Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-060 - Rules for Nursing Homes - Wireless Nurse Call Systems

(a) articles recognized in the Official United States Pharmacopeia, Official Homepathic Pharmacopeia of the United States, or Official National Formulary, or any supplement to any of them; and

(b) articles intended for use in the diagnosis, cure mitigation, treatment, or prevention of disease in man or other animal; and

(c) articles (other than food) intended to affect the structure or any function of the body of man or other animals; and

(d) articles specified in clause (a), (b) or (c); but does not include devices or their components, parts or accessories.

Drug Administration is an act restricted to nursing personnel as defined in Nurses Practice Act 432 or 1971, in which a single dose of a prescribed drug or biological is given to a patient. This activity includes the removal of the dose from a previously dispensed, properly labeled container, verifying it with the prescriber's orders, giving the individual dose to the proper patient, and recording the time and dose given.

Drug Dispensing is an act restricted to a pharmacist which involves the issuance of one or more doses of a medication in a container other than the original, with such new containers being properly labeled by the dispenser as to content and/or directions for use as directed by the prescriber. This activity also includes the compounding, counting, and transferring of medication from one labeled container to another.

Existing Facilities are those facilities which were in operation, or those proposed facilities which began construction or renovation of a building under final plans approved by the Division prior to adoption of these regulations.

Fire Resistance Rating shall mean the time in hours or fractions thereof that materials or their assemblies will resist fire exposure as determined by fire test conducted in accordance with recognized standards.

Governing Body shall mean the individuals or group in whom the ultimate authority and legal responsibility is vested for conduct of the nursing home.

Institution is any facility requiring licensure under these regulations.

Intermediate Care Facility (ICF) is a nursing home licensed by Arkansas Social Services as meeting the Intermediate Care Facility regulations. It is a health facility or a distinct part of a hospital or Skilled Nursing Facility staffed, organized, operated, and maintained to provide 24hour long term inpatient care and other restorative services under nursing supervision.

Legend Drugs are drugs, which because of their toxicity or other potentiality for harmful effect, or the method of their use, or the collateral measures necessary to their use, are not safe for use except under the supervision of a practitioner licensed by law to administer such drugs, or shall be dispensed only on prescription by the pharmacist. Such drugs bear the label "Caution: Federal Law Prohibits Dispensing Without Prescription."

License shall mean the basic document issued by the Division permitting the operation of nursing homes. This document constitutes the authority to receive patients and to perform the services included within the scope of these regulations.

Licensed Bed Capacity shall mean the exact number of beds for which license application has been made and granted.

Licensee shall mean any state, municipality, political subdivision, institution, public, or private corporation, association, individual, partnership or any other entity to whom a license is issued for the purpose of operating the nursing home, who shall assume primary responsibility for complying with approved standards for the institution.

New Construction means those facilities which are constructed or renovated for the purpose of operating an institution according to architectural plans approved by the Division subsequent to adoption of these rules.

Nursing Home shall mean and be construed to include any buildings, structure, agency, institution, or other place for the reception, accommodation, board, care, or treatment of two or more unrelated individuals, who, because of physical or mental infirmity are unable to sufficiently or properly care for themselves, and for which reception, accommodation, board, care, and treatment, a charge is made, provided the term "Nursing Home" shall not include the offices of private physicians and surgeons, boarding homes, or hospitals, or institutions operated by the Federal Government. (Section 2, Act 141 of 1961 as amended)

Nursing Home Classification shall mean the level of care the nursing home is capable of rendering such as Skilled Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility for the Mentally Retarded.

Long Term Care Facility Advisory Board shall mean the Long Term Care Facility Advisory Board as established under Act 28 of 1979.

O.T.C. Drugs are commonly referred to as "over-the-counter," or patient medication that may be provided without prescription.

Patient (interchangeable with resident) shall mean any individual who is being treated by a physician or whose health is being supervised by a physician while residing within the respective facility.

Patient Unit is an area designated to accommodate an individual patient bed, bedside cabinet, chair, reading light, and other necessary equipment placed at the bedside for the proper care and comfort of a patient.

Provisional Licensure is a temporary grant of authority to the purchaser to operate an existing long-term care facility upon application for licensure to the Office of Long Term Care.

Restorative Nursing or Rehabilitative Nursing shall mean measures directed toward prevention of deterioration in normal body alignment, and muscle tone, restoration of the resident to full activity insofar as his or her health problems permit and maintaining a state in which his or her total need for care is minimal.

Restraint is any device or instrument used to limit, restrict, or hold patients under control, not including safety vests or other instruments such as bed rails used for the safety and positioning of patients. Personal safety devices and postural support devices that restrict movement are considered restraints.

Sanitation is the process of promoting hygiene and preventing disease by maintaining sanitary conditions.

Skilled Nursing Facility (SNF) is a nursing home, or a distinct part of another facility, licensed by the Office of Long Term Care as meeting the skilled nursing facility licensure regulations. A health facility which provides skilled nursing care and supportive care on a 24-hour basis to residents whose primary need is for availability of skilled nursing care on an extended basis.

Qualified Social Worker is a person who is registered by the State Board of Social Work and is a graduate of a school of social work accredited or approved by the council on Social Work Education.

State Health Officer shall mean the Director of the Arkansas Department of Health, Secretary of the State Board of Health.

Sterile the state of being free from all forms of micro-organisms.

Unit Dose Medication System shall mean a system in which single doses of drugs are prepackaged and pre-labeled in accordance with all applicable laws and regulations governing these practices and made available separated by resident and by dosage time. The system includes all equipment and records deemed necessary and used in making the doses available to the resident in an accurate and safe manner. A pharmacist shall be in charge of and responsible for the system.

Guardian shall mean a court appointed person who by law is responsible for a patient's affairs.

Responsible Party shall mean the person who is accountable for the patient's affairs but who has not been appointed by the court.

Routine means the regular performance of a particular task.

Abbreviations

201 LICENSURE

Nursing homes, or related institutions, shall be operated, conducted, or maintained in this State by obtaining a license pursuant to the provisions of these Licensing Standards. Separate institutions operated by the same management require separate licenses. Separate licenses are not required for separate buildings on the same grounds. The classification of license shall be Skilled Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility for the Mentally Retarded.

Whenever ownership or controlling interest in the operation of a facility is sold, both the buyer and the seller must notify the Office of Long Term Care at least thirty (30) days prior to the completed sale. The thirty (30) day notice shall be the date the paperwork is stamped received by the Office of Long Term Care.

202 APPLICATION FOR LICENSE

Applicants for license shall file a notarized application with the Division upon forms prescribed by the Division and shall pay an annual license fee of ten cents ($0.10) per patient bed, or Ten Dollars ($10), whichever is greater. This fee shall be paid to the State Treasury. If the license is denied, the fee will be returned to the applicant. Facilities operated by any unit or division of state or local government shall be exempted from payment of a licensing fee. Application shall be signed by the owner if individually owned, by one partner if owned under partnership, by two officers of the board if operated under corporation, church or non-profit association, and incase of a governmental unit, by the head of the governmental entity having jurisdiction over it. Applicants shall set forth the full name and address of the institutions for which license is sought, the names of the persons in control, a signed statement by a registered nurse indicating responsibility for nursing services of the home, and such other information as the Division may require.

In these instances where a distinct part of a facility is to be licensed as a Skilled Nursing Facility and the remainder of the facility is to be licensed under some other category, separate applications must be filed for each license and separate licensure fees fill be required with each application.

Each home applying for and receiving a license must furnish the following information:

* The identity of each person directly or indirectly having an ownership interest of five (5) percent or more in such nursing home.

* In case such nursing home is organized as a corporation, the identify of each officer and director of the corporation.

* In case such nursing home is organized as a partnership, the identity of each partner.

* Identity of owners of building and equipment leased including ownership breakdown of leasing entity.

203 RENEWAL OF APPLICATION FOR LICENSURE

Application for annual license renewal shall be postmarked no later than January 2nd of the succeeding calendar year. License applications for existing institutions shall be subject to a penalty of one dollar ($1) per day after January 2nd of the succeeding year.

204 ISSUANCE OF LICENSE

License shall be effective on a calendar year basis and shall expire on December 31st of each year. License shall be issued only for the premises and persons in the application and shall not be assignable or transferable.

205 DENIAL, REVOCATION, OR SUSPENSION OF LICENSE

The Division is empowered to deny, suspend, or revoke licenses on any of the following grounds:

206 NOTICE AND PROCEDURE ON HEARING PRIOR TO DENIAL, SUSPENSION, OR REVOCATION OF LICENSE

Whenever the Division decides to deny, suspend, or revoke a license, it shall send to the applicant or licensee a notice stating the reasons for the action by certified mail. The applicant or licensee may appeal such notice to the Long Term Care Facility Advisory Board as permitted by Arkansas Statute Annotated §82-211. Procedures for appeal to the Long Term Care Facility Advisory Board are incorporated in these regulations as Appendix A.

207 APPEALS TO COURTS

Any applicant or licensee who considers himself injured in his person, business, or property by final agency action shall be entitled to judicial review thereof. Proceedings for review shall be made by filing a petition in the Circuit Court of any county in which the petitioner does business or in the Circuit Court of Pulaski County within thirty (30) days after service upon the petitioner of the agency's final decision. All petitions for judicial review shall be in accordance with the Administrative Procedures Act Arkansas Statute Annotated §5-713.

208 PENALTIES

Any person, partnership, association, or corporation, establishing, conducting, managing, or operating any institution within the meaning of this act (§§ 82-327 -- 82-354), without first obtaining a license therefor as herein provided, or who violates any provision of this act or regulations lawfully promulgated hereunder shall be guilty of a misdemeanor, and upon conviction thereof shall be liable to a fine of not less than Twenty-Five Dollars ($25) nor more than One-Hundred Dollars ($100) for the first offense and not less than One-Hundred Dollars ($100) nor more than Five-Hundred Dollars ($500) for each subsequent offense, and each day such institution shall operate after a first conviction shall be considered a subsequent offense. (Section 27, Act 414 of 1961)

209 INSPECTION

All institutions to which these rules and regulations apply shall be subject to inspection for reasonable cause at any time by the authorized representation of the Division.

210 COMPLIANCE

An initial license will not be issued until the applicant has demonstrated to the satisfaction of the Division that the facility is in substantial compliance with the licensing standards set forth in these regulations.

211 NONCOMPLIANCE

When noncompliance of the licensing standards are detected during surveys, licensees will be notified of the violations and will be requested to provide a plan of correction with a timetable for corrections. If an item of noncompliance is of a serious nature that affects the health and safety of patients and is not promptly corrected, action will be taken to suspend or revoke the facility's license.

212 VOLUNTARY CLOSURE

Any nursing home, or related institution, that voluntarily closes must meet the regulations for new construction to be eligible for re-licensure.

213 EXCEPTION TO LICENSING STANDARDS

The Division reserves the right to make temporary exceptions to these standards where it is determined that the health and welfare of the community requires the services of the institution. Exceptions will be limited to unusual circumstances and the safety and well-being of the residents will be carefully evaluated prior to making such exceptions.

Overbeds will be authorized only in cases of emergency. An emergency exits when it can be demonstrated that the resident's health or safety would be placed in immediate jeopardy if relocation were not accomplished. A fire, natural disaster (e.g., tornado, flood, etc.) or other catastrophic event that necessitates resident relocation will be considered an emergency. The Office of Long Term Care must be contacted for prior authorization of the overbed, and all authorizations must be in writing.

214 PROVISIONAL LICENSURE

Subject to the requirements below, a provisional license shall be issued to the Applicant and new operator of the long-term care facility when the Office of Long Term Care has received the Application for Licensure to Conduct a Long Term Care Facility. A provisional license shall be effective from the date the Office of Long-Term Care provides notice to the Applicant and new operator, until the date the long-term care license is issued. With the exception of Medicaid or Medicare provider status, a provisional license confers upon the holder all the rights and duties of licensure.

Prior to the issuance of a provisional license:

215-299 RESERVED

301 MANAGEMENT

302 GENERAL ADMINISTRATION

303 PERSONNEL ADMINISTRATION

304 STAFF DEVELOPMENT

305 EMERGENCY CALL DATA

The administrator shall be responsible for ensuring that emergency call information is posted in a conspicuous place so as to be immediately available to all personnel of the nursing home. Emergency call data shall include at least the following:

* Telephone number of fire and police departments.

* Names, addresses, and telephone numbers for emergency supplies, ambulance, minister, advisory dentist, Red Cross, and poison control center.

* Name, address, and telephone number of all personnel to be called in case of fire or emergency (to include the administrator and the director of nursing services).

* Name, address, and telephone number of an available physician to furnish necessary medical care in case of emergency.

306 REPORTING SUSPECTED ABUSE, NEGLECT, EXPLOITATION, INCIDENTS, ACCIDENTS, DEATHS FROM VIOLENCE AND MISAPPROPRIATION OF RESIDENT PROPERTY

Pursuant to federal regulation 42 CFR 483.13 and state law Ark. Code Ann. § 5-28-101 et seq. and 12-12-501et 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.

307 INSTITUTIONAL POLICIES AND/OR PROCEDURES

308 PATIENT CARE POLICIES

The administrator, in consultation with one or more physicians and one or more registered professional nurses, department heads, and other related professional health care personnel, shall develop and at least annually review appropriate written policies and procedures for all services and/or patient care practices to include but not limited to dietary, medical records, nursing, pharmaceutical, diagnostic services, laboratory and radiological, housekeeping, maintenance, and laundry services.

309 RESTRAINT OF RESIDENTS

Patients shall not be unduly restrained. Patients shall not be confined to rooms or restrained except when necessary to prevent injury to the patient or others and when alternative measures are not sufficient to accomplish these purposes. In any event, no locked doors or locked restraints are to be used at any time to restrain a patient. Doors (screen type), or the lower one half of a dutch door or approved type louvered doors may be hooked on the hall side of the door. Restraints, of the non-locking type, may be used only upon the order of a physician. In the event the order is obtained by phone, the signature of a physician shall be obtained within five days (Note: The aforementioned restraining type doors shall be installed in addition to the regular door to the room. They shall be removed during periods when they are not needed for the restraint of patients.) Upon the advice of the attending physician, unruly or excessively noisy patients shall be transferred from the home to an institution equipped for such patient care, since this type patient creates a disturbance for other patients in the home.

The written policy and procedures governing the use of restraints shall specify which staff member may authorize the use of restraints and clearly delineate at least the following:

* Orders indicating the specific reasons for the use of restraints.

* Their use is temporary, and the resident will not be restrained for an indefinite amount of time.

* Orders for restraints shall not be enforced for longer than twelve (12) hours, unless the patient's condition warrants.

* Restraints must be checked every thirty (30) minutes and loosened every two (2) hours for range of motion to restrained extremities.

310 PROTECTION OF PATIENT PROPERTY

An inventory of patient's personal belongings should be maintained for all items brought to the facility on admission and up-dated as appropriate for items added or sent home/disposed of.

311 NOTIFICATION OF CHANGE IN PATIENT'S STATUS

There shall be written polices and procedures available at each nurses' station for personnel to follow requiring the notification of the patient's attending physician and other responsible

persons in the event of severe illness, accident, or death of the patient or other significant change in the patient's status.

The name, address and telephone number of the patient's attending physician shall be recorded for ready reference.

312 PHYSICIAN'S SERVICES POLICIES

The facility shall have a written policy indicating that the health care of every patient is under the supervision of a physician, who based on a medical evaluation of the patient's immediate and long term needs, prescribes a planned regimen of total care.

313 SPECIALIZED REHABILITATIVE SERVICE POLICIES

If a facility offers specialized rehabilitative services, written administrative and patient care policies and procedure for rehabilitative services shall be developed for appropriate therapists and representatives of the medical, administrative, and nursing staffs.

314 SOCIAL SERVICE POLICIES

Facilities which do not directly provide social service shall have written procedures for referring patients in need of social services to appropriate service agencies.

315 CONFIDENTIALITY OF SOCIAL INFORMATION

Policies and procedures shall be established for ensuring the confidentiality of all patients' social information.

316 RIGHTS OF RESIDENTS

Facilities shall establish policies and procedures setting forth the rights of resident and prohibiting their mistreatment or abuse.

317 REGISTRATION OF COMPLAINTS

Facilities shall establish policies for the registration and disposition of complaints without threat of discharge or other reprisal against any patient.

318 ADMISSION, TRANSFER, AND DISCHARGE POLICIES

These policies shall include, as a minimum, the following:

319 CONFIDENTIALITY OF MEDICAL RECORD INFORMATION

There shall be written policies adopted by the management of the nursing home covering confidentiality of medical records and procedures regarding release of medical information.

320 INFECTION CONTROL

Written policies and procedures shall be established for investigating, controlling and preventing infections. Procedures shall be reviewed annually and revised as necessary for effectiveness and improvement. The policies and procedures shall include as a minimum:

* Aseptic and isolation techniques.

* Proper disposal techniques for infected dressings, disposable syringes, needles, etc.

* Prohibiting the use of the common towel, common bath and hand soap, and the common drinking cup or glass.

321 HANDLING OF OXYGEN AND FLAMMABLE GASES

Policies shall be written for the proper handling of oxygen and flammable gases.

322 PERSONNEL POLICIES

Written personnel policies shall be provided and shall be available to all personnel and to the Division.

323 TRANSPORTATION OF RESIDENTS

The facility shall establish a written policy regarding transportation of residents, when necessary, to the hospital, medical clinics, and dentist offices. The facility must assume responsibility for seeing that the patient's transportation needs are met.

324 BEDPAN SANITATION

Written policies shall be established to ensure all individually assigned bed pans are sanitized by the boiling method for a minimum of twenty (20) minutes at least once a week or by other methods approved by the Division.

325 OUTSIDE RESOURCE AGREEMENTS

326 SPECIALIZED REHABILITATIVE SERVICES

If the facility does not offer specialized rehabilitative services directly, patients in need of such services, i.e., physical therapy, occupational therapy, speech pathology, and audiology, shall not be admitted or retained in the facility unless arrangements for these services have been provided with an outside resource. Terms of the agreement should include reimbursement, responsibility of each party, and documentation responsibilities.

327 ADVISORY DENTIST

Facilities shall establish a written cooperative agreement with an advisory dentist or dental service. The agreement shall include provisions for a dentist or dental service. The agreement shall include provisions for a dentist to participate annually in the staff development program and to recommend oral hygiene policies and practices.

328 SOCIAL SERVICES

If a facility provides social services directly and the designated staff member is not a qualified social worker, a written agreement shall be established to provide consultation from such a qualified person or a recognized social agency.

329 ACTIVITY DIRECTOR

In a nursing facility, if the staff member designated responsible for the activity program is not a qualified patient activity coordinator, a written agreement shall be established with a person so qualified. The MSW consultant may also serve as consultant to the activity director.

330 PHARMACIST

If a facility does not employ a licensed pharmacist, it shall establish a written agreement with a licensed pharmacist to provide consultation on methods and procedures for ordering, storage, administration, disposal, and record keeping of drugs and biologicals.

331 MEDICAL AND REMEDIAL SERVICES

A nursing home shall establish a written agreement for all medical and remedial services, i.e., laboratory, radiological, and other services, required by the resident but not regularly provided within the facility.

332 TRANSFER AGREEMENT

A facility shall have in effect a written transfer agreement with one or more hospitals sufficiently close to the facility to make feasible the transfer of patients. It shall be the duty of each nursing home administrator to supply basic information at the time of a patient's transfer from one nursing home to another or to a hospital.

333-399 RESERVED

401 GENERAL STANDARDS FOR EXISTING STRUCTURES

402 GENERAL

Every institution must be maintained, managed, and equipped to provide adequate care, safety, and treatment of each resident.

403 FACILITY GROUNDS AND PARKING

* All homes shall be provided with dust free drives and parking lots.

* Parking areas shall be provided in a ratio of one (1) individual parking space for each five (5) licensed beds.

404 DOORS

* All exterior doors shall be effectively weather stripped

* Doors shall swing into rooms except closet, toilet, and exit doors.

* The doors to all rooms, toilets, baths, and closets shall be legibly marked with names or numbers, as appropriate to identify the area.

* Exit doors shall not be locked in such a way that a key is necessary to open the door from the inside of the building. A latch or other fastening device on the door shall be provided with a knob, handle, panic bar or other simple type of releasing device, which is part of the door handle hardware, of which the method of operation is obvious even in darkness.

405 STANDARD PATIENT ROOMS, BATH, AND TOILET FACILITIES

406 INTENSIVE CARE ROOM

An intensive care room shall be provided for each thirty-five (35) beds or major portion thereof and shall be located near the nurses' station. Each room shall have the standard square footage as set forth in these regulations. The room shall be provided with standard unit equipment and a lavatory with a gooseneck spout and elbow or wrist-action blade-handle controls, and a soap and a towel dispenser. At least one of these rooms is a single room which can be used for isolation.

407 CORRIDORS

Corridors in facilities licensed prior to 1973 shall be at least six (6) feet wide.

408 HANDRAILS

Standard handrails shall be provided on each side of the corridor in all areas used by patients; however, a six (6) foot passageway must be maintained. For six (6) foot corridors, a handrail shall be required only on one side.

409 BEDPAN CLEANING AND STORAGE ROOM

There shall be one properly equipped bedpan cleaning room with deep metal sink. In addition to bedpan cleaning equipment, appropriate hand-washing facilities shall be provided. The room shall include equipment for sterilization (unless a separate central sterilization is provided).

410 DAY ROOM AND DINING ROOM

A well lighted, clean, orderly, and ventilated room or rooms shall be provided for patient activities and for dining areas. A minimum of twenty (20) square feet per bed shall be provided for this purpose. At least half of the required area may be used for dining.

411 CEILINGS, WALLS AND FLOORS

412 HEATING AND COOLING

413 LIGHTING

414 EMERGENCY POWER

The facility shall provide an emergency source of electrical power necessary to protect the health and safety of patients in the event the normal electrical supply is interrupted. The emergency electrical power system must supply power adequate at least for lighting in all means of egress; equipment to maintain fire detection, alarm, and extinguishing systems. Dry battery or wet-cell batteries may be used as emergency power in facilities where life support systems are not used.

Where life support systems are used, emergency electrical service is provided by an emergency generator located on the premises.

415 WATER SERVICE

416 NURSES' STATION

Nurses' stations shall be provided and so designated that they contain a minimum of sixty (60) square feet per each thirty-five (35) bed patient unit, and are not more than one-hundred twenty (120) linear feet from each patient room. The station shall include adequate storage and preparation areas(s), medication, toilet and hand-washing facilities, and sufficient lighting.

417 JANITORS' CLOSETS

Janitors' closets shall be provided for each nursing unit, and a separate janitor's closet shall be provided within the kitchen area. These closets shall be provided with hot and cold running water, a floor receptor or service sink, and shelves for the storage of janitorial equipment and supplies. The closets shall be mechanically vented to the outside. Janitor closets in patient areas must be kept locked.

418 NURSES' CALL SYSTEM

A nurses' call system comprised of an electric buzzer and/or light system shall be so designed that the location of a call can be determined from the corridor and nurses' station. In addition emergency call stations shall be provided in all patient bath, toilet and shower areas. Wireless nurse call systems may be substituted for wired call systems. Wireless call systems shall meet the requirements set forth in Section 440 of these regulations.

419 FIRE ALARM SYSTEM

Each nursing home shall have an electrically-supervised, manually-operated fire alarm system in accordance with Section 6-3 NFPA 101, Life Safety Code handbook that applies to their nursing home.

420 PHYSICAL ENVIRONMENT

421 STANDARDS FOR NEW CONSTRUCTION AND/OR ALTERATIONS

422 GENERAL

423 SITE LOCATION, INSPECTION, APPROVALS AND SUBSOIL INVESTIGATION

424 SUBMISSION OF PLANS, SPECIFICATIONS, AND ESTIMATES

425 PLANS AND SPECIFICATIONS

426 CODES AND STANDARDS

The following codes and standards are incorporated into and made a part of these regulations:

427 STANDARD PATIENT ROOM AND TOILET DESIGN

428 INTENSIVE CARE ROOM DESIGN

Other than requirements set forth for existing structures, 406, an intensive care room shall be mechanically vented to the outside and provided with a standard private toilet and hand-washing facility. The intensive care room may also serve as an isolation room.

429 CORRIDORS

Corridors shall be at least eight (8) feet wide.

430 LAUNDRY

Laundry in new facilities must provide complete separation (by partition) of the soiled laundry area (including washer) and the clean laundry area. A lavatory with soap and towel dispensers must be provided for the staff in each area, and a rinsing sink provided in the soiled laundry area. A linen folding table must be provided in the clean laundry area. If the laundry area is included in the main nursing home building, it shall be so located as to be as remove as possible from the patient area.

431 STORAGE

There shall be a minimum of five (5) square feet per bed for general storage space provided in those cases where built-in closets are provided in patient rooms. It is recommended that this be concentrated in one general area except for small storage areas within the nursing units for wheelchairs, patient lifts, walkers, etc.

432 DIETETIC SERVICE AREA (LESS DINING AREAS)

433 ADMINISTRATIVE OFFICES

Separate office space shall be provided for administrative and business functions as follows:

* Office for the administrator.

* Office for the director of nursing services.

* Office or space for social and activity director.

434 RESIDENTS' DINING AND RECREATION AREAS

The total area set aside for residents' dining and recreation purposes shall be not less than twenty (20) square feet per bed. Additional space shall be provided if the facility participates in a day care program. The areas shall be well lighted and well ventilated.

435 UTILITY ROOMS

436 BEDPAN ROOM

There shall be at least one bedpan cleaning room. In addition to the bedpan cleaning equipment, hand-washing facilities with blade-handle controls shall be provided. There shall be provisions for equipment sterilization.

437 JANITORS' CLOSETS

Janitors' closets shall be provided for each nursing unit, and a separate janitor's closet shall be provided within the kitchen area. These closets shall be provided with hot and cold running water, a floor receptor and service sink, and shelves for the storage of janitorial equipment and supplies. The closets shall be mechanically vented to the outside. Janitor closets in patient areas must be kept locked.

438 LINEN CLOSETS

Closets for clean linens shall be provided for each nurses' station.

439 SOILED LINEN CLOSETS

Closet for soiled linens shall be provided for each nurses' station. This dirty linen storage shall be in a separate room and ventilated to the outside.

440 NURSES' CALL SYSTEM

441 NURSES' STATION

Nurses' station shall be provided and so designed that they contain a minimum of sixty (60) square feet per each thirty-five (35) bed patient unit, and are not more than one-hundred-twenty (120) linear feet from each patient room. The station shall include adequate storage and preparation area(s), medication, toilet and hand-washing facilities, and sufficient lighting.

442 FIRE ALARM SYSTEM

Each nursing home shall be an electrically supervised, manually operated fire alarm system in accordance with Section 6-3 NFPA 101, Life Safety Code handbook that applies to their nursing home.

443 LIMITATIONS

The following limitations shall apply:

444 CEILINGS, WALLS, AND FLOORS

* Ceilings shall be a minimum of eight (8) feet. (Refer to Section 411 for surfaces.)

* Walls (Refer to Section 411).

* Floors (Refer to Section 411).

445 WATER COOLER

An electrically operated water fountain of an approved type shall be provided for each nurses' station. The water fountain shall be accessible to the physically handicapped. Water fountains must be recessed not to obstruct the corridor.

446-449 RESERVED

450 FURNISHINGS, EQUIPMENT, AND SUPPLIES

451 FURNISHINGS

452 LINENS AND BEDDING

453 EQUIPMENT AND SUPPLIES

Nursing equipment and supplies shall be provided to meet the patients' needs and maintained in good condition to ensure adequate nursing care of the patients.

454 CARE AND CLEANING OF MEDICAL SUPPLIES AND EQUIPMENT

455 STORAGE

456-469RESERVED

470 HOUSEKEEPING/MAINTENANCE

471 HOUSEKEEPING - MAINTENANCE

472-499 RESERVED

501 PHYSICIAN SERVICES

502 ADMISSION ONLY ON RECOMMENDATION OF A PHYSICIAN

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.

503 CONTINUED SUPERVISION OF CARE

The health care of every patient shall be under the continuing supervision of a physician, who, based on a medical evaluation of the patient's immediate and long term needs, prescribes a planned regimen of total patient care. Patients in need of skilled care should be seen by a physician at least every sixty (60) days, and all others seen at least every one hundred twenty (120) days. A notation should be made at each visit and orders for treatment and medication renewed.

504 PHYSICAL EXAMINATION OF PATIENTS

The medical evaluation of the patient shall be based on a history and physical examination done within seventy-two (72) hours of admission unless such 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.

505 PLANNED REGIMEN OF CARE

The planned regimen of total care for each patient shall be based on the attending physician's order and shall cover medication, treatment, rehabilitative services (where appropriate), diets, precautions related to activities undertaken by the patient, and plans for continuing care and discharge.

506 ESTABLISHMENT RESTORATION POTENTIAL

The attending physician shall establish at the time of admission a restoration potential for the patient. This should be updated as needed but not less than on an annual basis.

507 EMERGENCY PHYSICIAN

The facility should make arrangements for emergency coverage by a physician if the attending physician or his attendant cannot be located. This should be done by a written agreement signed by the physician and the facility administrator.

510 NURSING

511 PROFESSIONAL NURSE SUPERVISION

512 CHARGE NURSE

513 NURSING STAFF

514 PERSONNEL ASSIGNMENTS

515 RESTRICTIONS IN EMPLOYMENT AND/OR ASSIGNMENT

No person who has been a patient in a mental hospital and who has not been completely discharged by that institution shall be employed in a nursing home in a supervisory capacity.

516 NURSING CARE REQUIREMENTS

517 TREATMENT AND MEDICATIONS

518 REHABILITATIVE NURSING

519 SUPERVISION OF PATIENT NUTRITION

Nursing personnel shall be aware of the nutritional needs, food, and fluid in-take of patients and assist promptly where necessary in the feeding of patients.

520 MINIMUM DIRECT-CARE STAFFING REQUIREMENTS

521 TUBERCULOSIS SURVEILLANCE

Upon admission to the nursing home, physician orders shall be obtained to administer a PPD (intermediate strength) tuberculosis skin test to the resident and to repeat in ten (10) to fourteen (14) days if necessary. If this initial test reacts positively, the physician should be notified and a chest X-ray obtained and read. The record of this X-ray should be placed on the resident's chart. If it is not possible to obtain a chest X-ray, a sputum sample should be taken and forwarded for culture. If treatment is indicated, orders are obtained from the attending physician.

If the result of the initial skin test is negative, the skin test should be repeated in ten (10) to fourteen (14) days. If the result of this test is positive, the physician should be notified and a chest X-ray or sputum culture obtained. If treatment is indicated as a result of these tests, orders are obtained from the attending physician.

Once a resident has shown a positive skin test (regardless of whether or not further testing indicated treatment), he/she must be re-evaluated yearly. Either a chest X-ray or sputum culture should be obtained. If neither of these is possible, the resident should be evaluated for any visible signs of the disease such as productive cough or weight loss. Alternatively, if a nurse familiar with the resident finds no fever, no weight loss and no significant cough, this can be recorded in the medical record and will suffice for annual surveillance; if any symptoms are present, then a chest film should be is indicated on medical grounds, and should be noted in the medical record. There should be evidence in the medical record of this yearly re-evaluation. If, however, the second skin test after admission is also negative, there need be no further testing of this resident unless an active case of tuberculosis is identified in the facility.

The medical record of all residents who have shown a positive skin test should be flagged to note that this resident does need to be re-evaluated yearly and that a sputum culture should be obtained following any pulmonary infection.

Recordation of tuberculin information shall be maintained in each resident's medical record and shall be recorded on forms provided by the Arkansas Department of Health.

530 SPECIALIZED REHABILITATIVE SERVICES

531 SERVICES BASED ON RESIDENT NEEDS

In addition to rehabilitative nursing, the facility shall, as ordered by a physician, provide, according to the needs of each patient, specialized and supportive services, i.e., physical therapy, speech pathology, audiology and occupational therapy, either directly, by referral, or through arrangements with qualified personnel.

532 WRITTEN PLAN OF CARE

If provided, specialized rehabilitative services shall be provided under a written plan of care, initiated by the attending physician, and developed in consultation with appropriate therapist(s) and nursing services.

533 REVIEW OF RESIDENT PROGRESS

A report of the patient's progress shall be communicated to the attending physician within two (2) weeks of the initiation of the specialized rehabilitative services and regularly thereafter.

534 RE-EVALUATION OF PLAN

The plan of specialized rehabilitative care shall be re-evaluated as necessary, but at least every thirty (30) days by the physician and/or the therapist.

535 DOCUMENTATION OF SERVICES

The physician's orders, the plan of specialized rehabilitative care, services rendered, evaluation of progress and other pertinent information shall be recorded in the patient's medical record and dated and signed by the physician ordering the service and the person who provided the service.

540 PHARMACEUTICAL SERVICES

541 RESPONSIBILITY FOR PHARMACY COMPLIANCE

The administrator shall be responsible for full compliance with Federal and State laws governing procurement, control, and administration of all drugs. Full compliance is expected with the Comprehensive Drug Abuse Prevention and Control Act of 1970, Public Law 91-513, and all amendments to this set and all regulations and rulings passed down by the Federal Drug Enforcement Agency (DEA), Ark. Code Ann. § 5-64-101 et seq. and all amendments to it and these rules and regulations.

542 PHARMACY CONSULTANTS PERMIT

Each nursing home shall have a formal arrangement with a licensed pharmacist to provide supervision and consultation on methods and procedures for ordering, storing, administering, disposition, and record keeping of drugs and biologicals.

A consultant pharmacist's permit shall be obtained yearly from the Arkansas State Board of Pharmacy and shall be displayed in a conspicuous place in the facility.

The consultant pharmacist shall visit the nursing home at least monthly to perform his consultant duties.

Before a nursing home consultant's permit shall be issued, the pharmacist must certify to the Board of Pharmacy that he has attended a seminar or meeting explaining pharmaceutical duties and responsibilities in a nursing home as approved by the Board of Pharmacy and that he has

read and understands the regulations governing pharmaceutical services in a nursing home and will abide by them.

The consultant pharmacist shall submit a written report at least monthly to the administrator of the facility. This monthly report should be a summary of the duties performed by the consultant pharmacist that month, any error or problems found in the facility, delivery of pharmaceutical services, and a detailed listing of any discrepancies and/or irregularities noted by the pharmacist during his drug regimen reviews. The pharmacist, in cooperation with the facility staff, should develop and implement policies and procedures to govern all aspects of the drug distribution system. The pharmacist may also agree to abide by and function with those policies and procedures already being used by the facility at the time of his employment.

543 PRESCRIPTIONS ON INDIVIDUAL BASIS

All drugs prescribed for each patient shall be on an individual prescription basis. Medications prescribed for one patient shall not be administered to another patient.

544 ADMINISTRATION OF MEDICATION

545 EQUIPMENT FOR ADMINISTERING MEDICATIONS

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.

546 MEDICINE CARDS

In administering medications, medication cards current with the physician's orders must be used. Medicine cards shall be provided to include:

* Name of patient.

* Rooms or bed number.

* Medication and dosage.

* Hours to be given.

547 STOP ORDER POLICY

Medications not specifically limited as to time or number of doses when ordered by the physician shall be controlled by the facility's policy regarding automatic stop orders.

The facility's automatic stop order policy, at a minimum, shall cover the following categories of medications:

* C II Narcotics.

* C II Non-narcotics.

* C III, C IV, and C V medications.

* Anticoagulants.

* Antibiotics.

548 STORAGE OF DRUGS

549 EMERGENCY DRUG BOX

A container which contains emergency stimulants and drugs for life saving measures must be maintained. This box should be located where it can be readily available to nursing personnel but kept in a secure place and should have a breakaway lock. There should be a list on the box of the drugs which are contained in the box. The drugs in the box should be checked periodically with the list to make sure that these drugs have been replaced after use and are not outdated. Only drugs which have been approved for this purpose by the Pharmaceutical Services Committee or Medical Director, as applicable, and/or the physician, can be place in this box. All

controlled substances assigned to the box must be kept with the other controlled substances and labeled "Emergency Box". All controlled substances assigned to the "Emergency Box" must be entered into the bound book. The location of these controlled substances should be noted on the list of drugs. The drug list should be signed by the physician member of the 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.

550 RECORD OF CONTROLLED DRUGS

A record shall be kept in a bound ledger book with consecutively numbered pages of all controlled drugs procured and administered. This record shall contain on each separate page:

* Name, strength, and quantity of drug received.

* Date received.

* Patient's name.

* Prescribing physician.

* Name of pharmacy.

* Date and time of dosage given.

* Quantity of drug remaining.

* Signature of person administering the drug.

The person responsible for entering the controlled drug into the bound ledger should be the same person who signs for it in the drug ordering and receiving record. This record shall be retained by the facility as a permanent record and be readily available.

551 CONTROLLED DRUG ACCOUNTABILITY

There shall be a count of all C 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.

552 REVIEW OF MEDICATION BY THE NURSE AND/OR PHARMACIST

There shall be for each patient a separate medication/drug regimen review sheet. This sheet is to be used to document the performance of a medication/drug regimen review by the pharmacist and/or registered nurse. This monthly review must be dated and signed by the person making the review. Any discrepancy, interaction, etc., should be entered on the review sheet.

553 REVIEW OF MEDICATIONS BY CONSULTANT PHARMACISTS

In an Intermediate Care Facility, the review of the medication/drug regimen of the skilled care patients must be done at least each month, and at least quarterly on the Intermediate and Minimum care patients. In Skilled Nursing Facilities, the review of medication/drug regimen must be done monthly on all patients.

In reviewing the medication/drug regimens of the patients, the pharmacist and registered nurse should, as a minimum, compare the doctor's orders with the medication administration record, the medication cards, cardex, actual medications, and prescription labels. Any discrepancies, interactions, irregularities, contraindications, errors, and incompatibilities will be noted on the medication/drug regimen review sheet, and if medication/drug review is being performed by the pharmacist, on the pharmacist's monthly written report to the administrator. Irregularities observed by the pharmacist that would warrant immediate action should be brought to the Director of Nursing Services' attention immediately upon their finding.

The person delegated the responsibility of correcting or following through on the errors, irregularities, and discrepancies listed on the pharmacist's monthly report should document their actions on their report, date it, and sign it. A photocopy of the report may be used for this purpose, but both must be retained in the facility. If no irregularities or discrepancies are found during the medication/drug regimen review, the person performing the review must note on the review sheet that he has reviewed that drug regimen and found no irregularities. This notation must be dated and signed.

554 CYCLE-FILL, PHARMACY NOTIFICATION AND DISPOSITION OF UNUSED DRUGS

Schedule II, 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.

555 PHARMACY PREPARED MEDICATION CONTAINER SYSTEMS DESIGNED FOR ADMINISTRATION WITH THE USE OF MEDICATION CARDS (UNIT DOSE SYSTEM)

All policies and procedures related to systems of 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.

556-559 RESERVED

560 DIETETIC SERVICES

561 STAFFING

Staff supervisory responsibility for the dietetic services is assigned to a full time, qualified dietetic service supervisor or Certified Dietary Manager. A qualified supervisor is one who has:

562 HYGIENE OF STAFF

All food service employees shall wear appropriate, light-colored clothing including hairnet and shall keep themselves and their clothing clean.

All persons working as food handlers in nursing homes shall have in their possession or on file in the home in which they are employed, a current, approved health card.

Persons having symptoms of communicable or infectious diseases or lesions shall not be allowed to work in the dietetic services. Food service employees shall not be assigned duties outside dietetic services.

563 MINIMUM DAILY FOOD REQUIREMENTS

All patients shall be served an approved, appetizing, adequate diet that conforms to the recommended dietary allowances of the Food and Nutrition Board, National Research Council or with, "Food for Fitness - a Daily Guide" leaflet #424, United States Department of Agriculture.

Facilities are permitted to serve commodity foods provided that the facility is registered as a nonprofit organization and the foods were legally obtained directly from USDA sources. Commodity foods obtained from an individual may not be used. Commodity foods shall be utilized pursuant to USDA regulations. Facilities utilizing commodity foods shall maintain documentation, or be able to provide evidence, that the foods were obtained through proper channels. Failure to meet this requirement may result in a deficiency finding and a report to federal authorities.

The daily food allowances for each patient shall include, unless contraindicated by the patient's physician:

564 FREQUENCY OF MEALS

565 MEAL SERVICE

566 MENUS

567 THERAPEUTIC DIETS

568 PREPARATION AND STORAGE OF FOOD

569 SANITARY CONDITIONS

570 DIETETIC SERVICES STAFFING

571-579 RESERVED

580 SOCIAL WORK SERVICES AND ACTIVITIES PROGRAMMING

581 POLICIES AND PROCEDURES

582 JOB DESCRIPTION

Separate for social services designee/worker.

Include actual functions of position.

Include other duties that may be assigned to designee/worker.

583 SOCIAL SERVICES RECORDS

584 STAFFING AND CONSULTATION FOR SOCIAL SERVICES/ACTIVITIES

585 PROGRAM OPERATIONS

586 PET THERAPY

587-599 RESERVED

601 RESIDENT RECORD MAINTENANCE

The facility will maintain an individual record on all residents admitted in accordance with accepted professional standards and practices. The resident record service must have sufficient staff, facilities, and equipment to provide records that are completely and accurately documented, readily accessible, and systematically organized.

602 CONTENTS OF RECORDS (TO FACILITATE RETRIEVING AND COMPILING INFORMATION)

The resident records will contain sufficient information to identify the resident, his/her diagnosis(es) and treatment, and to document the results accurately.

603 INDEX

There will be an index of all residents admitted to the facility including:

* Name of resident.

* Record number.

* Former Address.

* Name of physician.

* Date of birth.

* Date of discharge.

604 RETENTION AND PRESERVATION OF RECORDS

605 CONFIDENTIALITY

The information contained in the resident records is confidential and is not to be released without legal authorization or subpoena.

The records will be available to State Survey Agency personnel.

606 STAFFING

An individual will be designated as responsible for the resident record service. There will be written job descriptions for the resident record service personnel.

607 GENERAL INFORMATION

All entries in the resident records will be recorded in ink. There will be no alteration of information in the resident records. If an error is made, a single line will be drawn through the error, the word "error" written above and initialed.

608-699 RESERVED

a. Activities of Daily Living (ADLs): The tasks for self-care that are performed either independently, with supervision, with assistance, or by others. Activities of daily living include, but are not limited to, ambulating, transferring, grooming, bathing, dressing, eating and toileting.

b. Advertise: To make publicly and generally known. For purposes of this definition, advertise includes, but is not limited to:

c. Alzheimer's Special Care Unit: A separate and distinct unit within a Long Term Care facility that segregates and provides a special program for residents with a diagnosis of probable Alzheimer's disease or related dementia, and that advertises or otherwise holds itself out as having one (1) or more special units for residents with a diagnosis of probable Alzheimer's disease or related dementia.

d. Alzheimer's Disease: An organic, neurological disease of the brain that causes progressive degenerative changes.

e. Common Areas: Portions of the Alzheimer's Special Care Unit exclusive of residents' rooms and bathrooms. Common areas include any facility grounds accessible to residents of the Alzheimer's Special Care Unit (ASCU).

f. Continuous: Available at all times without cessation, break or interruption.

g. Dementia: A loss or decrease in intellectual ability that is of sufficient severity to interfere with social or occupational functioning; it describes a set of symptoms such as memory loss, personality change, poor reasoning or judgment, and language difficulties.

h. Department: Department of Human Services (DHS), Division of Medical Services (DMS), or Office of Long Term Care (OLTC)

i. Direct Care Staff: An individual who is an employee of the facility or who is an employee of a temporary agency assigned to work in the facility, and who has received, or will receive, in accordance with these regulations, specialized training regarding Alzheimer's or related dementia, and is responsible for providing direct, hands-on care or services to residents in the ASCU.

j. Disclosure Statement: A written statement prepared by the facility and provided to individuals or their responsible parties, and to individuals' families, prior to admission to the unit, disclosing form of care, treatment, and related services especially applicable or suitable for the ASCU.

k. Facility: A long-term care facility that houses an ASCU.

l. Individual Assessment Team: A group of individuals possessing the knowledge and skills to identify the medical, behavioral, and social needs of a resident and to develop services designed to meet those needs

m. Individual Support Plan: A written plan developed by an Individual Assessment Team (IAT) that identifies services to a resident.

n. Nursing Personnel: Registered or Licensed Practical nurses who have specialized training, or will undergo specialized training by the Alzheimer's Special Care Unit, in accordance with these regulations.

o. Responsible Party: An individual, who, at the request of the applicant or resident, or by appointment by a court of competent jurisdiction, agrees to act on behalf of a resident or applicant for the purposes of making decisions regarding the needs and welfare of the resident or applicant. These regulations, and this definition, does not grant or permit, nor should be construed as granting or permitting, any individual authority or permission to act for, or on behalf of, a resident or applicant in excess of the authority or permission granted by law. A competent resident may select a responsible party or may choose to not select a responsible party. In no event may an individual act for, or on behalf of, a resident or applicant when the resident or applicant has a legal guardian, attorney-in-fact, or other legal representative. For purposes of these regulations only, responsible party will also refer to the terms legal representative, legal guardian, power of attorney or similar phrase.

901 GENERAL ADMINISTRATION

902 TREATMENT PHILOSOPHY

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.

903 ASSESSMENTS

904 ADMISSIONS, DISCHARGES, TRANSFERS

905 STAFFING

Alzheimer's Special Care Units shall staff according to the Rules and Regulations for Nursing Facilities. Furthermore, the following staffing requirements are established for Alzheimer's Special Care Units.

906 PHYSICAL ENVIRONMENT, DESIGN AND SAFETY

907 THERAPEUTIC ACTIVITIES

908 PENALTIES

1001 DEFINITIONS

1002 PURPOSE

1003 APPOINTMENT AND SUPERVISION OF A MONITOR(S):

1004 DETERMINATION OF NEED FOR RECEIVERSHIP

1005 PETITION FOR NOTICE OF RECEIVERSHIP

1006 POST PETITION ACTIVITIES

Immediately upon appointment of a receiver the Department shall assist the receiver and insure the following functions and responsibilities are accomplished:

1007 ASSISTANCE WITH DUTIES OF THE RECEIVER TO STAFF

Immediately upon completion of the assessment in Section 1006 above, but in no event more than 72 hours after appointment, the Department shall assist the Receiver to:

1008 ASSISTANCE WITH RESPONSIBILITIES OF RECEIVER TO RESIDENTS, GUARDIANS AND FAMILIES

Immediately upon completion of assessment in Section 1006 above, but in no event more than 72 hours after appointment the Department shall assist the receiver to:

1009 LONG RANGE RESPONSIBILITIES OF RECEIVER

Upon appointment, the department shall assist in taking appropriate action with regard to the on-going operation of the facility. That action shall include:

1010 REPORTING OF PROGRESS OF RECEIVER

1011 QUALIFICATIONS AND MAINTENANCE OF LIST FOR RECEIVER

1012 DEPARTMENT TO FURNISH RECEIVER WITH COPY OF LEGAL PROCEEDING

1013 MANDATED PATIENT TRANSFER

1014-1999 RESERVED

2001 REQUESTING AN INFORMAL DISPUTE RESOLUTION

A written request for an informal dispute resolution must be made to the Arkansas Department of Health, Health Facility Services, 5800 West 10th, Suite 400, Little Rock, AR 72204 within ten calendar days of the receipt of the Statement of Deficiencies from the Office of Long Term Care. The request must:

2002 MATTERS WHICH MAY BE HEARD AT IDR

The IDR is limited to deficiencies cited on a Statement of Deficiencies. Issues that may not be heard at an IDR include, but are not limited to:

2003 APPEAL OF IDR RESULTS

If a Medicaid certified facility is not satisfied with the results of the informal dispute resolution, it may request a hearing before the Long Term Care Facility Advisory Board

within the 60 day time frame for appeal. If the facility chooses, it may by-pass the informal dispute resolution process and appeal directly to the board within the 60 day appeal period. Requests must be submitted in writing to:

Chairman

Long Term Care Facility Advisory Board

P.O. Box 8059, Slot S409

Little Rock, AR 72203-8059

Medicare and Medicare/Medicaid certified facilities may request a hearing by either the Associate Regional Administrator in the Dallas office of the Health Care Financing Administration or the Departmental Appeals Board at the addresses below at any point within the 60 day time frame for appeals.

HCF-2

Associate Regional Administrator

Division of Health Standards and Quality

Centers for Medicare and Medicaid Services

1200 Main Tower Building

Dallas, TX 75202

Department of Health and Human Services Departmental Appeals Board, MS 6127 Civil Remedies Division 330 Independence Avenue, S.W. Cohen Building - Room G-644 Washington, D.C. 20201

If the facility chooses to appeal to either of these agencies, a copy of the appeal should also be forwarded to the OLTC.

2004-2999 RESERVED

3001 The facility shall have written policies and procedures defining the rights and responsibilities of residents. The policies shall present a clear statement defining how residents are to be treated by the facility, its personnel, volunteers, and others involved in providing care.

3002 A copy of the synopsis of the residents' bill of rights must be prominently displayed within the facility.

3003 Each resident admitted to the facility is to be fully informed of these rights and of all rules and regulations governing resident conduct and responsibilities. The facility is to communicate these expectations/rights during the period of not more than two weeks before or five working days after admission, unless medically contraindicated in writing. The facility shall obtain a signed acknowledgement from the resident, his guardian or other person responsible for the resident. The acknowledgement is maintained in the resident's medical record.

3004 Appropriate means shall be utilized to inform non-English speaking, deaf, or blind residents of the residents' rights.

3005 Residents' Rights shall be deemed appropriately signed if:

3006 Staff members must fully understand all residents' rights.

3007 Facility staff will be provided a copy of residents' rights. Staff shall complete a written acknowledgement stating they have received and read the residents' rights. A copy of the acknowledgement shall be placed in each employee's personnel file.

3008 The facility's policies and procedures regarding residents' rights and responsibilities will be formally included in ongoing staff development program for all personnel, including new employees.

3009 Each resident admitted to the facility will be fully informed, prior to or at the time of admission, and as need arises during residency, of services available in the facility and any charges for services. Residents have the right to choose, at their own expense, a personal physician and pharmacist.

3010 The facility shall make available to all residents a schedule of the kinds of services and articles provided by the facility. A schedule of charges for services and supplies not included in the facility's basic per diem rate shall be provided at the time of admission. This schedule shall be updated should any change be made.

3011 Each resident admitted to the facility shall be fully informed by a physician of his medical condition. The resident shall be afforded the opportunity to participate in the planning of his total medical care and may refuse experimental treatment.

3012 Total resident care includes medical care, nursing care, rehabilitation, restorative therapies, and personal cleanliness in a safe and clean environment. Residents shall be advised by appropriate professional providers of alternative courses of care and treatments and the consequences of such alternatives when such alternatives are available.

3013 A resident may be transferred or discharged only for:

3014 The term "transfer" applies to the movement of the resident from facility to another facility.

3015 "Medical reasons" for transfer or discharge shall be based on the resident's needs and are to be determined and documented by a physician. That documentation shall become a part of the resident's permanent medical record.

3016 "Reasonable notice of transfer or discharge" means the decision to transfer or discharge a resident shall be discussed with the resident and the resident will be told the reason(s) and alternatives available. A minimum of thirty (30) days written notice must be given. Transfer for the welfare of the resident or other residents may be affected immediately if such action is documented in the medical record.

3017 An appeals process for residents objecting to transfer or discharge shall be developed by the facility, in accordance with Ark. Code Ann. § 20-10-1005 as amended. The process shall include:

3018 The facility shall provide preparation and orientation to resident designed to ensure a safe and orderly transfer or discharge.

3019 The facility must provide reasonable written notice of change in room or roommate.

3020 Each resident admitted to the facility will be encouraged and assisted to exercise all constitutional and legal rights as a resident and as a citizen including the right to vote, and the facility shall make reasonable accommodations to ensure free exercise of these rights. Residents may voice grievances or recommend changes in policies or services to facility staff or to outside representatives of their choice, free from restraint, coercion, discrimination, or reprisal.

3021 Residents shall have the right to free exercise of religion including the right to rely on spiritual means for treatment.

3022 Complaints or suggestions made to the facility's staff shall be responded to within ten (10) days. Documentation of such response will be maintained by the facility administrator or his designee.

3023 Each resident may retain and use personal clothing and possessions as space and regulations permit.

3024 A representative resident council shall be established in each facility. The resident council's duties shall include:

3025 The facility administrator shall designate a staff coordinator and provide suitable accommodations within the facility for the residents' council. The staff coordinator shall assist the council in scheduling regular meetings and preparing written reports of meetings for dissemination to residents of the facility. The staff coordinator may be excluded from any meeting of the council.

3026 The facility shall inform residents' families of the right to establish a family council within the facility. The establishment of such council shall be encouraged by the facility. This family council shall have the same duties and responsibilities as the resident council and shall be assisted by the staff coordinator designated to assist the resident council.

3027 Each resident admitted to the facility may manage his personal financial affairs, or if the resident request such affairs be managed by the facility, an accounting shall be maintained in accordance with applicable regulations.

3028 Residents shall be free from mental and physical abuse, chemical and physical restraints (except in emergencies) unless authorized, in writing, by a physician, and only for such specified purposes and limited time as is reasonably necessary to protect the resident from injury to himself or others.

3029 Mental abuse includes humiliation, harassment, and threats of punishment or deprivation.

3030 Physical abuse refers to corporal punishment or the use of restraints as a punishment.

3031 Drugs shall not be used to limit, control, or alter resident behavior for convenience of staff.

3032 Physical restraint includes the use of devices designed or intended to limit residents' total mobility.

3033 Physical restraints are not to be used to limit resident mobility for the convenience of staff, as a means of punishment, or when not medically required to treat the resident's medical symptoms. If a resident's behavior is such that it will result in injury to himself or others any form of physical restraint utilized shall be in conjunction with a treatment procedure designed to modify the behavioral problems for which the resident is restrained and only after failure of therapy designed or intended to modify the threatening behavior.

3034 The facility's written policy and procedures governing the use of restraint shall specify which staff members may authorize the use of restraints and must clearly specify the following:

3035 Each resident is assured confidential treatment of his personal and medical records. Residents may approve or refuse the release of such records to any individual except in case of a transfer to another health care institution, or as required by law or third party payment contract.

3036 Each resident will be treated with consideration, respect, and full recognition of dignity and individuality, including privacy in treatment and care for personal needs.

3037 Staff shall display respect for residents when speaking with, caring for, or talking about residents, and shall seek to engage in the constant affirmation of resident individuality and dignity as a human being.

3038 Schedules of daily activities shall provide maximum flexibility and allow residents to exercise choice in participation. Residents' individual preferences regarding such things as menus, clothing, religious activities, friendships, activity programs, and entertainment will be elicited and respected by the facility.

3039 Residents shall be examined or treated in a manner that maintains and ensures privacy. A closed door or a drawn curtain shall shield the resident from passers-by. People not involved in the care of the residents are not to be present during examination or treatment without the residents' consents.

3040 Privacy will be afforded residents during toileting, bathing, and other activities of personal hygiene.

3041 Residents may associate or communicate privately with persons of their choice, and may send or receive personal mail unopened, unless medically contraindicated and documented by the physician in the medical record.

3042 Policies and procedures shall permit residents to receive visits from anyone they wish; provided a particular visitor may be restricted for the following reasons:

3043 Decisions to restrict a visitor shall be reviewed and evaluated each time the resident's plan of care or medical orders are reviewed by the physician or nursing staff, or at the resident's request.

3044 Accommodations will be provided for residents to allow them to receive visitors in reasonable comfort and privacy.

3045 Residents are allowed to manage their own personal financial affairs.

3046 Should the facility manage the resident's personal financial affairs, this authorization must be in writing and shall be signed appropriately as follows:

3047 The facility shall have written policies and procedures for the management of client trust accounts.

3048 An employee shall be designated to be responsible for resident accounts.

3049 The facility shall establish and maintain a system that assures full and complete accounting of residents' personal funds using generally accepted accounting principles.

3050 The facility shall not commingle resident funds with any other funds other than resident funds.

3051 The facility system of accounting includes written receipts for funds received by or deposited with the facility, and disbursements made to or for the resident.

3052 All personal allowance monies received by the facility are placed in a collective checking account.

3053 The checking account will be reconciled on a monthly basis.

3054 Any cost incurred for this account shall not be charged to the resident.

3055 Any interest earned from this account shall not be charged to the resident.

3056 When appropriate individual savings accounts shall be opened for residents in accordance with Social Security rules governing savings accounts.

3057 A cash fund specifically for petty cash shall be maintained in the facility to accommodate the small cash requirement of residents.

3058 The facility shall, at the resident's request, keep on deposit personal funds over which the resident has control. Should the resident request these funds, they are given to him on request with receipts maintained by the facility and a copy to the resident.

3059 The financial record must be available to the resident and his/her guardian, and responsible party.

3060 If the facility makes financial transactions on a resident's behalf, the resident, guardian, or responsible party shall receive an itemized accounting of disbursements and current balances at least quarterly.

3061 A copy of the resident's quarterly statement shall be maintained in the facility.

SYNOPSIS OF RESIDENTS' BILL OF RIGHTS

WELCOME

This facility must ensure and protect the human rights of every individual in residence and to that end will provide a clean, healthy attractive environment wherein the resident will receive treatment without discrimination as to race, color, religion, sex, national origin or source of payment. Upon request, every resident has the right to the name and function of persons providing them service and the identification of other health care facilities, nursing homes, hospitals and other institutions that may provide them with service.

INFORMATION

THE RESIDENT HAS THE RIGHT TO:

* Be fully informed before, or at admission, of his rights and responsibilities as a resident.

* Know immediately of any changes or amendments to those rights and responsibilities.

* Be fully informed prior to or at admission and during stay, of services available in the facility and of related charges of services.

* Reasonable notice of any changes in the costs or availability of services.

MEDICAL CONDITION AND TREATMENT

AS A RESIDENT, YOU HAVE THE RIGHT TO:

* Choose, at your own expense, a personal physician and pharmacist.

* Be fully informed by a physician of your health and medical condition unless the physician documents in your medical record that such knowledge is contraindicated.

* Be given the opportunity to participate in planning your total care and medical treatment.

* Be given the opportunity to refuse treatment.

* Be given the opportunity to refuse to participate in experimental research.

* Receive rehabilitative and restorative therapies.

* Be advised by physician or appropriate professional staff of alternative courses of care and treatments and their consequences.

* Receive medical care, nursing care and personal cleanliness in a safe and clean environment.

EXERCISING RIGHTS

AS A RESIDENT, YOU ARE ENCOURAGED OR WILL BE ASSISTED TO:

* Exercise all constitutional and legal rights as a resident and as a citizen, including the right to vote.

* Voice grievances and recommend changes in nursing home policies and services to facility staff and to outside representatives of your choice, free from restraint, interference, coercion, discrimination or reprisal. All complaints and suggestions made to the nursing home must be responded to.

* Exercise your religious beliefs including the right to rely on spiritual means for treatment.

* Participate in the Resident Council and be informed of its activities and recommendations to the facility.

TRANSFER, DISCHARGE, AND CHANGE OF ACCOMMODATION

EVERY RESIDENT HAS THE RIGHT TO KNOW:

* You will be transferred or discharged only for: medical reasons, for your welfare or that of others, you no longer need the services, the facility ceases operations, or for non-payment.

* Except in emergency the facility must give you a thirty (30) day written notice of transfer or discharge. You shall be given reasonable notice of change of room or roommate within the facility.

* Transfer and discharge shall be discussed with you and you shall be told the reason and alternatives that are available.

* There is an appeals process for residents objecting to transfer or discharge.

* You shall be provided preparation and orientation to ensure a safe and orderly transfer or discharge.

* You shall be given reasonable notice of change of room or roommate change in the facility. FINANCIAL AFFAIRS

AS A RESIDENT YOU HAVE THE RIGHT TO:

* Manage your personal financial affairs, or delegate that management to a responsible party.

* Delegate that management or a part thereof to the nursing home and receive at least a quarterly report of transactions made on your behalf

FREEDOM FROM ABUSE AND RESTRAINTS

AS A RESIDENT YOU HAVE THE RIGHT TO BE:

* Free from mental and physical abuse (Mental abuse includes humiliation, harassment, and threats of punishment or deprivation. Physical abuse refers to corporal punishment and the use of restraints as a punishment).

* Free from chemical and physical restraints except when authorized in writing by a physician for a specific and limited period of time and only to protect you from injury to yourself or others.

PRIVACY

EVERY RESIDENT HAS THE RIGHT TO:

* Considerate and respectful care. Every resident will be treated with consideration, respect and full recognition of his dignity and individuality.

* Privacy during treatment and care of personal needs. People not involved in the care of residents shall not be present without the consent from the resident during examinations and treatment.

* Know that he is assured confidential treatment of all information contained in his medical records and that his or his legal appointee's written consent is required for the release of information to persons not otherwise authorized to receive it.

* Know that photographs and interviews shall not be released without written consent of the resident or his responsible party.

* Privacy during visits with spouse.

* Share a room, in the case of married residents, unless medically contraindicated by a physician in writing.

WORK

Every resident has the right to refuse work. No resident is required to perform any service for the nursing home.

ACTIVITIES

AS A RESIDENT, YOU HAVE THE RIGHT TO:

* Participate in activities of social, religious, and community groups unless medically contraindicated in writing by your physician.

* Refuse to participate in activities.

* Be provided a schedule of daily activities that allow flexibility in what you will do and when you will do it.

* Individual preferences regarding such things as food, clothing, religious activities, friendships, activity programs and entertainment. Such preferences shall be elicited and respected by the nursing home staff

PERSONAL POSSESSIONS

EVERY RESIDENT HAS THE RIGHT TO:

* Associate and communicate privately with persons of his choice, and send and receive personal mail unopened unless medically contraindicated and documented by the physician in the medical record.

* Space to receive visitors in reasonable comfort and privacy.

* Retain and use personal possessions and clothing as space permits.

IF YOU FEEL YOUR RIGHTS HAVE BEEN VIOLATED BY THE LONG TERM CARE FACILITY CALL THE OFFICE OF LONG TERM CARE AT 501-682-8430 OR YOUR LOCAL NURSING HOME OMBUDSMAN AT THE LOCAL AREA AGENCY ON AGING (LISTED IN YOUR TELEPHONE DIRECTORY) OR THE ADULT PROTECTIVE SERVICES AT 501-682-8491.

4001 Definitions

As used in these regulations, the following definitions will apply, unless the context requires otherwise.

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:

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

4007 Class C Violations

4008 Class D Violations

4009 Notification of Violations

4010 Hearings on the Imposition of Civil Money Penalties

4011 Denial of Admissions