Ariz. Admin. Code § R9-10-503 - Administration

A. A governing authority shall:

1. Consist of one or more individuals responsible for the organization, operation, and administration of an ICF/IID;

2. Establish, in writing, the ICF/IID's scope of services;

3. Designate, in writing, an administrator for the ICF/IID who:

a. Is at least 21 years old; and

b. Either:

i. Is a nursing care institution administrator, or

ii. Has a minimum of three-years' experience working in an ICF/IID;

4. Adopt a quality management program according to R9-10-504;

5. Review and evaluate the effectiveness of the quality management program at least once every 12 months;

6. Designate, in writing, an acting administrator who meets the requirements in subsection (A)(3), if the administrator is:

a. Expected not to be present on the premises of the ICF/IID for more than 30 calendar days, or

b. Not present on the premises of the ICF/IID for more than 30 calendar days; and

7. Except as permitted in subsection (A)(6), when there is a change of administrator, notify the Department according to A.R.S. § 36-425(I) and, if applicable, submit a copy of the new administrator's license under A.R.S. § 36-446.04 to the Department.

B. An administrator:

1. Is directly accountable to the governing authority of an ICF/IID for the daily operation of the ICF/IID and all services provided by or at the ICF/IID;

2. Has the authority and responsibility to manage the ICF/IID;

3. Except as provided in subsection (A)(6), designates, in writing, an individual who is present on the premises of the ICF/IID and accountable for the ICF/IID when the administrator is not present on the ICF/IID's premises; and

4. Ensures the ICF/IID's compliance with A.R.S. §§ 36-411 and, as applicable, 8-804 or 46-459.

C. An administrator shall ensure that:

1. Policies and procedures are established, documented, and implemented to protect the health and safety of a resident that:

a. Cover job descriptions, duties, and qualifications, including required skills, knowledge, education, and experience for personnel members, employees, volunteers, and students;

b. Cover the process for checking on a personnel member through the adult protective services registry established according to A.R.S. § 46-459;

c. Cover orientation and in-service education for personnel members, employees, volunteers, and students;

d. Include methods to prevent abuse or neglect of a resident, including:

i. Training of personnel members, at least annually, on how to recognize the signs and symptoms of abuse or neglect; and

ii. Reporting of abuse or neglect of a resident;

e. Include how a personnel member may submit a complaint relating to resident care;

f. Cover the requirements in A.R.S. Title 36, Chapter 4, Article 11;

g. Cover cardiopulmonary resuscitation training including:

i. Which personnel members are required to obtain cardiopulmonary resuscitation training,

ii. The method and content of cardiopulmonary resuscitation training,

iii. The qualifications for an individual to provide cardiopulmonary resuscitation training,

iv. The time-frame for renewal of cardiopulmonary resuscitation training, and

v. The documentation that verifies an individual has received cardiopulmonary resuscitation training;

h. Cover first aid training;

i. Include a method to identify a resident to ensure the resident receives active treatment and other physical health services and behavioral care as ordered;

j. Cover resident rights, including assisting a resident who does not speak English or who has a disability to become aware of resident rights;

k. Cover specific steps for:

i. A resident to file a complaint, and

ii. The ICF/IID to respond to a resident's complaint;

l. Cover health care directives;

m. Cover medical records, including electronic medical records;

n. Cover a quality management program, including incident reports and supporting documentation;

o. Cover contracted services;

p. Cover the process for receiving a fee for a resident and refunding a fee for a resident;

q. Cover resident's personal accounts;

r. Cover petty cash funds;

s. Cover fees and refund policies;

t. Cover smoking and the use of tobacco products on the premises; and

u. Cover when an individual may visit a resident in an ICF/IID; and

2. Policies and procedures for active treatment and other physical health services and behavioral care are established, documented, and implemented to protect the health and safety of a resident that:

a. Cover resident screening, admission, transport, transfer, discharge planning, and discharge;

b. Cover the provision of active treatment and other physical health services and behavioral care;

c. Cover acuity, including a process for obtaining sufficient nursing personnel and therapists to meet the needs of residents;

d. Include when general consent and informed consent are required;

e. Cover storing, dispensing, administering, and disposing of medication, including provisions for inventory control and preventing diversion of controlled substances;

f. Cover infection control;

g. Cover interventions to address a resident's inappropriate behavior, including:

i. The hierarchy for use;

ii. Use of time outs for inappropriate behavior; and

iii. Except in an emergency, require positive techniques for behavior modification to be used before more restrictive methods are used;

h. Cover restraints, both chemical restraints and physical restraints if applicable, that:

i. Require an order, including the frequency of monitoring and assessing the restraint; and

ii. Are necessary to prevent imminent harm to self or others, including how personnel members will respond to a resident's sudden, intense, or out-of-control behavior;

i. Cover seclusion of a resident including:

i. The requirements for an order, and

ii. The frequency of monitoring and assessing a resident in seclusion;

j. Cover telemedicine, if applicable;

k. Cover environmental services that affect resident care;

l. Cover the security of a resident's possessions that are allowed on the premises;

m. Cover methods to encourage participation of a resident's family or friends or other individuals in activities planned according to R9-10-513(C)(2);

n. Include a method for obtaining an advocate for a resident, if necessary;

o. Cover resident outings;

p. Cover the process for obtaining resident preferences for social, recreational, or rehabilitative activities and meals and snacks; and

q. Cover whether pets and animals are allowed on the premises, including procedures to ensure that any pets or animals allowed on the premises do not endanger the health or safety of residents or the public;

3. Policies and procedures are reviewed at least once every three years and updated as needed;

4. Policies and procedures are available to personnel members, employees, volunteers, and students; and

5. Unless otherwise stated:

a. Documentation required by this Article is provided to the Department within two hours after a Department request; and

b. When documentation or information is required by this Chapter to be submitted on behalf of an ICF/IID, the documentation or information is provided to the unit in the Department that is responsible for licensing and monitoring the ICF/IID.

D. An administrator shall designate an individual who is:

1. A qualified intellectual disabilities professional to oversee rehabilitation services provided by or on behalf of the ICF/IID; and

2. If the facility is authorized to admit patients who require intermittent nursing services or continuous nursing services, a registered nurse is appointed as director of nursing to oversee nursing services provided by or on behalf of the ICF/IID.

E. If abuse, neglect, or exploitation of a resident is alleged or suspected to have occurred before the resident was admitted or while the resident is not on the premises and not receiving services from an ICF/IID's employee or personnel member, an administrator shall report the alleged or suspected abuse, neglect, or exploitation of the resident as follows:

1. For a resident 18 years of age or older, according to A.R.S. § 46-454; or

2. For a resident under 18 years of age, according to A.R.S. § 13-3620.

F. If an administrator has a reasonable basis, according to A.R.S. § 13-3620 or 46-454, to believe that abuse, neglect, or exploitation has occurred on the premises or while a resident is receiving services from an ICF/IID's employee or personnel member, an administrator shall:

1. If applicable, take immediate action to stop the suspected abuse, neglect, or exploitation;

2. Report the suspected abuse, neglect, or exploitation of the resident as follows:

a. For a resident 18 years of age or older, according to A.R.S. § 46-454; or

b. For a resident under 18 years of age, according to A.R.S. § 13-3620;

3. Document:

a. The suspected abuse, neglect, or exploitation;

b. Any action taken according to subsection (F)(1); and

c. The report in subsection (F)(2);

4. Maintain the documentation in subsection (F)(3) for at least 12 months after the date of the report in subsection (F)(2);

5. Initiate an investigation of the suspected abuse, neglect, or exploitation and document the following information within five working days after the report required in subsection (F)(2):

a. The dates, times, and description of the suspected abuse, neglect, or exploitation;

b. A description of any injury to the resident related to the suspected abuse or neglect and any change to the resident's physical, cognitive, functional, or emotional condition;

c. The names of witnesses to the suspected abuse, neglect, or exploitation; and

d. The actions taken by the administrator to prevent the suspected abuse, neglect, or exploitation from occurring in the future; and

6. Maintain a copy of the documented information required in subsection (F)(5) and any other information obtained during the investigation for at least 12 months after the date the investigation was initiated.

G. An administrator shall:

1. Allow a resident advocate to assist a resident or the resident's representative with a request or recommendation, and document in writing any complaint submitted to the ICF/IID;

2. Ensure that a monthly schedule of recreational activities for residents is developed, documented, and implemented; and

3. Ensure that the following are conspicuously posted on the premises:

a. The current ICF/IID license issued by the Department;

b. The name, address, and telephone number of:

i. The Department's Office of Long Term Care, and

ii. Adult Protective Services of the Department of Economic Security;

c. A notice that a resident may file a complaint with the Department concerning the ICF/IID;

d. The monthly schedule of recreational activities; and

e. One of the following:

i. A copy of the current license survey report with information identifying residents redacted, any subsequent reports issued by the Department, and any plan of correction that is in effect; or

ii. A notice that the current license survey report with information identifying residents redacted, any subsequent reports issued by the Department, and any plan of correction that is in effect are available for review upon request.

H. An administrator shall provide written notification to the Department of a resident's:

1. Death, if the resident's death is required to be reported according to A.R.S. § 11-593, within one working day after the resident's death; and

2. Self-injury, within two working days after the resident inflicts a self-injury that requires immediate intervention by an emergency medical services provider.

I. An administrator shall:

1. Notify a resident's representative, family member, or other individual designated by the resident within one calendar day after:

a. The resident's death,

b. There is a significant change in the resident's medical condition, or

c. The resident has an illness or injury that requires immediate intervention by an emergency medical services provider or treatment by a health care provider; and

2. For an illness or injury in subsection (I)(1)(c), document the following:

a. The date and time of the illness or injury;

b. A description of the illness or injury;

c. If applicable, the names of individuals who observed the injury;

d. The actions taken by personnel members, according to policies and procedures;

e. The individuals notified by the personnel members; and

f. Any action taken to prevent the illness or injury from occurring in the future.

J. If an administrator administers a resident's personal account at the request of the resident or the resident's representative, the administrator shall:

1. Comply with policies and procedures established according to subsection (C)(1)(q);

2. Designate a personnel member who is responsible for the personal accounts;

3. Maintain a complete and separate accounting of each personal account;

4. Obtain written authorization from the resident or the resident's representative for a personal account transaction;

5. Document an account transaction and provide a copy of the documentation to the resident or the resident's representative upon request and at least every three months;

6. Transfer all money from the resident's personal account in excess of $50.00 to an interest-bearing account and credit the interest to the resident's personal account; and

7. Within 30 calendar days after the resident's death, transfer, or discharge, return all money in the resident's personal account and a final accounting to the resident, the resident's representative, or the probate jurisdiction administering the resident's estate.

K. If a petty cash fund is established for use by residents, the administrator shall ensure that:

1. The policies and procedures established according to subsection (C)(1)(r) include:

a. A prescribed cash limit of the petty cash fund, and

b. The hours of the day a resident may access the petty cash fund; and

2. A resident's written acknowledgment is obtained for a petty cash transaction.

L. An administrator shall ensure that an acuity plan is developed, documented, and implemented for each unit in the ICF/IID that:

1. Includes:

a. A method that establishes the types and numbers of personnel members that are required for each unit in the ICF/IID to ensure resident health and safety, and

b. A policy and procedure stating the steps the ICF/IID will take to obtain or assign the necessary personnel members to address resident acuity;

2. Is used when making assignments for resident treatment; and

3. Is reviewed and updated, as necessary, at least once every 12 months.

M. An administrator shall establish and document the criteria for determining when a resident's absence is unauthorized, including the criteria for a resident who:

1. Is absent against medical advice,

2. Is under the age of 18, or

3. Does not return to the ICF/IID at the expected time after an authorized absence.

N. An administrator shall ensure that the following are on the premises of the ICF/IID:

1. The most recent inspection report of the ICF/IID conducted by the Arizona Department of Economic Security under A.R.S. § 36-557(G)(1), and

2. Documentation of the most recent monitoring of the ICF/IID conducted by the Arizona Department of Economic Security under A.R.S. § 36-557(G)(2).

Notes

Ariz. Admin. Code § R9-10-503

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 20 A.A.R. 1409, effective 7/1/2014. Adopted by final rulemaking at 25 A.A.R. 1222, effective 4/25/2019. Amended by exempt rulemaking at 26 A.A.R. 72, effective 1/1/2020.