Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 25 - Division of Provider Services and Quality Assurance
Rule 016.25.19-008 - Rules Pertaining to Post-Acute Head Injuries Retraining and Residential Adult Care Facilities
Universal Citation: AR Admin Rules 016.25.19-008
Current through Register Vol. 49, No. 9, September, 2024
Department of Health and Human Services
Division of Economic & Medical Services
Office of Long Term Care
AUTHORITY
The following rules for Post-Acute Retraining and Residential Adult Care Facilities in Arkansas are duly adopted and promulgated by the Department of Human Services, Division of Economic and Medical Services, Office of Long Term Care, pursuant to the authority expressly conferred by the laws of the State of Arkansas in Act 602 of 1987.
100 DEFINITIONS: The following terms are defined for the purpose of these rules.
100.1.
Behavior
Modification: Things or events that are used in a timely manner to
discourage undesired behavior.
100.2.
Board: The
Long Term Care Facility Advisory Board.
100.3.
Department:
The Arkansas Department of Human Services.
100.4.
Division: The
Division of Medical Services of the Department of Human Services.
100.5.
Facility: A
Post-Acute Head Injury Retraining and Residential Care Facility.
100.6.
Facility
Services: The residential, retraining, and rehabilitation services
provided within each licensed Facility in accordance with its License.
100.7
Head
Injury: An injury or neurological impairment to the brain caused
by illness or accident.
100.8.
Head Injury Retraining and Rehabilitation: The
individualized program of instruction offered in a residential or day program
designed to assist an individual suffering from disability as a result of Head
Injury to reduce the adverse effects of the disability and improve functioning
in daily living, education, and vocational activities.
100.9.
Immediate
Family: Father, Mother, Children, Spouse, Brother, and
Sister.
100.10.
Independently Mobile: Physically and mentally capable
of vacating a structure in case of emergency, including the capability to
ascend or descend stairs that are 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 other persons
to vacate and can do as required by local fire code.
100.11.
License: A
non-transferable permit issued by the Office of Long Term Care to a Licensee
authorizing the Licensee to operate a Facility for a specific time
period.
100.12.
Licensee: Any person, firm, corporation, governmental
agency, or other legal entity to whom the License is issued and who is
responsible for maintaining approved standards. Facilities owned or regulated
by the Veterans Administration or by Division Development Disabilities
Services, the Office on Alcohol and Drug Abuse, and Christian Science homes
shall be excluded from licensure under these rules.
100.13.
The Office of Long Term
Care: The survey and licensure agency of the Division.
100.14.
Post-Acute Head Injury
Retraining and Residential Care Facility: A building, or group of
buildings, if located contiguously and operated jointly, used or maintained to
provide, for pay, Retraining and Rehabilitation for three (3) or more
individuals who are disabled on account of Head Injury and who are not in
present need of in-patient diagnostic care in a hospital or related.
100.15.
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.
100.16.
Rules : The
Rules pertaining to Post-Acute Head Injury Retraining and Residential Care
Facilities promulgated by the Office of Long Term Care pursuant to Act 602 of
1987.
100.17.
Residents: Any individual who receives services from a
Facility.
100.18.
Resident's Sponsor: The person or agency legally
responsible for the welfare and support of the Resident.
100.19.
Residential
Area: An area used by Residents for sleeping and for daily living
activities. A Residential Area may be less than the entire area of a building
and there may be more than one Residential Area within a single
building.
100.20.
Sponsor: See "Resident Sponsor."
100.21.
Staff. Any
officer, employee, or agent of a Facility.
100.22.
Time-out
Techniques: Devices or procedures designed to improve a Resident's
behavior by removing positive reinforcements when the Resident's behavior is
undesirable.
100 RESPONSIBLITIES
101.
Responsibilities of the Office of Long Term Care: The
Office of Long Tern Care shall have the following responsibilities:
101.1 To review and grant or deny all
applications for licenses to operate as a Facility.
101.2 To investigate and take appropriate
action against any Person providing Head Injury Retraining and Rehabilitation
in contravention of these rules.
101.3 To inspect Facilities and their
operations to determine compliance with these rules and to take appropriate
action.
101.4 To investigate
complaints made against Facilities and to take appropriate action.
101.5 To provide technical assistance to
Facilities to improve services provided to Residents.
101.6 To refer violations of other state or
federal laws or Regulations to the appropriate administrative agency or law
enforcement office.
101.7 To
provide directories of Facilities to all interested persons, and
101.8 To notify all agencies which place
Residents in Facilities whenever a Facility becomes unlicensed or is in
substantial violations of the rules.
102.
Responsibilities of the
Facility: Each Facility shall have the following responsibilities:
102.1. To provide to its Residents a
comprehensive program of care which:
A.
Conforms fully with these rules;
B.
Meets the needs of the Residents;
C. Provides Ml protection of Residents'
rights; and
D. Promotes the social,
physical, and mental well-being of Residents.
102.2. Subject to the Residents' right to
privacy, to allow the Office of Long Term Care full access to residents and the
Facility's grounds and buildings at any time.
102.3. To allow personnel from the Office of
Long Term Care full access to the Facility, books and records at all
times.
102.4. To notify the Office
of Long Term Care immediately of any extraordinary event or set of
circumstances which has resulted in serious injury to a Resident or constitutes
a continuing threat of injury to a Resident.
200 LICENSURE
201.
Operation Without a
License: No Facility shall be established, operated, or maintained
in the State of Arkansas without first obtaining a License.
202.
Application for
License: Applicants for licenses shall file applications under
oath with the Office of Long Term Care upon forms prescribed by the Division
and shall pay an annual fee of $10.00 to the Division. Such fee shall be
refunded if the License is denied. Applications shall be filed by the
prospective Licensee. Applications shall set forth the following information:
202.1. The full name and address of the
Facility for which the License is requested;
202.2. The name of each person owning,
directly or indirectly, 5% or more of equity interest of the
Facility;
202.3. The name and
address of each officer and director, if applicant is a corporation;
202.4. The name of each partner, whether
general or limited, if the applicant is a partnership; and
202.5. Such additional information as the
Division may require on the application form.
202.6. The agent name and address of the
agent for service of process is the applicant is other than an
individual.
203.
Qualification for License: A Licensee must satisfy the
following minimum qualifications:
203.1.
Sufficient financial resources to meet the needs of its Residents;
203.2. Have no prior convictions under Act 28
of 1979; and
203.3. Have sufficient
qualified staff to meet the needs of the Residents in the following areas:
vocational rehabilitation, occupational therapy, speech therapy, physical
therapy, psychology, cognitive training, recreational and educational
services.
204.
Term: A License is effective from the date of issue
through December 31 of the then- current calendar year.
205.
Renewal:
Applications for renewal shall be made annually, and on forms provided by
Office of Long Term Care, applications shall contain the name and address of
the applicant and such information which has changed since the filing of the
previous application. Applications for renewal shall be postmarked no later
than January 2 following expiration. The annual fee of $10.00 shall be
submitted with the renewal. A penalty of ($1) one dollar per day will be
accessed for each day passed January 2.
206.
Transfer:
Licenses are not transferable. The transfer of 30% or more equity interest in
the Licensee shall be considered a change of ownership and shall require a new
application for licensure.
207.
Closure: Any Facility that closes or that loses or
surrenders its License for whatever reason must meet the rules for new
construction to be eligible for re-licensure.
208.
Separate
Premises: Separate Licenses are required for operations maintained
at separate, noncontiguous premises, even if they are operated under the same
management.
209
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.
210.
Compliance:
When non-compliance with licensure standards is detected during surveys, the
Licensee will be notified of the violations and will be requested to provide a
plan of correction which must include a timetable for completion of the
corrections. If an item of non-compliance that affects the health and safety of
Residents is nor promptly corrected, the Office of Long Term Care shall have
the option to sanction pursuant to Section 214 or initiate action to suspend or
revoke the Facility's license.
211.
Revocation of License: The Division may deny, suspend,
or revoke a license on any of the following grounds:
211.1. Violation of any of the Provisions of
Act 28 of 1979, as amended by Act 602 of 1987 resulting in a notice of
violation being issued pursuant to Section 4 of the Act, or these
rules;
211.2. Permitting, aiding or
abetting the commission of any unlawful act in connection with the operation of
a Facility;
211.3. Non-compliance
with inspections conducted by state or local inspectors (i.e., fire marshal,
city building inspector, county sanitarian);
211.4. Failure to allow admission to
Department or Office of Long Term Care Personnel;
211.5. Accepting and retaining Residents for
whom the Facility cannot provide services as required in Section 400 of these
rules.
212.
Notice and Procedure on Hearing Prior to Denial, Suspension, or
Revocation of a License: Whenever the Office of Long Term Care
denies, suspends, or revokes a License, it shall send to the applicant or
Licensee, by certified mail, a notice stating the reasons for the action. The
notice shall state the nature of intended action, the rule allegedly violated,
and the nature of the evidence supporting the allegation and shall set forth
with particularity the asserted violations, discrepancies, and dollar amounts.
The applicant or Licensee may appeal such notice to the Long Term Care
Facility's Advisory Board as permitted by Ark. Code Ann. §
20-10-303.
212.1. All appeals shall be made in writing,
directed to the Chairman of the Board, within 30 days of receipt of notice of
intended action. The appeal shall state the basis for the appeal with
supporting documentation attached and shall set forth with particularity those
asserted violations, discrepancies, and dollar amounts which the appellant
contends are in compliance with these rules.
212.2. 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 hearings at least seven (7)
working days prior to the hearing date.
212.3. Preliminary motions must be made in
writing and submitted to the Chairman of hearing officer, with service to the
opposing party, at least three (3) days prior to hearing date, unless otherwise
directed by the Chairman or hearing officer.
212.4. All pleadings filed in any proceeding
shall be typewritten on white paper, size 8 1/2 by 11 inches, using one side of
the paper only and double-spaced. They shall bear a caption clearly showing the
title of the proceeding in connection with which they are filed.
All pleadings shall be signed by the party or his authorized representative or attorney and shall contain signer's address and telephone number. All pleadings shall be served upon each of the parties, unless the Board orders otherwise because of numerous parties. Each pleading required to be served upon a party shall contain a statement by the party or his attorney stating that a copy of the pleading has been served, the date and method of service, and, if by mail, the name and address of the persons served. Service on the Office of Long Term Care shall be made to the Office of Chief Counsel of the Department of Human Services. Service on a party represented by an attorney shall be on the attorney.
212.5 The Chairman of the Board shall act as
Chairman in all appeal hearings. In the absence of the Chairman, the Board may
elect one of their members to serve as Chairman. The Chairman shall vote only
in case of a tie. The Chairman or Board may request legal Counsel and staff
assistance in the conduct of the hearing and in the formal preparation of their
decision.
212.6 A majority of the
members of the Board shall constitute a quorum of all appeals.
212.7 If the appellant fails to appear at a
hearing, the board may dismiss the appeal or render a decision based on the
evidence available.
212.8 A
dismissal for non-appearance may be set aside by the Board if the appellant
makes application to the Chairman in writing within ten (IO) 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 the decision.
212.9. Any party may appear at the hearing
and be heard through an attorney at law or through a designated representative.
All persons practiced by attorneys before the courts of the State.
212.10. 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.
212.11.
Testimony shall be taken only on oath or affirmation under penalty or
perjury.
212.12. 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 reasonable prudent persons 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, any part of the parties will not be
substantially prejudiced; any part of the evidence may be received in written
form.
212.13. 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.
212.14. A party shall arrange for the
presence of his witnesses at the hearing.
212.15. Any member of the Board may question
any party or witness.
212.16. 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.
212.17.
Written notice of the time and place of 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.
212.18. In addition to these rules the
hearing provisions of the Administrative Procedure Act (Ark. Code Ann. §
25-15-101
et seq.) shall apply.
212.19. 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 those members, the Board
may direct that findings of fact and conclusions of law be prepared to reflect
the Board's recommendations to the Chairman. At his discretion the Chairman
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 Chairman shall be
rendered in writing to the appellant.
213.
Appeals To
Court: Any applicant or Licensee who considers himself injured in
his person, business, or property by the final decision of the Chairman shall
be entitled to judicial review thereof 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 Chairman's final decision. All
petitions for judicial review shall be in accordance with the Administrative
Procedure Act.
214.
Penalties: Any person establishing, conducting,
managing, or operating any Facility without first obtaining a License, or who
violates any provisions of Act or rules shall be guilty of a misdemeanor, and
upon conviction shall be liable to a fine of not less than $25.00 (Twenty-Five
Dollars) nor more that $100.00 (One Hundred Dollars) nor more that $500.00
(Five Hundred Dollars) for each subsequent offense, and each day such Facility
shall operate after a first conviction shall be considered a subsequent
offense.
215.
Receivership: Ark. Code Ann. §
20-10-902
describes the purpose for development of a mechanism for the concept of
receivership to protect residents in Long Term Care Facilities. Utilization of
the receivership mechanism shall be a remedy of last resort and shall be
implemented consistent with the criteria set forth in Arkansas Code Annotated
20-10-904.
216.
Fines and
Sanctions: Ark. Code Ann. §
20-10-205
provides for fines and sanctions of Long Term Care Facilities for violations of
rules duly adopted and promulgated by the Department of Human Services,
Division of Economic and Medical Services, Office of Long Term Care.
300 ADMISSIONS AND DISCHARGE OF CLIENTS
301.
Admission
Criteria: A Facility shall admit, retain, and care for only those
Residents for whose needs the Facility is capable of providing and is licensed
to provide. Each Resident admitted must meet the following criteria:
301.1. Be at least 18 years of age. Residents
16 or 17 years of age may be admitted if sufficiently mature to adapt to the
Facility and its program of services.
301.2. Suffer from Head Injury or other
neurological impairment
301.3. Be
able to self-administer any required medication, or needing only medicine which
can be administered by licensed Home Health Agency Personnel; and
301.4. Be independently mobile, except that
Residents needing assistance with transfer or with vacating a building may be
admitted if the Facility has sufficient staff continually available to allow
the building or buildings in which such Resident is living or receiving
treatment to be evacuated within the time provided by the applicable fire
code.
302.
Policies: Each Facility shall develop, subject to
review and approval by the Office of Long Term Care, written policies and
practices concerning the admission, transfer, and discharge of
Residents.
303.
Program
Development:
303.1 The Facility,
prior to admitting any Resident, shall interview the Resident and the
Resident's Sponsor to identify the Resident's needs and determine whether the
Facility may meet those needs adequately.
303.2. Upon admission, the Facility shall
execute with, and provide a copy to, the Resident and the Resident's Sponsor an
admission agreement specifying the following information:
A. The services to be rendered to the
Resident;
B. The method of
calculating the charges for the services (whether on a per them rate, a per
service charge, or other basis);
C.
The schedule of rates necessary to calculate the charges for
services;
D. A statement that the
method of calculating charges and the schedule of rates will be changed only
after 30 days' written notice of changes is given to the Resident and the
Resident's Sponsor;
E. A statement
that no charges will be imposed for services or major items of equipment other
than those specified in the admission agreement or subsequently agreed to by
the Resident or the Resident's Sponsor, unless the supplemental services and
supplies are necessitated by a change in the Resident's condition;
F. A provision that advance payments will be
refunded on a pro rata basis in the event of transfer, death, or discharge and
an explanation of the calculation of the proration;
G. A statement that at least 10 days written
notice prior to discharge or transfer will be given to the Resident and the
Resident's Sponsor, unless the discharge or transfer is at the request of the
Resident or Resident's Sponsor, is ordered by a physician, or is caused by a
change in the Resident's condition which renders the Resident unsuited for
retention and which prevents the giving of prior notice;
H. A provision that upon discharge or
transfer, the Resident or the Resident's Sponsor shall receive within thirty
(30) days a final written statement of the Resident's account. All monies,
property, or things of value held in the custody of the Facility will be
returned to the Resident or the Resident's Sponsor on or before this
date;
I. A listing of all monies,
property, or things of value given or to be given to the Facility on
admission;
J. A provision that the
Resident and the Resident's Sponsor shall not be required to provide to the
Licensee, the Facility, or the Facility's Personnel any remuneration for any
service or supplies provided or arranged in accordance with statute, rule, or
agreement; and
K. A provision that
the Facility will oversee Resident's personal funds.
304.
Discharge and Transfer:
304.1. Occupancy of a Facility by any
Resident shall not be terminated unless such termination is permitted under the
terms of the admission agreement or this section.
304.2. Every Resident, if competent, or the
Resident's Sponsor if the Resident is not competent, shall have the right to
discharge the Resident from the Facility.
304.3. If a Resident develops a communicable
disease or condition that requires in-patient medical or nursing care or which
cannot be adequately or safely treated at the Facility, immediate arrangements
shall be made by the Facility to transfer such Resident to an appropriate acute
medical, nursing, or psychiatric facility.
304.4. In the event that a Resident exhibits
symptoms of behavioral or judgmental defects to a degree that constitutes a
danger to the Resident or other Residents, the Facility shall arrange for
appropriate professional evaluation of the Resident's condition and, if
necessary, transfer the Resident to a facility providing the proper level of
care.
304.5. In the event of any
planned Resident discharge or transfer, other than self-discharge, the Facility
shall provide at least ten (10) days prior notification to the Resident and the
Resident's Sponsor.
304.6. Upon
transfer of a Resident to a nursing home, or other care facility, a copy of all
pertinent Resident records shall accompany Resident, except when emergency
situations do not permit such transmittal. In such emergency cases, pertinent
information shall be telephoned to the receiving facility and written transfer
documents shall be sent within 24 hours.
304.7. Each Facility shall assist all
Residents proposed to be discharged or transferred to the extent necessary to
insure that the Resident is placed in a care setting which is adequate and
appropriate to the conditions for which the Resident is discharged or
transferred, and where possible, consistent with the wishes of the Resident.
400 RESIDENTS RIGHTS
401.
Specific Residents
Rights: Each resident shall have the following specific rights,
and each Facility shall safeguard and not abridge these rights:
The facility shall have written policies and procedures defining the rights and responsibilities of residents. The policies shall present a clear statement defining how residents are to be treated by the facility, its personnel, volunteers, and others involved in providing care.
A copy of the synopsis of the resident's bill of rights must be prominently displayed within the facility.
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 during the period of nor more that two weeks before or five work days after admission, unless medically contraindicated in writing. The facility shall obtain a signed acknowledgement from the resident, his guardian or other maintained in the resident's medical records.
Appropriate means shall be utilized to inform non-English speaking, deaf, or blind residents of the resident's rights.
Resident Rights shall be deemed appropriately signed by:
A. Residents capable of understanding: signed
by resident before one witness.
B.
Residents incapable because of illness: The attending physician documents the
specific impairment that prevents the residents from understanding or signing
their rights. Responsible party and two witnesses sign.
C. Resident mentally retarded: Rights read
and if he understands resident signs before staff member and outside
disinterested party. If he cannot understand, rights are explained to, and
signed by guardian before witness.
D. Resident capable of understanding but
acknowledges with other mark (X); Mark acknowledged by two witnesses.
Staff members must fully understand all resident rights.
Facility staff will be provided a copy of resident rights. Staff shall complete written acknowledgment stating they have received and read the resident rights. A copy of the acknowledgment shall be placed in the employee's personnel file.
The facility's policies and procedures regarding resident's rights and responsibilities will be formally included in ongoing staff development program for all personnel, including new employees.
402. Each resident
admitted to the facility will be fully informed, prior to or at the time of
admission and as need arises during residency, of services available in the
facility including any charges for services. Residents have the right to
choose, at their own expense, a personal physician and pharmacist.
The facility shall make available to all residents, a schedule of the kinds of services and articles provided by the facility. A schedule of charges for services and supplies not included in the facility's basic per them rate shall be provided at the time of admission. The schedule shall be updated should any change be made.
403. Each resident admitted to the facility
shall be fully informed by a physician of his medical condition. The resident
shall be afforded the opportunity to participate in the planning of his total
medical care and may refuse experimental treatment.
Total resident care includes medical care. Nursing care, rehabilitation, restorative therapies, and personal cleanliness in a safe and clean environment. Residents shall be advised by appropriate professional providers of alternative courses of care and treatments and the consequences of such alternatives when such alternatives are available.
404. A resident may be transferred or
discharged only for: medical reasons; his welfare or the welfare of other
residents; the resident presents a danger to safety or health of other
residents; because the resident no longer needs the services provided by the
facility; non- payment for his stay; or the facility ceases operation. The
resident shall be given reasonable written notice to ensure orderly transfer or
discharge.
404.1. The term "transfer" applies
to the movement of a resident from facility to another facility.
404.2. "Medical reasons" for transfer or
discharge shall be based on the resident's needs and are to be determined and
documented by a physician. That documentation shall become a part of the
resident's permanent medical record.
404.3. "Reasonable notice of transfer or
discharge" means the decision to transfer or discharge a resident shall be
discussed with the resident and the resident will be told the reason(s) and
alternatives available. A minimum of thirty (30) days written notice must be
given. Transfer for the welfare of the resident or other residents may be
affected immediately if such action is documented in the medical
record.
404.4. An appeals process
for residents objecting to transfer or discharge shall be developed by the
facility, in accordance with Ark. Code Ann. §
20-10-1005
as amended. That process shall include:
A.
The written notice of transfer or discharge shall state the reason for the
proposed transfer or discharge. The notice shall inform the resident that they
have the tight to appeal the decision to the Director within seven (7) calendar
days. The resident must be assisted by the facility in filing the written
objection to transfer or discharge.
B. Within fourteen (14) days of the filing of
the written objections a hearing will be scheduled.
C. A final determination in the matter will
be rendered within seven (7) days of the hearing.
404.5. The facility shall provide preparation
and orientation to residents designed to ensure a safe and orderly transfer or
discharge.
404.6. The facility must
provide reasonable written notice of change in room or
roommate.
405. Each
resident admitted to the facility will be encouraged and assisted to exercise 0
constitutional and legal rights as a resident and a citizen including the right
to vote, and the facility shall make accommodations to ensure free exercise of
these rights. Residents may voice grievances or recommend changes in policies
or services to facility staff or to outside representatives of their choice,
free from restraint, coercion, discrimination, or reprisal.
405.1. Residents shall have the right to free
exercise of religion including the right to rely on spiritual means for
treatment.
405.2. Complaints or
suggestions made to the facility's staff shall be responded to within ten (IO)
days. Documentations of such response will be maintained by the facility
administrator his designee.
405.3.
Each resident may retain and use personal clothing and possessions as space and
rules permits.
405.4. A
representative resident council shall be established in each facility. The
resident council's duties shall include;
1)
Review of policies and procedures required for implementation of resident
rights.
2) Recommendation of
changes or additions in the facility's policies and procedures, including
programming.
3) Representation of
residents in their complaints to the Office of Long Term Care or any other
person or agency.
4) Assist in
identification of problems and orderly resolution of same.
405.5 The facility administrator shall
designate a staff coordinator and provide suitable accommodations within the
facility for the resident's 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.
405.6 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 designed to assist the resident
council.
406. Each
resident admitted to the facility may manage his personal financial affairs, or
if the resident requests such affairs be managed by the facility, an accounting
shall be maintained in accordance with applicable rules.
407. Residents shall be free from mental and
physical abuse, chemical and physical restraints (except in emergencies) unless
authorized, in writing, by a physician, and only for such specified purposes
and limited time as is reasonably necessary to protect the resident from injury
to himself or others.
407.1. Mental abuse
includes humiliation, harassment, and threats of punishment or
deprivation.
407.2. Physical abuse
refers to corporal punishment or the use of restraints as a
punishment.
407.3. Drugs shall not
be used to limit, control, or alter resident behavior for convenience of
staff.
407.4. All physical
restraints designed to limit residents mobility and the practice of locking
residents behind doors or other barriers is strictly
prohibited.
408.
Mechanical supports used to achieve body position and balance must be designed
and applied under the supervision of a qualified professional and in accordance
with principles of good body alignment, concern for circulation, and allowance
for change of position.
408.1. The facilities
written policy and procedures governing the use of mechanical supports shall
specify which staff members may authorize the use of supports and must clearly
specify the following:
A. Orders shall
indicate the specific reasons for the use of the supports.
B. Use of supports must be temporary and the
resident will not be supported for an indefinite or unspecified amount of
time.
C. Application of supports
shall not be allowed for longer that 12 hours unless the resident's condition
warrants and specified medical authorization is maintained in the resident's
medical record.
D. A resident
placed in supports shall be checked at least every thirty (30) minutes by
appropriately trained staff. A written record of this activity shall be
maintained in the residents' medical record. The opportunity for motion and
exercise shall be provided for a period of not less that ten (10) minutes
during each two (2) hours in which supports are employed, except at
night.
E. Recorder, extensions or
reimposition of supports shall occur only upon review of the resident's
condition by the physician, and is documented in the physician's progress
notes.
F. The use of supports shall
not be employed as punishment, the convenience of the staff, or a substitute
for supervision.
G. Mechanical
supports must be employed in such manner as to avoid physical injury to the
resident and provide a minimum of discomfort.
409. Each resident is assured confidential
treatment of his personal and medical records. Residents may approve or refuse
the release of such records to any individual except in case of a transfer to
another health care institution, or as required by law or third party payment
contract.
410. Each resident will
be treated with consideration, respect, and full recognition of dignity and
individuality, including privacy in treatment and care for personal needs.
410.1 Staff shall display respect for
residents when speaking with, caring for, or talking about residents, and shall
seek to engage in the constant affirmation of resident individuality and
dignity as a human being.
410.2
Schedules of daily activities shall provide maximum flexibility and allow
residents to exercise choice in participation. Resident's individual
preferences regarding such things as menus, clothing, religious activities,
friendships, activity programs, and entertainment will be elicited and
respected by the facility.
410.3
Residents shall be examined or treated in a manner that maintains and ensures
privacy. A closed door or a drawn curtain shall shield the resident from
passersby. People not involved in the care of the residents are not to be
present during examination or treatment without the resident's
consent.
410.4 Privacy will be
afforded residents during toileting, bathing, and other activities of personal
hygiene.
411. Residents
may associate or communicate privately with persons of their choice, and may
send or receive personal mail unopened, unless medically contraindicated and
documented by the physician in the medical record.
412. Policies and procedures shall permit
residents to receive visits from anyone they wish; provided a particular
visitor may be restricted for the following reasons:
A. The resident refuses to see the
visitor.
B. The resident's
physician specifically documents that such a visit would be harmful to the
resident's health.
C. The visitor's
behavior is unreasonably disruptive to the facility. This does not include
those individuals who, because they advocate administrative change to protect
resident rights, are considered a disruptive influence by the
administrator.
412.1 Decisions to
restrict a visitor shall be reviewed and evaluated each time the resident's
plan of care or medical orders are reviewed by the physician or nursing staff,
or at the resident's request.
412.2
Accommodations will be provided for residents to allow them to receive visitors
in reasonable comfort and privacy.
413. Residents are allowed to manage their
own personal financial affairs.
413.1. Should
the facility manage the resident's personal financial affairs; this
authorization must be in writing and shall be signed appropriately as follows:
A. If the resident is capable of
understanding the authorization shall be signed by the resident and one (1)
witness.
B. If the resident is
mentally retarded the authorization shall be read and if he/she understands,
the resident will sign along with a staff member and an outside disinterested
party. If he/she cannot understand, the authorization should be explained and
signed by the guardian and witness. If the resident is capable of understanding
and acknowledges such with a mark (X) then two witnesses are
required.
414.
The facility shall have written policies and procedures for the management of
client trust accounts.
415. An
employee shall be designated to be responsible for resident accounts.
416. The facility shall establish and
maintain a system that using generally accepted accounting
principles.
417. The facility shall
not commingle resident funds with any other funds other than resident
funds.
418. 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.
419. All personal allowance monies received
by the facility are placed in a collective checking account.
420. The checking account will be reconciled
on a monthly basis.
421. Any cost
incurred for this account shall not be charged to the resident.
422. Any interest earned from this account
shall not be charged to the resident.
423. When appropriate individual savings
accounts shall be opened for residents in accordance with Social Security rules
governing savings accounts.
424. A
cash fund specifically for petty cash shall be maintained in the facility to
accommodate the small cash requirement of the residents.
425. The facility shall, at the resident
request, keep on deposit personal funds over which the resident has control.
Should the resident request these funds, they are given to him on request with
receipts maintained by the facility and a copy to the resident.
426. The financial record must be available
to the resident and his/her guardian, and responsible party.
427. If the facility makes financial
transactions on a resident's behalf, the resident, guardian, or responsible
party shall receive an itemized accounting of disbursements and current
balances at least quarterly.
427.1. A copy of
the residents quarterly statement shall be maintained in the
facility.
428.
Control and Discipline of Residents: Each facility
shall develop a written policy for the control and discipline of Residents. A
copy of the policy shall be posted in each residential area at the facility. A
copy of the policy shall be provided to each Resident and Resident's Sponsor at
the time of the admission of the Resident.
No Facility may allow the following:
A. Corporal punishment to a
resident;
B. A Resident to
discipline another Resident; and
C.
A Resident to be locked in a room without constant supervision.
429.
Behavior
Modification: Each Facility shall develop a written policy of the
use of behavior modification in accordance with applicable state and federal
laws and regulations and shall furnish a copy of such policy to the Office of
Long Term Care.
430.
Grievances: Each Resident shall have the right to
present to the Facility or to the Office of Long Term Care any grievance
without fear of reprisal.
431.
Individual Service Plan:
431.1. Within 30 days of the admission of a
Resident to a Facility, the Facility shall prepare an Individual Service Plan
setting forth the needs of the Resident to be treated by the Facility, the
services to be provided by the Facility to meet those needs, ad timetable for
meeting those needs.
431.2. The
Individual Service Plan shall be developed as follows:
A. Upon admission, the Facility shall appoint
a member of the Facility's staff who shall serve as program manager in the
development and implementation of the Individual Service Plan.
B. The Facility shall review all information
concerning the Resident received upon referral of the Resident to the
Facility.
C. The Facility shall
evaluate the Resident's physical, psychological, social, familial, vocational,
and educational status.
D. The
Facility, with input from the Resident and the Resident's Sponsor, shall
develop the goals to be achieved by the treatment supplied by the
Facility.
E. The Facility shall
evaluate the services needed to achieve those goals. Commonly utilized services
that should be considered included but are not limited to:
1 Advocacy;
2. Alcoholism and drug abuse treatment
services;
3. Audiology;
4. Chaplaincy
5. Dentistry;
6. Dietary/nutrition;
7. Driver training;
8. Education;
9. Independent living skills
instruction;
10. Interpretive
services for those who are deaf or hearing impaired;
11. Job placement;
12. Manual communication
instruction;
13. Medication
management;
14. Mobility
instruction for those who are blind or visually impaired;
15. Nursing;
16. Occupational skills training;
17. Occupational therapy;
18. Orthotics;
19. Pharmacy;
20. Physical therapy;
21. Physician;
22. Prosthetics;
23. Psychological evaluation and
treatment;
24.
Recreational;
25. Rehabilitation
counseling;
26. Rehabilitation
engineering;
27.
Residential;
28. Social casework or
group work;
29. Specialized
services for those who are deaf and blind;
30. Speech-language pathology;
31. Transportation;
32. Vocational evaluation; and
33. Work adjustment
431.3 Based on the review and
assessment required by Paragraph
431.4 The facility shall develop an
Individual Service Plan containing statements of:
A. The resident's goals;
B. The treatment or services to be
provided;
C. The specific goals to
be obtained from each service;
D.
The time intervals at which treatment or service outcomes will be
reviewed;
E. The anticipated time
frames for the attainment of each of the Resident's specified goals;
and
F. The measures to be used to
assess the effects of treatment or services.
431.5. The resident's Individual Service Plan
shall be in writing. A copy of the Individual Service Plan shall be provided
and explained to the Resident and the Resident's Sponsor. A copy of the
Individual Service Plan shall be maintained in the Resident's records at the
facility.
431.6. The facility shall
review and revise the Resident's Individual Service Plan upon a substantial
change in the Resident's needs and no less often than quarterly to determine:
A. The Resident's current physical,
psychological, social, familiar, vocational, and educational status;
B. The Resident's attainment of the goals
previously established;
C. Any
changes in the goals of the Individual Service Plan; and
D. Any changes in the services to be provided
to achieve those goals.
431.7. A single program manager shall be
designated for each Resident and shall:
A. Be
responsible for the Resident during the implementation of the Individual
Service Plan;
B. Assure that the
Resident is adequately oriented to his Individual Service Plan;
C. Assure that the Individual Service Plan
proceeds in an orderly and goal-directed manner;
D. Encourage the Resident's participation in
the program;
E. Assure that the
Resident and the Resident's Sponsor are involved on an ongoing basis in
evaluation and revision of the Individual Service Plan;
F. Participate in staff conferences
concerning the Resident; and
G.
Assure that the discharge decision and arrangements for follow-up and
appropriate support services are made.
431.8. Conferences of the Facility staff
shall be held at least monthly to review the progress of the Resident, to
develop further plans, and to maintain integrated and coordinated services. The
Resident and the Resident's Sponsor shall be allowed to provide input into
these conferences.
432.
Health, Mental Health and Other Professional Services:
432.1 The facility shall assure that each
Resident has access to health, mental health and other professional services
necessary to maintain the Resident's physical and mental health.
432.2 The Facility shall assist the Resident,
as necessary, in making arrangements to secure all services, examinations, and
reports needed to maintain and document the maintenance of the Resident's
physical health or mental health.
432.3 The Facility shall document that each
Resident has a physician of the Resident's choice who is responsible for the
overall management of the Resident's health and mental needs.
432.4 In the event of a Resident's illness or
accident, the Facility shall:
A. Notify the
Resident's personal physician, or in the event such physician is not available,
a qualified alternate;
B. Take
immediate and appropriate stapes to see that the Resident receives necessary
medical attention including, if necessary, transfer to an appropriate medical
facility;
C. Make a notation of the
illness or accident in the Resident's personal record; and
D. Upon transfer of a Resident to a health,
mental health, or other Residential Care Facility, send a copy of pertinent
resident records, except when emergency situation prohibits such transmittal.
In such cases pertinent information shall be telephoned into the receiving
facility, and written transfer documents shall be sent within 72
hours.
432.5 For
Residents who require mental health services which are not to be provided by
the Facility, the Facility shall:
A. Allow,
with the written permission of the Resident, appropriate mental health
professionals access to the Resident's records having direct bearing on the
mental health care of the Resident;
B. Provide appropriate space to carry out the
services provided or prescribed; and
C. Participate in the development and
implementation of programs designed to enhance treatment plans prescribed for
the Resident.
432.6 The
Facility shall assist each Resident to obtain regular and emergency dental
services.
432.7 The Facility shall
assist each Resident in obtaining proper foot care.
432.8 The Facility shall assist each Resident
in obtaining other routine or special services as his needs may require,
including but not limited to:
A. Eye
examinations and eye glasses; or
B.
Auditory testing and hearing aid.
433.
Medications:
433.1 Any medication required by a Resident
must be self-administered by the Resident or administered by a licensed Home
Health Agency. A Facility and its staff shall not administer any medication,
other than emergency or first aid measures. Emergency measures are defined as
those necessary to prevent death or trauma until the Resident can be
transported to an appropriate medical facility. First aid measures are defined
as those necessary immediately to relieve trauma or injury.
433.2 A Facility may provide training and
minimal assistance or guidance to Residents who self-administer medication,
including, but not limited to, reminding the Resident of the time to take the
medication and reading to the Resident the medication regimen on the medication
container.
433.3 If a Facility
makes provision for administration of medication by a Home health Agency, the
Home Health Agency shall be responsible for:
A. Planning, directing, and supervising the
administration of medication to Residents and assisting the Resident in
ordering medications;
B. Reviewing
each Resident's condition and medication regimen at regular intervals and
documenting those reviews; and
C.
Providing appropriate instruction to Residents in self- administration of
medication and documenting those instructions.
433.4 Written orders, signed by a licensed
medical practitioner, for all medications administered to Residents shall be
retained in the Resident's records.
433.5 All medications shall be stored and
safeguarded as follows:
A. Medication shall be
stored in a secure area; provided, however, that medications may be kept in the
Resident's room in the sole discretion of the Facility depending on the
capabilities of the Resident.
B.
Prescription medications shall be properly labeled in accordance with current
applicable laws and rules.
C.
Non-prescription or over-the-counter medications must be individually labeled
and kept in the original container if stored by Facility.
D. Stock supplies of any medication are
prohibited.
E. Any medication which
has been prescribed for but is no longer in use by a Resident shall be
destroyed or disposed of in accordance with state law if stored by the
Facility.
F. Under no circumstances
will one Resident's medication be shared with another Resident.
433.6 If the Facility stores and
supervises a Resident's medication, a notation shall be made on the individual
record for each Resident who refuses or is unable to self-administer his
medications. The notation shall include the date, time, and dosage of
medication that was not taken, and a notation that the resident's attending
physician was notified within a reasonable amount of time.
434.
Home Health
Service: Home Health Services, including skilled nursing visits
and procedures, physical or speech therapy, and home health aide services,
maybe provided in a Facility by a licensed Home Health Agency. Any Home Health
services must be ordered by the Resident" attending physician. The Home Health
Agency must provide the Facility with a complete Home Health Service Plan for a
Resident, signed by the Resident's attending physician, within 72 hours of
employment.
435. Supervision: A
Facility shall provide, as part of services included in the basic program,
supervision as is appropriate to maintain and promote the well-being of each
Resident. Supervision shall mean guidance of a Resident in caring out
activities of daily living and social activities including, but not limited it,
reminding a Resident to maintain the medication schedule directed by the
attending physician, encouraging the Resident to attend meals, reminding the
Resident of important activities to be carried out, assisting the Resident in
keeping appointments, and being aware of a Resident's general location even
though the Resident may travel independently about the community. In the event
a Resident is absent from the Facility and the Resident's location is unknown
the Facility shall immediately notify the Resident's Sponsor, the appropriate
law enforcement agency, and the Office of Long Term Care. The Facility shall
through supervision assure that Residents are:
435.1 Treated with kindness and consideration
at all times and are not abused, neglected, or exploited in any
manner;
435.2 Dressed appropriately
for the activities in which the Resident is engaged and for the
weather;
435.3 Encourage to
participate, with staff assistance and support as needed, in social,
recreational, vocational, and religious activities within the community and
Facility.
435.4 Encourage to
perform personal hygiene activities including, as a minimum:
A. A tub bath or shower as desired or
required;
B. Daily oral hygiene
and, if necessary and requested by the Resident, shaving; and
C. Trimming and shaping of fingernails and
toenails, unless prohibited by the Resident's attending physician.
435.5 Not routinely confined to
room or bed except as necessary for the treatment of a routine short-term
illness or in conformity with behavior modification protocols in the Resident's
Individual Service Plan; and
435.6
Not locked in the Resident's room or restrained except in accordance with the
provisions of Section 404.
436.
Activities and
Socialization: Each Facility shall provide, as part of the
services and accommodations included in the Individual Service Plan, an
organized program of individual and group activities appropriate to the
Resident's needs, interests, and wishes:
436.1
Accommodation and space shall be provided for recreation and socialization
services.
436.2 Group recreation
and socialization services shall be planned and available to each
Resident.
436.3 The Facility shall
provide appropriate equipment and supplies.
436.4 A schedule of group activities shall be
prepared and posted in advance of its proposed implementation.
437.
Unauthorized Services: No Facility shall provide
medical or nursing services. No Facility shall accept or retain any Resident
who requires a skilled nursing or intermediate level of care or who exhibits
the conditions listed below:
437.1 Suffering
from such a degree of behavioral or judgmental deficiency or recurrent
habituation or addiction to alcohol or other drugs that the Resident is a cause
of danger to the Resident or others;
437.2 Is in need of a higher level of
medical, mental health, or nursing care that can be rendered safely and
effectively at the Facility by approved community resources, such as a licensed
Home Health Agency or other community service agency;
437.3 In need of a religious, cultural, or
dietary regimen that cannot be met by the Facility;
437.4 Suffering from a communicable or other
disease of sufficient seriousness requiring in-patient medical treatment or
which cannot be treated by use of reasonable means and therefore constitutes a
potential danger to other Residents and staff;
437.5 Is not independently mobile, as defined
in Section 604.12, provided that the Facility may accept and retain Residents
needing assistance with transfers or with vacating a building including if the
Facility has sufficient staff available twenty-four hours a day, seven days a
week, to provide assistance to all Residents requiring assistance within the
time provided by the applicable fire code;
437.6 Is incapable of self-administration of
required medications or treatments, unless administration of medications is
provided by a licensed Home Health Agency;
437.7 Persons with Levines tubes, gastrostomy
tubes, intravenous tubes, tracheotomies, unless management of such devices is
provided by either the Resident or by a licensed Home Health Agency;
and
437.8. Persons with indwelling
catheters, unless self-managed or managed by a licensed Home Health Agency.
438.
Transfer: Facilities shall make arrangements with a
licensed physician, hospital, or nursing home to transfer Residents who require
skilled or intermediate nursing care or more technical nursing or medical
services that those permissible within the Facility. When notified by the
Office of Long Term Care, the Facility shall provide for transfer within ten
(10) days of such notification. Less time may be given by the Office of Long
Term Care of a Resident's life or health requires immediate medical attention.
The responsibility for ensuring the Resident's care shall rest with the
Facility.
439.
Personal
funds accounts: Each Resident shall have the opportunity to place
personal funds in a Facility-maintained account.
439.1 The Facility shall administer the
Resident's personal funds account as follows:
A. All personal finds deposited by Residents
in personal funds account shall be held in trust for the benefit of the
Residents.
B. A Resident's personal
funds shall not be commingled with the funds of the Facility or Licensee or
used by the Facility other than for the benefit of the Resident.
C. The Facility may commingle personal finds
deposited by Residents, but shall maintain individual records for each Resident
showing all deposits, withdrawals, and the current balance.
D. The Facility shall provide Residents
access to their personal funds account during regular posted hours Monday
through Friday.
E. The Facility
shall document all personal funds transactions and maintain copies of all paid
bills, vouchers, and other payment and receipt documentation.
F. The Facility may deposit Resident's
personal funds in individual or collective federally insured accounts, which do
not need to be interest bearing. If the funds are deposited in interest-bearing
accounts, the Facility shall develop a procedure to prorate equitably interest
to each Resident.
G. Upon request,
the Facility shall supply any Resident who has a personal funds account with a
statement showing all deposits and withdrawals, and the current balance of the
Resident's personal funds.
H.
Within 72 hours of receiving a request from a Resident or the Resident's
Sponsor, the Facility shall pay to the Resident the balance of the Resident's
personal funds account.
I. The
Facility shall provide the Office of Long Term Care with access during normal
business hours to all records of Resident's personal funds account.
439.2 The Resident's personal
funds account shall be used as follows:
A. The
personal finds shall, at her discretion of the resident, be used in obtaining
clothing, personal hygiene items, and any other supplies, services,
entertainment or transportation for personal use not otherwise provided by the
Facility pursuant to the admission agreement or required by these
rules
B. The Facility shall not
demand, require or contract for payment of all or any part of the personal
funds in satisfaction of the Facility rate for supplies or services.
C. The Facility shall or charge the Resident
for supplies or services that the Facility is by law, rule, or the admission
agreement required to provide. This also applies to medical supplies or
services for which payment is known to be available for the Resident under
Medicare, Medicaid, or other third party coverage.
D. Services or major items of equipment
provided by the Facility beyond those required by law, rule, or the admission
agreement may be charged to the Resident only with the specific written consent
of the Resident or the Resident's Sponsor unless the supplemental services or
supplies are necessitated by changes in the Resident's condition. The Resident
shall be furnished with an itemized statement setting forth the charges for
such services or supplies provided by the Facility. Such statement shall be
provided to the Resident in advance except in an emergency.
439.3 At the time of discharge of
a Resident from the Facility, the Resident or the Resident's Sponsor shall be
provided a final accounting of the Resident's personal funds account and issued
a check for the balance. Upon the death of a Resident, a final accounting of
the Resident's personal funds account and a check for the balance shall be
given to the Resident's estate, subject to state law.
439.4 Upon change of ownership, the existing
Licensee shall provide the new owner with a written statement of all Residents'
personal funds. This statement shall verify that the balance being transferred
in each Resident's personal fund account is true and accurate as of the date of
transfer. At change of ownership, the new owner shall assume responsibility for
Residents' personal funds account balances turned over at the change of
ownership, together with responsibility for all requirements of this Section,
including holding of Resident's personal funds in trust.
439.5 The Facility shall provide for
inventory records and security of all monies, property or things of value which
the Resident has, in writing, voluntarily authorized the Facility to hold in
custody or exercise control over at the time of admission or any subsequent
time.
500 ADMIMSTRATION, PLANT, AND MAINTENANCE REQUIREMENTS
501.
Administration:
Each Facility shall have on the premises a manager or other individual
delegated with supervisory authority. All communications between the Office of
Long Term Care and the Facility will be through the manager. The manager or any
supervisory employee must:
Be at least 21 years of age;
Be able to read or write;
Be able to understand and comply with these rules;
Be a full-time employee;
Have no prior criminal convictions under Act 28 of 1979, as amended; and
Have no prior history of abuse or neglect of others.
502.
Staff. Sufficient staff shall be present at all times
to meet the ordinary needs of the Residents.
503.
Resident
Records: Each Facility shall maintain individual records for each
Resident.
The following information shall be contained in each Resident's record:
A. Resident's name and
residential address prior to admission;
B. Resident's Sponsor's name, residential
address, home telephone number, and business telephone.
C. Name and regular emergency telephone
numbers of the Resident's attending physicians;
D. Reports of referring source;
E. Reports of outside service
referrals;
F. Resident's Individual
Service Plan;
G. Name and home
telephone of the program manager for the Resident;
H. Evaluation reports from each
service;
I. Reports of staff
conferences concerning the Resident;
J. The Resident's Home Health Care service
plan;
K. A copy of the Resident's
Rights Statement signed by the Resident or the Resident's Sponsor;
L. Written authorization from the Resident's
attending physician for any medications being received by the
Resident;
M. Any correspondence
pertinent to the Resident;
N. A
list of all insurance policies insuring the life of a Resident of which the
Facility is a beneficiary; and
O. A
signed copy of the Facility's admission/discharge and transfer agreement with
the Resident.
The Facility shall maintain all Resident records as follows:
A. All information
and documents shall be organized in a systematic fashion and affixed to the
record binder.
B. All Resident
records shall be maintained at a central location.
C. A designated staff member shall be
responsible for the control of all Resident records.
D. An indexing and filing system shall be
maintained for all Resident's records
E. Resident records shall be stored under
lock with reasonable protection against fire, water, and other hazards.
The Facility shall protect the confidentiality of Resident records as follows:
A. Each
Resident or the Resident's Sponsor shall have the right to inspect the
Resident's records during normal business hours.
B. Provide access to the agents,
representatives and employees of Office of Long Term Care in furtherance of the
performance of official duties.
C.
The Facility shall not disclose any Resident's records to any person or agency
other than the Resident, the Resident's Sponsor, the personnel of the Facility
or personnel of the Office of Long Term Care, except upon express written
consent of the Resident, unless the disclosure is required by state or federal
law.
D. Any inspection,
investigative reports, or written complaints which are accessible to the public
shall not disclose the identity of any Resident.
Upon discharge or death, a copy of the Resident's discharge report or death certificate shall be placed in the Resident's record. The records of discharged or deceased Residents must be retained for three years but may be stored separate from the records of present Residents.
504.
Dietary
Services: Each Facility shall provide to its Residents food and
drink which furnishes sufficient nutrients and calories based on current
recommendations of the Food and Nutrition Board of the National Academy of
Sciences, National Research Council.
Each Facility shall provide three balanced meals per day and have available between meal snacks. The three meals, together, shall provide the following minimum dietary requirements:
A. Milk - Two or more cups served as a
beverage or used in cooking. Fortified whole, skim, low fat milk, flavored
whole or fortified milk, buttermilk, or cheese may be used. Cheese may be used
as a milk substitute or as a meat substitute, but nor both;
B. Meat Group - Two or more servings of meat,
fish, poultry, eggs, cheese, or equivalent; at least four or five ounces edible
portions per day;
C. Vegetable and
Fruit Group - Four or more servings (two cups) which shall include citrus or
other fruit, a vegetable for Vitamin C and a dark green or yellow vegetable for
Vitamin A at least every other day;
D. Other vegetables and fruits, including
potatoes; and
E. Bread and Cereal
Group - Four or more servings of whole grain or enriched bread.
The Facility in serving the three meals daily shall:
A. Serve the meals at
approximately the same time each day;
B. Assist and supervise the Residents in
consumption of the meals;
C. Serve
food which is chopped, ground or pureed if necessary to meet the individual
needs of a Resident.
If a Resident refuses to consume meals for more than two (2) days or shorter period, as the Resident's physician specifies, the Facility shall notify the Resident's attending physician and act on the physician's instructions.
Dining room space and furnishings shall be maintained in good repair. Dining room space and furnishings must be sufficient to serve the Residents in no more than two (2) seatings.
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 three-day supply of non-perishable. The food supply must come from sources approved by the State Department of Health.
Each Facility shall have adequate refrigeration and storage space. Refrigerator temperatures shall not exceed 45ºF, and freezer temperatures shall not exceed 0ºF. Thermometers shall be placed in each refrigerator and freezer. Left-over food placed in the refrigerator shall be sealed and dated and must be used within 48 hours.
All food shall be prepared, cooked, served, and stored in such manner that protects against contamination and spoilage.
The kitchen and dining area shall be cleaned after each meal.
An all purpose #5 ABC fire extinguisher shall be provided in the kitchen.
Food scraps shall be placed in garbage cans with tight fitting lids and bag liners. The liners must be sealed and the cans emptied after each meal.
All food service personnel shall have health cards and shall wear clean clothes.
505
Laundry and Linen
Service:
Each Facility shall provide laundry services to its Residents. Laundry services may be provided by the Facility, by contract with an outside linen service, or by permitting Residents with supervision to do their own personal laundry.
In-house laundries shall be located in areas separate from kitchen, bathroom, and bedroom areas.
Facilities with in-house laundries shall have washers and dryers of adequate size to serve the needs of the Facility.
Laundry dryers shall be properly vented to the outside.
The laundry room shall be cleaned on a daily basis to prevent lint accumulation and to remove clutter.
Portable electric eaters or stove shall not be used in the laundry area.
The laundry room shall be well lighted and vented to the outside by either power vents, gravity vents, or by outside windows.
Resident's clothing and kitchen linens shall be washed separately from bed linens. Bed linens, including washable blankets, shall be washed at a minimum temperature of 150'F or with a disinfecting agent.
The following minimum amounts of linen shall be available in the Facility at all times:
A. Sheets -
Two (2) times the Facility's census.
B. Pillow Cases - Two (2) times the
Facility's census.
C. Bath Towels -
Two (2) times the Facility's census.
D. Hand Towels - Two (2) times the Facility's
census.
E. Washcloths - Two (2)
times the Facility's census.
F. One
blanket and one pillow for each Resident.
Bed linens shall be changed at least once a week and more often as needed. Beds shall be straightened as necessary by the Resident or staff.
506.
Housekeeping:
506.1
Each Facility shall keep all areas clean and free of insects, rodents, and
trash. All equipment and furnishings shall be maintained in good operating
condition.
506.2 Each Residential
Area shall be cleaned before each used by another Resident. Resident should be
encouraged to keep their own rooms clean and supervision from Facility
staff.
506.3 Corridors shall not be
sued for storage.
506.4 Attics,
cellars, basements, below stairways, and similar areas shall be kept clean of
accumulation of refuse, old newspapers, discarded furniture and other flammable
or combustible materials.
506.5
Throw or scatter rugs must have non-skid backing.
506.6 Polish used on floors shall provide
non-slip finish.
506.7 Flammable
material, such as gasoline, kerosene, paint, and paint thinners, shall not be
stored inside any building containing a Residential Area or in the attic of any
building.
506.8 Metal or UL
approved plastic wastepaper baskets shall be provided in Residential Areas and
other areas in which Residents smoke.
506.9 Outside trash containers shall be
equipped with covers.
506.10 There
shall be an adequate and available supply of soap and toilet tissues for each
Resident.
507.
Space, Furnishings, and Equipment:
507.1 All rooms, including bedrooms, shall
have light switches at the entrance to the room.
507.2 Windows shall be kept clean and in good
repair and supplied with curtains, shades, or drapes. Each window shall have a
screen which is clean and in good condition.
507.3 Light fixtures shall be equipped with
covers to prevent glare and hazards to the Residents.
507.4 All fans located within seven (7) feet
of the floor shall be protected by screen guards of not more than one-fourth
inch mesh.
507.5 All Resident
bedrooms shall have a hinged door in working order.
507.6 All Facilities shall have at least one
telephone available for outside calls for every forty (40) Residents.
507.7 All Residential Areas shall be
decorated, painted, and appropriately furnished.
507.8 All furnishings and equipment shall be
durable, clean, and appropriate to its functions.
507.9 All areas shall be well lighted to
insure Residents safety.
508.
Residential
Areas.
508.1 Each Residential
Areas shall have living room space meeting the following requirements:
A. At least 20 square feet of living room
space must be provided for each licensed bed in the Residential Area.
B. The living room space shall be easily
accessible to all Residents residing in the Residential area.
C. Living rooms shall not be used as
bedrooms
D. Living rooms shall be
available or use by Residents at appropriate times to provide periods of social
diversion and individual or group activities.
508.2 Each Residential Area shall have dining
room space meeting the following requirements:
A. Sufficient dining room space shall be
provided to allow the serving of all Residents regularly utilizing it in not
more than two seatings.
B. Each
dining room shall be readily accessible to the Residents utilizing
it.
C. Each dining room shall be
furnished with sufficient dining tables and chairs to serve all Residents
regularly utilizing it in not more than two seatings.
D. Dining room areas may serve more than one
Residential Area may serve the entire Facility.
508.3 Dogs and cats may be permitted in
Residential Areas if a pet therapy plan for the Facility has been approved by
the Office of Long Term Care and the pets are maintained as part of a
Resident's Individual Service Plan. Guide dogs for the visually impaired are
permitted without approval of the Office of Long Term Care. Proper sanitary
conditions must be maintained by the Facility.
509.
Baths and
Toilets:
509.1 In Residential
Areas, there shall be a minimum of one toilet and one lavatory for each six
Residents. A minimum of one tub or shower shall be provided for each ten
Residents. In educational and administrative areas, the requirements of the
Arkansas State Plumbing Code shall be satisfied.
509.2 Each bathroom shall have a door in
working order.
509.3 If the
Facility accepts Residents who must use wheelchairs of other assistive devices,
the Facility shall insure that adequate accessible bath and toilet facilities
are available to such Residents.
509.4 Hot water tanks serving bathroom
fixtures shall be maintained on the lowest possible setting to avoid possible
bums to Residents. No tank shall be located in a Residential Area. Each tank
shall have a pressure release valve. In all Facilities which commence operation
after adoption of these rules and in all future construction at all Facilities,
an adjustable thermostatically controlled mixing valve shall be installed at
the hot water tank on all hot water heaters.
509.5 Bathrooms shall provide privacy for
each Resident.
509.6 Toilet and
bathing facilities shall be vented to the outside.
510.Bedrooms:
510.1 No bedrooms shall be below ground
level. If the floor level of a bedroom is above grade on one exterior wall, the
bedroom shall not be considered to be below ground level. For natural
ventilation each bedroom shall have an outside window with openings equal to
one-eighth of the floor space. The opening of windows may be restricted if
necessitated by a Resident's condition or behavior.
510.2 A bedroom occupied by a single Resident
shall contain at least 80 square feet, exclusive of entrance way and closet
space.
510.3 A bedroom occupied by
more than one Resident shall provide at least 80 square feet for the first
Resident and at least 60 spare feet for each additional Resident. The beds
shall be at least three feet apart.
510.4 No more that three Residents shall
share a bedroom.
510.5 Each
Facility shall furnish every bedroom with the following equipment:
A. A standard or single bed in good repair
for each Resident. Rollaway beds, cots, and folding beds shall not be
used;
B. Each bed shall be equipped
with well-constructed springs and mattresses in good repair, and a clean
comfortable pillow;
C. Suitable
furniture and storage facilities for personal articles for each Resident;
and
D. At least three linear feet
of closet or locker space shall be provided for each Resident.
510.6 Male and female Residents
shall not have adjoining bedrooms which do not have full floor-to-ceilings
partitions and closable solid core doors. Male and female Residents shall not
be permitted to co-habitate outside the bounds of matrimony.
511.
Other
Plant Requirements:
511.1 An
adequate supply of potable water, under pressure, shall be provided at all
times. When public water systems is available, a connection to it shall be
made. If water from a source other than public water supply is used, the supply
shall meet the requirements set forth under Rules of the State Board of
Health.
511.2 All sewage shall be
disposed of by means of either:
A. A public
system, if one is accessible within 300 feet, or
B. An approved sewage disposal system which
is constructed and operated in conformance with the standards established for
such systems by the Arkansas State Board of Health.
511.3 All plumbing shall be installed and
maintained in accordance with the Arkansas State Plumbing and Gas
Code.
511.4 Electrical wiring,
fixtures, appliances, motors, and other electrical equipment shall be installed
in accordance with the national electrical code NFPA Pamphlet #70 and shall
comply with the local regulations and codes where they exist. The use of
extension cords is strictly prohibited
511.5 All heating units or systems shall
comply with the following requirements:
A. 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.
B. All gas heating
units shall 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.
C. All gas heating units and water heaters
shall be vented adequately to care the by-products of combustion to the outside
atmosphere. Vents shall be constructed and maintained to provide a continuous
draft to the outside atmosphere in accordance with the American Gas Association
Recommended Procedures.
D. All
heating units shall be provided with a sufficient supply of outside air so as
to support combustion without depletion of the air in the occupied
room.
E. All heating and cooling
units must be installed and maintained in a manner which will provide for the
safety and comfort of the occupants.
F. Wood heaters may be used if UL approved
and installed per UL instructions.
511.6 Facilities must be operated in areas
permitted by local zoning codes. Each Facility shall provide the Office of Long
Term Care with documentation that the Facility is in compliance with zoning
Requirements.
511.7 Conditions of
soil, groundwater level, drainage and topography shall not create hazards to
the property or to the health and safety of the occupants. The site shall not
be subject to unpredictable flooding and shall be large enough to provide an
exercise area for Residents.
512.
Safety
Standards:
512.1 Life Safety
Code 1985, Chapters I through 7 shall apply to all buildings containing
Residential Areas. Chapters 16, 18, 20, and 2 1, as appropriate, shall apply to
buildings containing Residential Areas, depending on the living and structural
arrangement of each building.
512.2
Tornado drills shall be conducted annually and documented. Fire drills shall be
conducted quarterly and documented. Smoke detectors checked monthly and
documented. Fire extinguishers 5 #ABC shall be located in bedroom
areas.
512.3 Steam pipes and
heating pipes with which Residents may come in contact shall be covered to
prevent injury or burns.
512.4 Grab
bars shall be provided in Resident bathrooms for toilets, tubs, and showers.
Bathtubs shall be equipped with non-slip surfaces.
512.5 Bedrooms must access directly to an
exit corridor. Access to toilet and bathing areas shall not be through another
Resident's bedroom. Access to bedroom areas shall not be through toilet or
bathing areas.
512.6 Any practices
which create a fire hazard are prohibited, including but not limited to:
A. Portable electric space heaters or
self-contained, fuel-burning space heaters, unless specifically authorized by
the Office of Long Term Care in writing;
B. Use of electrical cooking appliances or
mini-kitchens in Resident's bedrooms;
C. Combustible containers for smoking
material or ashes;
D. The
accumulation of combustible material, such as rags, paper items, and general
trash, and
E. Unsafe storage of
oil-based paints, varnishes or other flammables.
512.7 Doors in Resident bedrooms may be
secured by the Resident provided such doors can be unlocked from the outside
and keys are available to staff at all times.
512.8 Chain locks, clasps, bars, padlocks,
and similar devices on doors shall not be used in any area of the Facility
intended for use by Residents.
512.9 A diagram of the building shall be
posted in each building showing exits and fire extinguishers.
512.10 Emergency telephone numbers shall be
posted in large print in each building. The list shall include fire department,
police department, physician, ambulance service, poison control center,
emergency services, and the Office of Long Term Care.
513.
Maintenance:
513.1 Each Facility shall establish and
conduct a maintenance program to insure the continued maintenance of the
Facility's plant, to promote good housekeeping procedures, and to insure
sanitary practices.
513.2 Each
Facility shall:
A. Maintain the building and
grounds in a clean, orderly condition in good repair;
B. Maintain draperies and furniture in good
and safe repair;
C. Promptly
replace or repair cracks in plaster, peeling wallpaper or paint, missing or
damaged tiles, and tears or splits in floor coverings;
D. Maintain the electrical systems, including
appliances, cords, and switches, in compliance with the state and local
codes;
E. Maintain plumbing and
plumbing fixtures in compliance with Arkansas Plumbing and Gas Codes;
F. Maintain ventilation, heating, air
conditioning, and air changing systems. Gas systems shall e inspected at least
every 12 months to assure safe operation. Inspection certificates, where
applicable, shall be maintained for review;
G. Maintain the building, grounds and other
buildings free of breeding areas for flies, other insects, and
rodents;
H. Maintain entrances,
exits, steps, and outside walkways free from ice, snow, and other hazards; and
L. Repairs or additions must meet
then-existing building codes.
600 MISCELLANEOUS PROVISIONS
601.
Severabilily: If any provision of these rules, or
their application to any person or circumstance is held invalid, such
invalidity shall not affect other provisions and application of these rules
which can be given effect without the invalid provisions or applications, and
to this end the provisions of the rules are declared to be severable.
602.
Interpretation:
Whenever in these rules any word importing the singular or plural number is
used in describing any matter, person, or thing, the word shall be deemed to
include the plural or singular.
603.
Judicial Power of
Enforcement:
603.1 The Office of
Long Term Care may bring an action for a temporary restraining order,
preliminary injunction, or permanent injunction against the Licensee of a
Facility to enjoin one or more of the following:
A. Operation of:
1. An unlicensed Facility;
2. A previously licensed Facility which has
had its license suspended or revoked; or
3. A licensed Facility for which procedures
for non- renewal or revocation of the Facility's License has been initiated and
an emergency exists.
B.
Acts or omissions which constitute a continuing violation of these
rules;
C. Admission of new
Residents into a Facility:
1. Which is
operating without a license;
2.
Which has had its license suspended or revoked;
3. Which is presently involved in proceedings
for non- renewal, suspension, or revocation of the license and an emergency
exists; or
4. In which continued
admissions into the Facility will place the lives, health, safety, and welfare
of the present and future Residents in imminent danger.
603.2 The Office of Long Term Care
may relocate Residents from a Facility if any of the following conditions
exists:
A. One or more violations remain
uncorrected after efforts seeking compliance have failed, and the violation
significantly impairs the Facility's ability to provide an adequate level of
services and assistance to its Residents;
B. An emergency exists in the
Facility;
C. The Licensee
voluntarily closes the Facility; or
D. The Facility requests the aid of the
Office of Long Term Care in the removal of Residents and the removal is made:
1. With consent of the Residents;
2. For valid medical reasons; or
3. For the welfare of the Resident or other
Residents.
603.3 The Office of Long Term Care may
suspend the admission of Residents to a Facility on the following grounds:
A. One or more deficiencies that directly
affect the health and safety of Residents remain uncorrected after efforts
seeking compliance have failed and the effect of the violation or violations is
to impair significantly the Facility's ability to provide an adequate level of
services or assistance to its Residents; or
B. An emergency exists in the Facility.
Before new admissions are suspended, the Licensee shall receive prompt notice
of the Office of Long Term Care's decision. The suspension shall terminate upon
the Office of Long Term Care's determination that the Facility is in
substantial compliance or upon successful appeal of the suspension by the
Licensee.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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