E1. Does the Landlord-Tenant law apply at the site for which you are filling out this assessment?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) or a blank lease agreement indicating persons-served are afforded protections against eviction, the same as persons not receiving HCBS services.
NOTE: CMS has indicated to KDADS that it is the provider’s responsibility to ensure those protections are in place. E1 is a trigger question for whether the Landlord-Tenant Law applies in the area of the residence.
NOTE: Please ensure that any evidence has been de-identified and does not include PHI.
CMS/Final Rule Guidance: The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement will be in place for each HCBS participant, and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law.
E1.1 Is there a written agreement at this site that offers responsibilities/protections from eviction for persons-served?
Policy & Evidence Expectation: Preferred evidence would be policy(s)/procedure(s) indicating that all tenants regardless of whether they have a disability or not have the same rights to protections from eviction as outlined in the Landlord-Tenant law.
NOTE: Please ensure that any all evidence has been de-identified and does not include PHI.
NOTE: If question E1 is valid then question E1.1 is valid
CMS/Final Rule Guidance: The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement will be in place for each HCBS participant, and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law.
F1. Does this site have entrance doors that can be locked by the persons-served, with only appropriate staff having keys to door?
Policy & Evidence Expectation: Preferred evidence would be policy(s)/procedure(s) indicating entrance doors can be locked by persons-served and only appropriate staff have keys to the doors. Entrance doors may indicate the doors to the individuals personal living space.
CMS/Final Rule Guidance: Each individual has privacy in their sleeping or living unit: Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.
F2. Does this site provide anyone (besides the persons-served and appropriate staff) with a key or a way to be ''buzzed in'' for entering the facility?
Policy & Evidence Expectation: Preferred evidence would be policy indicating that setting has an alternative method for allowing entry. This can be achieved through knocking, a doorbell or other methods. It should also extend to the person-served having some amount of control over allowing their own visitors to come and go.
CMS/Final Rule Guidance: Individuals are able to have visitors of their choosing at any time. Each individual has privacy in their sleeping or living unit: Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.
F3. Can persons-served at this site lock the bathroom door for privacy?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space with only appropriate staff having access to their personal living space.
CMS/Final Rule Guidance: The setting ensures an individual’s rights of privacy, dignity and respect, and freedom from coercion and restraint. Each individual has privacy in their sleeping or living unit.
F4. Do persons-served at this site have the option of locking his/her bedroom door for privacy when they choose?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space with only appropriate staff having access to their personal living space.
CMS/Final Rule Guidance: Each individual has privacy in their sleeping or living unit: Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.
F5. Do staff at this site knock on the door or ring a doorbell for access to persons-served private room(s)?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space with only appropriate staff having access to their personal living space. This policy(s)/procedure(s) should indicate that staff are required to announce themselves (knock, ring entry bell, or other method) and request permission to access the persons-served personal living space.
CMS/Final Rule Guidance: Each individual has privacy in their sleeping or living unit: Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.
F6. Are the living spaces at this site arranged in a way that ensures privacy during personal care?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space with only appropriate staff having access to their personal living space. This can be achieved through having locks, doors or other methods for obtaining privacy. Most importantly, evidence should reflect in policy that persons-served are assured privacy while addressing their own personal needs and care.
CMS/Final Rule Guidance: Ensures an individual’s rights of privacy, dignity and respect, and freedom from coercion and restraint. Each individual has privacy in their sleeping or living unit.
F7. Does the facility at this site offer privacy to persons-served while using a telephone, internet, or any other personal communication devices?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space. This should include privacy while using the telephone, internet, or any other personal communication devices. Persons-served should at the very least have the same assurance of privacy as someone not receiving HCBS services in their own home.
CMS/Final Rule Guidance: Ensures an individual’s rights of privacy, dignity and respect, and freedom from coercion and restraint. The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
F8. Does the facility at this site have larger than double occupancy bedrooms?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space with only appropriate staff having access to their personal living space. This policy(s)/procedure(s) would include the ability to choose their roommate if a double occupancy or larger living space.
CMS/Final Rule Guidance: Each individual has privacy in their sleeping or living unit. Ensures an individual’s rights of privacy, dignity and respect, and freedom from coercion and restraint. Individuals sharing units have a choice of roommates in that setting.
F9. Are persons-served at this site given the option to choose their roommate when sharing a bedroom? (If you have single occupancy rooms ONLY, select "Yes").
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served are assured privacy in their personal living space with only appropriate staff having access to their personal living space. This policy(s)/procedure(s) would include the ability to choose their roommate if a double occupancy or larger living space.
CMS/Final Rule Guidance: Individuals sharing units have a choice of roommates in that setting.
F10 (a). Are bedroom decorations and furniture arranged at the discretion of the person-served at this site?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have the right to and can decorate and furnish their personal living space as they choose.
CMS/Final Rule Guidance: Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement.
F10 (b). Are furniture decorations arranged at the discretion of the person-served at this site?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have the right to and can decorate and furnish their personal living space as they choose.
CMS/Final Rule Guidance: Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement.
F11. Do persons-served at this site set their own daily routines for things such as hygiene, care delivery, recreation, and meals?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have the right to set their own daily routines for such things as hygiene, care delivery, recreation and meals.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to food at any time.
F12. Do persons-served at this site have full access to laundry facilities?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have full access to the laundry facilities.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to laundry facilities at any time.
F13. Can persons-served at this site choose to do their own laundry?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have the right to choose to do their own laundry.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to laundry facilities at any time.
F14. Do persons-served at this site have full access to the common area?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have full access to the common areas.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to common areas at any time.
F15. Do persons-served at this site have full access to the dining area?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have full access to the dining area.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time.
F16. Do persons-served at this site have full access to the microwave and refrigerator?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have full access to the microwave and refrigerator.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to food at any time.
F17. Do persons-served at this site have full access to the kitchen?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have full access to the kitchen.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to food at any time.
F17.1 Do persons-served at this site have access to a separate meal prep area or options to cook if they desire (within the limitations of their service plan)?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have access to a separate meal prep area or options to cook if they desire. Modifications/limitations to this would be indicated in the persons-served personal care plan.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to food at any time. Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact.
F18. Do persons-served at this site have a choice of when AND what to eat?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have a choice of when and what to eat.
CMS/Final Rule Guidance: Individuals have the freedom and support to control their own schedules and activities and have access to food at any time. Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact. The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
F19. Do persons-served at this site have a choice to eat alone or with others?
Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have a choice to eat alone or with others, including with whom they would like to eat with.
CMS/Final Rule Guidance: Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment and with whom to interact.