Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.05-095 - Minimum Staffing for Nursing Homes
Current through Register Vol. 49, No. 9, September, 2024
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
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.
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. |
Licensed Practical Nurse |
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L.P.T.N. |
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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FT. |
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 |
200 GENERAL PROVISIONS FOR 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.
Applicants for license shall file a notarized application with the Division upon forms prescribed by the Division and shall pay an annual license fee often 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.
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.
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.
The Division is empowered to deny, suspend, or revoke licenses on any of the following grounds:
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.
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.
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)
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.
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.
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.
Any nursing home, or related institution, that voluntarily closes must meet the regulations for new construction to be eligible for re-licensure.
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.
300 ADMINISTRATION
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.
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.
Administrators-in-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."
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.
Pursuant to federal regulation 42 CFR 483.13 and state law Ark. Code Ann. § 5-28-101 et seq. and 12-12-501et 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.
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.
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.
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.
hours duration.
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.
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.
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.
The facility's written policies and procedures shall include, at a minimum, requirements specified in this section.
ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-7734
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.
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.
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.
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.
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.
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.
Facilities which do not directly provide social service shall have written procedures for referring patients in need of social services to appropriate service agencies.
Policies and procedures shall be established for ensuring the confidentiality of all patients' social information.
Facilities shall establish policies and procedures setting forth the rights of resident and prohibiting their mistreatment or abuse.
Facilities shall establish policies for the registration and disposition of complaints without threat of discharge or other reprisal against any patient.
These policies shall include, as a minimum, the following:
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.
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.
Policies shall be written for the proper handling of oxygen and flammable gases.
Written personnel policies shall be provided and shall be available to all personnel and to the Division.
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.
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.
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.
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.
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.
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.
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.
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.
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.
400 PHYSICAL ENVIRONMENT
Every institution must be maintained, managed, and equipped to provide adequate care, safety, and treatment of each resident.
* 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.
* 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.
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.
Corridors in facilities licensed prior to 1973 shall be at least six (6) feet wide.
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.
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).
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.
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.
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.
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 minimum, 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.
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.
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 minimum pressure of fifteen (15) pounds at the top floor fixtures during maximum demand periods.
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.
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.
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.
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.
Plans shall be submitted to the Division in the following stages.
Architect preparing plans should contact Office of Long Term Care for preliminary review.
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 facade.
* 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.
* Plumbing, drainage, and standpipe systems:
* 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
* General Requirements
* Sections describing material and workmanship in detail for each class of work.
The following codes and standards are incorporated into and made a part of these regulations:
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.
Corridors shall be at least eight (8) feet wide.
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.
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.
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.
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.
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.
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.
Closets for clean linens shall be provided for each nurses' station.
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.
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.
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.
The following limitations shall apply:
supporting documentation must be provided to evidence proper allocation of costs and compliance with all applicable state and federal laws and regulations.
* 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).
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.
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
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.
* 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 and needles
* F orcep s and forcep s j ars
* 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.
* Additional trapeze frames as needed
* Oxygen unit (total of two (2) units required)
* Sterile IV. 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)
* Steam autoclave
* Pressure cooker
* Liquid sterilizing solution
* Dry heat sterilizer
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.
500 PATIENT CARE SERVICES
Patients shall be admitted to the facility only on recommendation 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 home placement should be obtained on the date of admission and a re-certification statement obtained every sixty (60) days.
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.
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 examination 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.
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.
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.
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.
* 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.
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.
|
Skilled |
Every two (2) weeks |
|
Intermediate I |
Every two (2) weeks |
|
Intermediate II |
Monthly |
|
Intermediate III |
Monthly |
* 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.
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:
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.
* 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.
Personal items such as toilet articles and cosmetic articles may be kept at the bedside.
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.
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.
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.
Beginning 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 of 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 -r- 6 = 13.67 [Round to 14; total number of direct-care staff required]
Step 3: 82 -r- 40 = 2.05 [Round to 2; number of licensed 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-care-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 -r- 9 = 10.77 [Round to 11; total number of direct-care staff required]
Step 3 - 97 -T- 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
ExampleThe 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.
Step 1 - Census of 142
Step 2 - 142 -5-14 = 10.14 [Round to 10; total number of direct-care staff]
Step 3 - 142 -7- 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
Violations of these regulations shall be punishable in accordance with Ark. Code Ann. § 20-10-1407 and 20-10-1408.
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.
Instructions for Completing Form DMS-7780
As required by Ark. Code Ann. § 20-10-1401 et seq., a copy of the Form DMS-7780 is to be completed and posted daily as specified in these instructions and LTC Section 520.9.
Start a new Log with each Day Shift.
* specify his/her time in
* sign name
* specify time out
RNs, LPNs and RNAs working as CNAs will sign in under the section for their 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
* 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.
There shall be calibrated medicine containers to correctly measure liquid medications. Calibrated medicine containers include calibrated 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.
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.
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:
* C II Narcotics.
* C II Non-narcotics.
* C III, C IV, and C V medications.
* Anticoagulants.
* Antibiotics.
* 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.
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 committee 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.
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.
There shall be a count of all C II controlled medications at each change of shift. All C III, 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.
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.
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.
Schedule II, III, 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 II, III, 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 554.3, 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.
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;
the facility to all charitable clinics with which the facility has a contract to donate drugs;
All policies and procedures related to systems of this 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.
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.
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:
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.
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.
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:
(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.
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.
Facilities may wash and sanitize such items in a mechanical spray type dishwashing machine as approved by the OLTC.
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.
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.
* Type of information to be obtained.
* Confidentiality of data and protection.
* Availability of data: who, when, how, and why.
* Transmittal of data on referral.
Separate for social services designee/worker.
Include actual functions of position.
Include other duties that may be assigned to designee/worker.
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.
Important happenings shall be entered promptly into social services' progress record. At least a quarterly update shall be done.
Pertains to referrals for social/emotional needs rather than medical. May be a separate form or reflected in progress notes.
* 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.
* 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
600 RESIDENT RECORDS
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.
The resident records will contain sufficient information to identify the resident, his/her diagnosis(es) and treatment, and to document the results accurately.
* 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.
* Medical history
* Physical findings which includes a complete review of systems and diagnosis(es)
* Date and signature of physician
* 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.
* Written at the time of each visit.
* Dated.
* Signature of the physician.
* Written at least every sixty (60) days on skilled care patients and every one-hundred twenty (120) days on others.
* 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 nourishment 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 then be recorded at least monthly.
* 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.
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.
|
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, Intake and Output, etc.) |
Three months |
|
11. |
Medication and Treatment Records |
Three months |
|
12. |
Personal Effects Inventory |
Most recent |
|
13. |
Hospital Discharge Summary |
Current 12 |
|
(Including History and Physical) |
months |
|
|
14. |
TB Surveillance Record |
Permanent |
|
15. |
Classification Status |
Current |
|
16. |
Consultant Reports |
Initial and |
|
- Physicians Occupational Therapist Speech Therapist - Physical Therapist Social Worker - Psychologist Others |
Most recent |
|
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. |
PASSAR Level II |
Most recent |
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.
An individual will be designated as responsible for the resident record service. There will be written job descriptions for the resident record service personnel.
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.
700-800 RESERVED
900 ALZHEIMER'S SPECIAL CARE UNITS DEFINITIONS
For the purposes of these regulations the following terms are defined as follows:
Services (DMS), or Office of Long Term Care (OLTC)
The process used for assessment and 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;
The ASCU shall meet and comply with the same requirements for Residents' Rights applicable to the facility housing the ASCU.
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.
The ASCU must follow the facility's policies and procedures and applicable state and federal laws and regulations governing:
Each Alzheimer's Special Care Unit shall develop a mission statement that reflects the ASCU's treatment philosophy for those residents diagnosed with Alzheimer's or related dementia.
and upon a change to a resident's physical, mental, emotional, functional, or behavioral condition or status in which the resident:
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 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:
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.
In addition to the physical design standards required for the facility's license, an Alzheimer's Special Care Unit shall include the following:
The Alzheimer's Special Care Unit shall:
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:
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.
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:
1000 RECEIVERSHIP
f Owner - The holder of the title to the real estate in which the facility is maintained.
Code Ann. § 20-10-905) the Department shall be notified and:
Immediately upon appointment of a receiver the Department shall assist the receiver and insure the following functions and responsibilities are accomplished:
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:
f Meet all department heads to:
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:
Upon appointment, the department shall assist in taking appropriate action with regard to the on-going operation of the facility. That action shall include:
f Hold regular department head meetings - weekly to start, with an agenda that includes:
2000 INFORMAL DISPUTE RESOLUTION
When a long term care facility does not agree with deficiencies cited on a Statement of 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.
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:
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:
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.
3000 RESIDENTS' RIGHTS
f The facility ceases operation.
The resident shall be given reasonable written notice to ensure orderly transfer or discharge.
4000 FINES AND SANCTIONS
4001 Definitions
As used in these regulations, the following definitions will apply, unless the context requires otherwise.
Services.
where appropriate, an organization as that term is defined in Ark. Code Ann. § 5-2-501(1).
prudent man would form under the circumstances in question and one not recklessly or negligently formed.
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.
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:
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
4006 Class B Violations
One thousand (1,000) points shall be assigned when:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
Five hundred (500) points shall be assigned when a facility is found to exceed their licensed bed capacity.
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.
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.
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.
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.
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.
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
4009 Notification of Violations
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.
4010 Hearings on the Imposition of Civil Money Penalties
4011 Denial of Admissions
APPENDIX A
RULES OF ORDER FOR ALL APPEALS BEFORE THE LONG TERM CARE
FACILITY ADVISORY BOARD
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.
