Pennsylvania Regulatory Compliance Resources for Residential Care Facilities

Personal care homes are subject to several prohibitions to ensure resident health, safety, and rights. These include:

• Discriminatory Practices: A resident may not be discriminated against based on race, color, religious creed, disability, handicap, ancestry, sexual orientation, national origin, age, or sex.
• Mistreatment and Abuse: A resident may not be neglected, intimidated, physically or verbally abused, mistreated, subjected to corporal punishment, or disciplined in any way. The definition of abuse includes infliction of injury, unreasonable confinement, intimidation or punishment resulting in harm/pain/anguish; willful deprivation of necessary goods or services; sexual harassment/rape/abuse; exploitation; neglect resulting in harm/pain/anguish; and abandonment or desertion. Neglect specifically includes failure to provide care, supervision, and services necessary to maintain a resident’s health, safety, and well-being that the home agreed to provide.
• Deprivation of Rights: A resident may not be deprived of their rights. A resident’s rights may not be used as a reward or sanction.
• Restraints and Safe Management Techniques:
  • Seclusion (involuntary confinement preventing physical exit) is prohibited, except for admission to a secured dementia care unit.
  • Aversive conditioning (applying startling, painful, or noxious stimuli) is prohibited.
  • Pressure point techniques (applying pain for compliance) are prohibited.
  • Chemical restraints (using drugs/chemicals solely to control acute/episodic aggressive behavior) are prohibited; this does not include drugs prescribed for a medical condition or as pretreatment.
  • Mechanical restraints (devices restricting movement or function), such as geriatric chairs, handcuffs, poseys, waist straps, etc., are prohibited. Devices prescribed by a medical professional for support or balance are not considered mechanical restraints as long as the resident can easily remove them.
  • Manual restraints (hands-on physical means restricting movement) are prohibited; this does not include prompting, escorting, or guiding for ADLs/IADLs.
• Food Practices: Withholding meals, beverages, snacks, or desserts as punishment is prohibited (unless for prescribed medical/dental procedures). Forcing a resident to eat food is prohibited. Food served and returned from an individual’s plate may not be served again or used in preparation of other dishes. Staff, volunteers, or residents with discharging/infected wounds/sores/lesions on hands or exposed body parts may not work in kitchen areas. Regular use of plastic and paper plates, utensils, and cups for meals is prohibited. Use of a common towel is prohibited.
• Financial Management: The legal entity, administrator, and staff persons are prohibited from being assigned power of attorney or guardianship of a resident or a resident’s estate. Seeking or accepting payments from a resident in excess of one-half of any funds received by the resident under the Senior Citizens Rebate and Assistance Act is prohibited. Requiring or permitting a resident to assign assets to the home in return for a life care contract/guarantee is prohibited, unless the home is a continuing care community with a Certificate of Authority from the Insurance Department. Commingling of resident funds and home funds is prohibited. Resident funds and property shall only be used for the resident’s benefit.
• Physical Site and Safety:
  • Poisonous materials must be stored separately from food and kept locked and inaccessible to residents, unless all residents can safely use or avoid them.
  • Heat sources exceeding 120°F that are accessible to residents must be equipped with protective guards or insulation.
  • Portable space heaters are prohibited.
  • The use of kerosene burning heaters is prohibited.
  • Combustible and flammable materials may not be located near heat sources or hot water heaters and must be inaccessible to residents.
  • Stairways, hallways, doorways, passageways, and egress routes must be unlocked and unobstructed. Doors used for egress may not have key-locking devices, electronic card systems, or other devices preventing immediate egress, unless the home has written approval or a variance from the Department of Labor and Industry, Health, or local authority.
  • Elevators may not be used during a fire drill or a fire.
  • Firearms, weapons, and ammunition are only permitted if stored in a locked cabinet/area separate from resident rooms/common areas, ammunition separate from firearms, and the key is held by the administrator/designee who is the only one permitted access. A resident may not take a firearm, weapon, or ammunition out of the locked cabinet into living areas.
  • Swimming areas may not be used without a staff person trained in first aid and certified in obstructed airway techniques and CPR who serves as a lifeguard.
• Bedroom Conditions: Cots and portable beds are prohibited. Bunk beds or other raised beds requiring residents to climb are prohibited. A bedroom may not be used as an exit from or passageway to another part of the home unless in an emergency. A resident may not be required to share a bedroom with an individual of the opposite sex.
• Pet Conditions: Pets accessible to residents must be in good health and nonaggressive.
• Transportation: The driver of a home vehicle used for transportation cannot be a resident.
• Medications: Outdated or spoiled food or dented cans may not be used. Keeping outdated, expired, or medications for residents no longer served at the home is prohibited.

Personal care homes must maintain various types of documentation, including licenses, records, plans, policies, and reports. Key required documentation includes:

• Licensure and Approval:
  • Current license, a copy of the current license inspection summary, and a copy of Chapter 2600 must be posted in a conspicuous and public place.
  • Written fire safety approval from the Department of Labor and Industry, Department of Health, or appropriate local building authority is required prior to licensing.
  • If the home serves residents with mobility needs, a valid Certificate of Occupancy specifying the required use and occupancy classification is to be possessed. If the Certificate of Occupancy is incorrect, the home must provide a plan to the Department, and if pursuing a new CO, a step-by-step renovation plan is required. If a correct CO cannot be obtained, documentation demonstrating safe emergency evacuation through staffing or operation is required.
  • A copy of a Certificate of Authority from the Insurance Department is required for continuing care communities exempt from the life care contract prohibition.
• Policies and Procedures:
  • Written policies and procedures on the prevention, reporting, notification, investigation, and management of reportable incidents and conditions.
  • Written procedures for the delivery and management of services from admission to discharge.
  • A written policy and procedures regarding the safety, access, and use of resident-owned firearms, weapons, and ammunition, if applicable.
  • Written policy and procedures addressing resident record accessibility, security, storage, authorized use, release, and who is responsible for records.
  • Written procedures for the safe storage, access, security, distribution, and use of medications and medical equipment by trained staff. These must include documentation of controlled substances/prescription medications receipt, a process to investigate missing medications/errors, limited access to storage areas, and documentation of administration for residents receiving assistance.
  • Written emergency medical plan.
  • Written emergency procedures, reviewed, updated, and submitted annually to the local emergency management agency.
  • Written smoking policy if smoking is permitted.
  • Home rules, including whether pets are permitted.
• Resident-Specific Documentation:
  • A separate record for each resident.
  • Entries in resident records must be permanent, legible, dated, and signed by staff. Standardized forms must be used. Records must be kept on the premises where the resident lives and stored in locked containers or a secured area accessible to authorized individuals.
  • Resident record content must include identity information (name, gender, admission date, birth date, SSN, race, height, weight, hair/eye color, religion, identifying marks, recent photograph, language/communication means), designated person contact information, physician/healthcare source contact information, current and previous 2 years’ physician reports/medical evaluations, list of medications (prescribed, OTC, CAM), dietary restrictions, resident incident reports, list of allergies, documentation of health care services/orders, preadmission screening, initial intake assessment, current annual assessment, support plan, applicable court orders, medical insurance information, dates of entrance/relocations/discharges.
  • A written resident-home contract is required prior to or within 24 hours after admission, signed by the administrator/designee, resident, payer (if different), and cosigned by the designated person if the resident agrees. A copy must be given to the resident and filed in the resident’s record.
  • Documentation that the administrator or designee reviewed and explained the resident-home contract to the resident and designated person.
  • Documentation of efforts made to obtain signature if a resident or designated person is unable or chooses not to sign the support plan.
  • Medical evaluation by a physician, physician’s assistant, or certified registered nurse practitioner on a Department-specified form (within 60 days prior or 30 days after admission, and annually or upon condition change).
  • Preadmission screening on the Department’s form (within 30 days prior to admission).
  • Personal care home assessment completed within 15 days after admission on a Department form.
  • Support plan developed and implemented within 30 days after admission, documented on the Department’s form or an equivalent. The support plan must be revised within 30 days upon completion of the annual assessment or changes in needs. Participants in support plan development must sign and date it. The resident’s ability to self-administer medications or need for assistance/reminders must be documented in the support plan. Documentation of medical, dental, vision, hearing, mental health, or other behavioral care services or referrals made available/needed.
  • Current emergency medical and health information for each resident (name, birth date, SSN, diagnosis, physician contact, current medication/dosage/frequency, allergies, other relevant conditions, insurance info, POA/proxy info, designated person contact info, advance directives/DNR/organ donation) must be available at all times and accompany the resident needing emergency medical attention.
  • Documentation of resident’s special dietary needs prescribed by a professional.
  • Documentation of notifying the resident and designated person of a report of suspected abuse or neglect involving the resident.
  • Documentation of resident education on the right to question or refuse medication.
  • Documentation of adverse reactions to medication, the prescriber’s response, and action taken in the resident’s record.
  • Documentation of notifying the prescriber within 24 hours of a resident’s refusal to take a prescribed medication, and subsequent refusals as required by the prescriber, recorded in the resident’s record and medication record.
  • If a resident refuses to eat or drink continuously for 24 hours, immediate notification of the primary care physician and designated person must be documented.
  • Written consent for treatment for a serious medical or dental condition.
  • Written receipt from the resident for cash disbursements.
  • Itemized account of financial transactions made on the resident’s behalf, provided quarterly to the resident and designated person, with a copy kept in the resident’s record.
  • Written notice of discharge or transfer (30-day advance notice unless emergency) to the resident, designated person, and referral agent, citing reasons. Date, reason, and destination of discharge/transfer must be recorded in the resident record.
  • For secured dementia care units: Documentation that the resident and designated person have not objected to admission/transfer. Medical evaluation documentation (60 days prior to admission) for residents with primary dementia diagnosis. Written cognitive preadmission screening on Department form (72 hours prior to admission). For individuals without primary dementia diagnosis residing in the unit: medical evaluation (60 days prior or 30 days after residence). Written agreement containing disclosure of services, admission/discharge criteria, change in condition policies, programming, costs, and fees. Documentation of measures implemented to enhance environmental awareness and maximize independence.
  • If the home voluntarily closes, written notice of intent to close must be given to the Department at least 60 days prior.
• Staffing and Training Documentation:
  • Current list of the names, addresses, and telephone numbers of staff persons, including substitute personnel and volunteers.
  • Record of training including the individual trained, date, source, content, length of each course, and copies of certificates received for administrator and direct care staff training.
  • Written verification of successful completion of administrator training provided to the Department’s regional office.
  • Staff training plan developed annually, including staff name, position, duties, required courses, and scheduled training dates/times/locations. Documentation of compliance with the plan.
  • Proof that each administrator training instructor is certified by the Department and documentation of the instructor’s academic credentials, instructional experience, and work experience.
  • Training certificates issued to participants completing Department-approved administrator training.
• Maintenance and Safety Documentation:
  • Written sanitation approval for the sewage system by the sewage enforcement official for homes with 9+ residents not connected to a public sewer.
  • Documentation of quarterly coliform water tests, remediation activity, and laboratory certification for homes not connected to a public water system.
  • Certificate of operation for elevators and stair glides.
  • Written report of missing or stolen resident property within 24 hours of discovery.
  • Current certificate of rabies vaccination from a licensed veterinarian for cats and dogs on the premises.
  • Documentation of annual furnace inspection and cleaning.
  • Documentation of annual inspection and cleaning of wood and coal burning stoves if used as a regular heating source.
  • Written record of monthly smoke detector and fire alarm testing.
  • Annual inspection and approval date marked on fire extinguishers. Documentation of annual fire safety inspection and drill conducted by a fire safety expert. Written fire drill record including specific details.
• Transportation Documentation:
  • Current copies of vehicle registration, valid driver’s license for operators, vehicle insurance, and current inspection for each home vehicle used for transportation. Commercial driver’s license if applicable.
• Hospice Care Documentation:
  • Documentation of compliance with specific hospice requirements, including a copy of the hospice agency license, written certification by the physician that the resident is actively dying, written informed consent for care in the home, and written documentation of the home’s consideration of relocating the resident’s bedroom. This documentation should be kept in the fire drill record and the resident’s record.

The staffing requirements for personal care homes in Pennsylvania depend on the size of the home, the needs of the residents, and the specific duties performed by staff members.

• Administrator Staffing:
  • The administrator must be present in the home an average of **20 hours or more per week**, in each calendar month.
  • The administrator must meet specific qualification criteria, which vary based on the home’s size (8 or fewer residents vs. more than 8 residents). These qualifications include combinations of nursing licenses, college degrees/credit hours, or high school diploma/GED with relevant experience. The administrator must be **21 years of age or older**.
  • The administrator is responsible for overall administration, management, resident health/safety/well-being, policy implementation, and compliance with regulations. They must have the ability to provide or supervise personal care services, knowledge of the regulations, ability to comply with laws, maintain records, and be free from medical conditions that would impair their duties.
  • Administrators hired or promoted prior to December 1, 2004, or those who transfer with limited break in service, may be exempt from current staff qualification requirements.
  • Administrators must successfully complete a Department-approved orientation, a **100-hour standardized training course**, and a competency test before initial employment, unless hired/promoted prior to October 24, 2005. The training covers various topics related to home operation and resident care.
  • Administrators must have at least **24 hours of annual training** related to their job duties, from Department-approved sources or accredited colleges/universities. Licensed nursing home administrators may have modified training requirements.
• Direct Care Staffing:
  • Direct care staff persons must meet specific qualifications, including being **18 years of age or older** (with limited exceptions for 16/17 year olds), having a high school diploma, GED, or active status on the PA nurse aide registry, and being free from medical conditions that would impair their ability to provide care. Individuals 16 or 17 years old cannot perform medication administration or incontinence care/bathing/dressing without supervision.
  • Volunteers performing Activities of Daily Living (ADLs) must meet the same qualifications and training requirements as direct care staff. Residents voluntarily performing tasks are not considered volunteers under these rules.
  • Direct care staff hired or promoted prior to December 1, 2004, or those who transfer with limited break in service, may be exempt from current staff qualification requirements.
  • Presence in the Home: At all times one or more residents are present, at least **one direct care staff person who is 21 years of age or older** and serves as the designee must be present. This staff person may be the administrator if they provide direct care.
  • Personal Care Service Hours:
    • Direct care staff must be available to provide at least **1 hour per day** of personal care services to each mobile resident.
    • Direct care staff must be available to provide at least **2 hours per day** of personal care services to each resident who has mobility needs.
    • At least **75%** of these required personal care service hours must be available during waking hours.
    • Residents in a secured dementia care unit are considered residents with mobility needs for staffing purposes.
  • Awake Staff: If a home serves **16 or more residents**, all direct care staff persons on duty must be awake at all times residents are present.
  • Multiple Buildings: For homes with multiple buildings, direct care staffing requirements apply when **four or more mobile residents**, or **one or more residents with mobility needs**, are present in the home.
  • Additional Staffing: Staffing must be provided to meet resident needs as specified in their assessment and support plan. The Department may require additional staffing if necessary to protect resident health, safety, and well-being, based on resident needs, home design/construction, and operation/management. Additional staff hours (or contractual) must be provided for laundry, food service, housekeeping, and maintenance needs.
  • Substitute Personnel: When regular direct care staff are absent, substitute personnel must meet the required qualifications and training requirements.
  • First Aid, CPR, Obstructed Airway: At least **one staff person for every 50 residents** who is trained in first aid and certified in obstructed airway techniques and CPR must be present in the home at all times. Training must be provided by a certified trainer. Licensed, certified, or registered medical personnel meet these qualifications and are exempt from this specific training. Trained staff must provide these services unless there is a do not resuscitate order.
  • Training and Orientation:
    • Prior to or during the first workday, direct care staff, ancillary staff, substitutes, and volunteers must receive orientation in general fire safety and emergency preparedness.
    • Within **40 scheduled working hours**, they must receive orientation covering resident rights, the emergency medical plan, mandatory abuse/neglect reporting, and reporting of reportable incidents/conditions.
    • Within **6 months** of hire or beginning service, direct care staff, ancillary staff, substitutes, and volunteers must successfully complete pre-service training covering specific topics related to resident care, safety, and home operation.
    • Direct care staff must have at least **12 hours of annual training** related to their job duties. Specific annual training topics include fire safety, emergency preparedness, resident rights, the Older Adult Protective Services Act, falls/accident prevention, and training on new population groups served.
  • Medication Administration: Staff administering certain medications must have successfully completed a Department-approved medication administration course and competency test within the past **2 years**. Administering insulin requires additional training.