	certifies 	it 	is 	safe
for 	the 	employee 	to 	resume 	such
duties;
(B) 	If 	the 	tuberculin 	skin 	test 	is
positive, 	a 	standard 	chest 	x-ray with
appropriate medical 	follow-up 	must 	be
obtained, 	as 	well 	as 	three 	subsequent
yearly 	chest 	x-rays. 	If 	all 	three
chest 	x-rays 	are 	negative, 	no 	further
tuberculin 	tests 	shall 	be 	required,
except 	that 	additional 	chest 	x-rays
may 	be 	required 	at 	the 	discretion 	of
the 	director;
(C) 	If 	the 	tuberculin 	skin 	test 	is
negative, 	a 	second 	skin 	test 	shall 	be
done 	after 	one week, 	but 	not 	later
than 	three 	weeks 	after 	the 	first 	test.
The 	results 	of 	the 	second 	test 	shall
be 	considered 	the 	baseline 	test 	and
used 	to 	determine 	appropriate
treatment 	and 	follow-up. 	That 	is, 	if
the 	second 	skin 	test 	is 	positive, 	then
proceed, 	as 	in 	section
11-96-19(c) (5) (B). 	If 	the 	skin 	test
is 	negative, 	a 	single 	skin 	test 	shall
be 	repeated 	yearly; 	and
(D) 	When 	a 	known 	negative 	tuberculin 	skin
test 	on 	a 	particular employee 	or
client 	converts 	to 	a 	positive 	test, 	it
shall 	be 	considered 	a 	new case 	of
tuberculosis 	infection 	and 	shall 	be
reported 	to 	the 	department 	as 	required
in 	Chapter 	11-164.
~!~~h: 	~~ ef§~d~~1, 	32i-11)
(Imp: 	HRS 	§§321-9, 	321-11)
96-20
1 	99

§11-96-22
§11-96-20 	Housekeeping 	and maintenance. 	(a)
Each 	center 	shall 	be 	kept 	clean, 	safe, 	and 	in 	good
repair 	at 	all 	times.
(b) 	There 	shall 	be 	records 	that 	document 	that
inspection 	of 	all 	devices 	essential 	to 	health 	and
safety 	of 	clients 	and 	personnel 	shall 	be 	carried 	out
daily 	or 	at 	sufficiently 	frequent 	intervals 	to 	ensure
operational 	performance. 	[Eff 	NOV '? 2 1991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-21 	Infection control. 	(a) 	There 	shall
be 	appropriate 	policies 	and procedures 	written 	and
implemented 	for 	the 	prevention 	and 	control 	of
infectious 	diseases 	and management 	and 	disposal 	of
infectious 	waste.
(b) 	Efforts 	shall 	be made 	to 	promptly 	return 	to
their 	homes 	those 	clients who 	have 	infectious
conditions. 	[Eff. 	NOV 2 21991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-22 	Inservice 	education. 	(a) 	There 	shall
be 	a 	staff 	inservice 	education 	program 	that 	includes:
(1) 	Orientation 	for 	all 	new 	employees 	to
acquaint 	them with 	the 	philosophy,
organization, 	program, 	policies 	and
procedures, 	practices, 	and 	goals 	of 	the
center;
(2) 	Training 	for 	employees 	who 	have 	not
achieved 	the 	desired 	level 	of 	competence,
and 	continuing 	inservice 	education 	to
update 	and 	improve 	the 	skills 	and
competencies 	of 	all 	employees; 	and
(3) 	Annual, 	or more 	frequent, 	training which
shall 	include, 	but 	not 	be 	limited to,
prevention and 	control 	of 	infections, 	fi
pr 7vention. and 	safety, 	accident 	pr eve( 	... 	.1,
clients' 	rights, 	and 	problems 	and 	neeas-~f
the 	aged, 	ill, 	and 	disabled. 	Provision
shall 	be made 	for 	training 	appropriate
personnel 	in 	cardiopulmonary 	resuscitation
and 	appropriate 	first 	aid 	techniques.
(b) 	Records 	shall 	be maintained 	for 	all
orientation and 	staff 	development 	programs.
[Eff 	NOV 2 2 1991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
96-21
1

§11-96-23
§11-96-23 	Laundry. 	(a) 	Where 	laundry 	service
is 	provided, 	daily 	clothing 	and 	linen 	needs 	shall 	be
met 	without 	delay.
(b) 	Provisions 	shall 	be made 	for 	the 	proper
handling, 	storage, 	and 	transportation 	of 	soiled 	and
clean 	laundry 	and 	for 	satisfactory 	cleaning
procedures. 	[Eff 	NOV 2? 1Q91 	]
(Auth: 	HRS 	§321-11) 	(!mp: 	!iRS 	§3.21-11)
§11-96-24 	Health 	record 	system. 	(a) 	There
shall 	be 	available 	appropriately 	qualified 	staff 	to
facilitate 	the 	accurate 	processing, 	checking,
indexing, 	filing, 	and prompt 	retrieval 	of 	records 	and
record 	data.
(b) 	The 	following 	information 	shall 	be 	obtained
and 	entered 	in 	the 	clients• 	record 	at 	the 	time 	of
admission 	to 	the 	center:
(1) 	Identifying 	information 	such 	as: 	date 	of
admission, 	date 	of 	birth, 	marital 	status,
social 	security number 	or 	an 	admission
number which 	can 	be 	used 	to 	identify the
client without 	use 	of 	name when 	the 	latter
is 	desirable;
(2) 	Name 	and 	address 	of 	next 	of 	kin 	or 	legal
guardian 	or 	care 	taker;
(3) 	Sex, 	height, 	weight, 	race, 	language 	spoken
and 	understood; 	and
Admission 	diagnosis, 	summary 	of 	prior
medical 	care, 	recent 	physical
examination,to 	include 	functional,
cognitive, 	tuberculosis 	status, 	and
physician's 	orders 	as 	described 	in 	section
11-96-5.
Records 	during 	stay 	shall 	also 	include:
Appropriate 	authorization 	and 	consents 	for
"'nedical 	procedures;
)cords 	of 	all 	periods 	of 	restraints 	with
/J1istification 	and 	authorization 	for 	each;
(3) 	Copies 	of 	initial 	and 	periodic 	examinations
and 	evaluations, 	as 	well 	as 	progress 	notes
at 	appropriate 	intervals;
(4) 	Annual 	review 	of 	an 	overall 	plan 	of 	care
setting 	forth 	goals 	to 	be 	accomplished
through 	individually 	designed 	activities,
therapies, 	and 	treatments, 	and 	indicating
which 	professional 	service 	or 	individual 	is
96-22
1

responsible 	for 	providing the 	care 	or
service;
§11-96-24
(5) 	Entries 	describing 	treatments, 	medications,
tests, 	ancillary 	services 	rendered; 	and
(6) 	Documentation 	of 	any 	injuries 	or 	accidents;
(d) 	When 	a 	client 	is 	discharged, 	there 	shall 	be
a 	discharge 	summary which 	shall 	include:
(1) 	The 	reason 	for 	discharge;
(2) 	Except 	in 	an 	emergency, 	documentation 	to
indicate 	that 	the 	client 	understood 	the
reason 	for 	discharge, 	or 	that 	the 	guardian
and 	family 	were 	notified; 	and
(3) 	A summary 	of 	current 	status 	and 	care, 	final
diagnosis, 	and prognosis.
(e) 	There 	shall 	be 	a 	master 	alphabetical 	index
of 	all 	clients 	admitted to 	the 	center.
be: (f) 	All 	entries 	in 	the 	clients' 	record 	shall
(1) 	Legible, 	typed, 	or written 	in 	ink;
(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 	an
automated 	data 	bank, 	shall 	be 	considered
confidential.
(h) 	The 	record 	shall 	be 	the 	property 	of 	the
center, 	whose 	responsibility 	shall 	be 	to 	secure 	the
information 	against 	loss, 	destruction, 	defacement,
tampering, 	or 	use 	by unauthorized 	persons.
(i) 	There 	shall 	be written policies 	governing
access 	to, 	duplication 	of, 	and 	dissemination 	of
information 	from 	the 	record. 	Written 	consent 	of 	the
client, 	if 	competent, 	or the 	guardian 	if 	the 	client
is 	not 	competent, 	shall 	be 	required 	for 	the 	releas
of 	information 	to 	persons 	not 	otherwise 	authorized
receive 	it. 	Consent 	forms 	shall 	include:
(1) 	Use 	for 	which 	requested 	information
be 	used;
(2) 	Sections 	or 	elements 	of 	information 	to 	be
released 	and 	specific 	periods 	of 	time
during which 	the 	information 	is 	to 	be
released; 	and
(3) 	Consent 	of 	client, 	or 	legal 	guardians, 	for
release 	of 	specific 	health 	record
information.
(j) 	Records 	shall 	be 	readily 	accessible 	and
96-23
1499

§11-96-24
available 	to 	authorized 	department 	personnel 	for 	the
purpose 	of 	determining 	compliance with 	this 	chapter.
(k) 	If 	a 	client has 	been 	absent 	for 	thirty 	days
or more 	because 	of 	illness, 	there must 	be a 	written
statement by 	a 	physician 	that 	the 	client 	is 	well
enough 	to 	be 	readmitted 	to 	the 	program.
[Eff 	NOV 2 21991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11).
§11-96-25 	Nursing 	service. 	(a) 	Each program
shall 	have 	nursing 	staff 	sufficient 	in 	number 	and
qualifications 	to 	meet 	the 	needs 	of 	the 	clients.
(b) 	Nursing 	services 	shall 	be under 	the
supervision 	of 	a 	registered 	nurse.
(c) 	If 	there 	are 	clients 	admitted who 	require
skilled 	nursing, 	the 	services 	will 	be 	provided by 	a
registered 	nurse 	or under 	the 	direct 	supervision 	of 	a
registered 	nurse.
(d) 	Nursing 	services 	shall 	include, 	but not 	be
limited 	to 	the 	following:
(1) 	Nursing 	assessment 	of 	each 	client 	and
development 	of 	an 	appropriate 	plan 	of 	care
by 	a 	registered 	nurse;
(2) 	Nursing 	observations 	and 	summaries 	of 	the
client's 	status 	recorded monthly, 	or more
frequently 	if 	appropriate, 	by 	a 	licensed
nurse;
(3) 	Completion 	of 	all 	physician's 	orders with
proper documentation;
supportive 	services 	for 	all 	clients 	to
encourage 	them 	to 	participate 	in
appropriate 	daily 	activities;
Physical 	care 	to 	keep 	clients 	well-groomed,
clean, 	comfortable, 	and 	protected 	from
accidents 	and 	infections;
(6 	~roper 	care 	to 	prevent 	decubiti,
)ntractures 	or 	deformities;
(7 	--c:bordination 	of 	an 	overall 	plan 	of 	care 	for
each 	client, 	consistent with 	the
physician's medical 	care 	plan 	and 	developed
by 	the 	various 	disciplines 	involved;
(8) 	Frequent physical 	checks 	to 	insure 	that 	all
clients 	are 	present 	and 	accounted 	for;
(9) 	Restorative 	and 	preventive 	nursing 	care
including 	client 	and 	family 	education 	as
appropriate 	for 	each 	client;
96-24
1 	9

(10) 	Weighing 	each 	client 	at 	least monthly;
(11) 	Provision 	of 	emergency care, 	including
arrangements 	for 	transportation;
§11-96-27
(12) 	Notification 	of 	the 	physician 	of 	any marked
changes 	in 	the 	client's 	condition; 	and
(13) 	Administration 	of medications 	or monitoring
of 	self-administration of medication 	by
clients.
(e) 	Nursing 	service 	space 	and beds 	shall 	be
provided 	for 	the 	treatment 	of 	clients.
[Eff 	NOV 2 2 1991 	] 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
§11-96-26 	Occupational 	therapy 	services. 	(a)
Occupational 	therapy 	services 	which 	utilize
purposeful 	activity 	shall 	be made 	available 	in 	each
center 	as 	necessary, 	and 	be 	provided under 	a
physician's 	order, 	and 	shall 	include, 	but 	not 	be
limited to, 	the 	following:
(1) 	Assessment 	of 	the 	client 	and 	formation 	of
an 	individual 	plan 	of 	care 	in 	conjunction
with 	the multidisciplinary 	team; 	and
(2) 	Progress 	notes 	written 	at 	least 	quarterly
(b)
under 	the
( 1)
in 	the 	clients' 	health 	record 	and 	signed by
the 	occupational 	therapist.
The 	occupational 	therapy 	services 	shall 	be
supervision 	of 	an 	occupational 	therapist.
An 	occupational 	therapy 	assistant 	shall
work 	only under 	the 	supervision 	of 	an
occupational 	therapist; 	and
(2) 	An 	occupational 	therapy 	aide 	shall 	work
only 	under 	the 	immediate 	supervision 	of 	an
occupational 	therapist 	or 	an 	occupational
therapy 	assistant.
(c) 	Adequate 	space 	shall 	be 	provided 	for
occupational 	therapy 	services 	and 	for 	storage 	of
equipment• 	[ Ef f 	NOV 2 2 199 f 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-27 	Physical 	therapy 	services. 	(a)
Physical 	therapy 	services 	shall 	be made 	available 	in
each 	center 	as 	necessary, 	and 	be 	provided under 	a
physician's 	order, 	and 	shall 	include, 	but 	not 	be
limited to, 	the 	following:
(1) 	Provide 	initial 	and 	continuing 	assessment
96-25
1 499

§11-96-27
of 	the 	client by 	the 	physical 	therapist 	in
the 	formation 	of 	an 	individual 	plan 	of 	care
in 	conjunction with 	the multidisciplinary
team;
(2) 	Progress 	notes 	written 	at 	least 	quarterly
in 	the 	client's 	health 	record 	and 	signed 	by
the 	physical 	therapist; 	and
(3) 	Treatment 	of 	clients 	to 	achieve 	and
maintain maximum performance 	using 	physical
means 	such 	as 	exercises, 	massage, 	heat,
sound, 	or water.
(b) 	Physical 	therapy 	services 	shall 	be under
the 	supervision 	of a 	physical 	therapist.
(1) 	A physical 	therapy 	assistant 	shall 	work
only under 	the 	supervision 	of 	a 	physical
therapist; 	and
(2) 	A physical 	therapy 	aide 	shall 	work only
under 	the 	immediate 	supervision 	of 	a
physical 	therapist 	or 	a 	physical 	therapy
assistant.
(c) 	Adequate 	space 	shall 	be 	provided 	for
treating 	the 	clients 	and 	for 	storage 	of 	equipment.
[Eff 	'NOV 2 21991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
n 	§11-96-28 	Ownership 	and 	financial 	capability.
• (aY '+:;('he 	center 	shall 	provide 	to 	the 	director 	current
inf:\ ' 1ration 	in 	regard 	to:
\,fl) 	The 	name 	of 	each 	person 	owning 	10 	percent
or more 	of 	the 	business, 	either directly 	or
indirectly;
(\) 	If 	a 	corporation, 	the 	names 	of 	the 	officers
and 	directors;
(3/ 	If 	a 	partnership, 	the 	names 	of 	each
, 	Y)artner; 	and
( 4 ;1 	;1e names 	of 	each 	person who 	is 	the 	owner
"s0 •· 	(in whole 	or 	in 	part) 	of 	any mortgage, 	deed
or 	trust, 	note 	or 	other 	obligation 	recurred
(in whole 	or 	in 	part) 	by 	the 	center.
(b) 	The 	financial 	resources 	of 	the 	owner 	shall
be 	sufficient 	to 	operate 	and maintain 	the 	program
according 	to 	the 	standards 	set 	forth 	in 	the 	chapter.
The 	owner 	shall 	provide 	upon 	request, 	such 	evidence
as 	deemed 	necessary 	by 	the 	director 	to 	establish 	that
fact. 	[Eff 	NOV 2. 2 i99' 	J 	(Auth: 	HRS 	§321-11)
96-26
9

§11-96-29
(Imp: 	HRS 	§321-11)
§11-96-29 	Pharmaceutical 	services. 	(a) 	The
center 	shall 	consult with a 	licensed 	pharmacist 	on
methods 	and 	procedures 	for 	storage, 	administration,
disposal, 	and 	record 	keeping 	of 	drugs 	and 	biological
substances.
(b) 	A pharmacy policy manual 	shall 	be 	developed
and 	kept 	current by 	the 	licensed nursing 	staff,
consultant pharmacist 	or a 	licensed physician which:
(1) 	Contains 	appropriate 	policies 	and
procedures 	and 	defines 	the 	functions 	and
responsibilities 	relating 	to 	pharmacy
services;
(2) 	Is 	revised 	as 	necessary 	to 	keep 	up 	to 	date
with development 	in 	overall 	drug 	usage;
(3) 	Specifies 	the 	safe 	administration 	and
handling 	of 	all 	drugs; 	and
(4) 	Includes 	policies 	regarding 	self-
administration 	of 	drugs.
(c) 	Medications 	administered 	to 	a 	client 	shall
be 	ordered by 	the 	attending 	physician 	in writing.
(1) 	Where 	physicians' 	verbal 	orders 	are
directed 	to 	the 	center, 	only 	the 	facility's
licensed medical 	or 	nursing 	staff 	shall
receive 	such 	orders; 	and
(2) 	Any 	verbal 	or telephone 	medication 	orders
shall 	be 	recorded 	and 	signed by 	the 	person
receiving 	them and must 	be 	verified 	in
writing 	by 	the 	attending 	physician within
four 	days.
(d) 	Each drug 	shall 	be 	rechecked 	and 	identifie
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 	d~u
and 	the 	name 	of 	the 	prescribing physician 	are 	f
recorded 	in 	the 	client's 	record. 	'
(f) 	Only 	appropriately 	licensed 	and 	trained
staff 	shall 	be 	allowed 	to 	administer 	drugs 	and 	shall
be 	responsible 	for 	proper 	recording 	of 	the medication
including 	the 	route 	of 	administration. 	Medication
errors 	and 	drug 	reactions 	shall 	be 	recorded 	in 	the
client's 	health 	record, 	reported 	immediately 	to 	the
prescribing 	physician 	and an 	incident 	report
prepared. 	All 	incident 	reports 	shall 	be 	kept
96-27
1 49

§11-96-29
available 	for 	inspection by 	the 	director 	for 	a 	period
of 	three 	years.
(g) 	Drugs 	shall 	be 	stored under proper
conditions 	of 	sanitation, 	temperature, 	light,
moisture, 	ventilation, 	segregation, 	and 	security when
placed 	in 	the 	care 	of 	the 	center.
(1) 	All 	drugs 	shall 	be 	kept 	under 	lock and 	key
except when 	authorized 	personnel 	are 	in
attendance;
(2) 	Poisons, 	drugs 	used 	externally, 	and 	drugs
taken 	internally 	shall 	be 	stored 	in 	locked,
well 	marked 	separate 	cabinets, 	at 	all
locations;
(3) 	Medications 	that 	are 	stored 	in 	a
refrigerator containing 	things 	other than
drugs 	shall 	be 	kept 	apart 	and 	in 	a 	locked
container;
(4) 	Discontinued and 	out 	dated 	drugs,drugs 	left
by 	clients who 	have 	expired 	or who 	have 	not
visited 	the 	center 	for 	thirty 	days,
containers with worn, 	illegible, 	or missing
labels, 	shall 	be 	returned 	to 	the 	client's
family 	or 	responsible 	party 	for 	proper
disposition. 	[Eff 	NOV 2 2199, 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
f'?, 	§11-96-30 	Physical 	plant 	construction
req\irements. 	(a) 	The 	center 	shall 	be 	fully
acc., ·1~ible 	to 	and 	functional 	for 	physically
hand\tapped 	clients, 	personnel, 	and 	the 	public.
·,(b) 	Each 	center 	shall 	comply with 	state 	and
local\puilding 	requirements.
t;) 	Each 	center 	shall 	have 	a 	working, 	listed
teleph~1e 	on 	the 	premises.
(d;\ 	Temperature 	and 	humidity 	shall 	be
main ta ii \eel. within 	a 	normal 	comfort 	range.
( e'i 	·,ere 	shall 	be 	provisions within 	the 	center
for 	one lpdf-..;fuore 	areas 	for 	dining, 	social 	activities,
secluded 	areas, 	and 	therapy 	areas.
(1) 	The 	center 	shall 	be 	equipped with 	adequate
natural 	and 	artificial 	lighting, 	tables,
chairs, 	or 	their 	equivalent, 	for 	the 	use
and 	comfort 	of 	the 	client;
(2) 	Dining 	areas 	shall 	be 	equipped with 	tables
and 	chairs. 	A sufficient 	number 	of 	tables
shall 	be 	of 	proper 	height 	to 	accommodate
96-28
1499'

(3)
(4)
§11-96-30
wheelchair 	clients;
If 	a 	multi-purpose 	room 	is 	used 	for 	dining
and 	recreational 	activities, 	there 	shall 	be
sufficient 	space 	to 	accommodate 	all
activities; 	and
A secluded 	area 	shall 	be 	set 	aside 	for
clients who 	require 	bed 	rest 	during 	the
day;
(A) 	The 	secluded 	area 	shall 	have 	chaise
lounges 	or beds 	in 	the 	number
necessary 	to meet 	the 	needs 	of 	the
clients under written 	order 	of 	the
staff 	or 	attending physician; 	and
(B) 	Space 	around 	sleeping 	accommodations
shall 	permit 	easy passage.
(f) 	Total 	area 	for 	recreational 	and 	dining
activities 	shall 	be 	not 	less 	than 	fifty 	square 	feet
per 	client.
(g) 	Activity, 	dining 	and 	service 	areas 	shall 	be
accessible 	to 	all 	clients.
(1) 	There 	shall 	be 	adequate 	space 	to 	allow 	free
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 	not 	suitable 	for
sleeping 	shall 	not 	be used 	as 	rest 	or 	sleep
areas.
(h) 	There 	shall 	be 	one 	toilet 	room 	for 	every
twelve 	clients.
(1) 	The 	toilet 	room shall 	contain a 	toilet 	and
lavatory;
(2) 	Appropriately 	placed grab 	bars 	shall 	be
provided 	in designated 	toilets, 	bathtubs,
and 	shower 	enclosures;
(3) 	Curtains 	or doors 	to 	ensure 	privacy 	sh~ll0
be 	provided; 	(
(4) 	An 	adequate 	supply 	of 	hot 	and 	cold 	pot~b~~
running water must 	be 	provided 	at 	all
times. 	Temperatures 	of 	hot 	water 	at
plumbing 	fixture 	used 	by 	clients 	shall 	be
automatically 	regulated 	and 	shall 	be
maintained 	at 	a 	level 	between 	100° 	to
ll0°F;
(5) 	Each 	toilet 	and bath 	center 	shall 	have 	an
auditory 	call 	system which permits 	the
96-29
149

§11-96-30
client 	to 	signal 	staff 	in 	an 	emergency;
(6) 	There 	shall 	be 	at 	least 	one 	bathtub 	or
shower 	available; 	and
(7) 	Separate 	toilet 	facilities 	shall 	be
provided 	for 	the 	use 	of 	personnel.
(i) 	Ramps 	must 	be 	designed 	to 	permit use by
clients 	in wheelchairs. 	Ramps 	shall 	meet 	the
provisions 	of 	the 	1987 	Uniform 	Building Code.
(j) 	Walls 	and 	floors 	of 	rooms 	used by 	clients
shall 	be made 	of 	materials 	which 	shall 	permit washing
or 	cleaning.
(k) 	Where 	appropriate, 	screening 	of 	doors 	and
windows 	shall 	be 	provided, 	using 	screening having
sixteen meshes 	per 	inch.
(1) 	Double 	acting doors 	shall 	be 	provided with
vision 	panels 	of 	sufficient 	height 	to 	permit use 	by
walkers 	as 	well 	as 	wheelchair 	riders.
(m) 	The minimum clear width 	of 	a 	corridor
shall 	be 	thirty-six 	inches 	except 	that 	corridors
serving 	one 	or more 	clients who 	require 	the 	use 	of 	a
wheel 	chair 	or walking 	aids 	shall 	be 	not 	less 	than
forty-four 	inches. 	Stationary handrails 	shall 	be
installed 	at 	least 	along 	one 	side 	of 	corridors.
(n) 	Locked 	storage 	space 	shall 	be 	provided 	for
janitors' 	supplies 	and 	equipment. 	Storage 	space,
conveniently 	located, 	for 	general 	and 	specialized
equipment 	shall 	be 	provided.
O 	(o) 	The 	water 	supply 	shall 	be 	in 	accordance
wif \ 	Chapter 	340E, 	Hawaii 	Revised 	Statutes.
', 	iP) 	Chapter 	11-39 	relating 	to 	air 	conditioning
and \Jntilation, 	shall 	be 	followed.
\(q) 	Flashlights 	shall 	be 	in 	readiness 	and
funct~onal 	at 	all 	times.
ctn 	Open 	flame 	types 	of 	light 	shall 	not 	be
used. 	'\
(~ 	Space 	for 	outdoor 	activities 	shall 	be
easily~ 	ca~ssible 	to 	all 	clients 	and 	protected 	from
traffic\ 	l
(t~- 	facilities 	shall 	be maintained 	in
accordance 	with 	provisions 	of 	state 	and 	county 	fire
safety, 	sanitation 	laws 	and 	ordinances.
[Eff 	NOV '221991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
§11-96-31 	Physicians 	services. 	(a) 	All 	clients
admitted 	to 	a 	center 	shall 	be 	under 	the 	care 	of 	a
96-30

§11-96-32
physician 	selected by 	the 	client.
(b) 	The 	physician 	shall 	authorize 	the 	client's
initial 	individualized plan 	of 	care 	and major
revisions 	thereafter. 	The 	plan 	of 	care 	shall 	be
reviewed 	at 	least 	annually.
(c) 	There 	shall 	be a 	statement 	from 	the
physician 	as 	to 	the medical 	condition 	and 	functional
status 	of 	the 	client, 	prescribed 	therapies, 	and any
special 	care 	or 	observations 	which 	is 	required 	at
least 	annually, 	with updates 	whenever 	there 	are
changes which 	significantly 	alter 	the 	client's
medical 	or 	functional 	status.
(d) 	There 	shall 	be 	a 	statement 	from 	the
physician 	that 	the 	client does 	not 	have 	active
tuberculosis.
(e) 	There 	shall 	be 	directions 	from 	the
physician 	as 	to 	the 	procedures 	to 	be 	followed 	if 	the
physician 	is 	not 	immediate~¥ 	available 	in 	the 	event
of 	an 	emergency. 	[Eff 	NOV 2 2 1991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-32 	Program director. 	(a) 	Each 	center
shall 	have 	a 	full 	time program director.
(1) 	The 	administrator may 	serve 	in 	this
capacity 	except 	as 	specified 	in 	section
11-96-4(d);
(2) 	The 	program director 	shall 	be 	present 	on
the 	premises 	and 	available 	to 	clients,
employees, 	and 	relatives; 	and
(3) 	When 	the 	program director 	is 	temporarily
absent, 	another 	staff member 	shall 	be
designated 	in writing 	to 	serve 	as 	the 	.
acting 	program director. 	{..
(b) 	The 	program director 	shall 	have 	experienc
in working with 	impaired persons 	and 	be 	knowledgeabl=
about 	their 	physical, 	social, 	and mental 	heal th 	r . ,,
needs. 	{ 	..
(c) 	The 	duties 	of the 	program director 	sha!tr¼~
be:
(1) 	Coordinating the 	development 	and
implementation 	of 	the 	program, 	as
determined by 	the 	multidisciplinary 	team;
and
(2) 	Periodically holding 	team 	conferences 	to
evaluate 	clients 	and 	adjust 	programs 	as
needed. 	[Eff 	NOV 221991 	J
96-31
1 49

§11-96-33
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-33 	Psychiatric 	or 	psychological 	services.
(a) 	Every 	adult 	day 	health 	center 	shall 	have
available 	appropriate 	consultant 	staff 	trained 	in
psychiatric 	care when there 	is 	a 	client 	in the 	adult
day 	health 	center 	requiring 	the 	services while 	at 	the
center.
(b)
( 1)
(2)
The 	consultant 	shall:
Participate 	in 	the 	initial 	and 	continuing
assessments 	for 	the 	development 	of 	an
individual 	plan 	of 	care by 	the
multidisciplinary 	team when 	indicated;
Maintain 	signed 	progress 	records 	in 	the
client's 	health 	record when 	providing
services;
(3) 	Form 	liaisons with 	or be 	advisory 	to 	other
members 	of 	the multidisciplinary 	team,
family 	members 	and 	referral 	agencies 	that
may 	yield 	information 	of value 	to
psychiatric 	or psychological 	treatment; 	and
(4) 	Provide 	counseling 	and 	other 	services 	as
appropriate 	to 	client 	needs.
(c) 	Sufficient 	space 	and 	privacy 	shall 	be
provided 	for 	individual 	or 	group 	counseling.
[Eff 	NOV 2 21991 	J 	(Auth: 	HRS 	§321-11)
( 	: 	HRS 	§321-11)
11-96-34 	Recreation 	and 	social 	activities. 	(a)
Every 	adult 	day 	health 	center 	shall 	provide 	a 	program
of 	social 	and 	recreatioal 	activities 	that 	is
super~\sed 	and 	directed 	by 	an 	activity 	coordinator 	to
meet 	tl5) 	needs 	and 	interests 	of 	each 	client.
(~D 	The 	activity 	coordinator's 	duties 	shall
includel ·• .. ~~. least 	the 	following:
( J.\ 	)articipation 	in 	initial 	and 	continuing
~· 	,ssessment 	of 	the 	client's 	needs 	for 	the
development 	of 	the 	individual;
(2) 	Provision 	of a 	signed 	quarterly 	progress
record 	and 	individualized 	activity 	plan 	in
the 	client's 	health 	record;
(3) 	Posting 	of 	a 	schedule 	of 	planned 	activities
in 	a 	central 	location 	readily 	accessible 	to
client, 	family, 	guardian, 	or 	authorized
representative;
96-32
4

§11-96-35
(4) 	Involvement 	of 	clients 	in 	the 	planning 	of
the 	program 	as 	appropriate;
(5) 	Utilization 	of volunteers 	as 	needed 	to
implement 	the 	plan; 	and
(6) 	Utilization 	of 	the 	adult 	day 	health
center's 	transportation 	to 	provide
activities 	in 	the 	community 	as 	indicated by
client's 	needs 	and 	interests.
(c) 	Each 	client 	shall 	engage 	in 	activities
suitable 	to 	the 	client's 	needs 	and 	interests.
(d) 	The 	activity coordinator 	shall 	be 	a 	full
time 	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 	'NOV 2 2 199f 	] 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
§11-96-35 	Restraints. 	(a) 	There 	shall 	be
written policies 	and 	procedures 	governing 	the 	use 	of
restraints.
(b) 	Physical 	restraints 	shall 	be 	used 	only
under 	physicians' 	orders 	for 	specified 	and 	limited
periods 	of 	times 	and 	their 	use 	shall 	be 	documented.
(1) 	If 	physical 	restraints 	are 	used 	in 	an
emergency 	situation, 	the 	attending
physician 	shall 	be 	contacted 	immediately
for 	orders 	supporting 	or discontinuing
temporary 	use;
(2) 	Only 	a 	staff member 	so 	designated 	in 	the
written 	policy 	shall 	have 	the 	authority
apply 	restraints 	in 	an 	emergency 	situ< 	,;
(3) 	Regular 	observation 	and 	regular 	release
client 	shall 	be 	required while 	restraints
are 	in 	use; 	and
(4) 	No 	restraints 	with 	locking 	devices 	shall 	be
(c)
following
(1)
used.
Restraints 	shall 	be used 	only under 	the
conditions:
In 	emergency 	conditions 	to 	prevent 	imminent
danger 	to 	health 	or 	safety by 	a 	client 	to
96-33
1499

§11-96-35
self 	or 	others; 	and
(2) 	For temporarily 	positioning 	the 	client 	to
prevent 	the 	client 	from 	falling 	out 	of 	a
chair 	or 	from 	a 	treatment 	table 	or bed.
(d) 	Restraints 	shall 	include 	only 	cloth vests,
soft 	ties, 	soft 	cloth mittens, 	seat 	belts, 	or
wheelchair 	trays. 	Soft 	ties 	means 	soft 	cloth which
does 	not 	cause 	skin 	abrasion 	and which 	does 	not
restrict 	blood 	circulation.
(e) 	Restraints 	shall 	not 	be 	used 	as 	punishment
or 	as 	a 	convenience 	to 	the 	staff.
(f) 	Restraints 	shall 	be 	applied 	in 	a 	manner 	so
that 	they 	can be 	speedily 	removed 	in 	case 	of 	fire 	or
other 	emergency.
(g) 	Various 	types 	of 	adult 	chairs 	referred 	to
as 	geriatric 	chairs 	are 	not 	defined 	as 	a 	restraint 	if
the 	type 	of 	closing mechanism 	on 	the 	chair and 	the
physical 	and 	mental 	capability 	of 	the 	specific 	client
allows 	for 	easy 	removal. 	[Eff 	NOV 2 2 1991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
§11-96-36 	Sanitation. 	(a) 	Every 	center 	shall
be 	in 	compliance with 	all 	applicable 	laws 	of 	the
State 	of 	Hawaii 	and 	rules 	of 	the department 	relating
to 	sanitation.
(b) 	Reports 	of 	annual 	inspections 	by 	state 	or
CO('\nty health 	authorities 	and 	records 	of 	action 	taken
irJ1 )iforrection 	of 	deficiencies 	and 	recommendations
slrc\ \ 	be 	kept 	on 	file 	at 	the 	facility.
'\) (c) 	The 	center 	shall 	provide 	a 	sufficient
number 	of water 	tight 	receptacles 	of metal, 	or 	other
materials 	acceptable 	to 	the 	department, 	for 	rubbish,
garba~~, 	refuse 	and 	other 	discarded matter. 	In
ki tche..\ and 	food 	preparation 	areas, 	receptacles 	shall
be 	kepi( closed by 	tight 	fitting 	covers 	except 	in 	the
kitche1\\, qμring 	peak hours 	of 	food 	preparation.
[Eff 	\ 	.. )V 2 21991 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	Ii\e.{S v§ 3 21-11)
§11-96-37 	Social 	services. 	(a) 	Every 	adult 	day
health 	center 	shall 	have 	available 	social 	services 	as
appropriate 	to 	assist 	clients 	and 	their 	families 	to
solve 	social 	problems 	that 	arise 	as 	a 	result 	of 	the
client's 	disability.
(b) 	Social 	services 	shall 	consist 	of 	the
96-34
l

§11-96-38
following:
(1) 	Providing 	initial 	and 	continuing assessment
of 	the 	client by 	the 	social 	worker 	in 	the
formation 	of 	an 	individual 	plan 	of 	care by
the 	multidisciplinary 	team 	as 	appropriate;
(2) 	Maintaining 	signed 	progress 	notes 	in 	the
clients' 	health 	record 	at 	least 	quarterly;
(3) 	Assumption 	of 	responsibility 	for
implementation and 	coordination 	of 	the
discharge 	plan;
(4) 	Providing 	referral 	to 	outside 	resources 	and
assisting with counseling when 	applicable;
(5) 	Providing problem 	oriented discussion
groups 	among 	clients;
(6) 	Serving 	as 	a 	liaison with 	the 	client's
family 	and 	home; 	and
(7) 	Providing 	referral 	and 	follow-up 	for
referred 	persons 	not 	appropriate 	for 	adult
day 	health 	care.
(c) 	Social 	services 	shall 	be 	provided 	or
supervised 	by 	a 	social 	worker.
(d) 	A social 	work 	assistant 	shall 	provide
social 	services 	only under 	the 	supervision 	of 	a
social 	worker.
(e) 	Space 	to 	allow privacy 	shall 	be 	provided
for 	the 	social 	worker when 	counseling 	clients 	or
families 	of 	clients. 	[Eff 	Nnv 2 21991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	9321~11)
§11-96-38 	Speech therapy 	services. 	(a) 	Speech
therapy 	services 	shall 	be made 	available 	in 	each
center 	as 	necessary, 	and be 	provided under 	a
physician's 	order, 	and 	shall 	include: 	.
(1) 	Initial 	and 	continuing 	assessment 	of 	the 	/
client 	by 	the 	speech therapist 	in 	the 	1·
multidisciplinary 	team; 	and
(2) 	Progress 	notes, 	written 	at 	least 	quartt~l\~
or more 	often, 	if 	necessary 	in 	the 	client\s
health 	record 	and 	signed 	by 	the 	speech
therapist.
(b) 	The 	speech therapist 	shall 	work the 	number
of hours 	necessary 	to meet 	the 	needs 	of 	each 	client
as 	specified 	in 	the 	individualized 	plan 	of 	care
developed 	by 	the multidisciplinary 	team.
(c) 	Space 	that 	is 	free 	from 	noise 	shall 	be
provided 	to 	the 	extent 	that 	such 	conditions 	are
96-35
1499

§11-96-38
within 	the 	reasonable 	control 	of 	the 	center.
[Eff 	NOV 2 ') 1oa1 	] 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§32!-11)
§11-96-39 	Staffing. 	(a) 	Staffing 	shall 	be
sufficient 	to 	carry 	out 	daily 	activities, 	nursing
services, 	physician 	orders, 	and 	individualized plans
of 	care.
(b) 	The 	program director 	of 	a 	center whose
average 	daily 	attendance 	is 	twenty 	or 	less may also
serve 	as 	the 	registered 	nurse, 	social 	worker,
occupational 	therapist, 	physical 	therapist, 	activity
coordinator, 	speech therapist 	or dietitian 	provided
that 	the 	program director meets 	the 	qualifications,
in 	accordance 	with 	11-96-32, 	and 	is 	not 	also 	the
administrator.
(c) 	Support 	employees 	shall 	include 	aides,
maintenance, 	food 	service, 	and 	clerical 	employees
sufficient 	in 	number 	to 	perform the 	necessary duties.
(d) 	Volunteers may 	be 	utilized 	in 	centers, 	but
shall 	not 	be 	used 	to 	replace 	required 	professionally
qualified 	employees 	unless 	they 	are 	so 	qualified.
Each 	volunteer 	shall 	receive 	orientation, 	training,
and 	supervision.
(e) 	When 	regular 	employees 	are 	absent, 	there
shall 	be 	coverage 	by 	employees 	with 	suitable
qunlifications. 	[Eff 	NOV 2 2 1991 	J
(N 1
th: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)	½. ':	
'\,'.;, ,,,
··y
§11-96-40 	Transportation 	safety. 	(a) 	Every
adult 	day 	health 	center which 	provides 	direct
transnortation 	services 	for 	clients 	shall 	meet
specit\c 	operational 	standards. 	The motor vehicle
shall~t 	Be 	operated 	only by 	drivers 	who 	have
V 	t'JPPropriate valid Hawaii 	drivers 	license;
(~~ 	~Be 	equipped with 	safety devices 	to 	protect
clients 	during 	transportation;
(3) 	Be maintained 	in 	a 	safe 	and 	reliable
condition and 	shall 	meet 	the 	provisions 	of
the 	current Hawaii 	Vehicle 	Code.
(b) 	The 	center 	shall 	develop 	policies 	regarding
transportation 	safety and 	maintenance 	of 	vehicles.
[Eff 	NOV 2 2199, 	J 	(Auth: 	HRS 	§321-11)
(Imp: 	HRS 	§321-11)
96-36
l 	9

§11-96-42
§11-96-41 	Transportation 	services.
Transportation 	for 	clients 	to 	and 	from 	the 	center may
be 	provided 	or arranged by 	the 	center.
[Eff 	NOV 2 2 1991 	] 	(Auth: 	HRS 	§321-11}
(Imp: 	HRS 	§321-11}
§11-96-42 	Severability. 	If 	a 	provision 	of 	this
chapter 	or 	the 	application 	thereof 	to 	any 	person 	or
circumstances 	is 	held 	invalid, 	the 	remainder 	of 	this
chapter 	or 	the 	application 	of 	the 	provisions 	to 	other
persons 	or 	circumstances 	shall 	not 	be 	affected
thereby. 	[Eff 	NOV 2 2 1991 	J
(Auth: 	HRS 	§321-11) 	(Imp: 	HRS 	§321-11)
96-37
l 4 	9