11-90

C
..,
§11-90-1
§11-90-2
§11-90-3
§11-90-4
§11-90-5
§11-90-6
§11-90-7
§11-90-8
§11-90-9
§11-90-10
§11-90-11
HAWAII 	ADMINISTRATIVE 	RULES
TITLE 	11
DEPARTMENT 	OF 	HEALTH
CHAPTER 	90
ASSISTED 	LIVING 	FACILITY
Purpose
Definitions
Licensing
Minimum 	building 	and 	structural
requirements
Emergency 	care 	and 	disaster 	planning
General 	policies, 	practices 	and
administration
Inservice 	education
Range 	of 	services
Records 	and 	reports
Admission 	and 	discharge 	requirement
Severability
§11-90-1 	Purpose. 	The 	purpose 	of 	this 	chapter 	is
to 	establish 	a 	new 	category 	of 	community 	based
residential 	care 	setting 	to 	be 	named 	"assisted 	living
facility" 	and 	to 	establish 	minimum 	standards 	and
requirements 	for 	licensure 	to 	protect 	the 	health,
welfare, 	and 	safety 	of 	residents 	in 	such 	facilities.
Assisted 	living 	facilities 	shall 	serve 	the 	purpose 	of
providing 	a 	combination 	of 	housing, 	meal 	services,
health 	care 	services, 	and 	personalized 	supportive
services 	designed 	to 	respond 	to 	individual 	needs. 	The
following 	principles 	are 	applied:
(1) 	Aging 	in 	place;
(2) 	Negotiated 	plan 	of 	care· 	and
(3) 	Managed 	risk. 	[Eff 	AU 	23 	999 	] 	(Auth:
HRS 	§§321-1, 	321-9, 	321-10, 	321-11(10),
3 21-15 . 1) 	(Imp: 	HRS 	§ § 3 2 1-9 , 	3 21-11 ( 1 O) ,
321-15.1)
§11-90-2 	Definitions. 	As 	used 	in 	this 	chapter:
"Abuse" 	means 	actual 	or 	imminent 	physical 	injury,
psychological 	abuse 	or 	neglect, 	sexual 	abuse, 	financial
exploitation, 	negligent 	treatment, 	or 	maltreatment 	as
90-1
2212. 	, j'.~

§11-90-2
further 	defined 	in 	section 	346-222, 	HRS.
"Activities 	of 	Daily 	Living" 	or 	"ADL" 	means 	those
personal 	functional 	activities 	required 	by 	an
individual 	for 	continued well-being 	including 	eating,
dressing, 	personal 	hygiene, 	mobility, 	toileting, 	and
behavior 	management.
"Aging 	in 	place" 	means 	the 	process 	of 	remaining 	in
his 	or 	her 	living 	environment 	("home") 	despite 	the
physical 	or mental 	decline 	that 	may 	occur 	due 	to 	the
aging 	process. 	For 	aging 	in 	place 	to 	occur, 	needed
services 	are 	provided, 	increased 	or 	adjusted 	to
compensate 	for 	the 	physical 	or mental 	decline 	of 	the
individual .within 	the 	ability 	of 	the 	facility.
"Assistance" 	means 	the 	resident 	can 	perform 	some
part 	of 	an 	activity, 	but 	cannot 	do 	it 	entirely 	alone.
"Assisted 	living" 	means 	encouraging 	and 	supporting
individuals 	to 	live 	independently 	and 	receive 	services
and 	assistance 	to 	maintain 	independence. 	All
individuals 	have 	a 	right 	to 	live 	independently with
respect 	for 	their 	privacy 	and 	dignity, 	and 	to 	live 	in 	a
setting 	free 	from 	restraints.
"Assisted 	living 	facility" 	means 	an 	assisted
living 	facility 	as 	defined 	in 	section 	321-15.1, 	HRS.
This 	facility 	shall 	consist 	of 	a 	building 	complex
offering 	dwelling 	units 	to 	individuals 	and 	services 	to
allow 	residents 	to 	maintain 	an 	independent 	assisted
living 	lifestyle. 	The 	environment 	of 	an 	assisted
living 	facility 	shall 	include 	one 	in 	which 	meals 	are
provided, 	staff 	are 	available 	on 	a 	24-hour 	basis 	and
services 	are 	based 	on 	the 	individual 	needs 	of 	each
resident. 	Each 	resident, 	family 	member, 	and
significant 	others 	shall 	work 	together 	with 	facility
staff 	to 	assess 	what 	is 	needed 	to 	support 	the 	resident
so 	that 	the 	resident 	can 	achieve 	his 	or 	her 	greatest
capacity 	for 	living 	independently. 	The 	facility 	shall
be 	designed 	to 	maximize 	the 	independence 	and 	self-
esteem 	of 	limited-mobility 	persons 	who 	feel 	that 	they
are 	no 	longer 	able 	to 	live 	on 	their 	own.
"Choice" 	means 	viable 	options 	created 	for
residents 	to 	enable 	them 	to 	exercise 	greater 	control
over 	their 	lives.
"Department" 	means 	the 	department 	of 	health.
"Dependent" 	means 	the 	resident 	cannot 	perform 	any
part 	of 	an 	activity; 	the 	activity 	must 	be 	done 	entirely
b:y 	someone 	else.
"Dietitian" 	means 	a 	person 	who 	is 	registered 	or
90-2

§11-90-2
eligible 	for 	registration 	by 	the 	Commission 	on 	Dietetic
Registration 	of 	the 	American 	Dietetic Association.
"Dignity" 	means 	providing 	support 	in 	such 	a 	way 	as
to 	validate 	the 	self-worth 	of 	the 	individual. 	Dignity
is 	supported 	by 	designing 	a 	residential 	program 	that
delivers 	services 	in 	a 	manner 	which 	shows 	courtesy 	and
respect 	for 	a 	resident's 	right 	to make 	decisions.
"Direct 	care 	staff" 	means 	an 	employee 	of 	an
assisted 	living 	facility 	who 	is 	responsible 	and
available 	for 	providing 	services 	directly 	to 	residents
including 	assistance with 	activities 	of 	daily 	living,
such 	as 	assistance with 	bathing, 	dressing, 	grooming,
eating, 	money 	management, 	or 	recreation.
"Director" 	means 	the 	director 	of 	health 	or 	the
director's 	designated 	representative.
"Emergency" 	means 	a 	life-threatening 	situation.
It 	also 	means 	those 	conditions 	specific 	to 	a 	resident
which 	are 	identified 	in 	the 	resident's 	care 	plan 	as
requiring 	emergency 	care which may 	include 	behavior
that 	poses 	a 	danger 	to 	staff 	or 	others.
"Health 	care 	services" 	means 	the 	provision 	of
services 	in 	an 	assisted 	living 	facility 	that 	assist 	the
individual 	in 	achieving 	and maintaining 	the 	highest
state 	of 	positive well-being 	(i.e., 	psychological,
social, 	physical, 	and 	spiritual) 	and 	functional 	status.
This 	may 	include 	nursing 	assessments 	and 	the 	monitoring
and 	delegation 	of 	nursing 	tasks 	by 	registered 	nurses
pursuant 	to 	chapter 	457, 	HRS, 	care management, 	records
management, 	and 	coordinating 	basic health 	care 	and
social 	services 	per 	residents 	in 	such 	settings.
"Homelike" 	means 	a 	type 	of 	environment which
promotes 	the 	dignity, 	security, 	and 	comfort 	of
residents 	through 	the 	provision 	of 	personalized 	care
and 	services 	to 	encourage 	independence, 	choice 	and
decision-making 	by 	each 	resident. 	A homelike
environment 	is 	also 	supported 	by 	the 	use 	of 	residential
building materials 	and 	furnishings.
"Independence" 	means 	supporting 	resident
capabilities 	and 	facilitating 	use 	of 	their 	abilities.
Independence 	is 	supported 	by 	creating 	barrier 	free
structures 	and 	careful 	design 	of 	assistive 	devices.
"Independent" 	means 	the 	resident 	can 	perform the
ADL with 	assistance.
"Individuality" 	means 	recognizing 	variability 	in
residents' 	needs 	and 	preferences 	and 	having 	flexibility
to 	organize 	services 	in 	response 	to 	such 	needs 	and
90-3

§11-90-2
preferences.
"Legal 	representative 	or 	designee" 	means 	an
attorney 	at 	law, 	a 	person holding 	a 	general 	power 	of
attorney 	or 	special 	power 	of 	attorney 	for 	health 	care,
guardian, 	conservator, 	or 	any 	person 	appointed 	by 	a
court 	to 	manage 	the 	personal 	or 	financial 	affairs 	of
the 	resident 	or 	person 	or 	agency 	legally 	responsible
for 	the 	welfare 	or 	support 	of 	the 	resident, 	other 	than
the 	facility.
"License" 	means 	an 	assisted 	living 	facility
license.
"Licensed 	nurse" 	means 	a 	person who 	is 	licensed 	as
a 	registered 	nurse 	in 	the 	State 	of 	Hawaii 	pursuant 	to
chapter 	457, 	HRS.
"Licensee" 	means 	the 	person 	or 	entity 	(the 	owners)
to 	whom 	a 	license 	to 	operate 	an 	assisted 	living
facility 	is 	issued 	and 	who 	is 	legally 	responsible 	for
the 	operation 	of 	the 	facility.
"Managed risk" 	means 	a 	formal 	process 	of
negotiating 	and 	developing 	a 	plan 	to 	address 	resident
needs, 	decisions, 	or 	preferences 	to 	reduce 	the
probability 	of 	a 	poor 	outcome 	for 	the 	resident 	or 	of
putting 	others 	at 	risk 	for 	adverse 	consequences.
"Misappropriation 	of 	resident's 	property" 	means
the 	illegal 	or 	improper 	use 	of 	a 	client's 	funds 	or
property 	for 	profit 	or 	advantage.
"Modified 	diet" 	means 	a 	diet 	for 	a 	diabetic, 	a 	low
fat 	diet, 	low 	sodium 	diet, 	or 	soft 	diet, 	or 	a 	special
diet 	otherwise 	ordered 	by 	a 	physician.
"Neglect" 	means 	a 	type 	of 	action 	or 	conduct,
performed without 	the 	resident's 	informed 	consent,
which 	results 	in 	the 	deprivation 	of 	food, 	water,
medication, 	medical 	services, 	shelter, 	or 	other
services 	necessary 	to 	maintain minimum 	physical 	or
mental 	health.
"Negotiated 	Plan 	of 	Care 	or 	Service 	Plan 	or
Agreement" 	means 	a 	written 	plan 	for 	services 	developed
with 	the 	resident 	or 	significant 	others 	and 	which
includes 	a 	recognition 	of 	the 	resident's 	capabilities
and 	choices. 	The 	plan 	defines 	the 	division 	of
responsibility 	in 	the 	implementation 	of 	services 	and
specifies 	measurable 	goals.
"Personal 	care" 	means 	the 	following 	two 	categories
of 	activities:
(1) 	Activities 	of 	daily 	living 	such 	as
ambulation, 	mobility, 	transfer 	and 	lifting,
90-4

§11-90-2
positioning 	and 	turning, 	bowel 	and 	bladder
care, 	toileting, 	bathing, 	dressing, 	grooming,
feeding, 	exercise, 	and 	range 	of motion; 	and
(2) 	Instrumental 	activities 	of 	daily 	living which
are 	directly 	related 	to 	the 	well-being 	of 	the
resident 	such 	as 	meal 	preparation, 	bed,
kitchen 	and 	bathroom 	cleanliness,
housekeeping, 	laundry, 	essential 	errands,
transportation, 	medication 	assistance, 	and
maintenance 	of 	health 	records.
"Physician" 	means 	a 	person who 	is 	licensed 	to
practice 	medicine 	or 	osteopathy 	under 	chapter 	453 	or
chapter 	460, 	HRS.
"Primary 	care 	provider" 	means 	a 	person who 	is
licensed 	to 	practice 	medicine 	or 	osteopathy 	under
chapter 	453 	or 	chapter 	460, 	HRS, 	or 	a 	person 	who 	is
licensed 	and 	recognized 	as 	an 	advanced 	practice
registered 	nurse 	under 	chapter 	457.
"Privacy" 	means 	a 	specific 	area 	or 	time 	over 	which
the 	resident 	maintains 	a 	large 	degree 	of 	control.
Privacy 	is 	supported with 	services 	that 	are 	delivered
with 	respect 	for 	the 	resident's 	civil 	rights.
"Resident" 	means 	any 	person who 	is 	receiving 	room,
board, 	care, 	and 	services 	in 	an 	assisted 	living
facility 	for 	a 	fee 	on 	a 	24-hour 	basis.
"Self-administration 	of 	medication" 	means 	the 	act
of 	a 	resident 	placing medication 	in 	or 	on 	his 	or 	her
own 	body 	without 	assistance. 	This 	means 	the 	resident
manages 	and 	takes 	his 	or 	her 	own medications, 	the
resident 	identifies 	his 	or 	her 	own medication, 	the 	time
and 	manner 	of 	administration.
"Service 	plan" 	means 	a 	written 	plan 	for 	services
developed 	with 	input 	from 	a 	facility 	staff
representative, 	the 	resident 	or 	significant 	other 	(if
the 	resident 	consents) 	and 	includes 	recognition 	of 	the
resident's 	capabilities 	and 	choices. 	The 	plan 	defines
the 	division 	of 	responsibility 	in 	the 	implementation 	of
the 	services 	to 	be 	provided 	and 	specifies 	measurable
goals. 	The 	service 	plan 	also 	specifies 	who 	will 	be
responsible 	for 	providing 	services 	and 	when 	and 	how
often 	care 	and 	services 	will 	be 	provided 	or 	arranged.
The 	plan 	shall 	be 	developed 	at 	the 	time 	of 	admission
and 	shall 	be 	reviewed 	and 	updated 	at 	least 	semi-
annually 	or when 	the 	condition 	of 	the 	resident 	changes,
or 	when 	the 	need 	arises.
"Services" 	means 	activities 	or 	care 	provided 	by
90-5

§11-90-2
the 	facility 	which 	assist 	the 	residents 	in 	developing
appropriate 	skills 	to 	increase 	or 	maintain 	their 	level
of 	functioning 	or which 	assist 	them 	in 	performing
personal 	care 	or 	activities 	of 	daily 	living.
"Social work 	services" 	means 	the 	professional
activity 	of 	helping 	individuals, 	groups, 	or 	communities
to 	enhance 	or 	restore 	their 	capacity 	for 	social
functioning 	and 	to 	create 	societal 	conditions 	favorable
to 	their 	goals.
"Unlicensed 	assistive 	personnel" 	means 	an
individual 	who 	is 	not 	licensed 	to 	practice 	nursing, 	but
who 	provides 	tasks 	of 	nursing 	care 	in 	the 	State 	of
Hawaii 	pursuant 	to 	chapter 	457, 	HRS.
"Waiver" 	means 	an 	exemption 	from 	a 	specific 	rule
for 	a 	duration 	not 	longer 	than 	one 	year 	which may 	be
permitted 	a 	facility, 	for 	a 	specified 	period 	of 	time,
at 	the 	discretion 	of 	the 	director.
Whenever 	the 	singular 	is
may 	include 	the 	plural. 	[Eff ---u-:,,. chapter 	it
HRS 	§§321-1, 	321-9, 	321-10, 	321-11(10),
HRS 	§§321-9, 	321-11(10), 	321-15.1)
] 	(Auth:
321-15.1} 	(Imp:
§11-90-3 	Licensing. 	(a) 	The 	facility 	shall 	meet
all 	requirements 	for 	licensure 	under 	state 	law. 	All
assisted 	living 	facilities 	shall 	be 	licensed 	except
those 	operated 	by 	the 	federal 	government. 	The 	licensee
shall 	file 	an 	application 	with 	the 	director 	and 	the
facility 	shall 	be 	licensed 	pursuant 	to 	this 	chapter
prior 	to 	admitting 	residents.
(b) 	The 	director 	or 	designated 	representative
shall 	inspect 	each 	assisted 	living 	facility 	no 	less
than 	every 	two 	years 	for 	relicensing. 	The 	director 	or
designated 	representative, 	without 	prior 	notice, 	may
enter 	the 	premises 	at 	any 	reasonable 	time 	to 	secure
compliance 	with 	or 	to 	prevent 	a 	violation 	of 	this
chapter.
(c) 	Summary 	reports 	of 	licensing 	inspections
shall 	be 	kept 	on 	file 	in 	the 	facility 	and 	shall 	be
available 	upon 	request.
(d) 	No 	facility 	licensed 	under 	the 	provisions 	of
this 	chapter, 	shall 	deny 	admission 	to 	any 	individual 	on
account 	of 	race, 	religion, 	ancestry, 	sexual
orientation, 	or 	national 	origin.
(e) 	The 	director 	shall 	prescribe 	the 	content 	and
form 	of 	the 	license, 	and may 	authorize 	a 	waiver 	or

§11-90-3
waivers 	for 	a 	particular 	facility.
(f) 	In 	the 	event 	of 	a 	change 	of 	name, 	location,
ownership, 	or 	licensed 	occupancy, 	the 	director 	shall 	be
notified 	fifteen 	days 	prior 	to 	the 	change; 	an
inspection 	at 	the 	discretion 	of 	the 	director 	shall 	be
conducted 	and, 	if 	the 	provisions 	of 	this 	chapter 	are
met, 	a 	new 	license 	issued.
(g) 	Every 	license 	shall 	continue 	in 	force 	for 	a
period 	of 	no 	less 	than 	two 	years 	unless 	otherwise
specified, 	or 	unless 	suspended 	or 	revoked.
(h) 	Following 	inspection 	of 	the 	facility 	by 	the
department, 	a 	list 	of 	deficiencies, 	if 	any, 	shall 	be
presented 	to 	the 	facility. 	The 	facility 	shall 	return 	a
plan 	of 	correction 	to 	the 	department 	within 	ten 	days
that 	addresses 	each 	of 	the 	deficiencies 	identified 	by
the 	department. 	Facilities 	shall 	be 	allowed 	a
reasonable 	time 	to 	implement 	the 	plan 	of 	correction. 	A
follow-up 	survey 	and 	inspection 	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. 	At 	the 	discretion 	of 	the
director, 	a 	provisional 	license 	may 	be 	issued.
(i) 	The 	current 	license 	shall 	be 	posted 	in 	a
conspicuous 	place 	visible 	to 	the 	public 	within 	the
facility. 	A facility 	which 	has 	fulfilled 	the
requirements 	of 	licensure 	shall 	be 	known 	as 	an 	assisted
living 	facility 	and 	this 	designation 	shall 	be 	reflected
on 	the 	facility's 	license.
(j) 	The 	director 	may 	suspend, 	revoke, 	or 	refuse
to 	issue 	a 	license 	for 	failure 	to 	comply with 	the
requirements 	of 	this 	chapter, 	or 	for 	any 	cause 	deemed 	a
potential 	hazard 	to 	the 	health 	and 	safety 	of 	the
residents, 	employees, 	or 	the 	general 	public. 	Any
person 	affected 	by 	the 	director's 	final 	decision 	of
denial, 	suspension, 	or 	revocation may 	appeal 	in
accordance 	with 	chapter 	91, 	HRS.
(k) 	An 	applicant 	for 	a 	license 	or 	relicensing may
be 	denied 	a 	license 	or 	relicense 	for 	any 	of 	the
following 	reasons:
(1) 	Failure 	to 	meet 	requirements 	of 	this 	chapter;
(2) 	Financial 	inability 	to 	operate 	and 	conduct
the 	facility 	in 	accordance 	with 	these 	minimum
standards 	and 	rules;
(3) 	Conviction 	in 	a 	court 	of 	law; 	or
(4) 	Had 	a 	substantiated 	finding 	of 	abuse, 	neglect
90-7

§11-90-3
or 	misappropriation 	of 	resident 	funds 	or
property 	in 	any 	civil 	action.
(1) 	Penalties, 	hearing, 	and 	appeals. 	In 	addition
to 	any 	other 	appropriate 	action 	to 	enforce 	this 	chapter
pursuant 	to 	state 	law, 	the 	director 	may 	initiate
procedures 	for 	invoking 	fines 	as 	provided 	in 	section
321-20, 	HRS 	and 	to 	revoke 	the 	license 	after 	hearing
held 	in 	accordance with 	chapter 	91, 	HRS.
Infractions which may 	require 	invoking 	the
procedures 	in 	this 	subsection 	include, 	but 	are 	not
limited 	to 	the 	operation 	of 	an 	assisted 	living 	facility
without 	a 	license 	granted 	by 	the 	department 	or 	if
substantive 	violations 	of 	this 	chapter 	are 	found 	as 	a
result 	of 	routine 	or 	unannounced 	inspection 	of 	a
facility 	which 	has 	a 	license.
(m) 	Applicants 	for 	licensure 	or 	existing
licensees 	applying 	for 	license 	renewal 	shall 	pay
appropriate 	fees, 	as 	determined 	by 	the 	director. 	Prior
notice 	of 	the 	amount 	of 	the 	fee 	shall 	be 	provided 	the
licensee.
(n) 	Separate 	buildings 	located 	contiguously 	and
operated 	as 	an 	integrated 	unit 	by 	the 	same management
are 	not 	required 	to 	have 	separate 	licenses. 	Distinct
staffing plans 	are 	required 	for 	each 	building 	and 	must
be 	approved 	in 	advance 	by 	the 	department.
(o) 	Applications 	for 	licensure 	shall 	be made 	to
the 	department 	on 	a 	form 	provided 	by 	the 	department 	and
shall 	include 	full 	and 	complete 	information 	as 	follows:
(1) 	Identity 	and 	financial 	interest 	of 	any
person, 	including 	stockholders, 	who 	have
ownership 	in 	the 	facility 	representing 	an
interest 	of 	ten 	per 	cent 	or more 	in 	such
assisted 	living 	facility;
(2) 	Each 	officer 	and 	director 	of 	the 	corporation
if 	the 	facility 	is 	organized 	as 	a
corporation, 	each 	general 	partner 	if 	the
facility 	is 	organized 	as 	a 	partnership, 	or
the 	governing 	body 	if 	the 	facility 	is
government 	owned;
(3) 	A summary 	of 	all 	lease, 	management, 	and 	sales
agreements 	and 	contracts 	relative 	to 	the
direct 	operation 	and 	ownership 	of 	the
facility. 	The 	applicant 	shall 	provide 	a 	copy
of 	any 	of 	the 	above, 	if 	requested 	by 	the
department;
(4) 	Name 	of 	the 	administrator 	of 	the 	facility 	and
90-8

§11-90-4
a 	list 	of 	three 	references;
(5) 	Location 	(address) 	of 	the 	facility 	and
mailing 	address;
(6) 	Maximum 	number 	of 	residents 	to 	be 	served 	at
any 	one 	time;
(7) 	Information 	and 	supporting 	documentation
regarding 	qualifications 	and 	training 	of
staff 	as 	required 	in 	these 	rules;
(8) 	Verification 	of 	evacuation 	capacity
designation 	for 	fire 	and 	life 	safety
protection;
(9) 	Proposed 	annual 	budget 	identifying 	sources 	of
revenue; 	and
(10) 	Evidence 	that 	the 	premises 	comply with 	state
and 	county 	building, 	housing, 	fire, 	and 	other
codes, 	ordinances, 	and 	laws 	for 	the 	type 	of
occupancy 	to 	be 	licensed. 	Compliance 	shall
include 	but 	not 	be 	limited 	to 	the 	following:
(A) 	Occupancy 	requirement 	of 	the 	county
building 	code;
(B) 	Applicable 	zoning 	ordinance 	of 	the
county;
(C) 	The 	obtainment 	of 	a 	use 	permit 	if
required 	by 	the 	county; 	and
(D) 	Applicable 	state 	laws 	and 	administrative
rules 	relating 	to 	sanitation, 	health,
and 	e 	'ronmental 	safety.
[Eff 	G2 3 1999 	] 	(Auth: 	HRS
§§321-1, 	321-9, 	321-10, 	321-11(10),
321-15.1) 	(Imp: 	HRS 	§§321-9, 	321-11(10),
321-15.1)
§11-90-4 	Minimum 	building 	and 	structural
reauirements. 	The 	facility 	shall 	provide 	each 	resident
with 	the 	following:
(1) 	Apartment 	unit 	with 	a 	bathroom, 	refrigerator,
and 	cooking 	capacity, 	including a 	sink;
(2) 	The 	unit 	shall 	be 	a 	minimum 	of 	220 	square
feet, 	not 	including 	the 	bathroom;
(3) 	The 	cooking 	capacity may 	be 	removed 	or
disconnected 	depending 	on 	the 	individual
needs 	of 	the 	resident;
(4) 	The 	unit 	shall 	have 	a 	separate 	and 	complete
bathroom with 	a 	sink, 	shower, 	and 	toilet;
(5) 	The 	unit 	shall 	accommodate 	physically
90-9

§11-90-4
challenged persons 	and 	persons 	in
wheelchairs, 	as 	needed;
(6) 	The 	unit 	shall 	have 	a 	call 	system monitored
24-hours 	a 	day 	by 	facility 	staff;
(7) 	The 	unit 	shall 	be 	wired 	for 	telephone 	and
television;
(8) 	Access 	to 	common 	areas 	such 	as 	activity
rooms, 	lounges, 	dining 	rooms, 	and 	laundry;
and
(9) 	Private 	accessible mailbox 	in which 	the
resident may 	send 	and 	receive 	mail, 	which
meets~9~tal 	standards.
[Eff 	AUb 231999 	) 	(Auth: 	HRS 	§§321-1,
321-9, 	321-10, 	321-11(10), 	321-15.1) 	(Imp:
HRS 	§§321-9, 	321-11(10), 	321-15.1)
§11-90-5 	Emergency 	care 	and 	disaster 	planning.
(a) 	There 	shall 	be 	written 	policies 	and 	procedures 	to
follow 	in 	an 	emergency which 	shall 	include 	provisions
for 	the 	following:
(1) 	Arranging 	for 	rapid 	primary 	care 	provider
attention 	or 	arranging 	for 	other 	available
assistance;
(2) 	Transportation 	arrangements 	for
hospitalization 	or 	other 	services 	which 	are
appropriate;
(3) 	Maintenance 	of 	an 	appropriate 	first 	aid 	kit
for 	emergency 	use; 	and
(4) 	Quarterly 	rehearsal 	of 	emergency 	evacuation
plans 	for 	staff 	and 	residents 	to 	follow 	in
case 	of 	fire, 	explosion, 	or 	other 	civil
emergency 	occurring 	in 	or 	within 	the 	environs
of 	the 	facility.
(b) 	The 	facility 	shall 	develop 	and 	maintain 	a
written 	disaster 	preparedness 	plan 	to 	be 	followed 	in
case 	of 	emergency 	or 	disaster. 	A copy 	of 	the 	plan
shall 	be 	readily 	available 	at 	all 	times 	within 	the
facility. 	Such 	plan 	shall 	include 	procedures 	for
evacuating 	all 	individuals 	in 	the 	facility, 	which 	shall
include 	the 	following:
(1) 	Provisions 	for 	evacuating 	residents 	with
impaired mobility 	or 	cognitive 	impairments;
(2) 	Provisions 	for 	transporting 	all 	of 	the
residents 	of 	the 	facility 	to 	a 	predetermined
appropriate 	facility 	or 	facilities 	that 	will
90-10

§11-90-7
accommodate 	all 	the 	residents 	of 	the 	facility
in 	case 	of 	a 	disaster 	requiring 	evacuation 	of
the 	facility; 	and
(3) 	A written 	transfer 	agreement, 	renewed 	every
two 	years, 	with 	the 	appropriate 	facility 	or
facilities 	for 	accommodating 	all 	of 	the
residents 	of 	the 	facility 	in 	case 	of 	a
dis~s~er 	requiri~~ 1 ~vfl~u~hh@ 	of 	the
facility. 	[Eff AUO ;:t 3 i!,8~ 	J 	(Auth: 	HRS
§§321-1, 	321-9, 	321-10, 	321-11(10), 	321-15.1)
(Imp: 	HRS 	§§321-9, 	321-11(10), 	321-15.1)
§11-90-6 	General 	policies, 	practices, 	and
administration. 	(a) 	The 	administrator 	or 	director 	of
the 	assisted 	living 	facility 	shall:
(1) 	Have 	at 	least 	two 	years 	experience, 	in 	a
management 	capacity, 	in 	the 	housing 	or 	health
care 	services 	or 	personal 	care 	industries, 	or
any 	combination thereof;
(2) 	Show 	evidence 	of 	having 	completed an 	assisted
living 	facility 	administrator's 	course 	or
equivalent 	course 	acceptable 	to 	the
department; 	and
(3) 	Be 	accountable 	for 	providing 	training 	for 	all
facility 	staff 	in 	provision 	of 	services 	and
principles 	of 	assisted 	living.
(b) 	All 	facility 	staff 	shall 	be 	in 	compliance
with 	current 	department 	tuberculosis 	clearance
procedures.
(c) 	All 	staff 	shall 	be 	trained 	in 	cardiopulmonary
resuscitation 	and 	first 	aid.
(d) 	The 	facility 	shall 	have 	written 	policies 	and
procedures 	which 	incorporate 	the 	assisted 	living
principles 	of 	individuality, 	independence, 	dignity,
home-like 	environment.
] 	(Auth: 	HRS 	§§321-1, 	321-9,
3 21-10 , 	3 21- 	1 ( 10) , 	3 21-15 . 1) 	(Imp: 	HRS 	§ § 3 21-9 ,
321-11(10), 	321-15.1)
§11-90-7 	Inservice 	education. 	There 	shall 	be 	a
staff 	inservice 	education program 	for 	the 	entire 	staff
that 	includes:
(1) 	Orientation 	for 	all 	new 	employees 	to 	acquaint
them with 	the 	philosophy, 	organization,
90-11

§11-90-7
practice, 	and 	goals 	of 	assisted 	living; 	and
(2) 	Ongoing 	inservice 	training 	on 	a 	regularly
scheduled 	basis 	(minimum 	of 	six hours
annually) . 	[ Eff AUG 2 	J 	(Auth: 	HRS
§§321-1, 	321-9, 	321-10, 	(10), 	321-15.1)
(Imp: 	HRS 	§§321-9, 	321-11(10), 	321-15.1)
§11-90-8 	Range 	of 	services. 	(a) 	Service plan.
(1) 	The 	assisted 	living 	facility 	staff 	shall
conduct 	a 	comprehensive 	assessment 	of 	each
resident's 	needs, 	plan 	and 	implement
responsive 	services, 	maintain 	and 	update
resident 	records 	as 	needed, 	and 	periodically
evaluate 	results 	of 	the 	plan. 	The 	plan 	shall
reflect 	the 	assessed 	needs 	of 	the 	resident
and 	resident 	choices, 	including 	resident's
level 	of 	involvement; 	support 	principles 	of
dignity, 	privacy, 	choice, 	individuality,
independence, 	and 	home-like 	environment; 	and
shall 	include 	significant 	others 	who
participate 	in 	the 	delivery 	of 	services;
(2) 	A service plan 	shall 	be 	developed 	and
followed 	for 	each 	resident 	consistent 	with
the 	resident's 	unique 	physical,
psychological, 	and 	social 	needs, 	along with
recognition 	of 	that 	resident's 	capabilities
and 	preferences. 	The 	plan 	shall 	include 	a
written 	description 	of 	what 	services 	will 	be
provided, 	who 	will 	provide 	the 	services, 	when
the 	services will 	be 	provided, 	how 	often
services 	will 	be 	provided, 	and 	the 	expected
outcome. 	Each 	resident 	shall 	actively
participate 	in 	the 	development 	of 	the 	service
plan 	to 	the 	extent 	possible;
(3) 	The 	initial 	service 	plan 	shall 	be 	developed
prior 	to 	the 	time 	the 	resident 	moves 	into 	the
facility 	and 	shall 	be 	revised 	if 	needed
within 	30 	days. 	The 	service 	plan 	shall 	be
reviewed 	and 	updated 	by 	the 	facility, 	the
resident, 	and 	others 	as 	designated 	by 	the
resident 	at 	least 	annually 	or 	more 	often 	as
needed; 	and
(4) 	The 	facility 	shall 	designate 	a 	staff 	member
to 	review, 	monitor, 	implement, 	and make
appropriate 	modifications 	to 	the 	service 	plan
90-12

for 	each 	resident.
(b) 	Services.
§11-90-8
(1) 	The 	assisted 	living 	facility 	shall 	provide
the 	following:
(A) 	Twenty-four 	hour 	on-site 	direct 	staff 	to
meet 	the 	needs 	of 	the 	residents;
(B) 	Three meals 	daily, 	seven 	days 	a 	week,
including modified 	diets 	and 	snacks
which 	have 	been 	evaluated 	and 	approved
by 	a 	dietitian 	on 	a 	semi-annual 	basis
and 	are 	appropriate 	to 	residents' 	needs
and 	choices;
(C) 	Laundry 	services 	to 	the 	extent 	that 	the
resident 	is 	unable 	to 	perform 	these
tasks 	for 	himself 	or 	herself;
(D) 	Opportunities 	for 	individual 	and 	group
socialization;
(E) 	Services 	to 	assist 	the 	resident 	in
performing 	all 	activities 	of 	daily
living, 	including 	bathing, 	eating,
dressing, 	personal 	hygiene, 	grooming,
toileting, 	and 	ambulation;
(F) 	Nursing 	assessment, 	health 	monitoring,
and 	routine 	nursing 	tasks, 	including
those 	which may 	be 	delegated 	to
unlicensed 	assistive 	personnel 	by 	a
currently 	licensed 	registered 	nurse
under 	the 	provisions 	of 	the 	state 	Board
of 	Nursing; 	and
(G) 	Household 	services 	essential 	for 	the
health 	and 	comfort 	of 	the 	resident 	(e.g.
floor 	cleaning, 	dusting, 	bed making,
etc.) .
(2) 	The 	assisted 	living 	facility 	shall 	also 	have
the 	capability 	to 	provide 	or 	arrange 	access
to 	the 	following 	services:
(A) 	Transportation 	for 	medical 	and 	social
appointments;
(B) 	Ancillary 	services 	for 	medically 	related
care 	(e.g. 	physician, 	pharmacist,
therapy, 	podiatry, 	etc.), 	barber 	or
beauty 	care 	services, 	social 	or
recreational 	opportunities, 	and 	other
services 	necessary 	to 	support 	the
resident;
(C) 	Services 	for 	residents 	who 	have 	behavior
90-13

§11-90-8
problems 	requiring 	ongoing 	staff
support, 	intervention, 	and 	supervision;
(D) 	Social work 	services; 	and
(E) 	Maintenance 	of 	a 	personal 	fund 	account
for 	residents 	showing 	deposits 	and
withdrawals.
(3) 	The 	assisted 	living 	facility 	shall 	have
policies 	and 	procedures 	relating 	to
medications 	to 	include 	but 	not 	be 	limited 	to:
(A) 	Self-medication:
(i) 	Residents 	must 	have 	physician 	or
prescribing 	advanced 	practice
registered 	nurse's 	written 	order 	of
approval 	for 	self-medication 	of
prescription medications;
(ii) 	Residents 	able 	to 	handle 	their 	own
medication 	regimen may 	keep
prescription medications 	in 	their
unit;
(iii) 	Residents 	may 	keep 	and 	use 	over-
the-counter 	medications 	in 	their
unit 	without 	a 	written 	order 	unless
otherwise 	indicated 	by 	a 	physician
or 	prescribing 	advanced 	practice
registered 	nurse's 	written 	orders;
(iv) 	If 	more 	than 	one 	resident 	resides
in 	the 	unit, 	an 	assessment 	shall 	be
made 	of 	each 	person's 	ability 	to
safely 	have medications 	in 	the
unit. 	If 	safety 	is 	a 	factor, 	the
medication 	shall 	be 	kept 	in 	a
locked 	container 	in 	the 	unit; 	and
(v) 	Residents 	who 	self-medicate with
prescription 	drugs 	or 	maintain
over-the-counter 	drugs 	in 	their
units 	shall 	have 	all 	their
medications 	reviewed 	by 	either 	a
registered 	pharmacist, 	registered
nurse, 	or 	physician 	at 	least 	every
90 	days.
(B) 	Administration 	of 	medication:
(i) 	Prescription 	and 	non-prescription
medications 	which 	the 	facility 	has
responsibility 	for 	administering 	to
a 	resident 	must 	be 	identified 	in
the 	resident's 	record 	and 	must 	be
90-14

§11-90-9
prescribed 	in 	writing 	for 	the
resident 	by 	a 	physician 	or
prescribing 	advanced 	practice
registered 	nurse; 	and
(ii) 	The 	facility 	shall 	provide 	and
implement 	policies 	and procedures
which 	assure 	that 	all 	medications
administered 	by 	the 	facility 	are
reviewed 	at 	least 	once 	every 	90
days 	by 	a 	registered 	nurse 	or
physician, 	and 	is 	in 	compliance
with 	applicable 	state 	laws 	and
administrative 	rules.
(4) 	Recreational 	or 	social 	activities 	are 	to 	be
made 	available 	to 	residents 	on 	a 	daily 	basis.
(c) 	Licensed 	nursing 	staff 	shall 	be 	available
seven 	days 	a 	week 	to 	meet 	the 	care managel\~~t
monitoring 	needs 	of 	the 	residents. 	[Efff\UO 	J
(Auth: 	HRS 	§§321-1, 	321-9, 	321-10, 	321-11(10),
321-15.1) 	(Imp: 	HRS 	§§321-9, 	321-11(10), 	321-15.1)
§11-90-9 	Record 	and 	reports 	system. 	(a) 	The
facility 	shall 	establish 	policies 	and 	procedures 	to
maintain 	a 	system 	of 	records 	and 	reports 	which 	shall
include 	the 	following:
(1) 	Copy 	of 	a 	current 	physician 	or 	primary 	care
provider's 	report 	of 	resident's 	physical
examination which 	includes 	tuberculosis
clearance 	and 	verification 	that 	the 	resident
is 	free 	from 	other 	infectious 	or 	contagious
diseases;
(2) 	Service plan;
(3) 	Contracts 	or 	other 	documents 	which 	set 	forth
details 	of 	services 	to 	be 	delivered, 	charges,
and 	other 	conditions 	agreed 	to 	between 	the
resident 	and 	the 	facility; 	and
(4) 	Incident 	reports 	of 	any 	bodily 	injury 	or
other 	unusual 	circumstances 	affecting 	a
resident 	which 	occurs 	within 	the 	facility, 	on
the 	premises, 	or 	elsewhere, 	shall 	be 	retained
by 	the 	facility 	under 	separate 	cover, 	and 	be
available 	to 	authorized 	personnel 	and 	the
department. 	The 	resident's 	physician 	or
primary 	care 	provider 	shall 	be 	called
immediately 	if 	medical 	care 	is 	necessary 	or
90-15

§11-90-9
indicated.
(b) 	The 	facility 	records 	and 	reports 	shall 	be
available 	for 	review 	at 	any 	time 	by 	authoriz
personnel 	and 	the 	department. 	[Eff AUG 23 	J
(Auth: 	HRS 	§§321-1, 	321-9, 	321-10, 	321-11(10,
321-15.1) 	(Imp: 	HRS 	§§321-9, 	321-11(10), 	321-15.1)
§11-90-10 	Admission 	and 	discharge. 	(a) 	The
facility 	shall 	develop 	admission 	policies 	and
procedures 	which 	support 	the 	principles 	of 	dignity 	and
choice. 	The 	admissions 	process 	shall 	include
completion 	of 	or 	the 	providing 	of 	the 	following:
(1) 	A service 	listing 	which 	details 	the 	services
available, 	the 	base 	rates, 	the 	services
included 	in 	the 	base 	rate, 	and 	the 	fees 	for
all 	other 	additional 	services. 	A service
listing 	shall 	also 	describe 	services 	which
the 	facility 	does 	not 	provide, 	but will
assist 	to 	arrange 	or 	coordinate;
(2) 	Handbook 	or 	house 	rules 	which 	state 	the
assisted 	living 	philosophy 	and 	clearly 	define
the 	privileges 	and 	responsibilities 	of 	the
resident 	and 	the 	conditions 	under 	which
apartment 	units 	may 	be 	occupied 	by 	the
residents;
(3) 	A service 	plan 	for 	the 	resident 	developed 	by
facility 	staff 	with 	the 	resident 	and
significant 	others, 	specifying 	care 	and
services 	to 	be 	provided, 	based 	on 	resident
needs 	and 	choices;
(4) 	A service 	contract which 	documents 	a
completed 	agreement 	between 	the 	resident 	and
the 	facility, 	describing 	services 	to 	be
provided, 	rates 	charged, 	and 	conditions 	under
which 	additional 	services 	or 	fees 	may 	be
charged;
(5) 	The 	resident 	shall 	be 	informed 	of 	his 	or 	her
rights, 	including 	steps 	for 	complaints 	and
appeals 	upon 	admission; 	and
(6) 	Designation 	of 	alternative 	decision-maker 	or
legal 	representative.
(b) 	The 	facility 	shall 	develop 	discharge 	policies
and 	procedures 	that 	include, 	but 	not 	be 	limited 	to, 	the
following:
(1) 	Residents 	shall 	receive 	a 	written 	14 	day
90-16

(
§11-90-11
notice 	when:
(A) 	Resident's 	behavior 	imposes 	an 	imminent
danger 	to 	self 	or 	others;
(B) 	The 	facility 	cannot 	meet 	the 	resident's
needs 	wi th 	available 	support 	services 	or
services 	are 	not 	available; 	and
(C) 	Resident 	or 	responsible 	person 	has 	a
documented 	established 	pattern 	in 	the
facility 	of 	not 	abiding 	by 	agreements
necessary 	for 	assisted 	living; 	or
(2) 	Residents 	shall 	receive 	a 	written 	notice
when:
(A) 	The 	facility 	has 	had 	its 	license
revoked, 	not 	renewed, 	or 	voluntarily
surrendered; 	or
(B) 	Non-payment 	of 	charges 	by 	the 	resident.
(3) 	Residents 	shall 	be 	given 	the 	opportunity 	of
an 	informal 	conference 	if 	requested, 	in
writing, 	within 	10 	days 	of 	receip t 	of
discharge 	notice. 	The 	purpose 	of 	the
conference 	is 	to 	determine 	if 	a 	satisfactory
resolution 	can 	be 	reached. 	Participants 	in
the 	conference may 	include 	the 	facility
representative, 	the 	resident, 	and 	others 	as
designated 	by 	the 	resident, 	a 	family 	member,
or 	al \ 	ok these 	indi victuals.
[Eff 	AUo 2 3 1999 	] 	(Auth: 	HRS 	§§321-1,
321-9, 	321-10, 	321-11(10), 	321-15.1) 	(Imp:
HRS 	§§321-9, 	321-11(10), 	321-15.1)
§11-90-11 	Severability. 	If 	any 	provision 	of 	this
chapter 	or 	the 	application 	thereof 	to 	any 	person 	or
circumstance 	is 	held 	invalid, 	the 	remainder 	of 	this
chapter, 	or 	the 	application 	of 	the 	provision 	to 	other
persons 	or 	circUJ1) 9 h a Rc&srg fit-Q. all 	not 	be 	affected
thereby. 	[Eff 	AUb ,J 	~~ 	J 	(Auth: 	HRS 	§§321-1,
321-9, 	321-10, 	321-11(10), 	321-15.1) 	(Imp: 	HRS 	§§321-9,
321-11(10), 	321-15.1)	,,
90-17
221!