(a)As used in this Code section, the term:
(1)"Direct care staff person" means any employee, facility volunteer, or contract staff who provides to residents:
(A)Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or (B) Any other limited nursing services, as defined in subsection (b) of Code Section 31-7-12.2 .
(2)"Personal care home" means any dwelling, whether operated for profit or not, which undertakes through its ownership or management to provide or arrange for the provision of housing, food service, and one or more personal services for two or more adults who are not related to the owner or adminis
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(a) As used in this Code section, the term: (1) "Direct care staff person" means any employee, facility volunteer, or contract staff who provides to residents: (A) Any personal services, including but not limited to, medication administration or assistance, assistance with ambulation and transfer, and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting; or (B) Any other limited nursing services, as defined in subsection (b) of Code Section 31-7-12.2 . (2) "Personal care home" means any dwelling, whether operated for profit or not, which undertakes through its ownership or management to provide or arrange for the provision of housing, food service, and one or more personal services for two or more adults who are not related to the owner or administrator by blood or marriage. This term shall not include host homes, as defined in paragraph (18) of subsection (b) of Code Section 37-1-20 . (3) "Personal services" includes, but is not limited to, individual assistance with or supervision of self-administered medication and essential activities of daily living such as eating, bathing, grooming, dressing, and toileting. Personal services shall not include medical, nursing, or health services; provided, however, that the department shall be authorized to grant a waiver of this provision in the same manner as provided for in Code Section 31-7-12.3 for the waiver of rules and regulations and in the same manner and only to the same extent as granted on or before June 30, 2011. (b) All personal care homes shall be licensed as provided for in Code Section 31-7-3 , except that, in lieu of licensure, the department may require persons who operate personal care homes with two or three beds for nonfamily adults to comply with registration requirements delineated by the department. Such registration requirements within this category shall authorize the department to promulgate pursuant to Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," reasonable standards to protect the health, safety, and welfare of the occupants of such personal care homes. (c) Upon the designation by the department and with the consent of county boards of health, such boards may act as agents to the department in performing inspections and other authorized functions regarding personal care homes licensed under this chapter. With approval of the department, county boards of health may establish inspection fees to defray part of the costs of inspections performed for the department. (d) The state ombudsman or community ombudsman, on that ombudsman's initiative or in response to complaints made by or on behalf of residents of a registered or licensed personal care home, may conduct investigations in matters within the ombudsman's powers and duties. (e) The department shall promulgate procedures to govern the waiver, variance, and exemption process related to personal care homes pursuant to Chapter 2 of this title. Such procedures shall include published, measurable criteria for the decision process, shall take into account the need for protection of public and individual health, care, and safety, and shall afford an opportunity for public input into the process. (f) On and after July 1, 2024, personal care homes with 25 or more beds shall be required to meet the following staffing and training requirements: (1) Ensure that each direct care staff person receives initial and annual training covering topics specified by the department to ensure a demonstrated knowledge and understanding of caring for elderly and disabled adults; (2) Maintain an average monthly minimum on-site staffing ratio of one direct care staff person for every 15 residents during all waking hours and one direct care staff person for every 20 residents during all nonwaking hours; provided, however, that either such ratio is adequate to meet the needs of the residents; and (3) Ensure that no fewer than two on-site administrators or on-site direct care staff persons are present on the premises at all times with at least one staff person on each occupied floor and that person shall be required to remain posted on their designated floor at all times; provided, however, that the staff person posted on the designated floor may move about the premises as necessary if the personal care home has implemented a medical alert system and each resident has been provided a wearable device that connects to such system when activated to alert an administrator or direct care staff person of a medical emergency. (g) On and after July 1, 2021, personal care homes with 25 or more beds shall be required to meet the following financial stability requirements: (1) Upon initial application for licensure or upon a change of ownership, provide a financial stability affidavit to the department from a certified public accountant affirming the applicant's or licensee's financial status. The department shall establish a mandatory financial stability affidavit form pursuant to rules and regulations to be used for purposes of this paragraph and shall assess the applicant's or licensee's financial status, in its own discretion, based on such financial stability affidavit; (2) Provide a minimum of 60 days' written notice to the department and all residents of any impending bankruptcy or property eviction that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight; and (3) Provide a minimum of 14 days' written notice to the department and all residents of any impending change of ownership that may force discharge or relocation of residents or otherwise adversely impact the provision of safe care and oversight. (h) (1) A personal care home with 25 or more beds which operates a memory care center in its facility may employ certified medication aides for the purpose of performing the technical aspects of the administration of certain medications in accordance with this subsection. Any such personal care home may utilize certified medication aides in its memory care center and anywhere in the same building in which the memory care center is located. A personal care home that employs one or more certified medication aides must have a safe medication and treatment administration system that meets all the requirements of this subsection. (2) A personal care home may not employ an individual as a medication aide unless such individual is listed in the medication aide registry established by the department pursuant to paragraph (2) of subsection (g) of Code Section 31-7-12.2 in good standing. An applicant for certification as a medication aide shall meet the qualifications contained in paragraph (3) of subsection (g) of Code Section 31-7-12.2 . (3) A personal care home shall annually conduct a comprehensive clinical skills competency review of each medication aide employed by the personal care home. (4) A medication aide who meets the criteria established in this subsection shall be permitted to perform the following tasks in a personal care home in accordance with the written instructions of a physician: (A) Administer physician ordered oral, ophthalmic, topical, otic, nasal, vaginal, and rectal medications; (B) Administer insulin, epinephrine, and B12 pursuant to physician direction and protocol; (C) Administer medication via a metered dose inhaler; (D) Conduct finger stick blood glucose testing following established protocol; (E) Administer a commercially prepared disposable enema as ordered by a physician; (F) Assist residents in the supervision of self-administration of medication; and (G) Administer liquid morphine to a resident of the personal care home who is the patient of a licensed hospice, pursuant to a hospice physician's written order that contains specific instructions for indication, dosage, frequency, and route of administration, provided that the licensed hospice consents to the use and administration of liquid morphine as described in this subparagraph. The medication aide shall observe and document the resident's need for all "as needed" (PRN) liquid morphine in such resident's record and such indications of need may include verbalizations of pain, groaning, grimacing, or restlessness. The initial dose of any liquid morphine administered pursuant to this subparagraph shall be administered and assessed by a licensed hospice health care professional to observe and address any adverse reactions to such medication. The personal care home shall ensure that any medication aides who will be administering liquid morphine to any hospice patients in such personal care home pursuant to this subparagraph receive adequate training from a licensed hospice on the safe and proper administration of liquid morphine prior to such administration and on an annual basis thereafter. The personal care home shall maintain documentation of all training provided and shall adhere to all security and storage requirements for liquid morphine required under state and federal law, including but not limited to, any rules promulgated by the department. Notwithstanding the foregoing, the supply of liquid morphine on-site at the personal care home shall be limited to no more than 50 ml for each hospice patient in the personal care home and shall only be administered under limited circumstances when a licensed hospice health care professional is not otherwise available. The department shall promulgate rules and regulations to implement this subparagraph. (5) A medication aide shall record in the medication administration record all medications that such medication aide has personally administered to a resident of a personal care home and any refusal of a resident to take a medication. A medication aide shall observe a resident to whom medication has been administered and shall report any changes in the condition of such resident to the personal representative or legal surrogate of such resident. (6) All medication administered by a medication aide in accordance with this subsection shall be in unit or multidose packaging. (7) A personal care home that employs one or more medication aides to administer medications in accordance with this subsection shall secure the services of a licensed pharmacist to perform the following duties: (A) Perform a quarterly review of the drug regimen of each resident of the personal care home and report any irregularities to the personal care home administrator; (B) Remove for proper disposal any drugs that are expired, discontinued, in a deteriorated condition, or when the resident for whom such drugs were ordered is no longer a resident; (C) Establish or review policies and procedures for safe and effective drug therapy, distribution, use, and control; and (D) Monitor compliance with established policies and procedures for medication handling and storage. (8) A personal care home that employs one or more medication aides to administer medications in accordance with this subsection shall ensure that each medication aide receives ongoing medication training as prescribed by the department. A registered professional nurse or licensed pharmacist shall conduct random medication administration observations on a quarterly basis and report any issues to the personal care home administrator.