Kentucky Administrative Regulations
Title 902 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR PUBLIC HEALTH
Chapter 20 - Health Services and Facilities
Section 902 KAR 20:051 - Operation and services; intermediate care
Universal Citation: 902 KY Admin Regs Service 20:051
Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO: KRS 216B.010-216B.130, 216B.990
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Cabinet for Health Services regulate health facilities and health services. This administrative regulation establishes licensure requirements for the operation of and services provided by intermediate care facilities. Executive Order 96-862, effective July 2, 1996, reorganizes the Cabinet for Human Resources and places the Office of Inspector General and its programs under the Cabinet for Health Services.
Section 1. Definitions.
(1) "Activities of daily living" means
activities of self-help (e.g., being able to feed, bathe and/or dress oneself),
communication (e.g., being able to place phone calls, write letters and
understanding instructions) and socialization (e.g., being able to shop, being
considerate of others, working with others and participating in
activities).
(2) "Administrator"
means a person who is licensed as a nursing home administrator pursuant to
KRS
216A.080.
(3) "Facility" means an intermediate care
facility.
(4) "License" means an
authorization issued by the cabinet for the purpose of operating an
intermediate care facility and offering intermediate care services.
(5) "PRN medications" means medications
administered as needed.
(6)
"Qualified dietician" or "nutritionist" means:
(a) A person who has a bachelor of science
degree in foods and nutrition, food service management, institutional
management or related services and has successfully completed a dietetic
internship or coordinated undergraduate program accredited by the American
Dietetic Association (ADA) and is a member of the ADA or is registered as a
dietician by ADA; or
(b) A person
who has a master's degree in nutrition and is a member of ADA or is eligible
for registration by ADA; or
(c) A
person who has a bachelor of science degree in home economics and three (3)
years of work experience with a registered dietician.
(7) "Restraint" means any pharmaceutical
agent or physical or mechanical device used to restrict the movement of a
patient or the movement of a portion of a patient's body.
Section 2. Scope of Operations and Services. Intermediate care facilities are establishments with permanent facilities including inpatient beds. Services provided include twenty-four (24) hour supervision of patients, services including physician, nursing, pharmaceutical, personal care, activities and residential services. Patients in an intermediate care facility must have a physical or mental condition that requires intermittent nursing services along with continuous supervision of the activities of daily living.
Section 3. Administration and Operation.
(1) Licensee. The licensee shall be legally
responsible for the facility and for compliance with federal, state and local
laws and regulations pertaining to the operation of the facility.
(2) Administrator.
(a) All facilities shall have an
administrator who is responsible for the operation of the facility and who
shall delegate such responsibility in his absence. The administrator shall not
be the nursing services supervisor in a facility with more than sixty (60)
beds.
(b) The licensee shall
contract for professional and supportive services not available in the facility
as dictated by the needs of the patient. The contract shall be in
writing.
(3)
Administrative records.
(a) The facility shall
maintain a bound, permanent, chronological patient registry showing date of
admission, name of patient, and date of discharge.
(b) The facility shall require and maintain
written recommendations or comments from consultants regarding the program and
its development on a per visit basis.
(c) Menu and food purchase records shall be
maintained.
(d) A written report of
any incident or accident involving a patient (including medication errors or
drug reactions), visitor or staff shall be made and signed by the administrator
or nursing service supervisor, and any staff member who witnessed the incident.
The report shall be filed in an incident file.
(4) Policies. The facility shall establish
written policies and procedures that govern all services provided by the
facility. The written policies shall include:
(a) Patient care and services to include
physician, nursing, pharmaceutical (including medication stop orders policy),
and residential services.
(b) Adult
and child protection. The facility shall have written policies which assure the
reporting of cases of abuse, neglect or exploitation of adults and children
pursuant to KRS Chapters 209 and 620.
(c) Use of restraints. The facility shall
have a written policy that addresses the use of restraints and a mechanism for
monitoring and controlling their use.
(d) Missing patient procedures. The facility
shall have a written procedure to specify in a step-by-step manner the actions
which shall be taken by staff when a patient is determined to be lost,
unaccounted for or on other unauthorized absence.
(5) Patient rights. Patient rights shall be
provided for pursuant to
KRS
216.510 to
216.525.
(6) Admission.
(a) Patients shall be admitted only upon the
referral of a physician. The facility shall admit only persons who have a
physical or mental condition which requires intermittent nursing services and
continuous supervision of activities of daily living. The facility shall not
admit persons whose care needs exceed the capability of the facility.
(b) Upon admission the facility shall obtain
the patient's medical diagnosis, physician's orders for the care of the patient
and the transfer form. Within seventy-two (72) hours after admission the
facility shall obtain a medical evaluation from the patient's physician
including current medical findings, medical history and physical examination.
The medical evaluation may be a copy of the discharge summary or history and
physical report from a hospital or long-term facility if done within fourteen
(14) days prior to admission.
(c)
Before admission the patient and a responsible member of his family or
committee shall be informed in writing of the established policies of the
facility including fees, reimbursement, visitation rights during serious
illness, visiting hours, type of diets offered and services rendered.
(d) The facility shall provide and maintain a
system for identifying each patient's personal property and facilities for
safekeeping of his declared valuables. Each patient's clothing and other
property shall be reserved for his own use.
(7) Discharge planning. The facility shall
have a discharge planning program to assure the continuity of care for patients
being transferred to another health care facility or being discharged to the
home.
(8) Transfer and discharge.
The facility shall comply with the requirements of
900 KAR
2:050 when transferring or discharging residents.
(a) The facility shall have written transfer
procedures and agreements for the transfer of patients to other health care
facilities which can provide a level of inpatient care not provided by the
facility. Any facility which does not have a transfer agreement in effect but
which documents a good faith attempt to enter into such an agreement shall be
considered to be in compliance with the licensure requirement. The transfer
procedures and agreements shall specify the responsibilities each institution
assumes in the transfer of patients and establish responsibility for notifying
the other institution promptly of the impending transfer of a patient and
arrange for appropriate and safe transportation.
(b) When the patient's condition exceeds the
scope of services of the facility, the patient, upon physician's orders (except
in cases of emergency), shall be transferred promptly to a hospital or a
skilled nursing facility, or services shall be contracted for from another
community resource.
(c) When
changes and progress occur which would enable the patient to function in a less
structured and restrictive environment, and the less restrictive environment
cannot be offered at the facility, the facility shall offer assistance in
making arrangements for patients to be transferred to facilities providing
appropriate services.
(d) Except in
an emergency, the patient, his next of kin, or guardian, if any, and the
attending physician shall be consulted in advance of the transfer or discharge
of any patient.
(e) When a transfer
is to another level of care within the same facility, the complete medical
record or a current summary thereof shall be transferred with the
patient.
(f) If the patient is
transferred to another health care facility or home to be cared for by a home
health agency, a transfer form shall accompany the patient. The transfer form
shall include at least: physician's orders (if available), current information
relative to diagnosis with history of problems requiring special care, a
summary of the course of prior treatment, special supplies or equipment needed
for patient care, and pertinent social information on the patient and his
family.
(9) Tuberculosis
testing. All employees and patients shall be tested for tuberculosis in
accordance with the provisions of
902
KAR 20:200, Tuberculosis testing in long term care
facilities.
(10) Personnel.
(a) Job descriptions. Written job
descriptions shall be developed for each category of personnel, to include
qualifications, lines of authority and specific duty assignments.
(b) Employee records. Current employee
records shall be maintained and shall include a resume of each employee's
training and experience, evidence of current licensure or registration where
required by law, health records, records of in-service training and ongoing
education, and the employee's name, address and Social Security
number.
(c) Staffing requirements.
1. The facility shall have adequate personnel
to meet the needs of the patients on a twenty-four (24) hour basis. The number
and classification of personnel required shall be based on the number of
patients and the amount and kind of personal care, nursing care, supervision
and program needed to meet the needs of the patients as determined by medical
orders and by services required by this administrative regulation.
2. When the staff to patient ratio does not
meet the needs of the patients, the Division for Licensing and Regulation shall
determine and inform the administrator in writing how many additional personnel
are to be added and of what job classification and shall give the basis for
this determination.
3. A
responsible staff member shall be on duty and awake at all times to assure
prompt, appropriate action in cases of injury, illness, fire or other
emergencies.
4. Volunteers shall
not be counted to make up minimum staffing requirements.
5. Supervision of nursing services shall be
by a registered nurse or licensed practical nurse employed on the day shift
seven (7) days per week. The supervisor shall have training in rehabilitative
nursing. When a licensed practical nurse serves as the supervisor, consultation
shall be provided by a registered nurse at regular intervals, not less than
four (4) hours weekly. The responsibilities of the nursing services supervisor
shall include:
a. Developing and maintaining
nursing service objectives, standards of nursing practice, nursing procedure
manuals, and written job descriptions for each level of nursing
personnel.
b. Recommending to the
administrator the number and levels of nursing personnel to be employed,
participating in their recruitment and selection and recommending termination
of employment when necessary.
c.
Assigning and supervising all levels of nursing care.
d. Participating in planning and budgeting
for nursing care.
e. Participating
in the development and implementation of patient care policies.
f. Coordinating nursing services with other
patient care services.
g.
Participating in the screening of prospective patients in terms of required
nursing services and nursing skills available.
h. Assuring that a written monthly assessment
of the patient's general condition is completed.
i. Assuring that the establishment, review
and modification of nursing care plans for each patient is done by licensed
nursing personnel.
j. Assuring that
all medications are administered by licensed personnel or by other personnel
who have completed a state-approved training program.
k. Assuring that a monthly review of each
patient's medications is completed and notifying the physician when changes are
appropriate.
6. The
facility shall employ a licensed pharmacist on a full-time, part-time or
consultant basis to direct pharmaceutical services.
7. Each facility shall have a full-time
person designated by the administrator, responsible for the total food service
operation of the facility and on duty a minimum of thirty-five (35) hours each
week.
8. Each facility shall
designate a person for the following areas who will be responsible for:
a. Medical records;
b. Arranging for social services;
and
c. Developing and implementing
the activities program and therapeutic recreation.
9. Supportive personnel, consultants,
assistants and volunteers shall be supervised and shall function within the
policies and procedures of the facility.
(d) Health requirements. No employee
contracting an infectious disease shall appear at work until the infectious
disease can no longer be transmitted.
(e) Orientation program. The facility shall
conduct an orientation program for all new employees to include review of all
facility policies (that relate to the duties of their respective jobs),
services and emergency and disaster procedures.
(f) In-service training.
1. All employees shall receive in-service
training and ongoing education to correspond with the duties of their
respective jobs.
2. All nursing
personnel shall receive in-service or continuing education programs at least
quarterly.
(11)
Medical records.
(a) The facility shall
develop and maintain a system of records retention and filing to insure
completeness and prompt location of each patient's record. The records shall be
held confidential. The records shall be in ink or typed and shall be legible.
Each entry shall be dated and signed. Each record shall include:
1. Identification data including the
patient's name, address and Social Security number (if available); name,
address and telephone number of referral agency; name and telephone number of
personal physician; name, address and telephone number of next of kin or other
responsible person; and date of admission.
2. Admitting medical evaluation by a
physician including current medical findings, medical history, physical
examination and diagnosis. (The medical evaluation may be a copy of the
discharge summary or history and physical report from a hospital, skilled
nursing facility if done within fourteen (14) days prior to
admission.)
3. Dated and signed
orders for medication, diet, and therapeutic services.
4. Physician's progress notes describing
significant changes in the patient's condition, written at the time of each
visit.
5. Findings and
recommendations of consultants.
6.
A medication sheet which contains the date, time given, name of each medication
dosage, name of prescribing physician, advanced practice registered nurse,
therapeutically-certified optometrist, or physician assistant, and name of
person who administered the medication.
7. Nurse's notes indicating changes in
patient's condition, actions, responses, attitudes, appetite, etc. Nursing
personnel shall make notation of response to medications, response to
treatments, mode and frequency of PRN medications administered, condition
necessitating administration of PRN medication, reaction following PRN
medication, visits by physician and phone calls to the physician, medically
prescribed diets and preventive, maintenance or rehabilitative nursing
measures.
8. Written assessment of
the patient's monthly general condition.
9. Reports of dental, laboratory and x-ray
services (if applicable).
10.
Changes in patient's response to the activity and therapeutic recreation
program.
11. A discharge summary,
signed and dated by the attending physician within one (1) month of discharge
from the facility.
(b)
Retention of records. After patient's death or discharge the completed medical
record shall be placed in an inactive file and retained for five (5) years or,
in case of a minor, three (3) years after the patient reaches the age of
majority under state law, whichever is the longest.
Section 4. Provision of Services.
(1) General requirements.
(a) Patient care equipment. There shall be a
sufficient quantity of patient care equipment of satisfactory design and in
good condition to carry out established patient care procedures. The equipment
shall include:
1. Wheelchairs with
brakes;
2. Walkers;
3. Bedside rails;
4. Bedpans and urinals (permanent or
disposable);
5. Emesis basins and
wash basins (permanent or disposable);
6. Footstools;
7. Bedside commodes;
8. Foot cradles;
9. Foot boards;
10. Under-the-mattress bed boards;
11. Trapeze frames;
12. Transfer board; and
13. An autoclave for sterilization of nursing
equipment and supplies or an equivalent alternate method of
sterilization.
(b)
Infection control and communicable diseases.
1. There shall be written infection control
policies, which are consistent with the Centers for Disease Control guidelines
including:
a. Policies which address the
prevention of disease transmission to and from patients, visitors and
employees, including:
(i) Universal blood and
body fluid precautions;
(ii)
Precautions for infections which can be transmitted by the airborne route;
and
(iii) Work restrictions for
employees with infectious diseases.
b. Policies which address the cleaning,
disinfection, and sterilization methods used for equipment and the
environment.
2. The
facility shall provide in-service education programs on the cause, effect,
transmission, prevention and elimination of infections for all personnel
responsible for direct patient care.
3. Sharp wastes.
a. Sharp wastes, including needles, scalpels,
razors, or other sharp instruments used for patient care procedures, shall be
segregated from other wastes and placed in puncture resistant containers
immediately after use.
b. Needles
shall not be recapped by hand, purposely bent or broken, or otherwise
manipulated by hand.
c. The
containers of sharp wastes shall either be incinerated on or off site, or be
rendered non-hazardous by a technology of equal or superior efficacy, which is
approved by both the Cabinet for Health Services and the Natural Resources and
Environmental Protection Cabinet.
4. Disposable waste.
a. All disposable waste shall be placed in
suitable bags or closed containers so as to prevent leakage or spillage, and
shall be handled, stored, and disposed of in such a way as to minimize direct
exposure of personnel to waste materials.
b. The facility shall establish specific
written policies regarding handling and disposal of all wastes.
c. The following wastes shall be disposed of
by incineration, autoclaved before disposal, or carefully poured down a drain
connected to a sanitary sewer: blood, blood specimens, used blood tubes, or
blood products.
d. Any wastes
conveyed to a sanitary sewer shall comply with applicable federal, state, and
local pretreatment regulations.
5. Patients infected with the following
diseases shall not be admitted to the facility unless the patient's attending
physician certifies in writing that the condition of the patient is not
communicable to others in the long-term care environment: anthrax,
campylobacteriosis, cholera, diphtheria, hepatitis A, measles, pertussis,
plague, poliomyelitis, rabies (human), rubella, salmonellosis, shigellosis,
typhoid fever, yersiniosis, brucellosis, giardiasis, leprosy, psittacosis, Q
fever, tularemia, and typhus. If an attending physician is in doubt regarding
the communicability of a patient's condition, he may contact the Department for
Health Services.
6. A facility may
admit a noninfectious tuberculosis patient under continuing medical supervision
for his tuberculosis disease.
7.
Patients with active tuberculosis may be admitted to the facility whose
isolation facilities and procedures have been specifically approved by the
cabinet.
8. If, after admission, a
patient is suspected of having a communicable disease that would endanger the
health and welfare of other patients the administrator shall assure that a
physician is contacted and that appropriate measures are taken on behalf of the
patient with the communicable disease and the other patients.
(c) Use of restraints.
1. No restraints shall be used except as
permitted by
KRS
216.515(6).
2. Restraints that require lock and key shall
not be used.
3. Restraints shall be
applied only by appropriately trained personnel.
4. Restraints shall not be used as a
punishment, as discipline, as a convenience for the staff, or as a mechanism to
produce regression.
(2) Physician services. All patients shall be
under the medical supervision of a licensed physician. These services shall
include:
(a) Physician's visit for medical
evaluation as often as necessary and in no case less often than every sixty
(60) days, unless justified and documented by the attending physician in the
patient's medical report.
(b)
Physician services for medical emergencies available on a twenty-four (24)
hour, seven (7) days-a-week basis.
(3) Nursing services. Nursing services shall
include:
(a) The establishment of a nursing
care plan for each patient. Each plan shall be reviewed and modified as
necessary, or at least quarterly. Each plan shall include goals and nursing
care needs;
(b) Rehabilitative
nursing care to achieve and maintain the highest degree of function, self-care
and independence. Rehabilitative measures shall be practiced on a twenty-four
(24) hour, seven (7) day week basis. Those procedures requiring medical
approval shall be ordered by the attending physician. Rehabilitative measures
shall include:
1. Positioning and turning.
Nursing personnel shall encourage and assist patients in maintaining good body
alignment while standing, sitting, or lying in bed.
2. Exercises. Nursing personnel shall assist
patients in maintaining maximum joint range of motion or active range of
motion.
3. Bowel and bladder
training. Nursing personnel shall make every effort to train incontinent
patients to gain bowel and bladder control.
4. Training in activities of daily living.
Nursing personnel shall encourage and when necessary teach patients to function
at their maximum level in appropriate activities of daily living for as long
as, and to the degree that, they are able.
5. Ambulation. Nursing personnel shall assist
and encourage patients with daily ambulation unless otherwise ordered by the
physician.
(c)
Administration of medications including oral, rectal, hypodermic, and
intramuscular;
(d) Written monthly
assessment of the patient's general condition by licensed nursing
personnel;
(e) Treatments such as:
enemas, irrigations, catheterizations, applications of dressings or bandages,
supervision of special diets;
(f)
The recording of any changes, as they occur, in the patient's condition,
actions, responses, attitudes, appetite, etc.
(g) Implementing a regular program to prevent
decubiti with emphasis on the following:
1.
Procedures to maintain cleanliness of the patient, his clothes and linens shall
be followed each time the bed or the clothing is soiled. Rubber, plastic, or
other type of linen protectors shall be properly cleaned and completely covered
to prevent direct contact with the patient.
2. Special effort shall be made to assist the
patient in being up and out of bed as much as his condition permits, unless
medically contraindicated. If the patient cannot move himself, he shall have
his position changed as often as necessary but not less than every two (2)
hours.
(4)
Pharmaceutical services.
(a) The facility
shall provide appropriate methods and procedures for obtaining, dispensing, and
administering drugs and biologicals, developed with the advice of a licensed
pharmacist or a pharmaceutical advisory committee which includes one (1) or
more licensed pharmacists.
(b) If
the facility has a pharmacy department, a licensed pharmacist shall be employed
to administer the pharmacy department.
(c) If the facility does not have a pharmacy
department, it shall have provision for promptly obtaining prescribed drugs and
biologicals from a community or institutional pharmacy holding a valid pharmacy
permit issued by the Kentucky Board of Pharmacy, pursuant to
KRS
315.035.
(d) An emergency medication kit approved by
the facility's professional personnel shall be kept readily available. The
facility shall maintain a record of what drugs are in the kit and document how
the drugs are used.
(e) Medication
requirement and services.
1. All medications
administered to patients shall be ordered in writing by the prescribing
physician, advanced practice registered nurse as authorized in
KRS
314.011(8) and
314.042(8),
therapeutically-certified optometrist in the practice of optometry as defined
in
KRS
320.210(2), or physician
assistant as authorized in
KRS
311.560(3) and (4). Oral
orders shall be given only to a licensed nurse or pharmacist, immediately
reduced to writing, and signed. Medications not specifically limited as to time
or number of doses, when ordered, shall be automatically stopped in accordance
with the facility's written policy on stop orders. A registered nurse or the
pharmacist shall review each patient's medical profile monthly. Medications
shall be reviewed at least quarterly by the attending or staff physician. The
patient's attending physician shall be notified of stop order policies and
contacted promptly for renewal of such orders so that continuity of the
patient's therapeutic regimen is not interrupted. Medications shall be released
to patients on discharge or visits only after being labeled appropriately and
on the written authorization of the physician.
2. Administration of medications. All
medications shall be administered by licensed nurses or personnel who have
completed a state-approved training program, from a state approved training
provider. Each dose administered shall be recorded in the medical record.
Intramuscular injections shall be administered by a licensed nurse or a
physician. If intravenous injections are necessary they shall be administered
by a licensed physician or registered nurse.
a. The nursing station shall have items
required for the proper administration of medications.
b. Medications prescribed for one (1) patient
shall not be administered to any other patient.
c. Self-administration of medications by
patients shall not be permitted except on special order of the patient's
physician and a predischarge program under the supervision of a licensed
nurse.
d. Medication errors and
drug reactions shall be immediately reported to the patient's physician and
pharmacist and an entry thereof made in the patient's medical record as well as
on an incident report.
3.
The facility shall provide up-to-date medication reference texts for use by the
nursing staff (e.g., Physician's Desk Reference).
4. Labeling and storing medications. All
medications shall be plainly labeled with the patient's name, the name of the
drug, strength, name of pharmacy, prescription number, date, physician name,
caution statements and directions for use except where accepted modified unit
dose systems conforming to federal and state laws are used. The medications of
each patient shall be kept and stored in their original containers and
transferring between containers shall be prohibited. All medicines kept by the
facility shall be kept in a locked place and the persons in charge shall be
responsible for giving the medicines and keeping them under lock and key.
Medications requiring refrigeration shall be kept in a separate locked box of
adequate size in the refrigerator in the medication area. Drugs for external
use shall be stored separately from those administered by mouth and injection.
Provisions shall also be made for the locked separate storage of medications of
deceased and discharged patients until such medication is surrendered or
destroyed in accordance with federal and state laws and regulations.
5. Controlled substances. Controlled
substances shall be kept under double lock (e.g., in a locked box in a locked
cabinet). There shall be a controlled substances record, in which is recorded
the name of the patient; the date, time, kind, dosage, balance remaining and
method of administration of all controlled substances; the name of the
physician who prescribed the medications; and the name of the nurse who
administered it, or staff who supervised the self-administration. In addition,
there shall be a recorded and signed Schedule II controlled substances count
daily, and Schedule III, IV and V controlled substances count once per week by
those persons who have access to controlled substances. All controlled
substances which are left over after the discharge or death of the patient
shall be destroyed in accordance with
21 CFR
1307.21.
(5) Personal care services.
(a) All facilities shall provide services to
assist patients to achieve and maintain good personal hygiene including the
level of assistance necessary with:
1.
Bathing of the body to maintain clean skin and freedom from offensive odors. In
addition to assistance with bathing, the facility shall provide soap, clean
towels, and wash cloths for each patient. Toilet articles such as brushes and
combs shall not be used in common.
2. Shaving.
3. Cleaning and trimming of fingernails and
toenails.
4. Cleaning of the mouth
and teeth to maintain good oral hygiene as well as care of the lips to prevent
dryness and cracking. All patients shall be provided with tooth brushes, a
dentifrice, and denture containers, when applicable.
5. Washing, grooming, and cutting of
hair.
(b) The staff shall
encourage and assist the patients to dress in their own street clothing (unless
otherwise indicated by the physician).
(6) Dental services. The facility shall
assist patients in obtaining dental services. Conditions necessitating dental
services shall be noted and such dental procedures and services provided shall
be recorded in the patient's record.
(7) Social services. The facility shall
provide or arrange for social services as needed by the patient.
(a) Social services shall be integrated with
other elements of the plan of care.
(b) A plan for such care shall be recorded in
the patient's record and periodically evaluated in conjunction with the
patient's total plan of care.
(c)
Social services records shall be maintained as an integral part of case record
maintained on each patient.
(8) Activities and therapeutic recreation.
(a) All facilities shall provide a program to
stimulate physical and mental abilities to the fullest extent, to encourage and
develop a sense of usefulness and self respect and to prevent, inhibit or
correct the development of symptoms of physical and mental regression due to
illness or old age. The program shall provide sufficient variety to meet the
needs of the various types of patients in the facility. When possible, the
patient shall be included in the planning of activities.
(b) All facilities shall meet the following
program requirements:
1. Staff. A person
designated by the administrator shall be responsible for the program.
2. A program shall be developed for each
patient and shall be incorporated in the patient's plan of care and revised
according to the patient's needs. Changes in his response to the program shall
be recorded in the medical record.
3. There shall be a planned and supervised
activity period each day. The schedule shall be current and posted.
4. The program shall be planned for group and
individual activities, both within and outside of the facility, weather
permitting.
5. The person
responsible for activities shall maintain a current list of patients on which
precautions are noted regarding a patient's condition that might restrict or
modify his participation in the program.
6. A living or recreation room and outdoor
recreational space shall be provided for patients and their guests.
7. The facility shall provide supplies and
equipment for the activities program.
8. Reading materials, radios, games and TV
sets shall be provided for the patients.
9. The program may include religious
activities for each patient if it is the desire of the patient to participate.
Requests from a patient to be seen by a clergyman shall be acted upon as soon
as possible, and an area of private consultation shall be made
available.
10. The facility shall
allow the patient to leave the facility to visit, shop, attend church, or other
social activities provided this does not endanger his health or
safety.
(9)
Transportation.
(a) If transportation of
patients is provided by the facility to community agencies or other activities,
the following shall apply:
1. Special
provision shall be made for patients who use wheelchairs.
2. An escort or assistant to the driver shall
be provided in transporting patients to and from the facility if necessary for
the patient's safety.
(b)
The facility shall arrange for appropriate transportation in case of medical
emergencies.
(10)
Residential care services. All facilities shall provide residential care
services to all patients including: room accommodations, housekeeping and
maintenance services, and dietary services. All facilities shall meet the
following requirements relating to the provision of residential care services.
(a) Room accommodations.
1. Each patient shall be provided a standard
size bed at least thirty-six (36) inches wide, equipped with substantial
springs, a clean comfortable mattress, a mattress cover, two (2) sheets and a
pillow, and such bed covering as is required to keep the patients comfortable.
Rubber or other impervious sheets shall be placed over the mattress cover
whenever necessary. Beds occupied by patients shall be placed so that no
patient may experience discomfort because of proximity to radiators, heat
outlets, or by exposure to drafts.
2. The facility shall provide window
coverings, bedside tables with reading lamps (if appropriate), comfortable
chairs, chest or dressers with mirrors, a night light, and storage space for
clothing and other possessions.
3.
Patients shall not be housed in unapproved rooms or unapproved detached
buildings.
4. Basement rooms shall
not be used for sleeping rooms for patients.
5. Patients may have personal items and
furniture when it is physically feasible.
6. There shall be a sufficient number of
tables provided that can be rolled over a patient's bed or be placed next to a
bed to serve patients who cannot eat in the dining room.
7. Each living room or lounge area and
recreation area shall have an adequate number of reading lamps, and tables and
chairs or settees of sound construction and satisfactory design.
8. Dining room furnishings shall be adequate
in number, well constructed and of satisfactory design for the
patients.
9. Each patient shall be
permitted to have his own radio and television set in his room unless it
interferes with or is disturbing to other patients.
(b) Housekeeping and maintenance services.
1. The facility shall maintain a clean and
safe facility free of unpleasant odors. Odors shall be eliminated at their
source by prompt and thorough cleaning of commodes, urinals, bedpans and other
obvious sources.
2. An adequate
supply of clean linen shall be on hand at all times. Soiled clothing and linens
shall receive immediate attention and shall not be allowed to accumulate.
Clothing or bedding used by one (1) patient shall not be used by another until
it has been laundered or dry cleaned.
3. Soiled linen shall be placed in washable
or disposable containers, transported in a sanitary manner and stored in
separate, well-ventilated areas in a manner to prevent contamination and odors.
Equipment or areas used to transport or store soiled linen shall not be used
for handling or storing of clean linen.
4. Soiled linen shall be sorted and laundered
in the soiled linen room in the laundry area. Hand-washing facilities with hot
and cold water, soap dispenser and paper towels shall be provided in the
laundry area.
5. Clean linen shall
be sorted, dried, ironed, folded, transported, stored and distributed in a
sanitary manner.
6. Clean linen
shall be stored in clean linen closets on each floor, close to the nurses'
station.
7. Personal laundry of
patients or staff shall be collected, transported, sorted, washed and dried in
a sanitary manner, separate from bed linens.
8. Patients' personal clothing shall be
laundered by the facility as often as is necessary. Patients' personal clothing
shall be laundered by the facility unless the patient or the patient's family
accepts this responsibility. Patients capable of laundering their own personal
clothing and wishing to do so may, instead, be provided the facilities to do
so. Patient's personal clothing laundered by the facility shall be marked to
identify the patient-owner and returned to the correct patient.
9. Maintenance. The premises shall be well
kept and in good repair. Requirements shall include:
a. The facility shall insure that the grounds
are well kept and the exterior of the building, including the sidewalks, steps,
porches, ramps and fences are in good repair.
b. The interior of the building including
walls, ceilings, floors, windows, window coverings, doors, plumbing and
electrical fixtures shall be in good repair. Windows and doors shall be
screened.
c. Garbage and trash
shall be stored in areas separate from those used for the preparation and
storage of food and shall be removed from the premises regularly. Containers
shall be cleaned regularly.
d. A
pest control program shall be in operation in the facility. Pest control
services shall be provided by maintenance personnel of the facility or by
contract with a pest control company. The compounds shall be stored under
lock.
(c)
Dietary services. The facility shall provide or contract for food service to
meet the dietary needs of the patients including modified diets or dietary
restrictions as prescribed by the attending physician. When a facility
contracts for food service with an outside food management company, the company
shall provide a qualified dietician on a full-time, part-time or consultant
basis to the facility. The qualified dietician shall have continuing liaison
with the medical and nursing staff of the facility for recommendations on
dietetic policies affecting patient care. The company shall comply with all of
the appropriate requirements for dietary services in this administrative
regulation.
1. Therapeutic diets. If the
designated person responsible for food service is not a qualified dietician or
nutritionist, consultation by a qualified dietician or qualified nutritionist
shall be provided.
2. Dietary
staffing. There shall be sufficient food service personnel employed and their
working hours, schedules of hours, on duty and days off shall be posted. If any
food service personnel are assigned duties outside the dietary department, the
duties shall not interfere with the sanitation, safety or time required for
regular dietary assignments.
3.
Menu planning.
a. Menus shall be planned,
written and rotated to avoid repetition. Nutrition needs shall be met in
accordance with the current recommended dietary allowances of the Food and
Nutrition Board of the National Research Council adjusted for age, sex and
activity, and in accordance with physician's orders.
b. Meals shall correspond with the posted
menu. Menus must be planned and posted one (1) week in advance. When changes in
the menu are necessary, substitutions shall provide equal nutritive value and
the changes shall be recorded on the menu and kept on file for thirty (30)
days.
c. The daily menu shall
include daily diet for all modified diets served within the facility based on
an approved diet manual. The diet manual shall be a current manual with copies
available in the dietary department, that has the approval of the professional
staff of the facility. The diet manual shall indicate nutritional deficiencies
of any diet. The dietician shall correlate and integrate the dietary aspects of
the patient care with the patient and patient's chart through such methods as
patient instruction, recording diet histories and participation in rounds and
conferences.
4. Food
preparation and storage.
a. There shall be at
least a three (3) day supply of food to prepare well balanced palatable
meals.
b. Food shall be prepared
with consideration for any individual dietary requirement. Modified diets,
nutrient concentrates and supplements shall be given only on the written orders
of a physician, advanced practice registered nurse as authorized in
KRS
314.011(8) and
314.042(8),
or physician assistant as authorized in
KRS
311.560(3) and
(4).
c. At least three (3) meals per day shall be
served with not more than a fifteen (15) hour span between the substantial
evening meal and breakfast. Between-meal snacks to include an evening snack
before bedtime shall be offered to all patients. Adjustments shall be made when
medically indicated.
d. Foods shall
be prepared by methods that conserve nutritive value, flavor and appearance and
shall be attractively served at the proper temperatures, and in a form to meet
the individual needs. A file of tested recipes, adjusted to appropriate yield
shall be maintained. Food shall be cut, chopped or ground to meet individual
needs. If a patient refuses foods served, nutritional substitutions shall be
offered.
e. All opened containers
or leftover food items shall be covered and dated when
refrigerated.
5. Serving
of food. When a patient cannot be served in the dining room, trays shall be
provided for bedfast patients and shall rest on firm supports such as overbed
tables. Sturdy tray stands of proper height shall be provided for patients able
to be out of bed.
a. Correct positioning of
the patient to receive his tray shall be the responsibility of the direct
patient care staff. Patients requiring help in eating shall be
assisted.
b. Adaptive self-help
devices shall be provided to contribute to the patient's independence in
eating.
6. Sanitation.
All facilities shall comply with all applicable provisions of
KRS
219.011 to
KRS 219.081 and
902 KAR
45:005.
Section 5. Separability. If any clause, sentence, paragraph, section or part of these administrative regulations shall be adjudged by any court of competent jurisdiction to be invalid, the judgment shall not affect, impair or invalidate the remainder thereof, but shall be confined in its operation to the clause, sentence, paragraph, section or part thereof, directly involved in the controversy in which the judgment was rendered.
STATUTORY AUTHORITY: KRS 216B.042, 216B.105, 311.560(3), (4), 314.011(8), 314.042(8), 320.210(2), EO 96-862
Disclaimer: These regulations may not be the most recent version. Kentucky 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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
