Georgia Regulatory Compliance Resources for Residential Care Facilities

Based on the sources, personal care homes are restricted from admitting or retaining residents with certain conditions or needs.

• Persons admitted to a personal care home must be at least 18 years of age.
• Except for aging in place exceptions, personal care homes are permitted to admit and retain only **ambulatory residents** who are **capable of self-preservation with minimal assistance**. This means staff may assist the resident in transferring from sitting or reclining and provide verbal directions to residents who can self-propel to the nearest exit.
• Aging in place exceptions may allow up to three non-ambulatory residents to remain in the home under specific criteria, including ensuring safe and timely evacuation during emergencies and meeting other requirements. These exceptions can be revoked by the Department if criteria are not met.
• The home must not admit or retain persons who require the use of **physical or chemical restraints, isolation, or confinement for behavioral control**.
• No home is permitted to admit residents who either require **continuous medical services or continuous nursing care and treatment**.
• Medical, nursing, health, or therapeutic services required on a periodic basis or for short-term illness must be purchased by the resident or their representative from appropriately licensed providers managed independently from the home. The home may assist in arranging these services, but not provide them.
• No home is permitted to admit or retain a resident who needs **care beyond what the home is permitted to provide**.
• Where the Department has reason to believe that a resident is receiving or requires continuous medical or nursing care, the Department may require the home to discharge the resident.

The sources outline various documentation requirements for personal care homes:

• The application for a permit must be complete and include all required attachments and fees as specified in Chapter 111-8-25 of the rules.
• Each application must include a sketch, plat, photos, or drawing of the home and grounds, showing identification of all structures, windows, doors, room measurements, and bed placement, accompanied by documentation of ownership or lease agreement.
• The name of the administrator or on-site manager must be included with the application, or provided before a permit is issued if not known at the time of application.
• Ownership of the home must be fully disclosed in the application. For corporations, partnerships, and other bodies created by statute, corporate officers and individuals or family groups owning 10% or more must be disclosed, along with the registered agent for service of process.
• For initial applications for homes with 25 or more beds, a **financial stability affidavit from a certified public accountant** affirming the applicant’s ability to operate as a going concern for the next two years must be included.
• A signed copy of an electrical service inspection report from a licensed electrician or local code enforcement official, dated within six months prior to the application date, must be submitted as part of the application.
• A home undergoing changes resulting in a change to the floor sketch submitted during initial licensing must have such changes approved by the Department.
• Homes licensed for 25 or more beds must calculate and document **average monthly minimum staffing levels** using methods and forms specified by the department.
• Accurate **staffing plans** that consider resident needs and monthly work schedules for all employees, including relief workers, showing planned and actual coverage, must be developed and maintained. Completed staff schedules must be retained for a minimum of one year.
• When relocating residents due to an emergency, the home must provide timely notification of the relocation address to residents, family contacts, representatives, and the Department.
• Written notice must be provided to the Department and residents: a minimum of sixty (60) days for impending bankruptcy or eviction that may force discharge/relocation or adversely impact care, and a minimum of thirty (30) days for impending change of ownership.
• **Workforce qualifications and training documentation** must be maintained. This includes evidence of current certification in emergency first aid (unless a licensed health care professional), current certification in cardiopulmonary resuscitation (with demonstrated competency), training on emergency evacuation procedures, medical and social needs of residents, residents’ rights, identification and reporting of abuse, neglect, or exploitation (including employee receipt of the Long-Term Care Facility Resident Abuse Reporting Act copy), and general infection control principles.
• Documentation of **satisfactory completion of continuing education** (at least 16 hours per year) for all direct care staff, including the administrator or on-site manager, must be maintained.
• Documentation of **tuberculosis screening and physical examination** within twelve months prior to employment for the administrator, on-site manager, and each employee must be kept in the staff person’s file, accessible at the home or within one hour of request. Follow-up examination documentation for returning to work after significant illness or injury is also required.
• Documentation of **satisfactory fingerprint records check determinations** for owners, directors, administrators, on-site managers, and direct access employees must be obtained in compliance with Chapter 111-8-12 and maintained.
• Documentation of a **five-year employment history** (when possible) or a satisfactory personal reference check (if no prior employment history) must be obtained and maintained in the employee’s file.
• **Personnel files** for each employee must be maintained for three years following departure or discharge, either in the home or available within one hour of request or prior to the end of an on-site survey. These files must include evidence of satisfactory fingerprint record check determination (if applicable), physical examination report, evidence of trainings, skills competency determinations and recertifications, employment history, supporting documentation of basic qualifications (e.g., references, good standing by nursing board, no findings on nurse aide registry, driving record if transporting residents), and written evidence of satisfactory initial and annual work performance reviews.
• If a resident hires a companion-sitter, proxy caregiver, or aide, the home must require assurance that they are familiar with emergency evacuation routes and have documentation reflecting compliance with Proxy Caregivers rules if applicable.
• A written report of inspection is issued by the Department when rule violations are identified.
• Within 10 days of receiving the inspection report, the home must develop a **written plan of correction** identifying specific actions and dates to come into compliance. This plan must be filed with the Department.
• If the home disagrees with the inspection report, a written statement explaining the disagreement and supporting evidence may be included with the plan of correction.
• A copy of the most recent inspection report and plan of correction must be **displayed in a conspicuous place** in the home for residents and visitors. If the home has a website, a web link to inspection reports and plans of correction from the previous 18 months must be posted prominently. The plan of correction must also be filed electronically on the Department’s website when available and notified to the home.
• The home must complete and maintain an accurate and current **licensed residential care profile** on file with the Department when an electronic submission system is available.
• For memory care centers, an accurate **written description** must be developed, including philosophy, how services differ, staffing details (titles, training, continuing education, ratios), admission procedures, assessment and service planning protocol, physical environment description (including safety features), activities description, fee structure, discharge criteria, emergency procedures, and family involvement. This description must be disclosed to any person upon request and to the family or resident’s representative before admission to the memory care center.
• Memory care centers must maintain documentation reflecting course content, instructor qualifications, agenda, and attendance rosters for all **staff training sessions**. Documentation of dementia-specific orientation, direct care orientation (including general training and specialized competency-based training), and ongoing specialized competency-based training must be maintained. Documentation of hospice training for medication aides administering liquid morphine is also required.
• Residents in memory care centers who are at risk of eloping must have **current pictures retained on file** at the home.
• A **Report of Physical Examination** completed by a licensed physician, nurse practitioner, or physician’s assistant within 30 days prior to admission is required for all residents. This report must use the specific form made available by the Department.
• For memory care center placement, the physical examination report must clearly reflect a **diagnosis of probable Alzheimer’s Disease or other dementia** and symptoms demonstrating a need for placement, and establish that the resident does not require 24-hour skilled nursing care.
• For emergency placements requested by a governmental agency, local law enforcement, or case manager, the home must retain documentation of the need for emergency placement and obtain a copy of a physical examination within 14 days following admission.
• A **written admission agreement** must be entered into with the resident. This agreement must contain a statement of all fees, additional fee services (with resident signature acknowledging cost), statement of notice periods for fee increases (30 days for personal services, 60 days for room and board), resident authorization to release medical information, provisions for continuous needs assessment and referral/transfer, transportation provisions (basic or reimbursement), emergency transportation access, refund policy, statement that residents cannot perform services for the home, a copy of the house rules, disclosure on independent proxy caregivers/sitters/aides (for residents admitted after the rule effective date), disclosure on medication handling and who is responsible for acquisition/refilling and required packaging (for residents admitted after the rule effective date), explanation of discharge/transfer procedures, and explanation of how social media/photos are handled (for residents admitted after the rule effective date).
• A signed copy of the admission agreement must be retained in the resident’s file, and signed copies given to the resident and representative/legal surrogate.
• A **written care plan** is required within 14 days of admission for residents receiving proxy caregivers or memory care. This plan must describe care and social needs/services (including frequency), resident preferences, specific behaviors/interventions, physician/NP/PA orders for assistive devices, staff primarily responsible, evidence of resident/family involvement (when appropriate), and evidence of being updated annually (and more frequently with substantial change).
• For memory care centers, the **individual service plan** must be developed within 14 days of admission by a team including direct care staff from each shift, signed by all participating team members, and shared with direct care staff. It must include a description of care/social needs/services, resident preferences, specific behaviors/interventions, names of staff primarily responsible, evidence of family involvement (if possible, incorporating family/personal history), and evidence of being updated quarterly or more frequently.
• Where the home provides assistance with or supervises self-administered medications, or administers medications, a **daily Medication Assistance Record (MAR)** must be maintained for each resident receiving the service. The MAR must include resident name, known allergies, healthcare provider contact info, medication name, strength, directions (including severe side effects/adverse reactions summary), and a chart for staff initials, time, date, and recording when medications are taken, refused, or a medication error occurs. Staff must update the MAR each time medication is offered or taken.
• Documentation of any **unusual reactions to medications** must be made in the resident’s record and provided to the resident, representative, and healthcare provider as appropriate.
• Where liquid morphine is administered by a certified medication aide, staff must observe and document the resident’s need, date/time/location of the initial dose by hospice, dosage/time/route of administration in the community, training provided by hospice, and information regarding special circumstances when hospice was unavailable.
• A **physician, advance practice registered nurse, or physician assistant’s order or individualized prescription bottle** with clear instructions must be on file for staff to assist with or supervise self-administered medications, including over-the-counter medications.
• For controlled substances, a **log** must be maintained and updated daily by the home to account for all inventory.
• Homes using certified medication aides must maintain documentation of: checking the Georgia Certified Medication Aide Registry, administering **skills competency checks** when hired and annually thereafter, quarterly **random medication administration observations** conducted by a licensed registered professional nurse or pharmacist, quarterly **drug regimen reviews** by a licensed pharmacist, and **annual comprehensive clinical skills competency reviews** by a Georgia-licensed registered nurse, pharmacist, or physician.
• If a medication aide is terminated for cause related to performance, the home must provide a **separation notice** describing the facts and informing the aide about the impact on their registry standing. A copy of the separation notice must be submitted to the Georgia Certified Medication Aide Registry only if the termination for cause related to medication aide tasks has been upheld by the Department of Labor or the appeal time has expired.
• Homes providing certified medication aide training must maintain documentation verifying the aide is in good standing on the Georgia certified nurse aide registry and documentation necessary for placing the aide on the Georgia Certified Medication Aide Registry.
• Menus must be written and posted 24 hours prior to serving. Any changes or substitutions must be noted as part of the original menu.
• Homes must maintain **records of all menus as served** for 30 days after use.
• An individual **resident file** must be maintained for each resident. This file must include identifying information, contact information for next of kin/legal guardian/representative/surrogate/payee (and documentation of designation), contact information for persons/agencies providing additional services, an admission and discharge log, physician/hospital/pharmacy contact info, record of monetary transactions (with receipts), record of monies/valuables entrusted for safekeeping (with receipts), health information (appraisals, diagnoses, diets, medications, physician’s instructions), inventory of personal items, a signed copy of the Resident’s Rights form, a signed copy of the admission agreement, power of attorney/court documents/SSA documents regarding financial management, copy of living will/DPOA for health care/advance directive for health care (and physician’s order for life-sustaining treatment if any), a copy of the resident’s written waiver of the personal needs allowance charge, signed medical orders impacting end-of-life care, all required individual written care plans, any informed written consents for proxy caregiver performance of health maintenance activities, and a copy of National Sex Offender Registry search results and resulting safety plan.
• Resident files must be maintained by the home for a period of **three years after a resident’s discharge**.
• A record of all accidents or sudden adverse changes in a resident’s condition and the home’s response must be retained in the resident’s file.
• A copy of the notification report provided to the representative or legal surrogate regarding an accident or injury must be maintained in the resident’s file.
• The complete investigative review concerning an accident or injury (circumstances, cause, identified improvement opportunities) must be retained in a central file for quality assurance/peer review.
• Upon request from the Department, the governing body must provide a current physical examination report from a physician, nurse practitioner, or physician assistant indicating the resident’s continued ability to meet retention requirements if a significant change in physical or mental condition occurs.
• Documentation of the reasons for immediate transfer must be made in the resident’s file.
• Documentation in the resident’s file following an immediate transfer must include the reason for transfer, how the resident/representative/surrogate were informed, and the name/address/telephone number of the receiving facility.
• A copy of the resident file must be provided to the receiving facility within 24 hours of transfer, or prior to or at the time of transfer in non-immediate transfers.
• When discharging or transferring a resident (except for immediate transfer), the home must provide 30 days’ written notice to the resident and representative/legal surrogate.
• Incident reports for serious incidents (accidental/unanticipated death, serious injury requiring medical treatment, abuse/neglect/exploitation, external disaster, staff/family financial association with resident, owner/director/employee criminal record) must be submitted through the home’s peer review process within 24 hours. The report must include home name, administrator/manager name, date of incident, date home became aware, type and brief description of incident, and subsequent remedial/quality measures identified through peer review.

The sources detail requirements for staffing in personal care homes:

• The on-site manager and all other direct-care supervisory staff working in a personal care home must be **at least 21 years of age**.
• Non-supervisory staff providing hands-on care to the residents must be at least **18 years of age**.
• The home must have an **administrator** who is at least 21 years of age.
• Administrators of homes licensed for fewer than 25 beds must have either an Associate’s Degree or a G.E.D. or high school diploma and 2 years of experience working in a licensed personal care home or other healthcare-related setting.
• Administrators of homes licensed for 25 or more beds must hold a valid license from the State Board of Long-Term Care Facility Administrators within 60 days of hire or July 1, 2021, whichever is later.
• The administrator or on-site manager must designate **qualified staff** as responsible staff to act on their behalf during absences. A resident shall not be designated as staff.
• Personnel must be assigned duties consistent with their positions, training, and experience.
• **Minimum on-site staff to resident ratios** are specified:
  • Homes licensed for **less than 25 beds**: One awake direct care staff person per **15 residents** during waking hours. One awake direct care staff person per **25 residents** during non-waking hours for residents with minimal care needs.
  • Homes licensed for **25 or more beds**: An average monthly minimum on-site staff to resident ratio of one awake direct care staff person per **15 residents** during waking hours. An average monthly minimum on-site staff to resident ratio of one awake direct care staff person per **20 residents** during non-waking hours.
• **Notwithstanding the minimum ratios, all homes must staff above these minimums to meet the specific residents’ ongoing health, safety, and care needs**.
• Staff whose job duties do not routinely involve direct personal care (e.g., cooks, maintenance staff) and do not receive ongoing direct care training **must not be counted** towards minimum staffing ratios. Personnel working for other entities (e.g., home health, hospice, private sitters) also **cannot be counted** in the home’s staff ratios.
• At least one administrator, on-site manager, or responsible staff person must be on the premises **24 hours per day** and available to respond to resident needs, with a **minimum of one staff person per occupied floor**.
• Residents must be supervised consistent with their needs.
• Sufficient staff time must be provided to ensure each resident receives prescribed care, proper care to prevent pressure ulcers/contractures, comfort and cleanliness, dignity and respect, protection from avoidable injury/infection, prompt assistance with eating if needed, assistance with hygiene (bathing, oral care) if needed, and assistance with transferring if needed.
• The administrator, on-site manager, or staff person must not be under the influence of alcohol or other controlled substances while working.
• Homes licensed for more than 24 residents must ensure staff wear readily visible employee identification badges.
• For certified memory care centers, **additional staffing requirements** apply:
  • One **dementia trained direct care staff person** for every **12 residents** on-site during all waking hours (monthly average).
  • One **dementia trained direct care staff person** for every **15 residents** on-site during all nonwaking hours (monthly average). The ratio must be adequate to meet the residents’ needs.
  • One registered professional nurse, licensed practical nurse, or certified medication aide **on-site at all times**.
  • **Two direct care staff persons** on-site at all times, with at least one on each occupied floor.
  • One registered professional nurse or licensed practical nurse on-site or available in the building at all times based on center size [21(d)]:
    • 1-12 residents: minimum of **eight hours per week** [21(d)(i)].
    • 13-30 residents: minimum of **16 hours per week** [21(d)(ii)].
    • 31-40 residents: minimum of **24 hours per week** [21(d)(iii)].
    • More than 40 residents: minimum of **40 hours per week** [21(d)(iv)].