Rule 111-8-65-.09 - Administration and Organization(1) Services Description. A provider shall establish and implement written policies and procedures that define the scope of private home care services it offers and the types of clients it serves. No provider shall provide services that are prohibited by these rules, the applicable legal authority, or other laws.(2) Service Agreements. No provider shall offer to provide a client any private home care services that it cannot reasonably expect to deliver in accordance with these rules. (a) A provider shall establish and implement policies and procedures for service agreements. All services provided to a client shall be based on a written service agreement entered into with the client or the client's responsible party, if applicable. The service agreement must include the following:1. Date that provider makes initial contact with client for services;2. Date of referral, i.e. the date on which the provider received a specific request to deliver private home care services to a particular client;3. Description of services needed as stated by client or responsible party, if applicable;4. Description of services to be provided and expected frequency and duration of services;5. Charges for such services, and mechanisms for billing and payment of such charges;6. Acknowledgment of receipt of a copy of client's rights and responsibilities as outlined at rule .12;7. A telephone number of the provider that a client can call for information, questions, or complaints about services supplied by the provider;8. The telephone number of the state licensing authority, i.e. the department, to call for information or questions about the provider concerning a violation of licensing requirements that was not resolved to the client's satisfaction by complaining to the provider;9. Authorization from client or responsible party, if applicable, for access to client's personal funds when home management services are to be provided and when those services include assistance with bill paying or any activities, such as shopping, that involve access to or use of such funds; similarly approved authorization for use of client's motor vehicle when services to be provided include transport and escort services and when the client's personal vehicle will be used;10. Signatures for the provider's representative and the client or responsible party, if applicable, and date signed; if a client or responsible party refuses to sign the agreement, such refusal shall be noted on the agreement with an explanation from the provider's representative.(b) For new clients, such initial service agreements shall be completed not later than the second visit to the client's residence to provide services if the second visit occurs on a different day from the first visit or not later than seven calendar days after services are initially provided in the residence, whichever is earlier. 1. If the provider is unable to complete the service agreement for good cause, the provider will document such reason(s) in the client's file.2. Subsequent revisions to the initial service agreement may be handled by the provider noting in the client's record the specific changes in service (e.g. addition or deletion of service, changes in frequency, or duration, or charge for services, etc.) that will occur and that the change was discussed with and agreed to by the client and/or responsible party, as appropriate, who signed the initial agreement prior to the change in services occurring.(c) A client has the right to cancel any service agreement at any time and shall only be charged for services actually rendered prior to the time that the provider is notified of the cancellation. The provider may assess a reasonable charge for travel and staff time if notice of the cancellation of the service agreement is not provided in time to cancel the service prior to the provider's staff member arriving at the client's house to perform the service.(3) Administrator. The governing body shall appoint an administrator who shall have full authority and responsibility for the operation of the private home care provider. (a) Any administrator employed after the effective date of these rules must meet the following minimum qualifications: 1. Never have been shown by credible evidence (e.g. a court or jury, a department investigation, or other reliable evidence) to have abused, neglected, sexually assaulted, exploited, or deprived any person or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct as evidenced by an oral or written statement to this effect obtained at the time of application;2. Participate in the orientation and training required by these rules;3. Not have made any material false statements concerning qualifications requirements either to the department or the provider.(4) Record keeping. (a) Client Records. A provider shall maintain a separate file containing all written records pertaining to the services provided for each client that it serves and the file shall contain the following: 1. Identifying information including name, address, telephone number, and responsible party, if any;2. Current service agreement as described at rule .09(2);3. Current service plan as described at rule .11;4. Clinical and/or progress notes if the client is receiving nursing services that have been signed and dated by the staff providing the direct care;5. Documentation of personal care tasks and companion or sitter tasks actually performed for the client;6. Documentation of findings of home supervisory visits by the supervisor unless entered in service plan;7. Any material reports from or about the client that relate to the care being provided to the client including items such as progress notes and problems reported by employees of the provider, communications with personal physicians or other health care providers, communications with family members or responsible parties, or similar items;8. The names, addresses, and telephone numbers of the client's personal physicians, if any; and9. Date and source of referral.(b) Retention and Confidentiality of Client Records. Written policies and procedures shall be established and implemented for the maintenance and security of client records specifying who shall supervise the maintenance of records, who shall have custody of records, to whom records may be released and for what purposes and how long the records will be retained.1. At a minimum, all client records shall be retained for five years from the date of last service provided. The provider shall maintain the confidentiality of client records.2. Employees of the provider shall not disclose or knowingly permit the disclosure of any information in a client record except to appropriate provider staff, the client, responsible party (if applicable), the client's physician or other health care provider, the department, other individuals authorized by the client in writing or by subpoena.(c) Personnel Records. A provider shall maintain separate written records for each employee and the records shall include the following:1. Identifying information such as name, address, telephone number, and emergency contact person(s);2. A five year employment history or a complete employment history if the person has not been employed five years;3. Records of qualifications;4. Documentation of a satisfactory TB screening test upon employment and annually thereafter;6. The person's job description or statements of the person's duties and responsibilities;7. Documentation of orientation and training required by these rules;8. Documentation of at least an annual performance evaluation;9. Documentation of bonding if the employee performs home management services which permit unlimited access to the client's personal funds. (If bonding is provided through a universal coverage bond, evidence of bonding need not be maintained separately in each personnel folder.)(d) Reports of Complaints and Incidents. The provider shall maintain files of all documentation of complaints submitted pursuant to rule .12(2). A provider shall also maintain on file for a minimum of five years all incident reports or reports of unusual occurrences (e.g. falls, accidents, significant medication errors, etc.) that affect the health, safety, and welfare of its clients. Documentation required to be maintained shall include what actions, if any, the provider took to resolve clients' complaints and to address any incident reports or unusual occurrences required to be retained.(5) Staffing. The provider shall have sufficient numbers of qualified staff as required by these rules to provide the services specified in the service agreements with its clients. In the event that the provider becomes aware that it is unable to deliver the specified services to the client because of an unexpected staff shortage, the provider shall advise the client and refer the client to another provider if the client so desires. (a) All staff employed by a provider shall have included in their personnel records or files maintained by the particular provider a written evaluation that was performed within one year before or after the effective date of these rules. The written evaluation must reflect that the employee's performance of required job tasks was observed personally by a supervisor either by demonstration or observation and such performance was determined to be competent for all job tasks required to be performed. All staff hired after the effective date of these rules must meet the following minimum qualifications:1. Never have been shown by credible evidence (e.g. a court or jury, a department investigation, or other reliable evidence) to have abused, neglected, sexually assaulted, exploited, or deprived any person or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct as evidenced by an oral or written statement to this effect obtained at the time of application;2. Participate in the orientation and training required by these rules;3. Not have made any material false statements concerning qualifications requirements either to the department or the provider.(b) Nursing Personnel. Any persons employed by the provider to provide nursing services shall be licensed in Georgia in accordance with professional licensing laws and associated rules. Such persons may also provide any other types of private home care services offered by the provider.(c) Personal Care Assistant (PCA). The provider may have PCAs perform personal care tasks for clients. Such persons may also perform companion or sitter tasks for clients, but shall not provide nursing services unless qualified as stated in rule .09(5)(b) above. 1. Any PCA hired after the effective date of these rules shall have the following training and/or experience: (i) successful completion of a nurse aide training and competency evaluation program pursuant to the requirements of 42 CFR Part 483, Subpart D, as revised or recodified, if applicable; or(ii) successful completion of a competency examination for nurse aides recognized by the department; or(iii) successful completion of a health care or personal care credentialing program recognized and approved by the department; or(iv) successful completion or progress in the completion of a 40 hour training program provided by a private home care provider, which addresses at least the following areas: (I) Ambulation and transfer of clients, including positioning;(II) Assistance with bathing, toileting, grooming, shaving, dental care, dressing, and eating;(III) Basic first aide and CPR;(IV) Caring for clients with special conditions and needs so long as the services are within the scope of the tasks authorized to be performed by demonstration;(VI) Home safety and sanitation;(VII) Infection control in the home;(VIII) Medically related activities to include the taking of vital signs; and2. A training program described in rule .09(5)(c)1. (iv) must be conducted under the direction of a licensed registered professional nurse, or a health care professional with commensurate education and experience. Twenty hours of the program must be completed by the employee prior to serving clients and the additional twenty hours must be completed within six months of the date the training initially began. No PCA shall be assigned to perform a task for which training has not been completed and competency has not been determined. No PCA shall be assigned to care for a client with special conditions unless the PCA has received training and has demonstrated competency in performing such services related to such special conditions.(d) Companions or Sitters. The provider may have companions or sitters perform companion or sitter tasks for clients.1. Such persons may not provide other private home care services to clients unless qualified as stated in rules .09(5)(b)and(c).2. Any companion or sitter hired after the effective date of these rules must meet the following minimal requirements: (i) Be able to read and write, follow verbal and written instructions, and complete written reports and documents;(ii) Successfully complete training or demonstrate understanding and practical competency in the following areas: understanding the needs and characteristics of elderly, handicapped, or convalescing individuals; meal preparation and serving; transportation and escort services; housekeeping to include sanitation; home safety; handling medical emergencies in the home; and infection control.(6) Staff Training. Prior to working with clients, all employees hired or used on or after the effective date of these rules and who provide services to clients shall be oriented in accordance with these rules and shall thereafter receive additional training in accordance with these rules.(a) Orientation shall include instruction in:1. The provider's written policies and procedures regarding its scope of services and the types of clients it serves (rule .09(1) and clients rights and responsibilities and complaints (rule .12), as well as other policies that are relevant to the employee's range of duties and responsibilities;2. The employee's assigned duties and responsibilities;3. Reporting client progress and problems to supervisory personnel and procedures for handling medical emergencies or other incidents that affect the delivery of services in accordance with the client's services plan;4. The employee's obligation to report known exposure to tuberculosis and hepatitis to the employer.(b) Additional training consisting of a minimum of eight clock hours of training or instruction shall be provided annually for each employee after the first year of employment. Employees hired prior to the effective date of these rules are also required to receive eight clock hours of training or instruction annually beginning with the effective date of these rules. Such training or instruction shall be in subjects that relate to the employee's assigned duties and responsibilities.(7) Contracted Services. If a provider arranges with independent contractors, individuals, or agents for them to provide any authorized private home care services on behalf of the provider in any way, such arrangements shall be set forth in writing detailing the services to be provided. The provider must assure that the independent contractor, individual, or agent supplying the services follow the provisions of these rules and are qualified to provide the services. The services must be supervised, as outlined in rule .10(2) (Supervision of Services), by a supervisor of the licensed provider.Ga. Comp. R. & Regs. R. 111-8-65-.09
O.C.G.A. §§ 31-2-5, 31-2-7 and 31-7-300et seq.
Original Rule entitled "Administration and Organization" adopted. F. Feb. 20, 2013; eff. Mar. 12, 2013.