Tenn. Comp. R. & Regs. 0720-38-.05 - ADMINISTRATION

(1) Each TBI residential home shall meet the following staffing standards:

(a) A TBI residential home provider shall employ an Administrator to oversee the day-today operation of the TBI residential home when the TBI residential home provider is unavailable. The Administrator shall meet the education, experience and training requirements of a TBI residential home provider required by the Board.

(b) A TBI residential home provider shall employ staff members to supervise the residents at all times while in the home, including overnight and during weekends. Staff members providing overnight care and/or supervision shall hold national certification by the Academy of Certified Brain Injury Specialists as a Certified Brain Injury Specialist (CBIS) or hold a current license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional or licensed mental health professional trained and experienced in the care of and rehabilitation of residents with traumatic brain injury.

(c) A TBI residential home provider is not required to live in the home or to employ a resident manager or a substitute caregiver to live in the home.

(d) TBI residential home staff shall:

1. Be awake and available to meet the routine and emergency service needs of the residents twenty-four (24) hours a day;

2. Demonstrate documented competency in providing care for residents requiring specialized services;

3. Evacuate all residents within five (5) minutes or less;

4. Know how to operate the generator without assistance and be able to demonstrate its operation upon request.

5. Coordinate with primary care physicians, specialists, and other health care professionals as appropriate.

6. Be at least eighteen (18) years of age.

(e) A TBI residential home shall employ a qualified dietitian, full time, part-time, or on a consultant basis.

(f) A TBI residential home shall not employ an individual listed on the Abuse Registry maintained by the Department of Health.

(2) Each TBI residential home shall meet the following procedural standards:

(a) Policies and Procedures:

1. A TBI residential home shall have a written statement of policies and procedures outlining the TBI residential home's responsibilities to its residents, any obligations residents have to the home, and methods by which residents may file grievances and complaints.

2. A TBI residential home provider shall develop and implement an effective facility-wide performance improvement plan that addresses plans for improvement for self-identified deficiencies and documents the outcome of remedial action.

3. A TBI residential home provider shall develop a written policy, plan or procedure concerning a subject and adhere to its provisions whenever required to do so by these rules. A TBI residential home that violates its own policy established as required by these rules and regulations also violates the rules and regulations establishing the requirement.

4. A TBI residential home provider shall develop a written policy and procedure governing smoking practices of residents.

(i) Residents of the home are exempt from the smoking prohibition.

(ii) Smoke from permissible smoking areas shall not infiltrate into areas where smoking is prohibited.

5. A TBI residential home shall develop a concise statement of its charity care policies and shall post such statement in a place accessible to the public.

(b) Resident grievances:

1. The TBI residential home provider shall inform each resident verbally and in writing of the resident's right to file a complaint with the state at any time; the process for filing a complaint; and contact information for filing a complaint. Verbal and written communication to the resident shall indicate, at a minimum that:

(i) Complaints regarding suspected abuse, neglect, misappropriation of patient/resident property, or exploitation shall be reported to adult protective services;

(ii) Complaints regarding licensure shall be reported to the Board; and

(iii) All other complaints shall be reported to the appropriate state designated oversight entity.

2. The TBI residential home provider shall advise residents of the availability of a long-term care ombudsman, and how to contact such ombudsman for assistance.

3. The TBI residential home provider shall forward all complaints to the appropriate state oversight entity.

4. The TBI residential home provider shall not prohibit or discourage the filing of complaints or use intimidation against any person for filing a complaint.

5. The TBI residential home provider shall not retaliate against the resident or the person acting on behalf of the resident in any way.

6. Persons acting in good faith in filing a complaint are immune from any liability, civil or criminal.

(c) Allegations of abuse, neglect, misappropriation of patient/resident property, or exploitation: A TBI residential home shall place a TBI residential home provider, an Administrator, or TBI residential home staff against whom an allegation of abuse, neglect, misappropriation of patient/resident property, or exploitation has been made on administrative leave of absence until the investigation conducted by the appropriate state entity is complete.

(d) A TBI residential home shall keep a written up-to-date log of all residents that can be produced in the event of an emergency.

(e) A TBI residential home may allow pets in the TBI residential home only when they are not a nuisance and do not pose a health hazard. Plans for pet management must be approved by the Department. Proof of rabies vaccinations and any other vaccinations that are required for the pet by a licensed veterinarian must be maintained on the premises.

(f) No person associated with the licensee or TBI residential home shall act as a court-appointed guardian, trustee, or conservator for any resident of the TBI residential home or any of such resident's property or funds.

(3) A TBI residential home shall post the following at the main public entrance or other equally prominent place in the TBI residential home:

(a) A statement that a resident who may be the victim of abuse, neglect, misappropriation of patient/resident property, or exploitation may seek assistance or file a complaint with the Division of Adult Protective Services. The statement shall include the statewide toll-free number for the Division and the telephone number for the local district attorney's office. The posting shall be on a sign no smaller than eleven (11") inches in width and seventeen (17") inches in height. (This same information shall be provided to each resident in writing upon admission to any home.)

(b) A statement that any person, regardless of age, who may be the victim of domestic violence may call the nationwide domestic violence hotline for immediate assistance, with that number printed in boldface type, and posted on a sign no smaller than eight and one-half inches (81/2") in width and eleven inches (11") in height;

(c) A statement that the TBI residential home has liability insurance; the identity of the primary insurance carrier; and if self-insured, the corporate entity responsible for payment of any claims. It shall be posted on a sign no smaller than eleven inches (11") in width and seventeen inches (17") in height;

(d) "No Smoking" signs or the international "No Smoking" symbol, consisting of a pictorial representation of a burning cigarette enclosed in a red circle with a red bar across it, shall be clearly and conspicuously posted at every entrance;

(e) A statement that any person who has experienced a problem with a specific licensed TBI residential home may file a complaint with the Division of Health Care Facilities. The posting shall include the statewide toll-free telephone number for the Division's centralized complaint intake unit; and

(f) A copy of the resident's rights.

(4) Infection Control.

(a) A TBI residential home shall ensure that neither a resident nor an employee of the TBI residential home with a reportable communicable disease shall reside or work in the TBI residential home unless the TBI residential home has a written protocol approved by the Board's administrative office.

(b) A TBI residential home shall have an annual influenza vaccination program which shall include at least:

1. The offer of influenza vaccination to all staff and independent practitioners or accept documented evidence of vaccination from another vaccine source or facility;

2. A signed declination statement on record from all who refuse the influenza vaccination for other than medical contraindications;

3. Education of all direct care personnel about the following:

(i) Influenza vaccination;

(ii) Non-vaccine control measures; and

(iii) The diagnosis, transmission, and potential impact of influenza;

4. An annual evaluation of the influenza vaccination program and reasons for nonparticipation; and

5. A statement that the requirements to complete vaccinations or declination statements shall be suspended by the TBI residential home provider in the event of a vaccine shortage.

(c) A TBI residential home and its staff shall adopt and utilize standard precautions in accordance with guidelines established by the Centers for Disease Control and Prevention (CDC) for preventing transmission of infections, HIV, and communicable diseases, including adherence to a hand hygiene program which shall include:

1. Use of alcohol-based hand rubs or use of non-antimicrobial or antimicrobial soap and water before and after each resident contact if hands are not visibly soiled;

2. Use of gloves during each resident contact with blood or where other potentially infectious materials, mucous membranes, and non-intact skin could occur and gloves shall be changed before and after each resident contact;

3. Use of either a non-antimicrobial soap and water or an antimicrobial soap and water for visibly soiled hands; and

4. Health care worker education programs which may include:

(i) Types of resident care activities that can result in hand contamination;

(ii) Advantages and disadvantages of various methods used to clean hands;

(iii) Potential risks of health care workers' colonization or infection caused by organisms acquired from residents; and

(iv) Morbidity, mortality, and costs associated with health care associated infections.

(d) A TBI residential home provider shall develop and implement a system for measuring improvements in adherence to the hand hygiene program and influenza vaccination program.

(5) A TBI residential home shall ensure that no person will be excluded from participation in, be denied benefits of, or be otherwise subjected to discrimination in the provision of any care or service of the TBI residential home on the grounds of race, color, national origin, or handicap. A TBI residential home shall protect the civil rights of residents under the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973.

Notes

Tenn. Comp. R. & Regs. 0720-38-.05

Original rule filed October 28, 2015; effective January 26, 2016. Transferred from chapter 1200-08-37 pursuant to Public Chapter 1119 of 2022 effective 7/1/2022.

Authority: T.C.A. §§ 39-17-1804, 39-17-1805, 68-11-202, 68-11-206, 68-11-207, 68-11-209, 68-11-268, 68-11-269, 68-11-270, 68-11-271, and 68-11-273.