Current through Register Vol. 49, No. 9, September, 2024
The following rules for the licensure of residential long term
care facilities are duly adopted and promulgated by the Arkansas Department of
Human Services, Division of Medical Services, Office of Long Term Care,
pursuant to the authority expressly conferred by the laws of the State of
Arkansas in Arkansas Code Annotated §
20-76-201(b)(3),
§
20-10-203 and
§
20-10-224.
If any provisions of these rules, or the application thereof to
any person or circumstances is held invalid, such invalidity shall not affect
other provisions or applications, and to this end the provisions hereof are
declared severable.
"The Arkansas Department of Human Services is in compliance
with Titles VI and VII of the Civil Rights Act and operated, managed and
delivers services without regard to age, religion, disability, political
affiliation, veteran status, sex, race, color or national origin."
If you need this material in a different format, such as large
print, contact our Americans with Disabilities Act Coordinator at (501)
682-6240 (voice) or 682-8933 (TDD).
100 DEFINITIONS
As used in these rules the following definitions shall apply
unless the context clearly states otherwise. Where these rules refer to an
enactment of the General Assembly, such reference shall include subsequent
enactments or amendments by the General Assembly on the same subject
matter.
Note: Please refer to Appendix C of these rules for a listing
of Arkansas Statutes as referenced in the following definitions.
Absence - Circumstances where the resident
cannot be located or has left a facility and there is sufficient question as to
the whereabouts of the resident. Facilities must comply with all reporting
requirements of any special programs in which they participate.
Abuse- Shall have the same meaning as
prescribed by Arkansas Code Annotated §
5-28-101.
Administrator - The person designated as being
in charge of the daily operation of the facility. "Certified administrator"
shall mean an administrator who has completed the certification course offered
by the Arkansas Association of Residential Care Facilities.
Basic Charge - The lowest rate charged by a
facility to a client for specific services for a set period of time.
Boarding Home - Any place, building or
structure, other than a hotel, inn or transient lodging place, which is
offered, used, maintained or advertised to the public as a place of residence
which, incidental to occupancy, may also offer meals and housekeeping services
to the residents, but may not offer or furnish to residents, either directly or
in concert with any entities as defined in Arkansas Code Annotated §
20-10-213
- §
20-10-228,
oversight, supervision or care.
Caregiver - Shall have the same meaning
prescribed by Arkansas Code Annotated §
5-28-101.
Department - The Department of Human Services
or its successor as created by Arkansas Code Annotated §
25-10-101.
Direct Care Staff - A caregiver acting on
behalf of, employed by or under the control or supervision of a licensed
facility.
Direct Threat - A significant risk to the
health or safety of others that cannot be eliminated by reasonable
accommodation. This term as used in these rules is designed to assure
conformity with the Americans with Disabilities Act (ADA) in determining
whether an individual with a disability poses a "direct (health or safety)
threat". This determination must be made on a case-by-case basis, through
consideration of the following factors:
1. The duration of the risk;
2. The nature and severity of the potential
harm;
3. The likelihood that the
potential harm will occur; and
4.
The imminence of the potential harm.
29
CFR 1630.2(r)
This individualized inquiry must be based on the behavior of
the particular disabled person, not merely on generalizations about the
disability.
Division - The Division of Medical Services
within the Department of Human Services and prescribed by Arkansas Code
Annotated §
20-10-101.
Emergency Measures - Those measures necessary
to respond to a serious situation which may result in death or trauma.
Endangered Adult - Shall have the same meaning
as prescribed by Arkansas Code Annotated §
5-28-101.
Exploitation - Shall have the same meaning as
prescribed by Arkansas Code Annotated §
5-28-101.
First Aid Measures - Temporary procedures
necessary to relieve trauma or injury by applying dressing and/or
band-aids.
Imminent Danger to Health and Safety - Shall
have the same meaning as prescribed by Arkansas Code Annotated §
5-28-101.
Impaired Adult - Shall have the same meaning
as prescribed by Arkansas Code Annotated § 5- 28-101.
Independently Mobile - An individual who is
physically and mentally capable of vacating the residential care facility in
case of emergency, including the capability to ascend or descend stairs that
are present in the exit path. Residents who can use canes, wheelchairs or
walkers are considered independently mobile as long as they do not require more
than verbal or minimum assistance from another person to vacate and can do so
in three (3) minutes or as required by local fire code.
Initial Licensure - License that applies to
newly constructed residential care facilities and to all facilities not already
licensed as residential care facilities.
Long Term Care Facility - Shall have the same
meaning as prescribed by Arkansas Code Annotated §
20-10-213.
Long Term Care Facility License - A
time-limited non-transferrable permit required by Arkansas Code Annotated
§
20-10-224
issued for a maximum period of twelve (12) months to a licensee who complies
with Office of Long Term Care rules. This documentation must list the maximum
number of beds for the facility and any limitations thereto.
Mental Illness - A primary impairment of brain
function such as psychosis, neurosis or behavior reaction resulting in
difficulty in adapting to the environment.
Mental Retardation - Subnormal intellectual
functioning often present since birth or apparent in early life, the degree of
which may be indicated by the IQ of 70 (+ or - 5) or below.
Neglect - Shall have the same meaning as
prescribed by Arkansas Code Annotated §
5-28-101.
Office of Long Term Care - The Office in the
Division of Medical Services of the Department of Human Services that has
responsibility for the licensure, certification and regulation of long term
care facilities, herein referred to as the Office.
Personnel - Any person who, under the
direction, control or supervision of facility administration, provides services
for compensation or who provides services voluntarily, and includes the owner,
operator, professional, management and individuals, firms or entities providing
goods or services pursuant to a contract or agreement.
Proprietor/Licensee - Any person, firm,
corporation, governmental agency or other legal entity issued a residential
care facility license and who is responsible for maintaining approved
standards. Facilities owned and operated by entities exempted from state
licensure by state or federal law shall be excluded from these rules.
Protective Services - Shall have the same
meaning as prescribed by Arkansas Code Annotated §
5-28-101.
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.
Residential and Adult Day Care Section - The
unit within the Office of Long Term Care charged with survey, licensure and
complaint investigations for residential care facilities and adult day care
facilities.
Residential Care Facility (RCF) - Shall have
the same meaning as prescribed by Arkansas Code Annotated §
20-10-101(14).
Residential Care Facility Services - Services
provided, in accordance with these rules, to independently mobile adult
residents whose functional capabilities may have been impaired but who do not
require hospital or nursing home care on a daily basis but could require other
assistance in activities of daily living. A residential care facility does not
provide nursing or medical services and shall not offer, attempt to provide or
provide services to an individual in need of hospitalization, substance abuse
treatment, or nursing services. Residential care facility personnel may not
administer or attempt to administer medications.
Supportive Services - Occasional or
intermittent direction or monitoring of an individual resident as he/she
carries out activities of daily living and social activities. Supportive
services do not include continuous monitoring or delivery of actual hands-on or
physical assistance to a resident in the performance of the activities of daily
living.
Transfer - The movement of a resident from one
facility to another facility. Transfer does not include room changes within the
same facility.
Undue Burden - This term as used in these
rules is designed to assure conformity with the Americans with Disabilities Act
(ADA) in a determination that an individual's service needs are greater than
what the facility is licensed to provide and to that end shall be liberally
construed to effectuate the intent of the ADA. Before a facility may deny
admission or discontinue care based on a disability, meeting the individual's
needs must be shown to place an undue burden on the facility or to
fundamentally alter the program to the point where residential services are no
longer being provided.
In order to determine if an alteration would be an undue
burden, the following factors are to be considered:
1. The nature and cost of the action
needed;
2. The overall financial
resources of the site or sites involved in the action; the number of persons
employed at the site; the effect on expenses and resources; legitimate safety
requirements that are necessary for safe operation;
3. The geographic separateness, and the
administrative or fiscal relationship of the site or sites in question to any
parent corporation or entity;
4.
The overall financial resources of any parent corporation or entity; the
overall size of the parent corporation with respect to the number of its
employees; the number, type, and location of its facilities; and
5. The type of operation or operations of any
parent corporation or entity, including the composition, structure, and
functions of the workforce of the parent corporation or entity.
28
CFR 36.104
200 LICENSURE
200.1 No residential long term care facility
may be established, conducted or maintained in Arkansas without first obtaining
a long term care facility license as required by Arkansas Code Annotated §
20-10-201, et.
seq. and these licensing standards. All licenses issued hereunder are
non-transferable from one owner/proprietor to another and from one site or
location to another.
200.2 These
licensing requirements shall apply to all residential long term care facilities
existing in the State of Arkansas on or after the effective date of these rules
except as follows:
a. Any facility which was
initially licensed prior to the effective date of these rules shall be deemed
to satisfy the criteria set forth herein for purposes of licensure
renewal.
b. If a facility changes
ownership and the buyer and seller comply with the notice provisions set forth
in Section 204.7 of these rules, a license shall be issued to the buyer upon
the same terms and conditions as would have been imposed upon the seller as
though the license is being renewed.
c. If a facility initially licensed prior to
the effective date of these rules is modified, altered or amended, such
modification, alteration or amendment must comply with the rules in effect at
the time the modification, alteration or amendment is completed and placed into
service.
d. If a facility closes or
if a license is revoked, no new license shall be issued until the facility
satisfies criteria in effect at the time of application for a new
license.
201 LICENSING
INFORMATION
201.1 Licenses to operate a
residential long term care facility are issued on the state fiscal year basis
beginning July 1st and expiring the following June 30th.
201.2 Licenses shall be issued only for the
premises and persons specified in the application and shall not be
transferable.
201.3 Licenses shall
be posted in a conspicuous place on the licensed premises.
201.4 Separate licenses are required for
residential care facilities maintained on separate premises, even though they
are operated under the same management.
201.5 Every residential care facility owner
or operator shall designate a distinctive name for the facility, which shall be
included on the application for a license. The name of the facility shall not
be changed without first notifying the Office of Long Term Care in writing. The
change will be made when renewal of license is due.
202 LICENSURE EXCLUSIONS
202.1 Facilities owned and operated by the
Veteran's Administration are excluded from licensure under these
rules.
202.2 Facilities regulated
or licensed by the Department of Human Services' Division of Developmental
Disabilities Services or Division of Mental Health Services shall be excluded
from licensure under these requirements.
202.3 Facilities regulated by the Bureau of
Alcohol and Drug Abuse Prevention of the Arkansas Department of Health shall be
excluded from licensure under these rules.
203 INITIAL LICENSURE
203.1 Initial licensure shall apply to:
a. Newly constructed facilities designed to
operate as residential long term care facilities;
b. Existing structures not already licensed
as a residential long term care facility on the effective date of these rules;
and
c. Facilities that change
ownership as specified in Sections 204 and 205.
203.2 An initial license will be effective on
the date that the Office of Long Term Care determines the facility to be in
compliance with these licensing standards and will expire on the first June
30th following the issuance of the license.
204 APPLICATION, EXPIRATION AND RENEWAL OF
LICENSE
204.1 The Department shall furnish the
applicant or the licensee with the necessary forms to obtain initial or renewed
licensure or to request relicensure of the facility after a change of ownership
(see Section 204.7 below and Section 205). The issuance of an application form
is in no way a guarantee that the completed application will be acceptable or
that a license will be issued by the Department. A determination of licensure
will be made by the Department within 30 days of receipt of the completed
application.
204.2 The facility
shall not admit any residents until the license to operate a residential long
term care facility has been issued.
204.3 Applicants for initial license, renewal
or relicensure after a change in ownership, shall pay in advance, a license fee
of $5.00 per bed, which shall be paid to the Department. Such fee shall be
refunded to the applicant if a license is denied.
204.4 Annual renewal is required for all
residential long term care facility licenses. Licenses are effective on the
state fiscal year (July 1 through June 30) basis and expire on June 30th of
each year.
204.5 Applications for
annual license renewal shall be delivered, or if mailed, postmarked to the
Office of Long Term Care no later than June 1st before the June 30th expiration
of the license. Any license fee not paid when due is subject to a ten percent
(10%) penalty.
204.6 Applications
shall be signed by the administrator or owner of the facility.
204.7 When a change in ownership of
controlling interest in the facility is sold by person or persons named in the
license to any other person or persons the existing license and the new owner
shall, at least 30 days prior to completion of the sale, submit a new
application and license fee, be inspected and meet the applicable standards and
rules. Such change in ownership shall be reported by the seller in writing to
the Office of Long Term Care at least thirty (30) days before the change is to
be implemented. The buyer shall be subject to any plan of correction submitted
by the licensee and approved by the Department. The seller shall remain liable
for all penalties assessed against the facility which are imposed for
violations or deficiencies occurring prior to the sale of ownership or
operational control. The Department shall consider and may deny a license based
upon any criteria provided for at Arkansas Code Annotated §
20-10-224(f)(1).
204.8 The applicant/licensee must furnish the
following information:
a. The identity of
each person having (directly or indirectly) an ownership interest of five
percent (5%) or more in the facility;
b. The full name and address of the
residential long term care facility for which license is requested, and such
additional information as the Department may require, including affirmative
evidence of ability to comply with such reasonable standards, rules as are
lawfully prescribed hereunder;
c.
In case such facility is organized as a corporation, the identity of each
officer and director of the corporation;
d. In case such facility is organized as a
partnership, the identity of each partner;
e. A statement from the facility that they
are responsible for any funds that they handle for the residents, including
personal allowance funds. (If funds are stolen or lost, the facility is
responsible for replacing the funds);
f. A copy of any required service
agreement/contract meeting specifications in Section 303 of these
rules.
205
CHANGE IN OWNERSHIP
205.1 Transactions
constituting a change in ownership include, but are not limited to, the
following:
a. Sale or donation of the
facility's legal title;
b. Lease of
the entire facility's real and personal property;
c. A sole proprietor becomes a member of a
partnership or corporation, succeeding him as the new operator;
d. A partnership dissolves;
e. One partnership is replaced by another
through the removal, addition or substitution of a partner;
f. Two or more corporations merge and the
originally-licensed corporation does not survive;
g. Corporations consolidate; and
h. A non-profit corporation becomes a general
corporation, or a for-profit corporation becomes non-profit.
205.2 Transactions which do not
constitute a change of ownership include, but are not limited to, the
following:
a. Changes in the membership of a
corporate board of directors or board of trustees;
b. Two (2) or more corporations merge and the
originally licensed corporation survives;
c. Changes in the membership of a non-profit
corporation.
206 REVOCATION OF LICENSE
The Department is empowered to deny, suspend or revoke a
license on any of the following grounds:
a. Violations of any of the provisions of
Arkansas Code Annotated §
20-10-201, et.
seq., pursuant to licensing authority.
b. Permitting, aiding or abetting the
commission of any unlawful act in connection with the operation of a
residential long term care facility.
c. Non-compliance with inspections conducted
pursuant to applicable federal, state, county or municipal laws, rules,
regulations or ordinances.
d.
Failure to make available all records necessary to satisfy licensure
requirements or denial of admission or access to representatives or agents of
the Department for purposes of licensure inspection or investigation.
e. Accepting and retaining residents for whom
the facility cannot provide services as defined in Section 309.1.1 of these
rules.
207 NOTICE AND
PROCEDURE ON HEARING PRIOR TO DENIAL, SUSPENSION OR REVOCATION OF A LICENSE
Procedures for appeal to the Long Term Care Facility Advisory
Board are incorporated in these rules as Appendix A.
208 APPEALS TO COURT
Any applicant or licensee who considers himself/herself injured
in his/her person, business or property by final Department administrative
adjudication shall be entitled to judicial review thereof as provided for by
law. Proceedings for review shall be initiated 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 30 days after service upon the
petitioner of the Department's final decision. All petitions for judicial
review shall be in accordance with the Arkansas Administrative Procedure Act as
codified at Arkansas Code Annotated §
25-15-201 et
seq.
209 COMPLIANCE
An initial license will not be issued until an owner has
demonstrated to the satisfaction of the Department that the facility is in
compliance with the licensing standards set forth in these rules.
210 NON-COMPLIANCE
When non-compliance with licensing standards is detected during
survey inspection or investigation, the licensee will be notified of the
violations. A plan of correction will be requested. The plan of correction must
be submitted to the Department within 10 days of receipt of the notice and must
establish the means by which the violation will be corrected and a timetable
for implementation of the corrections. If an item of non-compliance that
affects the health and safety of residents is not promptly corrected, the
Office of Long Term Care shall have the option to sanction or initiate action
to suspend or revoke the facility's license.
211 CLOSURE
Any residential care facility that notifies the Office of Long
Term Care that it has or will close or cease operation, or surrenders or fails
to timely renew its license must meet the rules then in effect for new
construction and licensure to be eligible for licensure.
212 INJUNCTIONS
The Office of Long Term Care, working with assistance from the
Department of Human Services, Office of Chief Counsel, may bring action for a
temporary restraining order, preliminary injunction, or permanent injunction
against the owner/administrator/licensee of a residential long term care
facility to enjoin one or more of the following:
1. Operation of:
a. An unlicensed facility;
b. A previously licensed facility which has
had its license suspended or revoked;
c. A licensed facility for which procedures
for non-renewal or revocation of the facility's license has been initiated and
an emergency exists.
2.
Acts or omissions which constitute a violation of laws or promulgated rules. If
the violation does not pose an immediate or imminent threat to the health,
safety or welfare of the residents of the facility, the facility shall be
afforded a reasonable opportunity to correct the violation prior to the
Department seeking judicial relief.
3. Admission of new residents into a home:
a. Which is operating without a
license;
b. Which has had its
license suspended or revoked;
c.
Which is presently involved in proceedings for non-renewal revocation of the
license and there is reason to believe an emergency exists;
d. In which continued admissions into the
facility will place the lives, health, safety and welfare of the present and
future residents in imminent danger.
213 RELOCATION OF RESIDENTS
The Office of Long Term Care may relocate residents from a
residential long term care facility if any of the following conditions
exists:
1. One or more violations
remain uncorrected after efforts seeking compliance have failed and the
violation significantly impairs the licensee's ability to provide an adequate
level of service and assistance to the number of residents indicated on the
license.
2. An emergency exists in
the facility.
3. The licensee
voluntarily closes the facility.
4.
The facility requests the aid of the Office of Long Term Care in the removal of
residents and the removal is made:
a. With
consent of residents;
b. For valid
medical reasons;
c. For the welfare
of the resident or other residents.
214 SUSPENSION OF NEW ADMISSIONS
214.1 The Office of Long Term Care may
suspend the admission of residents to a residential long term care facility on
the following grounds:
a. One or more
deficiencies remain uncorrected after efforts to attain compliance have failed,
and the deficiencies affect the health and safety of residents or impair the
licensee's ability to provide adequate services or assistance to the total
number of residents indicated on the license;
b. An emergency exists in the facility and
the health and safety of the residents are threatened.
214.2 Before new admissions are suspended,
the licensee shall receive prompt notice of the Department's decision. The
suspension shall terminate upon the Department's determination that the
facility is in substantial compliance or upon successful appeal of the
suspension by the licensee.
215 PROVISIONAL LICENSURE
Subject to the requirements below, a provisional license shall
be issued to the Applicant and new operator of the long-term care facility when
the Office of Long Term Care has received the Application for Licensure to
Conduct a Long Term Care Facility. A provisional license shall be effective
from the date the Office of Long-Term Care provides notice to the Applicant and
new operator, until the date the long-term care license is issued. With the
exception of Medicaid or Medicare provider status, a provisional license
confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
1. The purchaser and the seller of the
long-term care facility shall provide the Office of Long Term Care with written
notice of the change of ownership at least thirty (30) days prior to the
effective date of the sale.
2. The
Applicant and new operator of the long-term care facility shall provide the
Office of Long Term Care with the application for licensure, including all
applicable fees.
3. The Applicant
and new operator of the long-term care facility shall provide the Office of
Long Term Care with evidence of transfer of operational control signed by all
applicable parties.
A provisional license holder may operate the facility under a
new name, whether fictitious or otherwise. For purposes of this section, the
term new name means a name that is different than the name
under which the facility was operated by the prior owner, and the term
"operate" means that the provisional license holder may hold the facility out
to the public using the new name. Examples include, but are not limited to,
signage, letterhead, brochures or advertising (regardless of media) that bears
the new name.
In the event that the provisional license holder operates the
facility under a new name, the facility shall utilize the prior name in all
communications with the Office of Long Term Care until such time as the license
is issued. Such communications include, but are not limited to, incident
reports, notices, Plans of Correction, and MDS submissions. Upon the issuance
of the license, the facility shall utilize the new name in all communications
with the Office of Long Term Care.
300 ADMINISTRATION
301 GOVERNING BODY
Each residential long term care facility must have a governing
body that has ultimate authority for:
1. The overall operation of the
facility;
2. The adequacy and
quality of care;
3. The financial
solvency of the facility and the appropriate use of its funds;
4. The implementation of the standards set
forth in these rules; and
5. The
adoption, implementation and maintenance, in accordance with the requirements
of state and federal laws and regulations and these licensing standards, of
resident care policies and administrative policies governing the operation of
the facility.
302
GENERAL PROGRAM REQUIREMENTS
Each person or legal entity issued a license to operate a
residential long term care facility shall provide an organized, continuous
24-hour-per-day program of supervision, care and services which:
1. Conforms with Office of Long Term Care
rules;
2. Meets the needs of the
residents of the facility;
3.
Assures the full protection of residents' rights; and
4. Promotes the social, physical and mental
well-being of residents.
303 REQUIRED SERVICE AGREEMENT/CONTRACTS
303.1 If a service required under these rules
is not provided directly by the facility, the facility must have a written
agreement/contract with an outside program, resource or service to furnish the
necessary service.
303.2 A
residential long term care facility that admits or retains persons with a
diagnosis of mental illness/disorder in need of active treatment must make
arrangements with a mental health service provider for the provision of an
active treatment plan. This provision shall apply regardless of the size of the
residential long term care facility.
304 INSPECTIONS BY DEPARTMENT
304.1 All areas of the licensed facility and
all records related to the care and protection of residents, including resident
and employee records, must be open for inspection by the Department for the
purpose of enforcing these rules. The Department or its agents shall be
afforded reasonable access to books and papers relating to the
facility.
304.2 The facility must
provide for the maintenance and submission of such statistical, financial or
other information, records or reports, in such form and at such time and in
such manner as the Department may require.
304.3 Facilities must provide a written
acceptable plan of correction within 10 days of receipt of written notification
for deficiencies found during routine inspections, special visits and complaint
investigations;
304.4 The facility
must post the Statement of Deficiencies from the latest survey in a prominent
location within the facility.
304.5
The Director of the Office of Long Term Care may assess fines and sanctions
against residential long term care facilities as specified in Appendix B of
these rules.
305
FACILITY ADMINISTRATOR REQUIREMENTS
305.1 Each
facility must have a full-time (minimum 40 hours per week) administrator on the
premises during normal business hours. The administrator must have
responsibility for daily operation of the facility. Correspondence between the
Office of Long Term Care and the facility must be through the
administrator.
305.2 The
administrator must not leave the residential care facility premises during the
day tour of duty without first delegating authority to a qualified individual
who will manage the facility temporarily during the administrator's
absence.
305.3 The facility
administrator must notify the Office of Long Term Care in writing if the
administrator's absence from the facility will exceed seven (7) consecutive
days. The name of the individual who will be in charge of the facility must be
listed in the letter.
305.4 Each
administrator will provide to the Office of Long Term Care on an annual basis a
copy of his/her current administrator certification certificate. All
certifications must be current within the limits of the certification agency.
This submission shall be made at the same time the facility seeks licensure,
renewal of licensure or upon a change of administrators.
305.5 The administrator must have the
following minimum qualifications:
a.
(1) Must be currently certified as a
Residential Care Facility Administrator through a certification program
approved by the Office, or must be in an approved certification program with an
expected completion date of no more than eighteen (18) months from the
effective date of these rules; or
(2) Must have satisfactorily completed a
course of instruction and training prescribed by the Office. The course shall
be designed as to content and administered so as to present sufficient
knowledge of the needs properly to be served by long term care facilities, laws
governing the operation of long term care facilities and the protection of the
interests of residents therein, and the elements of good long term care
facility administration; or
(3)
Must present evidence of satisfactorily completing an approved training program
to administer, supervise and manage a long term care facility; or
(4) Must have participated for one (1) year
in an administrator-in-training program approved by the Office;
b. Must be at least 21 years of
age, of good moral character and of sound physical and mental health.
"Character" and "health" may be determined by an investigation conducted by the
Office that may include such information as criminal records, doctor
statements, and any other information as requested by the Office.
c. Must be a high school graduate or have a
GED (Individuals serving as an administrator on the effective date of these
rules shall be deemed to have satisfied this criterion);
d. Must have the ability to comply with these
rules;
e. Must have no prior
conviction pursuant to Arkansas Code Annotated §
20-10-401 or
relating to the operation of a long term care facility (check
references);
f. Must not have been
convicted of abusing, neglecting or mistreating individuals (check adult abuse
register maintained by the Department of Human Services, Division of Aging and
Adult Services).
g.
306 REQUIRED POLICIES
AND PROCEDURES GOVERNING GENERAL ADMINISTRATION OF THE FACILITY
The facility must develop, maintain and make available for
public inspection the following policies and procedures:
1. Resident policies and procedures as
specified in Section 307;
2.
Admission policies as specified in Section 309;
3. Discharge and transfer policies as
specified in Sections 309.3 and 311.4;
4. Incident reporting policies and procedures
as specified in Section 310, including procedures for reporting suspected
abuse/neglect as specified in Section 310.7;
5. Policies and procedures for the management
of resident personal allowance accounts as specified in Section 311;
6. Residents' Rights policies and procedures
as specified in Section 312;
7.
Fire safety standards as specified in Section 308.1(f);
8. Smoking policies for residents and
facility personnel as specified in Section 308.1(g)
9. Policy and procedures regarding visitors,
mail and associates as specified in Section 312.15;
10. Policy and procedures regarding emergency
treatment plans as specified in Section 403.3;
11. Policy and procedures for the relocation
of residents in cases of emergencies (e.g. natural disasters, utility outages,
etc.).
307 GENERAL
REQUIREMENTS CONCERNING RESIDENTS
The facility must have written resident policies and procedures
that shall include, as a minimum, the following:
1. Established visiting hours must be posted
in plain view of visitors. Unrestricted visiting hours are
recommended.
2. Keys must be
readily available to facility personnel in charge of all locked doors within
the facility.
3. Pets may be
permitted in residential long term care facilities if sanitary conditions are
maintained. Current records of inoculations and license, as required by local
ordinance, must be maintained on file in the facility. Pets must not be allowed
in food preparation, storage or serving areas.
4. A quiet atmosphere shall be maintained.
Disturbances created within the facility will not be permitted.
5. Adult male and female residents must not
have adjoining rooms which do not have full floor to ceiling partitions and
closable solid core doors. Adult male and female residents must not be housed
in the same room (except husband and wife of the same marriage, or consenting
adults who request, and agree in writing executed by the resident, guardian or
responsible party as appropriate and maintained by the facility, to share a
room).
6. Residents may not perform
duties in lieu of direct care staff, but may be employed by the facility in
other capacities.
7. Residents
shall not be left in charge of the facility.
8. The facility will keep a written record of
life insurance policies purchased for the residents when the facility is named
as a beneficiary.
9. There must be
at least one telephone which is accessible at all times in case of emergency
and must be able to access either "911" or "0" without use of coins. Residents
must have access to a public telephone at a convenient location within the
facility.
308 PERSONNEL
ADMINISTRATION
308.1 Each facility must have
written employment and personnel policies and procedures which will include, as
a minimum, the following:
a. All employees
caring for residents must be at least 18 years of age;
b. No person with a communicable disease or
infected skin lesion that poses a direct threat to the health or safety of
other individuals in the workplace shall be permitted to work in the
facility;
c. No person who has been
convicted of abusing, neglecting or mistreating individuals may be employed in
the facility;
d. All employees must
have a skin test for tuberculosis within the first two (2) weeks of employment
and annually thereafter. Skin tests for tuberculosis are to be administered and
read by the local Health Department or personal physician. The results of the
test will be listed in the employee's personnel record;
e. A copy of all personnel policies and
procedures must be available to all facility personnel and to OLTC personnel
and any other Departmental entities having legal access authority;
f. Policies and procedures must be developed
for personnel about fire safety standards;
g. Policies and procedures must be developed
for smoking in the facility.
308.2 Sufficient staff must be present at all
times to meet the needs of the residents, including preparation of nutritional
meals, cleaning of the facility and provision of supportive services. Staffing
requirements will be based on current census rather than licensed capacity.
Required staff/resident ratios based on current resident census are for large
and small facilities:
|
# Residents |
Direct Care Staff Required Per Shift |
|
Day |
Evening |
Night |
|
1-16 |
1 |
1 |
1 |
|
17-32 |
2 |
1 |
1 |
|
33-49 |
2 |
2 |
2 |
|
50-66 |
3 |
2 |
2 |
|
67-83 |
4 |
2 |
2 |
|
84-above |
5 |
3 |
2 |
a. Other staff
requirements that affect small facilities (16 or fewer beds) are as follows:
a. Each staff person on duty may be
counted as direct care staff even if they are currently involved in
administrative, housekeeping or dietary activities;
b. The night person may be asleep in the
facility.
308.2.2 Other staff
requirements that affect large facilities (over 16 beds) are as follows:
a. For large facilities, the staffing table
shown above shall apply to direct care staff only and does not include
administrative, housekeeping or dietary staff.
b. The facility administrator shall not be
scheduled as direct care staff for purposes of meeting minimum staffing
requirements during normal business hours as referenced in Section
305.1.
c. In large facilities with
17 or more residents, staff involved in food and dietary services shall not be
permitted to perform non-food or non-dietary services during the same
shift.
d. In a multi-building
facility, at least one direct care staff person must be on duty and awake
during all hours. A relief direct care staff person must be available in the
facility to relieve direct care staff for meals, breaks, etc. and to cover if a
direct care staff person must leave the facility in an emergency.
e. The staffing schedule must be posted in
the facility.
f. The Office may
grant waivers to staffing standards in situations where the facility
demonstrates an ability to adequately meet service requirements with fewer
staff.
308.3
Orientation records will be maintained for each employee to include but not
limited to:
a. Job duties;
b. Orientation to resident rights;
c. Abuse/neglect reporting requirements;
and
d.
d.
Fire and tornado drills.
308.4 Four (4) hours of in-service training
or continuing education pertinent to the operation of a residential long term
care facility must be provided on a quarterly basis for all employees who have
direct contact with residents. Training must include (but not limited to):
a. Resident Rights;
b. Evacuation of building;
c. Safe operation of fire
extinguishers;
d. Incident
reporting;
e. Medication
supervision.
308.5 The
facility must establish and maintain a personnel file for each employee. At a
minimum, each employee's personnel file must contain:
a. Application for employment, including
resume if available;
b. Reference
checks, including name and position of person contacted and a statement that
references were checked;
c. License
or certificate, as appropriate (copy on file);
d. Current health card or copy;
e. Job description of the position the
employee occupies;
f. Facility
orientation documentation;
g. The
employee's signed acknowledgement that he/she has received and read a copy of
the Resident Rights;
h. Job
orientation documentation as required;
i. in-service training
documentation.
308.6
Employment applications for each employee must contain sufficient information
to support placement in the position to which each employee is
assigned.
308.7 Written job
descriptions must be developed for each employee classification (e.g.,
administrator, housekeepers, etc.), and shall include, as a minimum:
a. The responsibilities and/or actual work to
be performed in each classification;
b. The educational qualifications;
c. The physical requirements necessary to
perform the essential functions of the job; and
d. The licenses or certificates required for
each job classification.
309 ADMISSION, DISCHARGE AND TRANSFER
The facility must not admit or continue to care for residents
whose needs are greater than the facility is licensed to provide. If necessary
services cannot be obtained in or by the facility, the resident and/or
responsible party will be notified to seek alternate placement immediately. The
facility administrator should assist in helping to locate a facility that can
provide the appropriate level of care.
309.1 The facility must develop and implement
written admission policies and criteria that include, as a minimum,
requirements that the applicant/resident:
a.
Be eighteen (18) years of age or older;
b. Be independently mobile as defined in
Section 100;
c. Be able to
self-administer medications as outlined in Section 601;
d. Be capable of understanding and responding
to reminders and guidance from staff;
e. Is not totally incontinent of bowel and
bladder;
f. Does not have a feeding
or intravenous tube;
g. Does not
have a communicable disease that poses a direct threat to the health or safety
of other residents or staff;
h.
Does not need nursing services which exceed those that can be provided by a
certified home health agency on a temporary or infrequent basis;
i. Does not have a level of mental illness,
mental disorder, mental retardation, dementia, Alzheimer's disease, or
addiction to alcohol/drugs that requires a higher level of medical, nursing,
psychiatric care or active treatment than can be safely and effectively
provided in the residential care facility setting;
j. Does not require religious, cultural, or
dietary regimens that cannot be met by the facility without undue
burden;
k. Does not require
physical restraints, lock up, confinement, or have current violent behavior,
nor is the resident being admitted against his/her will by court order, or
being released from a correctional facility.
The facility will interview and document all prospective
residents and/or sponsors prior to admission in order to determine the needs of
the prospective resident and whether the facility can meet these needs.
309.2 Each facility
must provide to the resident and/or his/her responsible party at or prior to
admission and periodically thereafter as required, a written admission
agreement or contract duly executed, dated and signed by the facility
administrator and the resident and/or responsible party. A copy of the signed
agreement must be maintained in the resident's permanent record. The agreement
shall be printed and must contain, at a minimum, the following:
a. A statement describing all services,
materials, equipment and food to be included within the basic charge. The
agreement/contract must also state additional services delivered to the
resident and the additional charges to be paid by the resident;
b. A written acknowledgement that the
resident and/or responsible party has been notified of the charges for
services;
c. The conditions and
rules governing residency;
d. The
conditions and rules governing termination of a resident's placement in the
facility;
e. If the resident
receives state or federal funding, other than Medicaid, the amount must be
included in the agreement. If the resident is private pay there may be a
disclaimer signed by the responsible party that they have received a copy of
the charges;
f. A provision that no
additional charges shall be levied against the resident by the facility for
basic residential care facility services identified in the admissions agreement
or contract;
g. The conditions
under which the facility may adjust the basic monthly or daily rate and charges
for supplemental services and supplies, including the provision of a written
notification to the resident or responsible party, by providing prompt notice
of all changes in price prior to implementation.
h. A written refund policy that addresses
refund of advance payment(s) in the event of transfer, death, voluntary or
involuntary discharge. The policy shall include, as a minimum, the following:
1. For a fourteen-day period beginning on the
date of entry into a facility, the resident shall have the right to rescind any
contractual obligation into which he/she has entered and receive a full refund
of any moneys transferred to the facility. If the resident entered the facility
and received some benefit therefrom, the charges of the services provided shall
be prorated and payment made only for the benefits conferred prior to the
refund;
2. Residents with income of
SSA/SSI benefits shall receive refunds on a pro-rata basis from that income
source, without regard for the reason of transfer;
3. In the event of transfer for medical
reasons, the refund policy must address the resident's need to maintain
on-going medical care and services, and for that reason refunds shall be on a
pro-rata basis, regardless of income source.
4. If, after the expiration of the 14 day
period referenced in 309.2 (h)(1) above, the resident provides a ten (10) day
notice, any applicable refund shall be available the day the resident leaves
the facility. If the resident does not provide a ten (10) day notice, any
applicable refund will be available within ten (10) days of the resident's
departure.
i. A
statement that the resident or his/her legal representative shall have the
right to discharge the resident from the facility.
309.3 The facility must develop and implement
written discharge and transfer policies and procedures that include, at a
minimum, the following:
a. A resident may be
transferred or discharged only when:
1. The
resident's medical needs cannot be met by the facility, or a certified home
health agency, on a temporary or infrequent basis;
2. The resident presents a danger to the
health, safety or welfare of himself or others;
3. Non-payment for his/her stay; or
4. The facility ceases operation.
b. The reasons for transfer or
discharge of a resident must be documented in the resident's permanent record
and the transfer or discharge must be discussed with the resident his guardian
or personal representative, who must be given a copy of the documentation
setting forth the alternatives available. This notice must be given 30 days
prior to the date of transfer or discharge. Transfer for the welfare of the
resident or other residents may be effected immediately if the need for such
action is documented in the record;
c. The term "transfer" applies to the
movement of a resident from one facility to another facility and does not apply
to a change in room assignment or services within the same facility;
d. "Medical reasons" for transfer or
discharge must be based on the resident's needs and are to be determined and
documented by a physician. The resident's permanent record shall contain
documentation of medical reasons for transfer or discharge.
e. A written appeals process for residents
objecting to transfer or discharge must be developed by the facility in
conformity with Arkansas Code Annotated §
20-10-1005,
as amended, as well as all applicable rules. That process shall include:
1. The written notice of transfer or
discharge must state the reason for the proposed transfer or discharge as
documented in 309.3(b). The notice must inform the resident that he/she has the
right to appeal the decision to the Director within seven (7) calendar days.
The resident must be assisted by the facility in filing the written objection
to transfer or discharge;
2. Within
fourteen (14) days of filing of the written objections, a hearing will be
scheduled;
3. A final determination
in the matter will be rendered within seven (7) days of the hearing.
f. The facility must provide
assistance to residents to ensure a safe and orderly transfer or
discharge;
g. The facility, in
conjunction with the responsible party, must make arrangements to transfer
residents who require a higher level of medical, nursing or psychiatric care
than can be safely and effectively provided in a residential long term care
facility setting. (Refer to Section 309.1.1);
h. If the Office of Long Term Care determines
that a resident is inappropriate for continued placement in the facility, the
provider must arrange for transfer of the resident within ten (10) days of such
notification. Less time may be given by the Office of Long Term Care when a
resident's life or health requires immediate medical attention. The
responsibility for the resident's care or lack of care shall rest with the
provider. If the Office of Long Term Care determines that the transfer of a
resident is necessary for reasons other than appropriateness of placement, the
Office may afford the facility up to 30 days to effectuate the
transfer;
i. Upon transfer of a
resident to a health, mental health or other residential long term care
facility, a copy of all pertinent resident records, as required by this section
of the rules, must accompany the resident, except when emergency situations
prohibit such transmittal. In such cases, pertinent information shall be
telephoned to the receiving facility immediately and written transfer documents
sent within 72 hours;
j. The
facility must assist all residents proposed to be discharged or transferred to
assure the resident's placement in a care setting which is adequate and
appropriate to the resident's condition and, where possible, consistent with
the wishes of the resident.
310 The facility must develop and implement
written policies and procedures to ensure that 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 rules.
A facility is not required under this rule to report death by
natural causes. However, nothing in this rule 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 rules, 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.
310.1
NEXT-BUSINESS-DAY REPORTING OF INCIDENTS
The following events shall be reported to the Office of Long
Term Care by facsimile transmission to telephone number 501-682-8551 of the
completed Incident & Accident Intake Form (Form DMS-7734) no later than
11:00 a.m. on the next business day following discovery by the facility.
a. Any alleged, suspected or witnessed
occurrences of abuse or neglect to residents.
b. Any alleged, suspected or witnessed
occurrence of misappropriation of resident property, or exploitation of a
resident.
c. Any alleged, suspected
or witnessed occurrences of verbal abuse. For purposes of this rule, "verbal
abuse" means the use of oral, written, or gestured language that willfully
includes disparaging and derogatory terms to residents, or within their hearing
distance, regardless of their age, ability to comprehend, or disability.
Examples of verbal abuse include, but are not limited to: threats of harm;
saying things to frighten a resident, such as telling a resident that he or she
will never be able to see his or her family again.
d. Any alleged, suspected or witnessed
occurrences of sexual abuse to residents by any individual.
In addition to the requirement of a facsimile report by the
next business day on Form DMS-7734, the facility shall complete a Form DMS-762
in accordance with Section 310.2.
310.2 INCIDENTS OR OCCURRENCES THAT REQUIRE
INTERNAL REPORTING ONLY - FACSIMILE REPORT OR FORM DMS-762 NOT REQUIRED.
The following incidents or occurrences shall require the
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 310.3, as
applicable. Facilities must maintain these incident record files in a manner
that allows verification of compliance with this provision.
a. Incidents where a resident attempts to
cause physical injury to another resident without resultant injury. The
facility shall maintain written reports on these types of incidents to document
"patterns" of behavior for subsequent actions.
b. All cases of reportable disease, as
required by the Arkansas Department of Health.
c. Loss of heating, air conditioning or fire
alarm system of greater than two (2) hours duration.
310.3 INTERNAL-ONLY REPORTING PROCEDURE
Written reports of all incidents and accidents included in
section 310.2 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.
Reports of incidents specified in Section 310.2 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.
310.4 OTHER REPORTING REQUIREMENTS
The facility's administrator is also required to make any other
reports of incidents, accidents, suspected abuse or neglect, actual or
suspected criminal conduct, etc. as required by state and federal laws and
regulations.
310.5 ABUSE
INVESTIGATION REPORT
The facility must ensure that all alleged or suspected
incidents involving resident abuse, exploitation, neglect or misappropriations
of resident property are thoroughly investigated. The facility's investigation
must be in conformance with the process and documentation requirements
specified on the form designated by the Office of Long Term Care, Form DMS-762,
and must prevent further potential incidents while the investigation is in
progress.
The results of all investigations must be reported to the
facility's administrator, or designated representative, and to other officials
in accordance with state law, including the Office of Long Term Care. Reports
to the Office of Long Term Care shall be made via facsimile transmission by
11:00 a.m. the next business day following discovery by the facility, on form
DMS-7734. The follow-up investigation report, made on form DMS-762, shall be
submitted to the Office of Long Term Care within 5 working days of the date of
the submission of the DMS-7734 to the Office of Long Term Care. If the alleged
violation is verified, appropriate corrective action must be taken.
The DMS-762 may be amended and re-submitted at any time
circumstances require.
310.6 REPORTING SUSPECTED ABUSE OR NEGLECT
The facility's written policies and procedures shall include,
at a minimum, requirements specified in this section.
310.6.1 The requirement that the facility's
administrator or his or her designated agent immediately reports all cases of
suspected abuse or neglect of residents of a long-term care facility as
specified below:
a. Suspected abuse or neglect
of an adult (18 years old or older) shall be reported to the local law
enforcement agency in which the facility is located, as required by Arkansas
Code Annotated 5-28-203(b).
b.
Suspected abuse or neglect of a child (under 18 years of age) shall be reported
to the local law enforcement agency and to the central intake unit of the
Department of Human Services, as required by Act 1208 of 1991. Central intake
may be notified by telephone at 1-800-482 -5964.
310.6.2 The requirement that the facility's
administrator or his or her designated agent report suspected abuse or neglect
to the Office of Long Term Care as specified in this rule.
310.6.3 The requirement that facility
personnel, including but not limited to, licensed nurses, nursing assistants,
physicians, social workers, mental health professionals and other employees in
the facility who have reasonable cause to suspect that a resident has been
subjected to conditions or circumstances which have or could have resulted in
abuse or neglect are required to immediately notify the facility administrator
or his or her designated agent.
310.6.4 The requirement that, upon hiring,
each facility employee be given a copy of the abuse or neglect reporting and
prevention policies and procedures and sign a statement that the policies and
procedures have been received and read. The statement shall be filed in the
employee's personnel file.
310.6.5
The requirement that all facility personnel receive annual, in-service training
in identifying, reporting and preventing suspected abuse/neglect, and that the
facility develops and maintains policies and procedures for the prevention of
abuse and neglect, and accidents.
ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-7734
Incident & Accident Next Day Reporting Form
Purpose/Process
This form is designed to standardize and facilitate the process
for the reporting allegations of resident abuse, neglect, misappropriation of
property or injuries of an unknown source by individuals providing services to
residents in Arkansas long term care facilities for next day reporting pursuant
to LTC 310.2.
The purpose of this process is for the facility to compile the
information required in the form DMS-7734, so that next day reporting of the
incident or accident can be made to the Office of Long Term Care.
Completion/Routing
This form, with the exception of hand written witness
statements, MUST BE TYPED!
The following sections are not to be completed by the facility;
the Office of Long Term Care completes them:
1. The top section entitled COPIES
FOR:
2. The FOR OLTC USE ONLY
section found at the bottom of the form.
All remaining spaces must be completed. If the information can
not be obtained, please provide an explanation, such as "moved/address
unknown", "unlisted phone", etc.
If a requested attachment can not be provided please provide an
explanation why it can not be furnished or when it will be forwarded to
OLTC.
The original of this form must be faxed to the Office of Long
Term Care the next business day following discover by the facility. Any
material submitted as copies or attachments must be legible and of such quality
to allow recopying.
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ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-762
Facility Investigation Report for Resident Abuse, Neglect,
Misappropriation of Property, & Exploitation of Residents in Long Term Care
Facilities
Purpose/Process
This form is designed to standardize and facilitate the process
for the reporting allegations of resident abuse, neglect, or misappropriation
of property or exploitation of residents by individuals providing services to
residents in Arkansas long term care facilities. This investigative format
complies with the current rules requiring an internal investigation of such
incidents and submittal of the written findings to the Office of Long Term Care
(OLTC) within five (5) working days.
The purpose of this process is for the facility to compile a
substantial body of credible information to enable the Office of Long Term Care
to determine if additional information is required by the facility, or if an
allegation against an individual(s) can be validated based on the contents of
the report.
Completion/Routing
This form, with the exception of hand written witness
statements, MUST BE TYPED!
Complete all spaces! If the information can not be obtained,
please provide an explanation, such as "moved/address unknown", "unlisted
phone", etc. Required information includes the actions taken to prevent
continued abuse or neglect during the investigation.
If a requested attachment can not be provided please provide an
explanation why it can not be furnished or when it will be forwarded to
OLTC.
This form, and all witness and accused party statements, must
be originals. Other material submitted as copies must be legible and of such
quality to allow re-copying.
The facility's investigation and this form must be completed
and submitted to OLTC within five (5) working days from when the incident
became known to the facility.
Upon completion, send the form by certified mail to:
Office of Long Term Care, P.O. Box 8059, Slot S408, Little
Rock, AR 72203-8059.
Any other routing or disclosure of the contents of this report,
except as provided for in LTC 310.3 and 310.4, may violate state and federal
law.
Facility Investigation Report for Resident Abuse, Neglect,
Misappropriation of Property, & Exploitation of Residents in Long Term Care
Facilities
Section
I -Reporting Information
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Section
II -Complete Description of Incident
"See Attached Is Not
Acceptable!"
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Section
III - Findings and Actions Taken
Please include Resident's current medical condition
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Section
IV
- Notification/
Status
Administrator/Written Designee Must Be Notified!
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Section
VI
- Accused Party Information
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Section
VII
- Attachments
Attach the following information to the back of this form. If
you do not have one of the specified attachments, please provide an explanation
why it can not be obtained or if it will be forwarded in the future.
1. Statement from the accused
party.
2. All witness statements.
Use the attached OLTC Witness Statement Form for all witness statements
submitted. If the statement is a typed copy of a handwritten statement, the
handwritten statement must accompany the typed statement.
3. Law enforcement incident report. This can
be mailed at a later date if necessary.
4. Other pertinent reports/information, such
as Ombudsmen, autopsy, reports, etc. These can be mailed at a later date if
necessary.
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311 FINANCIAL
MANAGEMENT OF RESIDENT PERSONAL ALLOWANCE
311.1 Each facility must provide for the
safekeeping and accountability of resident personal allowance funds in
accordance with this Section (see Section 204.8.e).
311.2 Individuals receiving Supplemental
Security Income (SSI) will be entitled to a monthly personal allowance
consistent with federal requirements for SSI recipients.
311.3 The facility must have written policies
and procedures for the management of personal allowance accounts with an
employee designated to be responsible for these accounts. The facility
responsibilities are as follows:
a Each
individual receiving SSI shall have the opportunity to place personal allowance
funds in an account. No fee shall be charged by the facility for maintaining
these accounts;
b Individuals who
receive SSI are entitled to retain an amount from their income for personal
needs consistent with federal requirements;
c The facility shall hold personal allowance
funds in trust for the sole use of the residents, and such funds must not be
commingled with the funds of the facility or use for any purpose other than for
the benefit of the resident;
d The
resident may terminate the facility-maintained account and receive a check for
the current balance;
e The facility
must maintain individual records for each resident who has an account showing
all deposits, withdrawals and the current balance;
f The facility must document all personal
transactions and maintain all paid bills, vouchers and other appropriate
payment and receipt documentation in the manner prescribed by the
Department;
g The facility may
deposit personal allowance funds in individual or collective interest bearing,
federally insured bank accounts. If these accounts are established, the
facility must develop a procedure to insure the equitable distribution of
interest to each resident's account;
h Quarterly, the facility must supply each
resident or responsible party who has a personal account with a statement
showing all deposits, withdrawals and current balance of the resident's
personal allowance account;
i The
facility must provide the Department access to required resident records upon
request.
311.4 The use
of a resident's personal allowance funds must meet the following conditions:
a Any waiver of the right to a personal
allowance by a resident entitled to the allowance shall be void;
b At a minimum the resident shall have access
to his/her personal allowance account during the hours of 9:00 a.m. to 5:00
p.m. Monday through Friday, according to facility policies and
procedures;
c The personal allowance
shall, at the discretion of the resident, be used in obtaining clothing,
personal hygiene items, and other supplies, services, entertainment or
transportation for personal use not otherwise provided by the facility pursuant
to the admission agreement or required by rule;
d The facility shall not demand, require or
contract for payment of all or any part of the resident's personal allowance in
satisfaction of the facility rate for supplies and services;
e The facility shall not charge the resident
additional amounts for supplies and/or services that the facility is by law,
rule or agreement required to provide under the basic charge;
f Services or supplies provided by the
facility beyond those that are required to be included in the basic charge may
be charged to the individual only with the specific written consent of the
individual or guardian;
g The
individual will be furnished in advance of the provision of the supplies or
services with an itemized statement setting forth the charges for services or
supplies provided by the facility;
h
Whenever a resident authorizes a facility to exercise control over his/her
personal allowance, such authorization must be in writing and subscribed by the
parties to be charged. Any such money shall not be commingled with the funds or
become an asset of the facility or the person receiving the same, but shall be
segregated and recorded on the facility's financial records as independent
accounts.
311.5 Transfer
of resident funds must meet the following requirements:
311.5.a.1 At the time of discharge from the
facility, the resident, legal guardian or other appropriate individual or
agency shall be provided a final accounting of the resident's personal account
and issued a check for the outstanding balance. If the resident is being
transferred to another residential or health care facility, the resident or
his/her representative shall be given an opportunity to authorize transfer of
the balance to a resident account at the receiving facility;
311.5.a.2 Upon the death of a resident, a
final statement of the account must be made and all remaining funds shall be
transferred to the resident's estate, subject to applicable state
laws;
311.5.a.3 Upon change of
ownership, the existing owner must provide the new owner with a written
statement of all resident personal funds. This statement shall verify that the
balance being transferred in each resident fund account is true and accurate as
of the date of transfer;
311.5.a.4
At change of ownership, the new owner must assume responsibility for account
balances turned over at the change of ownership together with responsibility
for all requirements of this Section, including holding of resident's funds in
trust.
311.6 The
facility must provide for inventory records and security of all monies,
property or things of value which the resident has voluntarily authorized, in
writing, the facility to hold in custody or exercise control over at the time
of admission or any time thereafter.
311.7 If a legal guardian or payee fails to
pay a residential care facility's charges or provide for the resident's
personal needs, the facility shall notify the Department of Human Services,
Division of Aging and Adult Services, Adult Protective Services.
312 RESIDENT RIGHTS
312.1 Policies and procedures required by the
facility to assure resident's rights are as follows:
a The facility must have written policies and
procedures defining the rights and responsibilities of residents. The policies
shall present a clear statement defining treatment of residents by all who
provide care or services to residents;
b Any policies of resident conduct which the
facility has finalized and by which it expects residents to abide must be
included in the statement of rights and responsibilities which the resident
signs (refer to Section 309.2.c). These facility policies must be approved by
the Office of Long Term Care;
c A
copy of the synopsis of the Resident's Bill of Rights must be prominently
displayed within the facility;
d
Each resident admitted to the facility is to be fully informed of these rights
and of all rules governing resident conduct and responsibilities. The facility
is to communicate these expectations/rights both orally and in writing during
the period of not more than two weeks before or five working days after
admission. The facility must obtain a signed Resident Rights Statement from the
resident and this statement must be maintained in the resident's record. A
legal guardian or other person responsible for the resident may also sign. For
purposes of this provision, the Resident Rights Statement shall be deemed
appropriately signed by the resident if:
1. Resident capable of understanding: Signed
by the resident before one witness and the witness also signs.
2. Resident incapable because of illness: The
attending physician documents the specific impairment that prevents the
resident from understanding or signing. The resident's responsible party and
two witnesses sign.
3. Resident
mentally incapacitated: The resident's legal guardian is read and explained the
Rights. The legal guardian then signs the Resident Rights Statement before one
witness, who also signs the statement.
4. Resident capable of understanding but
acknowledge with other mark (X): Mark is made by the resident in front of two
witnesses who know the resident and also sign.
e. Effective means shall be utilized to
inform non-English speaking persons or persons with hearing or visual
impairments of the Resident Rights;
f. Staff members will be provided a copy of
the Resident Rights and must fully understand all rights. Staff must complete a
written acknowledgement stating they have received, read and understand the
Resident Rights. A copy of the signed acknowledgement shall be placed in the
employee's personnel file;
g. The
facility's procedures regarding resident's rights and responsibilities will be
formally included in ongoing staff development programs for all personnel,
including new employees.
312.2 The resident's right to know of
services available shall meet the following conditions:
a. Each resident admitted to the facility
will be fully informed, by the time of admission and as need arises during
residency, of services available in the facility, including any charges for
services;
b. Residents have the
right to choose, at their own expense, a personal physician and
pharmacist.
312.3 The
resident's right concerning transfers and discharges:
a. The facility must develop and implement
transfer and discharge policies and procedures as specified in Section
309.3;
b. The facility must give
the resident reasonable written notice of changes in room or roommate when the
change is not requested by the resident.
312.4 The resident's right to constitutional
and legal rights are as follows:
a. Each
resident admitted to the facility will be encouraged and assisted to exercise
all constitutional and legal rights as a resident and a citizen including the
right to vote. The facility shall make reasonable accommodations to ensure free
exercise of these rights;
b.
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;
c. Residents shall have the right to free
exercise of religion including the right to rely on spiritual means for
treatment.
312.5
Resident complaints or suggestions made to the facility's staff must be
responded to within ten (10) days. Documentation of such response will be
maintained by the facility administrator or his/her designee.
312.6 A representative resident council shall
be established in each facility. The resident council's duties shall include:
a. Review of policies and procedures required
for implementation of resident's rights;
b. Recommendation of changes or additions in
the facility's policies and procedures;
c. Representation of residents in their
complaints to the Office of Long Term Care or any other person or
agency;
d. Identification of
problems and orderly resolution of same.
a.
The facility administrator must designate a staff coordinator and provide
suitable accommodations within the facility for the resident 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.
312.7 The facility shall inform resident's
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.
312.8 The
resident has the right to be free from abuse and neglect. Residents shall be
free from mental and physical abuse, and from chemical and physical restraints.
Restraints must not be used on any resident by staff of a residential care
facility except during an emergency and only until appropriate action can be
taken by persons outside the facility. The facility must seek assistance
immediately. Additional clarifications of this provision are as follows:
a. Mental abuse includes humiliation,
harassment and threats of punishment or deprivation;
b. Physical abuse refers to corporal
punishment or the use of restraints as a punishment;
c. Drugs must not be used to limit, control
or alter resident behavior for the convenience of staff;
d. Physical restraints include the use of
devices designed or intended to limit the resident's total mobility. Full
length bed rails are considered restraints and may not be used. The gates of
facilities enclosed by a fence may not be locked to restrict the movement of
residents.
a. Any abuse, neglect or
exploitation must be reported as specified in Section 310.7.
312.9 Each resident is
assured confidential treatment of all information contained in his/her records.
The resident's written consent or legal appointee's written consent is required
for the release of information to persons not otherwise entitled to receive it.
The records shall be available to the Department as needed.
312.10 Each resident will be treated with
consideration, respect and full recognition of dignity and individuality. Staff
shall display respect and courtesy to 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.
312.10.1 Each resident has the right to
receive a response from a facility operator to any request of the resident
within a reasonable period of time.
312.11 Each resident shall have the right to
humane care and an environment which shall include but is not limited to:
a. The right to nutritional diets that follow
the recommended dietary allowance set by the Food and Nutrition Board,
including the right to have a diet which is consistent with any religious or
health-related restrictions;
b. The
right to a safe and sanitary living environment.
312.12 The resident's right to have control
and receipt of health-related services shall include the following:
a. Each resident shall have the right to
retain the services of his/her own personal physician;
b. Each resident shall have the right to
select the pharmacy or pharmacist of his/her choice;
c. Each resident shall have the right to
confidentiality and privacy concerning his/her medical conditions and
treatment;
d. Each resident shall
have the right to select the personal care or home health provider of his/her
choice and the facility shall assure that all such providers selected by the
resident have access for the purpose of delivering necessary
services.
312.13 The
resident shall have freedom of religion that includes the right to practice the
religion of his/her choice or abstain from religious practices. Residents shall
also be free from the imposition of the religious practice of others.
312.14 Each resident shall have the right to
accept or refuse employment or to perform services for the facility. The
resident has the right to accept employment and perform services for the
facility if the following conditions are met:
a. The facility has documented its need for
and the resident's desire to perform the work;
b. Compensation for services is at or above
prevailing rates;
c. The resident
agrees to the work arrangement;
d.
The employment is in keeping with the resident's care plan; and e. The Office
of Long Term Care is notified, in advance, of the work arrangement.
312.15 Each resident shall have
the right to interact freely with others both within the facility and in the
community including the following:
a. The
right to receive and send unopened correspondence and to be provided with pen,
envelopes and stamps at the expense of the resident if the resident is unable
to obtain these for himself;
b. The
right to privately access a telephone for outgoing and incoming
calls;
c. The right to unrestricted
communication including personal visitation with any person of the resident's
choice;
d. The right to make
contacts and interact with the community.
312.15.1 Policies and procedures shall permit
residents to receive visits from anyone they wish. Restrictions may be imposed
for the following reasons:
a. The resident
refuses to see the visitor;
b. The
resident's physician specifically documents that such a visit would be harmful
to the resident's health;
c. The
visitor's behavior is unreasonably disruptive to the facility. This does not
include those individuals who, because they advocate administrative change to
protect resident rights, are considered a disruptive influence by the facility
administrator;
d. The facility has
been ordered by the court or resident's guardian not to allow specified
individuals access to the resident.
312.16 The resident's right to personal
possessions shall include:
a. The right to
wear his/her own clothing;
b. The
right to determine his/her preference of dress, hair style or personal
effects;
c. The right to retain and
use his/her own personal property in the resident's own living area so as to
maintain individuality and personal dignity as agreed upon at the time of
admission;
d. The right to have a
separate storage area in his/her own living area.
312.17 Each resident's privacy shall be
respected in every aspect of daily living, including:
a. During any medical examination or health
related consultations the resident may have at the facility;
b. During visitations with other
persons;
c. In written, verbal and
telephone communications;
d. In the
resident's room or the resident's portion of the room. Staff of a facility
shall not enter a resident's room without making their presence known, except
in an emergency;
e. In the conduct
of the resident's personal affairs;
f. In visual privacy in tub, shower and
toilet rooms;
g. In permitting, but
not requiring, spouses or other consenting adults to share a room where both
are residents and space is available;
h. In taking all reasonable steps to comply
with a resident's expressed wish for privacy in particular activities of daily
living;
i. In permitting
representatives of protection and advocacy groups and community legal services
programs to have full and free access to the facility during normal business
hours.
312.18 Each
resident admitted to the facility may manage their personal financial affairs,
or, if the resident requests, such affairs may be managed by the facility. If
the facility manages residents' funds, then an accounting shall be maintained
in accordance with Section 311.2 of these rules.
312.18.1 In addition to any other
requirements, the facility's management of resident financial affairs shall
meet the following conditions:
a. Should the
facility manage the resident's personal financial affairs, written
authorization must be made and signed as provided in Section 312.1(d) of these
rules.
b. The financial record must
be available to the resident and his/her guardian, and responsible
party;
c. If the facility makes
financial transactions on behalf of a resident, the resident, guardian or
responsible party shall receive an itemized accounting of disbursements and
current balances at least quarterly;
d. A copy of the resident's quarterly
statements shall be maintained in the facility;
e. The facility shall establish and maintain
a system that assures full and complete accounting of resident personal funds
using generally accepted accounting principles;
f. The facility shall not commingle resident
funds with any other funds;
g. 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;
h. When appropriate,
individual savings accounts shall be opened for residents in accordance with
Social Security rules governing savings accounts;
i. A cash fund specifically for petty cash
shall be maintained in the facility to accommodate the small cash requirements
of the residents;
j. The facility
will notify the resident when the resident's account reaches $200 less than the
SSI resources limit for one person.
313 RESIDENT RECORDS
313.1 The facility must maintain a separate
and distinct record for each resident. The record must contain:
a. Resident's name;
b. Resident's last address;
c. Date the resident began residing at the
facility;
d. Name, office telephone
number and emergency telephone number of each physician who treats the
resident;
e. Name, address and
telephone number of family members and the person identified by the resident
who should be contacted in the event of an emergency or death of the
resident;
f. All identification
numbers, such as Medicaid, Medicare/Medipak, Social Security, Veterans
Administration and date of birth;
g. Any other information which the resident
requests the home to keep on record; h. A copy of the resident's signed
Resident Rights Statement;
i. A
copy of the Admission, Transfer and Discharge Agreements;
j. A written acknowledgement that the
resident and/or responsible party have been notified of the charges for the
services provided;
k. Information
about any specific health problem of the resident which might be necessary in a
medical emergency. Such records should specify any medication allergies. If
none, state "no known allergies";
l. A brief medical history;
m. A list of all current medications kept by
the facility for the resident;
n.
An entry shall be made at any time the resident's status changes or in the
event of an unusual occurrence. This documentation shall include:
a. Falls;
b. Illness;
c. Physician visits;
d. Any problem with staff members or
others;
e. Any
hospitalization;
f. Any physical
injury sustained, whatever the circumstances;
g. Changes in the resident's
condition;
o. A copy of
the completed assessment form done by a mental health service provider as
appropriate.
p. A copy of court
orders or letters of guardianship, if applicable.
q. Discharge date.
313.2 The facility must maintain the
resident's records in the following manner:
a. Each resident shall have the right to
inspect his/her records during normal business hours unless contraindicated by
the attending physician;
b. The
facility must not disclose any resident records maintained by the facility to
any person or agency other than the facility personnel or the Office of Long
Term Care except upon expressed written consent of the resident, unless the
disclosure is required by state or federal law or regulation;
c. Each facility must provide a locked file
cabinet or locked room for keeping resident's medical, social, personal and
financial records;
d. The facility
must maintain (on paper, microfilm, etc.) these records in an accessible manner
for a period of five (5) years following the death or discharge of a
resident.
400 SERVICES
Nothing in these rules, in this part or any other, shall be
construed to require a residential care facility to provide services at no
charge that are not included in the basic daily rate or monthly charge listed
in the admission agreement/ contract.
401 SUPPORTIVE SERVICES
The facility must provide, as part of services included in the
basic daily rate or monthly charge, supportive services appropriate to maintain
and promote the well-being of each resident. The facility must encourage and
permit the resident to maintain and develop skills that enable the resident to
function self-sufficiently and independently.
Supportive services shall be defined as giving occasional or
intermittent guidance, direction or monitoring of an individual resident as
he/she carries out activities of daily living and social activities. Supportive
services do not include monitoring or delivery of physical assistance to a
resident delivered in accordance with a physician's order.
400.1 The facility must provide supportive
services within the basic charge that assure the following;
a. Residents keep appointments for mental and
medical services;
b. Staff are
aware of the resident's general whereabouts even though he/she may travel
independently about the community;
c. The appropriate agencies and/or health
professional are notified when:
1. The
resident has had a major change in status;
2. The resident is absent from the facility
and his/her whereabouts are not known; and
3. An emergency situation arises concerning
the facility.
d.
Residents are treated with kindness and consideration at all times and are not
abused, neglected or exploited in any manner;
e. Residents are dressed appropriately for
the activities in which residents are engaged and for the weather.
f. Residents are encouraged to participate in
social, recreational, vocational and religious activities within the community
and facility;
g. Residents are
encouraged and permitted, if capable, to perform personal hygiene activities
including, at a minimum:
1. A tub bath or
shower as desired or required;
2.
Daily oral hygiene and shaving if desired or requested by the
resident;
3. Trimming and shaping
of fingernails and toenails unless prohibited by the resident's attending
physician.
h. Residents
are not routinely confined to their room or bed except as necessary for the
treatment of a routine short term illness;
i. Residents are not restrained nor locked in
their rooms.
402 ACTIVITIES AND SOCIALIZATION
403.1 Each facility must provide, as part of
services and accommodation included in the basic rate, an organized program of
individual and group activities appropriate to individual resident needs,
interests and wishes.
403.2 At a
minimum, the facility must provide:
a.
Accommodations, equipment and supplies for recreation and socialization
services;
b. Group recreation and
socialization services.
403 PROFESSIONAL SERVICES
403.1 The resident shall be assisted in
making arrangements to secure all community based health or other professional
services, examinations and reports needed to maintain and/or document the
maintenance of the resident's health, safety and welfare.
403.2 The facility must document that each
resident has a physician of his/her choice who is reponsible for the overall
management of the individual's health.
403.3 The facility must have written
emergency medical policy and procedures that shall include, at a minimum, the
requirement that in the event of a resident's illness or accident, the facility
shall:
a. Notify the resident's responsible
party, next of kin and personal physician, or in the event such physician is
not available, a qualified alternate;
b. Take immediate and appropriate steps to
see that the resident receives necessary medical attention including transfer
to an appropriate medical facility, if necessary, though an additional charge
may be levied for transportation;
c. Make a notation of the illness or accident
in the resident's personal record.
403.4 Each resident shall be assisted as part
of the basic charge in arranging regular and emergency dental
services.
403.5 Each resident shall
be assisted as part of the basic charge in arranging for necessary foot
care.
403.6 Residents shall be
assisted as part of the basic charge in arranging other routine or special
services, as their needs may require, for eye examinations, eye glasses,
auditory testing and hearing aids.
404 HOME HEALTH SERVICES
404.1 If home health services are provided in
a facility by a certified home health agency, the facility shall, as part of
the resident's record, maintain a copy of all home health care plans, notes and
other documentation furnished by the home health agency. The facility shall
request a copy of the foregoing from the home health agency.
404.2 Residents who require frequent skilled
nursing services on a continuing basis will be assessed by the Office of Long
Term Care to determine whether the resident requires nursing home placement.
The resident's personal physician may offer a statement to the Office for
consideration regarding the resident's need for placement in a nursing
facility.
405 PERSONAL
CARE SERVICES
405.1 Facilities enrolled in the
personal care program shall maintain written documentation certifying that
residents eligible to receive such services have been advised that they have a
freedom of choice of personal care providers and have chosen their personal
care providers.
405.2 If a personal
care provider other than the facility is chosen, the facility will ask the
personal care provider for a copy of the resident's care plan and place it in
the resident's file.
500 DIETARY SERVICES
501 REQUIRED FACILITY DIETARY SERVICES
As part of the basic charge each facility must provide food for
three (3) balanced meals (as specified in Section 502) and make between meal
snacks available. Fluids shall be available at all times. Meals shall be served
at approximately the same time each day. There shall be no more than five (5)
hours between breakfast and lunch and between lunch and the evening meal. There
shall be no more than 14 hours between the evening meal and breakfast.
As part of the basic charge the facility must provide
supportive services to residents in consumption of meals served. If the
resident requires more than supportive services in consumption of meals, an
additional charge may be levied.
In the event that a resident is unable or willing to consume
regular meals served to him/her for more than two (2) consecutive days, the
facility shall immediately notify the resident's personal physician and take
appropriate action to assure the physician's instructions are
implemented.
A supply of food must be maintained on the premises at all
times. This shall include at least a 24 hour supply of perishable food and a
three (3) days supply of non-perishable food. The food supply must come from a
source approved by the State Department of Health. Residential care facilities
attached to other licensed long term care facilities may utilize the kitchen
facilities of the attached long term care facility; however, the residential
care facility must assure that the kitchen facilities so utilized are adequate
to meet the needs of the residents of the residential care facility, and that
such kitchen facilities meet the requirements imposed by these rules.
Dietary employees must wear clean clothing and hair coverings
as appropriate.
Each facility must comply with rules relating to food service
for sanitation, safety and health as set forth by state, county and local
health departments.
Food service employees must insure that all food is prepared,
cooked, served and stored in such a manner that protects against contamination
and spoilage.
The kitchen and dining area must be cleaned after each
meal.
An adequate supply of eating utensils (i.e., cups, saucers,
plates, glasses and flatware) shall be provided each resident. An adequate
number of pots and pans shall be provided for preparing meals. Eating utensils
shall be free of chips and cracks.
Each residential long term care facility must have adequate
refrigeration and storage space. The refrigerator temperature shall not exceed
45 degrees Fahrenheit. Left over foods placed in the refrigerator must be
sealed, dated and used within 48 hours. Thermometers will be placed in each
refrigerator and freezer. Freezer temperatures should be zero degree Fahrenheit
or below.
An all purpose five (5) lbs. ABC fire extinguisher must be
provided in the kitchen.
Food scraps shall be placed in garbage cans with tight fitting
lids and bag liners and emptied as necessary or no less than daily.
502 DAILY NUTRITIONAL ALLOWANCE
Each residential long term care facility must meet the
following recommended daily dietary allowance:
1. Milk, yogurt and cheese: Two (2) to three
(3) servings as beverage or used in cooking. Fortified whole, skim, low fat
milk, flavored whole or fortified milk, buttermilk, yogurt or cheese may be
used. Cheese may be used as a milk substitute or as a meat substitute but not
both.
2. Meat, poultry, fish, dry
beans, eggs and nuts: Two (2) to three (3) servings with at least four (4) or
five (5) ounces edible portions per day with at least two (2) ounces available
at the evening meal.
3. Vegetables:
Three (3) to five (5) servings. This shall include a dark green or yellow
vegetable for Vitamin A at least every other day. Fresh vegetables shall be
included as often as possible.
4.
Fruits: Two (2) to four (4) servings per day including a citrus fruit important
for Vitamin C. Fresh fruits shall be included as often as possible.
5. Bread, cereal, rice and pasta: Six (6) to
eleven (11) servings of whole grain and/or enriched bread, cereal, baked goods,
pasta, or rice per day.
6. Fats,
oils, sweets: These are not a food group and should be used
sparingly.
7. Optional beverages -
coffee, tea, decaffeinated beverages.
8. Other foods may be added to the meal to
provide personal satisfaction, additional nutrition and calories.
9. Meals shall provide variety in foods,
seasonably adapted, and be prepared in a manner which conserves nutrient
value.
10. Home canned food shall
not be used.
600 MEDICATIONS
601 ADMINISTRATION
Each residential long term care facility must have written
policies and procedures to assure residents receive medications as appropriate.
In-service training on facility medications policies and procedures (see
Section 308.4) shall be provided at least annually for all facility employees
supervising medications.
Facilities must comply with applicable state laws and rules
governing the dispensing of medications and restrictions applicable to
non-licensed personnel. The facility owner(s), employees or others acting on
behalf of the facility are prohibited from administering, repackaging or
relabeling any resident medication.
The facility shall document in the resident's record whether
the resident or the facility is responsible for storing the resident's
medication.
Residents must be familiar with their medications and
comprehend administration instructions. Facility staff shall provide assistance
to enable residents to self-administer medications. For clarification, examples
of acceptable practices are listed below:
a. The resident may be reminded of the time
to take the medication;
b. The
medication regimen on the container label may be read to the
resident;
c. In the presence of the
resident, facility staff may remove the container cap or loosen the packaging,
but the resident must actually remove the medication from the
container;
d. A larger sterile
container may be provided to the resident if needed to prevent spillage. Such
containers must not be shared by residents and must be sterilized daily.
Changes in dosage or schedule of the medication shall be made
only upon the written authorization of the resident's attending
physician.
Facility personnel may perform emergency or first-aid
procedures as specified below:
a.
Emergencies are defined as those measures necessary to prevent death or trauma
until such time that the resident can be transported to the appropriate medical
facility;
b. First-aid measures
will be defined as temporary procedures necessary to relieve trauma or injury
by applying dressing and/or band aids;
c. First-aid supplies shall be available in
the facility.
602 STORAGE
Medication stored for residents by the facility must be stored
in a locked area in individual compartments or bins labeled with the resident's
name.
Medications may be kept in the resident's room. Residents who
keep medications in their rooms must demonstrate to facility staff that they
are capable of understanding and following instructions on the prescription
and/or label.
Medications must be stored in an environment that is clean, dry
and not exposed to extreme temperature ranges.
Prescriptive medications must be properly labeled in accordance
with current applicable laws and rules pertaining to the practice of
pharmacy.
Expiration dates must be checked monthly on all medications
(prescriptive and over-the- counter).
Medications must be individually labeled with the resident's
name and kept in the original container unless the resident or responsible
party transfers the medication into individual dosage containers. Under no
circumstances may an owner or employee of the facility repackage
medication.
Stock supplies of any medication are prohibited.
Any medication which has been prescribed for but is no longer
in use by a resident must be destroyed or disposed of in accordance with state
law if stored by the facility, or may be given to the resident's family.
Under no circumstances will one resident's medication that is
under the facility's control be shared with another resident.
603 RECORDING
If a facility stores a resident's medications, the facility
shall maintain a list of medications which must be maintained on file.
If the facility stores and supervises a resident's medication,
a notation must be made on the individual record for each resident who refuses
or is unable to self-administer his/her medications. The notation shall include
the date, time and dosage of medication that was not taken, including a
notation that the resident's attending physician was notified, as required by
physician's orders.
If medications are prescribed to be taken as needed (PRN) by
the resident, documentation in the resident's file should list the medication
and the date and time received by the resident.
700 PHYSICAL ENVIRONMENT
701 LAUNDRY SERVICES
701.1 Each residential long term care
facility must provide laundry facilities or services to its
residents.
701.2 Each residential
long term care facility must meet the following laundry service requirements:
a. In-house laundries must be located in
areas separate from kitchen, bathroom and bedroom areas. Facilities licensed
prior to the effective date of these rules shall not be required to satisfy
this rule except to the extent that the facility may be altered, modified or
amended subsequent to the effective date of these rules.
b. Facilities with in-house laundries must
have a washer and dryer of adequate size to serve the needs of the
facility;
c. Laundry dryers must be
properly vented to the outside;
d.
The laundry room must be cleaned on a daily basis to prevent lint accumulation
and to remove clutter;
e. Portable
electric heaters and/or stoves must not be used in the laundry area;
f. The laundry room must be well-lighted and
vented to the outside by either power vents, gravity vents or by outside
windows;
g. Resident's clothing,
kitchen linens and bed linens shall be washed separately. If linens, including
washable blankets, are not washed at a minimum temperature of 150 degrees
Fahrenheit, a disinfecting agent must be used.
h. The facility shall be responsible for
providing laundry services on all linens and supplies owned by the facility as
part of the services required under the basic charge. Residents shall be
responsible for laundering personal items with supportive services as needed.
The facility must provide reasonable access to the laundry room for this
purpose. If a resident is incapable of performing this task independently, the
facility may levy an additional charge.
702 HOUSEKEEPING/MAINTENANCE
702.1 Each residential long term care
facility must establish and conduct a housekeeping and maintenance program to
ensure the continued maintenance of the facility, to promote good housekeeping
procedures and ensure sanitary practices throughout the facility.
702.2 The facility shall have full
responsibility to clean and maintain all common areas and shall make no
additional charge to the resident or third parties, including Medicaid, for
such services. Residents shall be responsible for routine housekeeping chores
within their own rooms and the facility must make necessary supplies available
for this purpose. For purposes of thisrule, routine housekeeping does not
include waxing or polishing of floors, painting or maintenance of floors,
walls, ceilings, windows or doors, nor does it include shampooing,
steam-cleaning or scrubbing of carpets, draperies, curtains or blinds. If a
resident requires more than supportive services to perform routine
housekeeping, an additional charge may be levied.
702.3 Each residential long term care
facility must meet the following housekeeping/maintenance requirements:
a. All areas of the facility must be kept
clean and free of lingering odors, insects, rodents and trash;
b. Each residential unit must be cleaned
before use by another resident;
c.
Corridors must not be used for storage;
d. Attics, cellars, basements, below
stairways and similar areas must be kept clean of accumulation of refuse, old
newspapers and discarded furniture;
e. Polish used on floors shall provide a
non-slip finish;
f. There must be
an adequate and available supply of soap and toilet tissues for each
resident;
g. The building(s) and
grounds must be maintained in a clean, orderly condition and in good
repair;
h. The interior walls,
ceilings and floors must be clean. Cracked plaster, peeling wallpaper or paint,
missing or damaged tiles, and torn or split floor coverings shall be promptly
and adequately repaired or replaced;
i. Electric systems, including appliances,
cords and switches, shall be maintained in compliance with state and local
codes;
j. Plumbing and plumbing
fixtures shall be maintained in compliance with state plumbing and gas
codes;
k. Ventilation, heating, air
conditioning, and air changing systems shall be properly maintained. Gas
systems shall be inspected at least every 12 months to assure safe operation.
Inspection certificates, where applicable, shall be maintained for
review;
l. The building, grounds
and support structures shall be free of breeding areas for flies, other insects
and rodents;
m. Entrances, exits,
steps and outside walkways must be free from ice, snow and other
hazards;
n. Repairs or additions
must meet existing codes.
703 FURNISHINGS AND EQUIPMENT
The following are general provisions concerning furnishings and
equipment that each residential long term care facility must meet:
1 All rooms, including bedrooms, must have
working light switches at the entrance to the room.
2 Windows must be kept clean and in good
repair and supplied with curtains, shades or drapes. Each operable window shall
have a screen which is clean and in good repair.
3 Light fixtures in resident use areas must
be equipped with covers to prevent glare and hazards to the
residents.
4 All fans located
within seven (7) feet of the floor must be protected by screen guards.
5. Dining room space and
furnishings in good repair must be provided for each resident in the facility.
Dining room space and furnishings must be sufficient to serve the residents in
no more than two (2) shifts.
6. All
facilities must have at least one (1) telephone available for outside calls for
every forty (40) residents.
7. All
furnishings and equipment must be durable, clean and appropriate to its
functions.
8. All areas of a
facility must be well lighted to ensure resident's safety.
9. The facility must provide and maintain
draperies, equipment and furniture in good condition.
10. Residents may provide their own linens,
but may not be required by the facility to do so. The following minimum amounts
of linen must be available in the facility at all times:
b. Sheets - two (2) times the facility's
census;
c. Pillow cases - two (2)
times the facility's census;
d.
Bath towels - two (2) times the facility's census;
e. Hand towels - two (2) times the facility's
census;
f. Washcloths - two (2)
times the facility's census;
g.
Blankets - one (1) for each resident;
h. Pillows - one (1) per resident.
11 Bed linens must be changed at
least weekly or more often as needed. Beds shall be straightened as necessary
by the resident or facility staff.
12 Wastepaper baskets and trash containers
used in the facility must be metal or Underwriter's Laboratory approved plastic
baskets. Outside trash containers must be equipped with covers but this
requirement may be waived if trash and garbage is placed in bags and
sealed.
704 GENERAL
REQUIREMENTS FOR RESIDENT AREAS
704.1 Each
residential long term care facility must meet the following requirements for
resident general use areas:
a. Each facility
must have dining room and living room space easily accessible to all
residents;
b. Dining rooms and
living rooms must not be used as bedrooms;
c. Dining rooms and living rooms must be
available for use by residents at appropriate times to provide periods of
social diversion and individual or group activities;
d. All resident areas must be decorated,
painted and appropriately furnished;
e. Dining rooms must be furnished with dining
table and chairs appropriate to the size/function of the facility.
704.2 Square footage requirements
for living room, dining room and activities room are as follows:
a. Facilities with 16 beds or less:
1. The facility must have a combined total of
at least 20 square feet of living room and activities space per licensed
bed;
2. The facility must have at
least 20 square feet of designated dining space per licensed bed;
3. In facilities licensed prior to the
effective date of these rules, the space provided for living and dining room
purposes shall total a combined square footage of at least 20 square feet per
licensed bed.
b.
Facilities with more than 16 beds:
1. In
facilities with 17 to 46 beds, the living and activities space must be a
separate room with a square footage of at least 20 square feet per licensed
beds;
2. In facilities with 47 to
100 beds, there must be one (1) living room and two (2) activities rooms with a
combined square footage of at least 20 square feet per licensed bed;
3. In facilities with 101 or more beds, there
must be one (1) living room and three (3) activities rooms with a combined
square footage of at least 20 square feet per licensed bed;
4. In facilities that house residents in more
than one building, there shall be a living room and activities room located in
each building with at least 20 square feet per licensed bed;
5. In facilities with more than 16 beds, the
dining room will be a separate room with at least 20 square feet per licensed
bed;
6. In facilities housing
residents in more than one building, a single dining room may be used for the
complex. The dining room must have at least 20 square feet of space per
licensed bed in the facility;
7. In
facilities licensed prior to the effective date of these rules, the space
provided for living and dining room purposes shall total a combined square
footage of at least 20 square feet per licensed bed.
c. Any modification, alteration or addition
must satisfy all physical environment requirements in effect at the time the
modification, alteration or addition is placed into service.
705 BATH AND TOILET
FACILITIES
Each residential long term care facility must meet the
following requirements concerning bath and toilet facilities:
1. In facilities licensed after February
1985, there must be a minimum of one (1) toilet and one (1) lavatory for each
six (6) residents. A minimum of one (1) tub or shower shall be provided for
each 10 residents. Dormitory or communal type bathroom facilities are not
permitted in facilities licensed after the effective date of these
rules.
2. Each bathroom must have a
door in working order.
3. Bath and
toilet facilities must be accessible to residents confined to wheelchairs if
such residents are admitted to the facility.
4. Bathrooms must provide privacy for each
resident.
5. Toilet and bathing
facilities must be vented to the outside.
706. RESIDENT BEDROOMS
Each residential long term care facility must meet the
following requirements concerning resident bedrooms:
1. No facility bedrooms shall be below ground
level. Each bedroom area must have an outside window with openings of at least
1/16 of the floor space for natural ventilation. All resident rooms must have a
hinged door in working order.
2. A
single bedroom must contain at least 100 square feet, exclusive of entrance way
and closet space. Single bedrooms licensed prior to the effective date of these
rules may continue to use 80 square feet per resident.
3. A bedroom occupied by more than one
resident must provide at least 80 square feet for each resident.
4. No more than two (2) residents shall share
a bedroom, in any facility licensed after the effective date of these rules;
however, any addition, modification or alteration made after the effective date
of these rules must satisfy the requirements in effect at the time the
addition, modification or alteration is placed into service.
5. Each facility must furnish every bedroom
with the following equipment:
b. A standard or
single bed in good repair. Rollaway beds, cots and folding beds must not be
used;
c. Each bed must be equipped
with clean springs, well-constructed mattresses in good repair, and a clean
comfortable pillow;
d. Table and
storage facilities for personal articles for each resident. A comfortable chair
for each resident must be made available. The chair may be in the resident's
room or in the day room of the facility;
e. Separate closet or locker space must be
provided for each resident. Residents may share closet space if the areas are
divided by partitions.
707 SAFETY STANDARDS
Each residential long term care facility must meet the
following requirements concerning safety standards:
1. Life Safety Code 1985, Chapter 21, will
apply to all facilities built after these rules become effective.
2. Life Safety Code 1981, Chapter 20, will
apply to residential care facilities with 15 beds or less and Chapter 19 will
apply to facilities over 15 beds licensed prior to the effective date of these
rules.
3. All facilities must
comply with all local life safety code requirements.
4. Each resident bedroom, living room, dining
room and corridor must have a smoke detector listed by Underwriters Laboratory.
Attics and basements must have one smoke detector for each 1000 square feet of
floor space. Smoke detectors and/or alarm systems must be checked on a monthly
basis to insure that the unit is functioning properly. A written record
documenting the checks must be maintained by each facility.
5. In multi-story facilities licensed after
September 1989, smoke barriers of at least one (1) hour rating must be provided
between floors, including all solid core doors with closures at either top or
bottom of the stairway. Existing facilities will be required to have solid core
doors with closures to keep smoke from spreading between floors.
6. Properly charged ABC type fire
extinguishers at five (5) pounds in weight must be placed no more than five (5)
feet above the floor. Fire extinguishers must be checked annually.
7. Properly charged fire extinguishers must
be placed at easily accessible locations on each floor or wing.
8. Drills must be held quarterly in which
residents and employees participate. Employees shall be trained in the means of
rapidly evacuating the building through use of fire drills. A written record of
the drill must be maintained by each facility.
9. Tornado drills must be conducted annually
and documented.
10. Residents and
staff must be notified that smoking is permitted only in designated areas and
such restrictions shall be enforced.
11. No resident shall occupy any portion of
the third or higher floors of any combustible building. This does not apply to
facilities licensed before the effective date of these rules, except that any
modification, alteration or additions made after the effective date of these
rules must satisfy the criteria in effect at the time the modification,
alteration or addition is placed into service.
12. Emergency lights and exit signs:
b. Battery operated emergency light units
must be provided for hallways and stairwells. Facilities licensed for five (5)
beds or less are excluded from this requirement;
c. Illuminated exit signs must be provided at
the location of each exit door. Facilities licensed for five (5) beds or less
are excluded from this requirement.
13. Interior and exterior stairways must have
handrails.
14. Steam or heating
pipes with which residents or staff come in contact must be covered to prevent
injury or burns.
15. Grab bars must
be provided in resident bathrooms for toilets, tubs and showers. Bathtubs must
be equipped with non-slip surfaces.
16. In facilities licensed after September
1985, bedrooms must have direct access to an exit corridor. Access to toilet
and bathing areas shall not be through another resident's room.
17. In all facilities, access to bedroom
areas must not be through toilet or bathing areas.
18. Any practices or equipment which creates
a fire hazard are prohibited, including:
a.
Portable electric space heaters or self-contained fuel burning space heaters
unless specifically authorized by the Office of Long Term Care in writing.
(This authorization will be given only in cases of an emergency.);
b. Use of electrical cooking appliance or
mini-kitchens in resident rooms;
c.
Combustible containers for smoking material and/or ashes;
d. The accumulation of combustible material,
such as rags, paper items and general trash, in any part of the building is
prohibited;
e. Flammable material
such as gasoline, kerosene, paint, paint thinners, etc., shall not be stored
inside the facility;
f. Use of
extension cords or multi-plug adapters.
19. Doors in resident rooms may be secured by
the resident provided such doors can be unlocked from the outside and keys are
available to attendants at all times.
20. Chain locks, clasps, bars, padlocks and
similar devices must not be used in any area of a facility subject to use by
residents.
21. Exit doors must open
out with the flow of traffic in facilities licensed for 16 or more beds. Exit
doors shall not lock with a key. Panic hardware or turn knob shall be
used.
22. A diagram of the building
must be posted in each sleeping area in a conspicuous place showing the
location of exits and fire extinguishers.
23. Emergency telephone numbers must be
posted in large print in each facility. The list must include fire department,
police department, physician, ambulance service, poison control center,
emergency services, Advocacy Services, Inc. and the Office of Long Term Care,
etc. If 911 is used, this one number should be used for police, fire and
ambulance service.
24. If residents
are housed above the ground floor, each floor must have two (2) accessible
outside fire exits remote from each other. The exits shall be through a common
area and not through a resident's bedroom. The outside stairways should be
protected against snow and sleet. Windows are not acceptable exits.
25. Throw or scatter rugs without non-skid
backing are not permitted.
708 NEW CONSTRUCTION, REMODELING OR ADDITIONS
708.1 In new construction, prior to
construction, a copy of the facility floor plan must be submitted to the Office
of Long Term Care for approval. The building must be built in accordance with
Chapter 21 of the Life Safety Code 1985 and be readily accessible and useable
by individuals with disabilities including individuals who use
wheelchairs.
708.2 When additions
or remodeling is to be done to a facility, prior to construction, a copy of the
facility floor plan for the existing and new construction will be submitted to
the Office of Long Term Care for approval. The plan must assure the entire
facility (existing structure as well as the addition) meets Chapter 21 of the
Life Safety Code 1985 and must be readily accessible and useable by individuals
with disabilities including individuals who use wheelchairs.
708.3 If an existing facility that does not
comply with Chapter 21 of the 1985 Life Safety Code must be relicensed under
the requirements of Section 205, the new licensee must comply fully with the
appropriate Life Safety Code and the facility must be readily accessible and
useable by individuals with disabilities including individuals who use
wheelchairs.
708.4 Periodic
inspections will be made by personnel with the Office of Long Term Care during
construction. Once construction has been completed, the facility will be
required to submit documentation that the electrical, plumbing and gas has been
installed in accordance with local and state codes, along with the license
number of the person conducting the inspection.
709 WATER SUPPLY
An adequate supply of water, under pressure, must be provided
at all times. When a public water system is available, a connection must be
made thereto. If water from a source other than a public water supply is used,
the supply must meet the requirements set forth under rules of the State Board
of Health.
710 SEWAGE
All sewage must be disposed of by means of either:
1. A public system where one is accessible
within 300 feet; or
2. An approved
sewage disposal system which is constructed and operated in conformance with
the standards established for such systems by the State Board of
Health.
711 PLUMBING
Facilities must comply with all provisions of the state
plumbing and gas code and amendments thereto prescribing minimum requirements
for design, materials, appliances, workmanship and methods of
installation.
712
ELECTRICAL
Electrical wiring, fixtures, appliances, motors and other
electrical equipment must be installed in accordance with the national
electrical code National Fire Prevention Association's Pamphlet #70 and comply
with local regulations and/or codes where they exist.
713 HEATING/COOLING
713.3 All liquefied petroleum gas systems
must be installed and maintained in accordance with the State Code for
Liquefied Petroleum Gas Containers and Equipment, State of Arkansas.
713.3 All gas heating units must bear the
stamp of approval of the American Gas Association Testing Laboratories, Inc.,
or other nationally recognized testing agency for enclosed, vented heaters for
the type of fuel used.
713.3 All
gas heating units and water heaters must be vented adequately to carry the
products of combustion to the outside atmosphere. Vents must be constructed and
maintained to provide a continuous draft to the outside atmosphere in
accordance with the American Gas Association Recommended Procedures.
713.4 All heating units must be provided with
a sufficient supply of outside air so as to support combustion without
depletion of the air in the occupied room.
713.5 All heating and cooling units must be
installed and maintained in a manner which will provide for the safety and
comfort of the occupants.
713.6
Wood heaters may be used if U.L. approved and installed per U.L.
instructions.
713.7 In new
facilities licensed after the effective date of these rules, the facility must
be equipped with a heating and cooling system that will be maintained at a
minimum temperature of 72 degrees Fahrenheit during winter and 80 degrees
Fahrenheit during the summer in all resident areas when the temperature exceeds
95 degrees Fahrenheit. If temperature outside exceeds 100 degrees Fahrenheit
there must be a 15 degree difference in exterior to interior
temperatures.
714 ZONING
CODES
Each residential long term care facility must be operated in
areas permitted by local codes. Each owner must provide the Office of Long Term
Care with documentation that the facility is in compliance with zoning
requirements.
715 LOT
REQUIREMENTS
Conditions of soil, ground water level, drainage and topography
must not create hazards to the property as to the health and safety of the
occupants. The site shall not be subject to unpredictable and/or sudden
flooding and shall be large enough to provide an exercise area for
residents.
APPENDIX A RULES OF ORDER FOR ALL APPEALS BEFORE THE LONG TERM
CARE FACILITY ADVISORY BOARD
1.
Pursuant to Arkansas Code Annotated §
20-10-303
the Long Term Care Facility Advisory Board shall hear all appeals by licensed
long term care facilities, long term care administrators, or other parties
regulated by the Office of Long Term Care with regard to licensure and
certification.
2. All appeals shall
be made in writing to the Chairman of the Board within 30 days of receipt of
notice of intended action. The notice shall include the nature of intended
action, rule allegedly violated, and the nature of the evidence supporting
allegation and set forthwith particularity asserted violations, discrepancies
and dollar amounts which the appellant contends are in compliance with all
rules.
3. Appeals must be heard by
the Board within sixty (60) days following date of the Chairman's receipt of
written appeal unless otherwise agreed by both parties. The chairman shall
notify the party or parties of the date, time, and place of the hearing at
least seven (7) working days prior to the hearing date.
4. Preliminary motions must be made in
writing and submitted to the Chairman and/or hearing officer with service to
opposing party at least three (3) days prior to hearing date unless otherwise
directed by the Chairman or hearing officer.
5. All papers filed in any proceeding shall
be typewritten on white paper using one side of the paper only and will be
double spaced. They shall bear a caption clearly showing the title of the
proceeding in connection with which they are filed together with the docket
number, if any. All papers shall be signed by the party or his authorized
representative or attorney and shall contain his address and telephone number.
All papers shall be served either on the Office of Chief Counsel of the
Department of Human Services, the attorney for the party, or if no attorney for
the party, service shall be made on the party.
6. The Chairman of the Board shall act as
Chairman in all appeals hearings. In absence of the Chairman, the Board may
elect one of their members to serve as Chairman. The Chairman shall vote in
case of a tie. The Chairman and/or Board may request legal counsel and staff
assistance in the conduct of the hearing and in the formal preparation of their
decision.
7. A majority of the
members of the Board shall constitute a quorum for all appeals.
8. If the appellant fails to appear at a
hearing, the Board may dismiss the hearing and render a decision based on the
evidence available.
9. Any
dismissal may be rescinded by the Board if the appellant makes application to
the Chairman in writing within ten (10) calendar days after the mailing of the
decision, showing good cause for his failure to appear at the hearing. All
parties shall be notified in writing of an order granting or denying any
application to vacate a decision.
10. Any party may appear at the hearing and
be heard through an attorney at law or through a designated representative. All
persons appearing before the Board shall conform to the standards of conduct
practiced by attorneys before the courts of the State.
11. Each party shall have the right to call
and examine parties and witnesses; to introduce exhibits; to question opposing
witnesses and parties on any matter relevant to the issue; to impeach any
witness regardless of which party first called him to testify; and to rebut the
evidence against him.
12. Testimony
shall be taken only on oath, or affirmation under penalty of perjury.
13. Irrelevant, immaterial, and unduly
repetitious evidence shall be excluded. Any other oral or documentary evidence,
not privileged, may be received if it is of a type commonly relied upon by
reasonably prudent men in the conduct of their affairs. Objections to
evidentiary offers may be made and shall be noted of record. When a hearing
will be expedited, and the interests of the parties will not be substantially
prejudiced, any part of the evidence may be received in written form.
14. The Chairman or hearing officer shall
control the taking of evidence in a manner best suited to ascertain the facts
and safeguard the rights of the parties. The Office of Long Term Care shall
present its case first.
15. A party
shall arrange for the presence of his witnesses at the hearing.
16. Any member of the Board may question any
party or witness.
17. A complete
record of the proceedings shall be made. A copy of the record may be
transcribed and reproduced at the request of a party to the hearing provided he
bears the cost thereof.
18. Written
notice of the time and place of a continued or further hearing shall be given,
except that when a continuance or further hearing is ordered during a hearing,
oral notice of the time and place of the hearing may be given to each party
present at the hearing.
19. In
addition to these rules the hearing provisions of the Arkansas Administrative
Procedure Act (Arkansas Code Annotated §
25-15-201 et.
seq.) shall apply.
20. At the
conclusion of testimony and deliberations by the Board, the Board shall vote on
motions for disposition of the appeal. After reaching a decision by majority
vote, the Board may direct that findings of fact and conclusions of law be
prepared to reflect the Board's recommendations to the Director of the Division
of Medical Services. At his discretion and for good cause the Director of the
Division of Medical Services shall have the right to accept, reject or modify a
recommendation, or to return the recommendation to the Board for further
consideration for a more conclusive recommendation. All decisions shall be
based on findings of fact and law and are subject to and must be in accordance
with applicable state and federal laws and regulations. The final decision by
the Director of the Division of Medical Services shall be rendered in writing
to the appellant.
21. All decisions
of the Director of the Division of Medical Services may be reviewed by a court
of competent jurisdiction as provided under the Arkansas Administrative
Procedure Act.
111 CIVIL PENALTIES
The following civil penalties pertaining to classified
violations may be assessed by the Director of the Office of Long Term Care
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 rules.
In the case of Class B, C or D violations, the Director, in
his/her discretion, may elect to assess the civil penalties as outlined in
these rules or may allow a specified period of time for correction of said
violation(s).
1. Class A violations
are subject to a civil penalty not to exceed two thousand five hundred dollars
($2500) for the first violation. A second Class A violation occurring within a
six-month period from the first violation shall result in a civil penalty of
five thousand dollars ($5000). The third Class A violation occurring within a
six- month period from the first violation shall result in proceedings being
commenced for termination of the facility's Medicaid agreement and may result
in proceedings being commenced for revocation of licensure of the facility.
(See Section 112 for a list of Class A violations.)
2. Class B violations are subject to a civil
penalty not to exceed one thousand dollars ($1000). A second Class B violation
occurring within a six-month period shall be subject to a civil penalty of two
thousand dollars ($2000). A third Class B violation occurring within a
six-month period from the first violation shall result in proceedings being
commenced for termination of the facility's Medicaid agreement and may result
in proceedings being commenced for revocation of the licensure of the facility.
All Class B violations shall be based on a point system as contained in these
rules. (See Section 113 for a list of Class B violations.)
3. Class C violations are subject to a civil
penalty not to exceed five hundred dollars ($500) for each violation. Each
subsequent Class C violation within a six-month period from the first violation
shall subject the facility to a civil penalty double that of the preceding
violation until a maximum of one thousand dollars ($1000) per violation is
reached. All Class C violations shall be based on a point system as contained
in these rules. (See Section 114 for a list of Class C violations.)
4. Class D violations are subject to a civil
penalty not to exceed two hundred fifty dollars ($250) for each violation. Each
subsequent Class D violation occurring within a six-month period from the first
violation shall subject the facility to a civil penalty double that of the
preceding violation until a maximum of five hundred dollars ($500) is reached.
All Class D violations shall be based on a point system as contained in these
rules. (See Section 115 for a discussion of Class D violations.)
5. In no event may the aggregate civil
penalties assessed for violations in any one (1) month exceed five thousand
dollars ($5000).
111.1 In
determining whether a civil penalty is to be assessed and in affixing the
amount of the penalty to be imposed, the Director shall consider:
a. The gravity of the violation including the
probability that death or serious physical harm to a resident will result or
has resulted;
b. The severity and
scope of the actual or potential harm;
c. The extent to which the provisions of the
applicable statutes or rules were violated;
d. The "good faith" exercised by the
licensee. Indications of good faith include, but are not limited to:
1. Awareness of the applicable statutes and
rules and reasonable diligence in securing compliance;
2. Prior accomplishments manifesting the
licensee's desire to comply with the requirements;
3. Efforts to correct; and
4. Any other mitigating factors in favor of
the licensee;
e. Any
relevant previous violations committed by the licensee;
f. The financial benefit to the licensee of
committing or continuing the violation.
111.2 The Director shall assign value points
to conditions or occurrences and said value points shall represent a base to
which the considerations specified in Section 111.1 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).
111.3 Assessment of a civil penalty provided
by this section shall not affect the right of the Office of Long Term Care to
take such other action as may be authorized by law or rule.
112 CLASS "A" VIOLATIONS
Class A violations are:
1. Violations which create a condition or
occurrence relating to the operation and maintenance of a long term care
facility which results in death or serious harm to a resident; or
2. Violations which create a condition or
occurrence relating to the operation and maintenance of a long term care
facility which creates a substantial probability that death or serious physical
harm to a resident will result from the violation.
Class A violations and the points assigned to each are listed
below in Sections 112.1 through 112.3.9 and are subject to the conditions set
out in Section 111.
112.1
Any condition or occurrence relating to the operation of a long term care
facility in which the conduct, act or omission of a person or actor purposely,
knowingly, recklessly or negligently results in the death of a resident shall
be a Class A violation. In this instance two thousand five hundred (2500)
points shall be assigned.
112.2 Any
condition or occurrence relating to the operation of a long term care facility
in which the conduct, act or omission of a person or actor purposely,
knowingly, recklessly or negligently results in serious physical harm to a
resident shall be a Class A violation. In this instance two thousand five
hundred (2500) points shall be assigned.
112.3 The conduct, acts or omissions
specified in Sections 112.3.1 through 112.3.9, when not resulting in death or
serious physical harm, but which create a substantial probability that death or
serious physical harm to a resident will result therefrom are conditions or
occurrences relating to the operation of a long term care facility which are
Class A violations.
112.3.1 One thousand five
hundred (1500) points shall be assigned when a facility fails to maintain
required direct care staffing, or a safe environment and this failure directly
causes a fall by a resident. (e.g., equipment not properly maintained, or a
fall due to personnel not responding to resident request for
assistance.)
112.3.2 Two thousand
five hundred (2500) 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 this failure
causes an assault upon a resident of the facility by another resident. A Class
A violation shall also exist when a facility fails to perform adequate
screening of personnel and this failure causes an assault upon a resident by an
employee of the facility.
112.3.3
Two thousand two hundred fifty (2250) shall be assigned when a facility
personnel improperly apply physical restraints contrary to published
rules.
112.3.4 Two thousand five
hundred (2500) points shall be assigned when a facility fails to secure proper
medical assistance.
112.3.5 Two
thousand five hundred (2500) points shall be assigned when facility personnel
knowingly withhold medication from a resident as ordered by a physician and
such withholding of medication(s) results in death or serious injury to a
resident; or facility personnel fail to order and/or stock medication(s)
prescribed by the physician and the failure to order and/or stock
medication(s).
112.3.6 Two thousand
five hundred (2500) points shall be assigned when facility personnel knowingly
administer medications to a resident and the administration of that
medication(s) results in death or serious injury to a resident.
112.3.7 Two thousand five hundred (2500)
points shall be assigned when a facility fails to reasonably maintain its
heating and air conditioning system as required by ruleIsolated incidents of
breakdown or power failure shall not be considered a Class A violation under
this section.
112.3.8 Two thousand
(2000) points shall be assigned when a facility does not train staff in
fire/disaster procedures as required by rules or when staffing requirements are
not met.
112.3.9 Two thousand five
hundred (2500) points shall be assigned when a facility fails to maintain the
required life safety code systems. Isolated incidents of breakdown shall not be
considered a Class A violation under this section if the facility has
immediately notified the Office of Long Term Care upon discovery of the problem
and has taken all necessary measures to correct the problem.
113 CLASS "B"
VIOLATIONS
Class B violations involve conduct, acts or omissions which,
while not resulting in death or serious physical harm or the substantial
probability thereof to a resident, create a condition or occurrence relating to
the operation and maintenance of a long term care facility which directly
threatens the health, safety or welfare of a resident.
Class B violations and the points assigned to each are listed
below in Sections 113.1 through 113.13 and are subject to the conditions set
out in Section 111.
113.1 Seven
hundred fifty (750) points shall be assigned when a facility admits or retains
residents who need a higher level of care than the facility is licensed to
provide.
113.2 Seven hundred 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.
113.3 One thousand (1000) 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.
113.4 One
thousand (1000) points shall be assigned when facility personnel apply physical
restraints contrary to published rules.
113.5 One thousand (1000) points shall be
assigned when a facility fails to secure proper medical assistance, and this
failure threatens the health, safety, or welfare of a resident.
113.6 One thousand (1000) points shall be
assigned when facility personnel knowingly administer medications to a resident
contrary to published rules. One thousand (1000) 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.
113.7 One thousand (1000)
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.
113.8 Seven hundred 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 rule and this failure threatens the health, safety,
or welfare of a resident.
113.9 One
thousand (1000) points shall be assigned when a facility fails to maintain its
heating and air conditioning systems as required by ruleand 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.
113.10 Seven hundred
fifty (750) points shall be assigned when it is determined that the minimum
dietary needs of residents are not being met.
113.11 Seven hundred fifty (750) points shall
be assigned when facility personnel fail to inform a resident of his/her
Resident Rights as outlined inrule; or facility personnel fail to allow a
resident to honor or exercise any of his/her rights as outlined in rule or
statute.
113.12 Seven hundred fifty
(750) points shall be assigned when it is determined that rules relating to
sanitation are not met.
113.13
Seven hundred fifty (750) points shall be assigned when it is determined that a
facility does not have a certified administrator as required by rule.
114 CLASS "C" VIOLATIONS
Class C violations are related to administrative and reporting
requirements that do not directly threaten the health, safety, or welfare of a
resident.
Examples of Class C violations and the points assigned to each
are listed below in Sections 114.1 through 114.7 for illustrative purposes and
are subject to the conditions set out in Section 111.
114.1 Five hundred (500) points shall be
assigned when a facility is found to exceed their licensed bed capacity
(overbedding).
114.2 Five hundred
(500) points shall be assigned when it has been determined that any report,
resident assessment or other documents or records which the facility is
required to maintain has been intentionally falsified (false
reporting).
114.3 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 which the facility must
provide at no cost to the resident.
114.4 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.
114.5 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
rule.
114.6 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.
114.7 Five hundred (500) points shall be
assigned when a facility fails to comply with the establishment and operation
of a Resident's Council as defined by ruleor statute.
116 NOTIFICATION OF VIOLATIONS
116.1 If, upon inspection or investigation,
the Office of Long Term Care determines that a licensed long term care facility
is in violation of any sanction ruleherein described, any federal or state law
or regulation, then within 10 working days of the discovery of the violation
the Office of Long Term Care shall serve, by certified mail or other means that
gives actual notice, a notice of violation upon the licensee when the violation
is a classified violation as described in Arkansas Code Annotated 720-10-205.
The administrator shall post copies of the notice of Class A or Class B
violations.
116.2 Each notice of
violation shall be prepared in writing and shall specify:
a. The exact nature of the classified
violation;
b. The statutory
provision or specific rule alleged to have been violated;
c. The facts and ground constituting the
elements of the classification;
d.
The amount of the civil penalty assessed by the Director, if any; and
e. The licensee's right to a hearing under
Arkansas Code Annotated §
20-10-208.
(See Section 116.5)
116.3 The notice of violation issued to a
long term care facility by the Director of the Office of Long Term Care shall
be classified according to the nature of the violation and shall indicate the
classification on the face thereof as follows:
a. Class A violations create a condition or
occurrence relating to the operation and maintenance of a long term care
facility resulting in death or serious physical harm to a resident or creating
a substantial probability that death or serious physical harm to a resident
will result therefrom;
b. Class B
violations create a condition or occurrence relating to the operation and
maintenance of a long term care facility which directly threatens the health,
safety, or welfare of a resident;
c. Class C violations shall relate to
administrative and reporting requirements that do not directly threaten the
health, safety, or welfare of a resident;
d. Class D violations shall relate to the
timely submittal of statistical and financial reports to the Office of Long
Term Care. The failure to timely submit a statistical or financial report shall
be considered a separate Class D classified violation during any month or part
thereof of noncompliance. In addition to any civil penalty which may be
imposed, the Director is authorized after the first month of a Class D
violation to withhold any further reimbursement to the long term care facility
until the statistical and financial report is received by the Office of Long
Term Care.
116.4
Assessments (fines) shall be delivered to the Office of Long Term Care by the
licensee within ten (10) working days of the receipt of the Notice of
Violation.
116.5 If the licensee
decides to appeal the assessment of civil penalty, the request for hearing must
be received by the Executive Director of the Department of Human Services
within ten (10) working days after receipt by the facility of the Notice of
Violation. (Refer to Section 117, Hearings.)
117 HEARINGS
1. A licensee may contest the imposition of a
civil penalty by sending a written request for hearing to the Director of the
Arkansas Department of Human Services.
2. The request for hearing must be received
by the Director of the Arkansas Department of Human Services within ten (10)
working days after receipt by the facility of the Notice of
Violation.
3. The Director of the
Arkansas Department of Human Services shall designate a fair and impartial
Hearing Officer to preside over the case and make findings of fact and
conclusions of law in the form of a recommendation to the Director.
4. The Hearing Officer shall commence the
hearing within forty-five (45) calendar days of the Department's receipt of the
request for hearing.
5. The Hearing
Officer shall prepare and present a written report with a recommendation to the
Director of the Arkansas Department of Human Services.
6. The Director of the Arkansas Department of
Human Services shall review the case and make the final determination or remand
the case to the Hearing Officer for further findings of law or facts.
7. The Director of the Arkansas Department of
Human Services shall issue final decision within thirty (30) working days after
the close of the hearing. All decisions of the Director may be reviewed by a
court of competent jurisdiction as provided under the Arkansas Administrative
Procedure Act.
8. Assessment
payments (fines) shall be delivered to the Office of Long Term Care within ten
(10) working days of the receipt of the Notice of Violation (see Section 116.5)
or within ten (10) working days of receipt of the final adjudication. Checks
should be made payable to the State of Arkansas.
9. Facilities failing to pay duly assessed
civil penalties shall be subject to a corresponding reduction in succeeding
Medicaid vendor payment or initiation of proceedings to revoke the facility's
license or both.
10. All monies
collected by the licensing agency pursuant to these rules shall be deposited in
the Long Term Care Trust Fund as specified in Arkansas Code Annotated §
20-10-205.
APPENDI X C ARKANSAS STATUTES AS REFERENCED IN SECTION 100 -
DEFINITIONS
This Appendix is provided as a convenience to users of these
rules. Any omission is unintentional and, in the event this entry conflicts
with the statutes as codified in the Arkansas Code Annotated-Official Edition
and this Appendix, the Official Edition shall govern. The user hereof should
refer to the Official Edition prior to taking any action. The user's failure to
refer to the Official Edition shall be at the user's peril.
Note: This Appendix does not contain page
numbers.
