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A Primer on Assisted Living Abuse and Neglect – Nathan Hughey – SC ALF Regulations

At Hughey Law Firm, we regularly handle cases against assisted living facilities, including South Carolina assisted living abuse claims, Charleston assisted living neglect claims, and SC assisted living wrongful death lawsuits.

Assisted Living or Community Residential Care Facilities are basically one step below a nursing home.  Unlike nursing homes, they are not regulated on the federal level, but at the state level.  Assisted Living facilities are often owned by large out of state corporations who make little to no effort to comply with these provisions.  The facilities swear under oath that they will do so in order to receive a license.  If your loved one has suffered an injury as a result of assisted living neglect or abuse, contact Hughey Law Firm today.

South Carolina has a very detailed regulation governing assisted living facilities, DHEC R.61-84.  I have highlighted some important parts of it below:

Licensing / Enforcement

  • No person, private or public organization, political subdivision, or governmental agency shall establish, operate, maintain, or represent itself (advertise/ market) as a community residential care facility/assisted living facility in S.C. without first obtaining a license.
  •  A license shall not be issued to a proposed facility that has not been previously and continuously licensed under Department regulations until the licensee has demonstrated to the Department that the proposed facility is in substantial compliance with the licensing standards. In the event a licensee who already has a facility/activity licensed by the Department
  • The application includes both the applicant’s oath assuring that the contents of the application are accurate/true, and that the applicant will comply with this regulation.
  • When the Department determines that a facility is in violation of any statutory provision, rule, or regulation relating to the operation or maintenance of such facility, the Department, upon proper notice to the licensee, may impose a monetary penalty, deny, suspend, or revoke licenses.
  • Class I violations are those that the Department determines to present an imminent danger to the health, safety, or well-being of the persons in the facility or a substantial probability that death or serious physical harm could result therefrom. A physical condition or one or more practices, means, methods or operations in use in a facility may constitute such a violation.

Policies and Procedures

  • Written policies and procedures addressing each section of this regulation regarding resident care, rights, and the operation of the facility shall be developed and implemented, and revised as required in order to accurately reflect actual facility operation. The policies and procedures shall address the provision of any special care offered by the facility which would include how the facility shall meet the specialized needs of the affected residents such as Alzheimer’s disease and/or related dementia, physically/developmentally disabled, in accordance with any laws which pertain to that service offered, e.g., Alzheimer’s Special Care Disclosure Act. Facilities shall establish a time-period for review of all policies and procedures. These policies and procedures shall be accessible at all times and a hard copy shall be available or be readily accessible.
  • The policies and procedures shall describe the means by which the facility shall assure that the standards described in this regulation, which the licensee has agreed to meet, as confirmed by application for licensing, are met.

Staffing

  • Appropriate staff members/volunteers in numbers and training shall be provided to perform those duties that result in compliance to the regulation, to suit the needs and condition of the residents, and meet the demands of effective emergency on-site action that might arise. The facility may elect to not allow volunteers to work in the facility.
  • Training requirements/qualifications for the tasks each performs shall be in compliance with all local, state, and federal laws, and current professional organizational standards.
  • The number and qualifications of staff members/volunteers shall be determined by the number and condition of the residents.

Incident Reporting

  • Serious incidents and/or medical conditions and any sudden or unexpected illness or medication administration error resulting in death or inpatient hospitalization shall be reported immediately via telephone to the attending physician, the resident’s next-of-kin or responsible party.

Resident Records

  • The facility shall initiate and maintain an organized record for each resident.
  • The individualized care plan or ICP must describe: the needs of the resident, including the activities of daily living for which the resident requires assistance, i.e., what assistance, how much, who will provide the assistance, how often, and when

Admission / Retention

  • Individuals seeking admission shall be identified as appropriate for the level of care, services, or assistance offered. The facility shall establish admission criteria that are consistently applied and comply with local, state, and federal laws and regulations. The facility shall admit and retain only those persons appropriate for placement in a CRCF in compliance with the standards of this regulation.
  • Persons not eligible for admission/retention are: Any person who is likely to endanger him/herself or others; Serious aggressive, violent or socially inappropriate behavioral symptoms which cannot be controlled or improved in the facility; Anyone whose condition changes so that they do not meet the facility requirements for admission

Care Rendering

  • Residents shall receive care, including diet, services, i.e., routine and emergency medical care, podiatry care, dental care, counseling and medications, as ordered by a physician or other authorized healthcare provider. Such care and services shall be detailed in the ICP. (I)
  • Care/services shall be rendered effectively and safely in accordance with orders from physicians or other authorized healthcare providers, and precautions taken for residents with special conditions, e.g., pacemakers, wheelchairs, Alzheimer’s disease and/or related dementia, etc.
  • The facility shall comply with all current federal, state, and local laws and regulations concerning resident care, resident rights and protections.
  • There shall be a written, implemented quality improvement program that provides effective self-assessment and implementation of changes designed to improve the care/services provided by the facility.
  • The quality improvement program, as a minimum, shall: Establish desired outcomes and the criteria by which policy and procedure effectiveness is regularly, systematically, and objectively accomplished; Identify, evaluate, and determine the causes of any deviation from the desired outcomes;  Identify the action taken to correct deviations and prevent future deviation, and the person(s) responsible for implementation of these actions;
  • Establish ways to measure the quality of resident care and staff performance as well as the degree to which the policies and procedures are followed; Analyze the appropriateness of ICP’s and the necessity of care/services rendered; Analyze all incidents and accidents, to include all medication errors and resident deaths; Analyze any infection, epidemic outbreaks, or other unusual occurrences which threaten the health, safety, or well-being of the residents; Establish a systematic method of obtaining feedback from residents and other interested persons, e.g., family members and peer organizations, as expressed by the level of satisfaction with care/services received.

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