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  1. 1. L A 599 G RADUATION PROJECT ICOI Senior Daycare & assisted living Center Muhammad Ali Baghchehsarai 0558588 Fall Spring 2010 - 2011ICOI Senior Daycare & assisted living Research ! 1
  2. 2. TABLE OF CONTENTS1Purpose of Research! 6Definitions! 6Purpose of a daycare! 6Description! 7History! 8A Dummies guild how to start a Day Care! 9Evaluating Adult Day Care Centers! 10What Services Are Typica"y Available?! 10Overview for adult care regulations! 11Participant thresholds and hourly limits.! 12Parameters for Who Can Be Served! 12Required and Optional Services! 13Provisions Regarding Medications! 14Staffing Requirements! 14Staffing for persons with dementia.! 15Types of staff.! 16Training Requirements! 16Monitoring! 17ICOI Senior Daycare & assisted living Research ! 2
  3. 3. California Guild Book :-! 17Operations: Services! 26Conceptual Plan of services! 33Planning & Zoning! 35Design Standards! 49One bed room! 51Two bedroom! 52Special care room! 53Toilets! 54Nurses Station! 57Dinning room! 58corridor! 59Elements of Site Selection! 66Geology :-! 72Climate :-! 73Topography :-! 74Flora & fauna! 75Base Map! 76Safety Considerations! 77EarthQuake Safety :-! 77ICOI Senior Daycare & assisted living Research ! 3
  4. 4. Floods:-! 78WildFires :-! 78Religious a&ressions:-! 79Community safety! 79Medical transportation! 79General Design Policies :-! 80Wa"s and Fencing! 80Noise Attenuation! 80Building setbacks -! 80Projections Into Required Setback! 81Fences, Hedges and Wa"s! 81Building Height! 81Lot Coverage -! 81Between Buildings -! 81Electricity :-! 82Natural Gas:-! 82Telephone & cable :-! 82Sources! 84The Beginning! 86Form Concept! 87ICOI Senior Daycare & assisted living Research ! 4
  5. 5. Design program! 88Master plan! 89Site plan! 90Sections! 91Isometric View! 92Views! 93Roof garden :-! 94Green house! 96Final sheets! 97ICOI Senior Daycare & assisted living Research ! 5
  6. 6. GOALS OF RESEARCH “Copy om one, it’s plagiarism; Copy om two, it’s research” Wilson Mizner1Purpose of Researchis to understand Who,are the Users Of the project.What are there needs,Which Facilitiesare needed & How to cater to there needs.Definitions• Senior :- is an individual who is 59 years of age or older.• Day Care:- daytime care for the needs of people who cannot be fully independent, such as children or theelderly : family issues such as day care | [as adj. ] a day-care center for employees children.• Assisted Living:-housing for the elderly or disabled that provides nursing care, housekeeping, and preparedmeals as neededPurpose of a daycareThere are two general purposes for adult day-care. The first is to provide an alternative toplacement in a residential institution. The second is to create a respite for care-givers, of-ten the children of the persons for whom the care is being provided.ICOI Senior Daycare & assisted living Research ! 6
  7. 7. DescriptionThere are two general types of adult day care programs. One is based on a medical model andthe other on a social model. The medical model provides comprehensive medical, therapeutic,and rehabilitation day treatment. The social model offers supervised activities, peer support,companionship, and recreation. Both models assist older adults and those with chronic condi-tions to remain as independent as possible, for as long as possible.Programs organized along the medical model lines are often called adult day health care to dis-tinguish them from social programs. Adult day health care programs offer health services suchas physician visits, nursing care, and podiatry, as well as rehabilitation services such as physical,occupational, and speech therapy in a secure environment. This model of adult day care is of-fered to persons with a variety of chronic medical conditions including the following:% •% adults with Alzheimers disease, other forms of dementia, or depression% •% persons recovering from stroke or head or spinal cord injuries% •% people with chronic conditions such as diabetes or cardiovascular disease% •% adults with developmental disabilities such as Down syndrome% •% adults suffering from mental illnesses% •% weak or frail older adults requiring nursing care or assistance with daily livingactivitiesThe social model of adult day care emphasizes supervised group activities such as crafts, gar-dening, music, and exercise . Participants in this model may require some assistance with theactivities of daily living (e.g., eating, bathing, dressing) but they generally do not require skillednursing care. Like adult day health care facilities, these social programs generally providetransportation and a midday meal for participants, as well as caregiver support groups, infor-mation and referral services, and community outreach programs.In 2009, an estimated 40 million Americans will be aged 65 or older. According to statisticsfrom the U.S. Department of Labor, the fastest growing segment of older adults is the popula-tion aged 85 and older. Historically, approximately 80% of the frail elderly remain in the com-munity and are cared for by relatives, most commonly by adult daughters. Today, however, anincreasing number of women aged 35–54 are in the workforce and unable to care for aging par-ents or disabled adult children living at home.ICOI Senior Daycare & assisted living Research ! 7
  8. 8. Although the participants of adult day care are adults who attend the programs daily or severaltimes each week, adult day care also meets the needs of families and other caregivers. Beforewomen entered the workforce, they were available to care for relatives at home. Today, adultday care provides a secure, alternative source of care for women who work outside the home. Italso offers respite, or much needed breaks, for caregivers. Older adults caring for spouses, orchildren caring for aging parents find that adult day care helps ease the burden of caring for ill,confused, or disabled family members.HistoryThe first adult day care centers opened in England during the 1940s and 1950s. Established bypsychiatric hospitals, these centers were designed to reduce the frequency of hospital admis-sions. The first adult day care centers in the United States appeared during the early 1970s. To-day, there are more than 4,000 services and centers. Most centers and programs operate duringnormal business hours, Monday through Friday, but some offer weekend and evening care.As of 2003, 34 states offer licensure of adult day care, but only 25 require such licensure. Adultday care services or programs may be affiliated with hospitals, nursing homes , home healthagencies, or senior centers, but many are unaffiliated, independent programs. They may be lo-cated in storefronts, senior centers, community health and medical centers, and nursing homes.Among centers responding to a 1997 National Adult Day Services Association (NADSA) sur-vey, the average number of persons in an adult day care facility was approximately 40 and theaverage age of persons served was 76. About three out of four persons receiving adult day careservices lived with family. Nearly 80% of adult day centers offered nursing services, and ap-proximately 90% were not-for-profit. Fees ranged from $1 to $200 per day, with an average of$28 to $43 dollars per day. As of 2003, Medicare does not pay for any type of adult day care.However, in 35 states, Medicaid can be used to pay for adult day care services.Though fees for adult day care vary widely, the service is generally considered to be cost effec-tive when compared with the cost of institutional care, such as skilled nursing facilities or evenhome health care. More importantly, adult day care enables older adults, persons with physicaldisabilities, and those with cognitive impairments to maintain their independence. Researchhas demonstrated that adult day care also reduces the risks and frequency of hospitalization forolder adults. Adult day care satisfies two requirements of care. It provides a secure, protectedenvironment and is often the least restrictive setting in which care may be delivered.Quality and standards of care vary from state to state and from one center or program to an-other. NADSA and the National Council on the Aging have developed standards and bench-marks for care, but adherence to these standards is voluntary. NADSA is currently developinga certification program for adult day center administrators and directors. A certification proc-ess for program assistants also exists. Since no uniform national standards exist, it is difficultICOI Senior Daycare & assisted living Research ! 8
  9. 9. for consumers to know whether a program or center is staffed by qualified personnel or pro-vides appropriate services.Generally, quality adult day care centers or programs conduct thorough assessments of eachperson and develop individualized plans of care and activities to meet the needs of impaired,disabled, or frail older adults. The plans for each individual describe objectives in terms of im-provement or maintenance of health status, functional capabilities, and emotional well being.Centers must have sufficient staff to ensure safety, supervision, and close attention. Further, allpersonnel and volunteers should be qualified, trained, and sensitive to the special needs ofolder adults. For example, centers and services for persons with Alzheimers disease or otherdementias must take special precautions to ensure that people do not wander away from thefacility.A Dummies guild how to start a Day CareI. They generally only allowed a certain amount of senior citizens in the adult daycare business depending upon the size of the Building that you have It is always a good idea to talk to someone at the city office regarding how to get a business license and any special rules along with regulations that apply.II. You can either charge a hourly rate or a weekly rate. Senior Citizens usually have grandchil- dren or their own kids watch them day after day from time to time, but make sure that you can keep the senior citizens entertained at a reasonable affordable price each hour.III. . You want the senior citizens to be entertained while at the adult daycare center. You want them to have the option of playing cards or board games when visiting with other senior citizens. You need to schedule activities such as bowling or even tennis if it is available. Some senior citizens might even enjoy a movie day of a certain selection.IV. You need to offer healthy foods to the senior citizens. It is important to have meals provided to them at a regular time. A daycare center is usually required to serve a certain amount of food each week and different kinds of food too. You will have food regulations and rules to follow just like a regular daycare center. You will most likely need to get a food handlers permit.ICOI Senior Daycare & assisted living Research ! 9
  10. 10. Evaluating Adult Day Care Centers • Number of years in operation -- stability. • State license or certification, if required • Days and hours of operation • Financial costs -- be sure to look for any hidden costs (such as extra charges for transportation or special meals). Do they have any financial assistance available? • Meet the staff and ask for credentials -- can your loved ones health needs be met? • Is transportation provided? • Look at the menu -- can special dietary needs be met? It is a good sign if they ask you to stay for lunch.• Can they deal with conditions such as incontinence or dementia?What Services Are Typically Available?A well-run adult day care centers goals will focus on enriching the participants lives, buildingupon their skills, knowledge, and unique abilities and strengths. Below are some of the activi-ties that may be available:% •% Arts and crafts% •% Musical entertainment and sing-a-longs% •% Mental stimulation games such as BINGO% •% Stretching or other gentle exercise% •% Discussion groups (books, films, current events)% •% Holiday and birthday celebrations% •% Local outingsICOI Senior Daycare & assisted living Research ! 10
  11. 11. Adult day care centers have been providing a form of respite for caregivers for more thantwenty years. In 1978 there were only 300 centers nationwide. By the 1980s there were 2,100centers, and today there are about 4,000 centers nationwide, according to the National AdultDay Services Association (NADSA). NADSA reports that the need for such centers has"jumped sharply to keep pace with the mushrooming demand for home and community basedservices."This growth also is due in part to new funding sources such as Medicaid waiver pro-grams, which support alternatives to institutional long-term care and rehabilitation.Overview for adult care regulationsThis section provides a brief overview of states’ approaches to regulating ADS providers in keyareas and highlights similarities and differences among them.Licensing, Certification, and Other RequirementsThe majority of states approach ADS regulation by requiring licensure or certification in ac-cordance with state standards. 25 states require licensure, ten states require certification; andfour states require both licensure and certification (in these states, Medicaid and non-Medicaidproviders have different requirements.) Thirteen states require ADS providers to seek approvalfrom or enter into some type of agreement with a state agency. Exhibit 1 indicates whether astate requires licensure, certification, both, and/or some other arrangement.LicensureStates vary in their approach to licensure, primarily licensing providers of specific ADS pro-grams or operators of specific types of facilities or centers. Some states license a single pro-gram; others cover two or more program types under a single licensing category; some haveseparate licenses for specific types of programs in addition to basic licensure.For example, Maine licenses two types of programs--adult day health services and social ADSprograms--as Adult Day Services. Either program may operate a night program that providesservices to persons with dementia. However, the ADS provider must have a separate license tooperate a night program and must keep record keeping distinct.States do not generally license by levels of care. Louisiana is an exception. The state licensesboth adult day care and adult day health care and has a unique system of licensing with six dis-tinct types of licensed services settings related to the capacities of the clients with develop-mental disabilities whom they serve. Louisiana is the only state that defines adult day care as aICOI Senior Daycare & assisted living Research ! 11
  12. 12. service only for persons with developmental disabilities rather than for “older persons withdisabilities” or “adults with disabilities.”Participant thresholds and hourly limits.States do not vary much with regard to the maximum number of participants that providersmay serve before licensure or certification is required. The maximum is generally betweenthree and five individuals who are unrelated to the provider. Tennessee is an exception, settingthe threshold at ten individuals.States vary more with regard to specifying the maximum hours of services that ADS providersmay furnish. For example, in Idaho participants may be served during any part of the day butonly for less than 14 hours. Iowa’s maximum is 16 hours in a 24- hour period. Some states, suchas Kansas, do not specify minimums or maximums but only that facilities must operate fewerthan 24 hours a day. On the other hand, Tennessee defines adult day care services as those thatare provided for more than 3 hours per day but less than 24 hours per day, implying that pro-viders who furnish services fewer than 3 hours a day do not have to be licensed.Parameters for Who Can Be ServedThe regulation of a service targeted to frail elders and individuals with disabilities needs to as-sure that providers can meet the needs of their clients. One option for assuring this is throughexplicit admission/retention/discharge criteria that set the parameters for who can be served.ICOI Senior Daycare & assisted living Research ! 12
  13. 13. Many states lack specific provisions regarding the types or level of functional or health needsthat should trigger discharge. Most states do have provisions related to involuntary discharge,which generally give providers some discretion to determine1-8whether or not they can meet an individual’s needs. For example, Vermont’s rules limit in-voluntary discharges to the following situations: (1) the participant’s care needs exceed those anadult day center is certified to provide, (2) an adult day center is unable to meet the partici-pant’s assessed needs, or (3) the participant presents a threat to himself or herself or to otherparticipants or staff. Similarly, Alabama requires that providers discharge participants when theprogram of care can no longer meet their needs or when their condition presents an immediateand serious risk to the health, safety, or welfare of the participants or others.In most states, parameters for who can be served are set (although indirectly) through provi-sions regarding mandatory and optional services that indicate a participant’s level of need. Forexample, Virginia requires adult day health care centers (ADHC) to meet the needs of eachparticipant, but specifies that a minimum range of services must be available to every MedicaidADHC recipient, including nursing services and rehabilitation services. Virginia further speci-fies that centers can admit recipients who have skilled needs only if there is professional nurs-ing staff immediately available on site to provide the specialized nursing care these recipientsrequire. Provisions such as these indicate that persons with a high level of nursing or medicalneeds can be served in these centers.Required and Optional ServicesAll states identify a range of required and optional ADS in their licensing or certification re-quirements or other types of agreements. States list required and optional services for eachtype of ADS that they license, certify, or otherwise regulate (e.g., for adult day care and adultday health care).The services we included in our review are:␣ ADL assistance; ␣ health education; ␣ health monitoring;␣ medication administration; ␣ skilled nursing services; ␣ nursing services;% ␣ social services;and ␣ physical, occupational,%␣ transportation.and speech therapy;ICOI Senior Daycare & assisted living Research ! 13
  14. 14. We limited our review to these services because the purpose of this study is to better under-stand the role of ADS in addressing elderly persons’ health and functional needs. We did notinclude services such as emergency services and nutritional services, because they are providedto all residents regardless of residents’ functional or health status. See Section 2 for individualstate information about which services are required and optional.States generally require adult day care providers to furnish ADL assistance and health monitor-ing. Health education; physical, occupational, and speech therapy; and skilled nursing servicesare less likely to be cited as either required or optional.States generally require adult day health care or medical adult day care providers to furnishmore services than adult day care providers. In addition to ADL assistance, social services, andhealth monitoring, adult day health care providers are generally required to furnish medicationadministration; nursing services; physical, occupational, and speech therapy; and skilled nurs-ing services.Provisions Regarding MedicationsMost states do not specify medication administration as a required service, except for adultday health care providers. The majority of states require licensed personnel to administermedications. States that permit unlicensed staff to administer medications1-10generally required that they do so under nurse delegation provisions, though a few requireonly consultation with a physician or pharmacist or specific training.Most states require providers to have written policies for medication management and admini-stration. For example, Georgia requires adult day care programs to have a written policy formedication management designating specific staff to be authorized and trained to assist withthe administration of medications and designating the program’s role in the supervision of self-administered medications and/or staff- administered medications.Many states also specify requirements related to self-administration of medications. For exam-ple, Texas requires individuals who self-administer their medications to be counseled at leastonce a month by licensed nursing staff to ascertain if they continue to be capable of self-administering their medications.Staffing RequirementsStates vary with regard to the number of staff required. Most states specify minimum staff-to-participant ratios. As shown in Exhibit 2, mandatory ratios range between one to four and oneto ten. Some states require different ratios for different types of ADS, and some states specifyICOI Senior Daycare & assisted living Research ! 14
  15. 15. both a required ratio and a recommended ratio. Some states require lower ratios when servingparticipants with greater needs, but allow providers to determine what level of need requiresthe lower ratio.Several states do not have minimum staff-to-participant ratios and allow providers to deter-mine the number of staff, requiring only that they have “sufficient” staff to meet participants’needs. For example, Idaho states that staff must be adequate in numbers and skill to provideessential services but does not define essential services. The state further specifies that thenumber of staff per participant must increase appropriately if the number of participants inday care increases or if the degree of severity of participants’ functional or cognitive impair-ment increases. However, we identified no state guidance to providers for what constitutes an“appropriate” increase.Idaho’s Medicaid provisions, on the other hand, have more specific requirements. Medicaidproviders are required to have a minimum of one staff for every six participants, and a ratio ofone-to-four when serving a high percentage of participants who are severely impaired.Staffing for persons with dementia.Exhibit 3 lists the states that have special provisions for serving individuals with dementia,most of which relate to staffing and training requirements.Required staffing ratios for persons with dementia are generally one staff to four participants,though Michigan requires Dementia Adult Day Care programs to have a minimum staff/volunteer/student-to-participant ratio of one-to-three. Some states specify lower ratios forpeople with cognitive impairment who may not have a diagnosis of dementia. For example,Minnesota states that when an adult day care/services center serves both participants who arecapable of taking appropriate action for self- preservation under emergency conditions andparticipants who are not, it is required to maintain a staff-to-participant ratio of one-to-five forICOI Senior Daycare & assisted living Research ! 15
  16. 16. participants who are not capable of self-preservation and one-to-eight for participants who arecapable of self-preservation.Types of staff. In addition to staffing ratios, virtually all states require specific types of staff for ADS pro-grams. The major difference in requirements between adult day care and adult day health careis that states require the latter to have licensed nurses available in some capacity (e.g., as fulltime or part time employees or as consultants). Because most states require staffing consistentwith participants’ needs, licensed nurses are required if adult day health care service centersneed skilled nursing services.Training RequirementsVirtually all states have both orientation and initial and ongoing training requirements, butthey are minimal. Some requirements are quite general, while others are specific regarding thetype of training and the number of hours required. Most states require at least one staff trainedin first aid and CPR on duty at all times. Examples of the wide range of requirements follow:ICOI Senior Daycare & assisted living Research ! 16
  17. 17. California requires that adult day health care centers that provide care for adults with de-mentia provide staff training regarding the use and operation of egress control devices (pre-cluding the use of exits) utilized by the center, the protection of participants’ personal rights,wandering behavior and acceptable methods of redirection, and emergency evacuation proce-dures for persons with dementiaMonitoringThe majority of states require inspections--most of them annual inspections that coincide withan initial license application and annual license renewal. Several states also stipulate that unan-nounced visits by state personnel can occur at any time. Only one state does not have externalmonitoring. Alaska does not license or monitor ADS. The state’s rules require only that anadult day care program conducts an internal evaluation, at least annually, of its operation andservices. However, site visit inspections are required for programs receiving state grant funds.1California Guild Book :-ICOI Senior Daycare & assisted living Research ! 17
  18. 18. !"#$%&($")OverviewIn California, adult day care services are provided in two types of licensed facilities: adult day programs(ADP) and adult day health care (ADHC) centers. In addition, each local Area Agency on Agingdesignates at least one Alzheimer’s day care resource center (ADCRC) in its planning and service areato provide specialized Alzheimer’s care and community outreach and education.Adult day program providers are licensed by the State Department of Social Services (DSS)Community Care Licensing Division as community care facilities. The term “adult day program”replaced two earlier program names in legislation (SB 1982, Statutes of 2002): adult day care facility(ADCF) and adult day support center (ADSC). These two programs were licensed by DSS underseparate regulations in the California Code of Regulations (CCR) Title 22, based on California Healthand Safety Code. Because the regulations have not yet been combined, whenever they differ, they arepresented separately in this profile under the heading Adult Day Program. ADP services are notavailable under the Medicaid State Plan.Adult day health care providers are licensed by the Department of Health Services (DHS) Licensingand Certification Division as health facilities. The California Department of Aging (CDA) administers theprogram and certifies each center for Medi-Cal (California’s Medicaid State Plan) reimbursement.Licenses are not issued or renewed for an ADHC center that is not certified as a Medi-Cal provider ofADHC services. ADHC providers must meet, at a minimum, the licensing requirements specified inHealth and Safety Code, Chapter 3.3; the certification requirements specified in Welfare and InstitutionsCode, Chapter 8.7; and additional requirements specified in the CCR, Title 22. If an ADHC centerlicensee also provides adult day care or ADSC services, the ADHC license shall be the only licenserequired to provide these additional services.ADP and ADHC services are also available to clients of the Multipurpose Senior Service Program(MSSP), a case management program targeted to frail elderly clients who are eligible for nursing facilityplacement. MSSP operates under a Home and Community-Based Services (HCBS) waiver andcontracts with appropriately licensed and certified providers for services.In August 2004, a 1-year moratorium on new ADHC centers enrolling in the Medi-Cal program wasinstituted and will most likely be extended until the state transitions the ADHC program from theMedicaid State Plan to an HCBS waiver program. During the time of the moratorium, ADHC applicantsmay be licensed to provide services to persons who pay privately or have insurance coverage for theservices. ADHC centers may be certified for the Medi-Cal program only if they meet the exemptions tothe moratorium as specified in SB 1103.ADCRCs are specialized day care centers that target services to persons with Alzheimer’s disease andother dementias. Until recently, the law permitted ADCRCs to function without a facility license,although the majority of ADCRCs are located in licensed ADP or ADHC centers. Legislation (AB 2127,Statutes of 2004) amended Welfare and Institutions Code 9542 as follows: an Alzheimer’s day careresource center that was not licensed as an adult day program or adult day health care center prior toJanuary 1, 2005, shall be required to be so licensed by January 1, 2008. A direct services program thatqualifies to operate as an Alzheimer’s day care resource center after January 1, 2005, shall be requiredto be licensed as an adult day program or adult day health care center. The ADCRC program iscurrently authorized by statutes, and specific requirements are specified in a program manual, not inregulation. Regulations that were being developed for the ADCRC program were suspended, effectiveNovember 1, 2003. All ADCRCs are funded by grants from CDA. Services are reimbursed by Medi-Calfor eligible participants if the program is housed in an ADHC center. ICOI Senior Daycare & assisted living Research ! 18 2-17
  19. 19. Licensure and Certification RequirementsLicensure ADP Certification Both ADHC OtherOnly Only RequiredDefinitionsAdult Day ProgramAdult day program means any community-based facility or program that provides care to persons 18years of age or older in need of personal care services, supervision, or assistance essential tosustaining the activities of daily living (ADL) or for the protection of the individual on less than a 24-hourbasis.Adult day care facility means any facility of any capacity that provides nonmedical care andsupervision to adults on less than a 24-hour per day basis.Adult day support center means a community-based group program designed to meet the needs offunctionally impaired adults through an individual plan of care in a structured comprehensive programthat provides a variety of social and related support services in a protective setting on less than a 24-hour basis.Adult day support center services means those nonmedical services provided in an ADSC to adultswith physical, emotional, or mental impairments and who require assistance and supervision.Adult Day Health CareAdult day health care means an organized day program of therapeutic, social, and health activitiesand services provided to elderly persons with functional impairments, either physical or mental, for thepurpose of restoring or maintaining optimal capacity for self-care. Provided on a short-term basis,ADHC serves as a transition from a health facility or home health program to personal independence.Provided on a long-term basis, it serves as an alternative to institutionalization in a long-term healthcare facility when 24-hour skilled nursing care is not medically necessary or viewed as desirable by therecipient or their family.Adult day health center or adult day health care center means a licensed and certified facility thatprovides ADHC, or a distinct portion of a licensed health facility in which such care is provided in aspecialized unit under a special permit issued by the department.Parameters for Who Can Be ServedAdult Day ProgramAdult day care facility. Providers determine the parameters for who can be served insofar as they arerequired to determine whether they can meet prospective clients’ service needs prior to admission.They may serve clients with “obvious symptoms of illness” only if these clients are “separated fromother clients.”Adult day support center. Adults with physical, emotional, or mental impairments with nonmedicalneeds who require assistance and supervision may be served. Such persons include, but are notlimited to, the following: Persons who require assistance with ADL (e.g., bathing, dressing, grooming) and instrumental activities of daily living (IADL) (e.g., laundry, shopping, paying bills). These persons may live independently, at home with a care provider, in a community care facility, or in a health facility, but do not require a medical level of care during the day. Persons who require assistance and supervision in overcoming the isolation associated with functional limitations or disabilities. Persons who, without program intervention, are assessed to be at risk of physical deterioration or premature institutionalization due to their psychological condition. 2-18 ICOI Senior Daycare & assisted living Research ! 19
  20. 20. Providers determine in part the parameters for who can be served insofar as they are required todetermine whether they can meet prospective clients’ service needs prior to admission and candischarge those whose needs they can no longer meet or who pose a danger to themselves or others.The regulations also state that participants cannot have specific restricted health conditions asspecified in CCR, Title 22, Division 3, Subdivision 1, Chapter 5. (The list of these conditions is tooextensive to include here.)Adult Day Health CareADHC facilities may serve persons 55 years of age or older and other adults who are chronically ill orimpaired and would benefit from ADHC. Providers may not admit individuals for whom, in their clinicaljudgment, they cannot appropriately care. They may serve persons with dementia and other specialneeds populations, such as persons with developmental disabilities or persons with mental disabilities.Providers may discharge participants if they are unable or unwilling to use the prescribed services andADHC staff have made every effort to remove possible obstacles.Medicaid provisions for enrollment in ADHC specify that providers may serve individuals: (1) withmedical conditions that require treatment or rehabilitative services prescribed by a physician, (2) withmental or physical impairments that handicap ADL but which are not of such a serious nature as torequire 24-hour institutional care, and (3) who are at risk for deterioration and probableinstitutionalization if ADHC services were not available.Inspection and MonitoringYes NoAdult day program. Within 90 days after the date of issuance of a license or special permit, thedepartment shall conduct an inspection of the facility for which the license or special permit was issued.Any duly authorized officer, employee, or agent of the State Department of Social Services may enterand inspect any place providing personal care, supervision, and services at any time, with or withoutadvance notice, to secure compliance with, or to prevent a violation of, any provision of the GeneralLicensing Requirements, Health and Safety Code.Every licensed community care facility shall be subject to unannounced visits by the department. Thedepartment shall visit these facilities as often as necessary to ensure the quality of care provided. Thedepartment will conduct random annual unannounced visits to no less than 10 percent of facilities.Under no circumstances shall the department visit a community care facility less often than once every5 years.Adult day health care. If an ADHC center or an applicant for a license has not been previouslylicensed, the department may only issue a provisional license to the center. A provisional license tooperate an ADHC center shall expire 1 year from the date of issuance, or at an earlier time asdetermined by the department at the time of issuance. Within 30 days prior to the expiration of aprovisional license, the department shall give the ADHC center a full and complete inspection, and, ifthe ADHC center meets all applicable requirements for licensure, a regular license shall be issued.Annual licenses are required; however, the director has discretion to approve applications forrelicensure for a period of up to 24 months. ICOI Senior Daycare & assisted living Research ! 20
  21. 21. Required and Optional Services Adult Day Program Adult Day Health Care* Required Optional Required Optional ADL Assistance X X Health Education and Counseling ADSC only X Health Monitoring/Health-Related Services ADSC only X Medication Medication Administration X assistance Nursing Services X Physical Therapy, Occupational Therapy, X or Speech Therapy Skilled Nursing Services X Social Services ADSC only X Transportation X *ADHC centers are also required to provide medical services and psychiatric or psychological services. Provisions Regarding Medications Adult day program. Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. In ADCFs and ADSCs, staff may be trained by the client’s family or primary caregiver if the licensee obtains written documentation from the client’s family or primary caregiver outlining the procedures and the names of facility staff whom they have trained in those procedures, and the licensee ensures that the client’s family or primary caregiver reviews staff performance as necessary, but at least annually. All staff training shall be documented in the facility personnel files. Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee shall be authorized to assist clients with self-administration of injections as needed. For every prescription and nonprescription PRN medication for which the licensee provides assistance, there shall be a signed and dated written order from a physician on a prescription blank maintained in the client’s file and a label on the medication. Adult day health care. Each participant’s health record shall include a drug history that lists all medications currently being taken by the participant and any medications to which the participant is allergic. Medications stored in the center or administered by center personnel shall be labeled in conformance with state and federal laws and regulations. Medications shall be administered only by licensed medical or licensed nursing personnel. Self-administration of medications shall be permitted only under the following conditions: (1) the center shall have approved policies permitting self- administration of medications when approved by the multidisciplinary team; (2) training in self- administration of medications shall be provided to all participants based on the recommendation of the multidisciplinary team; and (3) the health record of each participant who is capable of self-medication shall name all drugs that are to be self-administered. Provisions for Groups with Special Needs Dementia ADHC Mental Retardation/ ADHC Other mental illness, Developmental Disabilities traumatic brain injury (ADHC) 2-20ICOI Senior Daycare & assisted living Research ! 21
  22. 22. Staffing Requirements Adult Day Program Adult Day Care Facility Type of staff. All ADCFs shall have an administrator. A licensee who is responsible for two or more ADCFs shall be permitted to serve as an administrator of one or more of the facilities. The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation. When the administrator is absent from the facility, there shall be coverage by a substitute designated by the licensee who shall be capable of and responsible and accountable for management and administration of the facility in compliance with applicable law and regulation. Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall at all times be employed in numbers necessary to meet such needs. The licensee shall provide for an overlap of staff at each shift change to ensure continuity of care. Care staff shall not be assigned to any of the support staff duties, such as housekeeping, cooking, or office work, unless the care and supervision needs of clients have been met. Staffing ratios. There shall be an overall ratio of not less than one staff member providing care and supervision for each 15 clients present. Whenever a client who relies upon others to perform all ADL is present, the following minimum staffing requirements shall be met: For Regional Center clients, staffing shall be maintained as specified by the Regional Center. For all other clients, there shall be a staff-client ratio of no less than one direct care staff to four such clients. Adult Day Support Center Type of staff. All ADSCs shall have an administrator. If an administrator is responsible for two or more ADSCs, there shall be at each site an employee who is responsible for the day-to-day operation of the center and who meets the following qualifications: (1) a baccalaureate degree in psychology, social work, or a related human services field or (2) a minimum of 1 year of experience in a supervisory or management position in the human services delivery system. An administrator shall not be responsible for more than five centers. When the administrator or the employee specified above is absent from the center, there shall be coverage by a substitute designated by the licensee who is on site and who shall be capable of, and responsible and accountable for, the management and administration of the center in compliance with applicable laws and regulations. Support staff and direct care staff are required. Direct care staff provide care and supervision to participants at least 70 percent of the hours of program operation per month. There shall be at least two persons on duty, at least one of whom is a direct care staff member, at all times when there are two or more participants in the center. The licensee shall provide for an overlap of staff at each shift change to ensure continuity of care. The center shall have at least one full-time staff member who has a current certificate in first aid and cardiopulmonary resuscitation present in the facility during operating hours. Staffing ratios. There shall be an overall ratio of not less than one direct care staff member providing care and supervision for each group of eight participants, or fraction thereof, present. For each group of 25 participants, or fraction thereof, there shall be at least one direct care staff person who has a baccalaureate degree in a health, social, or human service field, or 1 year documented full-time experience providing direct services to frail or physically, cognitively, or emotionally impaired adults. Whenever a participant who relies upon others to perform all ADL is present, the following minimum staffing requirements shall be met: For Regional Center participants, staffing shall be maintained as specified by the Regional Center.ICOI Senior Daycare & assisted living Research ! 22 2-21
  23. 23. For all other participants, there shall be a staff-participant ratio of no less than one direct care staff to four such participants. Volunteers may be included in the staff-to-participant ratio if the volunteer meets the requirements for direct care staff.Adult Day Health CareType of staff. Each center shall have an administrator. The administrator shall have the responsibilityand authority to carry out the policies of the licensee. Each center shall make provision for continuity ofoperation and assumption of the administrator’s responsibilities during the administrator’s absence. Theadministrator shall not be responsible for more than three centers without prior written approval by theDepartment. In this circumstance, there shall be one or more assistant administrators for every threeadditional centers.Each center shall have a full-time program director. The program director shall be on the premises andavailable to participants, employees, and relatives. When the program director is temporarily absent,another adult on the staff shall be designated to serve as the acting program director. Centers with acapacity of 50 and over shall provide both an administrator and a full-time program director.The program director of centers whose average daily attendance is 20 or fewer may also serve as theregistered nurse, social worker, occupational therapist, physical therapist, speech therapist, or dietitian,provided that the program director meets the professional qualifications for that position and theprogram director and the administrator are not the same person. Program aides shall be employed in asufficient number to meet the needs of the participants and the staffing requirements of theDepartment.The program director, a registered nurse with a public health background, a medical social worker, aprogram aide, and the activity coordinator shall be on duty during the hours the center offers basicservices. Other staff shall be employed in sufficient numbers to provide services as prescribed in theindividual plans or care in accordance with minimal requirements determined by each center’s averagedaily attendance based on the previous quarter experience. Medical services shall be provided to eachparticipant by a personal or a staff physician.Occupational, physical, and speech therapy services staff shall work the hours necessary to meet theneeds of each participant as specified in the individual plan of care and in accordance with the staffingrequirements of the Department.For the provision of psychiatric or psychological services, the center shall have consultant staffavailable a minimum of 3 hours per month and consisting of a psychiatrist, clinical psychologist,psychiatric social worker, or psychiatric nurse. Consultant staff shall spend a sufficient number of hoursin the center to meet the needs of each participant and the staffing requirements of the Department.Support employees shall include maintenance, food service, and clerical employees sufficient innumber to perform the necessary duties. Volunteers may be used in centers but shall not be used toreplace required employees. Each volunteer shall receive orientation, training, and supervision.Staffing ratios. There must be one program aide for every 16 participants during the hours ofoperation. An additional half-time social work assistant and an additional half-time licensed vocationalnurse shall be provided for each increment of ten in average daily attendance exceeding 40.Training RequirementsAdult Day ProgramAdult day care facility. All personnel shall be given on-the-job training or shall have relatedexperience that provides knowledge of and skill in the following areas, as appropriate to the jobassigned and as evidenced by safe and effective job performance: (1) principles of nutrition, foodpreparation and storage, and menu planning; (2) housekeeping and sanitation principles; (3) provisionof client care and supervision, including communication; (4) assistance with prescribed medications thatare self-administered; (5) recognition of early signs of illness and the need for professional assistance; 2-22 ICOI Senior Daycare & assisted living Research ! 23
  24. 24. (6) availability of community services and resources; and (7) Universal Precautions as defined in Title22, Section 8001(u)(1). Training in Universal Precautions may be provided in the facility, or staff mayattend training provided by a local health facility, county health department, or other local trainingresources.Adult day support center. The licensee shall develop, maintain, and implement a written plan for theorientation, continuing education, on-the-job training and development, supervision, and evaluation ofall direct care staff. (1) The plan shall require direct care staff to receive and document a minimum of 20hours of continuing education during the first 18 months of employment or within 18 months after theeffective date of these regulations and during each 3-year period thereafter. (2) The administrator shallreceive and document a minimum of 30 hours of continuing education every 24 months of employment.(3) Continuing education shall include completion of courses related to the principles and practices ofcare of the functionally impaired adult including, but not limited to, workshops, seminars, and academicclasses. The center shall train program staff and participants in emergency procedures.Adult Day Health CareA planned in-service education program, including orientation, skill training, and continuing education,shall be provided for employees. All staff members shall receive in-service training in first aid andcardiopulmonary resuscitation within the first 6 months of employment. An ADHC that provides care foradults with Alzheimer’s disease and other dementias must provide staff training regarding the use andoperation of the egress control devices (precluding the use of exits) used by the center, the protectionof participants’ personal rights, wandering behavior and acceptable methods of redirection, andemergency evacuation procedures for persons with dementia.Relevant Medicaid Contracting Requirements for Adult Day Services ProvidersTo obtain certification as a provider of ADHC under the state’s Medicaid program (Medi-Cal), a providermust meet all the requirements of licensure as an ADHC center pursuant to Chapter 3.3 (commencingwith Section 1570) of Division 2 of the Health and Safety Code, and Chapter 10, Division 5, Title 22 ofCCR. Medi-Cal has additional requirements for providers of ADHC services guided by the Adult DayHealth Medi-Cal Law pursuant to Chapter 8.7 of the Welfare and Institutions Code, and Chapter 5,Division 3, Subdivision 1, Title 22 of CCR. CDA may implement a 1-year moratorium on the certificationand enrollment into the Medi-Cal program of new ADHC centers.Purpose. The Medi-Cal benefit is intended to establish and continue a community-based system ofquality day health services that will: (1) ensure that elderly persons not be institutionalized prematurelyand inappropriately; (2) provide appropriate health and social services designed to maintain elderlypersons in their own homes; (3) establish adult day health centers in locations easily accessible to theeconomically disadvantaged elderly person; and (4) encourage the establishment of rural alternativeADHC centers, which are designed to make ADHC accessible to impaired Californians living in ruralareas.Discharge. An adult day health center shall not terminate the provision of adult day health services toany participant unless approved by the state department.Optional services. (1) Podiatric services, (2) optometric screening and advice for low-vision cases, (3)dental screening for the purpose of appraising the participant of the necessity of regular or emergencydental care, and (4) such other services within the concept and objectives of ADHC as may beapproved by the department.Inspection. Initial Medi-Cal certification for ADHC providers shall expire 12 months from the date ofissuance. The director shall specify any date he or she determines is reasonably necessary, but notmore than 24 months from the date of issuance, when renewal of the certification shall expire. Thecertification may be extended for periods of not more than 60 days if the Department determines it to benecessary. Every ADHC center shall be periodically inspected and evaluated for quality of care by arepresentative or representatives designated by the director, unless otherwise specified in theinteragency agreement entered into pursuant to Section 1572 of the Health and Safety Code. ICOI Senior Daycare & assisted living Research ! 24 2-23
  25. 25. Inspections shall be conducted prior to the expiration of certification, but at least every 2 years, and asoften as necessary to ensure the quality of care being provided. As resources permit, an inspectionmay be conducted prior to, as well as within, the first 90 days of operation.Staffing. A provider shall employ appropriately licensed personnel for furnishing required services. Aprovider serving a substantial number of participants of a particular racial or ethnic group, orparticipants whose primary language is not English, shall employ staff who can meet the cultural andlinguistic needs of the participant population.Training. An in-service training plan for each center staff member shall commence within the first 6months of employment. The training plan shall address, at a minimum, the specific medical, social, andother needs of each participant population the center proposes to serve.Location of Licensing, Certification, or Other Requirements1. http://www.dss.cahwnet.gov/getinfo/pdf/adcfman.PDF.2. http://www.dss.cahwnet.gov/getinfo/pdf/adscman.PDF.3. http://www.dss.cahwnet.gov/getinfo/pdf/genman1.PDF.4. http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=hsc&codebody=&hits=20.5. http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=wic&codebody=&hits=20.6. http://files.medi-cal.ca.gov/pubsdoco/Pubsframe.asp?hURL=/pubsdoco/io_search.asp.7. http://ccr.oal.ca.gov/cgi-bin/om_isapi.dll?clientID=138589&infobase=ccr&softpage= Browse_Frame_Pg42.Citations1. Adult Day Care Facilities--Community Care Licensing Division--Manual of Policies and Procedures (CCR, Title 22, Division 6, Chapter 3). Department of Social Services. [Updated 9/30/02]2. Adult Day Support Center--Community Care Licensing Division--Manual of Policies and Procedures (Title 22, Division 6, Chapter 3.5). Department of Social Services. [Updated 3/08/00]3. General Licensing Requirements. (CCR, Title 22, Division 6, Chapter 1, Article 1) Department of Social Services. [Updated 12/17/04]4. California Adult Day Health Care Act--California Health and Safety Code (Chapter 3.3, Section 1570-1596.5). [Effective 1978]5. Adult Day Health Care Program, California Welfare and Institutions Code (Chapter 8.7, Section 14520-14588). [Effective 1978]6. Adult Day Health Care Centers, Medi-Cal Inpatient/Outpatient Provider Manual, Department of Health Services. [Effective August 2000]7. Adult Day Health Care, California Medical Assistance Program, Health Care Services (CCR, Title 22, Division 3, Subdivision 1, Chapter 5) and Adult Day Health Centers, Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies, (CCR, Title 22, Division 5, Chapter 10). [Effective date unknown]Additional InformationA licensed and certified ADHC center may establish one or more satellites. A satellite may be in thecounty of the parent or a rural service area. The parent center’s license and certification shall coverADHC services at one or more satellites.A rural alternative ADHC center shall operate its programs a minimum of 3 days weekly unless theprogram can justify, to the satisfaction of the department, fewer days of operation due to space, staff,financial, or participant reasons.In December 2003, the Centers for Medicare & Medicaid Services (CMS) notified DHS that the ADHCprogram should not have been approved as an optional Medi-Cal benefit and directed the state totransition the program into an HCBS waiver. DHS and CDA are currently working on the waiverapplication, and the administration has introduced legislation that authorizes the state to obtain a waiverto continue ADHC services. 2-24ICOI Senior Daycare & assisted living Research ! 25
  26. 26. D ES I G N I NTRODUCTION:Operations: ServicesThe nursing home is divided into the following functional areas:--Residents care units-Therapeutic services- Resident support services- Administrative services- Logistical services- Environmental & maintenanceICOI Senior Daycare & assisted living Research ! 26
  27. 27. Space planning & design ICOI Senior Daycare & assisted living Research ! 27
  28. 28. Technical considerationsICOI Senior Daycare & assisted living Research ! 28
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  33. 33. Conceptual Plan of servicesICOI Senior Daycare & assisted living Research ! 33
  34. 34. Site considerations ICOI Senior Daycare & assisted living Research ! 34
  35. 35. Planning & ZoningICOI Senior Daycare & assisted living Research ! 35
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  49. 49. Design StandardsICOI Senior Daycare & assisted living Research ! 49
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  51. 51. One bed roomICOI Senior Daycare & assisted living Research ! 51
  52. 52. Two bedroomICOI Senior Daycare & assisted living Research ! 52
  53. 53. Special care roomICOI Senior Daycare & assisted living Research ! 53
  54. 54. ToiletsICOI Senior Daycare & assisted living Research ! 54
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  57. 57. Nurses StationICOI Senior Daycare & assisted living Research ! 57
  58. 58. Dinning roomICOI Senior Daycare & assisted living Research ! 58
  59. 59. corridorICOI Senior Daycare & assisted living Research ! 59
  60. 60. Planning & Design DataICOI Senior Daycare & assisted living Research ! 60
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  65. 65. BLANK PAGE SITE SELECTIONICOI Senior Daycare & assisted living Research ! 65
  66. 66. Elements of Site Selection-Distance from the islamic Center.-Distance From Medical services .-Function does not Contradicted with City’s Master Plan.-Quick access from freeway.-Acceptance of the Surrounding CommunitySince the project is Owned By The ICOI the site is better located in the cityICOI Senior Daycare & assisted living Research ! 66
  67. 67. L O C AT IO N O F I RVINE ,CAIrvine is located in Southern California in Orange County .From the North it’s Limits are Tustin,Costa messa.West Newport & laguna beach.East Lake irvineSouth laguna hills, Lake Forest & Aliso vejo .ICOI Senior Daycare & assisted living Research ! 67

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