100
DEFINITIONS
For the purpose of these standards the following definitions
shall apply:
Administrator means a person licensed
as a nursing home administrator by the Department who administers, manages,
supervises, or is in general administrative charge of a nursing home.
Alteration means any work other than
maintenance in an existing building and which does not increase the floor or
roof area or the volume of enclosed space.
Consultant shall mean a qualified
person who gives professional advice or service within his/her specialty, with
or without re-numeration.
Consultant Dietitian a person who is
eligible for registration by the Dietetic Association, has a baccalaureate
degree with major studies in food and nutrition, dietetics, or food service
management; has one year of supervisory experience in the dietetic service of a
health care institution and participates annually in continuing dietetic
education.
Consultant Pharmacist means a
qualified licensed, registered pharmacist, who under arrangement with an
institution, renders assistance in developing, implementing, evaluating, and
revising where indicated, policies and procedures for providing the
administrative and technical guidance of the pharmaceutical services relative
to labeling, storing, handling, dispensing, and all other matters pertaining to
the administration and control of drugs and medication. He/she provides such
services and monitors activities within the institution with the express
purpose of creating and maintaining the highest standards in medication
distribution, control, and service.
Controlled Substances means a drug,
substance or immediate precursor in Schedules I through V of Article 11 of the
Controlled Substances Act.
Department shall mean the Arkansas
Department of Human Services (DHS).
Director shall mean the Chief
Administrative Officer in the Office of Long Term Care
Disinfection shall mean the process
employed to destroy harmful microorganisms, but ordinarily not viruses and
bacterial spores.
Distinct Part shall mean an
identifiable unit accommodating beds and related facilities including, but not
limited to, a wing, floor, or building that is approved by the Division for a
specific purpose.
Division shall mean the DHS/Division
of Medical Services.
Drug means
(a) articles recognized in the Official
United States Pharmacopeia, Official Homepathic Pharmacopeia of the United
States, or Official National Formulary, or any supplement to any of them;
and
(b) articles intended for use
in the diagnosis, cure mitigation, treatment, or prevention of disease in man
or other animal; and
(c) articles
(other than food) intended to affect the structure or any function of the body
of man or other animals; and
(d)
articles specified in clause (a), (b) or (c); but does not include devices or
their components, parts or accessories.
Drug Administration is an act
restricted to nursing personnel as defined in Nurses Practice Act 432 or 1971,
in which a single dose of a prescribed drug or biological is given to a
patient. This activity includes the removal of the dose from a previously
dispensed, properly labeled container, verifying it with the prescriber's
orders, giving the individual dose to the proper patient, and recording the
time and dose given.
Drug Dispensing is an act restricted
to a pharmacist which involves the issuance of one or more doses of a
medication in a container other than the original, with such new containers
being properly labeled by the dispenser as to content and/or directions for use
as directed by the prescriber. This activity also includes the compounding,
counting, and transferring of medication from one labeled container to
another.
Existing Facilities are those
facilities which were in operation, or those proposed facilities which began
construction or renovation of a building under final plans approved by the
Division prior to adoption of these regulations.
Fire Resistance Rating shall mean the
time in hours or fractions thereof that materials or their assemblies will
resist fire exposure as determined by fire test conducted in accordance with
recognized standards.
Governing Body shall mean the
individuals or group in whom the ultimate authority and legal responsibility is
vested for conduct of the nursing home.
Institution is any facility requiring
licensure under these regulations.
Intermediate Care Facility (ICF) is a
nursing home licensed by Arkansas Social Services as meeting the Intermediate
Care Facility regulations. It is a health facility or a distinct part of a
hospital or Skilled Nursing Facility staffed, organized, operated, and
maintained to provide 24-hour long term inpatient care and other restorative
services under nursing supervision.
Legend Drugs are drugs, which because
of their toxicity or other, potentiality for harmful effect, or the method of
their use, or the collateral measures necessary to their use, are not safe for
use except under the supervision of a practitioner licensed by law to
administer such drugs, or shall be dispensed only on prescription by the
pharmacist. Such drugs bear the label "Caution: Federal Law Prohibits
Dispensing Without Prescription."
License shall mean the basic document
issued by the Division permitting the operation of nursing homes. This document
constitutes the authority to receive patients and to perform the services
included within the scope of these regulations.
Licensed Bed Capacity shall mean the
exact number of beds for which license application has been made and
granted.
Licensee shall mean any state,
municipality, political subdivision, institution, public, or private
corporation, association, individual, partnership or any other entity to whom a
license is issued for the purpose of operating the nursing home, who shall
assume primary responsibility for complying with approved standards for the
institution.
New Construction means those
facilities which are constructed or renovated for the purpose of operating an
institution according to architectural plans approved by the Division
subsequent to adoption of these rules.
Nursing Home shall mean and be
construed to include any buildings, structure, agency, institution, or other
place for the reception, accommodation, board, care, or treatment of two or
more unrelated individuals, who, because of physical or mental infirmity are
unable to sufficiently or properly care for themselves, and for which
reception, accommodation, board, care, and treatment, a charge is made,
provided the term "Nursing Home" shall not include the offices of private
physicians and surgeons, boarding homes, or hospitals, or institutions operated
by the Federal Government. (Section 2, Act 141 of 1961 as amended)
Nursing Home Classification shall mean
the level of care the nursing home is capable of rendering such as Skilled
Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility
for the Mentally Retarded.
Long Term Care Facility Advisory Board
shall mean the Long Term Care Facility Advisory Board as established under Act
28 of 1979.
O.T.C. Drugs are commonly referred to
as "over-the-counter," or patient medication that may be provided without
prescription.
Patient (interchangeable with
resident) shall mean any individual who is being treated by a physician or
whose health is being supervised by a physician while residing within the
respective facility.
Patient Unit is an area designated to
accommodate an individual patient bed, bedside cabinet, chair, reading light,
and other necessary equipment placed at the bedside for the proper care and
comfort of a patient.
Provisional Licensure is a temporary
grant of authority to the purchaser to operate an existing long-term care
facility upon application for licensure to the Office of Long Term Care.
Restorative Nursing or Rehabilitative
Nursing shall mean measures directed toward prevention of
deterioration in normal body alignment, and muscle tone, restoration of the
resident to full activity insofar as his or her health problems permit and
maintaining a state in which his or her total need for care is minimal.
Restraint is any device or instrument
used to limit, restrict, or hold patients under control, not including safety
vests or other instruments such as bed rails used for the safety and
positioning of patients. Personal safety devices and postural support devices
that restrict movement are considered restraints.
Sanitation is the process of promoting
hygiene and preventing disease by maintaining sanitary conditions.
Skilled Nursing Facility (SNF) is a
nursing home, or a distinct part of another facility, licensed by the Office of
Long Term Care as meeting the skilled nursing facility licensure regulations. A
health facility which provides skilled nursing care and supportive care on a
24-hour basis to residents whose primary need is for availability of skilled
nursing care on an extended basis.
Qualified Social Worker is a person
who is registered by the State Board of Social Work and is a graduate of a
school of social work accredited or approved by the council on Social Work
Education.
State Health Officer shall mean the
Director of the Arkansas Department of Health, Secretary of the State Board of
Health.
Sterile the state of being free from
all forms of micro-organisms.
Unit Dose Medication System shall mean
a system in which single doses of drugs are prepackaged and pre-labeled in
accordance with all applicable laws and regulations governing these practices
and made available separated by resident and by dosage time. The system
includes all equipment and records deemed necessary and used in making the
doses available to the resident in an accurate and safe manner. A pharmacist
shall be in charge of and responsible for the system.
Guardian shall mean a court appointed
person who by law is responsible for a patient's affairs.
Responsible Party shall mean the
person who is accountable for the patient's affairs but who has not been
appointed by the court.
Routine means the regular performance
of a particular task.
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Abbreviations
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R.N.
|
Registered Nurse
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L.P.N.
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Licensed Practical Nurse
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L.P.T.N.
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Licensed Psychiatric Technician Nurse
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N.A.
|
Nurse's Aide
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P.T.
|
Part-time
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F.T.
|
Full-time 40 hours per week in these regulations and
should not be confused with (Fair Labor Standards Act)
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N.H.
|
Nursing Home
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LTC
|
Long Term Care
|
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OLTC
|
Office of Long Term Care
|
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O.T.C.
|
Over-the-counter drugs
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200
GENERAL PROVISIONS FOR LICENSURE
201
LICENSURE
Nursing homes, or related institutions, shall be operated,
conducted, or maintained in this State by obtaining a license pursuant to the
provisions of these Licensing Standards. Separate institutions operated by the
same management require separate licenses. Separate licenses are not required
for separate buildings on the same grounds. The classification of license shall
be Skilled Nursing Facility, Intermediate Care Facility, and Intermediate Care
Facility for the Mentally Retarded.
Whenever ownership or controlling interest in the operation of
a facility is sold, both the buyer and the seller must notify the Office of
Long Term Care at least thirty (30) days prior to the completed sale. The
thirty (30) day notice shall be the date the paperwork is stamped received by
the Office of Long Term Care.
202
APPLICATION FOR LICENSE
Applicants for license shall file a notarized application with
the Division upon forms prescribed by the Division and shall pay an annual
license fee of ten cents ($0.10) per patient bed, or Ten Dollars ($10),
whichever is greater. This fee shall be paid to the State Treasury. If the
license is denied, the fee will be returned to the applicant. Facilities
operated by any unit or division of state or local government shall be exempted
from payment of a licensing fee. Application shall be signed by the owner if
individually owned, by one partner if owned under partnership, by two officers
of the board if operated under corporation, church or non-profit association,
and incase of a governmental unit, by the head of the governmental entity
having jurisdiction over it. Applicants shall set forth the full name and
address of the institutions for which license is sought, the names of the
persons in control, a signed statement by a registered nurse indicating
responsibility for nursing services of the home, and such other information as
the Division may require.
In these instances where a distinct part of a facility is to be
licensed as a Skilled Nursing Facility and the remainder of the facility is to
be licensed under some other category, separate applications must
be filed for each license and separate licensure fees fill be required with
each application.
Each home applying for and receiving a license must furnish the
following information:
* The identity of each person directly or indirectly having an
ownership interest of five (5) percent or more in such nursing home.
* In case such nursing home is organized as a corporation, the
identify of each officer and director of the corporation.
* In case such nursing home is organized as a partnership, the
identity of each partner.
* Identity of owners of building and equipment leased including
ownership breakdown of leasing entity.
203
RENEWAL OF APPLICATION FOR
LICENSURE
Application for annual license renewal shall be postmarked no
later than January 2nd of the succeeding calendar
year. License applications for existing institutions shall be subject to a
penalty of one dollar ($1) per day after January 2nd
of the succeeding year.
204
ISSUANCE OF LICENSE
License shall be effective on a calendar year basis and shall
expire on December 31st of each year. License shall
be issued only for the premises and persons in the application and shall not be
assignable or transferable.
205
DENIAL, REVOCATION, OR SUSPENSION
OF LICENSE
The Division is empowered to deny, suspend, or revoke licenses
on any of the following grounds:
205.1
Violation of any of the provisions of Act 28 of 1979 or the rules and
regulations lawfully promulgated hereunder.
205.2 Permitting, aiding, or abetting the
commission of any unlawful act in connection with the operation of the
institution, as defined in these regulations.
205.3 Conduct or practices detrimental to the
health of safety of residents and employees of any such institutions, but this
provision shall not be construed to have any reference to healing practices
authorized by law, as defined in these regulations.
205.4 Failure to comply with the provisions
of Act 58 or 1969 and the rules and regulations promulgated thereunder. (Note:
The aforementioned act requires the licensure of nursing home
administrators.)
206
NOTICE AND PROCEDURE ON HEARING PRIOR TO DENIAL, SUSPENSION, OR
REVOCATION OF LICENSE
Whenever the Division decides to deny, suspend, or revoke a
license, it shall send to the applicant or licensee a notice stating the
reasons for the action by certified mail. The applicant or licensee may appeal
such notice to the Long Term Care Facility Advisory Board as permitted by
Arkansas Statute Annotated §82-211. Procedures for appeal to the Long Term
Care Facility Advisory Board are incorporated in these regulations as Appendix
A.
207
APPEALS TO
COURTS
Any applicant or licensee who considers himself injured in his
person, business, or property by final agency action shall be entitled to
judicial review thereof. Proceedings for review shall be made by filing a
petition in the Circuit Court of any county in which the petitioner does
business or in the Circuit Court of Pulaski County within thirty (30) days
after service upon the petitioner of the agency's final decision. All petitions
for judicial review shall be in accordance with the Administrative Procedures
Act Arkansas Statute Annotated §5-713.
208
PENALTIES
Any person, partnership, association, or corporation,
establishing, conducting, managing, or operating any institution within the
meaning of this act (§§ 82-327 -- 82-354), without first obtaining a
license therefor as herein provided, or who violates any provision of this act
or regulations lawfully promulgated hereunder shall be guilty of a misdemeanor,
and upon conviction thereof shall be liable to a fine of not less than
Twenty-Five Dollars ($25) nor more than One-Hundred Dollars ($100) for the
first offense and not less than One-Hundred Dollars ($100) nor more than
Five-Hundred Dollars ($500) for each subsequent offense, and each day such
institution shall operate after a first conviction shall be considered a
subsequent offense. (Section 27, Act 414 of 1961)
209
INSPECTION
All institutions to which these rules and regulations apply
shall be subject to inspection for reasonable cause at any time by the
authorized representation of the Division.
210
COMPLIANCE
An initial license will not be issued until the applicant has
demonstrated to the satisfaction of the Division that the facility is in
substantial compliance with the licensing standards set forth in these
regulations.
211
NONCOMPLIANCE
When noncompliance of the licensing standards are detected
during surveys, licensees will be notified of the violations and will be
requested to provide a plan of correction with a timetable for corrections. If
an item of noncompliance is of a serious nature that affects the health and
safety of patients and is not promptly corrected, action will be taken to
suspend or revoke the facility's license.
212
VOLUNTARY CLOSURE
Any nursing home, or related institution, that voluntarily
closes must meet the regulations for new construction to be eligible for
re-licensure.
213
EXCEPTION TO LICENSING STANDARDS
The Division reserves the right to make temporary exceptions to
these standards where it is determined that the health and welfare of the
community requires the services of the institution. Exceptions will be limited
to unusual circumstances and the safety and well-being of the residents will be
carefully evaluated prior to making such exceptions.
Overbeds will be authorized only in cases of emergency. An
emergency exits when it can be demonstrated that the resident's health or
safety would be placed in immediate jeopardy if relocation were not
accomplished. A fire, natural disaster (e.g., tornado, flood, etc.) or other
catastrophic event that necessitates resident relocation will be considered an
emergency. The Office of Long Term Care must be contacted for prior
authorization of the overbed, and all authorizations must be in writing.
214
PROVISIONAL
LICENSURE
Subject to the requirements below, a provisional license shall
be issued to the Applicant and new operator of the long-term care facility when
the Office of Long Term Care has received the Application for Licensure to
Conduct a Long Term Care Facility, A provisional license shall be effective
from the date the Office of Long-Term Care provides notice to the Applicant and
new operator, until the date the long-term care license is issued. With the
exception of Medicaid or Medicare provider status, a provisional license
confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
1. The purchaser and the seller of the
long-term care facility shall provide the Office of Long Term Care with written
notice of the change of ownership at least thirty (30) days prior to the
effective date of the sale.
2. The
Applicant and new operator of the long-term care facility shall provide the
Office of Long Term Care with the application for licensure, including all
applicable fees.
3. The Applicant
and new operator of the long-term care facility shall provide the Office of
Long Term Care with evidence of transfer of operational control signed by all
applicable parties.
A provisional license holder may operate the facility under a
new name, whether fictitious or otherwise. For purposes of this section, the
term new name means a name that is different than the name under which the
facility was operated by the prior owner, and the term "operate" means that the
provisional license holder may hold the facility out to the public using the
new name. Examples include, but are not limited to, signage, letterhead,
brochures or advertising (regardless of media) that bears the new name.
In the event that the provisional license holder operates the
facility under a new name, the facility shall utilize the prior name in all
communications with the Office of Long Term Care until such time as the license
is issued. Such communications include, but are not limited to, incident
reports, notices, Plans of Correction, and MDS submissions. Upon the issuance
of the license, the facility shall utilize the new name in all communications
with the Office of Long Term Care.
215-299
RESERVED
300
ADMINISTRATION
301
MANAGEMENT
301.1
BYLAWS
The governing body shall adopt effective patient care policies
and administrative policies and by-laws governing the operation of the facility
in accordance with legal requirements.
301.2
ADMINISTRATOR
Each nursing home shall have a full-time (minimum forty (40)
hours per week) administrator on the premises during normal business hours, who
shall be currently licensed as a nursing home administrator in accordance with
Act 58 of 1969, Statute 82-2201 through 82-2215 and the rules and regulations
promulgated thereunder. Each facility administrator, if required, should
provide verification that a minimum of forty (40) hours is spent in the
facility. The administrator must have responsibility for overall operation of
the facility and is responsible for any non-compliance with regulations found
in the nursing home. Correspondence between this office and the facility shall
be through the licensed administrator.
The licensed administrator shall not leave the nursing home
premises during the day tour of duty without first delegating authority in
writing to a qualified individual who may manage the facility temporarily
during the administrator's absence. Nursing personnel on the day tour of duty
shall not be delegated authority to operate the facility unless relief nursing
personnel are employed to replace the selected nurse. Also, the facility
administrator shall notify this office in writing if an absence from the
facility will exceed seven (7) consecutive days. The name of the individual who
will be administratively in charge of the facility should also be listed in the
letter.
Admimstrators-m-training shall receive training in facilities
that employ a full-time licensed administrator. Administrators-in-training
shall not serve as a nursing home administrator until such time that a nursing
home administrator's license is obtained. Applicants that qualify to take the
administrator's examination shall not practice as a nursing home administrator
until licensed by this office.
Arkansas Statute 82-2215 provides, as follows: "It shall be
unlawful for any person to act or serve in the capacity of nursing home
administrator in this state unless such person has been licensed to do so as
authorized in this Act."
302
GENERAL ADMINISTRATION
302.1 Visitors shall be permitted during all
reasonable hours.
302.2 Incident
and accident reports of patients and personnel shall be completed and reviewed
to identify health and safety hazards.
302.3 An accurate daily census sheet as of
midnight shall be available to the Division at all times.
302.4 There shall be keys readily available
for all locked doors within the home.
302.5 Birds, cats, dogs, and other animals
are not permitted in nursing homes, except in the case of seeing eye dogs, and
as permitted under section 586.
302.6 The name, address, and telephone number
of attending physicians shall be available at each nurses' station.
302.7 Any home caring for patient with
contagious diseases shall comply with all current rules and regulations as
described in the licensing laws and standards for hospitals and related
institutions of Arkansas".
302.8
All containers of substances used by the facility shall be legibly and
accurately labeled as to content.
302.9 Fire extinguishers shall be adequate,
of the correct type, and properly located and installed as defined by NFPA
101,1973 edition.
302.10 A quiet
atmosphere shall be maintained. Disturbances created within the home will not
be permitted.
302.11 Laboratories
and radiological facilities operated in nursing homes shall comply with the
rules and regulations for hospitals and related institutions in Arkansas.
Pharmacies operated in nursing homes shall be operated in compliance with
Arkansas laws and shall be subject to inspection by personnel from the
Division.
302.12 Children under
sixteen (16) years of age shall not be cared for in a room with non-related
adults.
302.13 Adult male and
female patients shall not have adjoining rooms which do not have full floor to
ceiling partition and closing doors. They shall not be housed in the same room
(except husband and wife of the same marriage or parent and child).
302.14 Child patients, male and female, shall
not be housed in the same room when they are seven (7) or more years old. They
shaft be provided the same privacy required for adults.
302.15 The facility shall maintain written
accounts for all patients' funds received by or deposited with the facility for
safekeeping. A trustworthy employee shall be designated to be responsible for
patient accounts. The funds may be withdrawn by the patient upon request. The
patient shall be provided an itemized accounting of deposits, disbursements,
and withdrawals including the current balance at least quarterly.
303
PERSONNEL
ADMINISTRATION
303.1 The administrator
shall establish and maintain a personnel file for each employee.
303.2 Applications for each employee shall
contain sufficient information to support placement in the position to which
assigned. All applications from licensed and/or registered personnel shall
contain the appropriate certificate or registration number and current renewal
date. These registrations and/or certifications shall be verified.
303.3 No employee caring for patients shall
be less than sixteen (16) years of age. Employees shall wear uniforms and name
pines with job title.
303.4 No
person with a communicable disease or infected skin lesion shall be permitted
to work in the nursing home.
303.5
All employees must have a skin test for tuberculosis prior to employment or
service. These personnel shall be re-examined annually. The results of these
tests shall be on record in the nursing home. No person with active
tuberculosis or a communicable disease shall be allowed to work in the
facility.
303.6 Written job
descriptions shall be developed for each employee classification, i.e., R.N.,
L.P.N., aide, housekeepers, maids, etc., and shall include, as a minimum the
responsibilities and/or actual work to be performed in such classification. In
addition, the job description shall include the physical and educational
qualifications and licenses or certificates required for each job
classification.
303.7 Sufficiently
trained personnel shall be on duty at all times. Provisions shall be made for
relief of direct care personnel during vacations and other relief
periods.
303.8 Upon request, a
nursing home must make available to employees of the Division, payroll records
showing staff employed during recent pay periods. This is to verify that
minimum staffing has been maintained.
303.9 Copies of these regulations shall be
available to all personnel. All personnel shall be instructed by the
administrator in the requirements of the law and in the regulations pertaining
to their respective duties.
303.10
Nursing or personal care shall not be delegated to cooks, housekeeping, or
laundry personnel.
303.11 A weekly
time schedule shall be prepared and posted for each week and shall include the
employee's first and last name, classification, i.e., aide, R.N., cook, etc.,
and the beginning and ending time of each tour of duty, such as 7:00 a.m. to
3:00 p.m., etc.
304
STAFF DEVELOPMENT
304.1 Job
orientation shall be provided for all personnel to acquaint them with the needs
of the residents, the physical facility, disaster plan, and the employee's
specific duties and responsibilities. There should be written documentation
maintained to verify that orientation and in-service training are planned and
conducted. A continuing in-service training program is planned and conducted.
Attendance at such training shall be verified by each employee by signing their
names on the attendance record. Records of orientation shall include the
signature of the employee as well as topic of instruction and date of
successful completion.
304.2 A
reasonable supply of textbooks of basic practices shall be available in the
nursing home for the specific job needs of all employees.
304.3 At least ninety percent (90%) of
personnel on each shift shall be trained at least on a quarterly basis in the
proper use of all fire-fighting equipment, in the procedures for evacuation of
patients, and in the procedures to follow in case of fire or explosion.
Disaster drills, including tornado drills, should be conducted semi-annually
for each shift. A record of the drills held shall be maintained, and this
record shall include the time and date the drill was held, along with the
signature of all staff participating.
305
EMERGENCY CALL DATA
The administrator shall be responsible for ensuring that
emergency call information is posted in a conspicuous place so as to be
immediately available to all personnel of the nursing home. Emergency call data
shall include at least the following:.
* Telephone number of fire and police departments.
* Names, addresses, and telephone numbers for emergency
supplies, ambulance, minister, advisory dentist, Red Cross, and poison control
center.
* Name, address, and telephone number of all personnel to be
called in case of fire or emergency (to include the administrator and the
director of nursing services).
* Name, address, and telephone number of an available physician
to furnish necessary medical care in case of emergency.
306
REPORTING SUSPECTED ABUSE, NEGLECT,
EXPLOITATION, INCIDENTS, ACCIDENTS, DEATHS FROM VIOLENCE AND MISAPPROPRIATION
OF RESIDENT PROPERTY
Pursuant to federal regulation
42 CFR
483.13 and state law Ark. Code Ann. §
5-28-101
et
seq. and 12-12-501 et seq., the facility must develop
and implement written policies and procedures to ensure incidents,
including:
alleged or suspected abuse or neglect of
residents;
* accidents, including accidents resulting in
death;
* unusual deaths or deaths from violence;
* unusual occurrences; and,
* exploitation of residents or any misappropriation of
resident property,
are prohibited, reported, investigated and documented as
required by these regulations.
A facility is not required under this regulation to report
death by natural causes. However, nothing in this regulation negates, waives or
alters the reporting requirements of a facility under other regulations or
statutes.
Facility policies and procedures regarding reporting, as
addressed in these regulations, must be included in orientation training for
all new employees, and must be addressed at least
annually during in-service training for all facility
staff.
306.1
NEXT-BUSINESS-DAY
REPORTING OF INCIDENTS
The following events shall be reported to the Office of Long
Term Care by facsimile transmission to telephone number 501-682-8551 of the
completed Incident & Accident Intake Form (Form DMS-7734) no later than
11:00 a.m. on the next business day following discovery by the facility.
a. Any alleged, suspected or witnessed
occurrences of abuse or neglect to residents.
b. Any alleged, suspected or witnessed
occurrence of misappropriation of resident property, or exploitation of a
resident.
c. Any alleged, suspected
or witnessed occurrences of verbal abuse. For purposes of this regulation,
"verbal abuse" means the use of oral, written, or gestured language that
willfully includes disparaging and derogatory terms to residents, or within
their hearing distance, regardless of their age, ability to comprehend, or
disability. Examples of verbal abuse include, but are not limited to: threats
of harm; saying things to frighten a resident, such as telling a resident that
he or she will never be able to see his or her family again.
d. Any alleged, suspected or witnessed
occurrences of sexual abuse to residents by any individual.
In addition to the requirement of a facsimile report by the
next business day on Form DMS-7734, the facility shall complete a Form DMS-762
in accordance with Section 306.2.
306.2
INCIDENTS OR OCCURRENCES THAT
REQUIRE INTERNAL REPORTING ONLY - FACSIMILE REPORT OR FORM DMS-762 NOT
REQUIRED.
The following incidents or occurrences shall require the
nursing facility to prepare an internal report only and does
not require a facsimile report, or form DMS-762 to be made to the Office
of Long Term Care. The internal report shall include all content specified in
Section 306.3, as applicable. Nursing facilities must maintain these incident
record files in a manner that allows verification of compliance with this
provision.
a. Incidents where a
resident attempts to cause physical injury to another resident without
resultant injury. The facility shall maintain written reports on these types of
incidents to document "patterns" of behavior for subsequent actions.
b. All cases of reportable disease, as
required by the Arkansas Department of Health.
c. Loss of heating, air conditioning or file
alarm system of greater than two (2) hours duration.
306.3
INTERNAL-ONLY REPORTING
PROCEDURE
Written reports of all incidents and accidents included in
section 306.2 shall be completed within five (5) days after discovery. The
written incident and accident reports shall be comprised of all information
specified in forms DMS-7734 and 762 as applicable.
All written reports will be reviewed, initialed and dated by
the facility administrator or designee within five (5) days after discovery.
All reports involving accident or injury to residents will also be reviewed,
initialed and dated by the Director of Nursing Services or other facility
R.N.
Reports of incidents specified in Section 306.2 will be
maintained in the facility only and are not required to be
submitted to the Office of Long Term Care.
All written incident and accident reports shall be maintained
on file in the facility for a period of three (3) years.
306.4
OTHER REPORTING
REQUIREMENTS
The facility's administrator is also required to make any other
reports of incidents, accidents, suspected abuse or neglect, actual or
suspected criminal conduct, etc. as required by state and federal laws and
regulations.
306.5
ABUSE INVESTIGATION REPORT
The facility must ensure that all alleged or suspected
incidents involving resident abuse, exploitation, neglect or misappropriations
of resident property are thoroughly investigated. The facility's investigation
must be in conformance with the process and documentation requirements
specified on the form designated by the Office of Long Term Care, Form DMS-762,
and must prevent further potential incidents while the investigation is in
progress.
The results of all investigations must be reported to the
facility's administrator, or designated representative, and to other officials
in accordance with state law, including the Office of Long Term Care. Reports
to the Office of Long Term Care shall be made via facsimile transmission by
11:00 a.m. the next business day following discovery by the facility, on form
DMS-7734. The follow-up investigation report, made on form DMS-762, shall be
submitted to the Office of Long Term Care within 5 working days-of the date of
the submission of the DMS-7734 to the Office of Long Term Care. If the alleged
violation is verified, appropriate corrective action must be taken.
The DMS-762 may be amended and re-submitted at any time
circumstances require.
306.6
REPORTING SUSPECTED ABUSE OR
NEGLECT
The facility's written policies and procedures shall include,
at a minimum, requirements specified in this section.
306.6.1 The requirement that the facility's
administrator or his or her designated agent immediately reports all cases of
suspected abuse or neglect of residents of a long-term care facility as
specified below:
a. Suspected abuse or neglect
of an adult (18 years old or older) shall be reported to the local law
enforcement agency in which the facility is located, as required by Arkansas
Code Annotated 5-28-203(b).
b.
Suspected abuse or neglect of a child (under 18 years of age) shall be reported
to the local law enforcement agency and to the central intake unit of the
Department of Human Services, as required by Act 1208 of 1991. Central intake
may be notified by telephone at 1-800-482 -5964.
306.6.2 The requirement that the facility's
administrator or his or her designated agent report suspected abuse or neglect
to the Office of Long Term Care as specified in this regulation.
306.6.3 The requirement that facility
personnel, including but not limited to, licensed nurses, nursing assistants,
physicians, social workers, mental health professionals and other employees in
the facility who have reasonable cause to suspect that a resident has been
subjected to conditions or circumstances which have or could have resulted in
abuse or neglect are required to immediately notify the facility administrator
or his or her designated agent.
306.6.4 The requirement that, upon hiring,
each facility employee be given a copy of the abuse or neglect reporting and
prevention policies and procedures and sign a statement that the policies and
procedures have been received and read. The statement shall be filed in the
employee's personnel file.
306.6.5
The requirement that all facility personnel receive annual, in-service training
in identifying, reporting and preventing suspected abuse/neglect, and that the
facility develops and maintains policies and procedures for the prevention of
abuse and neglect, and accidents.
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Section
II - Complete Description of Incident
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Section
III - Finding and Actions Taken
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Section
IV - Notification/ Status
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Section
VI - Accused Party Information
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Section
VII
- Attachments
Attach the following information to the back of this form. If
you do not have one of the specified attachments, please provide an explanation
why it can not be obtained or if it will be forwarded in the future.
1. Statement from the accused
party.
2. All witness statements.
Use the attached OLTC Witness Statement Form for all
witness statements submitted. If the statement is a typed copy of a handwritten
statement, the handwritten statement must accompany the typed
statement.
3. Law enforcement
incident report. This can be mailed at a later date if necessary.
4. Other pertinent reports/information, such
as Ombudsmen, autopsy, reports, etc. These can be mailed at a later date if
necessary.
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307
INSTITUTIONAL POLICIES AND/OR
PROCEDURES
308
PATIENT CARE POLICIES
The administrator, in consultation with one or more physicians
and one or more registered professional nurses, department heads, and other
related professional health care personnel, shall develop and at least annually
review appropriate written policies and procedures for all services and/or
patient care practices to include but not limited to dietary, medical records,
nursing, pharmaceutical,, diagnostic services, laboratory and radiological,
housekeeping, maintenance, and laundry services.
309
RESTRAINT OF RESIDENTS
Patients shall not be unduly restrained. Patients shall not be
confined to rooms or restrained except when necessary to prevent injury to the
patient or others and when alternative measures are not sufficient to
accomplish these purposes. In any event, no locked doors or locked restraints
are to be used at any time to restrain a patient. Doors (screen type), or the
lower one half of a dutch door or approved type louvered doors may be hooked on
the hall side of the door. Restraints, of the non-locking type, may be used
only upon the order of a physician. In the event the order is obtained by
phone, the signature of a physician shall be obtained within five days (Note:
The aforementioned restraining type doors shall be installed in addition to the
regular door to the room. They shall be removed during periods when they are
not needed for the restraint of patients.) Upon the advice of the attending
physician, unruly or excessively noisy patients shall be transferred from the
home to an institution equipped for such patient care, since this type patient
creates a disturbance for other patients in the home.
The written policy and procedures governing the use of
restraints shall specify which staff member may authorize the use of restraints
and clearly delineate at least the following:
* Orders indicating the specific reasons for the use of
restraints.
* Their use is temporary, and the resident will not be
restrained for an indefinite amount of time.
* Orders for restraints shall not be enforced for longer than
twelve (12) hours, unless the patient's condition warrants.
* Restraints must be checked every thirty (30) minutes and
loosened every two (2) hours for range of motion to restrained
extremities.
310
PROTECTION OF PATIENT PROPERTY
An inventory of patient's personal belongings should be
maintained for all items brought to the facility on admission and up-dated as
appropriate for items added or sent home/disposed of.
311
NOTIFICATION OF CHANGE IN PATIENT'S
STATUS
There shall be written polices and procedures available at each
nurses' station for personnel to follow requiring the notification of the
patient's attending physician and other responsible persons in the event of
severe illness, accident, or death of the patient or other significant change
in the patient's status.
The name, address and telephone number of the patient's
attending physician shall be recorded for ready reference.
312
PHYSICIAN'S SERVICES
POLICIES
The facility shall have a written policy indicating that the
health care of every patient is under the supervision of a physician, who based
on a medical evaluation of the patient's immediate and long term needs,
prescribes a planned regimen of total care.
313
SPECIALIZED REHABILITATIVE SERVICE
POLICIES
If a facility offers specialized rehabilitative services,
written administrative and patient care policies and procedure for
rehabilitative services shall be developed for appropriate therapists and
representatives of the medical, administrative, and nursing staffs.
314
SOCIAL SERVICE
POLICIES
Facilities which do not directly provide social service shall
have written procedures for referring patients in need of social services to
appropriate service agencies.
315
CONFIDENTIALITY OF SOCIAL
INFORMATION
Policies and procedures shall be established for ensuring the
confidentiality of all patients' social information.
316
RIGHTS OF RESIDENTS
Facilities shall establish policies and procedures setting
forth the rights of resident and prohibiting their mistreatment or
abuse.
317
REGISTRATION OF COMPLAINTS
Facilities shall establish policies for the registration and
disposition of complaints without threat of discharge or other reprisal against
any patient.
318
ADMISSION, TRANSFER, AND DISCHARGE POLICIES
These policies shall include, as a minimum, the
following:
318.1 Patients shall be
admitted to the facility only on the recommendation of a physician licensed to
practice medicine in the State of Arkansas.
318.2 All persons admitted to a nursing home
shall have a history and physical examination at the time of admission or
within seventy-two (72) hours following admission unless such examination was
performed within fifteen (15) days prior to admission. A copy of the hospital
history, physical, and discharge summary (after completion) will satisfy the
requirement if the history and physical was completed within thirty (30) days.
The examination will be for medical evaluation purposes and to determine if the
patient is free from communicable diseases.
318.3 Recording shall be made of initial
examination and all subsequent examinations, including findings,
recommendations and progress notes. Hospital discharge summaries are to be
obtained after each hospitalization.
318.4 Patients who are not receiving public
assistance from the Division shall be classified, on admission and subsequently
re-classified, by the attending physician as skilled care, intermediate care,
or minimum care patients, and a report shall be kept in the home and available
to the Division. The classification shall be based upon the Division's
criterion.
318.5 Only those persons
are accepted whose needs can be met by the facility directly or in cooperation
with the community resources or other providers of care with which it is
affiliated or has contracts.
318.6
As changes occur in their physical or mental condition necessitating service or
care which cannot be adequately provided by the facility, residents shall be
transferred promptly to facilities which can provide appropriate
care.
318.7 Except in the case of
an emergency or voluntarily discharge, the resident, responsible party,
attending physician, and the responsible agency, if any, are consulted in
advance of the transfer or discharge of any resident. The resident and/or
responsible party will be provided written notification of his/her transfer,
ten days prior to the transfer.
319
CONFIDENTIALITY OF MEDICAL RECORD
INFORMATION
There shall be written policies adopted by the management of
the nursing home covering confidentiality of medical records and procedures
regarding release of medical information.
320
INFECTION CONTROL
Written policies and procedures shall be established for
investigating, controlling and preventing infections. Procedures shall be
reviewed annually and revised as necessary for effectiveness and improvement.
The policies and procedures shall include as a minimum:
* Aseptic and isolation techniques.
* Proper disposal techniques for infected dressings, disposable
syringes, needles, etc.
* Prohibiting the use of the common towel, common bath and hand
soap, and the common drinking cup or glass.
321
HANDLING OF OXYGEN AND FLAMMABLE
GASES
Policies shall be written for the proper handling of oxygen and
flammable gases.
322
PERSONNEL POLICIES
Written personnel policies shall be provided and shall be
available to all personnel and to the Division.
323
TRANSPORTATION OF RESIDENTS
The facility shall establish a written policy regarding
transportation of residents, when necessary, to the hospital, medical clinics,
and dentist offices. The facility must assume responsibility for seeing that
the patient's transportation needs are met.
324
BEDPAN SANITATION
Written policies shall be established to ensure all
individually assigned bed pans are sanitized by the boiling method for a
minimum of twenty (20) minutes at least once a week or by other methods
approved by the Division.
325
OUTSIDE RESOURCE
AGREEMENTS
326
SPECIALIZED REHABILITATIVE SERVICES
If the facility does not offer specialized rehabilitative
services directly, patients in need of such services, i.e., physical therapy,
occupational therapy, speech pathology, and audiology, shall not be admitted or
retained in the facility unless arrangements for these services have been
provided with an outside resource. Terms of the agreement should include
reimbursement, responsibility of each party, and documentation
responsibilities.
327
ADVISORY DENTIST
Facilities shall establish a written cooperative agreement with
an advisory dentist or dental service. The agreement shall include provisions
for a dentist or dental service. The agreement shall include provisions for a
dentist to participate annually in the staff development program and to
recommend oral hygiene policies and practices.
328
SOCIAL SERVICES
If a facility provides social services directly and the
designated staff member is not a qualified social worker, a written agreement
shall be established to provide consultation from such a qualified person or a
recognized social agency.
329
ACTIVITY DIRECTOR
In a nursing facility, if the staff member designated
responsible for the activity program is not a qualified patient activity
coordinator, a written agreement shall be established with a person so
qualified. The MSW consultant may also serve as consultant to the activity
director.
330
PHARMACIST
If a facility does not employ a licensed pharmacist, it shall
establish a written agreement with a licensed pharmacist to provide
consultation on methods and procedures for ordering, storage, administration,
disposal, and record keeping of drugs and biologicals.
331
MEDICAL AND REMEDIAL
SERVICES
A nursing home shall establish a written agreement for all
medical and remedial services, i.e., laboratory, radiological, and other
services, required by the resident but not regularly provided within the
facility.
332
TRANSFER AGREEMENT
A facility shall have in effect a written transfer agreement
with one or more hospitals sufficiently close to the facility to make feasible
the transfer of patients. It shall be the duty of each nursing home
administrator to supply basic information at the time of a patient's transfer
from one nursing home to another or to a hospital.
333
ELECTRONIC RECORDS AND
SIGNATURES
333.1 Facilities have the
option of utilizing electronic records rather than, or in addition to, paper or
"hardcopy" records. The facility must have safeguards to prevent unauthorized
access to the records and a process for reconstruction of the records in the
event of a system breakdown. Any electronic record or signature system shall,
at a minimum:
a. Require authentication and
dating of all entries. "Authentication" means identification of the author of
an entry by that author and no other, and that reflects the date of entry. An
authenticated record shall be evidence that the entry to the record was what
the author entered. To correct or enhance an entry, further authenticated
entries may be made, by the original author, or by any other author, as long as
the subsequent entries are authenticated as to who entered them, complete with
date and time stamp of the entry, and that the original entries are not
modified. "Entry" means any changes, deletions, or additions to a record, or
the creation of a record.
The electronic system utilized by the facility shall retain all
entries for the life of the medical record and shall record the date and time
of any entry, as well as identifying the individual who performed the entry.
The electronic system must not allow any original signed entry or any stored
data to be modified from its original content except for computer technicians
correcting program malfunction or abnormality. A complete audit trail of all
events as well as all "before" and "after" data must be maintained.
b. Require data access controls
using unique personal identifiers to ensure that unauthorized individuals
cannot make entries to a record, or create or enter an electronic signature for
a record. The facility shall maintain a master list of authorized users, past
and present. Facilities shall terminate user access when the user leaves
employment with the facility.
c.
Include physical, technical, and administrative safeguards to ensure
confidentiality of patient medical records, including procedures to limit
access to only authorized users. The authorized user must certify in writing
that the identifier will not be shared with or used by any other perscID and
that they are aware of the requirements and penalties related to imprPper usage
of their unique personal identifier.
d. Provide audit controls. The system must be
capable of tracking and logging user activity within its electronic files.
These audit logs shall include the date and time of access and the user ID
under which access occm-Ted. These logs shall be maintained a mfrrinmrn of six
years. The facility must certify in writing that it is monitoring the audit
logs to identify questionable data access activities, investigate breaches,
assess the security program, and are taking corrective actions when a breach in
the security system becomes known.
e. Have a data recovery plan. Data must be
backed up either locally or remotely. Backup media shall be stored at both
on-site and off-site locations or alternatively at multiple offsite locations.
The backup system must have the capability of timely restoring the data to the
facility or to the central server in the event of a system failure. Barring a
natural disaster of epic proportions (e.g., earthquake, tornado), timely means
that the restoration of the backup occurs within a period of time that will
permit no more than minimal disruption in the delivery of care and services to
the residents. Pending restoration from backup, the facility shall maintain
newly generated records in a paper format, and shall copy or transfer the
contents of the paper records to the electronic system upon restoration of the
system and backup. A full backup shall be performed at least weekly, with
incremental or differential backups daily. Back up media shall be maintained
both locally and at the off-site location or alternatively at multiple offsite
locations until the next full weekly backup is successfully completed. Backups
shall be tested periodically, but no less than monthly. Testing shall include
restoration of the backup to a computer or system that shall not interfere
with, or overwrite, current records. If utilizing a third party company for
computer data storage and retrieval, the facility shall require that said third
party company shall comply with these requirements.
f. Provide access to Department of Health and
Human Services (DHHS), Office of Long Term Care (OLTC), and Centers for
Medicaid or Medicare Services (CMS) personnel. Access may be by means of an
identifier created for DHHS, OLTC, or CMS personnel, by a printout of the
record, or both, as requested by DHHS, OLTC, or CMS personnel. Access must be
in a "human readable" format, and shall be provided in a manner that permits
DHHS, OLTC, or CMS personnel to view the records without facility personnel
being present. Access shall include all entries and accompanying logs and shall
list the date and time of any entry, as well as identifying the individual who
performed the entry. Any computer system utilized, whether in-house or from a
third-party vendor, must comply with this regulation.
333.2 Physicians' Orders. When facility
personnel take telephone orders from physicians or other individuals authorized
by law or regulations to issue orders the facility documents the appropriate
information, including but not limited to, the date and time of the order, and
the identity of the physician or other authorized individual giving the order
as well as the identity of the facility personnel taking the order. The
facility shall ensure that the physician electronically countersigns the
physician's order upon the physician's next rounds at the facility or through
Internet access from the physician's office.
333.3 For purposes of these regulations, in
all instances in which the regulations requires, or appears to require, the
facility to use written records or written signatures, the facility may use
electronic records or electronic signatures in lieu of written records or
written signatures when doing so conforms to the requirements of this section
for the use of electronic records or electronic signatures.
334-399
RESERVED.
400
PHYSICAL ENVIRONMENT
401
GENERAL STANDARDS FOR EXISTING
STRUCTURES
402
GENERAL
Every institution must be maintained, managed, and equipped to
provide adequate care, safety, and treatment of each resident.
403
FACILITY GROUNDS AND
PARKING
* All homes shall be provided with dust free drives and parking
lots.
* Parking areas shall be provided in a ratio of one (1)
individual parking space for each five (5) licensed beds.
404
DOORS
* All exterior doors shall be effectively weather
stripped
* Doors shall swing into rooms except closet, toilet, and exit
doors.
* The doors to all rooms, toilets, baths, and closets shall be
legibly marked with names or numbers, as appropriate to identify the
area.
* Exit doors shall not be locked in such a way that a key is
necessary to open the door from the inside of the building. A latch or other
fastening device on the door shall be provided with a knob, handle, panic bar
or other simple type of releasing device, which is part of the door handle
hardware, of which the method of operation is obvious even in darkness.
405
STANDARD PATIENT ROOMS,
BATH, AND TOILET FACILITIES
405.1
Standard patient rooms shall not have more than five (5) beds.
405.2 Single standard patient rooms shall
measure at least one-hundred (100) square feet. Multi-patient rooms shall
provide a minimum of seventy-two (72) square feet per bed. Patient beds shall
be located in rooms and placed at least three (3) feet apart in all directions
and so located as to avoid contamination (respiratory droplets), drafts,
excessive heat, or other discomfort to patients, to provide adequate room for
nursing procedures and to minimize the transmission of disease.
405.3 Each standard patient room shall be
equipped with or conveniently located near adequate toilet and bathing
facilities; at least four (4) patients toilet facilities and three bathing
units shall be provided for each thirty-five (35) beds. Each toilet facility
shall be in a separate stall. Toilets shall be equipped with hand-washing
facilities and toilet paper hangers.
405.4 Each standard patient room shall have
hand-washing facilities with both hot and cold running water, unless adequately
provided in a nearby room.
405.5
Each patient room shall have direct access to a corridor.
405.6 Rooms extending below ground level
shall not be used for patients unless they are dry, well ventilated by required
window space, and are otherwise suitable for occupancy. Non-ambulatory patients
may not be housed below ground level.
405.7 Each patient room shall have a window
not less than one-sixteenth (1/16) of the floor space or outside door arranged
and located so that it can be opened from the inside. The window shall be so
located that the patients have a reasonable outside view.
405.8 Each patient shall be provided with
storage space, closet, or other enclosed space, within his/her room, for
clothing and other possessions.
406
INTENSIVE CARE ROOM
An intensive care room shall be provided for each thirty-five
(35) beds or major portion thereof and shall be located near the nurses'
station. Each room shall have the standard square footage as set forth in these
regulations. The room shall be provided with standard unit equipment and a
lavatory with a gooseneck spout and elbow or wrist-action blade-handle
controls, and a soap and a towel dispenser. At least one of these rooms is a
single room which can be used for isolation.
407
CORRIDORS
Corridors in facilities licensed prior to 1973 shall be at
least six (6) feet wide.
408
HANDRAILS
Standard handrails shall be provided on each side of the
corridor in all areas used by patients; however, a six (6) foot passageway must
be maintained. For six (6) foot corridors, a handrail shall be required only on
one side.
409
BEDPAN
CLEANING AND STORAGE ROOM
There shall be one properly equipped bedpan cleaning room with
deep metal sink. In addition to bedpan cleaning equipment, appropriate
hand-washing facilities shall be provided. The room shall include equipment for
sterilization (unless a separate central sterilization is provided).
410
DAY ROOM AND DINING
ROOM
A well lighted, clean, orderly, and ventilated room or rooms
shall be provided for patient activities and for dining areas. A minimum of
twenty (20) square feet per bed shall be provided for this purpose. At least
half of the required area may be used for dining.
411
CEILINGS, WALLS AND FLOORS
411.1
Ceilings
Kitchens, and other rooms where food and drink are prepared
shall have a smooth, non-perforated surface that is washable.
Wallpaper shall not be used.
411.2
Walls
The walls of the facility shall be a smooth surface with
painted or equally washable finish:
* They shall be without cracks, and in conjunction with floors,
shall be waterproof and free from spaces which may harbor ants and roaches. The
walls in the examining room and treatment room shall have waterproof
paint.
* All walls shall be kept clean and in good repair.
411.1
Floors
All floor surfaces throughout the building shall provide a
surface or finish which is smooth, waterproof, grease proof, and resistant to
heavy wear. Safety devices shall be provided on ramps. All floors in baths,
toilets, lavatories, beneath kitchen dish washing facilities and bedpan rooms
shall have a floor covering of a continuous type. No cracks or joints in the
floor covering shall be permitted in these rooms. Carpet is permitted as floor
covering for the following areas, provided the carpet meets the following
requirements: The carpet has a flame spread rating of seventy-five (75) or
less, has a smoke density of one-hundred (100) or less, when the carpet is
treated in accordance with NFPA 253, Flooring Radiant Panel Test.
* Offices
* Corridors
* Chapels
* Day rooms
No pad will be permitted under the carpet. The carpet is to be
glued directly to the floor. Prior approval by the Division is required before
the carpet is installed. In nursing homes where carpet is installed, the home
must furnish equipment and have written cleaning procedures to clean and
maintain the carpet. This equipment must include, as a mium, a shampooer and
wet/dry vacuum.
Facilities presently having carpets in areas other than those
listed above may keep that carpet as long as it is maintained properly and free
of odors. If not properly maintained and free of odors, the carpet will be
removed and replaced with a hard smooth surface.
412
HEATING AND COOLING
412.1 The
institution shall be equipped with heating and cooling equipment that will
maintain a minimum temperature of seventy-five (75) degrees F during winter and
eighty (80) degrees F during summer in all patient areas when the temperature
outside does not exceed ninety-five (95) degrees F. If temperature outside
exceeds one-hundred (100) degrees F, there shall be a fifteen (15) degree F
difference in exterior to interior temperature. If air conditioner should break
down or malfunction, the OLTC should be notified immediately. Patients' toilets
and bathroom temperature shall be maintained at eighty (80) degrees
F.
412.2 Central heating systems
shall be provided with Underwriters; approved temperature controls throughout
the building.
413
LIGHTING
413.1 Each patient's
room shall have natural lighting during the day and have general lighting at
night. Natural lighting shall be augmented when necessary by artificial
illumination.
413.2 Approved "exit"
lights shall be provided at all exit areas and shall be continuously
illuminated.
414
EMERGENCY POWER
The facility shall provide an emergency source of electrical
power necessary to protect the health and safety of patients in the event the
normal electrical supply is interrupted. The emergency electrical power system
must supply power adequate at least for lighting in all means of egress;
equipment to maintain fire detection, alarm, and extinguishing systems. Dry
battery or wet-cell batteries may be used as emergency power in facilities
where life support systems are not used.
Where life support systems are used, emergency electrical
service is provided by an emergency generator located on the premises.
415
WATER SERVICE
415.1 The water supply used by the
institution shall meet the requirements of the Department of Health.
415.2 There shall be procedures to ensure
water to all essential areas in the event of loss of normal water
supply.
415.3 The water
service shall be brought into the building to comply with the
requirements of the Arkansas State Plumbing Code and shall be free of cross
connections.
415.4
Hot
Water Heaters
415.4.1 Hot water
heating and storage equipment shall have sufficient capacity to supply four (4)
gallons of water at one-hundred ten (110) degrees F (43 degrees C), per hour
per bed for institution fixtures, one (1) gallon at one-hundred sixty (160)
degrees F (71 degrees C), per hour per bed for the laundry and one (1) gallon
at one-hundred eight (180) degrees F (82 degrees C) per hour per bed for the
kitchen. The water temperature in patient areas shall not exceed one-hundred
ten (110) degrees F (49 degrees C).
415.4.2 The hot water storage tank, or tanks,
shall have a capacity equal to forty (40) percent of heater capacity.
415.4.3 Tanks and heaters shall be fitted
with pressure "temperature relief valves.
415.4.4 Temperatures of hot water at plumbing
fixtures used by residents shall be automatically regulated by control valves.
Water temperature in patient areas shall be checked weekly.
415.4.5 All gas, oil, or coal heaters shall
be vented to the outside.
415.5
Plumbing and Other Piping
Systems
All plumbing systems shall be designed and installed in
accordance with the requirements of Arkansas State Plumbing Code. From the cold
water service and hot water tanks, cold water and hot water mains and branches
shall be run to supply all plumbing fixtures and equipment which require hot
and cold water or both for their operation. Pipes shall be sized to supply hot
and cold water to all fixtures with a niinimum pressure of fifteen (15) pounds
at the top floor fixtures during maximum demand periods.
415.5.1 Water closets shall be the elongated
type, and water closet seats shall be of the open-front type.
415.5.2 Gooseneck spouts shall be used for
patients' lavatories and sinks which may be used for
filling pitchers.
415.5.3 Knee, elbow, wrist, or foot action
faucets shall be used in treatment rooms.
415.5.4 An electrically operated water
fountain shall be so located as to be accessible to patients.
415.5.5 Backflow preventers (vacuum breakers)
shall be installed with any water supply fixture where the outlet's end may at
times be submerged. Examples of such fixtures are hoses, sprays, direct
flushing valves, aspirators and under-rim water supply connections to a
plumbing fixture or receptacle in which the surface of the water in the fixture
or receptacle is exposed at all times to atmospheric pressure.
416
NURSES' STATION
Nurses' stations shall be provided and so designated that they
contain a minimum of sixty (60) square feet per each thirty-five (35) bed
patient unit, and are not more than one-hundred twenty (120) linear feet from
each patient room. The station shall include adequate storage and preparation
areas(s), medication, toilet and hand-washing facilities, and sufficient
lighting.
416.1 Separate utility room
shall be provided for clean items and soiled items for each nurses' station.
They shall be mechanically ventilated to the outside and adequately lighted.
Two or more electrical convenience outlets shall be provided for each utility
room. Blade handle control faucets shall be provided. Gooseneck spouts shall be
in a separate room and ventilated to the outside.
416.2 Closet for soiled linens shall be
provided for each nurses' station. This dirty linen storage shall be in a
separate room and ventilated to the outside.
417
JANITORS' CLOSETS
Janitors' closets shall be provided for each nursing unit, and
a separate janitor's closet shall be provided within the kitchen area. These
closets shall be provided with hot and cold running water, a floor receptor or
service sink, and shelves for the storage of janitorial equipment and supplies.
The closets shall be mechanically vented to the outside. Janitor closets in
patient areas must be kept locked.
418
NURSES' CALL SYSTEM
A nurses' call system comprised of an electric buzzer and/or
light system shall be so designed that the location of a call can be determined
from the corridor and nurses' station. In addition emergency call stations
shall be provided in all patient bath, toilet and shower areas. Wireless nurse
call systems may be substituted for wired call systems. Wireless call systems
shall meet the requirements set forth in Section 440 of these
regulations.
419
FIRE
ALARM SYSTEM
Each nursing home shall have an electrically-supervised,
manually-operated fire alarm system in accordance with Section 6-3 NFPA 101,
Life Safety Code handbook that applies to their nursing home.
420
PHYSICAL
ENVIRONMENT
421
STANDARDS FOR NEW CONSTRUCTION AND/OR ALTERATIONS
422
GENERAL
422.1 A "new institution" is one which had
plan approved by the Office of Long Term Care and began operation and/or
construction or renovation of a building for the purpose of operating an
institution on or after the adoption date of these regulations. The regulations
and codes governing new institutions apply if and when the institution proposes
to begin operation in a building not previously and continuously used as an
institution licensed under these regulations.
422.2 Additions to existing facilities shall
meet the standard for new construction.
422.3 The requirements outlined under section
1400, General Standards for Existing Structures, also apply when applicable.
423
SITE LOCATION,
INSPECTION, APPROVALS AND SUBSOIL INVESTIGATION
423.1 The building site shall afford good
drainage and shall not be subject to flooding or be located near insect
breeding areas, noise, or other nuisance producing locations, or hazardous
locations, industrial developments, airports, railways, or near penal or other
objectionable institutions or near a cemetery. The site shall afford the safety
of patients and not be subject to air pollution.
423.2 A site shall be adequate to accommodate
roads and walks within the lot lines to at least the main entrance, ambulance
entrance, and service entrance. All facility sites shall contain enough square
footage to provide at least as much space for walks, drives, and lawn space as
the square footage contained in the building.
423.3 The building site shall be inspected
and approved by the Division before construction is begun.
424
SUBMISSION OF PLANS,
SPECIFICATIONS, AND ESTIMATES
424.1
When construction is contemplated either for new buildings, additions, or major
alterations in excess of One-Hundred-Thousand dollars ($100,000), plans and
specifications shall be submitted in duplicate one (1) to the OLTC and one (1)
to the Plumbing Division of the Arkansas Department of Health, for review,
along with a copy of the statement of approval from the Comprehensive Health
Planning Agency. Final plan approval will be given by the OLTC.
424.2 Such plans and specifications should be
prepared by a registered professional engineer or an architect licensed in the
State of Arkansas (Act 270 of 1941 as amended) and should be drawn to scale
with the title and date shown thereon. The Division shall be a minimum of three
(3) weeks to review the drawing and specifications and submit their comments to
the applicant. Any proposed deviations from the approved plans and
specifications shall be submitted to the Division prior to making any changes.
Construction cannot start until approval of plans and specifications have been
reviewed from the Division. The Division shall be notified as soon as
construction of a new building or alteration to an existing facility is
started.
424.3 An estimate shall
accompany all working plans and specifications when the total cost of
construction is more than One-Hundred-Thousand dollars ($100,000).
424.4 Representatives from the Division shall
have access to the construction premises and the construction project for
purposes of making whatever inspections deemed necessary throughout the course
of construction.
425
PLANS AND SPECIFICATIONS
425.1
All institutions licensed under these standards shall be designated and
constructed to substantially comply with pertinent local and state laws, codes,
ordinances, and standards. All new nursing home construction shall be in
accordance with requirements of Section 10-132 if NFPA Standard 101,1973
edition.
Plans shall be submitted to the Division in the following
stages.
425.1.1
Preliminary Submission
Architect preparing plans should contact Office of Long Term
Care for preliminary review.
425.1.2
Final
Submission
Step (1) Working drawings and
specifications which shall be well prepared so that clear and
distinct prints may be obtained; accurate dimensions and including all
necessary explanatory notes, schedules and legends. Working drawings shall be
complete and adequate for contract purposes. Separate drawings shall be
prepared for each of the following branches of work; architectural, structural,
mechanical and electrical; and shall include the following:
* Approved plan showing all new topography, newly established
levels and grades, existing structures on the site (if any), new buildings and
structures, roadways, walks, and the extent of the areas to be seeded. All
structures and improvements which are to be removed under the construction
contract shall be shown. A print of the survey shall be included with the
working drawings.
* Plan of each floor and roof.
* Elevations of each fagade.
* Sections through building
* Scale and full size details as necessary to properly indicate
portions of the work.
* Schedule of finishes.
Step (2) Equipment Drawings: Large
scale drawings of typical and special rooms indicating all fixed equipment and
major items of furniture and movable equipment.
Step (3) Structural Drawings:
* Plans of foundations, floors, roofs, and all intermediate
levels shall show a complete design with sizes, sections, and the relative
location of the various members. Schedule of beams, girders, and columns shall
be included.
* Floor levels, column centers, and offsets shall be
dimensioned.
* Special openings and pipe sleeves shall be dimensioned or
otherwise noted for easy reference.
* Details of all special connections, assemblies, and expansion
joints shall be given.
Step (4) Mechanical Drawings: The
drawings with specifications shall show the complete heating, steam piping and
ventilation systems, plumbing, drainage and standpipe system, and
laundry.
* Heating, steam piping, and air-conditioning systems.
1. Radiators and steam heated equipment, such
as sterilizers, warmers, and steam tables.
2. Heating and steam mains and branches with
pipe sizes.
3. Sizes, types, and
heating surfaces of boilers, furnaces, with stokers and oil burners, if
any.
4. Pumps, tanks, boiler
breeching and piping and boiler room accessories.
5. Air-conditioning systems with required
equipment, water and refrigerant piping, and ducts.
6. Exhaust and supply ventilating systems
with steam connections and piping.
7. Air quantities for all room supply and
exhaust ventilating duct openings.
* Plumbing, drainage, and standpipe systems:
1. Size and elevation of: Street sewer, house
sewer, house drains, street water main and water service into the
building.
2. Locations and size of
soil, waste, and vent stacks with connections to house drains, clean outs,
fixtures, and equipment.
3. Size
and location of hot, cold and circulating mains, branches and risers from the
service entrance and tanks.
4.
Riser diagram to show all plumbing stacks with vents, water risers, and fixture
connections.
5. Gas, oxygen, and
special connections.
6. Plumbing
fixtures and equipment which require water and drain connections.
* Elevators and dumbwaiters: Details and dimensions of shaft,
pit and machine room; sizes of car platform and doors.
* Kitchens, laundry, refrigeration and laboratories; These
shall be detailed at a satisfactory scale to show the location, size, and
connections of all fixed equipment.
Step (5) Electrical Drawings:
* Drawings shall show all electrical wirings, outlets, smoke
detectors, and equipment which require electrical connections.
* Electrical Service entrances with switches, and feeders to
the public service feeders shall be shown.
* Plan and diagram showing main switchboard power panels, light
panels, and equipment.
* Light outlets, receptacles, switches, power outlets, and
circuits.
* Nurses' call systems with outlets for beds, duty stations,
door signal lights, enunciators, and wiring diagrams.
* Fire alarm system with stations, signal devices, control
board and wiring diagrams.
* Emergency electrical system with outlets, transfer switch,
source of supply, feeders and circuits.
Step (6) Specifications:
Specifications shall supplement the drawings to fully describe types, sizes,
capacities, workmanships, finishes, and other characteristics of all materials
and equipment and shall include the following:
* Cover or title sheet
* Index
* General conditions a General Requirements
* Sections describing material and workmanship in detail for
each class of work.
426
CODES AND STANDARDS
The following codes and standards are incorporated into and
made a part of these regulations:
426.1 The 1973 edition of the National Fire
Code (NFPA) applies to new construction and alterations or additions to
existing facilities. This edition includes NFPA No. 101, life Safety Code
(1973).
426.2 The 1967-68 edition
of the National Fire Code (NFPA) applies to existing facilities which met such
standards as of June 1,1976.
426.3
American National Standards Institute (ANSI) Standard No. A117.1, American
Standard Specifications for making building and facilities accessible to, and
usable by, the physically handicapped.
426.4 Arkansas State Plumbing Code.
426.5 Fire Resistance Index 1971,
Underwriters Laboratories, Inc.
426.6 Handbook of Fundamentals, American
Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE),
United Engineer Center, 345 East 47th Street, New
York, New York 10017..
426.7 Method
of Test for Surface Burning characteristics of Building Materials, Standard No.
E 84-61 American Society for Testing and Materials (ASTM) Standard No.
84-61,1961 Race Street, Philadelphia, Pennsylvania 19103.
426.8 Methods of Fire Test of Building
construction and Materials. Standard No. E 119, American Society of Testing and
Materials (ASTMO), 1961 Race Street, Philadelphia, Pennsylvania
19103.
426.9 Minimum Power Supply
Requirements, Bulletin No. XR4-10 National Electrical Manufacturers Association
(NEMA) 155 East 44th Street, New York, New York
10017.
427
STANDARD
PATIENT ROOM AND TOILET DESIGN
427.1
Built-in closets shall be provided in each patient room for storage of clothing
and other possessions.
427.2 Each
patient bed shall be provided with a suitable fixed light equipped with a
non-combustible shade to prevent direct glare for reading or other purposes,
and capable of being switched on and off by the patient.
427.3 To ensure privacy in multi-patient
rooms, each bed shall be provided with fixed flame retardant cubicle
curtain.
427.4 Each patient room
shall have an adequate toilet, bathing and hand-washing facility with hot and
cold running water unless provided in an adjacent room.
427.5 Each room has direct access to a
corridor and outside exposure, with the floor at or above grade
level.
427.6 Every patient unit
shall be provided with a bedside cabinet with at least two enclosed storage
spaces. The top drawer shall be for storage of personal items and the bottom
for individually assigned bedpans, urinals, etc.
427.7 Standard patient rooms shall measure at
least one-hundred (100) square feet. Multi-patient rooms shall provide a
minimum of eighty (80) square feet per bed.
427.8 Multi-patient rooms shall be limited to
four beds.
428
INTENSIVE CARE ROOM DESIGN
Other than requirements set forth for existing structures, 406,
an intensive care room shall be mechanically vented to the outside and provided
with a standard private toilet and hand-washing facility. The intensive care
room may also serve as an isolation room.
429
CORRIDORS
Corridors shall be at least eight (8) feet wide.
430
LAUNDRY
Laundry in new facilities must provide complete separation (by
partition) of the soiled laundry area (including washer) and the clean laundry
area. A lavatory with soap and towel dispensers must be provided for the staff
in each area, and a rinsing sink provided in the soiled laundry area. A linen
folding table must be provided in the clean laundry area. If the laundry area
is included in the main nursing home building, it shall be so located as to be
as remove as possible from the patient area.
431
STORAGE
There shall be a minimum of five (5) square feet per bed for
general storage space provided in those cases where built-in closets are
provided in patient rooms. It is recommended that this be concentrated in one
general area except for small storage areas within the nursing units for
wheelchairs, patient lifts, walkers, etc.
432
DIETETIC SERVICE AREA (LESS DINING
AREAS)
432.1 The kitchen shall be
located conveniently to the dining area. (Separation of the kitchen and dining
areas by corridors should be avoided.)
432.2 The food service area shall provided
adequate space and facilities for receiving food deliveries, storage,
preparation, tray assembly, and distribution serving of food, dishwashing and
utility cleaning, refuse collection and garbage disposal. The total area less
dining area, shall not be less than nine (9) square feet per bed for the first
one-hundred (100) beds and six (6) square feet per bed for all in excess of
one-hundred (100) beds.
432.3 A
suitable work area shall be provided for the dietitian or the dietary service
supervisor.
432.4 The kitchen shall
not serve as a passage between work or patient areas.
432.5 Adequate heat, light, and ventilation
shall be provided.
432.6 Hand
washing facility shall be provided in the dietary area with wrist-action
blade-handle controls and gooseneck spout.
433
ADMINISTRATIVE OFFICES
Separate office space shall be provided for administrative and
business functions as follows:
* Office for the administrator.
* Office for the director of nursing services.
* Office or space for social and activity director.
434
RESIDENTS' DINING AND
RECREATION AREAS
The total area set aside for residents' dining and recreation
purposes shall be not less than twenty (20) square feet per bed. Additional
space shall be provided if the facility participates in a day care program. The
areas shall be well lighted and well ventilated.
435
UTILITY ROOMS
435.1 Separate utility room shall be provided
for clean items and soiled items for each nurses'station.
435.2 Utility rooms shall be mechanically
ventilated to the outside and adequately lights. Two or more electrical
convenience outlets shall be provided for each utility. Blade-handle control
faucets shall be provided. Gooseneck spouts shall be provided in the clean
utility room.
436
BEDPAN ROOM
There shall be at least one bedpan cleaning room. In addition
to the bedpan cleaning equipment, hand-washing facilities with blade-handle
controls shall be provided. There shall be provisions for equipment
sterilization.
437
JANITORS' CLOSETS
Janitors' closets shall be provided for each nursing unit, and
a separate janitor's closet shall be provided within the kitchen area. These
closets shall be provided with hot and cold running water, a floor receptor and
service sink, and shelves for the storage of janitorial equipment and supplies.
The closets shall be mechanically vented to the outside. Janitor closets in
patient areas must be kept locked.
438
LINEN CLOSETS
Closets for clean linens shall be provided for each nurses'
station.
439
SOILED
LINEN CLOSETS
Closet for soiled linens shall be provided for each nurses'
station. This dirty linen storage shall be in a separate room and ventilated to
the outside.
440
NURSES' CALL SYSTEM
440.1 In general
patient areas, each room shall be served by at least one calling station, and
each bed shall be provided with a call button. Two call buttons serving
adjacent beds may be served by one calling station. Calls shall register with
the floor staff at the nurses' station and shall activate a visible signal at
the patient's room and audible signal at the nursing station. In multi-corridor
nursing units, additional visible signals shall be installed at corridor
intersections if patient room lights are not visible from the nurses' station.
Nurses' calling systems which provide two-way voice communication shall be
equipped with an indicating light at each calling station which lights and
remains lighted as long as the voice circuit is operating.
440.2 A nurses' call emergency button shall
be provided for patients' use at each patients' toilet, bath and shower room.
These call lights should be so designed that they can only be turned off in the
patient area.
440.3 Wireless Nurse
Call Systems - Facilities may substitute a wireless nurse call system for wired
call systems or may operate both a wireless and a wired nurse call system in
parallel. Wireless nurse call systems shall at a minimum:
a. Provide a call button at each patient bed,
bath, and toilet and at each whirlpool and each physical therapy
room.
b. Utilize FCC-approved radio
frequencies. Frequencies must not interfere with or disrupt pacemakers,
defibrillators, or other medical equipment.
c. Receive only signals initiated from the
manufacturer's system.
d. Provide
signal coverage and penetration throughout the entire facility and all facility
grounds.
e. Provide an audible
signal to any nurses' station that provides coverage to the room from which the
signal originates.
f. Provide
signaling for all wireless devices utilized by staff to receive the signal.
Signaling shall include either an audible tone or vibration to alert the person
carrying the receiving device, and shall display on the receiving device the
specific location from which the signal originated.
g. Provide escalation. Escalation means that
if a signal is unanswered for a designated period of time, the signal is
repeated and sent to other nurses' stations or to facility staff that were not
designated to receive the original signal.
441
NURSES' STATION
Nurses'" station shall be provided and so designed that they
contain a minimum of sixty (60) square feet per each thirty-five (35) bed
patient unit, and are not more than one-hundred-twenty (120) linear feet from
each patient room. The station shall include adequate storage and preparation
area(s), medication, toilet and hand-washing facilities, and sufficient
lighting.
442
FIRE
ALARM SYSTEM
Each nursing home shall be an electrically supervised, manually
operated fire alarm system in accordance with Section 6-3 NFPA 101, life Safety
Code handbook that applies to their nursing home.
443
LIMITATIONS
The following limitations shall apply:
443.1 No nursing home shall be connected to
any building other than a general hospital, chronic disease hospital,
rehabilitation facility, boarding home, adult day care, or Home Health Agency.
Upon request from the Office of Long Term Care, supporting documentation must
be provided to evidence proper allocation of costs and compliance with all
applicable state and federal laws and regulations.
443.2 A nursing home shall not be located
within thirty (30) feet from another nonconforming structure or the property
line of the facility except where prohibited by local codes.
443.3 Occupancies not under the control of,
or not necessary to the administration of a nursing home are prohibited therein
with the exception of the residence of the owner or manager.
444
CEILINGS,
WALLS, AND FLOORS
* Ceilings shall be a minimum of eight (8) feet. (Refer to
Section 411 for surfaces.)
* Walls (Refer to Section 411).
* Floors (Refer to Section 411).
445
WATER COOLER
An electrically operated water fountain of an approved type
shall be provided for each nurses' station. The water fountain shall be
accessible to the physically handicapped. Water fountains must be recessed not
to obstruct the corridor.
446-449
RESERVED
450
FURNISHINGS, EQUIPMENT, AND
SUPPLIES
451
FURNISHINGS
451.1 Each patient's bed
unit, bath and toilet shall be provided with a standard type, buzzer/light,
nurses' call signal, or, alternatively when a wireless nurse call system is
utilized, a call button designed to operate with the wireless nurse call
system.
451.2 Each bed shall be
provided with a light with a non-combustible shade to prevent direct glare for
reading or other purposes.
451.3 To
ensure privacy in multi-patient rooms, each bed shall be provided with flame
retardant cubicle curtains; in existing facilities, partitions or free-standing
folding screens may be used.
451.4
Each patient shall be provided with a rigid single bed in good repair measuring
a minimum of thirty-six (36) inches in width. Beds shall be provided with three
inch casters and at least two (2) of the four (4) casters shall be of the
locking type. (Roll-away beds, cots, or folding beds are not acceptable.) The
beds shall be equipped with a comfortable pillow and comfortable, firm mattress
at least five (5) inches thick and shall be covered with a moisture repellant
material. There shall be hospital type adjustable beds available for patients
receiving bed nursing care.
451.5
Each patient shall be provided with a bedside table with a compartment or
drawer for personal belongings, such as, soap, hairbrushes, combs, toothbrush
and dentifrice, and a lower enclosed compartment for storage of individual
bedpan or urinal (open-shelved stands are not acceptable.).
451.6 A comfortable chair shall be provided
for each licensed bed and be available at the bedside unless contraindicated by
the patient's condition.
451.7 Each
window shall be provided with a shade or flame retardant curtains.
451.8 Bed rails shall be provided for bed
patients and disoriented patients.
451.9 Furniture and play equipment used in
the care of children shall be painted with lead free paint.
451.10 All wastebaskets shall be the metal
type.
452
LINENS
AND BEDDING
452.1 Extra pillows shall
be available as need for treatment and/or comfort of patients.
452.2 Moisture proof rubber or plastic
sheeting shall be provided as necessary to keep mattress of pillows clean or
dry.
452.3 A supply of clean bed
linen shall be available at all times. A minimum of two clean sheets and one
pillowcase shall be provided for each bed on a weekly basis. Linens shall be
changed as often as necessary in order to keep the patients clean, comfortable,
and dry.
452.4 Each bed shall be
covered with a suitable bedspread or blanket at least during the hours of the
day when the bed is not occupied.
452.5 The minimum supply of linen based on
patient capacity shall be:
Sheets -- four (4) times bed capacity Draw Sheets -- three (3)
times bed capacity Pillowcases - three (3) times bed capacity Bath towels --
two (2) per patient per week Washcloths -- four (4) per patient per week
Bedspreads or blankets -- two (2) time bed capacity
452.6 Blankets shall be provided to assure
the warmth of each patient and shall be laundered to assure cleanliness and
freedom from odors. The blankets shall be individually assigned to patients and
not passed indiscriminately to patients without first being
laundered.
452.7 Where laundry is
provided on the facility premises:
452.7.1 An
employee shall be designated in charge of the service.
452.7.2 Table linens shall be laundered
separately from bed linen and clothing.
452.7.3 Patients and personal laundry shall
not be washed with bed linen.
452.7.4 Equipment and doorways in existing
laundries must be so arranged that soiled linen and clothing can be delivered
to the washing machines without coming near the dryers and clean laundered
material. Hand-washing facilities must be provided for the staff with soap and
towel dispensers nearby.
452.7.5
Soiled linens shall be covered or placed in enclosed containers before being
transported to the laundry.
452.7.6
Soiled linens shall be stored in a vented area designated only for soiled
linens.
452.7.7 Infected linens
shall be tagged with a label marked "Infected" prior to being sent to the
soiled linen storage room. In the laundry, infected linens shall be disinfected
by soaking in a chemical solution before being laundered.
453
EQUIPMENT AND
SUPPLIES
Nursing equipment and supplies shall be provided to meet the
patients' needs and maintained in good condition to ensure adequate nursing
care of the patients.
453.1 In nursing
homes licensed as Intermediate Care Facilities, the following equipment and
supplies shall be provided:
* *Individual soap dishes
* *Mouthwash cups
* *Drinking glasses or cups
* *Items for personal care and grooming
* *Denture cups
* *Wash basins
* *Emesis basins
* *Bedpans
* *Bedpan covers
* *Urinals
* Hypodermic syringes and needles
* Insulin syringes anjd needles
* Forceps and forceps jars
* Rubber and plastic sheeting
* Hot water bottles and ice caps with covers
* Grab bars in all bathtub, shower, and toilet areas
* Catheter trays and cover
* Irrigation stands or rods
* Suction machine for each thirty-five (35) patients or a major
fraction thereof
* Occupational therapy equipment according to patient
needs
* Adjustable crutches, canes and walkers for fifteen percent
(15%) of licensed capacity
* One oxygen unit
* Enema equipment
* Rubber rings
* Flashlights
* Examination lights
* Gloves
* Footboards
* Bed rails
* Commode chairs
* Weight scales
* Thermometers
* Bedpan brushes and containers
* Sphygmomanometer
* A bed cover cradle
* Stethoscope
* First Aid equipment and supplies
* Heating pads (waterproof type)
* An emergency medical kit
* A stretcher (collapsible stretcher recommended)
* Trapeze frames for five percent (5%) of licensed
capacity
* Wheelchairs for ten percent (10%) of licensed capacity
* Dressing cart or tray with sterile supplies
NOTE: * These items shall be assigned to
individual patients, kept clean, and maintained or stored at patient's bedside
cabinet.
453.2 In nursing
homes licensed as Skilled Nursing Facilities, the following equipment and
supplies shall be provided in addition to the equipment and supplies necessary
for facilities licensed as Intermediate Care Facilities:
* Additional trapeze frames as needed
* Oxygen unit (total of two (2) units required)
* Sterile I.V. equipment
* Tube feeding tray for each thirty-five (35) skilled care
patients or major fraction thereof.
* One patient life for each thirty-five (35) skilled care
patients or major fraction thereof.
* Wheelchairs for fifteen percent (15%) of licensed
capacity
* Sphygmomanometer (total of two (2) required)
* Stethoscope (total of two (2) required)
454
CARE AND
CLEANING OF MEDICAL SUPPLIES AND EQUIPMENT
454.1 In homes where commercially packaged
sterile disposable items, i.e., dressings, syringes, needles, gloves,
catheters, etc., are not provided, a method shall be utilized to achieve
sterility for these required items. Suitable methods for sterilization are:
* Steam autoclave
* Pressure cooker
* Liquid sterilizing solution
* Dry heat sterilizer
454.2 Thermometers shall be disinfected by
methods approved by the OLTC. One suitable method is to clean the thermometer
thoroughly with soap and water and place in solution of iodine one percent (1%)
and isopropyl alcohol for at least ten (10) minutes, and then rinse thoroughly
with cold water before use.
454.3
Methods approved by the OLTC shall be used to sanitize bedpans, urinals, and
emesis basins.
455
STORAGE
455.1 If bedpans,
urinals, and emesis basins are assigned to individual patients, they shall be
name labeled and stored in the patient's bedside cabinet. They shall be
cleansed after each use and sanitized by an approved method at least weekly. If
the utensils are not individually assigned, they shall be thoroughly cleansed
and effectively sanitized between each use and stored in a bedpan room. After
the discharge or transfer of any patient, all such equipment shall be cleansed
and boiled or autoclaved prior to reuse.
455.2 There shall be convenient storage space
for all linens, pillows, and other bedding items.
455.3 There shall be allotted at least five
(5) square feet of general storage space per bed.
455.4 Approved storage shall be provided for
all materials such as oxygen and flammable gases. One cylinder of oxygen may be
chained onto a cart and maintained at each nurses' station for emergency use in
the treatment of patients. All other such flammable gases shall be stored
outside the building in a sheltered area or in an oxygen storage room having
dual ventilation and at least a one and three-quarter (1 3/4) inch solid core
door. Such gases shall be chained or secured in such manner to support them in
an upright position. They shall not be stored in an exit-way.
455.5 Facilities shall be provided for
storage and preparation of medications and treatments and for storage of active
and inactive medical records.
455.6
Storage space shall be provided for recreational equipment and supplies.
456-469
RESERVED
470
HOUSEKEEPING/MAINTENANCE
471
HOUSEKEEPING -
MAINTENANCE
471.1 Housekeeping services of the nursing
home shall be under the direction of a full-time experienced person. The
facility shall have on duty one (1) housekeeper per thirty (30) residents in
order to maintain the nursing home. Housekeeping services shall be provided
daily, including weekend daytime coverage and for clean up after the evening
meal. Additional staff will be required if deficiencies are found that relate
to personnel shortage.
471.2
Sufficient housekeeping and maintenance equipment shall be available to enable
the facility to maintain a safe, clean, and orderly interior.
471.3 If a facility has a contract with an
outside resource for housekeeping services, the facility and/or outside
resource shall meet the requirements of these standards.
471.4 All rooms and every part of the
building (exterior and interior) shall be kept clean, orderly, and free of
offensive odors. Bath and toilet facilities and food areas shall be clean and
sanitary at all times.
471.5 Rooms
shall be cleaned and put in order daily.
471.6 If a patient keeps his own room, he
shall be closely supervised to ensure a clean, orderly room.
471.7 After discharge of a patient, the room
and its contents shall be thoroughly cleaned, aired, and disinfected if
necessary. Clean linens shall be provided. All patients' utensils shall be
washed and sanitized.
471.8 Polish
or wax used on floors shall be of a type that provides a non-slip finish.
Floors shall be maintained in a clean and safe condition.
471.9 Deodorants shall not be used to cover
up odors. Odor control shall be achieved by prompt cleansing of bedpans,
urinals, and commodes, by the prompt and proper care of patients and soiled
linens, and by approved ventilation.
471.10 Attics, cellars, beneath stairs, and
similar areas shall be kept clean of accumulation of refuse, old newspapers,
and discarded furniture.
471.11
Storage areas shall be kept in a safe and neat order.
471.12 Combustibles such as rags and cleaning
compounds and fluids shall be kept in closed metal containers and should be
labeled as to contents.
471.13
Buildings and grounds shall be kept free from refuse and litter.
471.14 Storage facilities with proper
ventilation shall be provided for mattresses.
471.15 All useless items and materials shall
be removed from the institution area and premises.
471.16 Matches and other flammable or
dangerous items shall be stored in metal containers with tight-fitting lids and
labeled as to contents.
471.17
Mechanical rooms, boiler rooms, and similar areas shall not be used for storage
purposes.
471.18 All inside
openings to attics and false ceilings shall be kept closed at all times. The
attic area shall be clean at all times.
471.19 Mop heads shall be of the removable
type and shall be laundered or replaced at frequent intervals to ensure a
standard of cleanliness.
471.20
Straw booms shall not be used for cleaning facility floors.
471.21 Garbage must be kept in approved
containers with tight-fitting covers.
The containers must be thoroughly cleaned before reuse. Garbage
or rubbish and trash shall be disposed of by incineration, burial, sanitary
fill, or other approved methods. Garbage areas shall be kept clean and in a
state of good repair.
471.22 All poisons, bleaches, detergents, and
disinfectants shall be kept in a safe place accessible only to employees. They
shall not be kept in storage areas or containers previously containing food or
medicine. Containers must have a label that states name, ingredients, and
antidote.
471.23 Unnecessary
accumulation of possessions, including equipment and supplies of patients,
staff, or the home's owner, shall not be kept in the home.
471.24 A minimum of one (1) full-time laundry
worker must be provided for each seventy (70) patients in the facility to
ensure that clean linen and clothing is provided each patient and to ensure
that dietary and nursing personnel are not required to perform laundry
duties.
471.25 Facilities that
perform their own pest control, rather than employing licensed pest control
experts or exterminators, and utilize restricted-use pesticides, shall be
licensed by the Arkansas State Plant Board for the use of the pesticides. To
obtain a list of restricted-use pesticides, please contact the Arkansas State
Plant Board.
472-499
RESERVED
500
PATIENT CARE SERVICES
501
PHYSICIAN SERVICES
502
ADMISSION ONLY ON RECOMMENDATION OF
A PHYSICIAN
Patients shall be admitted to the facility only oh
recommendatioii of a physician. At the time of admission the physician must
document level of care needed by the patient. A Certification Statement by the
physician explaining the reason for nursing honie placement should be obtained
on the date of admission and a re-certification statement obtained every sixty
(60) days.
503
CONTINUED SUPERVISION OF CARE
The health care of every patient shall be under the continuing
supervision of a physician, who, based .on a medical evaluation of the
patient's immediate and long term needs, prescribes a planned regimen of total
patient care. Patients in need of skilled care should be seen by a physician at
least every sixty (60) days, and all others seen at least every one hundred
twenty (120) days. A notation should be made at each visit and orders for
treatment and medication renewed.
504
PHYSICAL EXAMINATION OF
PATIENTS
The medical evaluation of the patient shall be based on a
history and physical examination done within seventy-two (72) hours of
admission unless such exaroination was performed within fifteen (15) days prior
to admission. A history and physical completed during the patient's
hospitalization may have been completed up to thirty (30) days prior to
admission to the nursing home; however, the hospital discharge summary (upon
completion) is to be forwarded to the nursing home.
505
PLANNED REGIMEN OF CARE
The planned regimen of total care for each patient shall be
based on the attending physician's order and shall cover medication, treatment,
rehabilitative services (where appropriate), diets, precautions related to
activities undertaken by the patient, and plans for continuing care and
discharge.
506
ESTABLISHMENT RESTORATION POTENTIAL
The attending physician shall establish at the time of
admission a restoration potential for the patient. This should be updated as
needed but not less than on an annual basis.
507
EMERGENCY PHYSICIAN
The facility should make arrangements for emergency coverage by
a physician if the attending physician or his attendant cannot be located. This
should be done by a written agreement signed by the physician and the facility
administrator.
510
NURSING
511
PROFESSIONAL NURSE SUPERVISION
511.1 A licensed registered nurse shall be
employed full-time as the Director of Nursing Services and normally work on the
day shift. In skilled nursing facilities registered nurse relief shall be
provided for the off days of the Director of Nursing Services. If the Director
of Nursing Services has other institutional responsibilities in addition to
written job description, a licensed registered nurse shall serve as assistant
so that there is the equivalent of a full-time Director of Nursing Services on
duty.
511.2 In Intermediate Care
Facilities the registered nurse must work forty (40) hours per week, normally
on the day shift. An LPN may serve as relief on the Director of Nursing
Services' days off.
511.3 The
Director of Nursing Services shall be responsible for the development and
maintenance of nursing service objectives, standards of nursing practice,
nursing policy and procedures manuals, written job descriptions for each level
of nursing personnel, scheduling of daily rounds to see all patients, methods
for coordination of nursing service with other patient services, for
recommending the number and levels of nursing personnel to be employed to meet
the needs of the patients, nursing staff development, and supervision of
nursing documentation.
511.4 The
Director of Nursing Services can serve as Director of Nursing Services in only
one facility.
512
CHARGE NURSE
512.1 In Skilled
nursing Facilities, the Director of Nursing Services shall designate as charge
nurse for each shift a registered nurse, a licensed practical nurse, or a
licensed psychiatric technician nurse. Responsibilities of the charge nurse
shall include supervision of the total nursing activities in the facility
during his/her assigned tour of duty.
512.2 In Intermediate Care Facilities, the
Director of Nursing Services shall designate as charge nurse for each shift a
registered nurse, a licensed practical nurse, or a licensed psychiatric
technician nurse. In facilities admitting or retaining patients requiring
medications or treatments on the night shift, the charge nurse designated on
the night shift must be a licensed nurse.
512.3 The charge nurse's duties shall include
as a minimum:
* Responsibility for observation of work performance of aides
in delivery of direct care.
* Administration of medication if there is no assigned
medication nurse.
* Ordering medications from the pharmacy.
* All direct observations of patients to observe and evaluate
physical and emotional status.
* Delegate responsibility for the direct care of specific
patients to the nursing staff based on the need of the patients.
* Taking phone orders from physicians or dentists.
* Giving shift report to the next shift.
* Shift count of control drugs.
* Dietary observations.
512.4 The Director of Nursing Services shall
not serve as charge nurse in a Skilled Nursing Facility with an average daily
total occupancy of seventy-one (71) or more patients. Waivered Licensed
Practical Nurses shall not serve as charge nurse unless they have passed the
State Pool Examination or Public Health Proficiency Examination.
513
NURSING
STAFF
513.1 All registered nurses,
licensed practical nurses, and licensed psychiatric technicians employed in the
nursing home shall be currently licensed in the State of Arkansas
513.2 The licensed nursing staff required
shall be computed in accordance with Section 520.
513.3 The nursing aide requirement shall be
computed in accordance with Section 520.
513.4 In nursing homes with more than one
classification of license, each distinct part shall be staffed according to the
requirements for each classification.
514
PERSONNEL ASSIGNMENTS
514.1 The nursing staff shall be engaged in
the direct care and treatment of the patients.
514.2 No aide shall be permitted to combine
the duties of housekeeping, laundry, or kitchen duties with nursing because of
the danger of cross infection to the patient.
514.3 In multi-story homes, each floor should
be staffed as an individual unit.
515
RESTRICTIONS IN EMPLOYMENT AND/OR
ASSIGNMENT
No person who has been a patient in a mental hospital and who
has not been completely discharged by that institution shall be employed in a
nursing home in a supervisory capacity.
516
NURSING CARE REQUIREMENTS
516.1 Charting
a. Summary charting should address the
resident's problems/needs, interventions to resolve those needs, and the
progress made toward achieving the resident goals as listed on the care
plan.
b. All disciplines (nursing,
dietary, therapies, social, etc.) may document their progress notes on the same
chart to promote continuity of care.
c. All charting notations made on the nurse's
progress notes or flow sheets shall be entered by time and date, and shall be
signed or initialed.
d. Minimum
requirements for summary charting based on the resident's Level of Care are as
follows:
|
Skilled
|
Every two (2) weeks
|
|
Intermediate I
|
Every two (2) weeks
|
|
Intermediate II
|
Monthly
|
|
Intermediate HI
|
Monthly
|
e. The
following observations must be charted upon occurrence*:
* If a flow sheet is utilized for documentation of the
following, it is only necessary to document a summarization on the nurse's
progress notes based on the time frequencies in item (d) above.
1. Accidents/Incidents (charting will be done
every shift for at least 48 hours or until the resident returns to pre-accident
status or stable condition, which ever is longer);
2. Significant changes in the residents
physical, mental, or psychosocial status (i.e., a deterioration in health,
mental, or psychosocial status in either life-threatening conditions or
clinical complications). Charting will be required on every shift until the
resident's condition becomes stable;
3. Any need to alter treatment significantly
(i.e., a need to discontinue an existing form of treatment, due to adverse
consequences, or to commence a new form of treatment);
4. Use of physical restraints to include the
type applied, time of application, checks, releases and exercise of resident.
(Flow sheet may be used.);
5.
Bedtime snacks for.therapeutic diets and physician ordered supplemental
feedings to include the type, amount served and amount consumed. (Flow sheet
may be used.);
6. Meal consumption
for residents at nutritional risk to include percentage of meal consumed. (Flow
sheet may be used.);
7. PRN
medications to include name, amount, route of administration, time, reason
given and response. PRN "controlled" drugs must also be charted in the nurse's
notes, which must also contain the condition of the patient before and after
administration.
8. Foley catheters
to include documentation of insertion, reinsertion, removal and catheter
irrigations. The total amount of urinary output must be documented, at. a
minimum, every eight (8) hours. (Flow sheet may be used.);
9. Nasogastric or gastrostomy tubes to
include documentation of insertion, reinsertion, removal, placement checks,
care of site, type of formula, amount of formula, rate of feeding, and flushes.
Total fluid intake must be documented, at a minimum, every eight (8) hours to
include formula and flushes. (Flow sheet may be used.);
10. Problem skin conditions to include date
of onset and weekly progress notes. Documentation must identify the skin
problem, stage, size, color, odor and drainage, if any. The chart shall also
document the date and time of treatments and dressings. (Flow sheet may be
used.);
11. Physician visits to
include date of visit;
12. Any
contacts with the physician (date and time) regarding the resident's condition
and the physician's response/instructions;
13. Resident's condition on discharge or
transfer;
14. Disposition of
personal belongings and medications upon discharge;
15. Time of death of a resident, the name of
person pronouncing death and disposition of the body.
f. Vital signs must be charted weekly and
weights monthly unless ordered more frequently. (Flow sheet: may be
used.)
516.2 Routine Care
and Services
Each patient in the home shall receive the type of nursing care
including restorative nursing as required by his/her condition. Patients shall
be encouraged to be active, to develop techniques for self-help, and be
stimulated to develop hobbies and interests. Criteria for determining adequate
and proper care includes:
516.2.1 Kind
and considerate care and treatment at all times.
516.2.2 A minimum of a complete bath twice a
week for all ambulatory patients with adequate assistance or supervision as
needed. Patients who are incontinent or are confined to bed shall have a
complete bath daily and partial baths each time the bed or clothing is wet or
soiled. All soiled linen and clothing shall be replaced with clean dry
ones.
516.2.3 A minimum of one
shampoo every week and assistance with daily hair grooming. Patients shall not
be required to pay for routine hair grooming provided by facility
staff.
516.2.4 Assistance with or
supervision of shaving of men patients at least every other day except when
contraindicated or refused by the patient. Patients shall not be required to
pay for routine shaving..
516.2.5
Oral care shall be provided at least twice a day.
516.2.6 Hands and feet shall have proper care
and attention. Nails shall be kept clean and trimmed. Additional lotion shall
be applied to hands and feet when indicated. Precautions shall be taken to
prevent foot drop in bed patients.
516.2.7 Bed linens shall be changed weekly or
more often as needed and adjusted at least daily.
516.2.8 Patients shall have clean and
seasonal clothing as needed to present a neat and clean appearance, to be free
of odors, and to be comfortable.
516.2.9 Measures shall be taken toward the
prevention of pressure sores, and if they exist, treatment shall be given on
written medical order. The position of bed patients shall be changed every two
(2) hours during the day and night.
516.2.10 Each mattress and pillow shall be
moisture proof or must have a moisture proof cover. Rubber or plastic sheets
shall be cleaned often to prevent accumulation of odors. Clean cloth draw
sheets shall be used over the rubber or plastic sheet.
516.2.11 Assistance with the use of commode,
bedpan, or toilet, and keeping the commode, bedpan, and urinal clean and free
of odors. Bedpans, urinals, and wash basins shall be name-labeled, cleaned
after each use, properly stored in the patient's bedside cabinet, and sanitized
at least weekly. Any of these utensils not name-labeled and stored in
individual bedside cabinets must be sterilized after each use.
516.2.12 Each patient shall be up and out of
bed for at least a brief period everyday unless the physician has written an
order for him/her to remain in bed.
516.2.13 Fluids shall be offered at frequent
intervals when the patient is unable to obtain them. Water pitchers shall be
refilled at least once each shift and should be kept in reach of patients.
Clean drinking glasses shall be kept with each water pitcher.
516.2.14 Physical findings (temperature,
pulse, respiration, and blood pressure) shall be taken and recorded as ordered
by the physician, but not less than one (1) time a week. All residents with
indwelling catheters should have urine output recorded each shift.
516.2.15 Administration of oxygen.
516.2.16 Documentation that a continuous
program of bowel or bladder training is provided when appropriate.
516.2.17 Proper bed and chair
positioning.
516.2.18 Nursing
equipment is in sufficient supply,, in good condition, is properly cleaned and
cared for, well organized, and readily available.
516.2.19 Precautions to assure the safety of
patients are continuously in effect. (See, also, Section 309 regarding
restraints.)
516.2.20 Bedside
nursing care.
516.2.21
Administration of hypodermic medications as prescribed.
516.2.22 Rehabilitation programs such as
physical therapy, occupational therapy, speech therapy, etc., as required by
written physician orders. Such therapies must be administered by qualified
persons.
516.3 Skilled
Nursing Facilities:
. In addition, the following services will be required in
Skilled Nursing Facilities:
* Intravenous feedings
* Complex dressings
* Skilled nursing care
* Tube feedings
There will be no administration of blood in the nursing home
unless the nursing home is physically connected to a hospital. In any nursing
home administering blood, a registered nurse must be on duty throughout the
entire administration.
517
TREATMENT AND MEDICATIONS
517.1 No medication or treatment shall be
given without the written order of the physician or dentist. Drugs shall be
administered in accordance with orders. Venapuncture by licensed practical
nurses to obtain blood samples for lab work is permitted after the LPN has been
trained by the Director of Nurses or an RN designated by the Director of
Nurses. The Director of Nurses and the LPN trained shall sign a form that
states that the LPN is qualified and has been trained by a Registered Nurse.
The facility shall have policies and procedures for venapuncture that are
available for review by nursing personnel and the Office of Long Term
Care.
517.2 If it is necessary to
take physician's or dentist's orders over the telephone or verbally, the order
shall be immediately written on the physician's order sheet in the medical
record and signed by the nurse who took the order. Documentation shall include
the name of the physician or dentist who gave the telephone or verbal order,
the date, and the time of the order. The order shall be countersigned by the
attending physician or dentist on his next regular visit or no more than seven
(7) days from the time the telephone or verbal order was given. There shall be
indication made by the nurse that the orders were transcribed (signature and
time).
517.3 When computerized
physician order sheets are utilized, the physician must sign each sheet at the
bottom of the sheet, and date each sheet. If a physician's signature is affixed
to the sheet other then at the bottom, all orders appearing after the signature
shall be invalid. When progress notes or recertification statements are written
on the computerized order sheet, the name and date affixed by the physician at
the bottom of the sheet will be sufficient. However, if progress notes or
recertification statements appear elsewhere in the medical record, each sheet
shall be signed and dated where they are written.
517.4 Each patient shall be identified prior
to administration of medication.
517.5 Each patient shall have an individual
medication record.
517.6 The dose
of a drug administered to a patient shall be properly recorded by the person
who administered the drug. Recordation shall occur only after the . medication
has been administered.
517.7
Medications shall be administered by authorized personnel.
517.8 Treatment of a lesion or open wound
shall be done only by licensed nursing personnel.
517.9 Medication setups will be prepared one
pass at a time. The medication must be administered on the same shift on which
they are prepared. Liquids and injectables shall not be set up more than one
(1) hour in advance except where approved unit dose systems are used.
517.10 Medications shall be administered by
the same person who prepared the doses for administration, except under single
unit dose package distribution systems.
517.11 The attending physician shall be
notified of an automatic stop order prior to the last dose so that the
physician may decide if the administration of the medication is to be continued
or altered.
517.12
Self-administration of medication is allowed only under the following
conditions: If the physician orders, a patient may keep at the bedside the
following nonprescription medications:
* Topical agents such as Vicks Salve, Mentholatum, etc.
* Eye drops such as Murine, Visine, etc.
* Cough drops, such as Ludens, Vicks, etc.
* Sublingual vasodilating agents such as Nitroglycerine
tablets, Isordil Sublingual tablets.
* Metered dose aerosols for asthmatics such as primatene or
bronkaid.
toilet articles and cosmetic articles may be kept at the
bedside.
518
REHABILITATIVE NURSING
518.1
Nursing personnel shall be trained in rehabilitative nursing measures. This
shall be documented in the orientation program, and in-service on this subject
shall be conducted at least annually.
518.2 The facility shall have an active
program of rehabilitative nursing care which is an integral part of nursing
service and is directed toward assisting each patient to achieve and maintain
an optimal level of self care and independence.
518.3 Rehabilitative nursing services such as
proper maintenance of body alignment, bed and chair positioning, use of
foodboards, use of handrolls, range of motion exercises, elevation of
extremities as indicated, assistance with ambulation, and bowel or bladder
training shall be performed daily and recorded routinely for those patients who
require such service.
519
SUPERVISION OF PATIENT NUTRITION
Nursing personnel shall be aware of the nutritional needs,
food, and fluid in-take of patients and assist promptly where necessary in the
feeding of patients.
520
MINIMUM DIRECT-CARE STAFFING REQUIREMENTS
520.1
Definitions
For purposes of this regulation, and unless otherwise specified
herein, the following definitions shall apply. The following definitions are
independent of, and in no way are intended to modify, amend or otherwise
change, the definitions set forth in the Reimbursement Methodology.
520.1.1
Direct-care staff
means any licensed or certified nursing staff who provides direct, hands-on
care to residents in a nursing facility. Direct-care Staff
shall not include therapy personnel or individuals acting as Director of
Nursing for a facility.
520.1.2
Midnight census means the number of residents occupying
nursing home beds in a nursing facility at midnight of each day.
520.1.3
Day shift means the
period of 7:00 a.m. to 3:00 p.m., or, in the event of flex staffing, the first
shift to begin after midnight.
520.1.4
Evening shift means
the period of 3:00 p.m. to 11:00 p.m., or, in the event of flex
staffing, the second shift to begin after
midnight.
520.1.5
Night
shift means the period of 11:00 p.m. to 7:00 a.m., or, in the event of
flex staffing, the third shift to begin after midnight.
520.1.6
Therapy personnel
shall include certified or licensed Medicare Part A Therapy personnel when they
are performing, or billing for, Medicare Part A therapy services.
520.1.7
Flex staffing means
the ability to vary the beginning and ending hours of a shift from the times
set forth in 520.1.3 through 520.1.5.
520.1.8
Pattern of failure
means a facility did not meet the minimum staffing requirements for more than
twenty percent (20%) of the total number of shifts for any one month.
520.1.9
Resident census
means the midnight census as defined in 520.1.2 taken prior to the
shift in question.
520.2
RATIO OF DIRECT-CARE STAFF TO RESIDENTS - COMPUTATION
520.2.1 Minimum staffing computations shall
be performed using the following method:
Step 1 - Determine the midnight census
for the date the shift begins.
Step 2 - Divide the census by the
ratio of direct-care staff required for the shift being computed. The result
will be the total number of direct-care staff required for the
shift.
Step 3 - Divide the census by the
required ratio of licensed personnel for the shift being computed. The result
will be the total number of licensed
direct-care staff required for the shift.
Step 4 - Subtract the results of Step
3 from the results of Step 2. The result will be the total number
of remaining direct-care staff required for the
shift.
520.2.2 All computations shall be carried to
the hundredth place. If the computations result in other than a whole number of
direct-care staff for a shift, the number shall be rounded up to the next whole
number when the computation, carried to the hundredth place, is fifty-one
hundredths (.51) or higher.
520.2.3
Facilities shall have no less than one (1) licensed personnel per shift for
direct-care staff as of July 1, 2001.
520.3
MINIMUM DIRECT-CARE STAFF
RATIOS
520.3.1 Beginning October 1,
2003, facilities shall maintain the following direct-care staff to resident
ratios:
520.3.1.1
Day Shift: One
(1) direct-care staff to every six (6) residents; of which
there shall be one (1) licensed nurse to every forty (40) residents.
520.3.1.2
Evening Shift: One (1)
direct-care staff to every nine (9) residents; of which there shall be one (1)
licensed nurse to every forty (40) residents.
520.3.1.3
Night Shift: One (1)
direct-care staff to every fourteen (14) residents; of which there shall be one
(1) licensed nurse to every eighty (80) residents.
Beeinnine October 1,
2003
Example The facility has
a census of eighty-two (82) residents as of midnight on December 10, 2003, and
is computing the required direct-care staff for the day shift erf December 11,
2003. The day shift has a direct-care-staff to resident ratio of one (1)
direct-care staff to every six (6) residents, of which there shall be one (1)
licensed staff member to every forty (40) residents.
Step 1: Census of 82
Step 2: 82 ÷ 6 = 13.67
[Round to 14; total number of direct-care staff required]
Step 3: 82 ÷ 40 = 2.05
[Round to 2; number of Hcensed direct-care staff
required]
Step 4: 14 - 2 = 12 [Number of
remaining direct-care staff required]
Total number of direct-care staff for the day shift: 14 Total
number of licensed direct-care staff for the day
shift: 2 Total number of remaining direct care staff
for the day shift: 12
Example The facility has
a census of ninety-seven (97) residents as of midnight on January 3, 2004, and
is computing the required direct-care staff for the evening shift. The evening
shift has a direct-caxe-staff to resident ratio of one (1) direct-care staff to
every nine (9) residents, of which there shall be one (1) licensed staff member
to every forty (40) residents.
Step 1 - Census of 97
Step 2 - 97 ÷ 9 = 10.77
[Round to 11; total number of direct-care staff required]
Step 3 - 97 ÷ 40 = 2.42
[Round to 2; number of
licensed direct-care staff
required]
Step 4-11 - 2 = 9 [Number of
remaining direct-care staff required]
Total number of direct-care staff for the evening shift:
11
Total number of licensed direct-care
staff for the evening shift: 2
Total number of remaining direct care
staff for the evening shift: 9
Example The facility has
a census of one hundred forty-two (142) residents as of midnight on December 7,
2003, and is computing the required direct-care staff for the night shift. The
night shift has a direct-care-staff to resident ratio of one (1) direct-care
staff to every fourteen (14) residents, of which there shall be one (1)
licensed staff member to every eighty (80) residents.
Stepl - Census of 142
Step 2 -142 ÷14 = 10.14
[Round to 10; total number of direct-care staff]
Step 3 -142 ÷ 80 = 1.77
[Round to 2; number of licensed direct-care
staff]
Step 4 - 10 - 2 = 8 [Number of
remaining direct-care staff]
Total number of direct-care staff for the night shift: 10 Total
number of licensed direct-care staff for the night
shift: 2 Total number of remaining direct care staff
for the night shift: 8
520.4
EXCEPTIONS TO MINIMUM STAFFING RATIOS
520.4.1 Upon an increase in a facility's
resident census, the facility shall be exempt from any corresponding increase
in staffing ratios for a period of nine (9) consecutive shifts beginning with
the first shift following the midnight census for the date of the expansion of
the resident census.
520.4.2 When
residents are relocated or transferred from facilities due to natural disaster,
emergency or as a result of state or federal action, the Department of Human
Services may waive, for a period of no more than three (3) months from the date
of transfer, some or all of any required increase in direct-care staff for the
facility or facilities . to whom the residents are relocated or transferred.
Waivers will only be granted for good cause shown, and upon telephone,
facsimile or written request. A grant of a waiver is within the sole discretion
of the Office of Long Term Care. Facilities may apply for a waiver by writing
the Director of the Office of Long Term Care. The written request should state,
at a minimum:
a. The date of the transfer for
each resident;
b. The number of
residents transferred for each date in which residents were received from
another facility;
c. The
anticipated date by which the facility will be able to meet the increased
number of minimum staff for the total number of residents of the entire
facility, including all residents received in transfer;
d. The name of the facility from which the
residents were transferred; and,
e.
A brief .explanation as to why the facility's staffing cannot be increased
prior to the anticipated increase date set out in c, above.
520.5
STAFFING
REPORTS
520.5.1 By the fifth
(5th) day of each month, each nursing facility or
nursing home shall submit a written report of all shifts for the preceding
month to the Office of Long Term Care, utilizing form
DMS-718.
520.5.2 In
addition, each report shall designate the shifts in which minimum staffing
standards were not met, as set forth in form DMS-718.
520.6
FLEX STAFFING
520.6.1 Hex staffing permits facilities to
vary the beginning and ending hours for shifts, so that facilities may maximize
staff time to the benefit of residents. Regardless whether a facility employs
shifts of greater duration than specified in these regulations - such as ten
(10) or twelve (12) hour shifts - for purposes of computing minimum staffing
ratios the facility shall base their computations on three shifts of equal
length. Facilities can, however, designate that their shifts will begin earlier
or later than specified in Sections 520.1.3 through
520.1.5.
520.6.2 When
facilities utilize flex staffing, the shifts must meet the staffing
requirements set forth herein for the entire period of the shift. As way of
example only, if a facility begins a shift at 5:30 a.m., the minimum staffing
requirements for that shift, which would end at 1:30, would be minimum staffing
requirements for the Day Shift as set forth in Sections 520.1.3
through 520.1.5, and those minimums must be maintained throughout
the entire shift.
520.6.3 The
Office of Long Term Care shall be notified in writing when a facility
implements a flex-staffing schedule. The written notice shall state the
beginning and ending hours of each shift under the flex staffing.
520.7
PENALTIES
Violations of these regulations shall be punishable in
accordance with Ark. Code Ann. §
20-10-1407 and
20-10-1408.
520.8
RESIDENT CARE NEEDS
AND INCREASES IN STAFFING
The staffing standards set forth in Section 520.3
are minimum requirements that facilities must meet at all
times, except as provided herein. In the event that the Office of Long Term
Care determines that sufficient personnel are not employed or available to meet
resident care needs, the Office of Long Term Care may require the facility to
either increase staff on a per-shift basis or reduce resident census. In such
cases, the Office of Long Term Care will notify the facility in writing of its
determination, including the basis for the determination. In addition, the
Office of Long Term Care will state the number of additional staff that must be
employed or available and the date by which the additional staff must be
employed or available; the amount by which the resident census must be reduced
and the date by which that reduction must be achieved; or both.
In the event that the Director of the Office of Long Term Care
determines that minimum staffing standards should be increased pursuant to Ark.
Code Ann. §
20-10-1409(b)(2),
the Director of the Office of Long Term Care shall certify the determination
and any proposed regulatory increases to minimum staffing standards to the
Director of the Division of Medical Services, who shall notify the Director of
the Department of Human Services and the Legislative Council of the
determination, and whether sufficient appropriated funds exist to fund the
costs, as defined as direct-care costs by the -Long Term Care Cost
Reimbursement Methodology of the Long Term Care Provider Reimbursement Manual
as in effect January 12, 2001, to be incurred by the proposed changes to the
minimum staffing standards.
In no event shall minimum staffing standards be increased
unless sufficient appropriated funds exist to fund the costs to be incurred by
the proposed increases to minimum staffing standards.
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520.9 POSTING
520.9.1 Definitions. For purposes of this
regulation:
(a)
Hall means a
corridor or passageway in a facility containing one or more resident
rooms.
(b)
Wing
means a section of a facility devoted to resident care and containing one or
more resident rooms.
(c)
Corridor means a passageway with one or more resident rooms
opening onto it.
(d)
Unit means one hall, one wing, or one corridor.
(e)
Daily Staffing Log means
form DMS-7780.
(f)
Day
Shift means the period of 7:00 a.m. to 3:00 p.m. The facility may
allow employees to begin their work shift up to two (2) hours prior to, or up
to two (2) hours following, 7:00 a.m. to meet patient care needs.
(g)
Evening Shift means the
period of 3:00 p.m. to 11:00 p.m. The facility may allow employees to begin
their work shift up to two (2) hours prior to, or up to two (2) hours
following, 3:00 p.m. to meet patient care needs.
(h)
Night Shift means the
period of 11:00 p.m. to 7:00 a.m. The facility may allow employees to begin
their work shift up to two (2) hours prior to, or up to two (2) hours
following, 11:00 p.m. to meet patient care needs.
(i)
Accessible means that
the Daily Staffing Log shall not be obscured or blocked, partially or in whole,
by any object; shall be located between four feet (4) to five feet
(51) as measured from the floor; and shall be posted
on a wall of each hall, wing or corridor that is not obstructed, blocked or is
in any manner behind any fixture, nurses' station or other object. Encasing the
Daily Staffing Log in a clear or transparent cover, binder or other similar
object is permissible.
520.9.2 The facility shall complete, post and
maintain Daily Staffing Logs utilizing form DMS-7780, and in conformity with
the instructions contained in that form and these regulations.
520.9.3 The Daily Staffing Log shall be
conspicuously posted on each hall, wing and corridor in a manner that makes it
accessible at all times.
520.9.4
The DMS-7780 shall be retained and filed by the facility until the next
standard survey by the Office of Long Term Care or one year from the month the
specific form is completed, whichever is greater. All DMS-7780s filed by the
facility shall be available for review by any interested person within
seventy-two (72) hours of receipt of a written request.
520.9.5 A violation of any provision of this
regulation shall be a Class C violation in accordance with Ark. Code Ann.
§
20-10-205
and
20-10-206.
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Instructions for Completing Form DMS-7780
As required by Ark. Code Ann. §
20-10-1401
et seq., a copy (rf the Form DMS-7780 is to be, completed-and-posted-daily-as-speeiiied-m-these-instruetions-and--kTG-Seetion-5-2(k9r
Start a new Log with each Day Shift.
1.
Date - Enter the current
date.
2.
Facility -
Enter facility name.
3.
Hall,
Wing or Corridor - Specify the hall, corridor, or wing that the Log
covers. See Section 520.9.1.
4.
Shift Sign-In Sheet - Staff will sign in at the beginning of each
shift and sign out at the end of each shift on the Shift Sign-In Sheet in the
section designated for their licensure or certification status. On the log,
each person will:
* specify his/her time in
* sign name
* specify time out
RNs, LPNs and RANs working as CNAs will sign in under fne
section lor 1heir licensure, but the facility shall denote on the form that
they are working as CNAs for that shift by placing "(CNA)" after their name.
Likewise, RNs working as LPNs will sign in under the RN section, but the
facility shall denote on the form that they are working as LPNs by placing
"(LPN)" after their name.
5
Today's Residents on Unit - At the beginning of each shift, the
Charge Nurse or designee will enter the number of residents on that unit as of
12:01 a.m. of the date of the report. See Section 520.9.1 for the definition of
shifts.
6.
Comments -
The Administrator or designee may eflter comments explaining any discrepancies
between required and actual staffing.
7.
Post the log - See Sections
520.9.1(a), (b), (c), (e), and (i), and 520.9.3.
8.
Review - The Administrator,
DON or Designee will sign and date each staffing log prior to filing.
9.
Save and file the logs for audit by
OLTC - See Section 520.9.4.
521
TUBERCULOSIS SURVEILLANCE
Upon admission to the nursing home, physician orders shall be
obtained to administer a PPD (intermediate strength) tuberculosis skin test to
the resident and to repeat in ten (10) to fourteen (14) days if necessary. If
this initial test reacts positively, the physician should be notified and a
chest X-ray obtained and read. The record of this X-ray should be placed on the
resident's chart. If it is not possible to obtain a chest X-ray, a sputum
sample should be taken and forwarded for culture. If treatment is indicated,
orders are obtained from the attending physician.
If the result of the initial skin test is negative, the skin
test should be repeated in ten (10) to fourteen (14) days. If the result of
this test is positive, the physician should be notified and a chest X-ray or
sputum culture obtained. If treatment is indicated as a result of these tests,
orders are obtained from the attending physician.
Once a resident has shown a positive skin test (regardless of
whether or not further testing indicated treatment), he/she must be
re-evaluated yearly. Either a chest X-ray or sputum culture should be obtained.
If neither of these is possible, the resident should be evaluated for any
visible signs of the disease such as productive cough or weight loss.
Alternatively, if a nurse familiar with the resident finds no fever, no weight
loss and no significant cough, this can be recorded in the medical record and
will suffice for annual surveillance; if any symptoms are present, then a chest
film should be is indicated on medical grounds, and should be noted in the
medical record. There should be evidence in the medical record of this yearly
re-evaluation. If, however, the second skin test after admission is also
negative, there need be no further testing of this resident unless an active
case of tuberculosis is identified in the facility.
The medical record of all residents who have shown a positive
skin test should be flagged to note that this resident does need to be
re-evaluated yearly and that a sputum culture should be obtained following any
pulmonary infection.
Recordation of tuberculin information shall be maintained in
each resident's medical record and shall be recorded on forms provided by the
Arkansas Department of Health.
530
SPECIALIZED REHABILITATIVE
SERVICES
531
SERVICES
BASED ON RESIDENT NEEDS
In addition to rehabilitative nursing, the facility shall, as
ordered by a physician, provide, according to the needs of each patient,
specialized and supportive services, i.e., physical therapy, speech pathology,
audiology and occupational therapy, either directly, by referral, or through
arrangements with qualified personnel.
532
WRITTEN PLAN OF CARE
If provided, specialized rehabilitative services shall be
provided under a written plan of care, initiated by the attending physician,
and developed in consultation with appropriate therapist(s) and nursing
services.
533
REVIEW
OF RESIDENT PROGRESS
A report of the patient's progress shall be communicated to the
attending physician within two (2) weeks of the initiation of the specialized
rehabilitative services and regularly thereafter.
534
RE-EVALUATION OF PLAN
The plan of specialized rehabilitative care shall be
re-evaluated as necessary, but at least every thirty (30) days by the physician
and/or the therapist.
535
DOCUMENTATION OF SERVICES
The physician's orders, the plan of specialized rehabilitative
care, services rendered, evaluation of progress and other pertinent information
shall be recorded in the patient's medical record and dated and signed by the
physician ordering the service and the person who provided the service.
540
PHARMACEUTICAL
SERVICES
541
RESPONSIBILITY FOR PHARMACY COMPLIANCE
The administrator shall be responsible for full compliance with
Federal and State laws governing procurement, control, and administration of
all drugs. Full compliance is expected with the Comprehensive Drug Abuse
Prevention and Control Act of 1970, Public Law 91-513, and all amendments to
this set and all regulations and rulings passed down by the Federal Drug
Enforcement Agency (DEA), Ark. Code Ann. §
5-64-101
et
seq. and all amendments to it and these rules and regulations.
542
PHARMACY CONSULTANTS
PERMIT
Each nursing home shall have a formal arrangement with a
licensed pharmacist to provide supervision and consultation on methods and
procedures for ordering, storing, administering, disposition, and record
keeping of drugs and biologicals.
A consultant pharmacist's permit shall be obtained yearly from
the Arkansas State Board of Pharmacy and shall be displayed in a conspicuous
place in the facility.
The consultant pharmacist shall visit the nursing home at least
monthly to perform his consultant duties.
Before a nursing home consultant's permit shall be issued, the
pharmacist must certify to the Board of Pharmacy that he has attended a seminar
or meeting explaining pharmaceutical duties and responsibilities in a nursing
home as approved by the Board of Pharmacy and that he has read and understands
the regulations governing pharmaceutical services in a nursing home and will
abide by them.
The consultant pharmacist shall submit a written report at
least monthly to the administrator of the facility. This monthly report should
be a summary of the duties performed by the consultant pharmacist that month,
any error or problems found in the facility, delivery of pharmaceutical
services, and a detailed listing of any discrepancies and/or irregularities
noted by the pharmacist during his drug regimen reviews. The pharmacist, in
cooperation with the facility staff, should develop and implement policies and
procedures to govern all aspects of the drug distribution system. The
pharmacist may also agree to abide by and function with those policies and
procedures already being used by the facility at the time of his
employment.
543
PRESCRIPTIONS ON INDIVIDUAL BASIS
All drugs prescribed for each patient shall be on an individual
prescription basis. Medications prescribed for one patient shall not be
administered to another patient.
544
ADMINISTRATION OF MEDICATION
544.1 No medication shall be given without a
written order by a Physician or dentist.
544.2 All medications shall be given by
authorized nursing personnel. The administrator or his appointed assistant
shall be responsible for ensuring that authorized nursing personnel administer
all medications ordered by a physician or dentist.
544.3 Caution shall be observed in
adrninistrating medication so that the exact dosage Of the prescribed
medication is given as is ordered by the doctor or dentist.
544.4 Each resident must have an individual
container, bin, compartment, or drawer for the storage of his medications in
the medication room except for stock medication and approved unit dose
systems.
544.5 The PRN medications
on current doctor's orders can be handled in one of four ways in a facility:
* Use medication from the emergency box.
* Have it as stock medication if it is a non-legend
drug.
* Have it on an individual patient basis.
* Have pharmacist maintain a policy and procedure for
twenty-four (24) hour emergency service from pharmacy.
544.6 Nursing personnel cannot transfer more
than one dose of medication from container to container. Loading narcotic
counters, preparing take-home supply of medications, incorporating supplies,
etc., by nursing personnel are not permitted.
545
EQUIPMENT FOR ADMINISTERING
MEDICATIONS
There shall be calibrated medicine containers to correctly
measure liquid medications.
Calibrated-medicme-contamers-mclude-ealibrated-syringes-when-used-to-measure-odd-liquid
dosages, such as 4cc, 8cc, etc. Disposable items shall not be reused.
Disposable syringes and needles must be disposed of by breaking and
incineration.
546
MEDICINE CARDS
In administering medications, medication cards'current with the
physician's orders must be used. Medicine cards shall be provided to
include:
* Name of patient.
* Rooms or bed number.
* Medication and dosage.
* Hours to be given.
547
STOP ORDER POLICY
Medications not specifically limited as to time or number of
doses when ordered by the physician shall be controlled by the facility's
policy regarding automatic stop orders.
The facility's automatic stop order policy, at a minimum, shall
cover the following categories of medications:
* CII Narcotics.
* CII Non-narcotics.
* C m, CIV, and C V medications.
* Anticoagulants.
* Antibiotics.
548
STORAGE OF DRUGS
548.1 All drugs on the premises of a nursing
home, except for the emergency tray, as defined by the Arkansas State Board of
Health and the Arkansas State Board of Pharmacy, shall be properly labeled
containers dispensed upon prescription by the pharmacy.
548.2 All medications shall be kept
in a locked cabinet or locked room at all times. Only the
nurse responsible for administering the medication, Director of Nursing, and
the Administrator shall have a key.
548.3 All controlled drugs shall be stored in
a separately locked, permanently affixed substantially constructed cabinet
within a locked drug room or cabinet. When mobile medication carts for
unit-dose or multiple day card systems are used, the condition for security
will be considered met provided that the mobile cart is in a locked room when
unit contains controlled drugs and is not in actual use, and provided the
controlled substances are in a separately locked compartment within the cart
unless the quantity stored is minimal and a missing dose can readily be
detected. A minimal quantity shall be considered to be a quantity of a
twenty-four (24) hour supply or less.
548.4 All drugs for external use shall be
kept in a safe place accessible only to employees and in a special area apart
from other medication and prescriptions.
548.5 Medicines requiring cold storage shall
be refrigerated. A locked container placed below food level in a home
refrigerator is considered satisfactory storage space.
548.6 Each patient's prescription medication
shall be kept in the original container and shall be clearly and adequately
labeled by the pharmacist. Label shall include:
* Prescription number.
* Patient's name.
* Name and strength of medicine.
* Physician's or dentist's name.
* Date of issue.
* Name of pharmacy.
* Appropriate, accessory and cautionary labels.
* Expiration date of drug where applicable.
* The quantity of tablets or capsules dispensed.
* Directions for administration.
548.7 Labels should be affixed to the
immediate container. The immediate container is that which is in direct contact
with the drug at all times.
548.8
O.T.C. medications (medications not requiring a prescription for purchase) that
are the private property of the patient do not have to be labeled by a
pharmacist. However, they must be identified with at least the patient's
name.
548.9 Drug rooms shall be
supplied with adequate lighting so that medications can be safely prepared for
administration.
548.10 Drug room
shall be properly ventilated so that the temperature requirements set by the
U.S.P. are met: 59 (fifty-nine) degrees to 86 (eighty-six) degrees F.
549
EMERGENCY DRUG
BOX
A container which contains emergency stimulants and drugs for
life saving measures must be maintained. This box should be located where it
can be readily available to nursing personnel but kept in a secure place and
should have a breakaway lock. There should be a list on the box of the drugs
which are contained in the box. The drugs in the box should be checked
periodically with the list to make sure that these drugs have been replaced
after use and are not outdated. Only drugs which have been approved for this
purpose by the Pharmaceutical Services Committee or Medical Director, as
applicable, and/or the physician, can be place in this box. All controlled
substances assigned to the box must be kept with the other controlled
substances and labeled "Emergency Box". All controlled substances assigned to
the "Emergency Box" must be entered into the bound book. The location of these
controlled substances should be noted on the list of drugs. The drug list
should be signed by-the-physician-member-of-the-eommittee indicating his
approval. The list and contents of the box shall be reviewed annually by the
appropriate committee and/or physician and so noted on the emergency drug
list.
550 RECORD OF
CONTROLLED DRUGS
A record shall be kept in a bound ledger book
with consecutively numbered pages of all controlled drugs
procured and administered. This record shall contain on each separate
page:
* Name, strength, and quantity of drug received.
* Date received.
* Patient's name.
* Prescribing physician.
* Name of pharmacy.
* Date and time of dosage given.
* Quantity of drug remaining.
* Signature of person administering the drug.
The person responsible for entering the controlled drug into
the bound ledger should be the same person who signs for it in the drug
ordering and receiving record. This record shall be retained by the facility as
a permanent record and be readily available.
551 CONTROLLED DRUG ACCOUNTABILITY
There shall be a count of all C U controlled medications at
each change of shift. All C Ul, IV, and V controlled
medications should be counted at least once daily unless a true unit dose
system is used. This count shall be made by the off-going charge nurse and the
on-coming charge nurse. If licensed personnel are not available on a shift, a
non-licensed employee can co-sign as a witness with the off-going nurse, and
co-sign as a witness again with the oncoming nurse. This count shall be
documented. This documentation shall include the date and time of the count, a
statement as to whether or not the count was correct, and if it was incorrect,
an explanation of the discrepancy. This record shall be retained by the
facility as a permanent record and be readily retrievable.
When loss, suspected theft, or an error in the administration
of controlled drugs occurs, it must be reported to the Director of Nursing
Services and an incident report filled out; also, a copy of the form for
reporting theft or lost controlled substances should be mailed to the Arkansas
Department of Health, Division of Drug Control.
All documentation must be retained in the facility as a
permanent record.
When a dose of a controlled drug is dropped or broken, two
people should make a statement in the bound ledger as to what occurred, and
both must sign their names. These two people shall be licensed nursing
personnel whenever possible.
552
REVIEW OF MEDICATION BY THE NURSE
AND/OR PHARMACIST
There shall be for each patient a separate medication/drug
regimen review sheet. This sheet is to be used to document the performance of a
medication/drug regimen review by the pharmacist and/or registered nurse. This
monthly review must be dated and signed by the person making the review. Any
discrepancy, interaction, etc., should be entered on the review sheet.
553
REVIEW OF MEDICATIONS BY
CONSULTANT PHARMACISTS
In an Intermediate Care Facility, the review of the
medication/drug regimen of the skilled care patients
must be done at least each month, and at least quarterly on the Intermediate
and Minimum care patients. In Skilled Nursing
Facilities, the review of medication/drug regimen must be done
monthly on all patients.
In reviewing the medication/drug regimens of the patients, the
pharmacist and registered nurse should, as a minimum, compare the doctor's
orders with the medication administration record, the medication cards, cardex,
actual medications, and prescription labels. Any discrepancies, interactions,
irregularities, contraindications, errors, and incompatibilities will be noted
on the medication/drug regimen review sheet, and if medication/drug review is
being performed by the pharmacist, on the pharmacist's monthly written report
to the administrator. Irregularities observed by the pharmacist that would
warrant immediate action should be brought to the Director of Nursing Services'
attention immediately upon their finding.
The person delegated the responsibility of correcting or
following through on the errors, irregularities, and discrepancies listed on
the pharmacist's monthly report should document their actions on their report,
date it, and sign it. A photocopy of the report may be used for this purpose,
but both must be retained in the facility. If no irregularities or
discrepancies are found during the medication/drug regimen review, the person
performing the review must note on the review sheet that he has reviewed that
drug regimen and found no irregularities. This notation must be dated and
signed.
554
CYCLE-FILL, PHARMACY NOTIFICATION AND DISPOSITION OF UNUSED DRUGS
Schedule II, m, IV, and V drugs dispensed by prescription for a
patient and no longer needed by the patient must be delivered in person or by
registered mail to: Drug Control Division, Arkansas Department of Health, 4815
West Markham Street, Little Rock, Arkansas 72201 along with Arkansas Department
of Health Form (PHA-DC-1) Report of Drugs Surrendered for Disposition According
to Law. When unused portions of controlled drugs go with a patient who leaves
the facility, the controlled drug record shall be signed by the person who
assumes responsibility for the patient and the person in charge of the
medication in the nursing home. This shall be done only on the written order of
the physician and at the time the patient is discharged, transferred, or visits
home.
Except as provided in Ark. Code Ann. §
17-92-1101
et seq. and subsection 554.4, below, all medications other
than Schedule H, IE, IV, and V not taken out of the home by the patient with
the physician's consent when he or she is discharged from the home shall be
destroyed. See Section 554r3, below, on handling
medication-when-a-resident-enters a hospital or is transferred. All
discontinued medications (except controlled drugs) shall be destroyed on the
premises of the facility. Destruction shall be made by the consultant
pharmacist and a nurse with a record made as to the date, quantity,
prescription number, patient's name, and strength of medications destroyed. The
destruction should be by means of incineration, garbage disposal, or flushing
down the commode. This record shall be kept in a bound ledger with
consecutively numbered pages. This record shall be retained by the facility as
a permanent record and be readily retrievable.
554.1 Only oral solid medications may be
cycle-filled. Provided, however, that if an oral solid medication meets one of
the categories below, then that oral solid medication may not be cycle-filled.
a. PRN or "as needed" medications.
b. Controlled drugs (CH - CV).
c. Refrigerated medications.
d. Antibiotics.
e. Anti-infectives
554.2 A facility shall notify the pharmacy in
writing of any change of condition that affects the medication status of a
resident. For purposes of this section, change of condition
includes death, discharge or transfer of a resident, as well as medical changes
of condition that necessitate a change to the medication prescribed or the
dosage given. The notification shall be made within twenty-four (24) hours of
the change of condition. If the notification would occur after 4:30 p.m. Monday
through Friday, or would occur on a weekend or holiday, the facility shall
notify the pharmacy by no later than 11:00 a.m. the next business day.
documentation for drugs ordered, changed or discontinued shall be retained by
the facility for a period of no less than fifteen (15) months.
554.3 When a resident is transferred or
enters a hospital, a facility shall hold all medication until the return of the
resident, unless otherwise directed by the authorized prescriber. All continued
or re-ordered medications will be placed in active medication cycles upon the
return of the resident. Except as provided in Ark. Code Ann. §
17-92-1101
et seq. and subsection 554.4, below, if the resident does not
return to the facility, any medications held by the facility shall be placed
with other medications or drugs for destruction or return as permitted by State
Board of Pharmacy regulations.
554.4 Pursuant to Ark. Code Ann. §
17-92-1101
et seq., facilities may elect to donate designated medications
to charitable clinics. If a facility elects to donate medications, facilities
shall:
a. Obtain the written consent of the
resident or the person who assumes responsibility for the resident through the
execution of a donor form created by the Arkansas State Board of Pharmacy that
states that the donor is authorized to donate the drugs and intends to
voluntarily donate them to a charitable clinic pharmacy;
b. Retains the donor form along with other
acquisition records in accordance with section 604.2 of these
regulations;
c. Obliterate from the
packaging before the nursing facility sends the drug to the charitable clinic
the donor patient's name, prescription number, and any other marks that
identify the resident;
d. Ensure
that the drug name, strength, and expiration date remain on the drug package
label;
e. Enter into a contract,
approved by the Arkansas State Board of Pharmacy, with all charitable clinics
to which the facility will donate drugs;
f. Donate drugs only in their original sealed
and tamper-evident packaging or, if acceptable to the charitable clinic, drugs
packaged in single-unit doses or blister packs with the outside packaging
opened if the single-unit dose packaging remains intact;
g. Ensure that all drugs physically
transferred from the nursing facility to a charitable clinic pharmacy is
performed by a person authorized by the Arkansas State Board of Pharmacy to
pick up the drugs for the charitable clinic;
h. Provide all drug recall notices and
information received by, or known to, the facility to all charitable clinics
with which the facility has a contract to donate drugs;
i. Donate only those medications permitted
under Ark. Code Ann. §
17-92-1101
etseq.; and,
j.
Comply with all applicable regulations concerning donation of unused drugs to
charitable clinics promulgated by the Arkansas State Board of Pharmacy.
555
PHARMACY PREPARED MEDICATION CONTAINER SYSTEMS DESIGNED FOR ADMINISTRATION WITH
THE USE OF MEDICATION CARDS (UNIT DOSE SYSTEM)
All policies and procedures related to systems of tbis type
must first be approved by OLTC before that system is put into operation.
The medication shall remain in the pharmacy-prepared container
up to the point of administration to the patient.
The medication container must be properly labeled by a licensed
pharmacist.
555.1
Freedom
of Choice
To ensure that each patient admitted to a long term care
facility is allowed freedom of choice in selecting a provider pharmacy, at the
time of admission the patient or responsible party must specify in writing the
pharmacy that they desire to use. The patient or responsible party must also
sign the statement, or form, and the signed form should be filed with the
signed Resident Rights' statement. The patient must be allowed to change the
provider pharmacy if he desires. If true unit dose system is used by the
facility the patient will not be afforded the freedom of choice of pharmacy
provider.
556-559
RESERVED
560
DIETETIC SERVICES
561
STAFFING
Staff supervisory responsibility for the dietetic services is
assigned to a full time, qualified dietetic service supervisor or Certified
Dietary Manager. A qualified supervisor is one who has:
a. Completed an approved food service
supervisor's course; or,
b. Been
certified by the Certifying Board for Dietary Managers; or,
c. For only those facilities having more than
fifty (50) beds, is enrolled in a food service supervisor course approved by
the Office of Long Term Care. For purposes of these regulations, the term
a food service supervisor course approved by the Office of Long Term
Care means a course of education and training in food service or food
service supervision provided by an licensed and accredited educational
institution.
Certified Dietary Managers and food service supervisors shall
complete fifteen (15) hours per year of continuing education courses approved
by the Office of Long Term Care. For purposes of these regulations, the term
continuing education courses approved by the Office of Long Term
Care means continuing education courses offered by the Dietary
Managers Association or comparable body, and approved by the Office of Long
Term Care.
562
HYGIENE OF STAFF
All food service employees shall wear appropriate,
light-colored clothing including hairnet and shall keep themselves and their
clothing clean.
All persons working as food handlers in nursing homes shall
have in their possession or on file in the home in which they are employed, a
current, approved health card.
Persons having symptoms of communicable or infectious diseases
or lesions shall not be allowed to work in the dietetic services. Food service
employees shall not be assigned duties outside dietetic services.
563
MINIMUM DAILY FOOD
REQUIREMENTS
All patients shall be served an approved, appetizing, adequate
diet that conforms to the recommended dietary allowances of the Food and
Nutrition Board, National Research Council or with, "Food for Fitness - a Daily
Guide" leaflet #424, United States Department of Agriculture.
Facilities are permitted to serve commodity foods provided that
the facility is registered as a nonprofit organization and the foods were
legally obtained directly from USDA sources. Commodity foods obtained from an
individual may not be used. Commodity foods shall be utilized pursuant to USDA
regulations. Facilities utilizing commodity foods shall maintain documentation,
or be able to provide evidence, that the foods were obtained through proper
channels. Failure to meet this requirement may result in a deficiency finding
and a report to federal authorities.
The daily food allowances for each patient shall include,
unless contraindicated by the patient's physician:
563.1
Milk two (2) or more
eight (8) ounce portions
1. Milk and milk products shall be obtained
from a source approved by the Arkansas Department of Health. They must be
produced and handled in accordance with regulations set forth by the Arkansas
Department of Health.
2. Milk shall
be served in the original individual containers or from a dispenser approved by
the Arkansas Department of Health.
3. Cartoned milk or milk products shall be
stored so that the tops are not covered with ice or water.
4. Milk and cream shall be kept in tightly
covered containers and refrigerated until served or used.
563.2
Meat five (5) ounces
of protein, i.e., lean meat, fish, poultry,
eggs, or
cheese.
1.
Count as a serving: two (2) to three (3) ounces of lean cooked meat, poultry,
or fish all without bones; two (2;) eggs; two (2) ounces of cheese; one (1) cup
cooked dried beans or peas; four (4) tablespoons of peanut butter.
2. Dried beans, dried peas, or peanut butter
may be served once a week in place of lean meat if one-half (1/2) pint of milk
is served at the same meal. If milk is refused by the resident, one (1) ounce
of meat or meat substitute such as cheese or
eggsshallbeservedinitsplaceT
3.
Meat shall be obtained from an approved source.
4. No raw eggs shall be served.
563.3
Fruits and
Vegetables - four (4) or more servings
1. Count as a serving: one-half (1/2) cup or
portion as ordinarily served, such as one medium apple, banana, pear, peach or
potato.
2. Include a citrus fruit
or other fruit or vegetable rich in Vitamin C every day and a dark green or
deep yellow vegetable for Vitamin A at least every other day.
3. No hermetically sealed low acid or
non-acid food which has been processed in a place other than a commercial food
processing establishment shall be used.
563.4
Breads and Cereal
four (4) or more servings, whole grain, enriched or
restored.
563.5
Other foods to round out meals and snacks
and to satisfy individual appetites and provide additional calories.
564
FREQUENCY OF
MEALS
564.1 At least three (3) meals
are served daily.
564.2 There shall
be at least a five (5) hour span between breakfast and the noon meal and
between noon meal and supper. The meals shall be served at approximately the
same hours each day.
564.3 There
shall not be more than fourteen (14) hours between a substantial supper and
breakfast. Supper shall include as a minimum: two (2) ounces of a substantial
protein food, a starch (or substitute) or soup, vegetable or fruit, dessert and
beverage, preferably milk.
564.4
Bedtime snacks of nourishing quality shall be routinely offered to all patients
whose diets do not prohibit the service of this night feeding. Milk, juices,
cookies, or crackers shall be offered.
565
MEAL SERVICE
565.1 All foods shall be served at the proper
temperatures and procedures established and implemented to serve the patient
cold foods between (forty-five to fifty-five (45 - 55) degrees Fahrenheit, and
hot foods should register one-hundred forty (140) degrees Fahrenheit on the
steam table and should reach the patient at no less than one-hundred fifteen
(115) degrees Fahrenheit.
565.2
Table service shall be provided for all who can and will eat at the table,
including wheelchair patients.
565.3 An over-bed table shall be provided for
bed patients. Patients who are served meals in their rooms shall be provided
with an over-bed table or an over-patient table of sturdy
construction.
565.4 The public,
personnel, or patients shall not be permitted to eat or drink in the kitchen,
dishwashing area, or store room.
565.5 Only dietetic services and
administrative personnel shall be allowed in the kitchen.
565.6 Only dietetic services personnel shall
be allowed to portion out food for patients or personnel.
565.7 Trays shall not be set up until the
meal is ready to be served. Foods shall not be at the patient's place in the
dining room until the patient is at the table.
565.8 Nursing home residents will not be
permitted to work in the dietetic services. If a patient is to be allowed to
scrape trays, there must be a physician's order.
565.9 All food transported to patient rooms
or to dining rooms which are not adjacent to the kitchen must be covered. If
hot and cold carts are not used to deliver trays, carts must be completely
cleaned before the next use.
566 MENUS
566.1 Menus shall be planned and written two
(2) weeks in advance and posted at least one (1) week in advance. Menus for
each level shall be written. Arrows, etc., are not acceptable.
566.2 Weekly menus shall not be repeated more
often than a three (3) week cycle. Identical meals
shall not be repeated more often that once every three (3) weeks.
566.3 Changes shall be recorded on both the
regular and therapeutic diet menus.
566.4 Menus which have been posted in the
kitchen shall not be redated and reused.
566.5 Meals served shall correspond
essentially with the posted menus and shall be served in sequential order as
planned and approved by the dietetic services consultant.
566.6 Records of menus as served shall be on
file and maintained for thirty (30) days.
566.7
Whensubstitutions-areTnadetheyshould-be-of-the-same-food groups-and-of-equal
nutritional value.
567
THERAPEUTIC DIETS
567.1 There
shall be a system of written communications between dietetic services and
nursing services, i.e., diet order forms. Nursing services should send a
written patient diet list monthly and diet change slips as diets are changed by
the physician.
567.2 Therapeutic
diets shall be served only to those patients for whom there is a physician's or
dentist's written order,
567.3 Diet
orders shall be reviewed by the physician every one hundred and twenty (120)
days for intermediate and minimum care patients and every sixty (60) days for
skilled care patients.
567.4 A
current manual approved by an affiliate of the American Dietetic Association,
such as the Arkansas Diet Manual, shall be used, and a copy of the approved
manuai shall be available atone nurses' station and! in tie
dietetic services.
567.5 In the
event that the calorie controlled menu patterns in use in the facility are
other than those in the approved manual, the calculations and the patterns
shall be in the policy and procedure manual on file in the dietary services and
posted in the kitchen..
567.6 A
copy of diets as ordered by the physicians shall be posted in the kitchen and
shall correspond to the diet as ordered on the medical chart and shall be kept
current. Patient diet lists shall include the patient's name, room number, and
diet, and shall be signed by licensed personnel.
567.7 Therapeutic diets that vary in the time
specified for regular meals shall be provided for the patients as ordered by
the physician.
567.8 There shall be
a system of patient identification for each tray served which includes the
following information:
1. Resident's
Name.
2. Resident's Diet.
3. Resident's Room Number.
4. Resident's Beverage Preference.
5. Any allergies the resident may have to
certain foods.
6. Any major
dislikes, for which there should be a substitution provided.
567.9 The hour of sleep feedings
for the calorie controlled diets shall be recorded I nurses' notes as served
and should include patient acceptance.
568
PREPARATION AND STORAGE OF
FOOD
568.1 An adequately-sized storage
room shall be provided with adequate shelving. Seamless containers with
tight-fitting lids, clearly labeled, shall be provided for bulk storage of dry
foods. (It is recommended that these containers be placed on dollies for easy
moving.) The storage room shall be of such construction as to prevent the
invasion of rodents and insects, the seepage of dust or water leakage, or any
other contamination. The room shall be clean, orderly, well ventilated and
without condensation of moisture on the walls. Food in any form shall not be
stored on the floor. If the bottom shelf is open it shall be of sufficient
height to clean underneath.
568.2
All food prepared in the nursing home shall be clean, wholesome, free from
spoilage and so prepared as to be safe for human consumption. All food stored
in the refrigerators shall be stored in covered containers. Leftover foods
shall be labeled and dated with the date of preparation. Foods stored in
freezers shall be wrapped in air tight packages, labeled and dated.
568.3 Fresh fruits and vegetables shall be
thoroughly washed in clean, safe water before use. Vegetables subject to
dehydration during storage shall be wrapped or bagged in plastic.
568.4 All readily perishable foods, including
eggs or fluids, shall be stored at or below forty-five (45) degrees Fahrenheit.
A reliable and visible thermometer shall be kept in the refrigerator.
568.5 All frozen foods shall be stored at
zero (0) degrees Fahrenheit or lower. A reliable and visible thermometer shall
be kept in the freezer. Frozen foods which have been thawed shall not be
refrozen.
568.6 Potentially
hazardous frozen foods shall be thawed at refrigerator temperatures of
forty-five (45) degrees Fahrenheit or below.
568.7 Eggs shall be stored below all other
foods. Fresh whole eggs shall not be cracked more than two (2) hours before
use.
568.8 All toxic compounds
shall be used with extreme caution and shall be stored in an area separate from
food preparation, storage and service areas.
568.9 Work areas and equipment shall be
adequate for the efficient preparation and service of foods.
568.10 Supplies of perishable foods for a one
(1) day period and of nonperishable foods for a three (3) day period shall be
on the premises at all times to meet the requirements of the planned menus. If
the facility consistently does not have the required one(1) day perishable and
three (3) day nonperishable foods, the OLTC will require that the facility
alter its food delivery schedule to meet regulations.
568.11 Food served in any nursing home must
have been prepared on the premises or in an establishment approved by, and
meeting regulatory standards of, the Arkansas Department of Health.
568.12 The use of tobacco in any form is
prohibited where food or drink is prepared, stored, cooked, or where dishes or
pots and pans are washed or stored.
568.13 Foods shall be cut, chopped, ground,
or pureed to meet the individual needs of the patient.
568.14 If a patient refuses foods served,
substitutes of similar nutritive value shall be offered.
569
SANITARY CONDITIONS
569.1 Food shall be procured from sources
approved or considered satisfactory by Federal, State and Local
authorities.
569.2 Floors shall be
cleaned after each meal.
569.3
Dishes, silverware, and glasses shall be free of breaks, tarnish, stain, cracks
and chips. There shall be an ample supply to serve all patients. Patients will
be furnished knives, forks, and spoons unless there is documentation to
indicate the patient is incapable of using these implements.
569.4 Vessels used in preparing, serving or
storing food shall be made of seamless metal or a nonabsorbent material which
can be easily cleaned and shall be used for no other purpose. Enamelware shall
not be used.
569.5 Rags from
patient bedding or clothing or bath shall not be used in dietetic services for
any purpose.
569.6 Dishes, knives,
forks, spoons, and other utensils used in the preparation and serving of foods
must be stored in such a manner as to be protected from rodents, flies or other
insects, dust, dirt, or other contamination. Silverware shall be stored
in a clean container that can be thoroughly washed and
sanitized.
569.7 Paper or loose
covering shall not be used on shelves, cabinets, cabinet drawers, refrigerators
or stoves. Storage cabinets shall be kept clean. Cardboard boxes shall not be
saved and used for the storage of food or articles which were not packed in
that original box.
569.8 Dishes,
trays, silverware, glasses and food preparation dishes shall be cleaned,
washed, and sanitized by only the following methods:
569.8.1
Manual
Dishwashing
Facilities may wash and sanitize such items in a
three-compartment sink. Items shall be first thoroughly cleaned and washed in
warm water, one-hundred to one-hundred-twenty (100 to 120) degrees Fahrenheit,
containing an adequate amount of an effective soap or detergent to remove
grease and solids. The wash water shall be changed often enough to keep it
reasonably clean. Next, they shall be rinsed in clean water which is heated to
a temperature of at least one-hundred-and-forty (140) degrees Fahrenheit. Next,
they shall be completely submerged for at least two (2) minutes in clean hot
water at a temperature of at least one-hundred-and-eighty (180) degrees
Fahrenheit. A visible and reliable thermometer shall be conveniently available
for testing the water temperature. Pots or pans which are used for preparing
food which will be cooked need not be sanitized. All other utensils used in the
preparing or serving of food shall be sanitized prior to use.
Dishes, trays, and glasses shall be allowed to air dry before
storage; drying cloths shall not be used.
569.8.2
Mechanical
Dishwashing Machine
Facilities may wash and sanitize such items in a mechanical
spray type dishwashing machine as approved by the OLTC.
569.9 All kitchen garbage, cans,
trash and other waste materials shall be stored in watertight containers
provided with close-fitting lids. The kitchen garbage container shall be
emptied and thoroughly washed after each meal and treated with a disinfectant
if necessary.
569.10 All equipment
and utensils shall be so constructed as to be cleaned easily and shall be kept
clean at all times.
569.11 All
mops, brushes, dustpans, and other housecleaning equipment shall be stored in a
janitor's closet when not in use.
569.12 Meat and other foods shall not be
placed in direct contact with ice.
569.13 Only ice of assured bacterial safety
shall be permitted for use in drinks, or for the cooling of drinks by direct
contact. A scoop shall be used for handling ice. Ice used to chill bottled
drinks or salads, or in any food preparation, shall not be used
fordrmking-purposes. Portableice'chestswhich'canbesanitizedshallbe-cleaned
daily, and the ice machine shall be cleaned at least weekly.
569.14 Hand-washing facilities shall be
equipped with blade-action controls and hot and cold water. Soap and towel
dispensers and a step-on trash can shall be located conveniently to the
lavatory. The kitchen lavatory shall be equipped with a goose-necked
spout.
569.15 If table covers are
used in the dining room they shall be of a fabric which can be laundered. They
shall be kept clean and changed at least daily.
570
DIETETIC SERVICES STAFFING
570.1 Staffing shall be correlated to the
size of the facility and the total patient meals served.
Facilities with fifty-nine (59) beds or less shall be staffed
at ten (10) minutes for each meal served.
Facilities with sixty (60) to eighty (80) beds shall be staffed
at eight and one-half (8.5) minutes for each meal served.
Facilities with eighty-one (81) to one-hundred twenty (120)
beds shall be staffed at six (6) minutes for each meal served.
Facilities with one-hundred twenty-one (121) beds or more shall
be staffed at five and one-half (5.5) minutes for each meal served.
570.2 Method for determining
dietary staffing:
Number (#) for minutes per meal times (x) three (3) equals (=)
number of minutes per day, number of minutes per day times (x) number of
patients divided by (/) 60 equals (=) number of hours required per day.
570.3 Food Service Supervisors or
Certified Dietary Managers in homes of fifty (50) beds or less may be assigned
to duties in the department, such as cooking, for no more than fifty percent
(50%) of their total work hours, but must be allowed adequate time for
supervisory tasks. In homes of more than fifty (50) beds the Food Service
Supervisor, Certified Dietary Manager, or an individual enrolled in a food
service supervisor course approved by the Office of Long Term Care may be
assigned to duties such as cooking no more than twenty-five percent (25%) of
their total work hours, but must be allowed adequate time from these
assignments for supervisory tasks.
570.4 The number of employees will be rounded
off to the nearest whole number.
570.5 If deficiencies are found that directly
relate to shortage of personnel, additional personnel will be required.
571-579
RESERVED
580
SOCIAL
WORK SERVICES AND ACTIVITIES PROGRAMMING
581
POLICIES AND PROCEDURES
581.1 Separate policies must be written for
social services and activity programs.
581.2 They shall be individualized for the
individual long-term care facility.
581.3 They shall reflect the actual programs
in operation at that facility.
581.4 They shall provide for the social and
emotional needs of the residents and provide activities that encourage
restoration and normal activity.
581.5 The policy manual shall include a
statement of the range of social services provided. When all needed services
are not provided directly, the manual shall state how needed services shall be
arranged.
581.6 Procedures shall
clearly outline the steps for identification of social and emotional needs and
the mechanism for meeting these needs.
581.7 Procedures shall reflect, concerning
resident social service records:
* Type of information to be obtained.
* Confidentiality of data and protection.
* Availability of data: who, when, how, and why.
* Transmittal of data on referral.
582
JOB DESCRIPTION
Separate for social services designee/worker.
Include actual functions of position.
Include other duties that may be assigned to
designee/worker.
583
SOCIAL SERVICES RECORDS
583.1
Social History/Assessment
Should give clear picture of individual over life span to date.
Incomplete information should specify reason for such. Reflects current
functioning level, limitations, strengths, and weaknesses.
583.2
Progress
Notes
Important happenings shall be entered promptly into social
services' progress record. At least a quarteriy update shall be done.
583.3
Referral
Form
Pertains to referrals for social/emotional needs rather than
medical. May be a separate form or reflected in progress notes.
583.4
Resident
Rights
1. Appropriately
signed:
* Resident capable of understanding: signs with one
witness.
* Resident incompetent: legal documentation of such; guardian
and one witness sign patient's rights.
* Resident incapable because of illness: Doctor must write
statement saying why resident cannot understand; responsible party and two
witnesses sign.
* Resident mentally retarded: Rights read and if he/she
understands, resident signs along with staff member and outside disinterested
party. If he/she cannot understand, rights explained to and signed by guardian
and witness.
2. Copies
posted around the facility.
3.
Staff members who administer rights must understand them fully.
4. Facility staff must understand patients'
rights and respect them.
584
STAFFING AND CONSULTATION
FOR SOCIAL SERVICES/ACTIVITIES
584.1 The social services designee shall
comply with the qualification requirements as set forth in Federal
Regulations.
584.2 There shall be
one (1) full-time social services designee/activities director for the first
one-hundred five (105) patients and one (1) additional worker for every fifty
(50) patients thereafter.
584.3 The
social service designee shall:
* Have an office or space and privacy in which he/she can talk
with residents and/or family.
* Be aware of policies and procedures for social services and
the other relevant policies of the long term care facility.
* Be knowledgeable of community and government
resources.
* Be familiar with the residents and their needs, limitations,
and strengths.
* Possess the skills to deal with families and their needs as
they relate to the resident and the long term care facility.
* Be able to identify problems and needs and plan accordingly.
585
PROGRAM OPERATIONS
585.1 There shall be
adequate staff to provide activity/recreational programs daily, including
Saturdays and Sundays. There should be at least two (2) group activities
scheduled daily.
585.2 Activities
shall be varied in nature and shall be designed to meet the needs, interests,
limitations of residents. This is to include all residents: bedfast,
ambulatory, and disabled. These activities should provide for the mental,
physical, social, and spiritual stimulation of the residents.
585.3 Residents and patients will be informed
of events and given opportunities to participate. A calendar of events shall be
posted in obvious places throughout the facility. The calendar should reflect
the actual activity program.
585.4
The utilization of community volunteers is encouraged, but they must work under
the direction of the facility's activity director.
585.5 The activity director shall be aware of
the limitations, strengths, and weaknesses of residents.
585.6 Plans for activity involvement both on
individual and group basis shall be developed for all residents.
585.7 Activity supplies as a rninimum:
A. Television
B. Dominoes
C. Checkers
D. Outside furniture (50% of ambulatory
patients)
E. Two daily newspapers
(one local and one having state-wide circulation) for each thirty-five (35)
patients and current copies of four (4) popular magazines.
586
PET
THERAPY
586.1 Animals will be allowed
to be brought into the nursing home for a short period of time on a limited
basis for therapy sessions.
586.2
These therapy sessions must be supervised at all times to see that the patients
are not in danger at any time during the session.
586.3 Animals brought into the facility for
these sessions should be animals that will present no danger to the
patients.
586.4 These sessions
shall be sponsored by organizations, groups, or family members that are
familiar with the actions and habits of the animals being used in the therapy
session.
586.5 Animals used in
therapy sessions shall be properly vaccinated, and records of the vaccinations
maintained by the facility.
586.6
Pets must be maintained outside the building, and the area in which they are
kept must be clean and sprayed on a regular basis to prevent rodents and
insects.
587-599
RESERVED
600
RESIDENT RECORDS
601
RESIDENT RECORD MAINTENANCE
The facility will maintain an individual record on all
residents admitted in accordance with accepted professional standards and
practices. The resident record service must have sufficient staff, facilities,
and equipment to provide records that are completely and accurately documented,
readily accessible, and systematically organized.
602
CONTENTS OF RECORDS (TO FACILITATE
RETRIEVING AND COMPILING INFORMATION)
The resident records will contain sufficient information to
identify the resident, his/her diagnosis(es) and treatment, and to document the
results accurately.
602.1
Admission and Discharge Record
* Record number
* Date and time of Admission
* Name
* Last known address
* Age
* Date of Birth
* Sex
* Marital status
* Name, address, and telephone numbers of attending physician
and dentist.
* Name, address, and telephone number of next of kin.
* Date and time of discharge or death.
* Admitting and final diagnosis.
602.2
History and Physical
Examination Prior to Admission
* Medical history
* Physical findings which includes a complete review of systems
and diagnosis(es)
* Date and signature of physician
602.3
Physician
Orders
* Date
* Orders for medication, treatment, care, diet, restraints,
extend of activity, therapeutic home visits, discharge, or transfer.
* Telephone or verbal orders may be taken and written by
licensed personnel and countersigned by the physician given the order within
seven (7) days. Telephone or verbal orders for restraints must be signed by the
physician giving the order within five (5) days.
602.4
PhvsicianProgressNotes
* Written at the time of each visit.
* Dated.
* Signature ot the physician.
* Written at least every sixty (60) days on skilled care
patients and every one-hundred twenty (120) days on others.
602.5
Nursing
Notes
* Each entry will be dated and signed by the person making such
entry.
* PRN medications will be documented as to the time given,
amount given, reason given, results, and signature of person giving the
medication.
* Vital signs shall be taken and recorded on all patients as
ordered by the attending physician, not less than weekly.
* Date and time of all treatments and dressings.
* Date and time of physician visits.
* Complete record of all restraints, including time of
application and release, type of restraint, and reason for applying.
* Record all incidents and accidents, and follow-up involving
the resident.
* The amount and type of bedtime nourishnient taken by
residents on calorie controlled diets.
* Condition on discharge or transfer.
* Disposition of personal belongings and medications upon
discharge.
* Time of death and the name of person, pronouncing the death
of the resident and disposition of the body.
* Heights and weights of the residents will be obtained at the
time of admission to the facility. Weights will the,n be recorded at least
monthly.
602.6
Discharge Summaries Should Include:
* Signature of the physician
* Admitting and final diagnosis.
* Course of resident's treatment and condition while in the
nursing home.
* Cause of death if applicable.
* Disposition of resident, i.e., transfer to hospital, nursing
home, mortuary, or home.
603
INDEX
There will be an index of all residents admitted to the
facility including:
* Name of resident.
* Record number.
* Former Address.
* Name of physician. Date of birth.
* Date of discharge.
604
RETENTION AND PRESERVATION OF
RECORDS
604.1 Retention Requirements
for Active Clinical Records
a. The
maintenance schedule for records on resident charts are as follows:
|
1.
|
Admission and Discharge Records
|
Permanent
|
|
2.
|
Miscellaneous Admission Records
- Admission Nurse's Notes
- Admission Height and Weight
- Advance Directives
- Informed Restraint Consent
- Patient Rights.
- Authorization for Treatment
|
Permanent
|
|
3.
|
History and Physical
|
Most recent
|
|
4.
|
Rehabilitation Potential Evaluation
|
Most recent
|
|
5.
|
Physician's orders
|
Six months
|
|
6.
|
Physician's Progress Notes
|
Six months
|
|
7.
|
Resident Body Weight
|
Six months
|
|
8.
|
Transfer Forms
|
12 months or
Most recent if older than 12 months
|
|
9.
|
Laboratory and X-Ray Reports
|
Six months or
12 months if ordered less often than
monthly
|
|
10.
|
Nurse's Notes/Nursing Flow Sheets (ADL, Restraints,
Clinitest: Results, intakeand-Outputretcr)
|
Three months
|
|
11.
|
Medication and Treatment Records
|
Three months
|
|
12.
|
Personal Effects Inventory
|
Most recent
|
|
13.
|
Hospital Discharge Summary (Including History and
Physical)
|
Current 12 months
|
|
14.
|
TB Surveillance Record
|
Permanent
|
|
15.
|
Classification Status
|
Current
|
|
16.
|
Consultant Reports
- Physicians
- Occupational Therapist
- Speech Therapist
- Physical Therapist
- Social Worker
- Psychologist
- Others
|
Initial and Most recent
|
b. The
maintenance schedule for active records in the nurse's station (other than
those required to be maintained on the chart) are as follows;
|
1.
|
Assessments and Re-assessments
|
Most recent 12 months
|
|
2.
|
Plan of Care
Summary of Quarterly Progress Notes
Change of Condition
|
12 months
|
|
3.
|
Pharmacy Reviews
|
Six months
|
|
4.
|
PASSARLevell
|
Permanent
|
|
5.
|
PASS AR Level H
|
Most recent
|
c.
Those portions of the active records not kept on the chart or at the nurse's
station must be maintained in the facility and retrievable within 15 minutes
upon request.
604.2
Requirements for Retention and Preservation of Inactive/Closed Records
a. Resident records will be retained in the
facility for a minimum of five years following discharge or death of the
resident.
b. Resident records for
minors will be kept for at least three years after they reach legal age of 18
years old.
c. The resident records
will be kept on the premises at all times and will only be removed by
subpoena.
d. In the case of change
of ownership, the resident records will remain with the facility.
e. In case of closure, the records will be
stored within the State of Arkansas for the retention period.
f. After the retention period is met, the
records may be destroyed either by burning or shredding.
g. Records will be protected against loss,
destruction or unauthorized use.
605
CONFIDENTIALITY
The information contained in the resident records is
confidential and is not to be released without legal authorization or
subpoena.
The records will be available to State Survey Agency
personnel.
606
STAFFING
An individual will be designated as responsible for the
resident record service. There will be written job descriptions for the
resident record service personnel.
607
GENERAL INFORMATION
All entries in the resident records will be recorded in ink.
There will be no alteration of information in the resident records. If an error
is made, a single line will be drawn through the error, the word "error"
written above and initialed.
608-699
RESERVED
700
GREEN HOUSET
FACILITIES
701
INTENT
Green HouseT facilities are an attempt to enhance residents'
quality of life through the use of a non-institutional facility model resulting
in a residential-style physical plant and specific principles of staff
interaction. The Greenhouse model utilizes small, freestanding, self-contained
homes surrounding or adjacent to a central administration unit, each housing
between ten (10) and twelve (12) private rooms, each with full bathrooms. The
residents' rooms are constructed around a central, communal, family-style open
space that includes a hearth, dining area, and residential-style kitchen. All
residents' room entrances are visible from the central communal area. Each home
is built to blend architecturally with neighboring homes. The intent of these
regulations is to create a framework that encourages the construction and
operation of Green HouseT facilities.
702
DESIGNATION
To be designated by the Office of Long Term Care as a Green
HouseT facility, the facility meet the rmnimum standards, and have approval to
use the Green HouseT service mark, issued by the Green HouseT Project and NCB
Capital Impact at the time of designation and at all times thereafter.
703
STAFFING
Facilities designated by the Office of Long Term Care as Green
HouseT facilities shall employ the same staffing ratios and otherwise comply
with Section 520 of these regulations; provided, however, that CNAs utilized in
Green HouseT facilities may act as universal workers. For purposes of this
regulation, universal worker means a Certified Nurse Assistant (CNA) who, in
addition to performing CNA duties, performs dietary, laundry, housekeeping and
other services to meet the needs of residents.
800
HOMESTYLE FACILITIES
801
PILOT PROJECT
The construction and operation of HomeStyle facilities is a
pilot project of the State of Arkansas to determine the efficacy of an
alternative long-term care model.
Facilities participating in the project will be required to
maintain detailed medical and social records of residents. The records will
contain an initial assessment of the medical and social conditions and needs of
residents at the time of admission which will form a baseline measure. The
baseline will be compared by the Office of Long Term Care or its designees with
subsequent records maintained by the facility to determine the level of
functioning, social interaction, and medical conditions of residents to
determine whether HomeStyle facilities result in improvements in those areas,
including but not limited to the type and dosage amounts and frequency of
medications. Further, facilities will be required to maintain detailed
financial records.
To ensure accurate and reliable findings, the number of
HomeStyle beds shall be limited to no more than one thousand (1000) in the
state at any time. In the event that applications for the pilot program exceed
one thousand (1000), the Office of Long Term Care shall have sole discretion in
determining projects that shall be designated as HomeStyle facilities. Factors
to be considered shall include, but not be limited to, the projected opening
date of the project, the location of the project (in an attempt to locate
projects in geographically and demographically diverse areas), whether the
applicant has secured a Permit of Approval, whether the proposed project would
meet criteria for approval by a nationally recognized organization that
licenses, certifies, or permits the use of service marks for HomeStyle-type
facilities, and related factors.
To qualify for the project, a facility must return to the
Health Services Permit Agency currently unoccupied facility beds in an amount
equal to twenty percent (20%) of the total number of beds that will be utilized
in the HomeStyle facility. The unused beds may originate from any location in
the State of Arkansas. An exception will be provided when the owner of the
proposed HomeStyle facility has no ownership interest, either directly or
indirectly, in more than one other nursing facility.
802
DEFINITIONS
a.
Clinical support team
means non-universal workers of the entire facility that provide services to
HomeStyle homes and any traditional nursing facility around which a HomeStyle
home is constructed by providing support to self-directed or self-managed work
teams through the development of goals and defining of roles, as well as
providing services to residents. The clinical support team includes but is not
limited to the Administrator, Director of Nursing, Assistant Director of
Nursing, and MDS nurse.
b.
HomeStyle or HomeStyle facilities means small, free-standing,
self-contained homes that:
1. Surround or are
adjacent to a central administration unit, which may or may not be a
traditional nursing facility;
2.
Provide up to twelve (12) private residents' rooms that are shared only at the
request of a resident to accommodate a spouse, partner, tamily member, or
friend. Additionally, a spouse that does not meet medical criteria for nursing
facility placement may reside in the room assigned to a spouse who is admitted
to the facility and who meets medical criteria for admission. The facility may
charge the spouse who does not meet medical criteria for room and board, as
Well as other services so long as the facility meets all
requirements for cost reporting;
3.
Has a ruff, accessible private bathroom for each resident room that contains at
a minimum a toilet, sink, and shower;
4. Has the appearance of a residential
dwelling for both the exterior and the interior;
5. Has residents' rooms constructed around a
central, communal, family-style open space that includes a hearth, dining area,
and residential-style kitchen. The central communal area shall contain a living
area where residents and staff may socialize, dine, and prepare food together
that, at a minimum, provides a living room seating area, a dining area large
enough for a single table serving all residents in the home plus two staff
members, and an open full kitchen. The communal area may include a gas
fireplace with a fixed, "stay-cool" glass screen;
6. Contains residential style design
approach, scale, details, and materials throughout the home that are similar to
the typical residential designs and finishes in the immediate surrounding
community and does not contain or utilize commercial and institutional elements
and products such as nurse station, medication carts, hospital or office type
florescent lighting, acoustical tile ceilings, institutional style railings and
corner guards, room numbering, labeling and signage that would not normally be
found in a home setting. Where regulations require specific institutional
elements, every effort shall be made to provide the
institutional elements in a manner consistent with what might be found in a new
home in the community (e.g., residential wall sconces used for required nurse
call lights);
7. Has outdoor space
that:
A. Allows residents to ambulate, with
or without assistive devices such as wheelchairs or walkers;
B. Signals staff wirelessly when someone
enters the outdoor space from the HomeStyle home;
C. Is partially covered to protect from sun
and elements under the covered area;
D. Provides for outdoor activities;
8. Utilizes a wireless alfcrt
system or call system meeting the requirements in Section 440.3. The system
shall also include, for residents who have been care planned to be at risk for
wandering or elopement, location bracelets that permit residents to signal for
assistance and permits staff to locate residents. Wired call or alert systems
and overhead paging are not permitted;
9. Utilizes a wireless communication and
notification system for staff. The system shall provide a means for
notification of staff both in the home and in other homes or other areas of the
facility by other staff;
10.
Contains ample natural light in each habitable space provided through exterior
windows and other means, with window areas, exclusive of skylights and
clearstories, being a minimum of 10 percent (10%) of the area of the
room;
11. Has built-in safety
features (e.g., magnetic locks on cabinets with chemicals or knives) to allow
all areas of the house, including the kitchen and any staff office, to be
accessible to the residents during the majority of the day and night;
12. Provides self-directed care for residents
through the establishment of self-managed or self-directed work teams
consisting of certified nursing assistants;
13. Prepares and cooks at least 80% of
resident meals in the HomeStyle home. Nothing in this regulation prohibits the
consumption of foods:
A. Prepared outside the
HomeStyle' home by family, acquaintances or social organizations such as
churches;
B. Grown in or on the
grounds of the HomeStyle home by residents or staff; or,
C. Prepared by local retail eating
establishments that are licensed or inspected by the Arkansas Department of
Health;
14. Trains all
staff involved in the operation of the project in the philosophy, operations,
and skills required to implement and maintain self-directed care, self-directed
or self-managed work teams, a non-institutional approach to life and care in
long-term care, appropriate safety and emergency skills, and other elements
required for successful operations and outcomes of the project;
15. Is designed to be fully independent and
disabled accessible;
16. Has
overhead lift tracks that run from the bed into the bathroom in each resident
room;
17. Has at least one lift
motor for each HomeStyle home;
18.
Has separate slings for each resident in the facility who
requires a lift;
19. Is not
connected to, or shares, any area that would not typically be connected or
shared between private homes in the surrounding community (such as a driveway);
and,
20. Has all residents' room
entrances visible from the central communal area.
c.
Home or homes means each
discrete HomeStyle unit housing up to twelve (12) private residents'
rooms.
d.
Person-directed
care means a holistic model that takes into consideration each
resident's physical, mental, and social needs in the development of a care and
treatment plan and the delivery of services that is driven to the greatest
extent possible by resident choice, as opposed to an institutional medical
model that is schedule and task driven.
e.
Self-directed or Self-managed work
team means the universal workers assigned to a specific HomeStyle home
and who determine, plan and manage day-to-day activities in the house with
little or no direct supervision.
f.
Food safety means a method of ensuring safe preparation and
delivery of food for and to residents.
g.
Family-style dining means
residential-style dining, in which all food is placed in serving bowls,
platters and similar residential serving dishes on the table, residents and
staff dine together, and residents are encouraged to serve themselves or serve
themselves with help from staff.
h.
Universal or Flexible Worker - A certified nursing assistant
who has received additional training in the areas of dietary, housekeeping,
activities, and laundry and is a member of the self-managed or self-directed
work team.
803
DESIGNATION
Facilities meeting the requirements for HomeStyle shall be
designated as such on the license issued to the facility, with the designation
specifying the number of HomeStyle homes and the total number of beds in the
HomeStyle homes. Facilities designated as Green House® facilities shall be
deemed to be HomeStyle facilities, and the one thousand (1000) bed limitation
shall include all beds for facilities designated or deemed to be Green
House® or HomeStyle.
A facility may combine HomeStyle homes with a traditional
nursing facility. However, the designation as HomeStyle shall apply only to
those homes that meet the requirements for HomeStyle set forth herein and not
to the facility as a whole.
804
STAFFING
Facilities designated by the Office of Long Term Care as
HomeStyle facilities shall employ the same staffing ratios and otherwise comply
with Section 520 of these regulations; provided, however, that Certified Nurse
Assistants (CNAs) utilized in HomeStyle facilities may act as universal
workers. For purposes of this regulation, universal or flexible
worker means a CNA who, in addition to performing CNA duties, performs
dietary, laundry, housekeeping, activities and other services to meet the needs
of residents.
Staffing ratios for HomeStyle homes shall be computed based on
the midnight census. Except for licensed staff, staffing ratios shall be
computed for each home individually and not the facility or all HomeStyle homes
as a whole. Each home shall have at least two (2) CNA present at all times
during the day and evening shifts and at least one (1) CNA present at all times
during the night shift.
805
STAFF TRAINING
a. In addition to
any state or federal training requirements pertaining to long term care
facilities, each CNA working in a HomeStyle home shall complete the following
eighty (80) hours of training to include but not limited to:
|
TRAINING
|
HOURS
|
|
HomeStyle Model v. Traditional Model
|
4.0
|
|
Activities development of, and appreciation for,
activities designed to meet the individual's personal preferences, and
needs.
|
|
|
Replacing the medical model role of employees
Disregarding the medical model role of residents Organizational Culture
Change
|
|
|
Universal/Flexible Worker
|
4.0
|
|
Concept
|
|
|
Responsibilities of the Worker
|
|
|
Person-directed Care
|
4.0
|
|
Concepts and Relationship Building
|
|
|
Execution
|
|
|
Documentation
|
|
|
Self-Managed or Self-Directed Work Team
|
8.0
|
|
Concept
|
|
|
Responsibilities
|
|
|
Conflict Resolution and Learning
Circles
|
|
|
Staffing
|
|
|
Food Safety
|
30.0
|
|
Introduction
|
|
|
Safety
|
|
|
Contamination
|
|
|
Allergies
|
|
|
Therapeutic Diets
|
|
|
Thickening Agents
|
|
|
Food Preparation
|
|
|
Family style dining
|
4.0
|
|
Concept
|
|
|
Measuring intake
|
|
|
Management
|
|
|
Safety
|
|
|
Documentation
|
|
|
Emergency Situations and Evacuation
|
8.0
|
|
Fire Drills
|
|
|
Tornado Drills
|
|
|
Disaster Drills
|
|
|
Evacuation
|
|
|
Emergency Equipment (fire extinguishers, generators,
water
|
|
|
and gas shut-offs, etc.)
|
|
|
Behavioral Issues
|
|
|
Choking
|
|
|
Emergency calls
|
|
|
Environmental policy
|
|
|
Cottage Equipment Use
|
8.0
|
|
Appliance Usage (microwave, vent-a-hood, stove, fryer,
lifts, whirlpools, washer and dryers, air-conditioners, etc.) Appliance Safety
(changing grease, cleaning vent-a-hood, etc.)
|
|
|
Cottage Orientation
|
2.0
|
|
Phone system
|
|
|
Call system
|
|
|
Cleaning Supply Storage
|
|
|
Cleaning Supply Usage
|
|
|
Workplace Organization
|
|
|
Communication
|
4.0
|
|
Communication Skills
|
|
|
Coaching Skills
|
|
|
Accountability
|
|
|
Support
|
|
|
Observation skills
|
4.0
|
|
How to obtain a history from
family
|
|
|
How to initiate a resident
observation
|
|
|
How a care plan is developed
|
|
|
How to read a care plan
|
|
|
How to modify a care plan
|
|
|
How to identify a resident's change in
condition
|
|
b.
Upon opening and for the first ninety days of continuous operation of a
HomeStyle unit, all CNAs working in that unit shall complete all of the
required training listed in (a) above prior to providing services in the
HomeStyle home.
c. After a
HomeStyle home has been in continuous operation servicing residents for at
least ninety (90) days, each CNA assigned to the HomeStyle home for the first
time, and who has not been trained in accordance with subsections (a) and (b),
above, shall complete the following sixteen (16) hour training schedule before
working with residents:
|
TRAINING
|
HOURS
|
|
HomeStyle Model v. Traditional Model
|
1.5
|
|
Universal/Flexible Worker
|
1.5.
|
|
Person-Directed Care
|
3.0
|
|
Self-Managed or Self-Directed Work Team
|
3.0
|
|
Food Safety
|
3.0
|
|
Family-style dining
|
1.0
|
|
Emergency Situations and Evacuations
|
1.0
|
|
Cottage Equipment Use
|
1.0
|
|
Cottage Orientation
|
1.0
|
Following the sixteen (16) hour training the CNA shall complete
the remaining sixty-four (64) hours of training listed in (a) above within
sixty (60) days.
d. All
shared common staff shall undergo the following within 30 days of the opening
of the first HomeStyle home.
|
TRAINING
|
HOURS
|
|
HomeStyle Model v. Traditional Model
|
1.5
|
|
Clinical Support Team
|
1.0
|
|
Universal Worker Concepts
|
1.0
|
|
Self-Managed or Self Directed Work Team
|
3.0
|
|
Person-Directed Care
|
3.0
|
|
Team Communication
|
1.0
|
|
Learning Circles
|
1.0
|
|
Understanding Aging in the Elderly
|
1.0
|
|
Medication Storage and Administration
|
1.5
|
|
Emergency Situations and Evacuation
|
2.0
|
|
Cottage Orientation
|
1.0
|
806
TRAINING APPROVAL
Each facility seeking designation as a HomeStyle facility shall
provide to the Office of Long Term Care a syllabus, a list of required
reference and study materials, and a proposed curriculum of training as
required in Section 805. For purposes of this section, the term
curriculum means a detailed study guide that states the
learning objectives and provides information or materials designed to impart to
the student or trainee the necessary skills, knowledge or ability required
under the learning objectives. The Office of Long Term Care shall evaluate the
submission and either approve the submission in writing or inform the facility
in writing as to any deficiencies in the training submission. All training
required under Section 805 must be approved in writing by the Office of Long
Term Care or shall be deemed to be in violation of the requirements of Section
805.
900
ALZHEIMER'S SPECIAL CARE UNITS DEFINITIONS
For the purposes of these regulations the following terms are
defined as follows:
a
Activities of Daily Living (ADLs): The
tasks for self-care that are performed either independently, with supervision,
with assistance, or by others. Activities of daily living include, but are not
limited to, ambulating, transferring, grooming, bathing, dressing, eating and
toileting.
b.
Advertise: To make publicly and generally
known. For purposes of this definition, advertise includes, but is not limited
to:
1. Signs, billboards, or
lettering;
2. Electronic publishing
or broadcasting, including the use of the Internet or email; and
3. Printed material.
c
Alzheimer's Special Care
Unit: A separate and distinct unit within a Long Term
Care facility that segregates and provides a special program
for residents with a diagnosis of probable Alzheimer's disease or related
dementia, and that advertises or otherwise holds itself out as having one (1)
or more special units for residents with a diagnosis of probable Alzheimer's
disease or related dementia.
d
Alzheimer's
Disease: An organic, neurological disease of the brain that
causes progressive degenerative changes.
e
Common
Areas: Portions of the Alzheimer's Special Care Unit
exclusive of residents' rooms and bathrooms. Common areas include any facility
grounds accessible to residents of the Alzheimer's Special Care Unit
(ASCU).
f
Continuous: Available at all times
without cessation, break or interruption.
g.
Dementia: A loss or decrease in
intellectual ability that is of sufficient severity to interfere with social or
occupational functioning; it describes a set of symptoms such as memory loss,
personality change, poor reasoning or judgment, and language
difficulties.
h.
Department: Department of Human Services
(DHS), Division of Medical Services (DMS), or Office of Long Term Care
(OLTC)
i
Direct
Care Staff: An individual who is an employee of the
facility or who is an employee of a temporary agency assigned to work in the
facility, and who has received, or will receive, in accordance with these
regulations, specialized training regarding Alzheimer's or related dementia,
and is responsible for providing direct, hands-on care or services to residents
in the ASCU.
j.
Disclosure Statement: A written statement
prepared by the facility and provided to individuals or their responsible
parties, and to individuals' families, prior to admission to the unit,
disclosing form of care, treatment, and related services especially applicable
or suitable for the ASCU.
k.
Facility: A long-term care facility that
houses an ASCU.
l.
Individual Assessment Team: A group of
individuals possessing the knowledge and skills to identify the medical,
behavioral, and social needs of a resident and to develop services designed to
meet those needs
m.
Individual Support Plan: A written plan
developed by an Individual Assessment Team (IAT) that identifies services to a
resident.
n.
Nursing Personnel: Registered or Licensed
Practical nurses who have specialized training, or will undergo specialized
training by the Alzheimer's Special Care Unit, in accordance with these
regulations.
o.
Responsible Party: An individual, who, at
the request of the applicant or resident, or by appointment by a court of
competent jurisdiction, agrees to act on behalf of a resident or applicant for
the purposes of making decisions regarding the needs and welfare of the
resident or applicant. These regulations, and this definition, does not grant
or permit, nor should be construed as granting or permitting, any individual
authority or permission to act for, or on behalf of, a resident or applicant in
excess of the authority or permission granted by law. A competent resident may
select a responsible party or may choose to not select a responsible party. In
no event may an individual act for, or on behalf of, a resident or applicant
when the resident or applicant has a legal guardian, attorney-in-fact, or other
legal representative. For purposes of these regulations only, responsible party
will also refer to the terms legal representative, legal guardian, power of
attorney or similar phrase.
901
GENERAL ADMINISTRATION
a.
General Program Requirements
1. Each
long-term care facility that advertises or otherwise holds itself out as having
one (1) or more special units for residents with a diagnosis of probable
Alzheimer's disease or a related dementia shall provide an organized,
continuous 24-hour-per-day program of supervision, care and services that
shall:
A. Meet all state, federal and ASCU
regulations.
B. Require the full
protection of residents' rights;
C.
Promote the social, physical and mental well-being of residents;
D. Is a separate unit specifically designed
to meet the needs of residents with a physician's diagnosis of Alzheimer's
disease or other related dementia;
E. Provide 24-hour-per-day care for those
residents with a dementia diagnosis and meets all admission criteria applicable
for that particular long-term care facility; and,
F. Receive approval of its disclosure
statement from the Office of Long Term Care prior to advertising its
ASCU.
2. Documentation
shall be maintained by the facility and shall include, but not be limited to, a
signed copy of all training received by the employee. Documentation shall be
signed by the trainer and employee at the time of training.
3. Provide for relief of direct care
personnel to ensure minimum staffing requirements are maintained at all
times.
4. Upon request, make
available to the Department payroll records of all staff employed during those
pay periods for which the unit or facility is being surveyed or
inspected.
5. Nursing, direct-care,
or personal care staff shall not perform the duties of cooks, housekeepers, or
laundry personnel during the same shift they perform nursing, direct-care or
personal care duties.
6. Regardless
of other policies or procedures developed by the facility, the ASCU will have
specific policies and procedures regarding:
A.
Facility philosophy related to the care of ASCU residents;
B. Use of ancillary therapies and
services;
C. Basic services
provided;
D. Admission, discharge,
transfer; and,
E. Activity
programming.
b. Disclosure Statement and Notice to the
Office of Long Term Care
1. Each facility,
prior to advertising that it has an Alzheimer's Special Care Unit, shall
develop a disclosure statement and submit it to the Office of Long Term Care.
The Office of Long Term Care shall examine the disclosure statement to ensure
compliance with these regulations, and shall notify the facility of its
determination. Thereafter, the Office of Long Term Care will, when surveying
the facility and unit, determine continued compliance with the disclosure
statement. The disclosure statement, once approved by.OLTC, shall be made
available to any person or the person's guardian or responsible party seeking
placement within the ASCU prior to admission. Specifics as to the minimum
requirements of the disclosure statement are listed in Sections 902-907
below.
2. Upon any changes to the
services offered by the ASCU, the disclosure statement shall be amended, and
shall be submitted to the Office of Long Term Care within thirty (30) days of
the amendment. The Office of Long Term Care will examine the amended disclosure
statement to' ensure compliance with these regulations, and shall notify the
facility of its determination. Thereafter, the Office of Long Term Care will,
when surveying the facility and unit, determine continued compliance with the
amended disclosure statement. The amended disclosure statement, once approved
by OLTC, shall be made available to any person or the person's guardian or
responsible party seeking placement within the ASCU prior to
admission.
3. The facility shall
submit to the Office of Long Term Care in writing the number of beds allocated
by the facility for the ASCU. The notification shall state the number of beds
allocated to the ASCU as of the date of the notice, and shall be submitted:
A. With the initial disclosure
statement;
B. With any amendment to
the disclosure statement; and,
C.
No less than July 1 of each year.
4. The facility shall notify the Office of
Long Term Care in writing when the facility no longer provides a special
program for residents with a diagnosis of probable Alzheimer's disease or
related dementia. The notice shall be provided to the Office of Long Term Care
at least thirty (30) days prior to the cessation of services.
5. Prior to admission into the Alzheimer's
Special Care Unit, the facility shall provide a copy of the disclosure
statement and Residents' Rights policy to the applicant or the applicant's
responsible party. The mission statement and treatment philosophy shall be
documented in the disclosure statement. A copy of the disclosure statement
signed by the resident or the resident's responsible party shall be kept in the
resident's file. The disclosure statement shall include, but iiot be limited
to, the following information about the facility's ASCU:
A. The philosophy of how care and services
are provided to the residents;
B.
The pre-admission screening process;
C. The admission, discharge and transfer
criteria and procedures;
D.
Training topics, amount of training time spent on each topic, and the name and
qualifications of t&e individuals used to train the direct care staff
utilized in the ASC-U;
E. The
minimum number of direct tfare staff assigned to the ASCU each shift;
F. A copy of the Residents' Rights;
G. Assessment, Individual Support Plan, and
Implementation.
The process used for assessment *md establishment of the plan
of care and its implementation, including the method by which the plan of care
evolves and is responsive to changes in condition of the residents;
H. Planning and implementation of
therapeutic activities and the methods used for monitoring; and,
I. Identification of what stages of
Alzheimer's or related dementia for which the ASCU will provide care*
J. Each facility shall document in their
disclosure statement the assessments and dates assessments shall be completed
and revised.
K. Admission,
discharge and transfer requirements shall be documented in the facility's
disclosure statement.
L. Staffing
ratios and staff training requirements shall be documented in the facility's
disclosure statement.
M. The
facility shall, in their disclosure statement, state the physical requirements
and safety standards for the ASCU.
N. Types and frequency of therapeutic
activities shall be listed in the facility's disclosure statement.
c. Residents' Rights
The ASCU shall meet and comply with the same requirements for
Residents' Rights applicable to the facility housing the ASCU.
d. Resident Record Maintenance
The ASCU shall develop and maintain a record-keeping system
that includes a separate record for each resident and that documents each
resident's health care, individual support plan, assessments, social
information, and protection of each resident's rights.
e. Resident Records
The ASCU must follow the facility's policies and procedures and
applicable state and federal laws and regulations governing:
1. The release of any resident information,
including consent necessary from the client, parents or legal
guardian;
2. Record
retention;
3. Record maintenance;
and,
4. Record content.
f. Miscellaneous
1. Visitors shall be permitted in the ASCU at
all times. However, facilities may deny visitation in the ASCU when visitation
results, or substantial probability exists that visitation will result, in
disruption of service to any resident, or threatens the health, safety, or
welfare of any resident.
2. Birds,
cats, dogs, and other animals may be permitted in the Alzheimer's Special Care
Unit. All animals that enter the facility shall have appropriate vaccinations
and licenses. A veterinary record shall be kept on all animals to verify
vaccinations and be made readily available for review. Pets may not be allowed
in food preparation, food storage or dining or serving areas.
3. Unmarried male and female residents shall
not be housed in the same room unless both residents, or their respective
responsible parties, have given consent.
902
TREATMENT PHILOSOPHY
Each Alzheimer's Special Care Unit shall develop a mission
statement triafTeflects'the ASCU's treatment philosophy for those residents
diagnosed with Alzheimer's or related dementia.
903
ASSESSMENTS
a. Psychosocial and Physical Assessments
1. Each resident shall receive a psychosocial
and physical assessment which includes the resident's degree or level of family
support, level of activities of daily living functioning, cognitive level,
behavioral impairment, and that identifies the resident's strengths and
weaknesses.
2. Prior to admission
to the ASCU, the applicant must be evaluated by, and have received from a
physician, a diagnosis of Alzheimer's or related dementia.
b. Individual Assessment Team (IAT)
1. Within 30 days after admission, the IAT
shall prepare for each resident an individual support plan. The ISP shall
address specific needs of, and services required by, the resident resulting
from the resident's Alzheimer's disease or related dementia. The plan shall
include and identify professions, disciplines, and services that:
A. Identifies and states the resident's
medical needs, social needs, disabilities and their causes;
B. Identifies the resident's specific
strengths;
C. Identifies the
resident's specific behavioral management needs;
D. Identifies the resident's need for
services without regard to the actual availability of services;
E. Identifies and quantifies the resident's
speech, language, and auditory functioning;
F. Identifies and quantifies the resident's
cognitive and social development; and,
G. Identifies and specifies the independent
living skills and other services provided by the ASCU to meet the needs of the
resident.
2. The IAT
shall perform accurate assessments or reassessments annually, and upon a change
to a resident's physical, mental, emotional, functional, or behavioral
condition or status in which the resident:
A.
Is regressing in, or losing, skills already gained;
B. Is failing to progress toward or maintain
identified objectives in the ISP; or,
C. Is being considered for changes in the
resident's ISP.
c. Individual Support Plan (ISP)
1. The ISP shall include a family and social
history. If the family and social history cannot be obtained, the ASCU
personnel shall document attempts to obtain the information, including but not
limited to, the names and telephone numbers of individuals contacted, or whom
the facility attempted to contact, and the date and time of the contact or
attempted contact.
2. The ISP shall
be reviewed, evaluated for its effectiveness, and up-dated at least quarterly,
and shall be updated when indicated by changing needs of the resident, or upon
any reassessments by the IAT. In the event that the reassessment by the IAT
documents a change of condition for which no change in services to meet
resident needs are required, the ISP shall document the change of condition,
and the reason or reasons why no change in services are required.
3. The ISP shall include:
A. Expected behavioral outcomes;
B. Barriers to expected outcomes;
C. Services, including frequency of delivery,
designed to achieve expected behavioral outcomes;
D. Methods of assessment and monitoring.
Monitoring shall occur no less than quarterly to determine progress toward the
outcome;
E. Documentation of
results from services provided, and achievement towards expected outcomes or
regression, and reasons for the regression; and,
F. The resident's likes, dislikes, and if
appropriate, his or her choices.
4. A copy of the ISP shall be made available
to all staff that work with the resident, and the resident or his or her
responsible party.
5. The ISP shall
be implemented only with the documented, written consent of the resident or his
or her responsible party.
904
ADMISSIONS, DISCHARGES,
TRANSFERS
a. Criteria for Services
1. Each Alzheimer's Special Care Unit shall
have written policies setting forth pre-admission screening, admission, and
discharge procedures.
2. Admission
criteria shall require:
A. A physician's
diagnosis of Alzheimer's disease or related dementia;
B. The facility's assessment of the
resident's level of needs; and,
C.
A list of the services that the ASCU can provide to address the needs
identified in 904(a)(2)(B).
3. Any individual admitted to the ASCU must
also meet admission criteria for the facility. The ASCU shall not maintain a
resident who requires a level of care greater than for which the facility is
licensed to provide, or for whom the ASCU is unable to provide the level or
types of services to address the needs of the resident. Discharge from the ASCU
shall occur when:
A. The resident's medical
condition exceeds the level of care for which the facility is licensed or is
able to provide;
B. The resident's
medical condition requires specialized nursing procedures that constitute more
than limited nursing services, or nursing services the facility is unable to
provide;
C. The resident has a loss
of functional abilities (e.g. ambulation) that results in the resident's level
of care requirements being greater than the level of care for which the
facility is licensed or able to provide;
D. Behavioral symptoms that result in the
resident's level of care requirements being greater than the level of care for
which the facility is licensed or able to provide; or
E. The resident requires a level of
involvement in therapeutic programming that is greater than the level of care
for which the facility is licensed or able to provide.
4. If the resident, or the resident's
responsible party, does not comply with, or refuses to accept, the requirements
of the ISP, the resident shall be discharged from the ASCU. The facility shall
document the refusal or non-compliance with the ISP. The documentation shall
include, but not be limited to:
A. The
identity of the person who is not willing or able to comply with the
requirements of the ISP; i.e., the resident or the resident's responsible
party;
B. The date and time of the
refusal; and,
C. The consequences
of the unwillingness or inability to comply with the requirements of the ISP,
and the name of the person providing this information to the resident or the
resident's responsible party.
b. Resident Movement, Transfer or Discharge
When a resident is moved from or within the ASCU, or is
transferred or discharged from the ASCU, measures shall be taken by the
facility to minimize confusion and stress to the resident. Further, the
discharge shall comply with the regulations applicable to the facility housing
the ASCU and Arkansas law.
905
STAFFING
Alzheimer's Special Care Units shall staff according to the
Rules and Regulations for Nursing Facilities. Furthermore, the following
staffing requirements are established for Alzheimer's Special Care
Units.
a. Professional Program
Services
A social worker or other professional staff, e.g., physician,
Registered Nurse, or Psychologist currently licensed by the State of Arkansas,
shall be utilized to perform the following functions:
1. Complete an initial social history
evaluation on each resident on admission;
2. Develop, coordinate, and use state or
national resources and networks to meet the needs of the residents or their
families;
3. Offer or encourage
participation in monthly family support group meetings with documentation of
meetings offered; and,
4. Assist in
development of the ISP, Including but not limitedlo:
A. Assuring that verbal stimulation,
socialization and reminiscing is identified in the ISP as a need;
B. Defining the services to be provided to
address those needs identified above; and, J. Identifying the resident's
preferences, likes, and dislikes.
b. Staff and Training
1. All ASCU staff members and consultants
shall have the training specified in these regulations in the care of residents
with Alzheimer's Disease and other related dementia. The facility shall
maintain records documenting what training each staff member and consultant has
received, the date it was received, the subject of the training, and the source
of the training.
2. Within six (6)
months of the date that the long-term care facility first advertises or
otherwise holds itself out as having one (1) or more special units for
residents with a diagnosis of probable Alzheimer's disease or a related
dementia, the facility shall have trained all staff who are scheduled or
employed to work in the ASCU.
3.
Subsequent to the requirements set forth hi Section 905(b)(2), fifty percent
(50%) of the staff working any shift shall have completed requirements as set
forth in Section 905(b)(5)(a), (b), and (c).
4. After meeting the requirements of Section
905(b)(2), all new employees who will be assigned to or will work in the ASCU
shall be trained within five (5) months of hiring, with no less than eight (8)
hours of training per month during the five (5) month period.
5. In addition to any training requirements
for any certification or licensure of the employee, training shall consist of,
at a minimum:
A. Thirty (30) hours on the
following subjects:
a. One (1) hour of the
ASCU's policies;
b. Three (3) hours
of etiology, philosophy and treatment of dementia;
c. Two (2) hours on the stages of Alzheimer's
disease;
d. Four (4) hours on
behavior management;
e. Two (2)
hours on use of physical restraints, wandering, and egress control;
f. Two (2) hours on medication
management;
g. Four (4) hours on
communication skills;
h. Two (2)
hours of prevention of staff burnout;
i. Four (4) hours on activity
programming;
j. Three (3) hours on
ADLs and Individual-Centered Care; and,
k. Three (3) hours on assessments and
creation of ISPs.
B.
On-going, in-service training consisting of at least two (2) hours every
quarter. The topics to be addressed in the in-service training shall include
the following, and each topic shall be addressed at least once per year:
i. The nature of Alzheimer's disease and
other dementia, including:
a. The definition
of dementia;
b. The harm to
individuals without a correct diagnosis; and,
c. The stages of Alzheimer's
disease.
ii. Common
behavior problems resulting from Alzheimer's or related dementia, and
recommended behavior management for the problems;
iii. Communication skills to facilitate
improved staff relations with residents;
iv. Positive therapeutic interventions and
activities, such as:
a. Exercise;
b. Sensory stimulation; and,
c. Activities of daily living.
v. The benefits of family
interaction with the resident, and the need for family interaction;
vi. Developments and new trends in the fields
of Alzheimer's or related dementia, and treatments for same;
vii. Environmental modifications to minimize
the effects and problems associated with Alzheimer's or related dementia;
and,
viii. Development of ISPs,
including but not limited to instruction on the method of updating and
implementing ISPs across shifts.
C. If that facility identifies or documents
that a specific employee requires training in areas other than those set forth
in 905(b), the facility may provide training in the identified or documented
areas, and may be substituted for those subjects listed in Section 905(b)(5)(A)
and (B).
c
Trainer Requirements
The individual providing the training shall have:
1. A minimum of one (1) year uninterrupted
employment in the care of Alzheimer's residents;
2. Training in the care of individuals with
Alzheimer's disease and other ' dementia; or,
3. Been designated by the Alzheimer's
Arkansas Program and Services or the Alzheimer's Association or its local
chapter as being qualified to meet training requirements.
d. Training Manual
The ASCU shall create and maintain a training manual consisting
of the topics listed in Section 905(b). Further, the trainer shall provide
training consistent with the training manual.
906
PHYSICAL ENVIRONMENT, DESIGN AND
SAFETY
a. Physical Design
In addition to the physical design standards required for the
facility's license, an Alzheimer's Special Care Unit shall include the
following:
1. A floor plan design that
does not require visitors or staff to pass through the ASCU to reach other
areas of the facility;
2. A
multipurpose room or rooms for dining, group and individual activities, and
family visits which complies with the LTC licensure requirements for common
space;
3. Secured outdoor space and
walkways that allow residents to ambulate, with or without assistive devices
such as wheelchairs or walkers, but prevents undetected egress. Such walkways
shall meet the accessibility requirements of the most current LTC and Americans
with Disabilities Act (ADA) structural building codes or regulations at the
time of licensure. Unrestricted access to secured outdoor space and walkways
shall be provided, and such areas shall have fencing or barriers that prevent
injury and elopement. Fencing shall be no less than 72 inches high;
4. Prohibit the use of plants that are
poisonous or toxic for human contact or consumption;
5. Visual contrasts between floors and walls,
and doorways and walls, in resident use areas. Except for fire exits, exit
doors and access ways shall be designed to minimize contrast and to obscure or
conceal areas the residents should not enter;
6. Non-reflective floors, walls, and ceilings
to minimize glare;
7. Evenly
distributed lighting to minimize glare and shadows; and,
8. A monitoring or nurses' station with:
A. A call system to alert staff to any
emergency needs of the residents; and,
B. A space for charting and for storage of
residents' records.
b. Physical Environment and Safety.
The Alzheimer's Special Care Unit shall:
1. Provide freedom of movement for the
residents to common areas and to their personal spaces. The facility shall not
lock residents out of, or inside, their rooms;
2. Provide plates and eating utensils that
have visual contrast between the plates, the utensils and the table, and that
maximizes the independence of the residents;
3. In common areas, provide comfortable
seating sufficient to seat all residents at the same time. The seating shall
consist of a ratio of one (1) gliding or rocking chair for every five (5)
residents;
4. Encourage and assist
residents to decorate and furnish their rooms with personal items and
furnishings based on the resident's needs and preferences as documented by the
ISP in the social history;
5.
Individually identify each resident's room based on the resident's cognitive
level to assist residents in locating their rooms, and to permit them to
differentiate their room from the rooms of other residents;
6. Keep corridors and passageways through
common-use areas free of objects which may cause falls, or which may obstruct
passage by physically impaired individuals; and,
7. Only use public address systems in the
unit for emergencies.
c.
Egress Policies
The Alzheimer's Special Care Unit shall develop policies and
procedures to deal with residents who wander or may wander. The procedures
shall include actions to be taken by the facility to:
1. Identify missing residents;
2. Notify all individuals or institutions
that require notification under law or regulation when a resident is missing;
and,
3. Attempt to locate the
missing resident.
d.
Locking Devices
1. All locking devices used on
exit doors shall be approved by the OLTC, building code agencies, and the fire
marshal having jurisdiction over the facility; shall be electronic; and shall
release upon activation of the fire alarm or sprinkler system.
2. If the unit uses keypads to lock and
unlock exits, directions for the keypad's operations to allow entrance shall be
posted on the outside of the door.
3. The keypads and locks shall meet the Life
Safety Code.
4. Staff shall be
trained in all methods of releasing, or unlocking, the locking
device.
907
THERAPEUTIC ACTIVITIES
a. Intent
and General Requirements
Therapeutic activities can improve a resident's eating or
sleeping patterns; lessen wandering, restlessness, or anxiety; improve
socialization or cooperation; delay deterioration of skills; and improve
behavior management. Therapeutic activities shall be designed to meet the
resident's current needs. The ASCU shall:
1. Provide activities appropriate to the
needs of individual residents. The activities shall be provided and directed by
direct care staff under the coordination of a program director.
2. Ensure that each resident's daily routine
is structured or scheduled so that activities are provided seven days a
week.
3. Utilize or contract with a
professional with specialized training in the care of Alzheimer's to:
A. Develop required daily activities, as set
forth in Section 907(b);
B. Train
direct care staff in those programs; and,
C. Provide ongoing consultation.
b. Required Daily
Activities
The following activities shall be offered daily:
1. Gross motor activities (e.g., exercise,
dancing, gardening, cooking, etc.);
2. Self-care activities (e.g., dressing,
personal hygiene, or grooming);
3.
Social activities (e.g., games, music, socialization); and,
4. Sensory enhancement activities (e.g.,
reminiscing, scent and tactile stimulation).
908
PENALTIES
a. If a facility having an Alzheimer's
special care unit does not meet the specific standards established herein, the
Office of Long Term Care shall instruct the facility to immediately cease
advertising or holding itself out as having one (1) or more special programs
for residents with a diagnosis of probable Alzheimer's disease or related
dementia.
b. If the facility fails
or refuses to comply with instructions from the Office of Long Term Care, the
Office of Long Term Care may sue in the name of the state the facility and any
owner, manager, or director of the facility to enjoin the facility from
advertising or holding itself out as having one (1) or more special programs
for residents with a diagnosis of probable Alzheimer's disease or related
dementia.
1000
RECEIVERSHIP
1001
DEFINITIONS
a.
Administrator - A long term facility administrator as
defined in Ark. Code Ann. §
20-10-101.
b.
Emergency - A
situation, physical condition, or one or more practices, methods or operations
which threatens the health, security, safety or welfare of residents.
c.
Facility - A long
term care facility that is required to be licensed under Ark. Code Ann. §
20-10-224.
d.
Habitual
Violation - A violation of state or federal laws which, due to its
repetition, presents a reasonable likelihood of serious physical or mental harm
to residents.
e.
Licensee - Any person or other legal entity who is
licensed to operate a facility.
f
Owner - The holder of the title to the real estate in
which the facility is maintained.
g.
Resident - Any
person who lives in and receives services or care in a long term care
facility.
h.
Substantial Violation - A violation of a state or
federal law which presents a reasonable likelihood of serious physical or
mental harm to residents.
i.
Department - The Arkansas Department of Human
Services.
j.
Office - Office of Long Term Care.
k.
Director of OLTC
- The Assistant Deputy Director of the Office of Long Term Care.
l.
Director - The
Director of the Arkansas Department of Human Services.
1002
PURPOSE
a. Ark. Code Ann. §
20-10-902
describes the purpose for development of a mechanism for the concept of
receivership to protect resident in long term care facilities. Utilization of
the receivership mechanism shall be a remedy of last resort and shall be
implemented consistent with the criteria set forth in Ark. Code Ann. §
20-10-904,
to wit:
1. An emergency exists in a facility
which threatens the health, security or welfare of residents.
2. A facility is In substantial or habitual
violation of the standards of "health, safety or resident care established
under state or federal regulations to the detriment of the welfare of the
residents.
3. A facility intends to
close but has not arranged at least thirty (30) days prior to closure for the
orderly transfer of its residents.
4. The facility is insolvent.
5. The Department has suspended, revoked or
refused to renew the existing license of the facility.
b. The objective of any receivership is:
1. To restore a nursing home's capability to
meet resident needs or, if that is not feasible;
2. To arrange for a transfer of ownership or
closing of the home.
1003
APPOINTMENT AND SUPERVISION OF A
MONITOR(S):
a. The Director, pursuant
to Ark. Code Ann. §
20-10-915,
may in its discretion place a designated employee in the facility in lieu of a
receiver.
1. The monitor(s) shall meet the
following minimum requirements:
A. Be in good
physical health.
B. Experience in
working with the elderly in programs such as patient care, social work, or
advocacy.
C. Have an understanding
of the rules and regulations which are the subject of the monitors' duties as
evidenced in a personal interview of the candidate.
D. Not be related to the owners of the
involved facility either through blood, marriage, or common ownership of real
or personal property.
E.
Successfully completed a baccalaureate degree or two years full-time work
experience in the long term care industry.
2. Monitor(s) shall be under the supervision
of the Department; shall perform the duties of a monitor delineated and
accomplish the following actions:
A. A
monitor shall visit the facility at least five (5) days per week or more
frequently as assigned by the Director.
B. Review all records pertinent to the
condition for such monitor's placement under 1(a) above.
C. Provide to the Director a weekly written
report and a daily oral report detailing the observed conditions of the
facility.
D. Shall be available as
a witness for hearings.
3. All communications, including, but not
limited to, data, memorandum, correspondence, records and reports shall be
transmitted to and become the property of the Department. Findings and results
of the monitor's work done under these rules and regulations shall be strictly
confidential, subject to disclosure only in accordance with the provisions of
the Freedom of Information Act.
4.
The assignment as a monitor may be terminated at any time by the
Director.
5. The monitors) shall
submit a written report setting forth findings and recommendations concerning
the operation of the facility.
1004
DETERMINATION OF NEED FOR
RECEIVERSHIP
a. Pre-Petition
Activities - Prior to the filing of a Petition of Receivership (Ark. Code Ann.
§
20-10-905) the Department shall be notified and:
1.
Coordinate the preparation and collection of documentation to support a
decision to recommend a receivership action.
2. In an emergency situation present the
supporting documentation and recommendations to the Director.
3. Receive information from any source, which
indicates a need for receivership action.
4. Request information concerning the
following:
A. Chronology of facility survey
history for the two years immediately prior to the determination of the
need.
B. Summary of physical
plant/life safety code compliance and actions necessary to correct
violations/deficiencies.
C
SumMary'ofnuniberofresidentsrcareievelsrspecial-needs-and an assessment of
major problems occurring in the facility, i.e., staffing, supply shortages (may
warrant an immediate on-site visit).
5. Review the need for receivership
considering the following options:
A. Would
relocation of residents be an alternative?
B. "Would appointment of a monitor be
sufficient?
6.
Identifies the total number and type of violations or deficiencies cited by
Department staff.
1005
PETITION FOR NOTICE OF
RECEIVERSHIP
a. The Department,
Attorney General, or prosecuting attorney or duly appointed deputy prosecuting
attorney of the district in which the facility is located may file in chancery
court of the county in which the facility is located a complaint requesting the
appointment of a receiver.
b. The
summons, complaint and notice of hearing shall be served on the owner and
administrator or licensee of the facility. The summons, complaint and notice
may be served by any means set forth in the Arkansas Rules of Civil Procedure,
Rule 4, giving actual notice to the owner and administrator or
licensee.
c. Emergency Appointment
1. If the complaint filed under Ark. Code
Ann. §
20-10-905
is filed by the Department and alleges that grounds set out in Ark. Code Ann.
§
20-10-904(a)
exist within the facility, and is accompanied by a verified affidavit setting
forth facts which would constitute such a ground, a temporary receiver shall be
appointed with or without notice to the owner or licensee.
2. The temporary appointment of a receiver
without notice to the owner, licensee, or administrator may be made only if the
court is satisfied that the Department has made a diligent attempt to provide
reasonable notice under the circumstances. The delivery of a copy of the
complaint to the facility upon filing shall constitute reasonable notice for
issuance of a temporary receivership order by the court.
3. Upon appointment of a temporary receiver,
the department shall proceed forthwith to obtain the service as provided in
20-10-905(d).
4. If the department does not proceed with
the complaint, the court shall dissolve the temporary receivership after ten
(10) days.
1006
POST PETITION ACTIVITIES
Immediately upon appointment of a receiver the Department shall
assist the receiver and insure the following functions and responsibilities are
accomplished:
a. Identify the need for
additional staff as necessary to evaluate problems identified
on-site.
b. Identify and work
closely with key nursing home personnel to assess the adequacy of services to
the patients in the home and to establish whether or not adequate and
appropriate inventories of supplies and equipment are available to meet the
needs of the patients. Determine the extent, condition and availability of
physical inventory and records.
c.
Identify and interview person(s) responsible for maintaining the home's
financial records, and identify the bank or other financial institution with
which the home is involved for mortgage financing, short term loans, daily
banking activities (checking, savings), etc.
d. Work closely with the director of nursing
and other nursing personnel and evaluate the quality and effectiveness of
resident care, including progress made on cited code violations.
e. Assesses:
1. The ability of licensed and attendant
staff to meet the needs of the resident population.
2. The degree to which the health needs of
the residents are met through direct observation of residents, interviews with
residents and staff, and examination of clinical records.
3. The quality and quantity of medical care
being rendered, and that physician's orders are being carried out
appropriately. (May request the services of a consulting physician to evaluate
this aspect).
4. The nutritional
status of the residents; examines the adequacy and appropriateness of
diets.
5. Other resident needs,
including grooming and hygiene, recreation, and restorative nursing.
6. The availability and adequacy of
appropriate nursing supplies and equipment.
f. May recommendlhe remova of residents
requiring a level of care greater than the available nursing
services.
g. Work closely with the
Director of Nursing in evaluation the status of residents.
h. Communicate with residents' families and
other interested parties to address concerns for the health, safety or welfare
of the residents.
i. Evaluate the
social services activity of the home.
1007
ASSISTANCE WITH DUTIES OF THE
RECEIVER TO STAFF
Immediately upon completion of the assessment in Section 1006
above, but in no event more than 72 hours after appointment, the Department
shall assist the Receiver to:
a.
Conduct an orientation meeting with staff to discuss identified problems,
present status of the operation, apparent priorities, establish a plan of
operation and receivership goals. Contract personnel will attend if
appropriate.
b. Coordinate
assignment of staff to receivership activities.
c. Distribute reports and other information
regarding receivership action to facility supervisory personnel.
d. Interview persons who maintain inventories
(food, medical supplies, etc.). to assure adequacy of supplies on
hand.
e. Interview medical
director, director of nursing, heads of housekeeping, maintenance, food
service, laundry, etc., to address adequacy of services and environmental
conditions of the facility.
f. Meet
all department heads to:
1. Explain the need
and purpose of the receivership.
2.
Discuss identified problems.
3.
Assess the strengths of the group and the facility.
4. Present a plan of operation including
apparent priorities and tentative goals.
5. Explain style of leadership;
expectations.
6. Encourage and
elicit free and open expression, noting their feelings, concerns.
7. Announce weekly department head group
meetings.
1008
ASSISTANCE WITH RESPONSIBILITIES
OF RECEIVER TO RESIDENTS, GUARDIANS AND FAMILIES
Immediately upon completion of assessment in Section 1006
above, but in no event more than 72 hours after appointment the Department
shall assist the receiver to:
a. Meet
with the residents/guardians, their families and/or interested parties to:
1. Explain purpose and necessity of
receivership.
2. Identify persons
who will operate the facility, and present plans of operation.
3. Describe expected goals and end
results.
4. Assure residents and
their families of care and continuing concern for their needs, health and
welfare and identify the person to be contacted if they have
questions.
5. Ask for their support
and patience during the course of the receivership action.
b. Prepare notice to families, responsible
parties and guardians of residents explaining:
1. Purpose and necessity of receivership
action.
2. Expected goals of
receivership and end results.
3.
The assurance of continuing care and concern for the residents.
4. The need for continued support and concern
for the residents.
5. Identify a
person to contact for information.
1009
LONG RANGE RESPONSIBILITIES OF
RECEIVER
Upon appointment, the department shall assist in taking
appropriate action with regard to the on-going operation of the facility. That
action shall include:
a. Meet
regularly with other staff.
b.
Convey copies of reports to the Director as scheduled.
c. Meet with facility department heads to
plan for achieving goals to remedy identified code violation, to mutually
review causes and ways to overcome past and present problems, and to promise
open communication and support between them. Agrees to other meetings as
necessary.
d. Receive required
reports from department heads as scheduled.
e. Keep daily log of activities and
observations for incorporation into written weekly reports to
Director.
f. Hold regular
department head meetings - weekly to start, with an agenda that includes:
1. Information from receivership team
administrator.
2. Information from
department heads.
3. Free exchange
of comments.
g. Monitor
closely the ongoing operation of the facility.
1. By daily presence on floors and in
departments, keep up the morale and confidence of employees and
residents.
2. Evaluate and document
performance of staff.
3. Review
security of the facility and changes locks as necessary.
4. Consistently work toward the correction of
any code violations.
5. Monitor and
control admission policies.
6.
Recommend to the Director any immediate changes in staff and/or staffing
patterns necessary to the safety, health and welfare of the
residents.
h. Review the
current resident care program in light of available skills and ability of the
staff to meet the needs of residents. Consider the need to close the home to
additional admissions, the need to transfer residents from the facility. Make
the appropriate recommendations to the Director.
i. Continuously monitor staffing in
relocation to the quantity and types of skills.
j. If the facility is permitted to continue
to accept admissions, review applications for admission, considering skills
required for proper care in relation to skills available at the home.
k. Evaluate the operation of the nursing
department, beginning with problems identified as existing code violations and
observations made by the pre-receivership team.
l. Assist the Director of Nursing in the
preparation, promotion and implementation of remedial actions.
1. Evaluate the effectiveness of selected
remedial programs on a continuing basis.
2. Report progress toward correction of
violations and other problems to receivership team administrator on a regular
basis.
m. Monitor all
phases of the nursing department and all services pertaining to the care of the
residents including:
1. Medical Care
A. Frequency of physician's visits
B. Physician's responsiveness to emergencies
or changes in residents' condition
C. Effectiveness of nurse/physician
relationships
D. Appropriate and
timely reporting by nursing staff of emergencies and/or significant physical
changes to attending physicians
E.
Evaluation of the role served by the facility's medical director
2. Care Delivery System
A. Medication System
i. Proper and effective methods of order
transcription
ii. Effective pharmacy
service
iii. Accuracy in
administration
iv. Accurate
recordkeeping
v. Proper methods of
disposal of outdated or discontinued medication
vi. Prompt renewal of medication
orders
B. Treatment
Systems
i. Adequacy and appropriateness of
treatment supplies if.
ii. Provision
of treatments as ordered by the physician
iii. Proper recording
iv . Utilization of proper
techniques
v. Charting of
effectiveness of prescribed treatment
C. Restorative Therapies
i. Comprehensive orders
ii. Proper follow-through
iii. Appropriate and accurate records
D Restorative Nursing
i. Activities of daily living retraining
being provided
ii. Staff promotion
of self-care to extent possible
iii.
Nursing staff follow-through on therapeutic restorative programs
iv. All residents up and dressed as
possible
3.
Accident/Incident Management
A. Proper care
and follow-up provided by nursing staff
B. Physicians notified
appropriately
C. Medical director
reviewing all reports
D
Comprehensive charting and accident reports available
4. Record Management
A. Medical records complete and in good
order
B. Charting by nursing staff
meaningful.
C. All reports
available in record
D. Closed
records complete and in good order
5. Laboratory and Other Contract Services
A. Responsive on a timely basis
B. Reports available promptly
C. Current orders available for tests and
treatment rendered
D. Physicians
promptly notified of test results
6. Dignity of Residents
A. Residents treated, by nursing staff with
courtesy and respect
B. Resident
rights known to all nursing staff and maintained consistently
7. Inservice Programming
A. Appropriate to the needs of the
staff
B. Appropriate planning and
scheduling
C. Adequate orientation
and training of new staff members being provided
8. Supply and Equipment Procurement
A. Supplies and equipment available and
adequate to meet the needs of the patient census
B. Supplies and equipment maintained in
sanitary condition and good working order
1010
REPORTING OF PROGRESS OF
RECEIVER
a. The Receiver shall report
to the court, the Department, the owner and administrator licensee on the
progress of the receivership action before the receivership can be concluded
and at such times as directed by the court, and prior to engaging in any
function, duty or activity for which a statutorilyntnandated report is
required. The preparation of the final report on all aspects of a receivership
action is coordinated by the Director,
b. The report details all activities and
their expenditures during the receivership. It clearly identifies whether the
objectives of the receivership have been achieved; i.e., to restore the home's
capabilities to meet patient needs, or to close the home. If the objective has
not been achieved, it clearly identifies what additional actions are necessary
and an estimate of how much time is required to complete them.
c. The receiver shall forward a report to the
Director for review, advice and assistance.
d. If the Court determines and orders the
facility is to continue operation, the receiver shall:
1. Prepare department heads for change in
administration. Provide information and instructions as needed, together with a
timetable for activities and required final reports. Such reports are to
include a brief summary statement to the receivership team administrator,
including statistics and numbers where appropriate, an assessment of strengths
and weaknesses and recommendations of the department head.
2. Meet all employees, each shift, to prepare
them for the change in administration, giving dates of action and names. Thank
them for cooperation and personal efforts.
3. Meet with, or arranges for meetings, as
needed, with residents and their families to prepare them for upcoming changes,
giving dates of action and names. Thanks them for their patience and
cooperation.
4. Notify families and
responsible parties to inform them of the approaching
changes.
5. Request and receive
concluding reports from all members of the receivership team, and compile final
report and forward to Director.
6.
On day of transition of control, collect all keys, records, books, etc., from
each member of the receivership team. Turn these items over to the incoming
administration.
7. Remain available
to new administration to ease turnover process.
8. Take and record a complete inventory.
Provides report to receivership team administrator.
9. Bring all records up to date; makes final
reconciliation of books.
10. Be
available to new financial officer, if any, to assist in an orderly
transition.
e. If the
Court determines and orders the facility to be closed, upon receipt of the
decision for closure, along with instructions regarding needed information and
procedures, the receiver shall:
1. Inform
other members of the receivership team of the decision for closure and the
responsibilities they will assume during the closure process.
2. Prepare department heads for closing,
giving information and instruction as needed, together with timetable for
actions. Instruct on final report as required, including brief summary
statements.
3. Meet with all
employees, each shift, giving general outline of concluding activities; ask
their cooperation to the end.
4.
Hold concluding meetings with each department head, collecting all final
reports, etc.
5. Receive and act
upon instructions regarding storage of files and records, disposition of
capital goods, equipment, building, etc.
6. Take final inventory.
7. Bring all records up to date and close
books.
8. Conclude all accounts,
pay all bills, collect all accounts receivable.
9. Under the direction of the Director, close
all bank accounts, and oversee the transfer of residents' funds to the
receiving facilities.
10. Work with
the facility staff in preparing residents and the families of residents for the
impending closure of the facility.
11. Seek additional nursing staff to assist
in the transfer, if necessary.
12.
Work with social service staff and the families of residents in securing
appropriate placement in other facilities.
13. Participate in the actual transfer
process, assuring the proper transfer of records, etc.
14. Oversee the closure of the nursing
department and nursing areas, seeing to the proper closure and storage of
records.
1011
QUALIFICATIONS AND MAINTENANCE OF LIST FOR RECEIVER
a. Through consultation with the long-term
care industry associations, professional organizations, consumer groups and
health-care management corporations, the Department shall maintain a list of
receivers. This list shall be updated semiannually. To be placed on the list,
individuals must:
1. Be in good physical
health.
2. Demonstrate an
understanding or working knowledge of applicable laws, rules and
regulations.
3. In addition to 1
and 2 above, individuals placed on the list shall:
A. Possess a current, valid Arkansas Nursing
Home Administrator's license;
B.
Possess a degree in business finance, management, health-care or a related
field and one (1) year work experience in the degreed field provided; an
individual not possessing a college degree but having five (5) years experience
in the above fields may substitute such experience for the requisite degree;
or,
C. Possess one year of
experience in working with the elderly in programs or fields such as patient
care, social work, or advocacy and having successfully completed a
baccalaureate degree in management program or field; or possess a license in
that program or field; or have two (2) years full-time working experience in
the Arkansas long-term care industry in a management capacity.
1012
DEPARTMENT TO FURNISH RECEIVER WITH COPY OF LEGAL PROCEEDING
a. Upon appointment of a receiver for a
facility by a court, the Department shall inform the individual of all legal
proceedings to date which concern the facility.
b. The receiver may request that the Director
of the Department, authorize expenditures from monies appropriated, pursuant to
Ark. Code Ann. §
20-10-916
of the Act, if incoming payments from the operation of the facility are less
than the costs incurred by the receiver.
1013
MANDATED PATIENT TRANSFER
a. In the case of Department ordered patient
transfers, the receiver may:
1. Assist in
providing for the orderly transfer of all residents in the facility to other
suitable facilities, or make other provisions for their continued
health.
2. Assist in providing for
transportation of the resident, his medical records and his belongings if he is
transferred or discharged; assist in locating alternative placement; assist in
preparing the resident for transfer; and permit the resident's legal guardian
to participate in the selection of the resident's new location.
3. Unless emergency transfer is necessary,
explain alternative placements to the resident and provide orientation to the
place chosen by the resident or resident's guardian.
1014-1999
RESERVED
2000
INFORMAL DISPUTE RESOLUTION
When a long term care facility does not agree with deficiencies
cited on a Statement ot Deficiencies, the facility may request an IDR meeting
of the deficiencies in lieu of, or in addition to, a formal appeal. The
Informal Dispute Resolution (IDR) process is governed by Act 1108 of 2003,
codified at Ark. Code Ann. §
20-10-1901
et seq.
The request for an informal dispute resolution of deficiencies
does not stay the requirement for submission of an acceptable plan of
correction and allegation of compliance within the required time frame or the
implementation of any remedy, and does not substitute for an appeal.
2001
REQUESTING AN INFORMAL DISPUTE
RESOLUTION
A written request for an informal dispute
resolution must be made to the Arkansas Department of Health, Health Facility
Services, 5800 West 10th, Suite 400, Little Rock, AR 72204 within ten calendar
days of the receipt of the Statement of Deficiencies from the Office of Long
Term Care. The request must:
1. List
all deficiencies the facility wishes to challenge; and,
2. Contain a statement whether the facility
wishes the IDR meeting to be conducted by telephone conference, by record
review, or by a meeting in which the parties appear before the impartial
decision maker.
2002
MATTERS WHICH MAY BE HEARD AT IDR
The IDR is limited to deficiencies cited on a Statement of
Deficiencies. Issues that may not be heard at an IDR include, but are not
limited to:
1. The scope and severity
assigned the deficiency by the Office of Long Term Care, unless the scope and
severity allege substandard quality of care or immediate jeopardy;
2. Any remedies imposed;
3. Any alleged failure of the survey team to
comply with a requirement of the survey process;
4. Any alleged inconsistency of the survey
team in citing deficiencies among facilities; and,
5. Any alleged inadequacy or inaccuracy of
the IDR process.
2003
APPEAL OF IDR RESULTS
If a Medicaid certified facility is not satisfied with the
results of the informal dispute resolution, it may request a hearing before the
Long Term Care Facility Advisory Board within the 60 day time frame for appeal.
If the facility chooses, it may by-pass the informal dispute resolution process
and appeal directly to the board within the 60 day appeal period. Requests must
be submitted in writing to:
Chairman
Long Term Care Facility Advisory Board
P.O. Box 8059, Slot S409
Little Rock, AR 72203-8059
Medicare and Medicare/Medicaid certified facilities may request
a hearing by either the Associate Regional Administrator in the Dallas office
of the Health Care Financing Administration or the Departmental Appeals Board
at the addresses below at any point within the 60 day time frame for
appeals.
HCF-2
Associate Regional Administrator
Division of Health Standards and Quality
Centers for Medicare and Medicaid Services
1200 Main Tower Building
Dallas, TX 75202
Department of Health and Human Services Departmental Appeals
Board, MS 6127 Civil Remedies Division 330 Independence Avenue, S.W. Cohen
Building - Room G-644 Washington, D.C. 20201
If the facility chooses to appeal to either of these agencies,
a copy of the appeal should also be forwarded to the OLTC.
2004-2999
RESERVED
3000
RESIDENTS' RIGHTS
3001 The facility shall have written policies
and procedures defining the rights and responsibilities of residents. The
policies shall present a clear statement defining how residents are to be
treated by the facility, its personnel, volunteers, and others involved in
providing care.
3002 A copy of the
synopsis of the residents' bill of rights must be prominently displayed within
the facility.
3003 Each resident
admitted to the facility is to be fully informed of these rights and of all
rules and regulations governing resident conduct and responsibilities. The
facility is to communicate these expectations/rights during the period of not
more than two weeks before or five working days after admission, unless
medically contraindicated in writing. The facility shall obtain a signed
acknowledgement from the resident, his guardian or other person responsible for
the resident. The acknowledgement is maintained in the resident's medical
record.
3004 Appropriate means
shall be utilized to inform non-English speaking, deaf, or blind residents of
the residents' rights.
3005
Residents' Rights shall be deemed appropriately signed if:
a. Residents capable of understanding: signed
by resident before one witness.
b.
Residents incapable because of illness: The attending physician documents the
specific impairment that prevents the residents from understanding or signing
their rights. Responsible party and two witnesses sign.
c. Residents mentally retarded: Rights read,
and if he understands, resident signs before staff member and outside
disinterested party. If he cannot understand, rights are explained to, and
signed by, guardian before witness.
d. Residents capable of understanding but
acknowledges with other mark (X): Mark must be acknowledged by two
witnesses.
3006 Staff
members must fully understand all residents' rights,
3007 Facility staff will be provided a copy
of residents' rights. Staff shall complete a written acknowledgement stating
they have received and read the residents' rights. A copy of the
acknowledgement shall be placed in each employee's personnel file.
3008 The facility's policies and procedures
regarding residents' rights and responsibilities will be formally included in
ongoing staff development program for all personnel, including new
employees.
3009 Each resident
admitted to the facility will be fully informed, prior to or at the time of
admission, and as need arises during residency, of services available in the
facility and any charges for services. Residents have the right to choose, at
their own expense, a personal physician and pharmacist.
3010 The facility shall make available to all
residents a schedule of the kinds of services and articles provided by the
facility. A schedule of charges for services and supplies not included in the
facility's basic per diem rate shall be provided at the time of admission. This
schedule shall be updated should any change be made.
3011 Each resident admitted to the facility
shall be fully informed by a physician of his medical condition. The resident
shall be afforded the opportunity to participate in the planning of his total
medical care and may refuse experimental treatment.
3012 Total resident care includes medical
care, nursing care, rehabilitation, restorative therapies, and personal
cleanliness in a safe and clean environment. Residents shall be advised by
appropriate professional providers of alternative courses of care and
treatments and the consequences of such alternatives when such alternatives are
available.
3013 A resident may be
transferred or discharged only for:
a. Medical
reasons;
b. His welfare or the
welfare of other residents;
c. The
resident presents a danger to the safety or health of other
residents;
d. Because the resident
no longer needs the services provided by the facility;
e. Non-payment for his stay; or,
f. The facility ceases operation.
The resident shall be given reasonable written notice to ensure
orderly transfer or discharge.
3014 The term "transfer" applies to the
movement of the resident from facility to another facility.
3015 "Medical reasons" for transfer or
discharge shall be based on the resident's needs and are to be determined and
documented by a physician. That documentation shall become a part of the
resident's permanent medical record.
3016 "Reasonable notice of transfer or
discharge" means the decision to transfer or discharge a resident shall be
discussed with the resident and the resident will be told the reason(s) and
alternatives available. A minimum of thirty (30) days written notice must be
given. Transfer for the welfare of the resident or other residents may be
affected immediately if such action is documented in the medical
record.
3017 An appeals process for
residents objecting to transfer or discharge shall be developed by the
facility, in accordance with Ark. Code Ann. §
20-10-1005
as amended. The process shall include:
a. The
written notice of transfer or discharge shall state the reason for the proposed
transfer or discharge. The notice shall inform the resident that they have the
right to appeal the decision to the Director within seven (7) calendar days.
The resident must be assisted by the facility in filing the written objection
to transfer or discharge.
b. Within
fourteen (14) days of the filing of the written objections a hearing will be
scheduled.
c. A final determination
in the matter will be rendered within seven (7) days of the hearing.
3018 The facility shall provide
preparation and orientation to resident designed to ensure a safe and orderly
transfer or discharge.
3019 The
facility must provide reasonable written notice of change in room or
roommate,
3020 Each resident
admitted to the facility will be encouraged and assisted to exercise all
constitutional and legal rights as a resident and as a citizen including the
right to vote, and the facility shall make reasonable accommodations to ensure
free exercise of these rights. Residents may voice grievances or recommend
changes in policies or services to facility staff or to outside representatives
of their choice, free from restraint, coercion, discrimination, or
reprisal.
3021 Residents shall have
the right to free exercise of religion including the right to rely on spiritual
means for treatment.
3022
Complaints or suggestions made to the facility's staff shall be responded to
within ten (10) days. Documentation of such response will be maintained by the
facility administrator or his designee.
3023 Each resident may retain and use
personal clothing and possessions as space and regulations permit.
3024 A representative resident council shall
be established in each facility. The resident council's duties shall include:
a. Review of policies and procedures required
for implementation, of resident rights.
b. Recommendation of changes or additions in
the facility's policies and procedures, including programming,
c. Representation of residents in their
complaints to the Office of Long Term Care or any other person or
agency.
d. Assist in identification
of problems and orderly resolution of same.
3025 The facility administrator shall
designate a staff coordinator and provide suitable accommodations within the
facility for the residents' council. The staff coordinator shall assist the
council in scheduling regular meetings and preparing written reports of
meetings for dissemination to residents of the facility. The staff coordinator
may be excluded from any meeting of the council.
3026 The facility shall inform residents'
families of the right to establish a family council within the facility. The
establishment of such council shall be encouraged by the facility. This family
council shall have the same duties and responsibilities as the resident council
and shall be assisted by the staff coordinator designated to assist the
resident council.
3027 Each
resident admitted to the facility may manage his personal financial affairs, or
if the resident request such affairs be managed by the facility, an accounting
shall be maintained in accordance with applicable regulations.
3028 Residents shall be free from mental and
physical abuse, chemical and physical restraints (except in emergencies) unless
authorized, in writing, by a physician, and only for such specified purposes
and limited time as is reasonably necessary to protect the resident from injury
to himself or others.
3029 Mental
abuse includes humiliation, harassment, and threats of punishment or
deprivation.
3030 Physical abuse
refers to corporal punishment or the use of restraints as a
punishment.
3031 Drugs shall not be
used to limit, control, or alter resident behavior for convenience of
staff.
3032 Physical restraint
includes the use of devices designed or intended to limit residents' total
mobility.
3033 Physical restraints
are not to be used to limit resident mobility for the convenience of staff, as
a means of punishment, or when not medically required to treat the resident's
medical symptoms. If a resident's behavior is such that it will result in
injury to himself or others any form of physical restraint utilized shall be in
conjunction with a treatment procedure designed to modify the behavioral
problems for which the resident is restrained and only after failure of therapy
designed or intended to modify the threatening behavior.
3034 The facility's written policy and
procedures governing the use of restraint shall specify which staff members may
authorize the use of restraints and must clearly specify the following:
a. Orders shall indicate the specific reasons
for the use of restraints.
b. Use
of restraints must be temporary and the resident will not be restrained for an
indefinite or unspecified amount of time.
c. Application of restraints shall not be
allowed for longer than 12 hours unless the resident's condition warrants and
specified medical authorization is maintained in the resident's medical
record.
d. A resident placed in
restraints shall be checked at least every thirty (30) minutes by appropriately
trained staff. A written record of this activity shall be maintained in the
resident's medical record. The opportunity for motion and exercise shall be
provided for a period of not less than ten (10) minutes during each two (2)
hours in which restraints are employed, except at night.
e. Reorder, extensions or re-imposition of
restraints shall occur only upon review of the resident's condition by the
physician, and shall be documented in the physician's progress notes.
f. The use of restraints shall not be
employed as punishment, the convenience of staff, or a substitute for
supervision.
g. Mechanical
restraints must be employed in such manner as to avoid physical injury to the
resident and provide a minimum of discomfort.
h. The practice of locking residents behind
doors or other barriers also constitutes physical restraint and must conform to
the policies and procedures for the. use of restraints.
3035 Each resident is assured confidential
treatment of his personal and medical records. Residents may approve or refuse
the release of such records to any individual except in case of a transfer to
another health care institution, or as required by law or third party payment
contract.
3036 Each resident will
be treated with consideration, respect, and full recognition of dignity and
individuality, including privacy in treatment and care for personal
needs.
3037 Staff shall display
respect for residents when speaking with, caring for, or talking about
residents, and shall seek to engage in the constant affirmation of resident
individuality and dignity as a human being.
3038 Schedules of daily activities shall
provide maximum flexibility and allow residents to exercise choice in
participation. Residents' individual preferences regarding such things as
menus, clothing, religious activities, friendships, activity programs, and
entertainment will be elicited and respected by the facility.
3039 Residents shall be examined or treated
in a manner that maintains and ensures privacy. A closed door or a drawn
curtain shall shield the resident from passers-by. People not involved in the
care of the residents are not to be present during examination or treatment
without the residents' consents.
3040 Privacy will be afforded residents
during toileting, bathing, and other activities of personal hygiene.
3041 Residents may associate or communicate
privately with persons of their choice, and may send or receive personal mail
unopened, unless medically contraindicated and documented by the physician in
the medical record.
3042 Policies
and procedures shall permit residents to receive visits from anyone they wish;
provided a particular visitor may be restricted for the following reasons:
a. The resident refuses to see the
visitor.
b. The resident's
physician specifically documents that such a visit would be harmful to the
resident's health.
c. The visitor's
behavior is unreasonably disruptive to the facility. This does not include
those individuals who, because they advocate administrative change to protect
resident rights, are considered a disruptive influence by the
administrator.
3043
Decisions to restrict a visitor shall be reviewed and evaluated each time the
resident's plan of care or medical orders are reviewed by the physician or
nursing staff, or at the resident's request.
3044 Accommodations will be provided for
residents to allow them to receive visitors in reasonable comfort and
privacy.
3045 Residents are allowed
to manage their own personal financial affairs.
3046 Should the facility manage the
resident's personal financial affairs, this authorization must be in writing
and shall be signed appropriately as follows:
a. If the resident is capable of
understanding the authorization shall be signed by the resident and one (1)
witness.
b. If the resident is
mentally retarded the authorization shall be read and if he/she understands,
the resident will sign along with a staff member and an outside disinterested
party. If he/she cannot understand, the authorization should be explained and
signed by the guardian and witness. If the resident is capable of understanding
and acknowledges with a mark (X) then two witnesses are required.
3047 The facility shall have
written policies and procedures for the management of client trust
accounts.
3048 An employee shall be
designated to be responsible for resident accounts.
3049 The facility shall establish and
maintain a system that assures full and complete accounting of residents'
personal funds using generally accepted accounting principles.
3050 The facility shall not commingle
resident funds with any other funds other than resident funds.
3051 The facility system of accounting
includes written receipts for funds received by or deposited with the facility,
and disbursements made to or for the resident.
3052 All personal allowance monies received
by the facility are placed in a collective checking account.
3053 The checking account will be reconciled
on a monthly basis.
3054 Any cost
incurred for this account shall not be charged to the resident.
3055 Any interest earned from this account
shall not be charged to the resident.
3056 When appropriate individual savings
accounts shall be opened for residents in accordance with Social Security rules
governing savings accounts.
3057 A
cash fund specifically for petty cash shall be maintained in
the facility to accommodate the small cash requirement of
residents.
3058 The facility shall,
at the resident's request, keep on deposit personal funds over which the
resident has control. Should the resident request these funds, they are given
to him on request with receipts maintained by the facility and a copy to the
resident.
3059 The financial record
must be available to the resident and his/her guardian, and responsible
party.
3060 If the facility makes
financial transactions on a resident's behalf, the resident, guardian, or
responsible party shall receive an itemized accounting of disbursements and
current balances at least quarterly.
3061 A copy of the resident's quarterly
statement shall be maintained in the facility.
SYNOPSIS OF RESIDENTS' BILL OF
RIGHTS
WELCOME
This facility must ensure and protect the human rights of every
individual in residence and to that end will provide a clean, healthy
attractive environment wherein the resident will receive treatment without
discrimination as to race, color, religion, sex, national origin or source of
payment. Upon request, every resident has the right to the name and function of
persons providing them service and the identification of other health care
facilities, nursing homes, hospitals and other institutions that may provide
them with service.
INFORMATION
THE RESIDENT HAS THE RIGHT TO:
[GREATER THAN] Be fully informed before, or at
admission, of his rights and responsibilities as a resident.
[GREATER THAN] Know immediately of any changes or amendments to
those rights and responsibilities.
[GREATER THAN] Be fully informed prior to or at admission and
during stay, of services available in the facility and of related charges of
services.
[GREATER THAN] Reasonable notice of any
changes in the costs or availability of services.
MEDICAL CONDITION AND
TREATMENT
AS A RESIDENT, YOU HAVE THE RIGHT TO:
[GREATER THAN] Choose, at your own expense, a personal
physician and pharmacist.
[GREATER THAN] Be fully informed by a
physician of your health and medical condition unless the physician documents
in your medical record that such knowledge is contraindicated.
[GREATER THAN] Be given the opportunity to participate in
planning your total care and medical treatment.
[GREATER THAN] Be given the opportunity to refuse
treatment.
[GREATER THAN] Be given the opportunity to refuse to
participate in experimental research.
[GREATER THAN] Receive rehabilitative and restorative
therapies.
[GREATER THAN] Be advised by physician or appropriate
professional staff of alternative courses of care and treatments and their
consequences.
[GREATER THAN] Receive medical care, nursing care and personal
cleanliness in a safe and clean environment.
EXERCISING RIGHTS
AS A RESIDENT, YOU ARE ENCOURAGED OR WILL BE ASSISTED
TO:
[GREATER THAN] Exercise all constitutional and
legal rights as a resident and as a citizen, including the right to
vote.
[GREATER THAN] Voice grievances and recommend changes in
nursing home policies and services to facility staff and to outside
representatives of jour choice, free from restraint, interference, coercion,
discrimination or reprisal. All complaints and suggestions made to the nursing
home must be responded to.
[GREATER THAN] Exercise your religious beliefs including the
right to rely on spiritual means for treatment.
[GREATER THAN] Participate in the Resident Council and be
informed of its activities and recommendations to the facility.
TRANSFER, DISCHARGE, AND CHANGE OF
ACCOMMODATION EVERY RESIDENT HAS THE RIGHT TO KNOW:
[GREATER THAN] You will be transferred or
discharged only for: medical reasons, for your welfare or that of others, you
no longer need the services, the facility ceases operations, or for
non-payment.
[GREATER THAN] Except in emergency the
facility must give you a thirty (30) day written notice of transfer or
discharge. You shall be given reasonable notice of change of room or roommate
within the facility.
[GREATER THAN] Transfer and discharge shall be discussed with
you and you shall be told the reason and alternatives that are
available.
[GREATER THAN] There is an appeals process for residents
objecting to transfer or discharge.
[GREATER THAN] You shall be provided
preparation and orientation to ensure a safe and orderly transfer or
[GREATER THAN] You shall be given reasonable notice of change
of room or roommate change in the facility.
FINANCIAL AFFAIRS
AS A RESIDENT YOU HAvE THE RIGHT TO:
[GREATER THAN] Manage your personal financial affairs, or
delegate that management to a responsible party.
[GREATER THAN] Delegate that management or a part thereof to
the nursing home and receive at least a quarterly report of transactions made
on your behalf.
FREEDOM FROM ABUSE AND
RESTRAINTS
AS A RESIDENT YOU HAVE THE RIGHT TO BE:
[GREATER THAN] Free from mental and physical abuse (Mental
abuse includes humiliation, harassment, and threats of punishment or
deprivation. Physical abuse refers to corporal punishment and the use of
restraints as a punishment.).
[GREATER THAN] Free from chemical and physical restraints
except when authorized in writing by a physician for a specific and limited
period of time and only to protect you from injury to yourself or
others.
PRIVACY
EVERY RESIDENT HAS THE RIGHT TO:
[GREATER THAN] Considerate and respectful
care. Every resident will be treated with consideration, respect and full
recognition of his dignity and individuality.
[GREATER THAN] Privacy during treatment and care of personal
needs. People not involved in the care of residents shall not be present
without the consent from the resident during examinations and treatment.
[GREATER THAN] Know that he is assured confidential treatment
of all information contained in his medical records and that his or his legal
appointee's written consent is required for the release of information to
persons not otherwise authorized to receive it.
[GREATER THAN] Know that photographs and interviews shall not
be released without written consent of the resident or his responsible
party.
[GREATER THAN] Privacy during visits with spouse.
[GREATER THAN] Share a room, in the case of married residents,
unless medically contraindicated by a physician in writing.
WORK
Every resident has the right to refuse work. No resident is
required to perform any service for the nursing home.
ACTIVITIES
AS A RESIDENT, YOU HAVE THE RIGHT TO:
* Participate in activities of social, religious, and community
groups unless medically contraindicated in writing by your physician.
* Refuse to participate in activities.
* Be provided a schedule of daily activities that allow
flexibility in what you will do and when you will do it.
* Individual preferences regarding such things as food,
clothing, religious activities, friendships, activity programs and
entertainment. Such preferences shall be elicited and respected by the nursing
home staff.
PERSONAL
POSSESSIONS
EVERY RESIDENT HAS THE RIGHT TO:
* Associate and communicate privately with persons of his
choice, and send and receive personal mail unopened unless medically
contraindicated and documented by the physician in the medical record.
*Space to receive visitors in reasonable comfort and
privacy.
* Retain and use personal possessions and clothing as space
permits.
IF YOU FEEL YOUR RIGHTS HAVE BEEN VIOLATED BY THE LONG
TERM CARE FACILITY CALL THE OFFICE OF LONG TERM CARE AT 501-682-8430 OR YOUR
LOCAL NURSING HOME OMBUDSMAN AT THE LOCAL AREA AGENCY ON AGING (LISTED IN YOUR
TELEPHONE DIRECTORY) OR THE ADULT PROTECTIVE SERVICES AT
501-682-8491.
4000
FINES
AND SANCTIONS
4001
Definitions
As used in these regulations, the following definitions will
apply, unless the context requires otherwise.
a. "Agency" means the Division of Medical
Services.
b. "Act" means a bodily
movement, and includes speech and the conscious possession or control of
property.
c. The verb "act" means
either to perform an act or to omit to perform an act.
d. "Actor" includes, where appropriate, a
person who possesses something or who omits to act.
e. "Civil Penalties" are an assessment of
financial fines against licensee for violations of regulations.
f. "Conduct" means an act or omission and its
accompanying mental state.
g.
"Department" is the Department of Human Services.
h. "Director" is the Director of the Office
of Long Term Care.
i. "Element of
the offense" means the conduct, the attendant circumstances, and the result of
that conduct that:
1. Is specified in the
definition of the offense; or,
2.
Establishes the kind of culpable mental state required for commission of the
offense; or,
3. Negates an excuse
or justification for the conduct.
j. "Executive Director" is the Director of
the Arkansas Department of Human Services.
k. "Facility/Licensee" is a long term care
facility which is required to be licensed under Ark. Code Ann. §
20-10-224.
l. "Knowingly" means a person acts
knowingly with respect to his conduct or the attendant circumstances when he is
aware that his conduct is of that nature or that such circumstances exist. A
person acts knowingly with respect to a result of his conduct when he is aware
that it is practically certain that his conduct will cause such a
result.
m. "Law" includes statutes
and court decisions.
n.
"Negligently" means a person acts negligently with respect to attendant
circumstances or a result of his conduct when he should be aware of a
substantial and unjustifiable risk that the circumstances exist or the result
will occur. The risk must be of such a nature and degree that the actor's
failure to perceive it, considering the nature and purpose of his conduct and
the circumstances known to him, involves a gross deviation from the standard of
care that a reasonable person would observe in the actor's situation.
o. "Omission" means a failure to perform and
act, the performance of which is required by law.
p. "Person", "actor", "defendant", "he", or
"him" includes any natural person and, where appropriate, an organization as
that term is defined in Ark. Code Ann. §
5-2-501(1).
q. "Physical harm or physical
injury" means the impairment of physical condition or the infliction of
substantial pain.
r. "Possess"
means to exercise actual dominion, control, or management over a tangible
object.
s. "Purposely" means a
person acts purposely with respect to his conduct or a result thereof when it
is his conscious object to engage in conduct of that nature or to cause such a
result.
t. "Reasonably believes" or
"reasonable belief" means the belief that an ordinary, prudent man would form
under the circumstances in question and one not recklessly or negligently
formed.
u. "Recklessly" means a
person acts recklessly with respect to attendant circumstances or a result of
his conduct when he consciously disregards a substantial and unjustifiable risk
that the circumstances exist or the result will occur. The risk must be of a
nature and degree that disregard thereof constitutes a gross deviation from the
standard of care that a reasonable person would observe in the actor's
situation.
v. "Regulation" means:
1. Any state or federal regulation pertaining
to licensure of a long term care facility.
2. Any state or federal regulation relating
to Title XIX Medicaid certification.
w. "Serious physical harm" means physical
injury that creates a substantial risk of death or that causes protracted
disfigurement, protracted impairment of health, or loss or protracted
impairment of the function of any bodily member or organ.
x. "Statute" includes the Constitution and
any statute of this state, any ordinance of a political subdivision of this
state, and any rule or regulation lawfully adopted by an agency of this
state.
y. "Violation" means:
1. Class A violations create a condition or
occurrence relating to the operation and maintenance of a long term care
facility resulting in death or serious physical harm to a resident or creating
a substantial probability that death or serious physical harm to a resident
will result therefrom.
2. Class B
violations create a condition or occurrence relating to the operation and
maintenance of a long term care facility which directly threatens the health,
safety, or welfare of a resident.
3. Class C violations shall relate to
administrative and reporting requirements that do not directly threaten the
health, safety, or welfare of a resident.
4. Class D violations shall relate to the
timely submittal of statistical and financial reports to the Office of Long
Term Care. The failure to timely submit a statistical or financial report shall
be considered a separate Class D classified violation during any month or part
thereof of noncompliance. In addition to any civil money penalty which may be
imposed, the director is authorized after the first month of a Class D
violation to withhold any further reimbursement to the long term care facility
until the statistical and financial report is received by the Office of Long
Term Care.
4002
Civil Penalties
The following listed civil penalties pertaining to classified
violations may be assessed by the Director against long term care facilities.
In the case of Class A violations, the following civil penalties shall be
assessed at the amount outlined in these regulations. In the case of Class B,
C, or D violations, the Director, in his discretion, may elect to assess the
following civil penalties or may allow a specified period of time for
correction of said violation.
a. Class
A violations are subject to a civil penalty not to exceed two thousand five
hundred dollars ($2,500) for the first violation. A second Class A violation
occurring within a six-month period from the first violation shall result in a
civil penalty of five thousand dollars ($5,000). The third Class A violation
occurring within a six-month period from the first violation shall result in
proceedings being commenced for termination of the facility's Medicaid
agreement and may result in proceedings being commencedfor revocation of
tfielicensure ofthefacility.
b.
Class B violations are subject to a civil penalty not to exceed one thousand
dollars ($1,000). A second Class B violation occurring within a six-month
period shall be subject to a civil penalty of two thousand dollars ($2,000). A
third Class B violation occurring within a six-month period from the first
violation shall result in proceedings being commenced for termination of the
facility's Medicaid agreement and may result in proceedings being commenced for
revocation of the licensure of the facility. All Class B violations shall be
based on a point system as contained in these regulations.
c. Class C violations are subject to a civil
penalty not to exceed five hundred dollars ($500) for each violation. Each
subsequent Class C violation within a six-month period from the first violation
shall subject the facility to a civil money penalty double that of the
preceding violation until a maximum of one thousand dollars ($1,000) per
violation is reached. All Class C violations shall be based on a point system
as contained in these regulations.
d. Class D violations are subject to a civil
penalty not to exceed two hundred fifty dollars ($250) for each violation. Each
subsequent Class D violation occurring within a six-month period from the first
violation shall subject the facility to a civil penalty double that of the
preceding violation until a maximum of five hundred dollars ($500) is reached.
All Class D violations shall be based on a point system as contained in these
regulations.
e. In no event may the
aggregate civil penalties assessed for violations in any one (1) month exceed
five thousand dollars ($5,000).
4003
Factors in Assessment of Civil
Penalties
In determining whether a civil penalty is to be assessed and in
affixing the amount of the penalty to be imposed, the Director shall
consider:
a. The gravity of the
violation including the probability that death or serious physical harm to a
resident will result or has resulted;
b. The severity and scope of the actual or
potential harm;
c. The extent to
which the provisions of the applicable statutes or regulations were
violated;
d. The "good faith"
exercised by the licensee. Indications of good faith include, but are not
limited
to:
1. Awareness of
the applicable statutes and regulations and reasonable diligence in securing
compliance;
2. Prior
accomplishments manifesting the licensee's desire to comply with the
requirements;
3. Efforts to
correct; and,
4. Any other
mitigating factors in favor of the licensee.
e. Any relevant previous violations committed
by the licensee; and,
f. The
financial benefit to the licensee of committing or continuing the violation.
The Director shall assign value points to conditions or
occurrences and said value points shall represent a base to which the above
considerations shall be applied by the Director prior to assessment of monetary
civil penalty. Each value point shall represent a base assessment of one dollar
($1.00).
4004
Right to Assess Civil Penalties not Merged in Other Remedies
Assessment of a civil penalty provided in this section shall
not affect the right of the Office of Long Term Care to take other such action
as may be authorized by law or regulation.
4005
Class A Violations
a. Class A violations are:
1. Violations which create a condition or
occurrence relating to the operation and maintenance of a long term care
facility which results in death or serious harm to a resident; or,
2. Violations which create a condition or
occurrence relating to the operation and maintenance of a long term care
facility which creates a substantial probability that death or serious physical
harm to a resident will result from the violation.
b. The following Class A violations and the
points assigned to each are provided and * are subject to the conditions set
out in Section 4003:
1. Death of a Resident
(2,500)
Any condition or occurrence relating to the operation of a
long-term care facility in which the conduct, act or omission of a person or
actor purposely, knowingly, recklessly or negligently results in the death of a
result shall be a Class A violation.
2. Serious Physical Harm to a Resident
(2;500)
Any condition or occurrence relating to the operation of a long
term care facility in which the conduct, act or omission of a person or actor
purposely, knowingly, recklessly or negligently results in serious physical
harm to a resident shall be a Class A violation.
3. Probability of Death or Serious Physical
Harm
The following conduct, acts or omissions, when not resulting in
death or serious physical harm, but which create a substantial probability that
death or serious physical harm to a resident will result therefrom are
conditions or occurrences relating to the operation of a long term care
facility which are Qlass A violations.
A Poisonous Substances
Two thousand five hundred (2,500) points shall be assigned when
a facility fails to provide proper storage of poisonous
substances.
B Falls by
Residents
One thousand five hundred (1,500) points shall be assigned when
a facility fails to maintain require direct care staffing, or a safe
environment and this failure directly causes a fall by a resident. (Examples:
equipment not properly maintained, or a fall due to personnel not responding to
patient requests for assistance.)
C Assaults
Two thousand five hundred (2,500) points shall be assessed when
a facility fails to maintain repuired direct care staffing or measures are not
taken when it is known that a resident is combative and assaultive with other
residents, and this failure causes an assault upon a resident of the facility
by another resident. A Class A violation shall also exist when a facility fails
to perform adequate screening of personnel and this failure causes an assault
upon a resident by an employee of the facility.
D Permanent Injury to an Extremity
Two thousand two hundred fifty (2,250) points shall be assigned
when a facility personnel improperly apply physical restraints contrary to
published regulations or fail to check and release restraints as directed by
physician's orders or regulations.
E Nosocomial Infection
Two thousand five hundred (2,500) points shall be assigned when
a facility does not follow or meet nosocomial infection control standards as
outlined by regulations or as ordered by the physician.
F Medical Services
Two thousand five hundred (2,500) points shall be assigned when
a facility fails to secure proper medical assistance or orders from a
physician.
G Decubitus
Ulcers
Two thousand five hundred (2,500) points shall be assigned when
a facility does not take decubitus ulcer measures as ordered by the physician
and such failure results in death or serious injury to a resident, or facility
personnel fail to notify the physician of such ulcers.
H Treatments
Two thousand five hundred (2,500) points when facility
personnel perform treatment(s) contrary to a physician's order and such
treatment results in death or serious injury to the resident.
I Medications
Two thousand five hundred (2,500) points shall be assigned when
facility personnel knowingly withhold medication from a resident as ordered by
a physician and such withholding of medication(s) results in death or serious
injury to a resident, or the facility personnel fail to order and/or stock
medication(s) prescribed by the physician and the failure to order and/or stock
medication(s) results in death or serious injury to the
resident.
J Elopement
One thousand eight hundred and fifty (1,850) points shall be
assigned when a facility does not provide necessary supervision of residents to
prevent a resident from wandering away from the facility and such failure
results in death or serious injury to a resident, or a facility does not
provide adequate measures to ensure that residents with an elopement history do
not wander away from the facility. (Examples of preventative measures include
but are not limited to documentation that an elopement history has been
discussed with the family of the resident, alarms have been placed on exit
doors, personnel have been trained to make additional efforts to watch the
resident with such history, and the physician of such a resident has been made
aware of such history.)
K
Failure to Provide Heating or Air Conditioning
Two thousand five hundred (2,500) points shall be assigned when
a facility fails to reasonably maintain its heating and air conditioning system
as required by regulation. Isolated incidents of breakdown or power failure
shall not be considered a Class A violation under this
section.
L Natural
Disaster/Fire
Two thousand (2,000) points shall be assigned when a facility
does not train staff in fire/disaster procedures as required by regulations or
when staffing requirements are not met.
M Life Safety Code System
Two thousand five hundred (2,500) points shall be assigned when
a facility fails to maintain tie required life safety code systems. Isolated
incidents of breakdown shall not be considered a Class A violation under this
section if the facility has immediately notified the Office of Long Term Care
upon discovery of the problem and has taken all necessary measures to correct
the problem.
4006
Class B Violations
a. The following conduct, acts or omissions,
when not resulting in death or serious physical harm to a resident, or the
substantial probability thereof, but creates a condition or occurrence relating
to the operation and maintenance of a long term care facility which directly
threatens the health, safety or welfare of a resident.
1. Nursing Techniques
One thousand (1,000) points shall be assigned when:
A. Medications or treatments are improperly
administered or withheld by nursing personnel.
B. There is a failure to feed residents who
are unable to feed themselves.
C.
There is a failure to change or irrigate catheters as ordered by a physician or
use irrigation sets and solutions which are outdated or not protected from
contamination.
D. There is a
failure to obtain physician orders for the use, type and duration of
restraints, or the improper application of a physical restraint, or failure of
facility personnel to check and release the restraint as specified in
regulations.
E. Staff knowingly
fails to answer call lights.
F.
There is a failure to turn or reposition residents as ordered by a physician or
as specified in regulation.
G.
There is a failure to provide rehabilitative nursing as ordered by a physician
or as specified in regulation.
2. Poisonous Substances
Seven hundred and fifty (750) points shall be assigned when a
facility fails to provide proper storage of poisonous substances and this
failure threatens the health, safety, or welfare of a resident.
3. Falls by Residents
Seven hundred and fifty (750) points shall be assigned when a
facility fails to maintain required direct care staffing, or a safe environment
and this failure directly threatens the health, safety, or welfare of a
resident.
4. Assaults
One thousand (1,000) points shall be assigned when a facility
fails to maintain required direct care staffing or measures are not taken when
it is known that a resident is combative and assaultive with other residents
and these measures threaten the health, safety, or welfare of a
resident.
5. Improper Use
of Restraints
One thousand (1,000) points shall be assigned when facility
personnel apply physical restraints contrary to published regulations or fail
to check and release restraints as directed by physician's order or regulations
and such failure threatens the health, safety, or welfare of a resident.
6. Medical Services
One thousand (1,000) points shall be assigned when a facility
fails to secure proper medical assistance or orders from a physician and this
failure threatens the health, safety, or welfare of a resident.
7. Decubitus Ulcers
One thousand (1,000) points shall be assigned when a facility
does not take decubitus ulcer measures as ordered by the physician and such
failure threatens the health, safety, or welfare of a resident, or facility
personnel fail to notify the physician of such ulcers and this failure
threatens the health, safety, or welfare of a resident.
8. Treatments
One thousand (1,000) points shall be assigned when facility
personnel perform treatments contrary to a physician's order and such treatment
threatens the health, safety, or welfare of a resident.
9. Medications
One thousand (1,000) points shall be assigned when facility
personnel withhold physician ordered medication(s) from a resident and such
withholding threatens the health, safety, or welfare of a resident, or facility
personnel fail to order or stock medication(s) prescribed by the physician and
this failure threatens the health, safety, or welfare of a resident.
10. Elopement
One thousand (1,000) points shall be assigned when a facility
does not provide necessary supervision of residents to prevent a resident from
wandering away from the facility and such failure threatens the health, safety,
or welfare of a resident, or a facility does not provide adequate measures to
ensure that residents with a history of elopement do not wander away from the
facility and such failure threatens the health, safety, or welfare of a
resident.
11. Food on Hand
One thousand (1,000) points shall be assigned when there is an
insufficient amount of food on hand in the facility to meet the menus for the
next twenty-four (24) hour period and this failure threatens the health,
safety, or welfare of a resident.
12. Nursing Equipment/Supplies
One thousand (1,000) points shall be assigned if equipment and
supplies to care for a resident as ordered by a physician are not provided, or
if the facility does not have sufficient equipment and supplies for residents
as specified by regulation and these conditions threaten the health, safety, or
welfare of a resident or residents.
13. Falls
Seven hundred and fifty (750) points shall be assigned when it
is determined that falls occurred in a facility as a result of the facility's
failure to maintain required direct care staffing or a safe environment as set
forth in regulation and this failure threatens the health, safety, or welfare
of a resident.
14. Call
System
One thousand (1,000) points shall be assigned when a facility
fails to maintain a resident call system or the call system is not functioning
for a period of twenty-four (24) hours. If call system cords are not kept
within reach of resident then it will be determined that the facility has
failed to maintain a resident call system and this failure threatens the
health, .safety, or welfare of a resident.
15. Heating and Air Conditioning
One thousand (1,000) points shall be assigned when a facility
fails to maintain its heating and air conditioning system as required by
regulation and such failure threatens the health, safety, or welfare of a
resident. Isolated incidents of breakdown or power failure shall not be
considered a Class B violation under this section.
16. Dietary Allowance
Seven hundred and fifty (750) points shall be assigned when it
is determined that the minimum dietary needs of a resident are not being met as
ordered by the physician.
17. Resident Rights
Seven hundred fifty (750) points shall be assigned when
facility personnel fail to inform a resident of his Resident Rights as outlined
in regulation, or facility personnel fail to allow a resident to honor or
exercise any of his rights as outlined in regulation or statute.
18. Sanitation
Seven hundred and fifty (750) points shall be assigned when it
is determined that regulations relating to sanitation are not met.
19. Administrator
Seven hundred fifty (750) points shall be assigned when it is
determined that a facility does not have a licensed administrator as required
by regulation.
20. Director
of Nurses
Seven hundred and fifty (750) points shall be assigned when
it is determined that a facility does not have a Director of
Nursing (DON) as required by regulation for five or more consecutive
days.
4007
Class C Violations
a. Class C violations are related to
administrative and reporting requirements that do not directly threaten the
health, safety, or welfare of a resident.
b. The following examples of Class C
violations and the points assigned to each are provided for illustrative
purposes and are subject to the conditions set out in Section 4003.
1. Quarterly Staffing Reports
Three hundred and fifty (350) points shall be assigned when a
facility does not submit quarterly staffing reports within ten (10) days
following the deadline given for submission of these reports.
2. Overbedding
Five hundred (500) points shall be assigned when a facility is
found to exceed their licensed bed capacity.
3. False Reporting
Five hundred (500) points shall be assigned when it has been
determined that a report, physician orders, nurses notes, or other documents or
records which the facility is required to maintain has been intentionally
falsified.
4. Resident
Trust Funds
Five hundred (500) points shall be assigned when it is
determined that the facility's records reflect that resident trust funds have
been misappropriated by facility personnel or if the resident has been charged
for items for which the facility must provide at not cost to the
resident.
5. Denied Access
to Facility
Five hundred (500) points shall be assigned when it is
determined that personnel from the Arkansas Department of Human Services, the
United States Department of Health and Human Services, or any other agency
personnel authorized to have access to any long term care facility have been
denied access to the facility, or any facility document or record.
6. Reporting of Unusual
Occurrences/Accidents
Five hundred (500) points shall be assigned when it has been
determined that any facility did not report any unusual occurrences or
accidents in a timely manner as mandated by regulation.
7. Posting of Survey Results
Five hundred (500) points shall be assigned when it has been
determined that a facility failed to post, in the appropriate manner, the
results of any survey, sanction, or survey/sanction cover letter issued by the
Department.
8.
Residents'Council
Five hundred (500) points shall be assigned when a facility
fails to comply with the establishment and operation of a Residents' Council as
defined by regulation or statute.
4008 Class D Violations
a. Class D violations are defined as the
failure of any long term care facility to submit in a timely manner a
statistical or financial report as required by regulation.
b. All Class D violations shall be assigned
two hundred and fifty (250) points.
4009 Notification of Violations
a. If upon inspection or investigation the
Office of Long Term Care determines that a licensed long term care facility is
in violation of any sanction regulation herein described, any federal or state
law or regulation, then it shall promptly serve by certified mail or other
means that gives actual notice, a notice of violation upon the licensee when
the violation is a classified violation as described in Ark. Code Ann. §
20-10-205.
b. Each notice of violation shall
be prepared in writing and shall specify the exact nature of the classified
violation, the statutory provision or specific rule alleged to have been
violated, the facts and grounds constituting the elements of the
classification, and the amount of the civil penalty assessed by the Director,
if any.
c. The notice of violation
issued to a long term care facility by the Director of the Office of Long Term
Care shall be classified according to the nature of the violation and shall
indicate the classification on the face thereof as follows.
d. The notice shall also inform the licensee
of the right to a hearing under Ark. Code Ann. §
20-10-208
when civil penalties are imposed, and the right to a hearing under Ark. Code
Ann. §
20-10-303
with regards to licensure and certification.
The request for a hearing under Ark. Code Ann. §
20-10-208
must be received by the Executive Director of the Arkansas Department of Human
Services within ten (10) working days after receipt by the facility of the
Notice of Violation.
The request for a hearing under Ark. Code Ann. §
20-10-303
must be in writing and must be submitted to the chairman of the Long Term Care
Facility Advisory Board.
e.
The Department shall provide a fair and impartial hearing officer for appeals.
4010
Hearings on
the Imposition of Civil Money Penalties
a. A licensee may contest the imposition of
civil penalty by sending a written request for hearing to the Executive
Director of the Arkansas Department of Human Services who shall designate a
Hearing Officer to preside over the case and make findings of fact and
conclusions of law in the form of a recommendation to the Executive Director of
the Arkansas Department of Human Services.
b. The Executive Director of the Arkansas
Department of Human Services shall review the case and make the final
determination or remand the case to the Hearing Officer for further findings of
law or facts.
c. The request for
hearings must be received by the Executive. Director of the Arkansas Department
of Human Services within ten (10) working days after receipt by the facility of
the Notice of Violation.
d. The
Hearing Officer shall commence the hearing within forty-five (45) days of
receipt of the request for hearing.
e. The Executive Director of the Arkansas
Department of Human Services shall issue a final decision within ten (10)
working days after the close of the hearing.
f. Assessments shall be delivered to the
Office of Long Term Care within ten (10) working days of the receipt of the
Notice of Violation or within ten (10) working days of receipt of the final
determination by the Executive Director of the Arkansas Department of Human
Services in contested cases. Checks should be made payable to the State of
Arkansas.
g. Facilities failing to
pay duly assessed civil penalties shall be subject to a corresponding reduction
in succeeding Medicaid vendor payment or initiation of proceedings to revoke
the facility's license or both.
h.
All monies collected by the licensing agency pursuant to these regulations
shall be deposited in the Long Term Care Trust Fund as specified in Ark. Code
Ann. §
20-10-205.
4011
Denial of Admissions
a. The Director may deny Medicaid payment for
new admissions to a long term care facility issued a Class A or B violation
until such time the Director determines that such facility has corrected the
violation and is in substantial compliance with all applicable
regulations.
b. If a denial of
payment is place into effect, the Director shall notify the Administrator of
the facility in writing by certified mail or other means which gives actual
notice, that denial of payment for new admissions shall continue until the
Director makes a determination that the facility has corrected the violation
and is in substantial compliance with all applicable regulations.
c. The facility may request an immediate
hearing by sending a written request to the Executive Director of the Arkansas
Department of Human Services. The Department shall provide a fair and impartial
Hearing Officer within ten (10) days of receipt of such request.
APPENDIX A
RULES OF ORDER FOR ALL APPEALS BEFORE THE
LONG TERM CARE FACULTY ADVISORY BOARD
1. The Long Term Care Facility Advisory Board
shall hear all appeals by licensed long term care facilities, long term care
administrators, or other parties regulated by the Office of Long Term Care with
regards to licensure and certification under the authority of Section
II of Act 58 of 1969 as amended
by Act 28 or 1979 (Ark. Stat. Ann §82-2211).
2. All appeals shall be made in writing to
the Chairman of the Board within thirty (30) days of receipt of notice of
intended action. The notice shall include the nature of intended action,
regulation allegedly violated, and the nature of the evidence supporting
allegation and set forth with particularity asserted basis for the appeal with
supporting documentation attached and set forth with particularity those
asserted violations, discrepancies, and dollar amounts which the appellant
contends are in compliance with all rules and regulations.
3. Appeals must be heard by the Board within
sixty (60) days following date of Chairman's receipt of written appeal unless
otherwise agreed by both parties. The Chairman shall notify the party or
parties of the date, time, and place of the hearing at least seven (7) working
days prior to the hearing date.
4.
Preliminary motions must be made in writing and submitted to the Chairman
and/or hearing officer with service to opposing party at least three (3) days
prior to hearing date unless otherwise directed by the Chairman of hearing
officer.
5. All papers filed in any
proceeding shall be typewritten on white paper using one side of the paper only
and will be double-spaced. They shall bear a caption clearly showing the title
of the proceeding in connection with which they are filed together with the
docket number if any.. All papers shall be signed by the party or his
authorized representative or attorney and shall contain his address and
telephone number. All papers shall be served either on the Legal Department of
Social Services, the attorney for the party, or if no attorney for the party,
service shall be made on the party.
6. The Chairman of the Board shall act as
Chairman in all appeal hearings. In the absence of the Chairman, the Board may
elect one of their members to serve as Chairman. The Chairman shall vote only
in case of a tie. The Chairman and/or Board may request legal counsel and staff
assistance in the conduct of the hearing and in the formal preparation of their
decision.
7. A majority of the
members of the Board shall constitute a quorum for all appeals.
8. If the appellant fails to appear at a
hearing, the Board may dismiss the hearing and render a decision based on the
evidence available.
9. Any
dismissal may be rescinded by the Board if the appellant makes application to
the Chairman in writing within ten (10) calendar days after the mailing of the
decision, showing good cause for his failure to appear at the hearing. All
parties shall be notified in writing of an order granting or denying any
application to vacate a decision.
10. Any party may appear at the hearing and
be heard through an attorney at law or through a designated representative. All
persons appearing before the Board shall conform to the standards of conduct
practiced by attorneys before the courts of the State.
11. Each party shall have the right to call
and examine parties and witnesses; to introduce exhibits; to question opposing
witnesses and parties on any matter relevant to the issued; to impeach any
witness regardless of which party first called him to testify; and to rebut the
evidence against which party first called him to testify; and to rebut the
evidence against him.
12. Testimony
shall be taken only on oath or affirmation under penalty of perjury.
13. Irrelevant, immaterial, and unduly
repetitious evidence shall be excluded. Any other oral or documentary evidence,
not privileged, may be received if it is of a type commonly relied upon by
reasonably prudent men in the conduct of their affairs. Objections to
evidentiary offers may be made and shall be noted of record. When a hearing
will be expedited, and the interests of the parties will not be substantially
prejudiced, any part of the evidence may be received in written form.
14. The Chairman or hearing officer shall
control the taking of evidence in a manner best suited to ascertain the facts
and safeguard the rights of the parties. The Office of Long Term Care shall
present its case first.
15. A party
shall arrange for the presence of his witnesses at the hearing.
16. Any member of the Board may question any
party or witness.
17. A complete
record of the proceedings shall be made. A copy of the record may be
transcribed and reproduced at the request of a party to the hearing provided he
bears the cost thereof.
18. Written
notice of the time and place of a continued or further hearing shall ge given,
except that when a continuance or further hearing is ordered during a hearing,
oral notice of the time and place of the hearing may be given to each party
present at the hearing.
19. In
addition to these rules, the hearing provisions of the Administrative Procedure
Act (Ark. Stat. Arm §5-701 et. seq.) shall apply.
20. At the conclusion of testimony and
deliberations by the Board, the Board shall vote on motions for disposition of
the appeal. After reaching a decision by majority vote, the Board may direct
that findings of fact and conclusions of law be prepared to reflect the Board's
recommendations to the Commissioner of Social Services. At this discretion and
for good cause the Commissioner of Social Services shall have the right to
accept, reject or modify a recommendation, or to return the recommendation to
the Board for further consideration for a more conclusive recommendation. All
decisions shall be based on findings of fact and law and are subject to and
must be in accordance with applicable State and Federal laws and regulations.
The final decision by the Commissioner of Social Services shall be rendered in
writing to the appellant.
21. All
decisions of the Commissioner may be reviewed by a court of competent
jurisdiction as provided under the Administrative Procedure
Act.
