Nursing Facilities
R. 06/01/2022
Rules for Nursing Homes
Office of Long Term Care
100 DEFINITIONS ............................................................................................................................................................................. 6
200 GENERAL PROVISIONS FOR LICENSURE ....................................................................................................................... 10
201
LICENSURE ............................................................................................................................................................................ 10
202
APPLICATION FOR
LICENSE .....................................................................................................................................................
10
203
RENEWAL OF APPLICATIONFOR LICENSURE ............................................................................................................... 11
204
ISSUANCE OF LICENSE ....................................................................................................................................................... 11
205
DENIAL, REVOCATION, OR SUSPENSION OF LICENSE .....................................................................................................
11
206
CHANGE OF OWNERSHIP OR MANAGEMENT
207
NOTICE AND PROCEDURE ON HEARING PRIOR TO DENIAL, SUSPENSION, OR REVOCATION OF LICENSE ....
11
208
APPEALS TO COURTS .......................................................................................................................................................... 11
209
PENALTIES ............................................................................................................................................................................ 12
210
INSPECTION .......................................................................................................................................................................... 12
211
COMPLIANCE ........................................................................................................................................................................ 12
212
NONCOMPLIANCE ............................................................................................................................................................... 12
213
VOLUNTARY
CLOSURE .............................................................................................................................................................
12
214
EXCEPTION TOLICENSING STANDARDS ....................................................................................................................... 12
215
PROVISIONAL
LICENSURE ........................................................................................................................................................
13
215-299 RESERVED ........................................................................................................................................................................... 13
300 ADMINISTRATION ................................................................................................................................................................. 14
301
MANAGEMENT ..................................................................................................................................................................... 14
302
GENERAL
ADMINISTRATION ...................................................................................................................................................
14
303
PERSONNEL
ADMINISTRATION ..............................................................................................................................................
15
304
STAFF
DEVELOPMENT ...............................................................................................................................................................
16
305
EMERGENCY CALL DATA .........................................................................................................................................................
17
306
REPORTING SUSPECTED ABUSE, NEGLECT, EXPLOITATION, INCIDENTS, ACCIDENTS, DEATHS FROM
VIOLENCE AND MISAPPROPRIATION OF RESIDENT PROPERTY ...............................................................................................
17
307
INSTITUTIONAL
POLICIES AND/OR
PROCEDURES ............................................................................................................
31
308
PATIENT CARE POLICIES ................................................................................................................................................... 31
309
RESTRAINT OF RESIDENTS ................................................................................................................................................ 31
310
PROTECTION OF PATIENT PROPERTY ............................................................................................................................. 31
311
NOTIFICATION OF CHANGE IN PATIENT'S STATUS ...........................................................................................................
31
312
PHYSICIAN'S SERVICES POLICIES .................................................................................................................................... 32
313
SPECIALIZED
REHABILITATIVE SERVICE
POLICIES .........................................................................................................
32
314
SOCIAL SERVICE
POLICIES .......................................................................................................................................................
32
315
CONFIDENTIALITY
OF SOCIAL
INFORMATION ..................................................................................................................
32
316
RIGHTS OF RESIDENTS ...............................................................................................................................................................
32
317
REGISTRATION
OF
COMPLAINTS ...........................................................................................................................................
32
318
ADMISSION, TRANSFER, ANDDISCHARGE POLICIES .................................................................................................. 32
319
CONFIDENTIALITY OF MEDICALRECORD INFORMATION ........................................................................................ 33
320
INFECTION
CONTROL .................................................................................................................................................................
33
321
HANDLING OF OXYGEN AND FLAMMABLE GASES ..........................................................................................................
33
322
PERSONNEL POLICIES......................................................................................................................................................... 33
323
TRANSPORTATION
OF
RESIDENTS.........................................................................................................................................
34
324
BEDPAN
SANITATION ................................................................................................................................................................
34
325
OUTSIDE RESOURCE AGREEMENTS ............................................................................................................................... 34
326
SPECIALIZED
REHABILITATIVE
SERVICES .........................................................................................................................
34
327
ADVISORY DENTIST ............................................................................................................................................................ 34
328
SOCIAL
SERVICES ........................................................................................................................................................................
34
329
ACTIVITY
DIRECTOR ..................................................................................................................................................................
34
330
PHARMACIST ........................................................................................................................................................................ 34
331
MEDICAL
AND REMEDIAL SERVICES ....................................................................................................................................
34
332
TRANSFER AGREEMENT .................................................................................................................................................... 35
1
2
R. 06/01/2022
Nursing Facilities
333
ELECTRONIC RECORDS AND SIGNATURES ................................................................................................................... 35
333-399 RESERVED ........................................................................................................................................................................... 37
400 PHYSICAL ENVIRONMENT ................................................................................................................................................. 38
401
GENERAL STANDARDS FOREXISTING STRUCTURES ................................................................................................. 38
402
GENERAL ............................................................................................................................................................................... 38
403
FACILITY GROUNDS AND PARKING ................................................................................................................................ 38
404
DOORS .................................................................................................................................................................................... 38
405
STANDARD PATIENT ROOMS, BATH, AND TOILET FACILITIES ................................................................................ 38
406
INTENSIVE CARE ROOM ..................................................................................................................................................... 39
407
CORRIDORS ........................................................................................................................................................................... 39
408
HANDRAILS .......................................................................................................................................................................... 39
409
BEDPAN CLEANING ANDSTORAGE ROOM.................................................................................................................... 39
410
DAY ROOM ANDDINING ROOM ....................................................................................................................................... 39
411
CEILINGS, WALLS AND FLOORS ...................................................................................................................................... 39
412
HEATING AND COOLING .................................................................................................................................................... 40
413
LIGHTING .............................................................................................................................................................................. 41
414
EMERGENCY POWER .......................................................................................................................................................... 41
415
WATER SERVICE .................................................................................................................................................................. 41
416
NURSES' STATION ................................................................................................................................................................ 42
417
JANITORS' CLOSETS ............................................................................................................................................................ 43
418
NURSES' CALL SYSTEM ...................................................................................................................................................... 43
419
FIRE ALARM SYSTEM ......................................................................................................................................................... 43
420
PHYSICAL ENVIRONMENT ................................................................................................................................................ 43
421
STANDARDS FOR NEW CONSTRUCTION AND/OR ALTERATIONS ............................................................................ 43
422
GENERAL ............................................................................................................................................................................... 43
423
SITE LOCATION, INSPECTION, APPROVALS AND SUBSOIL INVESTIGATION ................................................................. 43
424
SUBMISSION OF PLANS, SPECIFICATIONS, AND ESTIMATES .................................................................................... 44
425
PLANS AND SPECIFICATIONS ........................................................................................................................................... 44
426
CODES AND STANDARDS .................................................................................................................................................. 48
427
STANDARD PATIENT ROOM AND TOILET DESIGN ...................................................................................................... 48
428
INTENSIVE CARE ROOM DESIGN ..................................................................................................................................... 49
429
CORRIDORS ........................................................................................................................................................................... 49
430
LAUNDRY .............................................................................................................................................................................. 49
431
STORAGE ............................................................................................................................................................................... 49
432
DIETETIC SERVICE AREA (LESS DINING AREAS) ......................................................................................................... 49
433
ADMINISTRATIVE OFFICES ............................................................................................................................................... 50
434
RESIDENTS' DINING AND RECREATION AREAS ........................................................................................................... 50
435
UTILITY ROOMS ................................................................................................................................................................... 50
436
BEDPAN ROOM ..................................................................................................................................................................... 50
437
JANITORS' CLOSETS ............................................................................................................................................................ 50
438
LINEN CLOSETS ................................................................................................................................................................... 51
439
SOILED LINEN CLOSETS..................................................................................................................................................... 51
440
NURSES' CALL SYSTEM ...................................................................................................................................................... 51
441
NURSES' STATION ................................................................................................................................................................ 52
442
FIRE ALARM SYSTEM ......................................................................................................................................................... 52
443
LIMITATIONS ........................................................................................................................................................................ 52
444
CEILINGS, WALLS, AND FLOORS ..................................................................................................................................... 52
445
WATER COOLER ................................................................................................................................................................... 52
446-449 RESERVED ........................................................................................................................................................................... 53
450
FURNISHINGS, EQUIPMENT, AND SUPPLIES ................................................................................................................. 53
451
FURNISHINGS ....................................................................................................................................................................... 53
452
LINENS AND BEDDING ....................................................................................................................................................... 53
453
EQUIPMENT AND SUPPLIES .............................................................................................................................................. 55
454
CARE AND CLEANING OF MEDICAL SUPPLIES AND EQUIPMENT ............................................................................ 56
455
STORAGE ............................................................................................................................................................................... 56
456-469 RESERVED ........................................................................................................................................................................... 57
470 HOUSEKEEPING/MAINTENANCE ..................................................................................................................................... 57
471 HOUSEKEEPING - MAINTENANCE ................................................................................................................................... 57
472-499 RESERVED ........................................................................................................................................................................... 59
3
R. 06/01/2022
Nursing Facilities
500 PATIENT CARE SERVICES ................................................................................................................................................... 60
501
PHYSICIAN
SERVICES ................................................................................................................................................................
60
502
ADMISSION ONLY ON RECOMMENDATION OF A PHYSICIAN .......................................................................................
60
503
CONTINUED
SUPERVISION OF CARE .....................................................................................................................................
60
504
PHYSICAL
EXAMINATION OF PATIENTS ..............................................................................................................................
60
505
PLANNED REGIMEN OF CARE ..................................................................................................................................................
60
506
ESTABLISHMENT RESTORATION POTENTIAL .............................................................................................................. 60
507
EMERGENCY
PHYSICIAN ..........................................................................................................................................................
60
510
NURSING ................................................................................................................................................................................ 60
511
PROFESSIONAL
NURSE
SUPERVISION ..................................................................................................................................
60
512
CHARGE
NURSE ...........................................................................................................................................................................
61
513
NURSING STAFF ................................................................................................................................................................... 62
514
PERSONNEL ASSIGNMENTS .............................................................................................................................................. 62
515
RESTRICTIONS
IN
EMPLOYMENTAND/OR
ASSIGNMENT ...............................................................................................
62
516
NURSING CARE REQUIREMENTS ..................................................................................................................................... 62
517
TREATMENT
AND
MEDICATIONS ...........................................................................................................................................
66
518
REHABILITATIVE NURSING .............................................................................................................................................. 68
519
SUPERVISION
OF PATIENT
NUTRITION ................................................................................................................................
68
520
DIRECT-CARE STAFFING
REQUIREMENTS ........................................................................................................................
68
521
TUBERCULOSIS SURVEILLANCE ..................................................................................................................................... 76
530
SPECIALIZED
REHABILITATIVE
SERVICES .........................................................................................................................
76
531
SERVICES BASED ONRESIDENT NEEDS ......................................................................................................................... 76
532
WRITTEN PLAN OF CARE ...........................................................................................................................................................
76
533
REVIEW OF RESIDENT PROGRESS.................................................................................................................................... 77
534
RE-EVALUATION OF PLAN........................................................................................................................................................
77
535
DOCUMENTATION
OF
SERVICES ............................................................................................................................................
77
540
PHARMACEUTICAL
SERVICES ................................................................................................................................................
77
541
RESPONSIBILITY
FOR PHARMACY
COMPLIANCE .............................................................................................................
77
542
PHARMACY CONSULTANTS PERMIT .............................................................................................................................. 77
543
PRESCRIPTIONS
ON INDIVIDUAL BASIS ...............................................................................................................................
78
544
ADMINISTRATION
OF
MEDICATION ......................................................................................................................................
78
545
EQUIPMENT FOR ADMINISTERING MEDICATIONS ...................................................................................................... 79
546
MEDICINE CARDS ................................................................................................................................................................ 79
547
STOP ORDER POLICY........................................................................................................................................................... 79
548
STORAGE OF DRUGS ........................................................................................................................................................... 79
549
EMERGENCY DRUG BOX ...........................................................................................................................................................
80
550
RECORD
OF CONTROLLED DRUGS .........................................................................................................................................
81
551
CONTROLLED
DRUG
ACCOUNTABILITY .............................................................................................................................
81
552
REVIEW OF MEDICATION BY THE NURSE AND/OR PHARMACIST ................................................................................
82
553
REVIEW OF MEDICATIONS BY CONSULTANT
PHARMACISTS ......................................................................................
82
554
CYCLE-FILL, PHARMACY NOTIFICATION AND DISPOSITION OF UNUSED DRUGS .................................................
82
555
PHARMACY PREPARED MEDICATION CONTAINER SYSTEMS DESIGNED FOR ADMINISTRATION WITH THE
USE OF MEDICATION CARDS (UNIT DOSE SYSTEM) .....................................................................................................................
84
556-559 RESERVED ........................................................................................................................................................................... 85
560
DIETETIC
SERVICES ....................................................................................................................................................................
85
561
STAFFING .............................................................................................................................................................................. 85
562
HYGIENE OF STAFF .....................................................................................................................................................................
85
563
MINIMUM
DAILY FOOD
REQUIREMENTS ............................................................................................................................
86
564
FREQUENCY OF MEALS ...................................................................................................................................................... 87
565
MEAL SERVICE ..................................................................................................................................................................... 87
566
MENUS ................................................................................................................................................................................... 88
567
THERAPEUTIC
DIETS ..................................................................................................................................................................
89
568
PREPARATION AND STORAGE OF FOOD ...............................................................................................................................
90
569
SANITARY CONDITIONS .................................................................................................................................................... 91
570
DIETETIC
SERVICES
STAFFING ...............................................................................................................................................
93
571-579 RESERVED ........................................................................................................................................................................... 94
580
SOCIAL WORK SERVICES AND ACTIVITIES PROGRAMMING ........................................................................................
94
581
POLICIES
AND PROCEDURES ...................................................................................................................................................
94
582
JOB DESCRIPTION ................................................................................................................................................................ 94
583
SOCIAL
SERVICES
RECORDS ....................................................................................................................................................
94
4
R. 06/01/2022
Nursing Facilities
584
STAFFING AND CONSULTATION FOR SOCIAL SERVICES/ACTIVITIES ..........................................................................
95
585
PROGRAM OPERATIONS..............................................................................................................................................................
96
586
PET THERAPY ....................................................................................................................................................................... 97
587-599 RESERVED ........................................................................................................................................................................... 97
600 RESIDENT RECORDS ............................................................................................................................................................. 98
601
RESIDENT RECORD MAINTENANCE ...............................................................................................................................
98
602
CONTENTS OF RECORDS (TO FACILITATE RETRIEVING AND COMPILING INFORMATION) ..................................
98
603
INDEX ..................................................................................................................................................................................... 99
604
RETENTION AND PRESERVATION OF RECORDS ................................................................................................................
100
605
CONFIDENTIALITY ............................................................................................................................................................ 102
606
STAFFING ............................................................................................................................................................................ 102
607
GENERAL INFORMATION ..........................................................................................................................................................
102
608-699 RESERVED ......................................................................................................................................................................... 102
700 GREEN HOUSE™ FACILITIES ........................................................................................................................................... 103
701 INTENT ................................................................................................................................................................................. 103
702 DESIGNATION .................................................................................................................................................................... 103
703 STAFFING ............................................................................................................................................................................ 103
800 HOMESTYLE FACILITIES
.................................................................................................................................................. 104
801
PILOT PROJECT................................................................................................................................................................... 104
802
DEFINITIONS ....................................................................................................................................................................... 104
803
DESIGNATION .................................................................................................................................................................... 107
804
STAFFING ............................................................................................................................................................................ 107
805
STAFF TRAINING .........................................................................................................................................................................
107
806
TRAINING APPROVAL ...................................................................................................................................................... 110
900 ALZHEIMER’S SPECIAL CARE UNITS DEFINITIONS ................................................................................................. 111
901
GENERAL ADMINISTRATION ..........................................................................................................................................
112
902
TREATMENT PHILOSOPHY ...................................................................................................................................... 117
903
ASSESSMENTS .................................................................................................................................................................... 117
904
ADMISSIONS, DISCHARGES, TRANSFERS .............................................................................................................................
119
905
STAFFING ............................................................................................................................................................................ 120
906
PHYSICAL ENVIRONMENT, DESIGNAND SAFETY ..................................................................................................... 123
907
THERAPEUTIC ACTIVITIES .............................................................................................................................................. 126
908
PENALTIES .......................................................................................................................................................................... 127
1000 RECEIVERSHIP ................................................................................................................................................................. 128
1001 DEFINITIONS ................................................................................................................................................................... 128
1002 PURPOSE ..........................................................................................................................................................................
128
1003
APPOINTMENT AND SUPERVISION OF A MONITOR(S) ................................................................................................
129
1004
DETERMINATION OF NEED FOR RECEIVERSHIP ...........................................................................................................
130
1005 PETITION FOR NOTICEOF RECEIVERSHIP ............................................................................................................... 131
1006 POST PETITION ACTIVITIES ......................................................................................................................................... 132
1007
ASSISTANCE WITH DUTIES OF THE RECEIVER TO STAFF ..........................................................................................
133
1008 ASSISTANCE WITH RESPONSIBILITIES OF RECEIVER TO RESIDENTS, GUARDIANS AND FAMILIES .......... 134
1009
LONG RANGE RESPONSIBILITIES OF RECEIVER ...........................................................................................................
134
1010 REPORTING OF PROGRESSOF RECEIVER ................................................................................................................. 138
1011
QUALIFICATIONS AND MAINTENANCE OF LIST FOR RECEIVER .............................................................................
141
1012
DEPARTMENT TO FURNISH RECEIVER WITH COPY OF LEGAL PROCEEDING ......................................................
141
1013
MANDATED PATIENT TRANSFER .......................................................................................................................................
142
1014-1999 RESERVED ..................................................................................................................................................................... 142
2000 INFORMAL DISPUTE RESOLUTION ............................................................................................................................ 143
2001 REQUESTING AN INFORMALDISPUTE RESOLUTION ............................................................................................ 143
2002
MATTERS WHICH MAY BE HEARD AT IDR .....................................................................................................................
143
2003
APPEAL OF IDR RESULTS .....................................................................................................................................................
143
2004-2999 RESERVED ..................................................................................................................................................................... 144
3000 RESIDENTS' RIGHTS........................................................................................................................................................ 145
5
R. 06/01/2022
Nursing Facilities
SYNOPSIS OF RESIDENTS' BILL OF RIGHTS ............................................................................................................................ 152
4000 FINES AND SANCTIONS .................................................................................................................................................. 156
4001 D
EFINITIONS .............................................................................................................................................................................................................. 156
4002 C
IVIL PENALTIES ...................................................................................................................................................................................................... 158
4003 F
ACTORS IN ASSESSMENT OF CIVIL PENALTIES ............................................................................................................................................. 159
4004 R
IGHT TO ASSESS CIVIL PENALTIES NOT MERGED IN OTHER REMEDIES .............................................................................................. 160
4005 C
LASS A VIOLATIONS ............................................................................................................................................................................................. 160
4006 C
LASS B VIOLATIONS ............................................................................................................................................................................................. 163
4007 C
LASS C VIOLATIONS ............................................................................................................................................................................................. 167
4008 C
LASS D VIOLATIONS ............................................................................................................................................................................................. 168
4009 N
OTIFICATION OF VIOLATIONS ............................................................................................................................................................................ 168
4010 H
EARINGS ON THE IMPOSITION OF CIVIL MONEY PENALTIES ................................................................................................................... 169
4011 D
ENIAL OF ADMISSIONS ......................................................................................................................................................................................... 170
APPENDIX A ....................................................................................................................................................................................... 171
RULES OF ORDER FOR ALL APPEALS BEFORE THE LONG TERM CARE FACILITY ADVISORY BOARD ............................. 171
6
R. 06/01/2022
Nursing Facilities
100 DEFINITIONS
For the purpose of these standards the following definitions shall apply:
Administrator means a person licensed as a nursing home administrator by the Department who
administers, manages, supervises, or is in general administrative charge of a nursing home.
Alteration means any work other than maintenance in an existing building and which does not
increase the floor or roof area or the volume of enclosed space.
Consultant shall mean a qualified person who gives professional advice or service within his/her
specialty, with or without re-numeration.
Consultant Dietitian a person who is eligible for registration by the Dietetic Association, has a
baccalaureate degree with major studies in food and nutrition, dietetics, or food service
management; has one year of supervisory experience in the dietetic service of a health care
institution and participates annually in continuing dietetic education.
Consultant Pharmacist means a qualified licensed, registered pharmacist, who under arrangement
with an institution, renders assistance in developing, implementing, evaluating, and revising where
indicated, policies and procedures for providing the administrative and technical guidance of the
pharmaceutical services relative to labeling, storing, handling, dispensing, and all other matters
pertaining to the administration and control of drugs and medication. He/she provides such
services and monitors activities within the institution with the express purpose of creating and
maintaining the highest standards in medication distribution, control, and service.
Controlled Substances means a drug, substance or immediate precursor in Schedules I through V
of Article 11 of the Controlled Substances Act.
Department shall mean the Arkansas Department of Human Services (DHS).
Director shall mean the Director of the Division of Provider Services and Quality Assurance
Disinfection shall mean the process employed to destroy harmful microorganisms, but ordinarily
not viruses and bacterial spores.
Distinct Part shall mean an identifiable unit accommodating beds and related facilities including,
but not limited to, a wing, floor, or building that is approved by the Division for a specific purpose.
Division shall mean the DHS/Division of Provider Services and Quality Assurance
Drug means (a) articles recognized in the Official United States Pharmacopeia, Official
Homeopathic Pharmacopeia of the United States, or Official National Formulary, or any supplement
to any of them; and (b) articles intended for use in the diagnosis, cure mitigation, treatment, or
prevention of disease in man or other animal; and (c) articles (other than food) intended to affect
the structure or any function of the body of man or other animals; and (d) articles specified in
clause (a), (b) or (c); but does not include devices or their components, parts or accessories.
7
R.
06/01/2022
Nursing Facilities
Drug Administration is an act restricted to nursing personnel as defined in Nurses Practice Act 432
or 1971, in which a single dose of a prescribed drug or biological is given to a patient. This activity
includes the removal of the dose from a previously dispensed, properly labeled container, verifying
it with the prescriber's orders, giving the individual dose to the proper patient, and recording the
time and dose given.
Drug Dispensing is an act restricted to a pharmacist which involves the issuance of one or more
doses of a medication in a container other than the original, with such new containers being
properly labeled by the dispenser as to content and directions for use as directed by the prescriber.
This activity also includes the compounding, counting, and transferring of medication from one
labeled container to another.
Existing Facilities are those facilities which were in operation, or those proposed facilities which
began construction or renovation of a building under final plans approved by the Division prior to
adoption of these rules.
Fire Resistance Rating shall mean the time in hours or fractions thereof that materials or their
assemblies will resist fire exposure as determined by fire test conducted in accordance with
recognized standards.
Governing Body shall mean the individuals or group in whom the ultimate authority and legal
responsibility is vested for conduct of the nursing home.
Institution is any facility requiring licensure under these rules.
Intermediate Care Facility (ICF) is a nursing home licensed by Arkansas Social Services as
meeting the Intermediate Care Facility rules. It is a health facility, or a distinct part of a hospital or
Skilled Nursing Facility that is staffed, organized, operated, and maintained to provide 24- hour
long term inpatient care and other restorative services under nursing supervision.
Legend Drugs are drugs, which because of their toxicity or other potentiality for harmful effect, or
the method of their use, or the collateral measures necessary to their use, are not safe for use except
under the supervision of a practitioner licensed by law to administer such drugs, or shall be
dispensed only on prescription by the pharmacist. Such drugs bear the label "Caution: Federal Law
Prohibits Dispensing Without Prescription."
License shall mean the basic document issued by the Division permitting the operation of nursing
homes. This document constitutes the authority to receive patients and to perform the services
included within the scope of these rules.
Licensed Bed Capacity shall mean the exact number of beds for which license application has been
made and granted.
Licensee shall mean any state, municipality, political subdivision, institution, public, or private
corporation, association, individual, partnership or any other entity to whom a license is issued for
the purpose of operating the nursing home, who shall assume primary responsibility for complying
with approved standards for the institution.
Medication Assistant- Any medication assistive person who is qualified and certified under Ark. Code
Ann. §17-87-701 et. seq.
8
R.
06/01/2022
Nursing Facilities
New Construction means those facilities which are constructed or renovated for the purpose of
operating an institution according to architectural plans approved by the Division after adoption
of these rules.
Nursing Home shall mean and be construed to include any buildings, structure, agency, institution,
or other place for the reception, accommodation, board, care, or treatment of two (2) or more
unrelated individuals, who, because of physical or mental infirmity are unable to sufficiently or
properly care for themselves, and for which reception, accommodation, board, care, and treatment,
a charge is made, provided the term "Nursing Home" shall not include the offices of private
physicians and surgeons, boarding homes, hospitals, or institutions operated by the Federal
Government. (Section 2, Act 141 of 1961 as amended)
Nursing Home Classification shall mean the level of care the nursing home is capable of rendering
such as Skilled Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility for the
Mentally Retarded.
O.T.C. Drugs are commonly referred to as "over-the-counter," or patient medication that may be
provided without prescription.
Patient (interchangeable with resident) shall mean any individual who is being treated by a
physician or whose health is being supervised by a physician while residing within the respective
facility.
Patient Unit is an area designated to accommodate an individual patient bed, bedside cabinet, chair,
reading light, and other necessary equipment placed at the bedside for the proper care and comfort
of a patient.
Provisional Licensure is a temporary grant of authority to the purchaser to operate an existing long-
term care facility upon application for licensure to the Department.
Restorative Nursing or Rehabilitative Nursing shall mean measures directed toward prevention of
deterioration in normal body alignment, and muscle tone, restoration of the resident to full activity
insofar as their health problems permit and maintaining a state in which their total need for care is
minimal.
Restraint is any device or instrument used to limit, restrict, or hold patients under control, not
including safety vests or other instruments such as bed rails used for the safety and positioning of
patients. Personal safety devices and postural support devices that restrict movement are
considered restraints.
Sanitation is the process of promoting hygiene and preventing disease by maintaining sanitary
conditions.
Skilled Nursing Facility (SNF) is a nursing home, or a distinct part of another facility, licensed by
the Department as meeting the skilled nursing facility licensure rules. A health facility which
provides skilled nursing care and supportive care on a 24-hour basis to residents whose primary
need is for availability of skilled nursing care on an extended basis.
9
R.
06/01/2022
Nursing Facilities
Qualified Social Worker is a person who is registered by the State Board of Social Work and is a
graduate of a school of social work accredited or approved by the council on Social Work
Education.
State Health Officer shall mean the Director of the Arkansas Department of Health, Secretary of
the State Board of Health.
Sterile the state of being free from all forms of micro-organisms.
Unit Dose Medication System shall mean a system in which single doses of drugs are prepackaged
and pre-labeled in accordance with all applicable laws and rules governing these practices and
made available separated by resident and by dosage time. The system includes all equipment and
records deemed necessary and used in making the doses available to the resident in an accurate
and safe manner. A pharmacist shall be in charge of and responsible for the system.
Guardian shall mean a court appointed person who by law is responsible for a patient's affairs.
Responsible Party shall mean the person who is accountable for the patient's affairs but who has
not been appointed by the court.
Routine means the regular performance of a particular task.
Abbreviations
R.N. Registered Nurse
L.P.N. Licensed Practical Nurse
L.P.T.N. Licensed Psychiatric Technician Nurse
N.A. Nurse's Aide
P.T. Part-time
F.T. Full-time 40 hours per week in these rules and should not be
confused with (Fair Labor Standards Act)
N.H. Nursing Home
LTC Long Term Care
OLTC Office of Long Term Care
O.T.C. Over-the-counter drugs
10
R.
06/01/2022
Nursing Facilities
200
GENERAL PROVISIONS FOR LICENSURE
201
LICENSURE
Nursing homes, or related institutions, shall be operated, conducted, or maintained in this State by
obtaining a license pursuant to the provisions of these Licensing Standards. Separate institutions
operated by the same management require separate licenses. Separate licenses are not required for
separate buildings on the same grounds. The classification of license shall be Skilled Nursing
Facility, Intermediate Care Facility, and Intermediate Care Facility for the Mentally Retarded.
Whenever ownership or controlling interest in the operation of a facility is sold, both the buyer
and the seller must notify the Office of Long Term Care at least thirty (30) days prior to the
completed sale. The thirty (30) day notice shall be the date the paperwork is stamped received by
the Office of Long Term Care.
202
APPLICATION FOR LICENSE
Applicants for license shall file a notarized application with the Division upon forms prescribed
by the Division and shall pay an annual license fee of ten cents (10¢) per patient bed, or Ten Dollars
($10), whichever is greater. This fee shall be paid to the State Treasury. If the license is denied,
the fee will be returned to the applicant. Facilities operated by any unit or division of state or local
government shall be exempted from payment of a licensing fee. Application shall be signed by the
owner if individually owned, by one partner if owned under partnership, by two (2) officers of the
board if operated under corporation, church, or non-profit association, and in case of a
governmental unit, by the head of the governmental entity having jurisdiction over it. Applicants
shall set forth the full name and address of the institutions for which license is sought, the names
of the persons in control, a signed statement by a registered nurse indicating responsibility for
nursing services of the home, and such other information as the Division may require.
In these instances where a distinct part of a facility is to be licensed as a Skilled Nursing Facility
and the remainder of the facility is to be licensed under some other category, separate applications
must be filed for each license and separate licensure fees shall be required with each application.
202.1 Each home applying for and receiving a license must furnish the following information to the
Department:
• The identity of each person directly or indirectly having an ownership interest of five
percent (5%) or more in such nursing home.
• In case such nursing home is organized as a corporation, the identify of each officer and
director of the corporation.
• In case such nursing home is organized as a partnership, the identity of each partner.
• Identity of owners of building and equipment leased, including ownership breakdown
of the leasing entity.
• Information on the administrator, directors, management company, owner, operator, or
other management agent that the applicant or applicants will use to manage the facility.
11
R.
06/01/2022
Nursing Facilities
• Information on the owner or owners of the building or other structures that will be used
in the operation of the facility.
• Information on all other facilities owned, operated, or managed by the applicant or
applicants.
• Information on all other facilities owned, operated, or managed by the administrator,
directors, management company, owner, operator, or other management agent that the
applicant or applicants will use to manage the facility; and
• Affirmative evidence of ability to comply with standards, rules, and regulations as may be lawfully
prescribed.
202.2 The Department may deny a license if:
o The administrator, officers, directors, or management company, operator, or other management
agent that the applicant will use to manage the facility has ever been convicted of a felony;
o A facility or facilities owned or operated by the applicant or applicants have been found, after
final administrative decision, to have committed a Class A violation;
o A facility or facilities owned or operated by the administrator, directors, management company,
operator, or other management agent (that the applicant or applicants will use to manage the
facility) has been found, after final administrative decision, to have committed a Class A
violation;
o The applicant or applicants have had a license revoked or suspended;
o The administrator, directors, management company, operator, or other management agent that
the applicant or applicants will use to manage the facility have had a license revoked;
o The applicant or applicants have not demonstrated to the satisfaction of the department that any
other facility owned, operated, or administered by the applicant or applicants, administrator,
directors, management company, operator, or other management agent that the applicant or
applicants will use to manage the facility, is and has been in substantial compliance with the
standards as set by applicable state and federal law; or
o The applicant or applicants have not demonstrated to the satisfaction of the Department that any
other facility (owned, operated, or administered by the administrator, directors, management
company, operator, or other management agent that the applicant or applicants will use to
manage the facility) is and has been in substantial compliance with the standards as set by
applicable state and federal law.
The Department may consider the mitigation of compliance issues by an applicant or applicants that would
fall under the aforementioned section, including the administrator, directors, management company,
operator, or other management agent that the applicant or applicants will use to manage the facility.
12
R.
06/01/2022
Nursing Facilities
203
RENEWAL OF APPLICATION FOR LICENSURE
Annual licensure fees shall be tendered with each application for a new long-term care facility
license and annually thereafter by the anniversary of the date the department issued the long-term
care facility license. A license or licensure renewal shall not be issued unless the initial annual
licensure fee has been paid in full Any fee not paid when due shall be delinquent and shall be
subject to assessment of a ten-percent penalty. If a long-term care facility fails to pay the annual
licensure fee within sixty (60) calendar days of the anniversary of the date that the department
issued the long-term care facility license, the department may suspend the license until the annual
licensure fee is paid in full.
204
ISSUANCE OF LICENSE
A license shall remain effective unless revoked, suspended, or terminated by the Department. A
license shall be issued only for the premises and persons in the application and shall not be
assignable or transferable.
205
DENIAL, REVOCATION, OR SUSPENSION OF LICENSE
The Division is empowered to deny, suspend, or revoke licenses on any of the following grounds:
205.1
Violation of any of the provisions of Act 28 of 1979 or the rules lawfully
promulgated hereunder.
205.2
Permitting, aiding, or abetting the commission of any unlawful act in connection
with the operation of the institution, as defined in these rules.
205.3
Conduct or practices detrimental to the health of safety of residents and employees
of any such institutions, but this provision shall not be construed to have any
reference to healing practices authorized by law, as defined in these rules.
205.4
Failure to comply with the provisions of Act 58 or 1969 and the rules promulgated
thereunder. (Note: The aforementioned act requires the licensure of nursing home
administrators.)
206 CHANGE OF OWNERSHIP/MANAGEMENT
If a long-term care facility intends to add, remove, or otherwise change the management company, owner,
operator, or other management agent that manages the long-term care facility, the long-term care facility
shall notify the department. The long-term care facility shall notify the department of the change and
request approval at least thirty (30) days before the change occurs.
The long-term care facility shall complete the appropriate documents and provide the department with the
information required to allow the department to evaluate whether the new management company, owner,
operator, or other management agent that manages the long-term care facility meets the eligibility criteria
set forth in the disqualifying criteria stated in the aforementioned section. The long-term care facility shall
receive approval of the change from the department before the change occurs unless the change is required
due to an emergency.
13
R.
06/01/2022
Nursing Facilities
If a change occurs without prior approval from the department due to an emergency, the long-term care
facility shall notify the Department within ten (10) days of the change. The Department may deny a
requested change based on the criteria established in the above (second) paragraph of this section. If the
Department denies a requested change, the long-term care facility may not employ or otherwise use the
denied management company, owner, operator, or other management agent. A long-term care facility is
not required to notify or receive approval from the Department for a change involving vendors that
provide services to the long-term care facility but do not manage the facility.
Responsibilities of the seller and buyer:
•
The seller shall remain responsible for the operation of the facility until such time as a license is
issued to the buyer.
•
The buyer shall be subject to any plan of correction submitted by the previous licensee and
approved by the department.
•
The seller shall remain liable for all penalties assessed against the facility that are imposed for
violations or deficiencies occurring before the date the department issues the long-term care facility
license to the buyer.
•
The seller shall remain liable for all quality assurance fees and license fees that are assessed to the
facility before the date that the department issues the long-term care facility license to the buyer.
207
NOTICE AND PROCEDURE ON HEARING PRIOR TO DENIAL,
SUSPENSION, OR REVOCATION OF LICENSE
Whenever the Division decides to deny, suspend, or revoke a license, it shall send to the applicant
or licensee a notice stating the reasons for the action by certified mail. The applicant or licensee
may appeal such notice to the Long Term Care Facility Advisory Board as permitted by Arkansas
Statute Annotated §82-211. Procedures for appeal to the Long Term Care Facility Advisory Board
are incorporated in these rules as Appendix A.
208
APPEALS TO COURTS
Any applicant or licensee who considers himself injured in his person, business, or property by
final agency action shall be entitled to judicial review thereof. Proceedings for review shall be
made by filing a petition in the Circuit Court, of any county in which the petitioner does business,
or in the Circuit Court of Pulaski County, within thirty (30) days after service, upon the petitioner
of the agency's final decision. All petitions for judicial review shall be in accordance with the
Administrative Procedures Act Arkansas Statute Annotated §5-713.
14
R.
06/01/2022
Nursing Facilities
209
PENALTIES
Any person, partnership, association, or corporation, establishing, conducting, managing, or
operating any institution within the meaning of this act (§§ 82-327 -- 82-354), without first
obtaining a license therefor as herein provided, or who violates any provision of this act or rules
lawfully promulgated hereunder shall be guilty of a misdemeanor, and upon conviction thereof
shall be liable to a fine of not less than twenty five dollars ($25) nor more than one hundred dollars
($100) for the first offense and not less than one hundred dollars ($100) nor more than five hundred
dollars ($500) for each subsequent offense, and each day such institution shall operate after a first
conviction shall be considered a subsequent offense. (Section 27, Act 414 of 1961)
210
INSPECTION
All institutions to which these rules apply shall be subject to inspection for reasonable cause at any
time by the authorized representation of the Division.
211
COMPLIANCE
An initial license will not be issued until the applicant has demonstrated to the satisfaction of the
Division that the facility is in substantial compliance with the licensing standards set forth in these
rules.
212
NONCOMPLIANCE
When noncompliance of the licensing standards is detected during surveys, licensees will be
notified of the violations and will be requested to provide a plan of correction with a timetable for
corrections. If an item of noncompliance is of a serious nature that affects the health and safety of
patients and is not promptly corrected, action will be taken to suspend or revoke the facility's
license.
213
VOLUNTARY CLOSURE
Any nursing home, or related institution, that voluntarily closes must meet the rules for new
construction to be eligible for re-licensure.
214
EXCEPTION TO LICENSING STANDARDS
The Division reserves the right to make temporary exceptions to these standards where it is
determined that the health and welfare of the community requires the services of the institution.
Exceptions will be limited to unusual circumstances and the safety and well-being of the residents
will be carefully evaluated prior to making such exceptions.
Overbeds will be authorized only in cases of emergency. An emergency exits when it can be
demonstrated that the resident’s health or safety would be placed in immediate jeopardy if
relocation were not accomplished. A fire, natural disaster (such as a tornado or flood), or other
catastrophic event that necessitates resident relocation, will be considered an emergency. The
Department must be contacted for prior authorization of the overbed, and all authorizations must
be in writing.
15
R.
06/01/2022
Nursing Facilities
215
PROVISIONAL LICENSURE
Subject to the requirements below, a provisional license shall be issued to the Applicant and new
operator of the long-term care facility when the Department has received the Application for
Licensure to Conduct a Long Term Care Facility. A provisional license shall remain in effect
unless the provisional license is revoked, suspended, or terminated by the department. 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 Department
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
Department with the application for licensure, including all applicable fees.
3.
The Applicant and new operator of the long-term care facility shall provide the
Department 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.
215-299 RESERVED
16
R.
06/01/2022
Nursing Facilities
300
ADMINISTRATION
301
MANAGEMENT
301.1
BY-LAWS
The governing body shall adopt effective patient care policies and administrative
policies and by-laws governing the operation of the facility in accordance with legal
requirements.
301.2
ADMINISTRATOR
Each nursing home shall have a full-time (minimum forty (40) hours per week)
administrator on the premises during normal business hours, who shall be currently
licensed as a nursing home administrator in accordance with Act 58 of 1969, Statute
82-2201 through 82-2215 and the rules promulgated thereunder. Each facility
administrator, if required, should provide verification that a minimum of forty (40)
hours is spent in the facility. The administrator must have responsibility for overall
operation of the facility and is responsible for any non-compliance with rules found
in the nursing home. Correspondence between this office and the facility shall be
through the licensed administrator.
The licensed administrator shall not leave the nursing home premises during the
day tour of duty without first delegating authority in writing to a qualified
individual who may manage the facility temporarily during the administrator's
absence. Nursing personnel on the day tour of duty shall not be delegated authority
to operate the facility unless relief nursing personnel are employed to replace the
selected nurse. Also, the facility administrator shall notify this office in writing if
an absence from the facility will exceed seven (7) consecutive days. The name of
the individual who will be administratively in charge of the facility should also be
listed in the letter.
Administrators-in-training shall receive training in facilities that employ a full- time
licensed administrator. Administrators-in-training shall not serve as a nursing home
administrator until such time that a nursing home administrator's license is
obtained. Applicants that qualify to take the administrator's examination shall not
practice as a nursing home administrator until licensed by this office.
Arkansas Statute 82-2215 provides as follows: "It shall be unlawful for any person
to act or serve in the capacity of nursing home administrator in this state unless such
person has been licensed to do so as authorized in this Act."
302
GENERAL ADMINISTRATION
302.1
Visitors shall be permitted during all reasonable hours.
302.2
Incident and accident reports of patients and personnel shall be completed and
reviewed to identify health and safety hazards.
17
R.
06/01/2022
Nursing Facilities
302.3
An accurate daily census sheet as of midnight shall be available to the Division at
all times.
302.4
There shall be keys readily available for all locked doors within the home.
302.5
Birds, cats, dogs, and other animals are not permitted in nursing homes, except in
the case of seeing eye dogs, and as permitted under section 586.
302.6
The name, address, and telephone number of attending physicians shall be available
at each nurses' station.
302.7
Any home caring for patient with contagious diseases shall comply with all current
rules as described in the licensing laws and standards for hospitals and related
institutions of Arkansas.
302.8
All containers of substances used by the facility shall be legibly and accurately
labeled as to content.
302.9
Fire extinguishers shall be adequate, of the correct type, and properly located and
installed as defined by NFPA 101, 1973 edition.
302.10
A quiet atmosphere shall be maintained. Disturbances created within the home will
not be permitted.
302.11
Laboratories and radiological facilities operated in nursing homes shall comply
with the rules for hospitals and related institutions in Arkansas. Pharmacies
operated in nursing homes shall be operated in compliance with Arkansas laws and
shall be subject to inspection by personnel from the Division.
302.12
Children under sixteen (16) years of age shall not be cared for in a room with non-
related adults.
302.13
Adult male and female patients shall not have adjoining rooms which do not have
full floor to ceiling partition and closing doors. They shall not be housed in the
same room (except husband and wife of the same marriage or parent and child).
302.14
Child patients, male and female, shall not be housed in the same room when they
are seven (7) or more years old. They shall be provided the same privacy required
for adults.
302.15
The facility shall maintain written accounts for all patients' funds received by or
deposited with the facility for safekeeping. A trustworthy employee shall be
designated to be responsible for patient accounts. The funds may be withdrawn by
the patient upon request. The patient shall be provided an itemized accounting of
deposits, disbursements, and withdrawals including the current balance at least
quarterly.
303
PERSONNEL ADMINISTRATION
303.1
The administrator shall establish and maintain a personnel file for each employee.
18
R.
06/01/2022
Nursing Facilities
303.2
Applications for each employee shall contain sufficient information to support
placement in the position to which assigned. All applications from licensed and/or
registered personnel shall contain the appropriate certificate or registration number
and current renewal date. These registrations and/or certifications shall be verified.
303.3
No employee caring for patients shall be less than sixteen (16) years of age.
Employees shall wear uniforms and name pines with job title.
303.4
No person with a communicable disease or infected skin lesion shall be permitted
to work in the nursing home.
303.5
All employees must have a skin test for tuberculosis prior to employment or service.
These personnel shall be re-examined annually. The results of these tests shall be
on record in the nursing home. No person with active tuberculosis or a
communicable disease shall be allowed to work in the facility.
303.6
Written job descriptions shall be developed for each employee classification, i.e.,
R.N., L.P.N., aide, housekeepers, maids, etc., and shall include, as a minimum the
responsibilities and/or actual work to be performed in such classification. In
addition, the job description shall include the physical and educational
qualifications and licenses or certificates required for each job classification.
303.7
Sufficiently trained personnel shall be on duty at all times. Provisions shall be made
for relief of direct care personnel during vacations and other relief periods.
303.8
Upon request, a nursing home must make available to employees of the Division,
payroll records showing staff employed during recent pay periods. This is to verify
that minimum staffing has been maintained.
303.9
Copies of these rules shall be available to all personnel. All personnel shall be
instructed by the administrator in the requirements of the law and in the rules
pertaining to their respective duties.
303.10
Nursing or personal care shall not be delegated to cooks, housekeeping, or laundry
personnel.
303.11
A weekly time schedule shall be prepared and posted for each week and shall
include the employee's first and last name, classification, i.e., aide, R.N., cook, etc.,
and the beginning and ending time of each tour of duty, such as 7:00 a.m. to 3:00
p.m., etc.
304
STAFF DEVELOPMENT
304.1
Job orientation shall be provided for all personnel to acquaint them with the needs
of the residents, the physical facility, disaster plan, and the employee's specific
duties and responsibilities. There should be written documentation maintained to
verify that orientation and in-service training are planned and conducted. A
continuing in-service training program is planned and conducted. Attendance at
19
R.
06/01/2022
Nursing Facilities
such training shall be verified by each employee by signing their names on the
attendance record. Records of orientation shall include the signature of the
employee as well as topic of instruction and date of successful completion.
304.2
A reasonable supply of textbooks of basic practices shall be available in the nursing
home for the specific job needs of all employees.
304.3
At least ninety percent (90%) of personnel on each shift shall be trained at least on
a quarterly basis in the proper use of all fire-fighting equipment, in the procedures
for evacuation of patients, and in the procedures to follow in case of fire or
explosion. Disaster drills, including tornado drills, should be conducted semi-
annually for each shift. A record of the drills held shall be maintained, and this
record shall include the time and date the drill was held, along with the signature of
all staff participating.
305
EMERGENCY CALL DATA
The administrator shall be responsible for ensuring that emergency call information is posted in a
conspicuous place so as to be immediately available to all personnel of the nursing home.
Emergency call data shall include at least the following:
• Telephone number of fire and police departments.
• Names, addresses, and telephone numbers for emergency supplies, ambulance,
minister, advisory dentist, Red Cross, and poison control center.
• Name, address, and telephone number of all personnel to be called in case of fire or
emergency (to include the administrator and the director of nursing services).
• Name, address, and telephone number of an available physician to furnish necessary
medical care in case of emergency.
306
REPORTING SUSPECTED ABUSE, NEGLECT, EXPLOITATION, INCIDENTS,
ACCIDENTS, DEATHS FROM VIOLENCE AND MISAPPROPRIATION OF
RESIDENT PROPERTY
Pursuant to federal regulation 42 CFR 483.13 and state law Ark. Code Ann. § 5-28-101 et seq. and
12-12-501 et seq., the facility must develop and implement written policies and procedures to
ensure incidents, including:
• alleged or suspected abuse or neglect of residents;
• accidents, including accidents resulting in death;
• unusual deaths or deaths from violence;
• unusual occurrences; and,
• exploitation of residents or any misappropriation of resident property,
20
R.
06/01/2022
Nursing Facilities
are prohibited, reported, investigated and documented as required by these rules.
A facility is not required under this rule to report death by natural causes. However, nothing in this
rule negates, waives or alters the reporting requirements of a facility under other regulations or
statutes.
Facility policies and procedures regarding reporting, as addressed in these rules, must be included
in orientation training for all new employees, and must be addressed at least annually during in-
service training for all facility staff.
306.1
NEXT-BUSINESS-DAY REPORTING OF INCIDENTS
The following events shall be reported to the Office of Long Term Care by facsimile transmission
to telephone number 501-682-8551 of the completed Incident & Accident Intake Form (Form
DMS-7734) no later than 11:00 a.m. on the next business day following discovery by the facility.
a.
Any alleged, suspected or witnessed occurrences of abuse or neglect to residents.
b.
Any alleged, suspected or witnessed occurrence of misappropriation of resident
property, or exploitation of a resident.
c.
Any alleged, suspected or witnessed occurrences of verbal abuse. For purposes of
thisrule , "verbal abuse" means the use of oral, written, or gestured language that
willfully includes disparaging and derogatory terms to residents, or within their
hearing distance, regardless of their age, ability to comprehend, or disability.
Examples of verbal abuse include, but are not limited to: threats of harm; saying
things to frighten a resident, such as telling a resident that he or she will never be
able to see his or her family again.
d.
Any alleged, suspected or witnessed occurrences of sexual abuse to residents by
any individual.
In addition to the requirement of a facsimile report by the next business day on Form DMS-7734,
the facility shall complete a Form DMS-762 in accordance with Section 306.2.
306.2
INCIDENTS OR OCCURRENCES THAT REQUIRE INTERNAL REPORTING
ONLY - FACSIMILE REPORT OR FORM DMS-762 NOT REQUIRED.
The following incidents or occurrences shall require the nursing facility to prepare an
internal report only and does not require a facsimile report, or form DMS-762 to be made
to the Office of Long Term Care. The internal report shall include all content specified in
Section 306.3, as applicable. Nursing facilities must maintain these incident record files in
a manner that allows verification of compliance with this provision.
a.
Incidents where a resident attempts to cause physical injury to another resident
without resultant injury. The facility shall maintain written reports on these types
of incidents to document “patterns” of behavior for subsequent actions.
b.
All cases of reportable disease, as required by the Arkansas Department of Health.
21
R.
06/01/2022
Nursing Facilities
c.
Loss of heating, air conditioning or fire alarm system of greater than two (2)
hours duration.
306.3
INTERNAL-ONLY REPORTING PROCEDURE
Written reports of all incidents and accidents included in section 306.2 shall be completed within
five (5) days after discovery. The written incident and accident reports shall be comprised of all
information specified in forms DMS-7734 and 762 as applicable.
All written reports will be reviewed, initialed and dated by the facility administrator or designee
within five (5) days after discovery. All reports involving accident or injury to residents will also
be reviewed, initialed and dated by the Director of Nursing Services or other facility R.N.
Reports of incidents specified in Section 306.2 will be maintained in the facility only and are not
required to be submitted to the Office of Long Term Care.
All written incident and accident reports shall be maintained on file in the facility for a period of
three (3) years.
306.4
OTHER REPORTING REQUIREMENTS
The facility’s administrator is also required to make any other reports of incidents, accidents,
suspected abuse or neglect, actual or suspected criminal conduct, etc. as required by state and
federal laws and regulations.
306.5
ABUSE INVESTIGATION REPORT
The facility must ensure that all alleged or suspected incidents involving resident abuse,
exploitation, neglect or misappropriations of resident property are thoroughly investigated. The
facility’s investigation must be in conformance with the process and documentation requirements
specified on the form designated by the Office of Long Term Care, Form DMS-762, and must
prevent further potential incidents while the investigation is in progress.
The results of all investigations must be reported to the facility’s administrator, or designated
representative, and to other officials in accordance with state law, including the Office of Long
Term Care. Reports to the Office of Long Term Care shall be made via facsimile transmission by
11:00 a.m. the next business day following discovery by the facility, on form DMS-7734. The
follow-up investigation report, made on form DMS-762, shall be submitted to the Office of Long
Term Care within 5 working days of the date of the submission of the DMS-7734 to the Office of
Long Term Care. If the alleged violation is verified, appropriate corrective action must be taken.
The DMS-762 may be amended and re-submitted at any time circumstances require.
306.6
REPORTING SUSPECTED ABUSE OR NEGLECT
The facility’s written policies and procedures shall include, at a minimum, requirements specified
in this section.
22
R.
06/01/2022
Nursing Facilities
306.6.l The requirement that the facility’s administrator or his or her designated agent
immediately reports all cases of suspected abuse or neglect of residents of a long-
term care facility as specified below:
a.
Suspected abuse or neglect of an adult (18 years old or older) shall be reported
to the local law enforcement agency in which the facility is located, as required
by Arkansas Code Annotated 5-28-203(b).
b.
Suspected abuse or neglect of a child (under 18 years of age) shall be reported
to the local law enforcement agency and to the central intake unit of the
Department of Human Services, as required by Act 1208 of 1991. Central intake
may be notified by telephone at 1-800-482-5964.
306.6.2
The requirement that the facility’s administrator or his or her designated agent
report suspected abuse or neglect to the Office of Long Term Care as specified in
thisrule .
306.6.3
The requirement that facility personnel, including but not limited to, licensed
nurses, nursing assistants, physicians, social workers, mental health professionals
and other employees in the facility who have reasonable cause to suspect that a
resident has been subjected to conditions or circumstances which have or could
have resulted in abuse or neglect are required to immediately notify the facility
administrator or his or her designated agent.
306.6.4
The requirement that, upon hiring, each facility employee be given a copy of the
abuse or neglect reporting and prevention policies and procedures and sign a
statement that the policies and procedures have been received and read. The
statement shall be filed in the employee’s personnel file.
306.6.5
The requirement that all facility personnel receive annual, in-service training in
identifying, reporting and preventing suspected abuse/neglect, and that the facility
develops and maintains policies and procedures for the prevention of abuse and
neglect, and accidents.
23
R.
06/01/2022
Nursing Facilities
ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-7734
Incident & Accident Next Day Reporting Form
Purpose/Process
This form is designed to standardize and facilitate the process for the reporting allegations of
resident abuse, neglect, misappropriation of property or injuries of an unknown source by
individuals providing services to residents in Arkansas long term care facilities for next day
reporting pursuant to LTC 306.2.
The purpose of this process is for the facility to compile the information required in the form
DMS-7734, so that next day reporting of the incident or accident can be made to the Office of
Long Term Care.
Completion/Routing
This form, with the exception of hand written witness statements, MUST BE TYPED!
The following sections are not to be completed by the facility; the Office of Long Term Care
completes them:
1.
The top section entitled COPIES FOR:
2.
The FOR OLTC USE ONLY section found at the bottom of the form.
All remaining spaces must be completed. If the information can not be obtained, please provide
an explanation, such as “moved/address unknown”, “unlisted phone”, etc.
If a requested attachment can not be provided please provide an explanation why it can not be
furnished or when it will be forwarded to OLTC.
The original of this form must be faxed to the Office of Long Term Care the next business
day following discover by the facility. Any material submitted as copies or attachments must
be legible and of such quality to allow recopying.
24
R.
06/01/2022
Nursing Facilities
OLTC INCIDENT AND ACCIDENT REPORT (I&A)
Date & Time Submitted (if known):
Date & Time of Discovery:
Facility Name:
Facility Area Code and telephone # ( )
Facility Address:
Staff reporting I & A: Title:
Date of I & A Time: AM or PM
Name of Injured Resident: Age: Sex: Race:
Status of Alleged Perpetrator: Facility Employee
Family
Visitor
Other
Unknown
Type of Incident: Neglect
Misappropriation of Property:
Drugs
Abuse: Verbal
Personal Property
Sexual
Resident Trust Fund
Physical
Emotional/Mental
NOTIFICATIONS: FAMILY: Yes No DOCTOR: Yes No
LAW ENFORCEMENT: Yes No ADMINISTRATOR: Yes No
Summary of Incident:
(cont. on page 2)
Steps taken to prevent continued abuse or neglect during the investigation:
(cont. on page 3)
25
R.
06/01/2022
Nursing Facilities
SUMMARY OF INCIDENT – CONTINUED
26
R.
06/01/2022
Nursing Facilities
STEPS TAKEN TO PREVENT CONTINUED ABUSE OR NEGLECT
DURING THE INVESTIGATION– CONTINUED
27
R.
06/01/2022
Nursing Facilities
ARKANSAS DEPARTMENT OF HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-762
Facility Investigation Report for Resident Abuse, Neglect, Misappropriation of Property,
& Exploitation of Residents in Long Term Care Facilities
Purpose/Process
This form is designed to standardize and facilitate the process for the reporting allegations of
resident abuse, neglect, or misappropriation of property or exploitation of residents by
individuals providing services to residents in Arkansas long term care facilities. This
investigative format complies with the current rules requiring an internal investigation of such
incidents and submittal of the written findings to the Office of Long Term Care (OLTC) within
five (5) working days.
The purpose of this process is for the facility to compile a substantial body of credible
information to enable the Office of Long Term Care to determine if additional information is
required by the facility, or if an allegation against an individual(s) can be validated based on the
contents of the report.
Completion/Routing
This form, with the exception of hand written witness statements, MUST BE TYPED!
Complete all spaces! If the information can not be obtained, please provide an explanation, such
as “moved/address unknown”, “unlisted phone”, etc. Required information includes the actions
taken to prevent continued abuse or neglect during the investigation.
If a requested attachment can not be provided please provide an explanation why it can not be
furnished or when it will be forwarded to OLTC.
This form, and all witness and accused party statements, must be originals. Other material
submitted as copies must be legible and of such quality to allow re-copying.
The facility’s investigation and this form must be completed and submitted to OLTC within five
(5) working days from when the incident became known to the facility.
Upon completion, send the form by certified mail to:
Office of Long Term Care, P.O. Box 8059, Slot 404, Little Rock, AR 72203-8059.
Any other routing or disclosure of the contents of this report, except as provided for in LTC
306.3 and 306.4, may violate state and federal law.
28
R. 01/01/2020
Nursing Facilities
Facility I
nvestigation Report for Resident Abuse, Neglect, Misappropriation of Property,
& Exploitation of Residents in Long Term Care Facilities
Section I-Reporting Information
Name of Facility:
Phone #: ( )
Address:
City State Zip Code
Facility Staff Member Completing DMS 762:
Title:
Date Incident Reported/Faxed to OLTC: Time: AM/PM
Date & Time of Incident (if known):
Time & Time of Discovery:
Type of Incident: Neglect Misappropriation of Property: Drugs
Abuse: Verbal Personal Property
Sexual Resident's Trust Fund
Physical
Emotional/Mental
Name of Involved Resident: Room # :
Social Security #: DOB:
Height Weight Physician
Is Resident still Living: If not, Date of Death:
Ambulatory? YES NO Oriented Time, Place, Person, Events (Circle one or all).
Physical Functional Level/Impairment
Mental Functional Level
Primary Diagnosis
29
R. 01/01/2020
Nursing Facilities
Section II-Complete Description of Incident
“See Attached Is Not Acceptable!”
(Attach Additional Pages as Necessary)
30
R. 01/01/2020
Nursing Facilities
Section III- Findings and Actions Taken
Please include Resident's current medical condition
Facility Administrator’s Signature Date
31
R. 01/01/2020
Nursing Facilities
Section IV- Notification/ Status
Administrator/Written Designee Must Be Notified!
Name of Administrator
Date: Time: AM / PM
Family Notified: YES NO NONE Date: _ Time: AM/PM
Name of Family Member:
Relationship: Phone #:
Doctor Notified: YES NO Date: Time: AM/PM
Doctor’s Name: Phone #:
Resident Sent to Hospital: YES NO Date: Time: AM/PM
Admitted to Hospital: YES NO
Name/ Address/ Phone of Hospital:
Law Enforcement Must Be Notified for abuse and neglect
Date: Time: AM/PM
Name of Law Enforcement Agency:
Phone #:
Address:
City/Zip:
Was an Investigation Made by the Law Enforcement Agency?: YES NO
Date of Investigation: Time:
Name of Officer:
32
R. 01/01/2020
Nursing Facilities
Section VI-Accused Party Information
Name of Accused Party:
Job Title (if any): Phone #:
Home Address:
City/State/Zip:
Social Security #: DOB:
Dates of Current Employment: From To
Certified Nursing Assistant: YES NO
Registration # : Date Issued:
Date Criminal Background Check Completed:
Licensed by State Board of Nursing: YES NO
Type of License: RN # LPN #
Date Issued:
Section VII- Attachments
Attach the following information to the back of this form. If you do not have one of the specified attachments,
please provide an explanation why it can not be obtained or if it will be forwarded in the future.
1.
Statement from the accused party.
2.
All witness statements. Use the attached OLTC Witness Statement Form for all witness statements
submitted. If the statement is a typed copy of a handwritten statement, the handwritten statement must
accompany the typed statement.
3.
Law enforcement incident report. This can be mailed at a later date if necessary.
4.
Other pertinent reports/information, such as Ombudsmen, autopsy, reports, etc. These can be mailed at
a later date if necessary.
33
R. 01/01/2020
Nursing Facilities
Facility Investigation Report for Resident Abuse, Neglect, Misappropriation of Property,
& Exploitation of Residents in Long Term Care Facilities
OLTC Witness Statement Form
Date: Time: AM/ PM
Witness Full Name:
Job Title: Shift:
Home Address: City/Zip
Home Phone #: Work Phone #:
Relation to Resident (If Any?)
State in your own words what you witnessed (be very descriptive) and sign below.
(Continue on Back as Necessary)
The information provided above is true to the best of my knowledge:
Signature of Witness: Date:
31R. 06/01/2022
307
INSTITUTIONAL POLICIES AND/OR PROCEDURES
308
PATIENT CARE POLICIES
The administrator, in consultation with one or more physicians and one or more registered
professional nurses, department heads, and other related professional health care personnel, shall
develop and at least annually review appropriate written policies and procedures for all services
and/or patient care practices to include but not limited to dietary, medical records, nursing,
pharmaceutical, diagnostic services, laboratory and radiological, housekeeping, maintenance, and
laundry services.
309
RESTRAINT OF RESIDENTS
Patients shall not be unduly restrained. Patients shall not be confined to rooms or restrained except
when necessary to prevent injury to the patient or others and when alternative measures are not
sufficient to accomplish these purposes. In any event, no locked doors or locked restraints are to
be used at any time to restrain a patient. Doors (screen type), or the lower one half of a dutch door
or approved type louvered doors may be hooked on the hall side of the door. Restraints, of the non-
locking type, may be used only upon the order of a physician. In the event the order is obtained by
phone, the signature of a physician shall be obtained within five days (Note: The aforementioned
restraining type doors shall be installed in addition to the regular door to the room. They shall be
removed during periods when they are not needed for the restraint of patients.) Upon the advice of
the attending physician, unruly or excessively noisy patients shall be transferred from the home to
an institution equipped for such patient care, since this type patient creates a disturbance for other
patients in the home.
The written policy and procedures governing the use of restraints shall specify which staff
member may authorize the use of restraints and clearly delineate at least the following:
• Orders indicating the specific reasons for the use of restraints.
• Their use is temporary, and the resident will not be restrained for an indefinite
amount of time.
• Orders for restraints shall not be enforced for longer than twelve (12) hours, unless
the patient's condition warrants.
• Restraints must be checked every thirty (30) minutes and loosened every two (2)
hours for range of motion to restrained extremities.
310
PROTECTION OF PATIENT PROPERTY
An inventory of patient's personal belongings should be maintained for all items brought to the
facility on admission and up-dated as appropriate for items added or sent home/disposed of.
311
NOTIFICATION OF CHANGE IN PATIENT'S STATUS
There shall be written polices and procedures available at each nurses' station for personnel to
follow requiring the notification of the patient's attending physician and other responsible
32R. 06/01/2022
persons in the event of severe illness, accident, or death of the patient or other significant change
in the patient's status.
The name, address and telephone number of the patient's attending physician shall be recorded
for ready reference.
312
PHYSICIAN'S SERVICES POLICIES
The facility shall have a written policy indicating that the health care of every patient is under the
supervision of a physician, who based on a medical evaluation of the patient's immediate and long
term needs, prescribes a planned regimen of total care.
313
SPECIALIZED REHABILITATIVE SERVICE POLICIES
If a facility offers specialized rehabilitative services, written administrative and patient care
policies and procedure for rehabilitative services shall be developed for appropriate therapists and
representatives of the medical, administrative, and nursing staffs.
314
SOCIAL SERVICE POLICIES
Facilities which do not directly provide social service shall have written procedures for referring
patients in need of social services to appropriate service agencies.
315
CONFIDENTIALITY OF SOCIAL INFORMATION
Policies and procedures shall be established for ensuring the confidentiality of all patients' social
information.
316
RIGHTS OF RESIDENTS
Facilities shall establish policies and procedures setting forth the rights of resident and
prohibiting their mistreatment or abuse.
317
REGISTRATION OF COMPLAINTS
Facilities shall establish policies for the registration and disposition of complaints without threat
of discharge or other reprisal against any patient.
318
ADMISSION, TRANSFER, AND DISCHARGE POLICIES
These policies shall include, as a minimum, the following:
318.1
Patients shall be admitted to the facility only on the recommendation of a physician
licensed to practice medicine in the State of Arkansas.
318.2
All persons admitted to a nursing home shall have a history and physical
examination at the time of admission or within seventy-two (72) hours following
admission unless such examination was performed within fifteen (15) days prior to
admission. A copy of the hospital history, physical, and discharge summary (after
completion) will satisfy the requirement if the history and physical was completed
within thirty (30) days. The examination will be for medical
33R. 06/01/2022
evaluation purposes and to determine if the patient is free from communicable
diseases.
318.3
Recording shall be made of initial examination and all subsequent examinations,
including findings, recommendations and progress notes. Hospital discharge
summaries are to be obtained after each hospitalization.
318.4
Patients who are not receiving public assistance from the Division shall be
classified, on admission and subsequently re-classified, by the attending physician
as skilled care, intermediate care, or minimum care patients, and a report shall be
kept in the home and available to the Division. The classification shall be based
upon the Division's criterion.
318.5
Only those persons are accepted whose needs can be met by the facility directly or
in cooperation with the community resources or other providers of care with which
it is affiliated or has contracts.
318.6
As changes occur in their physical or mental condition necessitating service or care
which cannot be adequately provided by the facility, residents shall be transferred
promptly to facilities which can provide appropriate care.
318.7
Except in the case of an emergency or voluntarily discharge, the resident,
responsible party, attending physician, and the responsible agency, if any, are
consulted in advance of the transfer or discharge of any resident. The resident
and/or responsible party will be provided written notification of his/her transfer, ten
days prior to the transfer.
319
CONFIDENTIALITY OF MEDICAL RECORD INFORMATION
There shall be written policies adopted by the management of the nursing home covering
confidentiality of medical records and procedures regarding release of medical information.
320
INFECTION CONTROL
Written policies and procedures shall be established for investigating, controlling and preventing
infections. Procedures shall be reviewed annually and revised as necessary for effectiveness and
improvement. The policies and procedures shall include as a minimum:
• Aseptic and isolation techniques.
• Proper disposal techniques for infected dressings, disposable syringes, needles, etc.
• Prohibiting the use of the common towel, common bath and hand soap, and the
common drinking cup or glass.
321
HANDLING OF OXYGEN AND FLAMMABLE GASES
Policies shall be written for the proper handling of oxygen and flammable gases.
322
PERSONNEL POLICIES
34R. 06/01/2022
Written personnel policies shall be provided and shall be available to all personnel and to the
Division.
323
TRANSPORTATION OF RESIDENTS
The facility shall establish a written policy regarding transportation of residents, when necessary,
to the hospital, medical clinics, and dentist offices. The facility must assume responsibility for
seeing that the patient's transportation needs are met.
324
BEDPAN SANITATION
Written policies shall be established to ensure all individually assigned bed pans are sanitized by
the boiling method for a minimum of twenty (20) minutes at least once a week or by other methods
approved by the Division.
325
OUTSIDE RESOURCE AGREEMENTS
326
SPECIALIZED REHABILITATIVE SERVICES
If the facility does not offer specialized rehabilitative services directly, patients in need of such
services, i.e., physical therapy, occupational therapy, speech pathology, and audiology, shall not
be admitted or retained in the facility unless arrangements for these services have been provided
with an outside resource. Terms of the agreement should include reimbursement, responsibility of
each party, and documentation responsibilities.
327
ADVISORY DENTIST
Facilities shall establish a written cooperative agreement with an advisory dentist or dental service.
The agreement shall include provisions for a dentist or dental service. The agreement shall include
provisions for a dentist to participate annually in the staff development program and to recommend
oral hygiene policies and practices.
328
SOCIAL SERVICES
If a facility provides social services directly and the designated staff member is not a qualified
social worker, a written agreement shall be established to provide consultation from such a
qualified person or a recognized social agency.
329
ACTIVITY DIRECTOR
In a nursing facility, if the staff member designated responsible for the activity program is not a
qualified patient activity coordinator, a written agreement shall be established with a person so
qualified. The MSW consultant may also serve as consultant to the activity director.
330
PHARMACIST
If a facility does not employ a licensed pharmacist, it shall establish a written agreement with a
licensed pharmacist to provide consultation on methods and procedures for ordering, storage,
administration, disposal, and record keeping of drugs and biologicals.
331
MEDICAL AND REMEDIAL SERVICES
35R. 06/01/2022
A nursing home shall establish a written agreement for all medical and remedial services, i.e.,
laboratory, radiological, and other services, required by the resident but not regularly provided
within the facility.
332
TRANSFER AGREEMENT
A facility shall have in effect a written transfer agreement with one or more hospitals sufficiently
close to the facility to make feasible the transfer of patients. It shall be the duty of each nursing
home administrator to supply basic information at the time of a patient's transfer from one nursing
home to another or to a hospital.
333
ELECTRONIC RECORDS AND SIGNATURES
333.1
Facilities have the option of utilizing electronic records rather than, or in addition
to, paper or “hardcopy” records. The facility must have safeguards to prevent
unauthorized access to the records and a process for reconstruction of the records
in the event of a system breakdown. Any electronic record or signature system shall,
at a minimum:
a.
Require authentication and dating of all entries. "Authentication" means
identification of the author of an entry by that author and no other, and that
reflects the date of entry. An authenticated record shall be evidence that the
entry to the record was what the author entered. To correct or enhance an
entry, further authenticated entries may be made, by the original author, or
by any other author, as long as the subsequent entries are authenticated as
to who entered them, complete with date and time stamp of the entry, and
that the original entries are not modified. “Entry” means any changes,
deletions, or additions to a record, or the creation of a record.
The electronic system utilized by the facility shall retain all entries for the
life of the medical record and shall record the date and time of any entry, as
well as identifying the individual who performed the entry. The electronic
system must not allow any original signed entry or any stored data to be
modified from its original content except for computer technicians
correcting program malfunction or abnormality. A complete audit trail of
all events as well as all “before” and “after” data must be maintained.
b.
Require data access controls using unique personal identifiers to ensure that
unauthorized individuals cannot make entries to a record, or create or enter
an electronic signature for a record. The facility shall maintain a master list
of authorized users, past and present. Facilities shall terminate user access
when the user leaves employment with the facility.
c.
Include physical, technical, and administrative safeguards to ensure
confidentiality of patient medical records, including procedures to limit
access to only authorized users. The authorized user must certify in writing
that the identifier will not be shared with or used by any other
36R. 06/01/2022
person and that they are aware of the requirements and penalties related to
improper usage of their unique personal identifier.
d.
Provide audit controls. The system must be capable of tracking and logging
user activity within its electronic files. These audit logs shall include the
date and time of access and the user ID under which access occurred. These
logs shall be maintained a minimum of six years. The facility must certify
in writing that it is monitoring the audit logs to identify questionable data
access activities, investigate breaches, assess the security program, and are
taking corrective actions when a breach in the security system becomes
known.
e.
Have a data recovery plan. Data must be backed up either locally or
remotely. Backup media shall be stored at both on-site and off-site locations
or alternatively at multiple offsite locations. The backup system must have
the capability of timely restoring the data to the facility or to the central
server in the event of a system failure. Barring a natural disaster of epic
proportions (e.g., earthquake, tornado), timely means that the restoration of
the backup occurs within a period of time that will permit no more than
minimal disruption in the delivery of care and services to the residents.
Pending restoration from backup, the facility shall maintain newly
generated records in a paper format, and shall copy or transfer the contents
of the paper records to the electronic system upon restoration of the system
and backup. A full backup shall be performed at least weekly, with
incremental or differential backups daily. Back up media shall be
maintained both locally and at the off-site location or alternatively at
multiple offsite locations until the next full weekly backup is successfully
completed. Backups shall be tested periodically, but no less than monthly.
Testing shall include restoration of the backup to a computer or system that
shall not interfere with, or overwrite, current records. If utilizing a third
party company for computer data storage and retrieval, the facility shall
require that said third party company shall comply with these requirements.
f.
Provide access to Department of Health and Human Services (DHHS),
Office of Long Term Care (OLTC), and Centers for Medicaid or Medicare
Services (CMS) personnel. Access may be by means of an identifier created
for DHHS, OLTC, or CMS personnel, by a printout of the record, or both,
as requested by DHHS, OLTC, or CMS personnel. Access must be in a
“human readable” format, and shall be provided in a manner that permits
DHHS, OLTC, or CMS personnel to view the records without facility
personnel being present. Access shall include all entries and accompanying
logs and shall list the date and time of any entry, as well as identifying the
individual who performed the entry. Any computer system utilized, whether
in-house or from a third-party vendor, must comply with thisrule .
333.2
Physicians’ Orders. When facility personnel take telephone orders from physicians
or other individuals authorized by law or rules to issue orders the facility documents
the appropriate information, including but not limited to, the date and time of the
order, and the identity of the physician or other authorized individual giving the order
as well as the identity of the facility personnel taking the order. The facility shall ensure
that the physician electronically countersigns the physician’s order upon the
37R. 06/01/2022
physician’s next rounds at the facility or through Internet access from the physician’s
office.
333.3
For purposes of these rules, in all instances in which the rules requires, or appears
to require, the facility to use written records or written signatures, the facility may
use electronic records or electronic signatures in lieu of written records or written
signatures when doing so conforms to the requirements of this section for the use
of electronic records or electronic signatures.
333-399 RESERVED
38R. 06/01/2022
400
PHYSICAL ENVIRONMENT
401
GENERAL STANDARDS FOR EXISTING STRUCTURES
402
GENERAL
Every institution must be maintained, managed, and equipped to provide adequate care, safety,
and treatment of each resident.
403
FACILITY GROUNDS AND PARKING
• All homes shall be provided with dust free drives and parking lots.
• Parking areas shall be provided in a ratio of one (1) individual parking space for each
five (5) licensed beds.
404
DOORS
• All exterior doors shall be effectively weather stripped
• Doors shall swing into rooms except closet, toilet, and exit doors.
• The doors to all rooms, toilets, baths, and closets shall be legibly marked with names
or numbers, as appropriate to identify the area.
• Exit doors shall not be locked in such a way that a key is necessary to open the door
from the inside of the building. A latch or other fastening device on the door shall be
provided with a knob, handle, panic bar or other simple type of releasing device, which
is part of the door handle hardware, of which the method of operation is obvious even
in darkness.
405
STANDARD PATIENT ROOMS, BATH, AND TOILET FACILITIES
405.1
Standard patient rooms shall not have more than five (5) beds.
405.2
Single standard patient rooms shall measure at least one-hundred (100) square feet.
Multi-patient rooms shall provide a minimum of seventy-two (72) square feet per
bed. Patient beds shall be located in rooms and placed at least three (3) feet apart in
all directions and so located as to avoid contamination (respiratory droplets), drafts,
excessive heat, or other discomfort to patients, to provide adequate room for nursing
procedures and to minimize the transmission of disease.
405.3
Each standard patient room shall be equipped with or conveniently located near
adequate toilet and bathing facilities; at least four (4) patients toilet facilities and
three bathing units shall be provided for each thirty-five (35) beds. Each toilet
facility shall be in a separate stall. Toilets shall be equipped with hand-washing
facilities and toilet paper hangers.
39R. 06/01/2022
405.4
Each standard patient room shall have hand-washing facilities with both hot and
cold running water, unless adequately provided in a nearby room.
405.5
Each patient room shall have direct access to a corridor.
405.6
Rooms extending below ground level shall not be used for patients unless they are
dry, well ventilated by required window space, and are otherwise suitable for
occupancy. Non-ambulatory patients may not be housed below ground level.
405.7
Each patient room shall have a window not less than one-sixteenth (1/16) of the
floor space or outside door arranged and located so that it can be opened from the
inside. The window shall be so located that the patients have a reasonable outside
view.
405.8
Each patient shall be provided with storage space, closet, or other enclosed space,
within his/her room, for clothing and other possessions.
406
INTENSIVE CARE ROOM
An intensive care room shall be provided for each thirty-five (35) beds or major portion thereof
and shall be located near the nurses' station. Each room shall have the standard square footage as
set forth in these rules. The room shall be provided with standard unit equipment and a lavatory
with a gooseneck spout and elbow or wrist-action blade-handle controls, and a soap and a towel
dispenser. At least one of these rooms is a single room which can be used for isolation.
407
CORRIDORS
Corridors in facilities licensed prior to 1973 shall be at least six (6) feet wide.
408
HANDRAILS
Standard handrails shall be provided on each side of the corridor in all areas used by patients;
however, a six (6) foot passageway must be maintained. For six (6) foot corridors, a handrail shall
be required only on one side.
409
BEDPAN CLEANING AND STORAGE ROOM
There shall be one properly equipped bedpan cleaning room with deep metal sink. In addition to
bedpan cleaning equipment, appropriate hand-washing facilities shall be provided. The room shall
include equipment for sterilization (unless a separate central sterilization is provided).
410
DAY ROOM AND DINING ROOM
A well lighted, clean, orderly, and ventilated room or rooms shall be provided for patient activities
and for dining areas. A minimum of twenty (20) square feet per bed shall be provided for this
purpose. At least half of the required area may be used for dining.
411
CEILINGS, WALLS AND FLOORS
411.1
Ceilings
40R. 06/01/2022
Kitchens, and other rooms where food and drink are prepared shall have a smooth, non-
perforated surface that is washable.
Wallpaper shall not be used.
411.2
Walls
The walls of the facility shall be a smooth surface with painted or equally washable
finish:
• They shall be without cracks, and in conjunction with floors, shall be waterproof
and free from spaces which may harbor ants and roaches. The walls in the
examining room and treatment room shall have waterproof paint.
• All walls shall be kept clean and in good repair.
411.1 Floors
All floor surfaces throughout the building shall provide a surface or finish which is smooth,
waterproof, grease proof, and resistant to heavy wear. Safety devices shall be provided on
ramps. All floors in baths, toilets, lavatories, beneath kitchen dish washing facilities and
bedpan rooms shall have a floor covering of a continuous type. No cracks or joints in the
floor covering shall be permitted in these rooms. Carpet is permitted as floor covering for
the following areas, provided the carpet meets the following requirements: The carpet has
a flame spread rating of seventy-five (75) or less, has a smoke density of one-hundred (100)
or less, when the carpet is treated in accordance with NFPA 253, Flooring Radiant Panel
Test.
• Offices
• Corridors
• Chapels
• Day rooms
No pad will be permitted under the carpet. The carpet is to be glued directly to the floor.
Prior approval by the Division is required before the carpet is installed. In nursing homes
where carpet is installed, the home must furnish equipment and have written cleaning
procedures to clean and maintain the carpet. This equipment must include, as a minimum,
a shampooer and wet/dry vacuum.
Facilities presently having carpets in areas other than those listed above may keep that
carpet as long as it is maintained properly and free of odors. If not properly maintained and
free of odors, the carpet will be removed and replaced with a hard smooth surface.
412
HEATING AND COOLING
412.1
The institution shall be equipped with heating and cooling equipment that will
maintain a minimum temperature of seventy-five (75) degrees F during winter
41R. 06/01/2022
and eighty (80) degrees F during summer in all patient areas when the temperature
outside does not exceed ninety-five (95) degrees F. If temperature outside exceeds
one-hundred (100) degrees F, there shall be a fifteen (15) degree F difference in
exterior to interior temperature. If air conditioner should break down or
malfunction, the OLTC should be notified immediately. Patients' toilets and
bathroom temperature shall be maintained at eighty (80) degrees F.
412.2
Central heating systems shall be provided with Underwriters; approved temperature
controls throughout the building.
413
LIGHTING
413.1
Each patient's room shall have natural lighting during the day and have general
lighting at night. Natural lighting shall be augmented when necessary by artificial
illumination.
413.2
Approved "exit" lights shall be provided at all exit areas and shall be continuously
illuminated.
414
EMERGENCY POWER
The facility shall provide an emergency source of electrical power necessary to protect the health
and safety of patients in the event the normal electrical supply is interrupted. The emergency
electrical power system must supply power adequate at least for lighting in all means of egress;
equipment to maintain fire detection, alarm, and extinguishing systems. Dry battery or wet-cell
batteries may be used as emergency power in facilities where life support systems are not used.
Where life support systems are used, emergency electrical service is provided by an emergency
generator located on the premises.
415
WATER SERVICE
415.1
The water supply used by the institution shall meet the requirements of the
Department of Health.
415.2
There shall be procedures to ensure water to all essential areas in the event of loss
of normal water supply.
415.3
The water service shall be brought into the building to comply with the
requirements of the Arkansas State Plumbing Code and shall be free of cross
connections.
415.4
Hot Water Heaters
415.4.1 Hot water heating and storage equipment shall have sufficient
capacity to supply four (4) gallons of water at one-hundred ten
(110) degrees F (43 degrees C), per hour per bed for institution
fixtures, one (1) gallon at one-hundred sixty (160) degrees F (71
degrees C), per hour per bed for the laundry and one (1) gallon at
one-hundred eight (180) degrees F (82 degrees C) per hour per bed
42R. 06/01/2022
for the kitchen. The water temperature in patient areas shall not
exceed one-hundred ten (110) degrees F (49 degrees C).
415.4. 2 The hot water storage tank, or tanks, shall have a capacity equal to
forty (40) percent of heater capacity.
415.4. 3 Tanks and heaters shall be fitted with pressure temperature relief
valves.
415.4. 4 Temperatures of hot water at plumbing fixtures used by residents
shall be automatically regulated by control valves. Water
temperature in patient areas shall be checked weekly.
415.4.
5 All gas, oil, or coal heaters shall be vented to the outside.
415.5
Plumbing and Other Piping Systems
All plumbing systems shall be designed and installed in accordance with the requirements
of Arkansas State Plumbing Code. From the cold water service and hot water tanks, cold
water and hot water mains and branches shall be run to supply all plumbing fixtures and
equipment which require hot and cold water or both for their operation. Pipes shall be sized
to supply hot and cold water to all fixtures with a minimum pressure of fifteen (15) pounds
at the top floor fixtures during maximum demand periods.
415.5.
1 Water closets shall be the elongated type, and water closet seats shall
be of the open-front type.
415.5. 2 Gooseneck spouts shall be used for patients' lavatories and sinks
which may be used for filling pitchers.
415.5. 3 Knee, elbow, wrist, or foot action faucets shall be used in treatment
rooms.
415.5. 4 An electrically operated water fountain shall be so located as to be
accessible to patients.
415.5. 5 Backflow preventers (vacuum breakers) shall be installed with any
water supply fixture where the outlet's end may at times be
submerged. Examples of such fixtures are hoses, sprays, direct
flushing valves, aspirators and under-rim water supply connections
to a plumbing fixture or receptacle in which the surface of the water
in the fixture or receptacle is exposed at all times to atmospheric
pressure.
416
NURSES' STATION
Nurses' stations shall be provided and so designated that they contain a minimum of sixty (60)
square feet per each thirty-five (35) bed patient unit, and are not more than one-hundred twenty
(120) linear feet from each patient room. The station shall include adequate storage and
preparation areas(s), medication, toilet and hand-washing facilities, and sufficient lighting.
43R. 06/01/2022
416.1
Separate utility room shall be provided for clean items and soiled items for each
nurses' station. They shall be mechanically ventilated to the outside and adequately
lighted. Two or more electrical convenience outlets shall be provided for each
utility room. Blade handle control faucets shall be provided. Gooseneck spouts shall
be in a separate room and ventilated to the outside.
416.2
Closet for soiled linens shall be provided for each nurses' station. This dirty linen
storage shall be in a separate room and ventilated to the outside.
417
JANITORS' CLOSETS
Janitors' closets shall be provided for each nursing unit, and a separate janitor's closet shall be
provided within the kitchen area. These closets shall be provided with hot and cold running water,
a floor receptor or service sink, and shelves for the storage of janitorial equipment and supplies.
The closets shall be mechanically vented to the outside. Janitor closets in patient areas must be
kept locked.
418
NURSES' CALL SYSTEM
A nurses' call system comprised of an electric buzzer and/or light system shall be so designed that
the location of a call can be determined from the corridor and nurses' station. In addition emergency
call stations shall be provided in all patient bath, toilet and shower areas. Wireless nurse call
systems may be substituted for wired call systems. Wireless call systems shall meet the
requirements set forth in Section 440 of these rules.
419
FIRE ALARM SYSTEM
Each nursing home shall have an electrically-supervised, manually-operated fire alarm system in
accordance with Section 6-3 NFPA 101, Life Safety Code handbook that applies to their nursing
home.
420
PHYSICAL ENVIRONMENT
421
STANDARDS FOR NEW CONSTRUCTION AND/OR ALTERATIONS
422
GENERAL
422.1
A "new institution" is one which had plan approved by the Office of Long Term
Care and began operation and/or construction or renovation of a building for the
purpose of operating an institution on or after the adoption date of these rules. The
rules and codes governing new institutions apply if and when the institution
proposes to begin operation in a building not previously and continuously used as
an institution licensed under these rules.
422.2
Additions to existing facilities shall meet the standard for new construction.
422.1 The requirements outlined under section 1400, General Standards for Existing
Structures, also apply when applicable.
423
SITE LOCATION, INSPECTION, APPROVALS AND SUBSOIL
INVESTIGATION
44R. 06/01/2022
423.1
The building site shall afford good drainage and shall not be subject to flooding or
be located near insect breeding areas, noise, or other nuisance producing locations,
or hazardous locations, industrial developments, airports, railways, or near penal or
other objectionable institutions or near a cemetery. The site shall afford the safety
of patients and not be subject to air pollution.
423.2
A site shall be adequate to accommodate roads and walks within the lot lines to at
least the main entrance, ambulance entrance, and service entrance. All facility sites
shall contain enough square footage to provide at least as much space for walks,
drives, and lawn space as the square footage contained in the building.
423.3
The building site shall be inspected and approved by the Division before
construction is begun.
424
SUBMISSION OF PLANS, SPECIFICATIONS, AND ESTIMATES
424.1
When construction is contemplated either for new buildings, additions, or major
alterations in excess of One-Hundred-Thousand dollars ($100,000), plans and
specifications shall be submitted in duplicate one (1) to the OLTC and one (1) to
the Plumbing Division of the Arkansas Department of Health, for review, along
with a copy of the statement of approval from the Comprehensive Health Planning
Agency. Final plan approval will be given by the OLTC.
424.2
Such plans and specifications should be prepared by a registered professional
engineer or an architect licensed in the State of Arkansas (Act 270 of 1941 as
amended) and should be drawn to scale with the title and date shown thereon. The
Division shall be a minimum of three (3) weeks to review the drawing and
specifications and submit their comments to the applicant. Any proposed deviations
from the approved plans and specifications shall be submitted to the Division prior
to making any changes. Construction cannot start until approval of plans and
specifications have been reviewed from the Division. The Division shall be notified
as soon as construction of a new building or alteration to an existing facility is
started.
424.3
An estimate shall accompany all working plans and specifications when the total
cost of construction is more than One-Hundred-Thousand dollars ($100,000).
424.4
Representatives from the Division shall have access to the construction premises
and the construction project for purposes of making whatever inspections deemed
necessary throughout the course of construction.
425
PLANS AND SPECIFICATIONS
425.4 All institutions licensed under these standards shall be designated and constructed to
substantially comply with pertinent local and state laws, codes, ordinances, and
standards. All new nursing home construction shall be in accordance with
requirements of Section 10-132 if NFPA Standard 101, 1973 edition.
Plans shall be submitted to the Division in the following stages.
45R. 06/01/2022
425.1.1
Preliminary Submission
Architect preparing plans should contact Office of Long Term
Care for preliminary review.
425.1.2
Final Submission
Step (1) Working drawings and specifications which shall be well
prepared so that clear and distinct prints may be obtained;
accurate dimensions and including all necessary explanatory
notes, schedules and legends. Working drawings shall be
complete and adequate for contract purposes. Separate
drawings shall be prepared for each of the following
branches of work; architectural, structural, mechanical and
electrical; and shall include the following:
• Approved plan showing all new topography, newly
established levels and grades, existing structures on
the site (if any), new buildings and structures,
roadways, walks, and the extent of the areas to be
seeded. All structures and improvements which are
to be removed under the construction contract shall
be shown. A print of the survey shall be included
with the working drawings.
• Plan of each floor and roof.
• Elevations of each façade.
• Sections through building
• Scale and full size details as necessary to properly
indicate portions of the work.
• Schedule of finishes.
Step (2) Equipment Drawings: Large scale drawings of typical and
special rooms indicating all fixed equipment and major items
of furniture and movable equipment.
Step (3) Structural Drawings:
• Plans of foundations, floors, roofs, and all
intermediate levels shall show a complete design with
sizes, sections, and the relative location of the various
members. Schedule of beams, girders, and columns
shall be included.
• Floor levels, column centers, and offsets shall be
dimensioned.
46R. 06/01/2022
• Special openings and pipe sleeves shall be
dimensioned or otherwise noted for easy reference.
• Details of all special connections, assemblies, and
expansion joints shall be given.
Step (4) Mechanical Drawings: The drawings with specifications shall
show the complete heating, steam piping and ventilation
systems, plumbing, drainage and standpipe system, and
laundry.
• Heating, steam piping, and air-conditioning systems.
1.
Radiators and steam heated equipment, such as
sterilizers, warmers, and steam tables.
2.
Heating and steam mains and branches with pipe
sizes.
3.
Sizes, types, and heating surfaces of boilers,
furnaces, with stokers and oil burners, if any.
4.
Pumps, tanks, boiler breeching and piping and
boiler room accessories.
5.
Air-conditioning systems with required
equipment, water and refrigerant piping, and
ducts.
6.
Exhaust and supply ventilating systems with
steam connections and piping.
7.
Air quantities for all room supply and exhaust
ventilating duct openings.
• Plumbing, drainage, and standpipe systems:
1.
Size and elevation of: Street sewer, house sewer,
house drains, street water main and water service
into the building.
2.
Locations and size of soil, waste, and vent stacks
with connections to house drains, clean outs,
fixtures, and equipment.
3.
Size and location of hot, cold and circulating
mains, branches and risers from the service
entrance and tanks.
47R. 06/01/2022
4.
Riser diagram to show all plumbing stacks with
vents, water risers, and fixture connections.
5.
Gas, oxygen, and special connections.
6.
Plumbing fixtures and equipment which require
water and drain connections.
• Elevators and dumbwaiters: Details and dimensions of
shaft, pit and machine room; sizes of car platform and
doors.
• Kitchens, laundry, refrigeration and laboratories; These
shall be detailed at a satisfactory scale to show the
location, size, and connections of all fixed equipment.
Step (5) Electrical Drawings:
• Drawings shall show all electrical wirings, outlets,
smoke detectors, and equipment which require
electrical connections.
• Electrical Service entrances with switches, and feeders
to the public service feeders shall be shown.
• Plan and diagram showing main switchboard power
panels, light panels, and equipment.
• Light outlets, receptacles, switches, power outlets,
and circuits.
• Nurses' call systems with outlets for beds, duty
stations, door signal lights, enunciators, and wiring
diagrams.
• Fire alarm system with stations, signal devices,
control board and wiring diagrams.
• Emergency electrical system with outlets, transfer
switch, source of supply, feeders and circuits.
Step (6) Specifications: Specifications shall supplement the drawings
to fully describe types, sizes, capacities, workmanships,
finishes, and other characteristics of all materials and
equipment and shall include the following:
• Cover or title sheet
• Index
48R. 06/01/2022
• General conditions
• General Requirements
• Sections describing material and workmanship in
detail for each class of work.
426
CODES AND STANDARDS
The following codes and standards are incorporated into and made a part of these rules:
426.1
The 1973 edition of the National Fire Code (NFPA) applies to new construction
and alterations or additions to existing facilities. This edition includes NFPA No.
101, Life Safety Code (1973).
426.2
The 1967-68 edition of the National Fire Code (NFPA) applies to existing facilities
which met such standards as of June 1, 1976.
426.3
American National Standards Institute (ANSI) Standard No. A117.1, American
Standard Specifications for making building and facilities accessible to, and usable
by, the physically handicapped.
426.4
Arkansas State Plumbing Code.
426.5
Fire Resistance Index 1971, Underwriters Laboratories, Inc.
426.6
Handbook of Fundamentals, American Society of Heating, Refrigeration and Air-
conditioning Engineers (ASHRAE), United Engineer Center, 345 East 47
th
Street,
New York, New York 10017.
426.7
Method of Test for Surface Burning characteristics of Building Materials, Standard
No. E 84-61 American Society for Testing and Materials (ASTM) Standard No. 84-
61, 1961 Race Street, Philadelphia, Pennsylvania 19103.
426.8
Methods of Fire Test of Building construction and Materials. Standard No. E 119,
American Society of Testing and Materials (ASTMO), 1961 Race Street,
Philadelphia, Pennsylvania 19103.
426.9
Minimum Power Supply Requirements, Bulletin No. XR4-10 National Electrical
Manufacturers Association (NEMA) 155 East 44
th
Street, New York, New York
10017.
427
STANDARD PATIENT ROOM AND TOILET DESIGN
427.1
Built-in closets shall be provided in each patient room for storage of clothing and
other possessions.
427.2
Each patient bed shall be provided with a suitable fixed light equipped with a non-
combustible shade to prevent direct glare for reading or other purposes, and capable
of being switched on and off by the patient.
49R. 06/01/2022
427.3
To ensure privacy in multi-patient rooms, each bed shall be provided with fixed
flame retardant cubicle curtain.
427.4
Each patient room shall have an adequate toilet, bathing and hand-washing facility
with hot and cold running water unless provided in an adjacent room.
427.5
Each room has direct access to a corridor and outside exposure, with the floor at or
above grade level.
427.6
Every patient unit shall be provided with a bedside cabinet with at least two
enclosed storage spaces. The top drawer shall be for storage of personal items and
the bottom for individually assigned bedpans, urinals, etc.
427.7
Standard patient rooms shall measure at least one-hundred (100) square feet. Multi-
patient rooms shall provide a minimum of eighty (80) square feet per bed.
427.8
Multi-patient rooms shall be limited to four beds.
428
INTENSIVE CARE ROOM DESIGN
Other than requirements set forth for existing structures, 406, an intensive care room shall be
mechanically vented to the outside and provided with a standard private toilet and hand-washing
facility. The intensive care room may also serve as an isolation room.
429
CORRIDORS
Corridors shall be at least eight (8) feet wide.
430
LAUNDRY
Laundry in new facilities must provide complete separation (by partition) of the soiled laundry
area (including washer) and the clean laundry area. A lavatory with soap and towel dispensers
must be provided for the staff in each area, and a rinsing sink provided in the soiled laundry area.
A linen folding table must be provided in the clean laundry area. If the laundry area is included in
the main nursing home building, it shall be so located as to be as remove as possible from the
patient area.
431
STORAGE
There shall be a minimum of five (5) square feet per bed for general storage space provided in
those cases where built-in closets are provided in patient rooms. It is recommended that this be
concentrated in one general area except for small storage areas within the nursing units for
wheelchairs, patient lifts, walkers, etc.
432
DIETETIC SERVICE AREA (LESS DINING AREAS)
432.1
The kitchen shall be located conveniently to the dining area. (Separation of the
kitchen and dining areas by corridors should be avoided.)
50R. 06/01/2022
432.2
The food service area shall provided adequate space and facilities for receiving food
deliveries, storage, preparation, tray assembly, and distribution serving of food,
dishwashing and utility cleaning, refuse collection and garbage disposal. The total
area less dining area, shall not be less than nine (9) square feet per bed for the first
one-hundred (100) beds and six (6) square feet per bed for all in excess of one-
hundred (100) beds.
432.3
A suitable work area shall be provided for the dietitian or the dietary service
supervisor.
432.4
The kitchen shall not serve as a passage between work or patient areas.
432.5
Adequate heat, light, and ventilation shall be provided.
432.6
Hand washing facility shall be provided in the dietary area with wrist-action blade-
handle controls and gooseneck spout.
433
ADMINISTRATIVE OFFICES
Separate office space shall be provided for administrative and business functions as follows:
• Office for the administrator.
• Office for the director of nursing services.
• Office or space for social and activity director.
434
RESIDENTS' DINING AND RECREATION AREAS
The total area set aside for residents' dining and recreation purposes shall be not less than twenty
(20) square feet per bed. Additional space shall be provided if the facility participates in a day
care program. The areas shall be well lighted and well ventilated.
435
UTILITY ROOMS
435.1
Separate utility room shall be provided for clean items and soiled items for each
nurses' station.
435.2
Utility rooms shall be mechanically ventilated to the outside and adequately lights.
Two or more electrical convenience outlets shall be provided for each utility. Blade-
handle control faucets shall be provided. Gooseneck spouts shall be provided in the
clean utility room.
436
BEDPAN ROOM
There shall be at least one bedpan cleaning room. In addition to the bedpan cleaning equipment,
hand-washing facilities with blade-handle controls shall be provided. There shall be provisions for
equipment sterilization.
437
JANITORS' CLOSETS
51R. 06/01/2022
Janitors' closets shall be provided for each nursing unit, and a separate janitor's closet shall be
provided within the kitchen area. These closets shall be provided with hot and cold running water,
a floor receptor and service sink, and shelves for the storage of janitorial equipment and supplies.
The closets shall be mechanically vented to the outside. Janitor closets in patient areas must be
kept locked.
438
LINEN CLOSETS
Closets for clean linens shall be provided for each nurses' station.
439
SOILED LINEN CLOSETS
Closet for soiled linens shall be provided for each nurses' station. This dirty linen storage shall
be in a separate room and ventilated to the outside.
440
NURSES' CALL SYSTEM
440.1
In general patient areas, each room shall be served by at least one calling station,
and each bed shall be provided with a call button. Two call buttons serving adjacent
beds may be served by one calling station. Calls shall register with the floor staff at
the nurses' station and shall activate a visible signal at the patient's room and audible
signal at the nursing station. In multi-corridor nursing units, additional visible
signals shall be installed at corridor intersections if patient room lights are not
visible from the nurses' station. Nurses' calling systems which provide two-way
voice communication shall be equipped with an indicating light at each calling
station which lights and remains lighted as long as the voice circuit is operating.
440.2
A nurses' call emergency button shall be provided for patients' use at each patients'
toilet, bath and shower room. These call lights should be so designed that they can
only be turned off in the patient area.
440.3
Wireless Nurse Call Systems - Facilities may substitute a wireless nurse call system
for wired call systems or may operate both a wireless and a wired nurse call system
in parallel. Wireless nurse call systems shall at a minimum:
a.
Provide a call button at each patient bed, bath, and toilet and at each
whirlpool and each physical therapy room.
b.
Utilize FCC-approved radio frequencies. Frequencies must not interfere
with or disrupt pacemakers, defibrillators, or other medical equipment.
c.
Receive only signals initiated from the manufacturer’s system.
d.
Provide signal coverage and penetration throughout the entire facility and
all facility grounds.
e.
Provide an audible signal to any nurses' station that provides coverage to
the room from which the signal originates.
52R. 06/01/2022
f.
Provide signaling for all wireless devices utilized by staff to receive the
signal. Signaling shall include either an audible tone or vibration to alert the
person carrying the receiving device, and shall display on the receiving
device the specific location from which the signal originated.
g.
Provide escalation. Escalation means that if a signal is unanswered for a
designated period of time, the signal is repeated and sent to other nurses'
stations or to facility staff that were not designated to receive the original
signal.
441
NURSES' STATION
Nurses' station shall be provided and so designed that they contain a minimum of sixty (60)
square feet per each thirty-five (35) bed patient unit, and are not more than one-hundred-twenty
(120) linear feet from each patient room. The station shall include adequate storage and
preparation area(s), medication, toilet and hand-washing facilities, and sufficient lighting.
442
FIRE ALARM SYSTEM
Each nursing home shall be an electrically supervised, manually operated fire alarm system in
accordance with Section 6-3 NFPA 101, Life Safety Code handbook that applies to their nursing
home.
443
LIMITATIONS
The following limitations shall apply:
443.1
No nursing home shall be connected to any building other than a general hospital,
chronic disease hospital, rehabilitation facility, boarding home, adult day care, or
Home Health Agency. Upon request from the Office of Long Term Care,
supporting documentation must be provided to evidence proper allocation of costs
and compliance with all applicable state and federal laws and regulations.
443.2
A nursing home shall not be located within thirty (30) feet from another non-
conforming structure or the property line of the facility except where prohibited by
local codes.
443.3
Occupancies not under the control of, or not necessary to the administration of
a nursing home are prohibited therein with the exception of the residence of the
owner or manager.
444
CEILINGS, WALLS, AND FLOORS
• Ceilings shall be a minimum of eight (8) feet. (Refer to Section 411 for surfaces.)
• Walls (Refer to Section 411).
• Floors (Refer to Section 411).
445
WATER COOLER
53R. 06/01/2022
An electrically operated water fountain of an approved type shall be provided for each nurses'
station. The water fountain shall be accessible to the physically handicapped. Water fountains must
be recessed not to obstruct the corridor.
446-449 RESERVED
450
FURNISHINGS, EQUIPMENT, AND SUPPLIES
451
FURNISHINGS
451.1
Each patient's bed unit, bath and toilet shall be provided with a standard type,
buzzer/light, nurses' call signal, or, alternatively when a wireless nurse call system
is utilized, a call button designed to operate with the wireless nurse call system.
451.2
Each bed shall be provided with a light with a non-combustible shade to prevent
direct glare for reading or other purposes.
451.3
To ensure privacy in multi-patient rooms, each bed shall be provided with flame
retardant cubicle curtains; in existing facilities, partitions or free-standing folding
screens may be used.
451.4
Each patient shall be provided with a rigid single bed in good repair measuring a
minimum of thirty-six (36) inches in width. Beds shall be provided with three inch
casters and at least two (2) of the four (4) casters shall be of the locking type. (Roll-
away beds, cots, or folding beds are not acceptable.) The beds shall be equipped
with a comfortable pillow and comfortable, firm mattress at least five
(5) inches thick and shall be covered with a moisture repellant material. There shall
be hospital type adjustable beds available for patients receiving bed nursing care.
451.5
Each patient shall be provided with a bedside table with a compartment or drawer
for personal belongings, such as, soap, hairbrushes, combs, toothbrush and
dentifrice, and a lower enclosed compartment for storage of individual bedpan or
urinal (open-shelved stands are not acceptable.).
451.6
A comfortable chair shall be provided for each licensed bed and be available at the
bedside unless contraindicated by the patient's condition.
451.7
Each window shall be provided with a shade or flame retardant curtains.
451.8
Bed rails shall be provided for bed patients and disoriented patients.
451.9
Furniture and play equipment used in the care of children shall be painted with lead
free paint.
451.10
All wastebaskets shall be the metal type.
452
LINENS AND BEDDING
452.1
Extra pillows shall be available as need for treatment and/or comfort of patients.
54R. 06/01/2022
452.2
Moisture proof rubber or plastic sheeting shall be provided as necessary to keep
mattress of pillows clean or dry.
452.3
A supply of clean bed linen shall be available at all times. A minimum of two clean
sheets and one pillowcase shall be provided for each bed on a weekly basis. Linens
shall be changed as often as necessary in order to keep the patients clean,
comfortable, and dry.
452.4
Each bed shall be covered with a suitable bedspread or blanket at least during the
hours of the day when the bed is not occupied.
452.5
The minimum supply of linen based on patient capacity shall be:
Sheets -- four (4) times bed capacity
Draw Sheets -- three (3) times bed capacity
Pillowcases -- three (3) times bed capacity
Bath towels -- two (2) per patient per week
Washcloths -- four (4) per patient per week
Bedspreads or blankets -- two (2) time bed capacity
452.6
Blankets shall be provided to assure the warmth of each patient and shall be
laundered to assure cleanliness and freedom from odors. The blankets shall be
individually assigned to patients and not passed indiscriminately to patients without
first being laundered.
452.7
Where laundry is provided on the facility premises:
452.7.1
An employee shall be designated in charge of the service.
452.7.2
Table linens shall be laundered separately from bed linen and
clothing.
452.7.3
Patients and personal laundry shall not be washed with bed linen.
452.7.4
Equipment and doorways in existing laundries must be so arranged
that soiled linen and clothing can be delivered to the washing
machines without coming near the dryers and clean laundered
material. Hand-washing facilities must be provided for the staff with
soap and towel dispensers nearby.
452.7.5
Soiled linens shall be covered or placed in enclosed containers
before being transported to the laundry.
452.7.6
Soiled linens shall be stored in a vented area designated only for
soiled linens.
452.7.7
Infected linens shall be tagged with a label marked "Infected" prior
to being sent to the soiled linen storage room. In the laundry,
infected linens shall be disinfected by soaking in a chemical solution
before being laundered.
55R. 06/01/2022
453
EQUIPMENT AND SUPPLIES
Nursing equipment and supplies shall be provided to meet the patients' needs and maintained in
good condition to ensure adequate nursing care of the patients.
453.1
In nursing homes licensed as Intermediate Care Facilities, the following
equipment and supplies shall be provided:
• *Individual soap dishes
• *Mouthwash cups
• *Drinking glasses or cups
• *Items for personal care and grooming
• *Denture cups
• *Wash basins
• *Emesis basins
• *Bedpans
• *Bedpan covers
• *Urinals
• Hypodermic syringes and needles
• Insulin syringes and needles
• Forceps and forceps jars
• Rubber and plastic sheeting
• Hot water bottles and ice caps with covers
• Grab bars in all bathtub, shower, and toilet areas
• Catheter trays and cover
• Irrigation stands or rods
• Suction machine for each thirty-five (35) patients or a major fraction
thereof
• Occupational therapy equipment according to patient needs
• Adjustable crutches, canes and walkers for fifteen percent (15%) of
licensed capacity
• One oxygen unit
• Enema equipment
• Rubber rings
• Flashlights
• Examination lights
• Gloves
• Footboards
• Bed rails
• Commode chairs
• Weight scales
• Thermometers
• Bedpan brushes and containers
• Sphygmomanometer
• A bed cover cradle
• Stethoscope
• First Aid equipment and supplies
• Heating pads (waterproof type)
56R. 06/01/2022
• An emergency medical kit
• A stretcher (collapsible stretcher recommended)
• Trapeze frames for five percent (5%) of licensed capacity
• Wheelchairs for ten percent (10%) of licensed capacity
• Dressing cart or tray with sterile supplies
NOTE: * These items shall be assigned to individual patients, kept clean, and maintained
or stored at patient's bedside cabinet.
453.2
In nursing homes licensed as Skilled Nursing Facilities, the following equipment
and supplies shall be provided in addition to the equipment and supplies necessary
for facilities licensed as Intermediate Care Facilities:
• Additional trapeze frames as needed
• Oxygen unit (total of two (2) units required)
• Sterile I.V. equipment
• Tube feeding tray for each thirty-five (35) skilled care patients
or major fraction thereof.
• One patient life for each thirty-five (35) skilled care patients or
major fraction thereof.
• Wheelchairs for fifteen percent (15%) of licensed capacity
• Sphygmomanometer (total of two (2) required)
• Stethoscope (total of two (2) required)
454
CARE AND CLEANING OF MEDICAL SUPPLIES AND EQUIPMENT
454.1
In homes where commercially packaged sterile disposable items, i.e., dressings,
syringes, needles, gloves, catheters, etc., are not provided, a method shall be utilized
to achieve sterility for these required items. Suitable methods for sterilization are:
• Steam autoclave
• Pressure cooker
• Liquid sterilizing solution
• Dry heat sterilizer
454.2
Thermometers shall be disinfected by methods approved by the OLTC. One suitable
method is to clean the thermometer thoroughly with soap and water and place in
solution of iodine one percent (1%) and isopropyl alcohol for at least ten
(10) minutes, and then rinse thoroughly with cold water before use.
454.3
Methods approved by the OLTC shall be used to sanitize bedpans, urinals, and
emesis basins.
455
STORAGE
455.1
If bedpans, urinals, and emesis basins are assigned to individual patients, they shall
be name labeled and stored in the patient's bedside cabinet. They shall be cleansed
after each use and sanitized by an approved method at least weekly. If the utensils
are not individually assigned, they shall be thoroughly cleansed and
57R. 06/01/2022
effectively sanitized between each use and stored in a bedpan room. After the
discharge or transfer of any patient, all such equipment shall be cleansed and boiled
or autoclaved prior to reuse.
455.2
There shall be convenient storage space for all linens, pillows, and other bedding
items.
455.3
There shall be allotted at least five (5) square feet of general storage space per bed.
455.4
Approved storage shall be provided for all materials such as oxygen and flammable
gases. One cylinder of oxygen may be chained onto a cart and maintained at each
nurses' station for emergency use in the treatment of patients. All other such
flammable gases shall be stored outside the building in a sheltered area or in an
oxygen storage room having dual ventilation and at least a one and three-quarter (1
3/4) inch solid core door. Such gases shall be chained or secured in such manner to
support them in an upright position. They shall not be stored in an exit-way.
455.5
Facilities shall be provided for storage and preparation of medications and
treatments and for storage of active and inactive medical records.
455.6
Storage space shall be provided for recreational equipment and supplies.
456-469 RESERVED
470 HOUSEKEEPING/MAINTENANCE
471 HOUSEKEEPING - MAINTENANCE
471. 1 Housekeeping services of the nursing home shall be under the direction of
a full-time experienced person. The facility shall have on duty one (1)
housekeeper per thirty (30) residents in order to maintain the nursing home.
Housekeeping services shall be provided daily, including weekend daytime
coverage and for clean up after the evening meal. Additional staff will be
required if deficiencies are found that relate to personnel shortage.
471. 2 Sufficient housekeeping and maintenance equipment shall be available to
enable the facility to maintain a safe, clean, and orderly interior.
471. 3 If a facility has a contract with an outside resource for housekeeping
services, the facility and/or outside resource shall meet the requirements of
these standards.
471. 4 All rooms and every part of the building (exterior and interior) shall be kept
clean, orderly, and free of offensive odors. Bath and toilet facilities and food
areas shall be clean and sanitary at all times.
471. 5 Rooms shall be cleaned and put in order daily.
58R. 06/01/2022
471. 6 If a patient keeps his own room, he shall be closely supervised to ensure a
clean, orderly room.
471. 7 After discharge of a patient, the room and its contents shall be thoroughly
cleaned, aired, and disinfected if necessary. Clean linens shall be provided.
All patients' utensils shall be washed and sanitized.
471. 8 Polish or wax used on floors shall be of a type that provides a non-slip finish.
Floors shall be maintained in a clean and safe condition.
471. 9 Deodorants shall not be used to cover up odors. Odor control shall be
achieved by prompt cleansing of bedpans, urinals, and commodes, by the
prompt and proper care of patients and soiled linens, and by approved
ventilation.
471. 10 Attics, cellars, beneath stairs, and similar areas shall be kept clean of
accumulation of refuse, old newspapers, and discarded furniture.
471. 11 Storage areas shall be kept in a safe and neat order.
471. 12 Combustibles such as rags and cleaning compounds and fluids shall be kept
in closed metal containers and should be labeled as to contents.
471. 13 Buildings and grounds shall be kept free from refuse and litter.
471. 14 Storage facilities with proper ventilation shall be provided for mattresses.
471. 15 All useless items and materials shall be removed from the institution area
and premises.
471. 16 Matches and other flammable or dangerous items shall be stored in metal
containers with tight-fitting lids and labeled as to contents.
471. 17 Mechanical rooms, boiler rooms, and similar areas shall not be used for
storage purposes.
471. 18 All inside openings to attics and false ceilings shall be kept closed at all
times. The attic area shall be clean at all times.
471. 19 Mop heads shall be of the removable type and shall be laundered or replaced
at frequent intervals to ensure a standard of cleanliness.
471. 20 Straw booms shall not be used for cleaning facility floors.
471. 21 Garbage must be kept in approved containers with tight-fitting covers. The
containers must be thoroughly cleaned before reuse. Garbage or rubbish and
trash shall be disposed of by incineration, burial, sanitary fill, or other
approved methods. Garbage areas shall be kept clean and in a state of good
repair.
59R. 06/01/2022
471. 22 All poisons, bleaches, detergents, and disinfectants shall be kept in a safe
place accessible only to employees. They shall not be kept in storage areas
or containers previously containing food or medicine. Containers must have
a label that states name, ingredients, and antidote.
471. 23 Unnecessary accumulation of possessions, including equipment and
supplies of patients, staff, or the home's owner, shall not be kept in the
home.
471. 24 A minimum of one (1) full-time laundry worker must be provided for each
seventy (70) patients in the facility to ensure that clean linen and clothing is
provided each patient and to ensure that dietary and nursing personnel are
not required to perform laundry duties.
471. 25 Facilities that perform their own pest control, rather than employing
licensed pest control experts or exterminators, and utilize restricted-use
pesticides, shall be licensed by the Arkansas State Plant Board for the use
of the pesticides. To obtain a list of restricted-use pesticides, please contact
the Arkansas State Plant Board.
472-499 RESERVED
60R. 06/01/2022
500
PATIENT CARE SERVICES
501
PHYSICIAN SERVICES
502
ADMISSION ONLY ON RECOMMENDATION OF A PHYSICIAN
Patients shall be admitted to the facility only on recommendation of a physician. At the time of
admission the physician must document level of care needed by the patient. A Certification
Statement by the physician explaining the reason for nursing home placement should be obtained
on the date of admission and a re-certification statement obtained every sixty (60) days.
503
CONTINUED SUPERVISION OF CARE
The health care of every patient shall be under the continuing supervision of a physician, who,
based on a medical evaluation of the patient's immediate and long term needs, prescribes a planned
regimen of total patient care. Patients in need of skilled care should be seen by a physician at least
every sixty (60) days, and all others seen at least every one hundred twenty
(120) days. A notation should be made at each visit and orders for treatment and medication
renewed.
504
PHYSICAL EXAMINATION OF PATIENTS
The medical evaluation of the patient shall be based on a history and physical examination done
within seventy-two (72) hours of admission unless such examination was performed within fifteen
(15) days prior to admission. A history and physical completed during the patient's hospitalization
may have been completed up to thirty (30) days prior to admission to the nursing home; however,
the hospital discharge summary (upon completion) is to be forwarded to the nursing home.
505
PLANNED REGIMEN OF CARE
The planned regimen of total care for each patient shall be based on the attending physician's order
and shall cover medication, treatment, rehabilitative services (where appropriate), diets,
precautions related to activities undertaken by the patient, and plans for continuing care and
discharge.
506
ESTABLISHMENT RESTORATION POTENTIAL
The attending physician shall establish at the time of admission a restoration potential for the
patient. This should be updated as needed but not less than on an annual basis.
507
EMERGENCY PHYSICIAN
The facility should make arrangements for emergency coverage by a physician if the attending
physician or his attendant cannot be located. This should be done by a written agreement signed
by the physician and the facility administrator.
510
NURSING
511
PROFESSIONAL NURSE SUPERVISION
61R. 06/01/2022
511.1
A licensed registered nurse shall be employed full-time as the Director of Nursing
Services and normally work on the day shift. In skilled nursing facilities registered
nurse relief shall be provided for the off days of the Director of Nursing Services.
If the Director of Nursing Services has other institutional responsibilities in addition
to written job description, a licensed registered nurse shall serve as assistant so that
there is the equivalent of a full-time Director of Nursing Services on duty.
511.2
In Intermediate Care Facilities the registered nurse must work forty (40) hours per
week, normally on the day shift. An LPN may serve as relief on the Director of
Nursing Services' days off.
511.3
The Director of Nursing Services shall be responsible for the development and
maintenance of nursing service objectives, standards of nursing practice, nursing
policy and procedures manuals, written job descriptions for each level of nursing
personnel, scheduling of daily rounds to see all patients, methods for coordination
of nursing service with other patient services, for recommending the number and
levels of nursing personnel to be employed to meet the needs of the patients, nursing
staff development, and supervision of nursing documentation.
511.4
The Director of Nursing Services can serve as Director of Nursing Services in only
one facility.
512
CHARGE NURSE
512.1
In Skilled nursing Facilities, the Director of Nursing Services shall designate as
charge nurse for each shift a registered nurse, a licensed practical nurse, or a
licensed psychiatric technician nurse. Responsibilities of the charge nurse shall
include supervision of the total nursing activities in the facility during his/her
assigned tour of duty.
512.2
In Intermediate Care Facilities, the Director of Nursing Services shall designate as
charge nurse for each shift a registered nurse, a licensed practical nurse, or a
licensed psychiatric technician nurse. In facilities admitting or retaining patients
requiring medications or treatments on the night shift, the charge nurse designated
on the night shift must be a licensed nurse.
512.3
The charge nurse's duties shall include as a minimum:
• Responsibility for observation of work performance of aides in
delivery of direct care.
• Administration of medication if there is no assigned medication
nurse.
• Ordering medications from the pharmacy.
• All direct observations of patients to observe and evaluate
physical and emotional status.
62R. 06/01/2022
• Delegate responsibility for the direct care of specific patients to
the nursing staff based on the need of the patients.
• Taking phone orders from physicians or dentists.
• Giving shift report to the next shift.
• Shift count of control drugs.
• Dietary observations.
512.4
The Director of Nursing Services shall not serve as charge nurse in a Skilled
Nursing Facility with an average daily total occupancy of seventy-one (71) or more
patients. Waivered Licensed Practical Nurses shall not serve as charge nurse unless
they have passed the State Pool Examination or Public Health Proficiency
Examination.
513
NURSING STAFF
513.1
All registered nurses, licensed practical nurses, and licensed psychiatric technicians
employed in the nursing home shall be currently licensed in the State of Arkansas
513.2
The licensed nursing staff required shall be computed in accordance with Section
520.
513.3
The nursing aide requirement shall be computed in accordance with Section 520.
513.4
In nursing homes with more than one classification of license, each distinct part
shall be staffed according to the requirements for each classification.
514
PERSONNEL ASSIGNMENTS
514.1
The nursing staff shall be engaged in the direct care and treatment of the patients.
514.2
No aide shall be permitted to combine the duties of housekeeping, laundry, or
kitchen duties with nursing because of the danger of cross infection to the patient.
514.3
In multi-story homes, each floor should be staffed as an individual unit.
515
RESTRICTIONS IN EMPLOYMENT AND/OR ASSIGNMENT
No person who has been a patient in a mental hospital and who has not been completely
discharged by that institution shall be employed in a nursing home in a supervisory capacity.
516
NURSING CARE REQUIREMENTS
516.1
Charting
63R. 06/01/2022
a.
Summary charting should address the resident's problems/needs, interventions to
resolve those needs, and the progress made toward achieving the resident goals as
listed on the care plan.
b.
All disciplines (nursing, dietary, therapies, social, etc.) may document their
progress notes on the same chart to promote continuity of care.
c.
All charting notations made on the nurse’s progress notes or flow sheets shall be
entered by time and date, and shall be signed or initialed.
d.
Minimum requirements for summary charting based on the resident's Level of Care
are as follows:
Skilled Every two (2) weeks
Intermediate I Every two (2) weeks
Intermediate II Monthly
Intermediate III Monthly
e.
The following observations must be charted upon occurrence*:
* If a flow sheet is utilized for documentation of the following, it is only necessary to
document a summarization on the nurse's progress notes based on the time frequencies in
item (d) above.
1.
Accidents/Incidents (charting will be done every shift for at least 48 hours
or until the resident returns to pre-accident status or stable condition, which
ever is longer);
2.
Significant changes in the residents physical, mental, or psychosocial status
(i.e., a deterioration in health, mental, or psychosocial status in either life-
threatening conditions or clinical complications). Charting will be required
on every shift until the resident's condition becomes stable;
3.
Any need to alter treatment significantly (i.e., a need to discontinue an
existing form of treatment. due to adverse consequences, or to commence a
new form of treatment);
4.
Use of physical restraints to include the type applied, time of application,
checks, releases and exercise of resident. (Flow sheet may be used.);
5.
Bedtime snacks for therapeutic diets and physician ordered supplemental
feedings to include the type, amount served and amount consumed. (Flow
sheet may be used.);
6.
Meal consumption for residents at nutritional risk to include percentage of
meal consumed. (Flow sheet may be used.);
64R. 06/01/2022
7.
PRN medications to include name, amount, route of administration, time,
reason given and response. PRN "controlled" drugs must also be charted in
the nurse's notes, which must also contain the condition of the patient before
and after administration.
8.
Foley catheters to include documentation of insertion, reinsertion, removal
and catheter irrigations. The total amount of urinary output must be
documented, at. a minimum, every eight (8) hours. (Flow sheet may be
used.);
9.
Nasogastric or gastrostomy tubes to include documentation of insertion,
reinsertion, removal, placement checks, care of site, type of formula,
amount of formula, rate of feeding, and flushes. Total fluid intake must be
documented, at a minimum, every eight (8) hours to include formula and
flushes. (Flow sheet may be used.);
10.
Problem skin conditions to include date of onset and weekly progress notes.
Documentation must identify the skin problem, stage, size, color, odor and
drainage, if any. The chart shall also document the date and time of
treatments and dressings. (Flow sheet may be used.);
11.
Physician visits to include date of visit;
12.
Any contacts with the physician (date and time) regarding the resident's
condition and the physician's response/instructions;
13.
Resident’s condition on discharge or transfer;
14.
Disposition of personal belongings and medications upon discharge;
15.
Time of death of a resident, the name of person pronouncing death and
disposition of the body.
f.
Vital signs must be charted weekly and weights monthly unless ordered more
frequently. (Flow sheet: may be used.)
516.2
Routine Care and Services
Each patient in the home shall receive the type of nursing care including restorative
nursing as required by his/her condition. Patients shall be encouraged to be active,
to develop techniques for self-help, and be stimulated to develop hobbies and
interests. Criteria for determining adequate and proper care includes:
516.2.1 Kind and considerate care and treatment at all times.
516.2.2 A minimum of a complete bath twice a week for all ambulatory
patients with adequate assistance or supervision as needed. Patients
who are incontinent or are confined to bed shall have a complete
bath daily and partial baths each time the bed or clothing is wet or
soiled. All soiled linen and clothing shall be replaced with clean dry
ones.
65R. 06/01/2022
516.2.3 A minimum of one shampoo every week and assistance with daily
hair grooming. Patients shall not be required to pay for routine hair
grooming provided by facility staff.
516.2.4 Assistance with or supervision of shaving of men patients at least
every other day except when contraindicated or refused by the
patient. Patients shall not be required to pay for routine shaving.
516.2.5 Oral care shall be provided at least twice a day.
516.2.6 Hands and feet shall have proper care and attention. Nails shall be
kept clean and trimmed. Additional lotion shall be applied to hands
and feet when indicated. Precautions shall be taken to prevent foot
drop in bed patients.
516.2.7 Bed linens shall be changed weekly or more often as needed and
adjusted at least daily.
516.2.8 Patients shall have clean and seasonal clothing as needed to present
a neat and clean appearance, to be free of odors, and to be
comfortable.
516.2.9 Measures shall be taken toward the prevention of pressure sores, and
if they exist, treatment shall be given on written medical order. The
position of bed patients shall be changed every two (2) hours during
the day and night.
516.2.10 Each mattress and pillow shall be moisture proof or must have a
moisture proof cover. Rubber or plastic sheets shall be cleaned often
to prevent accumulation of odors. Clean cloth draw sheets shall be
used over the rubber or plastic sheet.
516.2.11 Assistance with the use of commode, bedpan, or toilet, and keeping
the commode, bedpan, and urinal clean and free of odors. Bedpans,
urinals, and wash basins shall be name-labeled, cleaned after each
use, properly stored in the patient's bedside cabinet, and sanitized at
least weekly. Any of these utensils not name-labeled and stored in
individual bedside cabinets must be sterilized after each use.
516.2.12 Each patient shall be up and out of bed for at least a brief period
everyday unless the physician has written an order for him/her to
remain in bed.
516.2.13 Fluids shall be offered at frequent intervals when the patient is
unable to obtain them. Water pitchers shall be refilled at least once
each shift and should be kept in reach of patients. Clean drinking
glasses shall be kept with each water pitcher.
66R. 06/01/2022
516.2.14
Physical findings (temperature, pulse, respiration, and blood
pressure) shall be taken and recorded as ordered by the physician,
but not less than one (1) time a week. All residents with indwelling
catheters should have urine output recorded each shift.
516.2.15 Administration of oxygen.
516.2.16 Documentation that a continuous program of bowel or bladder
training is provided when appropriate.
516.2.17 Proper bed and chair positioning.
516.2.18 Nursing equipment is in sufficient supply, in good condition, is
properly cleaned and cared for, well organized, and readily
available.
516.2.19 Precautions to assure the safety of patients are continuously in
effect. (See, also, Section 309 regarding restraints.)
516.2.20 Bedside nursing care.
516.2.21 Administration of hypodermic medications as prescribed.
516.2.22 Rehabilitation programs such as physical therapy, occupational
therapy, speech therapy, etc., as required by written physician
orders. Such therapies must be administered by qualified persons.
516. 3 Skilled Nursing Facilities:
In addition, the following services will be required in Skilled Nursing Facilities:
• Intravenous feedings
• Complex dressings
• Skilled nursing care
• Tube feedings
There will be no administration of blood in the nursing home unless the nursing
home is physically connected to a hospital. In any nursing home administering
blood, a registered nurse must be on duty throughout the entire administration.
517
TREATMENT AND MEDICATIONS
517.1
No medication or treatment shall be given without the written order of the physician
or dentist. Drugs shall be administered in accordance with orders. Venapuncture by
licensed practical nurses to obtain blood samples for lab work is permitted after the
LPN has been trained by the Director of Nurses or an RN designated by the Director
of Nurses. The Director of Nurses and the LPN trained shall sign a form that states
that the LPN is qualified and has been trained by a Registered Nurse. The facility
shall have policies and procedures for venapuncture that are available for review
by nursing personnel and the Office of Long Term Care.
67R. 06/01/2022
517.2
If it is necessary to take physician's or dentist's orders over the telephone or
verbally, the order shall be immediately written on the physician's order sheet in the
medical record and signed by the nurse who took the order. Documentation shall
include the name of the physician or dentist who gave the telephone or verbal order,
the date, and the time of the order. The order shall be countersigned by the attending
physician or dentist on his next regular visit or no more than seven (7) days from
the time the telephone or verbal order was given. There shall be indication made by
the nurse that the orders were transcribed (signature and time).
517.3
When computerized physician order sheets are utilized, the physician must sign
each sheet at the bottom of the sheet, and date each sheet. If a physician’s signature
is affixed to the sheet other then at the bottom, all orders appearing after the
signature shall be invalid. When progress notes or recertification statements are
written on the computerized order sheet, the name and date affixed by the physician
at the bottom of the sheet will be sufficient. However, if progress notes or
recertification statements appear elsewhere in the medical record, each sheet shall
be signed and dated where they are written.
517.4
Each patient shall be identified prior to administration of medication.
517.5
Each patient shall have an individual medication record.
517.6
The dose of a drug administered to a patient shall be properly recorded by the
person who administered the drug. Recordation shall occur only after the
medication has been administered.
517.7
Medications shall be administered by authorized personnel.
517.8
Treatment of a lesion or open wound shall be done only by licensed nursing
personnel.
517.9
Medication setups will be prepared one pass at a time. The medication must be
administered on the same shift on which they are prepared. Liquids and injectables
shall not be set up more than one (1) hour in advance except where approved unit
dose systems are used.
517.10
Medications shall be administered by the same person who prepared the doses for
administration, except under single unit dose package distribution systems.
517.11
The attending physician shall be notified of an automatic stop order prior to the last
dose so that the physician may decide if the administration of the medication is to
be continued or altered.
517.12
Self-administration of medication is allowed only under the following conditions:
If the physician orders, a patient may keep at the bedside the following non-
prescription medications:
• Topical agents such as Vicks Salve, Mentholatum, etc.
68R. 06/01/2022
• Eye drops such as Murine, Visine, etc.
• Cough drops, such as Ludens, Vicks, etc.
• Sublingual vasodilating agents such as Nitroglycerine tablets, Isordil
Sublingual tablets.
• Metered dose aerosols for asthmatics such as primatene or bronkaid.
Personal items such as toilet articles and cosmetic articles may be kept at the
bedside.
518
REHABILITATIVE NURSING
518.1
Nursing personnel shall be trained in rehabilitative nursing measures. This shall be
documented in the orientation program, and in-service on this subject shall be
conducted at least annually.
518.2
The facility shall have an active program of rehabilitative nursing care which is an
integral part of nursing service and is directed toward assisting each patient to
achieve and maintain an optimal level of self care and independence.
518.3
Rehabilitative nursing services such as proper maintenance of body alignment, bed
and chair positioning, use of foodboards, use of handrolls, range of motion
exercises, elevation of extremities as indicated, assistance with ambulation, and
bowel or bladder training shall be performed daily and recorded routinely for those
patients who require such service.
519
SUPERVISION OF PATIENT NUTRITION
Nursing personnel shall be aware of the nutritional needs, food, and fluid in-take of
patients and assist promptly where necessary in the feeding of patients.
520 DIRECT CARE STAFFING REQUIREMENTS AND FLEXIBILITIES FOR NURSING
FACILITIES
520.1 Definitions
For purposes of this section, the following definitions apply:
a. "Average direct care hours per resident day" means the total number of hours of direct care
services provided by direct care staff in a month, divided by the number of calendar days in
that month, and the facility's average daily resident census for that month.
b. "Certified nursing facility" means a nursing facility licensed by the Department of Human
Services that is certified to participate in the federal Medicare program as a skilled nursing
facility, or in the Arkansas Medicaid Program as a nursing facility, or both.
c. "Direct care services" means nursing and nursing-related services; clinical, diagnostic,
therapeutic, and rehabilitative services; physical, occupational, respiratory, and speech
therapy services; delegated physician tasks; behavioral health services; care management,
69R. 06/01/2022
care coordination, and care transition activities; medication administration; assistance with
activities of daily living; assessment, evaluation, planning, and implementation of care
plans; coordination and consultation with residents' physicians and other healthcare
providers; and other services and supports provided for nursing facility residents in response
to individual resident needs. However, the meaning of "direct care services" does not
include food preparation, laundry, housekeeping, or other maintenance of a nursing facility's
physical environment.
d. "Direct care staff" means a person who provides any direct care services to a nursing facility
resident through interpersonal contact with residents or resident care management, including
without limitation a licensed nurse; nurse aide; medication assistant; physician; physician
assistant; licensed physical or occupational therapist or licensed therapy assistant; registered
respiratory therapist; licensed speech-language pathologist; infection preventionist; and
other healthcare professionals licensed or certified in the state of Arkansas.
e. "Division" means the Division of Provider Services and Quality Assurance.
f. "Federal direct care data system" means the national online data reporting system operated
by the Centers for Medicare and Medicaid Services and used by nursing facilities
participating in the federal Medicare program, or the Arkansas Medicaid Program, or both
to electronically report detailed and standardized direct care and other staffing information.
g. "Licensed nurse" means any registered nurse, licensed practical nurse, advanced practice
registered nurse, or registered nurse practitioner licensed in the state of Arkansas.
h. "Medicare and Medicaid requirements of participation" means the federal requirements
established by the Centers for Medicare and Medicaid Services under 42 U.S.C. 1320a-7j,
42 U.S.C. 1395i-3, and 42 U.S.C. 1396r, that a licensed nursing facility is required to
follow to be certified as compliant with and participate in the federal Medicare program as
a skilled nursing facility, or the Medicaid program as a nursing facility, or both, as existing
on January 1, 2021.
i. "Medication assistant" means a medication assistive person who is qualified and certified
under Arkansas Code § 17-87-701 et. seq. Alternatively referred to as medication assistant-
certified in rules of the Arkansas Board of Nursing.
j. "Private pay-only nursing facility" means a licensed nursing facility that is not certified to
participate in the federal Medicare program as a skilled nursing facility or in the Arkansas
Medicaid Program as a nursing facility.
k. "Universal worker" means a certified nurse aide (CNA) who is designated by a skilled
nursing facility as a universal worker and who performs both CNA direct care service duties
and non-direct care tasks such as food service, laundry, and housekeeping, and other non-
direct care services to meet the needs of residents.
l. "Variance" means granting an alternate requirement or modifying a requirement in place of
a requirement established in rule.
m. "Waiver" means the grant of an exemption from a requirement established in rule.
520.2 Condition of Licensure
70R. 06/01/2022
a. As a condition of licensure by the department, a nursing facility, except a private pay-only
nursing facility, shall be certified to participate in the federal Medicare program as a skilled
nursing facility, or in the Arkansas Medicaid program as a nursing facility, or in both.
b. As a condition of licensure by the department, a private pay-only nursing facility shall (1)
comply with all state requirements applicable to a private pay-only nursing facility,
including rules promulgated by the department, and (2) cooperate with department audits,
inspections, and document requests.
520.3 Consistency with Federal Requirements
a. Under 42 U.S.C. 1395i-3 and 42 U.S.C. 1396r, a certified nursing facility (1) is subject to
federal requirements of participation and (2) must demonstrate substantial compliance with
applicable federal requirements to receive and maintain certification necessary to participate
in Medicaid, Medicare, or both.
b. As required under Arkansas Code § 20-10-1402(d)(2), department rules applicable to
certified nursing facilities (1) apply to conditions and processes of state licensure and (2)
may not exceed or duplicate federal requirements of participation, including staffing and
data reporting requirements, except average direct care hours per resident day requirements
under Arkansas Code § 20-10-1402(a)(2) and (b).
520.4 Average Direct Care Hours Per Resident Day; Certified Nursing Facilities
a. Each certified nursing facility shall:
1. Provide each month direct care services by direct care staff equivalent to at least three
and thirty-six hundredths (3.36) average direct care hours per resident day; and
2. On or before the fifteenth day of each month, a certified nursing facility shall report
electronically to the department the facility's actual average direct care hours per resident
day for the prior month.
b. Certified nursing facilities shall report aggregate direct care hours for the month using the
table provided in the electronic reporting form provided by the department. This table
shall consist of:
1. Rows for each direct care type of position (such as director of nursing, registered
nurse, registered nurse with administrative tasks, certified nurse aide, medication
assistant, medical director, or nurse practitioner) consistent with the same direct care
labor category titles (each with a unique job code number) used in the federal direct
care data system.
2. Two (2) columns for reporting the aggregate number of direct care hours in the month
attributable to each row, as follows:
(a) Column A for reporting all direct care hours reportable quarterly to the federal
direct care data system. Column A must be completed, regardless of the
additional direct care hours the facility may report in Column B. A facility's
direct care hours will be primarily reported under Column A.
71R. 06/01/2022
(b) Column B for reporting hours that (i) meet the definitions of direct care
services and direct care staff in Arkansas Code § 20-10-1401(3) and (4),
respectively; (ii) are not reportable quarterly to the federal direct care data
system; and (iii) are not reported in Column A.
(c) Direct care hours reportable under Column B will not, by themselves, be
sufficient to meet the minimum average direct care hours standard.
c. Within fifteen (15) days of the federal direct care data system reporting deadline for the
quarter, the facility shall electronically file an amended report for one (1) or more of the
three (3) monthly reports attributable to that quarter, if necessary to correct:
1. Direct care hours reported in Column A, based on the number of hours by type of
position (labor category) that the facility reported in its quarterly submission into the
federal direct care data system;
2. Direct care hours reported in Column B; or
3. The MDS-based average daily resident census shown in the original monthly report.
d. The monthly reports shall show the following information:
1. The full name and department-assigned vendor number of the reporting nursing facility.
2. The month and year for which the report is provided and whether the report is an original
or amended report for that month.
3. The completed table described in section 540(b).
4. Grand total of direct care services hours provided in the month, which is the sum of all
hours reported in Column A and Column B of the table described in section 540(b).
5. The number of calendar days in the monthly reporting period.
6. Average daily resident census for the month, which shall equal the facility's Minimum
Data Set (MDS) average daily resident census for the month
7. The average direct care hours per resident day for the month, which is the sum of (a) the
grand total of direct care hours in the month, divided by (b) the number of calendar days
in the month and (c) the MDS-based average daily resident census for the month
8. For the month, the difference between the actual average direct care hours per resident
day and the three and thirty-six hundredths (3.36) average direct care hours per resident
day standard required under Arkansas Code § 20-10-1402(a)(2), with an indication of
whether the actual hours provided met the standard, exceeded the standard, or did not
meet the standard.
72R. 06/01/2022
9. If the report is an amended report, a brief description of the reason for filing an amended
report.
e. The monthly reporting under this section is not intended to require reporting at the level of
detail required by the federal direct care data system or require reporting not otherwise
necessary to meet Arkansas Code § 20-10-1402(b).
f. Consistent with Arkansas Code § 20-10-1402(e), this section does not require or advise any
specific or minimum number of nursing staff hours, direct care staff hours, or hours of other
services for any nursing facility resident. The services an individual resident receives are
based on baseline and comprehensive, person-centered care plans required under 42 CFR §
483.21 and are governed by the services and staffing-related requirements in 42 CFR Part
483 Subpart B.
g. To ensure compliance with the requirements of this subsection, the department may:
1. Audit the monthly reports and request documentation from a certified nursing facility;
2. Review a facility's quarterly submissions to the federal direct care data system;
3. Compare a facility's monthly reports under this subsection with its corresponding
quarterly submissions to the federal direct care data system;
4. Review the results of federal audits of facility submissions to the federal direct care data
system; and
5. Request demonstrations of the vendor payroll and other systems that nursing facilities
commonly use to report direct care hours.
h. To ensure accurate monthly reporting and facilitate efficient auditing by DPSQA, all hours
reported in Column A or Column B for a month must be adequately documented in the
facility's records:
1. A facility must avoid any duplication or double counting of hours reported in
Column A and Column B or under particular types of direct care positions.
(a) For example, a specific hour reported under Column B should not be counted in
Column A or vice versa. However, hours provided by a particular direct care staff
person (such as the director of nursing) may be shown split between the columns,
with some of the hours reportable in Column A and others reportable in Column B.
(b) Similarly, specific hours reported for an initial position type should not be
duplicated in any other labor category title. For example, specific hours reported
under "Registered Nurse Director of Nursing”, or "Registered Nurse with
Administrative Duties" should not also appear in the "Registered Nurse" row.
2. A facility's payroll system and associated reporting capabilities are sufficient to
document direct care hours by employed staff.
73R. 06/01/2022
3. A facility will need to use other methods to adequately document direct care hours
reported under Column A or Column B, provided by contracted staff, consultants,
and other non-employed but licensed or certified health professionals that are
providing direct care services in the facility.
4. Acceptable methods for adequately documenting direct care service hours by non-
employees as reported in Column A or Column B of a monthly report include,
without limitation:
(a) A time tracking system the same or similar to that used by employed direct care
staff;
(b) Signed time sheets; or
(c) Invoices, in the case of contracted or consultant staff paid by the facility, provided
the invoices detail the number of direct care hours provided in the month.
520.5 Average Direct Care Hours Per Resident Day; Private Pay-Only Nursing Facilities
a. Each private pay-only nursing facility shall:
1. Provide each month direct care services by direct care staff equivalent to at least three
and thirty-six hundredths (3.36) average direct care hours per resident day; and
2. On or before the fifteenth day of each month, report electronically to the department the
facility's actual average direct care hours per resident day for the prior month.
b. In determining and reporting direct care hours as required:
1. A private pay-only facility shall follow the same or substantially comparable process
required of certified nursing facilities under sub-section 520.4. The process is the same,
except a private pay-only facility would not formally submit data to the federal direct
care data system.
2. Unless the department approves an alternative, the private pay-only facility shall:
(a) Use the same or substantially comparable payroll and time tracking system
capabilities or software that certified nursing facilities use to support reporting to the
federal direct care data system and preparation of monthly reports under subsection
520.4;
(b) Produce and provide to the department, quarterly direct care staffing reports
consistent with the detailed quarterly reports that certified nursing facilities are
required to submit to the federal direct care data system; and
(c) Report direct care staffing hours to the federal direct care data system when the
Centers for Medicare and Medicaid Services subsequently permits non-certified
licensed nursing facilities to use the system.
3. A process or system is substantially comparable if it records the same data or
information and has the same capabilities or software as the federal reporting system.
74R. 06/01/2022
c. The department may audit these monthly reports and request documentation from the private
pay-only facility to ensure compliance with the requirements of this subsection.
520.6 Certified Medication Assistants
a. Any licensed nursing facility may elect to use certified medication assistants (medication
assistants-certified) to perform the delegated nursing function of medication administration
and related tasks under the supervision of a licensed nurse on the premises and consistent
with the medication assistant rules of the Arkansas Board of Nursing.
b. A person who is both a certified medication assistant and certified nurse aide may perform
both functions in a nursing facility.
520.7 Modern Staffing Practices Supported
a. A licensed nursing facility may:
1. Engage the services of direct care staff and other personnel on a full-time or part-time
basis and through employment, contracting, and staffing agencies, or any combination
thereof;
2. Use fixed schedules, flex-time, rotating shifts, split shifts, compressed workweeks, and
other alternative staffing schedules; and
3. Use the universal worker model and assign other tasks to some or all certified nurse
aides, (such as food service, laundry, and housekeeping) in addition to their direct care
responsibilities:
(a) The universal worker option applies to both traditional and home-style type nursing
facilities.
(b) For certified nurse aides serving as universal workers, the facility must ensure that
direct care and non-direct care hours are properly differentiated for monthly reports
under subsections 520.4 and 520.5 and quarterly reporting to the federal direct care
data system.
b. Without limitation under department rules or need of a waiver or permission from the
department, a licensed nursing facility may engage in any staffing-related practice permitted
under federal requirements of participation.
520.8 Posting of Staffing Information
Each licensed nursing facility shall comply with the information posting requirements of 42
CFR § 483.35.
520.9 Waivers and Variances
a. In the event of a public health emergency, natural disaster, other major emergency, or severe
labor shortage, the department may temporarily waive the average direct care hours per
75R. 06/01/2022
resident day standard in subsections 520.4 and 520.5 for any certified facility in a county
or the state.
b. In the event of a public health emergency, a natural disaster, or other emergency declared
by the Governor or the U.S. Secretary of Health and Human Services, the department may
issue a temporary waiver or variance of any rule (including any staffing-related rule) that it
determines reasonable and necessary under one (1) or more of the following circumstances:
1. For licensed nursing facilities and ICFs-IID to (a) provide resident care; (b) protect the
health and safety of residents, staff, and visitors; (c) meet staffing needs; (d) meet new
federal requirements or guidance; (e) coordinate care delivery and emergency response
with hospitals, physicians, other providers, and public health or emergency management
authorities; or (f) adopt alternative staffing, practices, procedures, or technology; or
2. In response to any federal waiver or requirement modification issued under 42 U.S.C.
1320b–5, 42 CFR Part 483, or other federal authority.
c. A request for a waiver or variance must be made in writing by a licensed nursing facility to
the division director. The request must contain details of the reason for the waiver or
variance and the potential impact to the facility if said waiver or variance is not granted.
d. The department may approve or deny a waiver or variance request at its discretion.
Approvals and denials must be made in writing.
e. The department may extend or renew an approved waiver or variance and may impose such
conditions it deems necessary to (1) protect the health and safety of facility residents and
staff, (2) meet federal requirements or guidance, or (3) best meet the intended purpose of
the waiver or variance.
75
R. 06/01/2022
76
R. 06/01/2022
521 TUBERCULOSIS SURVEILLANCE
Upon admission to the nursing home, physician orders shall be obtained to administer a PPD
(intermediate strength) tuberculosis skin test to the resident and to repeat in ten (10) to fourteen
(14) days if necessary. If this initial test reacts positively, the physician should be notified and a
chest X-ray obtained and read. The record of this X-ray should be placed on the resident's chart. If
it is not possible to obtain a chest X-ray, a sputum sample should be taken and forwarded for
culture. If treatment is indicated, orders are obtained from the attending physician.
If the result of the initial skin test is negative, the skin test should be repeated in ten (10) to fourteen
(14) days. If the result of this test is positive, the physician should be notified and a chest X-ray or
sputum culture obtained. If treatment is indicated as a result of these tests, orders are obtained from
the attending physician.
Once a resident has shown a positive skin test (regardless of whether or not further testing indicated
treatment), he/she must be re-evaluated yearly. Either a chest X-ray or sputum culture should be
obtained. If neither of these is possible, the resident should be evaluated for any visible signs of
the disease such as productive cough or weight loss. Alternatively, if a nurse familiar with the
resident finds no fever, no weight loss and no significant cough, this can be recorded in the medical
record and will suffice for annual surveillance; if any symptoms are present, then a chest film
should be is indicated on medical grounds, and should be noted in the medical record. There should
be evidence in the medical record of this yearly re-evaluation. If, however, the second skin test
after admission is also negative, there need be no further testing of this resident unless an active
case of tuberculosis is identified in the facility.
The medical record of all residents who have shown a positive skin test should be flagged to note
that this resident does need to be re-evaluated yearly and that a sputum culture should be obtained
following any pulmonary infection.
Recordation of tuberculin information shall be maintained in each resident’s medical record and
shall be recorded on forms provided by the Arkansas Department of Health.
530
SPECIALIZED REHABILITATIVE SERVICES
531
SERVICES BASED ON RESIDENT NEEDS
In addition to rehabilitative nursing, the facility shall, as ordered by a physician, provide, according
to the needs of each patient, specialized and supportive services, i.e., physical therapy, speech
pathology, audiology and occupational therapy, either directly, by referral, or through
arrangements with qualified personnel.
532
WRITTEN PLAN OF CARE
77
R. 06/01/2022
If provided, specialized rehabilitative services shall be provided under a written plan of care,
initiated by the attending physician, and developed in consultation with appropriate therapist(s)
and nursing services.
533
REVIEW OF RESIDENT PROGRESS
A report of the patient's progress shall be communicated to the attending physician within two
(2) weeks of the initiation of the specialized rehabilitative services and regularly thereafter.
534
RE-EVALUATION OF PLAN
The plan of specialized rehabilitative care shall be re-evaluated as necessary, but at least every
thirty (30) days by the physician and/or the therapist.
535
DOCUMENTATION OF SERVICES
The physician's orders, the plan of specialized rehabilitative care, services rendered, evaluation of
progress and other pertinent information shall be recorded in the patient's medical record and dated
and signed by the physician ordering the service and the person who provided the service.
540
PHARMACEUTICAL SERVICES
541
RESPONSIBILITY FOR PHARMACY COMPLIANCE
The administrator shall be responsible for full compliance with Federal and State laws governing
procurement, control, and administration of all drugs. Full compliance is expected with the
Comprehensive Drug Abuse Prevention and Control Act of 1970, Public Law 91-513, and all
amendments to this set and all regulations and rulings passed down by the Federal Drug
Enforcement Agency (DEA), Ark. Code Ann. § 5-64-101 et seq. and all amendments to it and
these rules.
542
PHARMACY CONSULTANTS PERMIT
Each nursing home shall have a formal arrangement with a licensed pharmacist to provide
supervision and consultation on methods and procedures for ordering, storing, administering,
disposition, and record keeping of drugs and biologicals.
A consultant pharmacist’s permit shall be obtained yearly from the Arkansas State Board of
Pharmacy and shall be displayed in a conspicuous place in the facility.
The consultant pharmacist shall visit the nursing home at least monthly to perform his consultant
duties.
Before a nursing home consultant’s permit shall be issued, the pharmacist must certify to the Board
of Pharmacy that he has attended a seminar or meeting explaining pharmaceutical duties and
responsibilities in a nursing home as approved by the Board of Pharmacy and that he has
78
R. 06/01/2022
read and understands the rules governing pharmaceutical services in a nursing home and will
abide by them.
The consultant pharmacist shall submit a written report at least monthly to the administrator of the
facility. This monthly report should be a summary of the duties performed by the consultant
pharmacist that month, any error or problems found in the facility, delivery of pharmaceutical
services, and a detailed listing of any discrepancies and/or irregularities noted by the pharmacist
during his drug regimen reviews. The pharmacist, in cooperation with the facility staff, should
develop and implement policies and procedures to govern all aspects of the drug distribution
system. The pharmacist may also agree to abide by and function with those policies and procedures
already being used by the facility at the time of his employment.
543
PRESCRIPTIONS ON INDIVIDUAL BASIS
All drugs prescribed for each patient shall be on an individual prescription basis. Medications
prescribed for one patient shall not be administered to another patient.
544
ADMINISTRATION OF MEDICATION
544.1
No medication shall be given without a written order by a Physician or dentist.
544.2
All medications shall be given by authorized nursing personnel. The administrator
or his appointed assistant shall be responsible for ensuring that authorized nursing
personnel administer all medications ordered by a physician or dentist.
544.3
Caution shall be observed in administrating medication so that the exact dosage of
the prescribed medication is given as is ordered by the doctor or dentist.
544.4
Each resident must have an individual container, bin, compartment, or drawer for
the storage of his medications in the medication room except for stock medication
and approved unit dose systems.
544.5
The PRN medications on current doctor’s orders can be handled in one of four ways
in a facility:
• Use medication from the emergency box.
• Have it as stock medication if it is a non-legend drug.
• Have it on an individual patient basis.
• Have pharmacist maintain a policy and procedure for twenty-four (24)
hour emergency service from pharmacy.
544.6
Nursing personnel cannot transfer more than one dose of medication from container
to container. Loading narcotic counters, preparing take-home supply of
medications, incorporating supplies, etc., by nursing personnel are not permitted.
79
R. 06/01/2022
545
EQUIPMENT FOR ADMINISTERING MEDICATIONS
There shall be calibrated medicine containers to correctly measure liquid medications. Calibrated
medicine containers include calibrated syringes when used to measure odd liquid dosages, such as
4cc, 8cc, etc. Disposable items shall not be reused. Disposable syringes and needles must be
disposed of by breaking and incineration.
546
MEDICINE CARDS
In administering medications, medication cards current with the physician’s orders must be used.
Medicine cards shall be provided to include:
•
Name of patient.
•
Rooms or bed number.
•
Medication and dosage.
•
Hours to be given.
547
STOP ORDER POLICY
Medications not specifically limited as to time or number of doses when ordered by the
physician shall be controlled by the facility’s policy regarding automatic stop orders.
The facility’s automatic stop order policy, at a minimum, shall cover the following categories
of medications:
•
C II Narcotics.
•
C II Non-narcotics.
•
C III, C IV, and C V medications.
•
Anticoagulants.
•
Antibiotics.
548
STORAGE OF DRUGS
548.1
All drugs on the premises of a nursing home, except for the emergency tray, as
defined by the Arkansas State Board of Health and the Arkansas State Board of
Pharmacy, shall be properly labeled containers dispensed upon prescription by the
pharmacy.
548.2
All medications shall be kept in a locked cabinet or locked room at all times. Only
the nurse responsible for administering the medication, Director of Nursing, and
the Administrator shall have a key.
548.3
All controlled drugs shall be stored in a separately locked, permanently affixed
substantially constructed cabinet within a locked drug room or cabinet. When
mobile medication carts for unit-dose or multiple day card systems are used, the
condition for security will be considered met provided that the mobile cart is in a
locked room when unit contains controlled drugs and is not in actual use, and
provided the controlled substances are in a separately locked compartment within
80
R. 06/01/2022
the cart unless the quantity stored is minimal and a missing dose can readily be
detected. A minimal quantity shall be considered to be a quantity of a twenty- four
(24) hour supply or less.
548.4
All drugs for external use shall be kept in a safe place accessible only to employees
and in a special area apart from other medication and prescriptions.
548.5
Medicines requiring cold storage shall be refrigerated. A locked container placed
below food level in a home refrigerator is considered satisfactory storage space.
548.6
Each patient’s prescription medication shall be kept in the original container and
shall be clearly and adequately labeled by the pharmacist. Label shall include:
• Prescription number.
• Patient’s name.
• Name and strength of medicine.
• Physician’s or dentist’s name.
• Date of issue.
• Name of pharmacy.
• Appropriate, accessory and cautionary labels.
• Expiration date of drug where applicable.
• The quantity of tablets or capsules dispensed.
• Directions for administration.
548.7
Labels should be affixed to the immediate container. The immediate container is
that which is in direct contact with the drug at all times.
548.8
O.T.C. medications (medications not requiring a prescription for purchase) that are
the private property of the patient do not have to be labeled by a pharmacist.
However, they must be identified with at least the patient’s name.
548.9
Drug rooms shall be supplied with adequate lighting so that medications can be
safely prepared for administration.
548.10
Drug room shall be properly ventilated so that the temperature requirements set by
the U.S.P. are met: 59 (fifty-nine) degrees to 86 (eighty-six) degrees F.
549
EMERGENCY DRUG BOX
A container which contains emergency stimulants and drugs for life saving measures must be
maintained. This box should be located where it can be readily available to nursing personnel but
kept in a secure place and should have a breakaway lock. There should be a list on the box of the
drugs which are contained in the box. The drugs in the box should be checked periodically with
the list to make sure that these drugs have been replaced after use and are not outdated. Only drugs
which have been approved for this purpose by the Pharmaceutical Services Committee or Medical
Director, as applicable, and/or the physician, can be place in this box. All
81
R. 06/01/2022
controlled substances assigned to the box must be kept with the other controlled substances and
labeled “Emergency Box”. All controlled substances assigned to the “Emergency Box” must be
entered into the bound book. The location of these controlled substances should be noted on the
list of drugs. The drug list should be signed by the physician member of the committee indicating
his approval. The list and contents of the box shall be reviewed annually by the appropriate
committee and/or physician and so noted on the emergency drug list.
550
RECORD OF CONTROLLED DRUGS
A record shall be kept in a bound ledger book with consecutively numbered pages of all controlled
drugs procured and administered. This record shall contain on each separate page:
•
Name, strength, and quantity of drug received.
•
Date received.
•
Patient’s name.
•
Prescribing physician.
•
Name of pharmacy.
•
Date and time of dosage given.
•
Quantity of drug remaining.
•
Signature of person administering the drug.
The person responsible for entering the controlled drug into the bound ledger should be the same
person who signs for it in the drug ordering and receiving record. This record shall be retained by
the facility as a permanent record and be readily available.
551
CONTROLLED DRUG ACCOUNTABILITY
There shall be a count of all C II controlled medications at each change of shift. All C III, IV, and
V controlled medications should be counted at least once daily unless a true unit dose system is
used. This count shall be made by the off-going charge nurse and the on-coming charge nurse. If
licensed personnel are not available on a shift, a non-licensed employee can co-sign as a witness
with the off-going nurse, and co-sign as a witness again with the oncoming nurse. This count shall
be documented. This documentation shall include the date and time of the count, a statement as to
whether or not the count was correct, and if it was incorrect, an explanation of the discrepancy.
This record shall be retained by the facility as a permanent record and be readily retrievable.
When loss, suspected theft, or an error in the administration of controlled drugs occurs, it must be
reported to the Director of Nursing Services and an incident report filled out; also, a copy of the
form for reporting theft or lost controlled substances should be mailed to the Arkansas Department
of Health, Division of Drug Control.
All documentation must be retained in the facility as a permanent record.
When a dose of a controlled drug is dropped or broken, two people should make a statement in the
bound ledger as to what occurred, and both must sign their names. These two people shall be
licensed nursing personnel whenever possible.
82
R. 06/01/2022
552
REVIEW OF MEDICATION BY THE NURSE AND/OR PHARMACIST
There shall be for each patient a separate medication/drug regimen review sheet. This sheet is to
be used to document the performance of a medication/drug regimen review by the pharmacist
and/or registered nurse. This monthly review must be dated and signed by the person making the
review. Any discrepancy, interaction, etc., should be entered on the review sheet.
553
REVIEW OF MEDICATIONS BY CONSULTANT PHARMACISTS
In an Intermediate Care Facility, the review of the medication/drug regimen of the skilled care
patients must be done at least each month, and at least quarterly on the Intermediate and Minimum
care patients. In Skilled Nursing Facilities, the review of medication/drug regimen must be done
monthly on all patients.
In reviewing the medication/drug regimens of the patients, the pharmacist and registered nurse
should, as a minimum, compare the doctor’s orders with the medication administration record, the
medication cards, cardex, actual medications, and prescription labels. Any discrepancies,
interactions, irregularities, contraindications, errors, and incompatibilities will be noted on the
medication/drug regimen review sheet, and if medication/drug review is being performed by the
pharmacist, on the pharmacist’s monthly written report to the administrator. Irregularities observed
by the pharmacist that would warrant immediate action should be brought to the Director of
Nursing Services’ attention immediately upon their finding.
The person delegated the responsibility of correcting or following through on the errors,
irregularities, and discrepancies listed on the pharmacist’s monthly report should document their
actions on their report, date it, and sign it. A photocopy of the report may be used for this purpose,
but both must be retained in the facility. If no irregularities or discrepancies are found during the
medication/drug regimen review, the person performing the review must note on the review sheet
that he has reviewed that drug regimen and found no irregularities. This notation must be dated
and signed.
554
CYCLE-FILL, PHARMACY NOTIFICATION AND DISPOSITION OF UNUSED
DRUGS
Schedule II, III, IV, and V drugs dispensed by prescription for a patient and no longer
needed by the patient must be delivered in person or by registered mail to: Drug Control
Division, Arkansas Department of Health, 4815 West Markham Street, Little Rock,
Arkansas 72201 along with Arkansas Department of Health Form (PHA-DC-1) Report of
Drugs Surrendered for Disposition According to Law. When unused portions of controlled
drugs go with a patient who leaves the facility, the controlled drug record shall be signed
by the person who assumes responsibility for the patient and the person in charge of the
medication in the nursing home. This shall be done only on the written order of the
physician and at the time the patient is discharged, transferred, or visits home.
83
R. 06/01/2022
Except as provided in Ark. Code Ann. § 17-92-1101 et seq. and subsection 554.4, below,
all medications other than Schedule II, III, IV, and V not taken out of the home by the
patient with the physician's consent when he or she is discharged from the home shall be
destroyed. See Section 554.3, below, on handling medication when a resident enters a
hospital or is transferred. All discontinued medications (except controlled drugs) shall be
destroyed on the premises of the facility. Destruction shall be made by the consultant
pharmacist and a nurse with a record made as to the date, quantity, prescription number,
patient's name, and strength of medications destroyed. The destruction should be by means
of incineration, garbage disposal, or flushing down the commode. This record shall be kept
in a bound ledger with consecutively numbered pages. This record shall be retained by the
facility as a permanent record and be readily retrievable.
554.1
Only oral solid medications may be cycle-filled. Provided, however, that if an oral
solid medication meets one of the categories below, then that oral solid medication
may not be cycle-filled.
a. PRN or “as needed” medications.
b. Controlled drugs (CII – CV).
c. Refrigerated medications.
d. Antibiotics.
e. Anti-infectives
554.2
A facility shall notify the pharmacy in writing of any change of condition that
affects the medication status of a resident. For purposes of this section, change of
condition includes death, discharge or transfer of a resident, as well as medical
changes of condition that necessitate a change to the medication prescribed or the
dosage given. The notification shall be made within twenty-four (24) hours of the
change of condition. If the notification would occur after 4:30 p.m. Monday through
Friday, or would occur on a weekend or holiday, the facility shall notify the
pharmacy by no later than 11:00 a.m. the next business day. Documentation for
drugs ordered, changed or discontinued shall be retained by the facility for a period
of no less than fifteen (15) months.
554.3
When a resident is transferred or enters a hospital, a facility shall hold all
medication until the return of the resident, unless otherwise directed by the
authorized prescriber. All continued or re-ordered medications will be placed in
active medication cycles upon the return of the resident. Except as provided in Ark.
Code Ann. § 17-92-1101 et seq. and subsection 554.4, below, if the resident does
not return to the facility, any medications held by the facility shall be placed with
other medications or drugs for destruction or return as permitted by State Board of
Pharmacy rules.
554.4
Pursuant to Ark. Code Ann. § 17-92-1101 et seq., facilities may elect to donate
designated medications to charitable clinics. If a facility elects to donate
medications, facilities shall:
84
R. 06/01/2022
a.
Obtain the written consent of the resident or the person who assumes
responsibility for the resident through the execution of a donor form created
by the Arkansas State Board of Pharmacy that states that the donor is
authorized to donate the drugs and intends to voluntarily donate them to a
charitable clinic pharmacy;
b.
Retains the donor form along with other acquisition records in accordance
with section 604.2 of these rules;
c.
Obliterate from the packaging before the nursing facility sends the drug to
the charitable clinic the donor patient’s name, prescription number, and any
other marks that identify the resident;
d.
Ensure that the drug name, strength, and expiration date remain on the drug
package label;
e.
Enter into a contract, approved by the Arkansas State Board of Pharmacy,
with all charitable clinics to which the facility will donate drugs;
f.
Donate drugs only in their original sealed and tamper-evident packaging or,
if acceptable to the charitable clinic, drugs packaged in single-unit doses or
blister packs with the outside packaging opened if the single-unit dose
packaging remains intact;
g.
Ensure that all drugs physically transferred from the nursing facility to a
charitable clinic pharmacy is performed by a person authorized by the
Arkansas State Board of Pharmacy to pick up the drugs for the charitable
clinic;
h.
Provide all drug recall notices and information received by, or known to,
the facility to all charitable clinics with which the facility has a contract to
donate drugs;
i.
Donate only those medications permitted under Ark. Code Ann. § 17-92-
1101 et seq.; and,
j.
Comply with all applicable rules concerning donation of unused drugs to
charitable clinics promulgated by the Arkansas State Board of Pharmacy.
555
PHARMACY PREPARED MEDICATION CONTAINER SYSTEMS DESIGNED
FOR ADMINISTRATION WITH THE USE OF MEDICATION CARDS (UNIT
DOSE SYSTEM)
All policies and procedures related to systems of this type must first be approved by OLTC
before that system is put into operation.
85
R. 06/01/2022
The medication shall remain in the pharmacy-prepared container up to the point of
administration to the patient.
The medication container must be properly labeled by a licensed pharmacist.
555.1
Freedom of Choice
To ensure that each patient admitted to a long term care facility is allowed freedom
of choice in selecting a provider pharmacy, at the time of admission the patient or
responsible party must specify in writing the pharmacy that they desire to use. The
patient or responsible party must also sign the statement, or form, and the signed
form should be filed with the signed Resident Rights’ statement. The patient must
be allowed to change the provider pharmacy if he desires. If true unit dose system
is used by the facility the patient will not be afforded the freedom of choice of
pharmacy provider.
556-559 RESERVED
560
DIETETIC SERVICES
561
STAFFING
Staff supervisory responsibility for the dietetic services is assigned to a full time, qualified
dietetic service supervisor or Certified Dietary Manager. A qualified supervisor is one who has:
a. Completed an approved food service supervisor’s course; or,
b. Been certified by the Certifying Board for Dietary Managers; or,
c. For only those facilities having more than fifty (50) beds, is enrolled in a food service
supervisor course approved by the Office of Long Term Care. For purposes of these rules,
the term a food service supervisor course approved by the Office of Long Term Care means
a course of education and training in food service or food service supervision provided by
an licensed and accredited educational institution.
Certified Dietary Managers and food service supervisors shall complete fifteen (15) hours per year
of continuing education courses approved by the Office of Long Term Care. For purposes of these
rules, the term continuing education courses approved by the Office of Long Term Care means
continuing education courses offered by the Dietary Managers Association or comparable body,
and approved by the Office of Long Term Care.
562
HYGIENE OF STAFF
All food service employees shall wear appropriate, light-colored clothing including hairnet and
shall keep themselves and their clothing clean.
86
R. 06/01/2022
All persons working as food handlers in nursing homes shall have in their possession or on file in
the home in which they are employed, a current, approved health card.
Persons having symptoms of communicable or infectious diseases or lesions shall not be allowed
to work in the dietetic services. Food service employees shall not be assigned duties outside dietetic
services.
563
MINIMUM DAILY FOOD REQUIREMENTS
All patients shall be served an approved, appetizing, adequate diet that conforms to the
recommended dietary allowances of the Food and Nutrition Board, National Research Council or
with, “Food for Fitness - a Daily Guide” leaflet #424, United States Department of Agriculture.
Facilities are permitted to serve commodity foods provided that the facility is registered as a non-
profit organization and the foods were legally obtained directly from USDA sources. Commodity
foods obtained from an individual may not be used. Commodity foods shall be utilized pursuant
to USDA regulations. Facilities utilizing commodity foods shall maintain documentation, or be
able to provide evidence, that the foods were obtained through proper channels. Failure to meet
this requirement may result in a deficiency finding and a report to federal authorities.
The daily food allowances for each patient shall include, unless contraindicated by the patient’s
physician:
563.1
Milk - two (2) or more eight (8) ounce portions
1.
Milk and milk products shall be obtained from a source approved by the Arkansas
Department of Health. They must be produced and handled in accordance with rules
set forth by the Arkansas Department of Health.
2.
Milk shall be served in the original individual containers or from a dispenser
approved by the Arkansas Department of Health.
3.
Cartoned milk or milk products shall be stored so that the tops are not covered with
ice or water.
4.
Milk and cream shall be kept in tightly covered containers and refrigerated until
served or used.
563.2
Meat - five (5) ounces of protein, i.e., lean meat, fish, poultry, eggs, or cheese.
1.
Count as a serving: two (2) to three (3) ounces of lean cooked meat, poultry, or fish
all without bones; two (2) eggs; two (2) ounces of cheese; one (1) cup cooked dried
beans or peas; four (4) tablespoons of peanut butter.
87
R. 06/01/2022
2.
Dried beans, dried peas, or peanut butter may be served once a week in place of
lean meat if one-half (1/2) pint of milk is served at the same meal. If milk is refused
by the resident, one (1) ounce of meat or meat substitute such as cheese or eggs
shall be served in its place.
3.
Meat shall be obtained from an approved source.
4.
No raw eggs shall be served.
563.3
Fruits and Vegetables - four (4) or more servings.
1.
Count as a serving: one-half (1/2) cup or portion as ordinarily served, such as one
medium apple, banana, pear, peach or potato.
2.
Include a citrus fruit or other fruit or vegetable rich in Vitamin C every day and a
dark green or deep yellow vegetable for Vitamin A at least every other day.
3.
No hermetically sealed low acid or non-acid food which has been processed in a
place other than a commercial food processing establishment shall be used.
563.4
Breads and Cereal four (4) or more servings, whole grain, enriched or restored.
563.5
Other foods to round out meals and snacks and to satisfy individual appetites and
provide additional calories.
564
FREQUENCY OF MEALS
564.1
At least three (3) meals are served daily.
564.2
There shall be at least a five (5) hour span between breakfast and the noon meal
and between noon meal and supper. The meals shall be served at approximately the
same hours each day.
564.3
There shall not be more than fourteen (14) hours between a substantial supper and
breakfast. Supper shall include as a minimum: two (2) ounces of a substantial
protein food, a starch (or substitute) or soup, vegetable or fruit, dessert and
beverage, preferably milk.
564.4
Bedtime snacks of nourishing quality shall be routinely offered to all patients whose
diets do not prohibit the service of this night feeding. Milk, juices, cookies, or
crackers shall be offered.
565
MEAL SERVICE
565.1
All foods shall be served at the proper temperatures and procedures established and
implemented to serve the patient cold foods between (forty-five to fifty-five
88
R. 06/01/2022
(45 - 55) degrees Fahrenheit, and hot foods should register one-hundred forty
(140) degrees Fahrenheit on the steam table and should reach the patient at no less
than one-hundred fifteen (115) degrees Fahrenheit.
565.2
Table service shall be provided for all who can and will eat at the table, including
wheelchair patients.
565.3
An over-bed table shall be provided for bed patients. Patients who are served meals
in their rooms shall be provided with an over-bed table or an over-patient table of
sturdy construction.
565.4
The public, personnel, or patients shall not be permitted to eat or drink in the
kitchen, dishwashing area, or store room.
565.5
Only dietetic services and administrative personnel shall be allowed in the kitchen.
565.6
Only dietetic services personnel shall be allowed to portion out food for patients or
personnel.
565.7
Trays shall not be set up until the meal is ready to be served. Foods shall not be at
the patient’s place in the dining room until the patient is at the table.
565.8
Nursing home residents will not be permitted to work in the dietetic services. If a
patient is to be allowed to scrape trays, there must be a physician’s order.
565.9
All food transported to patient rooms or to dining rooms which are not adjacent to
the kitchen must be covered. If hot and cold carts are not used to deliver trays, carts
must be completely cleaned before the next use.
566
MENUS
566.1
Menus shall be planned and written two (2) weeks in advance and posted at least
one (1) week in advance. Menus for each level shall be written. Arrows, etc., are
not acceptable.
566.2
Weekly menus shall not be repeated more often than a three (3) week cycle.
Identical meals shall not be repeated more often that once every three (3) weeks.
566.3
Changes shall be recorded on both the regular and therapeutic diet menus.
566.4
Menus which have been posted in the kitchen shall not be redated and reused.
566.5
Meals served shall correspond essentially with the posted menus and shall be served
in sequential order as planned and approved by the dietetic services consultant.
89
R. 06/01/2022
566.6
Records of menus as served shall be on file and maintained for thirty (30) days.
566.7
When substitutions are made they should be of the same food groups and of equal
nutritional value.
567
THERAPEUTIC DIETS
567.1
There shall be a system of written communications between dietetic services and
nursing services, i.e., diet order forms. Nursing services should send a written
patient diet list monthly and diet change slips as diets are changed by the physician.
567.2
Therapeutic diets shall be served only to those patients for whom there is a
physician’s or dentist’s written order.
567.3
Diet orders shall be reviewed by the physician every one hundred and twenty
(120) days for intermediate and minimum care patients and every sixty (60) days
for skilled care patients.
567.4
A current manual approved by an affiliate of the American Dietetic Association,
such as the Arkansas Diet Manual, shall be used, and a copy of the approved manual
shall be available at one nurses’ station and in the dietetic services.
567.5
In the event that the calorie controlled menu patterns in use in the facility are other
than those in the approved manual, the calculations and the patterns shall be in the
policy and procedure manual on file in the dietary services and posted in the
kitchen.
567.6
A copy of diets as ordered by the physicians shall be posted in the kitchen and shall
correspond to the diet as ordered on the medical chart and shall be kept current.
Patient diet lists shall include the patient’s name, room number, and diet, and shall
be signed by licensed personnel.
567.7
Therapeutic diets that vary in the time specified for regular meals shall be provided
for the patients as ordered by the physician.
567.8
There shall be a system of patient identification for each tray served which includes
the following information:
1. Resident’s Name.
2. Resident’s Diet.
3. Resident’s Room Number.
4. Resident’s Beverage Preference.
5. Any allergies the resident may have to certain foods.
6. Any major dislikes, for which there should be a substitution provided.
90
R. 06/01/2022
567.9
The hour of sleep feedings for the calorie controlled diets shall be recorded I nurses’
notes as served and should include patient acceptance.
568
PREPARATION AND STORAGE OF FOOD
568.1
An adequately-sized storage room shall be provided with adequate shelving.
Seamless containers with tight-fitting lids, clearly labeled, shall be provided for
bulk storage of dry foods. (It is recommended that these containers be placed on
dollies for easy moving.) The storage room shall be of such construction as to
prevent the invasion of rodents and insects, the seepage of dust or water leakage, or
any other contamination. The room shall be clean, orderly, well ventilated and
without condensation of moisture on the walls. Food in any form shall not be stored
on the floor. If the bottom shelf is open it shall be of sufficient height to clean
underneath.
568.2
All food prepared in the nursing home shall be clean, wholesome, free from
spoilage and so prepared as to be safe for human consumption. All food stored in
the refrigerators shall be stored in covered containers. Leftover foods shall be
labeled and dated with the date of preparation. Foods stored in freezers shall be
wrapped in air tight packages, labeled and dated.
568.3
Fresh fruits and vegetables shall be thoroughly washed in clean, safe water before
use. Vegetables subject to dehydration during storage shall be wrapped or bagged
in plastic.
568.4
All readily perishable foods, including eggs or fluids, shall be stored at or below
forty-five (45) degrees Fahrenheit. A reliable and visible thermometer shall be kept
in the refrigerator.
568.5
All frozen foods shall be stored at zero (0) degrees Fahrenheit or lower. A reliable
and visible thermometer shall be kept in the freezer. Frozen foods which have been
thawed shall not be refrozen.
568.6
Potentially hazardous frozen foods shall be thawed at refrigerator temperatures of
forty-five (45) degrees Fahrenheit or below.
568.7
Eggs shall be stored below all other foods. Fresh whole eggs shall not be cracked
more than two (2) hours before use.
568.8
All toxic compounds shall be used with extreme caution and shall be stored in an
area separate from food preparation, storage and service areas.
568.9
Work areas and equipment shall be adequate for the efficient preparation and
service of foods.
91
R. 06/01/2022
568.10
Supplies of perishable foods for a one (1) day period and of nonperishable foods
for a three (3) day period shall be on the premises at all times to meet the
requirements of the planned menus. If the facility consistently does not have the
required one (1) day perishable and three (3) day nonperishable foods, the OLTC
will require that the facility alter its food delivery schedule to meet rules.
568.11
Food served in any nursing home must have been prepared on the premises or in
an establishment approved by, and meeting regulatory standards of, the Arkansas
Department of Health.
568.12
The use of tobacco in any form is prohibited where food or drink is prepared,
stored, cooked, or where dishes or pots and pans are washed or stored.
568.13
Foods shall be cut, chopped, ground, or pureed to meet the individual needs of the
patient.
568.14
If a patient refuses foods served, substitutes of similar nutritive value shall be
offered.
569
SANITARY CONDITIONS
569.1
Food shall be procured from sources approved or considered satisfactory by
Federal, State and Local authorities.
569.2
Floors shall be cleaned after each meal.
569.3
Dishes, silverware, and glasses shall be free of breaks, tarnish, stain, cracks and
chips. There shall be an ample supply to serve all patients. Patients will be
furnished knives, forks, and spoons unless there is documentation to indicate the
patient is incapable of using these implements.
569.4
Vessels used in preparing, serving or storing food shall be made of seamless metal
or a nonabsorbent material which can be easily cleaned and shall be used for no
other purpose. Enamelware shall not be used.
569.5
Rags from patient bedding or clothing or bath shall not be used in dietetic services
for any purpose.
569.6
Dishes, knives, forks, spoons, and other utensils used in the preparation and
serving of foods must be stored in such a manner as to be protected from rodents,
flies or other insects, dust, dirt, or other contamination. Silverware shall be stored
in a clean container that can be thoroughly washed and sanitized.
569.7
Paper or loose covering shall not be used on shelves, cabinets, cabinet drawers,
refrigerators or stoves. Storage cabinets shall be kept clean. Cardboard boxes
92
R. 06/01/2022
shall not be saved and used for the storage of food or articles which were not
packed in that original box.
569.8
Dishes, trays, silverware, glasses and food preparation dishes shall be cleaned,
washed, and sanitized by only the following methods:
569.8.1
Manual Dishwashing
Facilities may wash and sanitize such items in a three- compartment
sink. Items shall be first thoroughly cleaned and washed in warm
water, one-hundred to one-hundred-twenty (100 to 120) degrees
Fahrenheit, containing an adequate amount of an effective soap or
detergent to remove grease and solids. The wash water shall be
changed often enough to keep it reasonably clean. Next, they shall
be rinsed in clean water which is heated to a temperature of at least
one-hundred-and-forty (140) degrees Fahrenheit. Next, they shall be
completely submerged for at least two (2) minutes in clean hot water
at a temperature of at least one- hundred-and-eighty (180) degrees
Fahrenheit. A visible and reliable thermometer shall be conveniently
available for testing the water temperature. Pots or pans which are
used for preparing food which will be cooked need not be sanitized.
All other utensils used in the preparing or serving of food shall be
sanitized prior to use.
Dishes, trays, and glasses shall be allowed to air dry before storage;
drying cloths shall not be used.
569.8.2
Mechanical Dishwashing Machine
Facilities may wash and sanitize such items in a mechanical spray
type dishwashing machine as approved by the OLTC.
569.9
All kitchen garbage, cans, trash and other waste materials shall be stored in water-
tight containers provided with close-fitting lids. The kitchen garbage container shall
be emptied and thoroughly washed after each meal and treated with a disinfectant
if necessary.
569.10
All equipment and utensils shall be so constructed as to be cleaned easily and shall
be kept clean at all times.
569.11
All mops, brushes, dustpans, and other housecleaning equipment shall be stored in
a janitor’s closet when not in use.
569.12
Meat and other foods shall not be placed in direct contact with ice.
93
R. 06/01/2022
569.13
Only ice of assured bacterial safety shall be permitted for use in drinks, or for the
cooling of drinks by direct contact. A scoop shall be used for handling ice. Ice used
to chill bottled drinks or salads, or in any food preparation, shall not be used for
drinking purposes. Portable ice chests which can be sanitized shall be cleaned daily,
and the ice machine shall be cleaned at least weekly.
569.14
Hand-washing facilities shall be equipped with blade-action controls and hot and
cold water. Soap and towel dispensers and a step-on trash can shall be located
conveniently to the lavatory. The kitchen lavatory shall be equipped with a goose-
necked spout.
569.15
If table covers are used in the dining room they shall be of a fabric which can be
laundered. They shall be kept clean and changed at least daily.
570
DIETETIC SERVICES STAFFING
570.1
Staffing shall be correlated to the size of the facility and the total patient meals
served.
Facilities with fifty-nine (59) beds or less shall be staffed at ten (10) minutes for
each meal served.
Facilities with sixty (60) to eighty (80) beds shall be staffed at eight and one-half
(8.5) minutes for each meal served.
Facilities with eighty-one (81) to one-hundred twenty (120) beds shall be staffed at
six (6) minutes for each meal served.
Facilities with one-hundred twenty-one (121) beds or more shall be staffed at five
and one-half (5.5) minutes for each meal served.
570.2
Method for determining dietary staffing:
Number (#) for minutes per meal times (x) three (3) equals (=) number of minutes
per day, number of minutes per day times (x) number of patients divided by (/) 60
equals (=) number of hours required per day.
570.3
Food Service Supervisors or Certified Dietary Managers in homes of fifty (50) beds
or less may be assigned to duties in the department, such as cooking, for no more
than fifty percent (50%) of their total work hours, but must be allowed adequate
time for supervisory tasks. In homes of more than fifty (50) beds the Food Service
Supervisor, Certified Dietary Manager, or an individual enrolled in a food service
supervisor course approved by the Office of Long Term Care may be assigned to
duties such as cooking no more than twenty-five percent (25%) of their total work
hours, but must be allowed adequate time from these assignments for supervisory
tasks.
570.4
The number of employees will be rounded off to the nearest whole number.
94
R. 06/01/2022
570.5
If deficiencies are found that directly relate to shortage of personnel, additional
personnel will be required.
571-579 RESERVED
580
SOCIAL WORK SERVICES AND ACTIVITIES PROGRAMMING
581
POLICIES AND PROCEDURES
581.1
Separate policies must be written for social services and activity programs.
581.2
They shall be individualized for the individual long-term care facility.
581.3
They shall reflect the actual programs in operation at that facility.
581.4
They shall provide for the social and emotional needs of the residents and provide
activities that encourage restoration and normal activity.
581.5
The policy manual shall include a statement of the range of social services provided.
When all needed services are not provided directly, the manual shall state how
needed services shall be arranged.
581.6
Procedures shall clearly outline the steps for identification of social and emotional
needs and the mechanism for meeting these needs.
581.7
Procedures shall reflect, concerning resident social service records:
• Type of information to be obtained.
• Confidentiality of data and protection.
• Availability of data: who, when, how, and why.
• Transmittal of data on referral.
582
JOB DESCRIPTION
Separate for social services designee/worker.
Include actual functions of position.
Include other duties that may be assigned to designee/worker.
583
SOCIAL SERVICES RECORDS
583.1
Social History/Assessment
Should give clear picture of individual over life span to date. Incomplete information
should specify reason for such. Reflects current functioning level, limitations, strengths,
and weaknesses.
95
R. 06/01/2022
583.2
Progress Notes
Important happenings shall be entered promptly into social services’ progress record. At
least a quarterly update shall be done.
583.3
Referral Form
Pertains to referrals for social/emotional needs rather than medical. May be a separate
form or reflected in progress notes.
583.4
Resident Rights
1.
Appropriately signed:
• Resident capable of understanding: signs with one witness.
• Resident incompetent: legal documentation of such; guardian and one
witness sign patient’s rights.
• Resident incapable because of illness: Doctor must write statement saying
why resident cannot understand; responsible party and two witnesses sign.
• Resident mentally retarded: Rights read and if he/she understands, resident
signs along with staff member and outside disinterested party. If he/she
cannot understand, rights explained to and signed by guardian and witness.
2.
Copies posted around the facility.
3.
Staff members who administer rights must understand them fully.
4.
Facility staff must understand patients’ rights and respect them.
584
STAFFING AND CONSULTATION FOR SOCIAL SERVICES/ACTIVITIES
584.1
The social services designee shall comply with the qualification requirements as
set forth in Federal Regulations.
584.2
There shall be one (1) full-time social services designee/activities director for the
first one-hundred five (105) patients and one (1) additional worker for every fifty
(50) patients thereafter.
584.3
The social service designee shall:
96
R. 06/01/2022
• Have an office or space and privacy in which he/she can talk with
residents and/or family.
• Be aware of policies and procedures for social services and the other
relevant policies of the long term care facility.
• Be knowledgeable of community and government resources.
• Be familiar with the residents and their needs, limitations, and strengths.
• Possess the skills to deal with families and their needs as they relate to the
resident and the long term care facility.
• Be able to identify problems and needs and plan accordingly.
585
PROGRAM OPERATIONS
585.1
There shall be adequate staff to provide activity/recreational programs daily,
including Saturdays and Sundays. There should be at least two (2) group activities
scheduled daily.
585.2
Activities shall be varied in nature and shall be designed to meet the needs, interests,
limitations of residents. This is to include all residents: bedfast, ambulatory, and
disabled. These activities should provide for the mental, physical, social, and
spiritual stimulation of the residents.
585.3
Residents and patients will be informed of events and given opportunities to
participate. A calendar of events shall be posted in obvious places throughout the
facility. The calendar should reflect the actual activity program.
585.4
The utilization of community volunteers is encouraged, but they must work under
the direction of the facility’s activity director.
585.5
The activity director shall be aware of the limitations, strengths, and weaknesses of
residents.
585.6
Plans for activity involvement both on individual and group basis shall be
developed for all residents.
585.7
Activity supplies as a minimum:
A.
Television
B.
Dominoes
C.
Checkers
D.
Outside furniture (50% of ambulatory patients)
97
R. 06/01/2022
E.
Two daily newspapers (one local and one having state-wide
circulation) for each thirty-five (35) patients and current copies of
four (4) popular magazines.
586
PET THERAPY
586.1
Animals will be allowed to be brought into the nursing home for a short period of
time on a limited basis for therapy sessions.
586.2
These therapy sessions must be supervised at all times to see that the patients are
not in danger at any time during the session.
586.3
Animals brought into the facility for these sessions should be animals that will
present no danger to the patients.
586.4
These sessions shall be sponsored by organizations, groups, or family members that
are familiar with the actions and habits of the animals being used in the therapy
session.
586.5
Animals used in therapy sessions shall be properly vaccinated, and records of the
vaccinations maintained by the facility.
586.6
Pets must be maintained outside the building, and the area in which they are kept
must be clean and sprayed on a regular basis to prevent rodents and insects.
587-599 RESERVED
98
R. 06/01/2022
600
RESIDENT RECORDS
601
RESIDENT RECORD MAINTENANCE
The facility will maintain an individual record on all residents admitted in accordance with
accepted professional standards and practices. The resident record service must have sufficient
staff, facilities, and equipment to provide records that are completely and accurately documented,
readily accessible, and systematically organized.
602
CONTENTS OF RECORDS (TO FACILITATE RETRIEVING AND
COMPILING INFORMATION)
The resident records will contain sufficient information to identify the resident, his/her
diagnosis(es) and treatment, and to document the results accurately.
602.1
Admission and Discharge Record
• Record number
• Date and time of Admission
• Name
• Last known address
• Age
• Date of Birth
• Sex
• Marital status
• Name, address, and telephone numbers of attending physician and dentist.
• Name, address, and telephone number of next of kin.
• Date and time of discharge or death.
• Admitting and final diagnosis.
602.2
History and Physical Examination Prior to Admission
• Medical history
• Physical findings which includes a complete review of systems and
diagnosis(es)
• Date and signature of physician
602.3
Physician Orders
• Date
• Orders for medication, treatment, care, diet, restraints, extend of activity,
therapeutic home visits, discharge, or transfer.
• Telephone or verbal orders may be taken and written by licensed
personnel and countersigned by the physician given the order within seven
99
R. 06/01/2022
(7) days. Telephone or verbal orders for restraints must be signed by the
physician giving the order within five (5) days.
602.4
Physician Progress Notes
• Written at the time of each visit.
• Dated.
• Signature of the physician.
• Written at least every sixty (60) days on skilled care patients and every
one-hundred twenty (120) days on others.
602.5
Nursing Notes
• Each entry will be dated and signed by the person making such entry.
• PRN medications will be documented as to the time given, amount given,
reason given, results, and signature of person giving the medication.
• Vital signs shall be taken and recorded on all patients as ordered by the
attending physician, not less than weekly.
• Date and time of all treatments and dressings.
• Date and time of physician visits.
• Complete record of all restraints, including time of application and release,
type of restraint, and reason for applying.
• Record all incidents and accidents, and follow-up involving the resident.
• The amount and type of bedtime nourishment taken by residents on calorie
controlled diets.
• Condition on discharge or transfer.
• Disposition of personal belongings and medications upon discharge.
• Time of death and the name of person pronouncing the death of the
resident and disposition of the body.
• Heights and weights of the residents will be obtained at the time of
admission to the facility. Weights will then be recorded at least monthly.
602.6
Discharge Summaries Should Include:
• Signature of the physician
• Admitting and final diagnosis.
• Course of resident’s treatment and condition while in the nursing home.
• Cause of death if applicable.
• Disposition of resident, i.e., transfer to hospital, nursing home, mortuary,
or home.
603
INDEX
There will be an index of all residents admitted to the facility including:
100
R. 06/01/2022
•
Name of resident.
•
Record number.
•
Former Address.
•
Name of physician.
•
Date of birth.
•
Date of discharge.
604
RETENTION AND PRESERVATION OF RECORDS
604.1
Retention Requirements for Active Clinical Records
a.
The maintenance schedule for records on resident charts are as follows:
1.
Admission and Discharge Records Permanent
2.
Miscellaneous Admission Records Permanent
-
Admission Nurse's Notes
-
Admission Height and Weight
-
Advance Directives
-
Informed Restraint Consent
-
Patient Rights
-
Authorization for Treatment
3.
History and Physical Most recent
4.
Rehabilitation Potential Evaluation Most recent
5.
Physician's orders Six months
6.
Physician's Progress Notes Six months
7.
Resident Body Weight Six months
8.
Transfer Forms 12 months
or
Most recent
if older than
12 months
9.
Laboratory and X-Ray Reports Six months
or
12 months if
ordered less
often than
monthly
101
R. 06/01/2022
10.
Nurse's Notes/Nursing Flow Sheets Three months
(ADL, Restraints, Clinitest: Results,
Intake and Output, etc.)
11.
Medication and Treatment Records Three months
12.
Personal Effects Inventory Most recent
13.
Hospital Discharge Summary Current 12
(Including History and Physical) months
14.
TB Surveillance Record Permanent
15.
Classification Status Current
16.
Consultant Reports Initial and
-
Physicians Most recent
-
Occupational Therapist
-
Speech Therapist
-
Physical Therapist
-
Social Worker
-
Psychologist
-
Others
b.
The maintenance schedule for active records in the nurse's station (other than
those required to be maintained on the chart) are as follows:
1.
Assessments and Re-assessments Most recent 12
months
2.
Plan of Care 12 months
Summary of Quarterly Progress Notes
Change of Condition
3.
Pharmacy Reviews Six months
4.
PASSAR Level I Permanent
5.
PASSAR Level II Most recent
c.
Those portions of the active records not kept on the chart or at the nurse's station
must be maintained in the facility and retrievable within 15 minutes upon request.
604.2
Requirements for Retention and Preservation of Inactive/Closed Records
102
R. 06/01/2022
a.
Resident records will be retained in the facility for a minimum of five years
following discharge or death of the resident.
b.
Resident records for minors will be kept for at least three years after they reach
legal age of 18 years old.
c.
The resident records will be kept on the premises at all times and will only be
removed by subpoena.
d.
In the case of change of ownership, the resident records will remain with the
facility.
e.
In case of closure, the records will be stored within the State of Arkansas for the
retention period.
f.
After the retention period is met, the records may be destroyed either by burning
or shredding.
g.
Records will be protected against loss, destruction or unauthorized use.
605
CONFIDENTIALITY
The information contained in the resident records is confidential and is not to be released without
legal authorization or subpoena.
The records will be available to State Survey Agency personnel.
606
STAFFING
An individual will be designated as responsible for the resident record service.
There will be written job descriptions for the resident record service personnel.
607
GENERAL INFORMATION
All entries in the resident records will be recorded in ink. There will be no alteration of
information in the resident records. If an error is made, a single line will be drawn through the
error, the word “error” written above and initialed.
608-699 RESERVED
103
R. 06/01/2022
700 GREEN HOUSE™ FACILITIES
701 INTENT
Green House™ facilities are an attempt to enhance residents’ quality of life through the
use of a non-institutional facility model resulting in a residential-style physical plant and
specific principles of staff interaction. The Greenhouse model utilizes small, free- standing,
self-contained homes surrounding or adjacent to a central administration unit, each housing
between ten (10) and twelve (12) private rooms, each with full bathrooms. The residents’
rooms are constructed around a central, communal, family-style open space that includes a
hearth, dining area, and residential-style kitchen. All residents’ room entrances are visible
from the central communal area. Each home is built to blend architecturally with
neighboring homes. The intent of these rules is to create a framework that encourages the
construction and operation of Green House™ facilities.
702 DESIGNATION
To be designated by the Office of Long Term Care as a Green House™ facility, the facility
meet the minimum standards, and have approval to use the Green House™ service mark,
issued by the Green House™ Project and NCB Capital Impact at the time of designation
and at all times thereafter.
703 STAFFING
Facilities designated by the Office of Long Term Care as Green House™ facilities shall
employ the same staffing ratios and otherwise comply with Section 520 of these rules ;
provided, however, that CNAs utilized in Green House™ facilities may act as universal
workers. For purposes of thisrule , universal worker means a Certified Nurse Assistant
(CNA) who, in addition to performing CNA duties, performs dietary, laundry,
housekeeping and other services to meet the needs of residents.
104
R. 06/01/2022
800
HOMESTYLE FACILITIES
801
PILOT PROJECT
The construction and operation of HomeStyle facilities is a pilot project of the State of Arkansas
to determine the efficacy of an alternative long-term care model.
Facilities participating in the project will be required to maintain detailed medical and social
records of residents. The records will contain an initial assessment of the medical and social
conditions and needs of residents at the time of admission which will form a baseline measure.
The baseline will be compared by the Office of Long Term Care or its designees with subsequent
records maintained by the facility to determine the level of functioning, social interaction, and
medical conditions of residents to determine whether HomeStyle facilities result in improvements
in those areas, including but not limited to the type and dosage amounts and frequency of
medications. Further, facilities will be required to maintain detailed financial records.
To ensure accurate and reliable findings, the number of HomeStyle beds shall be limited to no
more than one thousand (1000) in the state at any time. In the event that applications for the pilot
program exceed one thousand (1000), the Office of Long Term Care shall have sole discretion in
determining projects that shall be designated as HomeStyle facilities. Factors to be considered shall
include, but not be limited to, the projected opening date of the project, the location of the project
(in an attempt to locate projects in geographically and demographically diverse areas), whether the
applicant has secured a Permit of Approval, whether the proposed project would meet criteria for
approval by a nationally recognized organization that licenses, certifies, or permits the use of
service marks for HomeStyle-type facilities, and related factors.
To qualify for the project, a facility must return to the Health Services Permit Agency currently
unoccupied facility beds in an amount equal to twenty percent (20%) of the total number of beds
that will be utilized in the HomeStyle facility. The unused beds may originate from any location
in the State of Arkansas. An exception will be provided when the owner of the proposed HomeStyle
facility has no ownership interest, either directly or indirectly, in more than one other nursing
facility.
802
DEFINITIONS
a.
Clinical support team means non-universal workers of the entire facility that provide services
to HomeStyle homes and any traditional nursing facility around which a HomeStyle home is
constructed by providing support to self-directed or self-managed work teams through the
development of goals and defining of roles, as well as providing services to residents. The
clinical support team includes but is not limited to the Administrator, Director of Nursing,
Assistant Director of Nursing, and MDS nurse.
b.
HomeStyle or HomeStyle facilities means small, free-standing, self-contained homes that:
105
R. 06/01/2022
1.
Surround or are adjacent to a central administration unit, which may or may not be a
traditional nursing facility;
2.
Provide up to twelve (12) private residents’ rooms that are shared only at the request of a
resident to accommodate a spouse, partner, family member, or friend. Additionally, a
spouse that does not meet medical criteria for nursing facility placement may reside in the
room assigned to a spouse who is admitted to the facility and who meets medical criteria
for admission. The facility may charge the spouse who does not meet medical criteria for
room and board, as well as other services so long as the facility meets all requirements for
cost reporting;
3.
Has a full, accessible private bathroom for each resident room that contains at a minimum
a toilet, sink, and shower;
4.
Has the appearance of a residential dwelling for both the exterior and the interior;
5.
Has residents’ rooms constructed around a central, communal, family-style open space that
includes a hearth, dining area, and residential-style kitchen. The central communal area
shall contain a living area where residents and staff may socialize, dine, and prepare food
together that, at a minimum, provides a living room seating area, a dining area large enough
for a single table serving all residents in the home plus two staff members, and an open full
kitchen. The communal area may include a gas fireplace with a fixed, “stay- cool” glass
screen;
6.
Contains residential style design approach, scale, details, and materials throughout the
home that are similar to the typical residential designs and finishes in the immediate
surrounding community and does not contain or utilize commercial and institutional
elements and products such as nurse station, medication carts, hospital or office type
florescent lighting, acoustical tile ceilings, institutional style railings and corner guards,
room numbering, labeling and signage that would not normally be found in a home setting.
Where rules require specific institutional elements, every effort shall be made to provide
the institutional elements in a manner consistent with what might be found in a new home
in the community (e.g., residential wall sconces used for required nurse call lights);
7.
Has outdoor space that:
A.
Allows residents to ambulate, with or without assistive devices such as wheelchairs or
walkers;
B.
Signals staff wirelessly when someone enters the outdoor space from the HomeStyle
home;
C.
Is partially covered to protect from sun and elements under the covered area;
D.
Provides for outdoor activities;
8.
Utilizes a wireless alert system or call system meeting the requirements in Section 440.3.
The system shall also include, for residents who have been care planned to be at risk for
wandering or elopement, location bracelets that permit residents to signal for assistance
and permits staff to locate residents. Wired call or alert systems and overhead paging are
not permitted;
9.
Utilizes a wireless communication and notification system for staff. The system shall
provide a means for notification of staff both in the home and in other homes or other areas
of the facility by other staff;
106
R. 06/01/2022
10.
Contains ample natural light in each habitable space provided through exterior windows
and other means, with window areas, exclusive of skylights and clearstories, being a
minimum of 10 percent (10%) of the area of the room;
11.
Has built-in safety features (e.g., magnetic locks on cabinets with chemicals or knives) to
allow all areas of the house, including the kitchen and any staff office, to be accessible to
the residents during the majority of the day and night;
12.
Provides self-directed care for residents through the establishment of self-managed or self-
directed work teams consisting of certified nursing assistants;
13.
Prepares and cooks at least 80% of resident meals in the HomeStyle home. Nothing in this
rule prohibits the consumption of foods:
A.
Prepared outside the HomeStyle home by family, acquaintances or social
organizations such as churches;
B.
Grown in or on the grounds of the HomeStyle home by residents or staff; or,
C.
Prepared by local retail eating establishments that are licensed or inspected by the
Arkansas Department of Health;
14.
Trains all staff involved in the operation of the project in the philosophy, operations, and
skills required to implement and maintain self-directed care, self-directed or self- managed
work teams, a non-institutional approach to life and care in long-term care, appropriate
safety and emergency skills, and other elements required for successful operations and
outcomes of the project;
15.
Is designed to be fully independent and disabled accessible;
16.
Has overhead lift tracks that run from the bed into the bathroom in each resident room;
17.
Has at least one lift motor for each HomeStyle home;
18.
Has separate slings for each resident in the facility who requires a lift;
19.
Is not connected to, or shares, any area that would not typically be connected or shared
between private homes in the surrounding community (such as a driveway); and,
20.
Has all residents’ room entrances visible from the central communal area.
c.
Home or homes means each discrete HomeStyle unit housing up to twelve (12) private
residents’ rooms.
d.
Person-directed care means a holistic model that takes into consideration each resident’s
physical, mental, and social needs in the development of a care and treatment plan and the
delivery of services that is driven to the greatest extent possible by resident choice, as opposed
to an institutional medical model that is schedule and task driven.
e.
Self-directed or Self-managed work team means the universal workers assigned to a specific
HomeStyle home and who determine, plan and manage day-to-day activities in the house with
little or no direct supervision.
f.
Food safety means a method of ensuring safe preparation and delivery of food for and to
residents.
g.
Family-style dining means residential-style dining, in which all food is placed in serving bowls,
platters and similar residential serving dishes on the table, residents and staff dine together,
and residents are encouraged to serve themselves or serve themselves with help from staff.
h.
Universal or Flexible Worker – A certified nursing assistant who has received additional
training in the areas of dietary, housekeeping, activities, and laundry and is a member of the
self-managed or self-directed work team.
107
R. 06/01/2022
803
DESIGNATION
Facilities meeting the requirements for HomeStyle shall be designated as such on the license issued
to the facility, with the designation specifying the number of HomeStyle homes and the total
number of beds in the HomeStyle homes. Facilities designated as Green House® facilities shall be
deemed to be HomeStyle facilities, and the one thousand (1000) bed limitation shall include all
beds for facilities designated or deemed to be Green House® or HomeStyle.
A facility may combine HomeStyle homes with a traditional nursing facility. However, the
designation as HomeStyle shall apply only to those homes that meet the requirements for
HomeStyle set forth herein and not to the facility as a whole.
804
STAFFING
Facilities designated by the Office of Long Term Care as HomeStyle facilities shall employ the
same staffing ratios and otherwise comply with Section 520 of these rules; provided, however, that
Certified Nurse Assistants (CNAs) utilized in HomeStyle facilities may act as universal workers.
For purposes of thisrule , universal or flexible worker means a CNA who, in addition to performing
CNA duties, performs dietary, laundry, housekeeping, activities and other services to meet the
needs of residents.
Staffing ratios for HomeStyle homes shall be computed based on the midnight census. Except for
licensed staff, staffing ratios shall be computed for each home individually and not the facility or
all HomeStyle homes as a whole. Each home shall have at least two (2) CNA present at all times
during the day and evening shifts and at least one (1) CNA present at all times during the night
shift.
805
STAFF TRAINING
a.
In addition to any state or federal training requirements pertaining to long term care facilities,
each CNA working in a HomeStyle home shall complete the following eighty (80) hours of
training to include but not limited to:
TRAINING
HOURS
HomeStyle Model v. Traditional Model
4.0
Activities development of, and appreciation for, activities
designed to meet the individual’s personal preferences and
needs.
Replacing the medical model role of employees
Disregarding the medical model role of residents
Organizational Culture Change
Universal/Flexible Worker
4.0
Concept
Responsibilities of the Worker
108
R. 06/01/2022
TRAINING
HOURS
Person-directed Care
4.0
Concepts and Relationship Building
Execution
Documentation
Self-Managed or Self-Directed Work Team
8.0
Concept
Responsibilities
Conflict Resolution and Learning Circles
Staffing
Food Safety
30.0
Introduction
Safety
Contamination
Allergies
Therapeutic Diets
Thickening Agents
Food Preparation
Family style dining
4.0
Concept
Measuring intake
Management
Safety
Documentation
Emergency Situations and Evacuation
8.0
Fire Drills
Tornado Drills
Disaster Drills
Evacuation
Emergency Equipment (fire extinguishers, generators, water
and gas shut-offs, etc.)
Behavioral Issues
Choking
Emergency calls
Environmental policy
Cottage Equipment Use
8.0
Appliance Usage (microwave, vent-a-hood, stove, fryer, lifts,
whirlpools, washer and dryers, air-conditioners, etc.)
Appliance Safety (changing grease, cleaning vent-a-hood, etc.)
Cottage Orientation
2.0
Phone system
Call system
Cleaning Supply Storage
Cleaning Supply Usage
Workplace Organization
109
R. 06/01/2022
TRAINING
HOURS
Communication
4.0
Communication Skills
Coaching Skills
Accountability
Support
Observation skills
4.0
How to obtain a history from family
How to initiate a resident observation
How a care plan is developed
How to read a care plan
How to modify a care plan
How to identify a resident’s change in condition
b.
Upon opening and for the first ninety days of continuous operation of a HomeStyle unit, all
CNAs working in that unit shall complete all of the required training listed in (a) above prior
to providing services in the HomeStyle home.
c.
After a HomeStyle home has been in continuous operation servicing residents for at least
ninety (90) days, each CNA assigned to the HomeStyle home for the first time, and who has
not been trained in accordance with subsections (a) and (b), above, shall complete the
following sixteen (16) hour training schedule before working with residents:
TRAINING
HOURS
HomeStyle Model v. Traditional Model
1.5
Universal/Flexible Worker
1.5
Person-Directed Care
3.0
Self-Managed or Self-Directed Work Team
3.0
Food Safety
3.0
Family-style dining
1.0
Emergency Situations and Evacuations
1.0
Cottage Equipment Use
1.0
Cottage Orientation
1.0
Following the sixteen (16) hour training the CNA shall complete the remaining sixty-four
(64) hours of training listed in (a) above within sixty (60) days.
d.
All shared common staff shall undergo the following within 30 days of the opening of the first
HomeStyle home.
TRAINING
HOURS
HomeStyle Model v. Traditional Model
1.5
Clinical Support Team
1.0
110
R. 06/01/2022
Universal Worker Concepts
1.0
Self-Managed or Self Directed Work Team
3.0
Person-Directed Care
3.0
Team Communication
1.0
Learning Circles
1.0
Understanding Aging in the Elderly
1.0
Medication Storage and Administration
1.5
Emergency Situations and Evacuation
2.0
Cottage Orientation
1.0
806
TRAINING APPROVAL
Each facility seeking designation as a HomeStyle facility shall provide to the Office of Long
Term Care a syllabus, a list of required reference and study materials, and a proposed curriculum
of training as required in Section 805. For purposes of this section, the term curriculum means a
detailed study guide that states the learning objectives and provides information or materials
designed to impart to the student or trainee the necessary skills, knowledge or ability required
under the learning objectives. The Office of Long Term Care shall evaluate the submission and
either approve the submission in writing or inform the facility in writing as to any deficiencies in
the training submission. All training required under Section 805 must be approved in writing by
the Office of Long Term Care or shall be deemed to be in violation of the requirements of
Section 805.
111
R. 06/01/2022
900 ALZHEIMER’S SPECIAL CARE UNITS DEFINITIONS
For the purposes of these rules the following terms are defined as follows:
a.
Activities of Daily Living (ADLs): The tasks for self-care that are performed either
independently, with supervision, with assistance, or by others. Activities of daily
living include, but are not limited to, ambulating, transferring, grooming, bathing,
dressing, eating and toileting.
b.
Advertise: To make publicly and generally known. For purposes of this definition,
advertise includes, but is not limited to:
1.
Signs, billboards, or lettering;
2.
Electronic publishing or broadcasting, including the use of the Internet or
email; and
3.
Printed material.
c.
Alzheimer’s Special Care Unit: A separate and distinct unit within a Long Term
Care facility that segregates and provides a special program for residents with a
diagnosis of probable Alzheimer’s disease or related dementia, and that advertises
or otherwise holds itself out as having one (1) or more special units for residents
with a diagnosis of probable Alzheimer's disease or related dementia.
d.
Alzheimer’s Disease: An organic, neurological disease of the brain that causes
progressive degenerative changes.
e.
Common Areas: Portions of the Alzheimer's Special Care Unit exclusive of
residents’ rooms and bathrooms. Common areas include any facility grounds
accessible to residents of the Alzheimer's Special Care Unit (ASCU).
f.
Continuous: Available at all times without cessation, break or interruption.
g.
Dementia: A loss or decrease in intellectual ability that is of sufficient severity to
interfere with social or occupational functioning; it describes a set of symptoms
such as memory loss, personality change, poor reasoning or judgment, and
language difficulties.
h.
Department: Department of Human Services (DHS), Division of Medical Services
(DMS), or Office of Long Term Care (OLTC)
i.
Direct Care Staff: An individual who is an employee of the facility or who is an
employee of a temporary agency assigned to work in the facility, and who has
received, or will receive, in accordance with these rules, specialized
112
R. 06/01/2022
training regarding Alzheimer's or related dementia, and is responsible for
providing direct, hands-on care or services to residents in the ASCU.
j.
Disclosure Statement: A written statement prepared by the facility and provided
to individuals or their responsible parties, and to individuals’ families, prior to
admission to the unit, disclosing form of care, treatment, and related services
especially applicable or suitable for the ASCU.
k.
Facility: A long-term care facility that houses an ASCU.
l.
Individual Assessment Team: A group of individuals possessing the knowledge
and skills to identify the medical, behavioral, and social needs of a resident and to
develop services designed to meet those needs
m.
Individual Support Plan: A written plan developed by an Individual Assessment
Team (IAT) that identifies services to a resident.
n.
Nursing Personnel: Registered or Licensed Practical nurses who have specialized
training, or will undergo specialized training by the Alzheimer's Special Care Unit,
in accordance with these rules.
o.
Responsible Party: An individual, who, at the request of the applicant or resident,
or by appointment by a court of competent jurisdiction, agrees to act on behalf of a
resident or applicant for the purposes of making decisions regarding the needs and
welfare of the resident or applicant. These rules, and this definition, does not grant
or permit, nor should be construed as granting or permitting, any individual
authority or permission to act for, or on behalf of, a resident or applicant in excess
of the authority or permission granted by law. A competent resident may select a
responsible party or may choose to not select a responsible party. In no event may
an individual act for, or on behalf of, a resident or applicant when the resident or
applicant has a legal guardian, attorney- in-fact, or other legal representative. For
purposes of these rules only, responsible party will also refer to the terms legal
representative, legal guardian, power of attorney or similar phrase.
901 GENERAL ADMINISTRATION
a.
General Program Requirements
1.
Each long-term care facility that advertises or otherwise holds itself out as
having one (1) or more special units for residents with a diagnosis of
probable Alzheimer's disease or a related dementia shall provide an
organized, continuous 24-hour-per-day program of supervision, care and
services that shall:
A.
Meet all state, federal and ASCU regulations.
113
R. 06/01/2022
B.
Require the full protection of residents' rights;
C.
Promote the social, physical and mental well-being of residents;
D.
Is a separate unit specifically designed to meet the needs of residents
with a physician’s diagnosis of Alzheimer’s disease or other related
dementia;
E.
Provide 24-hour-per-day care for those residents with a dementia
diagnosis and meets all admission criteria applicable for that
particular long-term care facility; and,
F.
Receive approval of its disclosure statement from the Office of
Long Term Care prior to advertising its ASCU.
2.
Documentation shall be maintained by the facility and shall include, but not
be limited to, a signed copy of all training received by the employee.
Documentation shall be signed by the trainer and employee at the time of
training.
3.
Provide for relief of direct care personnel to ensure minimum staffing
requirements are maintained at all times.
4.
Upon request, make available to the Department payroll records of all staff
employed during those pay periods for which the unit or facility is being
surveyed or inspected.
5.
Nursing, direct-care, or personal care staff shall not perform the duties of
cooks, housekeepers, or laundry personnel during the same shift they
perform nursing, direct-care or personal care duties.
6.
Regardless of other policies or procedures developed by the facility, the
ASCU will have specific policies and procedures regarding:
A.
Facility philosophy related to the care of ASCU residents;
B.
Use of ancillary therapies and services;
C.
Basic services provided;
D.
Admission, discharge, transfer; and,
E.
Activity programming.
b.
Disclosure Statement and Notice to the Office of Long Term Care
114
R. 06/01/2022
1.
Each facility, prior to advertising that it has an Alzheimer’s Special Care
Unit, shall develop a disclosure statement and submit it to the Office of
Long Term Care. The Office of Long Term Care shall examine the
disclosure statement to ensure compliance with these rules, and shall notify
the facility of its determination. Thereafter, the Office of Long Term Care
will, when surveying the facility and unit, determine continued compliance
with the disclosure statement. The disclosure statement, once approved by
OLTC, shall be made available to any person or the person’s guardian or
responsible party seeking placement within the ASCU prior to admission.
Specifics as to the minimum requirements of the disclosure statement are
listed in Sections 902-907 below.
2.
Upon any changes to the services offered by the ASCU, the disclosure
statement shall be amended, and shall be submitted to the Office of Long
Term Care within thirty (30) days of the amendment. The Office of Long
Term Care will examine the amended disclosure statement to ensure
compliance with these rules, and shall notify the facility of its
determination. Thereafter, the Office of Long Term Care will, when
surveying the facility and unit, determine continued compliance with the
amended disclosure statement. The amended disclosure statement, once
approved by OLTC, shall be made available to any person or the person’s
guardian or responsible party seeking placement within the ASCU prior to
admission.
3.
The facility shall submit to the Office of Long Term Care in writing the
number of beds allocated by the facility for the ASCU. The notification shall
state the number of beds allocated to the ASCU as of the date of the notice,
and shall be submitted:
A.
With the initial disclosure statement;
B.
With any amendment to the disclosure statement; and,
C.
No less than July 1 of each year.
4.
The facility shall notify the Office of Long Term Care in writing when the
facility no longer provides a special program for residents with a diagnosis
of probable Alzheimer’s disease or related dementia. The notice shall be
provided to the Office of Long Term Care at least thirty (30) days prior to
the cessation of services.
5.
Prior to admission into the Alzheimer’s Special Care Unit, the facility shall
provide a copy of the disclosure statement and Residents' Rights policy to
the applicant or the applicant's responsible party. The mission statement and
treatment philosophy shall be documented in the disclosure
115
R. 06/01/2022
statement. A copy of the disclosure statement signed by the resident or the
resident's responsible party shall be kept in the resident’s file. The
disclosure statement shall include, but not be limited to, the following
information about the facility's ASCU:
A.
The philosophy of how care and services are provided to the
residents;
B.
The pre-admission screening process;
C.
The admission, discharge and transfer criteria and procedures;
D.
Training topics, amount of training time spent on each topic, and the
name and qualifications of the individuals used to train the direct
care staff utilized in the ASCU;
E.
The minimum number of direct care staff assigned to the ASCU
each shift;
F.
A copy of the Residents' Rights;
G.
Assessment, Individual Support Plan, and Implementation.
The process used for assessment and establishment of the plan of
care and its implementation, including the method by which the plan
of care evolves and is responsive to changes in condition of the
residents;
H.
Planning and implementation of therapeutic activities and the
methods used for monitoring; and,
I.
Identification of what stages of Alzheimer's or related dementia for
which the ASCU will provide care.
J.
Each facility shall document in their disclosure statement the
assessments and dates assessments shall be completed and revised.
K.
Admission, discharge and transfer requirements shall be
documented in the facility’s disclosure statement.
L.
Staffing ratios and staff training requirements shall be documented
in the facility’s disclosure statement.
M.
The facility shall, in their disclosure statement, state the physical
requirements and safety standards for the ASCU.
116
R. 06/01/2022
N.
Types and frequency of therapeutic activities shall be listed in the
facility’s disclosure statement.
c.
Residents’ Rights
The ASCU shall meet and comply with the same requirements for Residents’
Rights applicable to the facility housing the ASCU.
d.
Resident Record Maintenance
The ASCU shall develop and maintain a record-keeping system that includes a
separate record for each resident and that documents each resident’s health care,
individual support plan, assessments, social information, and protection of each
resident’s rights.
e.
Resident Records
The ASCU must follow the facility’s policies and procedures and applicable state
and federal laws and regulations governing:
1.
The release of any resident information, including consent necessary from
the client, parents or legal guardian;
2.
Record retention;
3.
Record maintenance; and,
4.
Record content.
f.
Miscellaneous
1.
Visitors shall be permitted in the ASCU at all times. However, facilities may
deny visitation in the ASCU when visitation results, or substantial
probability exists that visitation will result, in disruption of service to any
resident, or threatens the health, safety, or welfare of any resident.
2.
Birds, cats, dogs, and other animals may be permitted in the Alzheimer’s
Special Care Unit. All animals that enter the facility shall have appropriate
vaccinations and licenses. A veterinary record shall be kept on all animals
to verify vaccinations and be made readily available for review. Pets may
not be allowed in food preparation, food storage or dining or serving areas.
3.
Unmarried male and female residents shall not be housed in the same room
unless both residents, or their respective responsible parties, have given
consent.
117
R. 06/01/2022
902 TREATMENT PHILOSOPHY
Each Alzheimer’s Special Care Unit shall develop a mission statement that reflects the
ASCU’s treatment philosophy for those residents diagnosed with Alzheimer’s or related
dementia.
903 ASSESSMENTS
a.
Psychosocial and Physical Assessments
1.
Each resident shall receive a psychosocial and physical assessment which
includes the resident’s degree or level of family support, level of activities
of daily living functioning, cognitive level, behavioral impairment, and that
identifies the resident’s strengths and weaknesses.
2.
Prior to admission to the ASCU, the applicant must be evaluated by, and
have received from a physician, a diagnosis of Alzheimer’s or related
dementia.
b.
Individual Assessment Team (IAT)
1.
Within 30 days after admission, the IAT shall prepare for each resident an
individual support plan. The ISP shall address specific needs of, and services
required by, the resident resulting from the resident’s Alzheimer’s disease
or related dementia. The plan shall include and identify professions,
disciplines, and services that:
A.
Identifies and states the resident's medical needs, social needs,
disabilities and their causes;
B.
Identifies the resident's specific strengths;
C.
Identifies the resident's specific behavioral management needs;
D.
Identifies the resident's need for services without regard to the
actual availability of services;
E.
Identifies and quantifies the resident's speech, language, and
auditory functioning;
F.
Identifies and quantifies the resident's cognitive and social
development; and,
G.
Identifies and specifies the independent living skills and other
services provided by the ASCU to meet the needs of the resident.
118
R. 06/01/2022
2.
The IAT shall perform accurate assessments or reassessments annually, and
upon a change to a resident’s physical, mental, emotional, functional, or
behavioral condition or status in which the resident:
A.
Is regressing in, or losing, skills already gained;
B.
Is failing to progress toward or maintain identified objectives in the
ISP; or,
C.
Is being considered for changes in the resident’s ISP.
c.
Individual Support Plan (ISP)
1.
The ISP shall include a family and social history. If the family and social
history cannot be obtained, the ASCU personnel shall document attempts to
obtain the information, including but not limited to, the names and telephone
numbers of individuals contacted, or whom the facility attempted to contact,
and the date and time of the contact or attempted contact.
2.
The ISP shall be reviewed, evaluated for its effectiveness, and up-dated at
least quarterly, and shall be updated when indicated by changing needs of
the resident, or upon any reassessments by the IAT. In the event that the
reassessment by the IAT documents a change of condition for which no
change in services to meet resident needs are required, the ISP shall
document the change of condition, and the reason or reasons why no change
in services are required.
3.
The ISP shall include:
A.
Expected behavioral outcomes;
B.
Barriers to expected outcomes;
C.
Services, including frequency of delivery, designed to achieve
expected behavioral outcomes;
D.
Methods of assessment and monitoring. Monitoring shall occur no
less than quarterly to determine progress toward the outcome;
E.
Documentation of results from services provided, and achievement
towards expected outcomes or regression, and reasons for the
regression; and,
F.
The resident’s likes, dislikes, and if appropriate, his or her choices.
119
R. 06/01/2022
4.
A copy of the ISP shall be made available to all staff that work with the
resident, and the resident or his or her responsible party.
5.
The ISP shall be implemented only with the documented, written consent
of the resident or his or her responsible party.
904 ADMISSIONS, DISCHARGES, TRANSFERS
a.
Criteria for Services
1.
Each Alzheimer’s Special Care Unit shall have written policies setting forth
pre-admission screening, admission, and discharge procedures.
2.
Admission criteria shall require:
A.
A physician’s diagnosis of Alzheimer’s disease or related dementia;
B.
The facility's assessment of the resident’s level of needs; and,
C.
A list of the services that the ASCU can provide to address the needs
identified in 904(a)(2)(B).
3.
Any individual admitted to the ASCU must also meet admission criteria for
the facility. The ASCU shall not maintain a resident who requires a level of
care greater than for which the facility is licensed to provide, or for whom
the ASCU is unable to provide the level or types of services to address the
needs of the resident. Discharge from the ASCU shall occur when:
A.
The resident’s medical condition exceeds the level of care for which
the facility is licensed or is able to provide;
B.
The resident’s medical condition requires specialized nursing
procedures that constitute more than limited nursing services, or
nursing services the facility is unable to provide;
C.
The resident has a loss of functional abilities (e.g. ambulation) that
results in the resident’s level of care requirements being greater than
the level of care for which the facility is licensed or able to provide;
D.
Behavioral symptoms that result in the resident’s level of care
requirements being greater than the level of care for which the
facility is licensed or able to provide; or
120
R. 06/01/2022
E.
The resident requires a level of involvement in therapeutic
programming that is greater than the level of care for which the
facility is licensed or able to provide.
4.
If the resident, or the resident's responsible party, does not comply with, or
refuses to accept, the requirements of the ISP, the resident shall be
discharged from the ASCU. The facility shall document the refusal or non-
compliance with the ISP. The documentation shall include, but not be
limited to:
A.
The identity of the person who is not willing or able to comply with
the requirements of the ISP; i.e., the resident or the resident's
responsible party;
B.
The date and time of the refusal; and,
C.
The consequences of the unwillingness or inability to comply with
the requirements of the ISP, and the name of the person providing
this information to the resident or the resident's responsible party.
b.
Resident Movement, Transfer or Discharge
When a resident is moved from or within the ASCU, or is transferred or discharged
from the ASCU, measures shall be taken by the facility to minimize confusion and
stress to the resident. Further, the discharge shall comply with the rules applicable
to the facility housing the ASCU and Arkansas law.
905 STAFFING
Alzheimer’s Special Care Units shall staff according to the Rules for Nursing Facilities.
Furthermore, the following staffing requirements are established for Alzheimer's Special
Care Units.
a.
Professional Program Services
A social worker or other professional staff, e.g., physician, Registered Nurse, or
Psychologist currently licensed by the State of Arkansas, shall be utilized to
perform the following functions:
1.
Complete an initial social history evaluation on each resident on
admission;
2.
Develop, coordinate, and use state or national resources and networks to
meet the needs of the residents or their families;
121
R. 06/01/2022
3.
Offer or encourage participation in monthly family support group meetings
with documentation of meetings offered; and,
4.
Assist in development of the ISP, including but not limited to:
A.
Assuring that verbal stimulation, socialization and reminiscing is
identified in the ISP as a need;
B.
Defining the services to be provided to address those needs
identified above; and,
C.
Identifying the resident's preferences, likes, and dislikes.
b.
Staff and Training
1.
All ASCU staff members and consultants shall have the training specified
in these rules in the care of residents with Alzheimer’s Disease and other
related dementia. The facility shall maintain records documenting what
training each staff member and consultant has received, the date it was
received, the subject of the training, and the source of the training.
2.
Within six (6) months of the date that the long-term care facility first
advertises or otherwise holds itself out as having one (1) or more special
units for residents with a diagnosis of probable Alzheimer's disease or a
related dementia, the facility shall have trained all staff who are scheduled
or employed to work in the ASCU.
3.
Subsequent to the requirements set forth in Section 905(b)(2), fifty percent
(50%) of the staff working any shift shall have completed requirements as
set forth in Section 905(b)(5)(a), (b), and (c).
4.
After meeting the requirements of Section 905(b)(2), all new employees
who will be assigned to or will work in the ASCU shall be trained within
five (5) months of hiring, with no less than eight (8) hours of training per
month during the five (5) month period.
5.
In addition to any training requirements for any certification or licensure of
the employee, training shall consist of, at a minimum:
A.
Thirty (30) hours on the following subjects:
a.
One (1) hour of the ASCU's policies;
b.
Three (3) hours of etiology, philosophy and
treatment of dementia;
122
R. 06/01/2022
c.
Two (2) hours on the stages of Alzheimer’s disease;
d.
Four (4) hours on behavior management;
e.
Two (2) hours on use of physical restraints,
wandering, and egress control;
f.
Two (2) hours on medication management;
g.
Four (4) hours on communication skills;
h.
Two (2) hours of prevention of staff burnout;
i.
Four (4) hours on activity programming;
j.
Three (3) hours on ADLs and Individual-Centered
Care; and,
k.
Three (3) hours on assessments and creation of
ISPs.
B.
On-going, in-service training consisting of at least two (2) hours
every quarter. The topics to be addressed in the in-service training
shall include the following, and each topic shall be addressed at least
once per year:
i. The nature of Alzheimer’s disease and other dementia,
including:
a. The definition of dementia;
b. The harm to individuals without a correct diagnosis;
and,
c. The stages of Alzheimer’s disease.
ii. Common behavior problems resulting from Alzheimer's or
related dementia, and recommended behavior management
for the problems;
iii. Communication skills to facilitate improved staff relations
with residents;
iv. Positive therapeutic interventions and activities, such as:
a. Exercise;
123
R. 06/01/2022
b. Sensory stimulation; and,
c. Activities of daily living.
v. The benefits of family interaction with the resident, and the
need for family interaction;
vi. Developments and new trends in the fields of Alzheimer's or
related dementia, and treatments for same;
vii. Environmental modifications to minimize the effects and
problems associated with Alzheimer's or related dementia;
and,
viii. Development of ISPs, including but not limited to
instruction on the method of updating and implementing
ISPs across shifts.
C.
If the facility identifies or documents that a specific employee
requires training in areas other than those set forth in 905(b), the
facility may provide training in the identified or documented areas,
and may be substituted for those subjects listed in Section
905(b)(5)(A) and (B).
c.
Trainer Requirements
The individual providing the training shall have:
1.
A minimum of one (1) year uninterrupted employment in the care of
Alzheimer’s residents;
2.
Training in the care of individuals with Alzheimer’s disease and other
dementia; or,
3.
Been designated by the Alzheimer’s Arkansas Program and Services or the
Alzheimer’s Association or its local chapter as being qualified to meet
training requirements.
d.
Training Manual
The ASCU shall create and maintain a training manual consisting of the topics
listed in Section 905(b). Further, the trainer shall provide training consistent with
the training manual.
906 PHYSICAL ENVIRONMENT, DESIGN AND SAFETY
124
R. 06/01/2022
a.
Physical Design
In addition to the physical design standards required for the facility’s license, an
Alzheimer’s Special Care Unit shall include the following:
1.
A floor plan design that does not require visitors or staff to pass through the
ASCU to reach other areas of the facility;
2.
A multipurpose room or rooms for dining, group and individual activities,
and family visits which complies with the LTC licensure requirements for
common space;
3.
Secured outdoor space and walkways that allow residents to ambulate, with
or without assistive devices such as wheelchairs or walkers, but prevents
undetected egress. Such walkways shall meet the accessibility requirements
of the most current LTC and Americans with Disabilities Act (ADA)
structural building codes or regulations at the time of licensure. Unrestricted
access to secured outdoor space and walkways shall be provided, and such
areas shall have fencing or barriers that prevent injury and elopement.
Fencing shall be no less than 72 inches high;
4.
Prohibit the use of plants that are poisonous or toxic for human contact or
consumption;
5.
Visual contrasts between floors and walls, and doorways and walls, in
resident use areas. Except for fire exits, exit doors and access ways shall be
designed to minimize contrast and to obscure or conceal areas the residents
should not enter;
6.
Non-reflective floors, walls, and ceilings to minimize glare;
7.
Evenly distributed lighting to minimize glare and shadows; and,
8.
A monitoring or nurses’ station with:
A.
A call system to alert staff to any emergency needs of the
residents; and,
B.
A space for charting and for storage of residents' records.
b.
Physical Environment and Safety.
The Alzheimer’s Special Care Unit shall:
125
R. 06/01/2022
1.
Provide freedom of movement for the residents to common areas and to
their personal spaces. The facility shall not lock residents out of, or inside,
their rooms;
2.
Provide plates and eating utensils that have visual contrast between the
plates, the utensils and the table, and that maximizes the independence of
the residents;
3.
In common areas, provide comfortable seating sufficient to seat all residents
at the same time. The seating shall consist of a ratio of one (1) gliding or
rocking chair for every five (5) residents;
4.
Encourage and assist residents to decorate and furnish their rooms with
personal items and furnishings based on the resident’s needs and
preferences as documented by the ISP in the social history;
5.
Individually identify each resident's room based on the resident’s cognitive
level to assist residents in locating their rooms, and to permit them to
differentiate their room from the rooms of other residents;
6.
Keep corridors and passageways through common-use areas free of objects
which may cause falls, or which may obstruct passage by physically
impaired individuals; and,
7.
Only use public address systems in the unit for emergencies.
c.
Egress Policies
The Alzheimer’s Special Care Unit shall develop policies and procedures to deal
with residents who wander or may wander. The procedures shall include actions to
be taken by the facility to:
1.
Identify missing residents;
2.
Notify all individuals or institutions that require notification under law or
rule when a resident is missing; and,
3.
Attempt to locate the missing resident.
d.
Locking Devices
1.
All locking devices used on exit doors shall be approved by the OLTC,
building code agencies, and the fire marshal having jurisdiction over the
facility; shall be electronic; and shall release upon activation of the fire
alarm or sprinkler system.
126
R. 06/01/2022
2.
If the unit uses keypads to lock and unlock exits, directions for the keypad's
operations to allow entrance shall be posted on the outside of the door.
3.
The keypads and locks shall meet the Life Safety Code.
4.
Staff shall be trained in all methods of releasing, or unlocking, the locking
device.
907 THERAPEUTIC ACTIVITIES
a.
Intent and General Requirements
Therapeutic activities can improve a resident’s eating or sleeping patterns; lessen
wandering, restlessness, or anxiety; improve socialization or cooperation; delay
deterioration of skills; and improve behavior management. Therapeutic activities
shall be designed to meet the resident's current needs. The ASCU shall:
1.
Provide activities appropriate to the needs of individual residents. The
activities shall be provided and directed by direct care staff under the
coordination of a program director.
2.
Ensure that each resident's daily routine is structured or scheduled so that
activities are provided seven days a week.
3.
Utilize or contract with a professional with specialized training in the care
of Alzheimer’s to:
A.
Develop required daily activities, as set forth in Section 907(b);
B.
Train direct care staff in those programs; and,
C.
Provide ongoing consultation.
b.
Required Daily Activities
The following activities shall be offered daily:
1.
Gross motor activities (e.g., exercise, dancing, gardening, cooking, etc.);
2.
Self-care activities (e.g., dressing, personal hygiene, or grooming);
3.
Social activities (e.g., games, music, socialization); and,
4.
Sensory enhancement activities (e.g., reminiscing, scent and tactile
stimulation).
127
R. 06/01/2022
908 PENALTIES
a.
If a facility having an Alzheimer's special care unit does not meet the specific
standards established herein, the Office of Long Term Care shall instruct the facility
to immediately cease advertising or holding itself out as having one (1) or more
special programs for residents with a diagnosis of probable Alzheimer's disease or
related dementia.
b.
If the facility fails or refuses to comply with instructions from the Office of Long
Term Care, the Office of Long Term Care may sue in the name of the state the
facility and any owner, manager, or director of the facility to enjoin the facility
from advertising or holding itself out as having one (1) or more special programs
for residents with a diagnosis of probable Alzheimer's disease or related dementia.
128
R. 06/01/2022
1000 RECEIVERSHIP
1001 DEFINITIONS
a.
Administrator – A long term facility administrator as defined in Ark. Code Ann.
§ 20-10-101.
b.
Emergency – A situation, physical condition, or one or more practices, methods
or operations which threatens the health, security, safety or welfare of residents.
c.
Facility – A long term care facility that is required to be licensed under Ark.
Code Ann. § 20-10-224.
d.
Habitual Violation – A violation of state or federal laws which, due to its repetition,
presents a reasonable likelihood of serious physical or mental harm to residents.
e.
Licensee – Any person or other legal entity who is licensed to operate a facility.
f.
Owner – The holder of the title to the real estate in which the facility is
maintained.
g.
Resident – Any person who lives in and receives services or care in a long term
care facility.
h.
Substantial Violation – A violation of a state or federal law which presents a
reasonable likelihood of serious physical or mental harm to residents.
i.
Department – The Arkansas Department of Human Services.
j.
Office – Office of Long Term Care.
k.
Director of OLTC – The Assistant Deputy Director of the Office of Long Term
Care.
l.
Director – The Director of the Arkansas Department of Human Services.
1002 PURPOSE
a.
Ark. Code Ann. § 20-10-902 describes the purpose for development of a
mechanism for the concept of receivership to protect resident 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 Ark. Code Ann. §
20-10-904, to wit:
129
R. 06/01/2022
1.
An emergency exists in a facility which threatens the health, security or
welfare of residents.
2.
A facility is in substantial or habitual violation of the standards of health,
safety or resident care established under state or federal regulations to the
detriment of the welfare of the residents.
3.
A facility intends to close but has not arranged at least thirty (30) days
prior to closure for the orderly transfer of its residents.
4.
The facility is insolvent.
5.
The Department has suspended, revoked or refused to renew the existing
license of the facility.
b.
The objective of any receivership is:
1.
To restore a nursing home’s capability to meet resident needs or, if that is
not feasible;
2.
To arrange for a transfer of ownership or closing of the home.
1003 APPOINTMENT AND SUPERVISION OF A MONITOR(S):
a.
The Director, pursuant to Ark. Code Ann. § 20-10-915, may in its discretion
place a designated employee in the facility in lieu of a receiver.
1.
The monitor(s) shall meet the following minimum requirements:
A.
Be in good physical health.
B.
Experience in working with the elderly in programs such as patient
care, social work, or advocacy.
C.
Have an understanding of the rules which are the subject of the
monitors’ duties as evidenced in a personal interview of the
candidate.
D.
Not be related to the owners of the involved facility either through
blood, marriage, or common ownership of real or personal property.
E.
Successfully completed a baccalaureate degree or two years full-
time work experience in the long term care industry.
130
R. 06/01/2022
2.
Monitor(s) shall be under the supervision of the Department; shall perform
the duties of a monitor delineated and accomplish the following actions:
A.
A monitor shall visit the facility at least five (5) days per week or
more frequently as assigned by the Director.
B.
Review all records pertinent to the condition for such monitor’s
placement under 1(a) above.
C.
Provide to the Director a weekly written report and a daily oral
report detailing the observed conditions of the facility.
D.
Shall be available as a witness for hearings.
3.
All communications, including, but not limited to, data, memorandum,
correspondence, records and reports shall be transmitted to and become the
property of the Department. Findings and results of the monitor’s work done
under these rules shall be strictly confidential, subject to disclosure only in
accordance with the provisions of the Freedom of Information Act.
4.
The assignment as a monitor may be terminated at any time by the Director.
5.
The monitor(s) shall submit a written report setting forth findings and
recommendations concerning the operation of the facility.
1004 DETERMINATION OF NEED FOR RECEIVERSHIP
a.
Pre-Petition Activities – Prior to the filing of a Petition of Receivership (Ark.
Code Ann. § 20-10-905) the Department shall be notified and:
1.
Coordinate the preparation and collection of documentation to support a
decision to recommend a receivership action.
2.
In an emergency situation present the supporting documentation and
recommendations to the Director.
3.
Receive information from any source, which indicates a need for
receivership action.
4.
Request information concerning the following:
A.
Chronology of facility survey history for the two years
immediately prior to the determination of the need.
131
R. 06/01/2022
B.
Summary of physical plant/life safety code compliance and actions
necessary to correct violations/deficiencies.
C.
Summary of number of residents, care levels, special needs and an
assessment of major problems occurring in the facility, i.e., staffing,
supply shortages (may warrant an immediate on-site visit).
5.
Review the need for receivership considering the following options:
A.
Would relocation of residents be an alternative?
B.
Would appointment of a monitor be sufficient?
6.
Identifies the total number and type of violations or deficiencies cited by
Department staff.
1005 PETITION FOR NOTICE OF RECEIVERSHIP
a.
The Department, Attorney General, or prosecuting attorney or duly appointed
deputy prosecuting attorney of the district in which the facility is located may file
in chancery court of the county in which the facility is located a complaint
requesting the appointment of a receiver.
b.
The summons, complaint and notice of hearing shall be served on the owner and
administrator or licensee of the facility. The summons, complaint and notice may
be served by any means set forth in the Arkansas Rules of Civil Procedure, Rule 4,
giving actual notice to the owner and administrator or licensee.
c.
Emergency Appointment
1.
If the complaint filed under Ark. Code Ann. § 20-10-905 is filed by the
Department and alleges that grounds set out in Ark. Code Ann. § 20-10-
904(a) exist within the facility, and is accompanied by a verified affidavit
setting forth facts which would constitute such a ground, a temporary
receiver shall be appointed with or without notice to the owner or licensee.
2.
The temporary appointment of a receiver without notice to the owner,
licensee, or administrator may be made only if the court is satisfied that the
Department has made a diligent attempt to provide reasonable notice under
the circumstances. The delivery of a copy of the complaint to the facility
upon filing shall constitute reasonable notice for issuance of a temporary
receivership order by the court.
3.
Upon appointment of a temporary receiver, the department shall proceed
forthwith to obtain the service as provided in 20-10-905(d).
132
R. 06/01/2022
4.
If the department does not proceed with the complaint, the court shall
dissolve the temporary receivership after ten (10) days.
1006 POST PETITION ACTIVITIES
Immediately upon appointment of a receiver the Department shall assist the receiver and
insure the following functions and responsibilities are accomplished:
a.
Identify the need for additional staff as necessary to evaluate problems identified
on-site.
b.
Identify and work closely with key nursing home personnel to assess the adequacy
of services to the patients in the home and to establish whether or not adequate and
appropriate inventories of supplies and equipment are available to meet the needs
of the patients. Determine the extent, condition and availability of physical
inventory and records.
c.
Identify and interview person(s) responsible for maintaining the home’s financial
records, and identify the bank or other financial institution with which the home is
involved for mortgage financing, short term loans, daily banking activities
(checking, savings), etc.
d.
Work closely with the director of nursing and other nursing personnel and evaluate
the quality and effectiveness of resident care, including progress made on cited code
violations.
e.
Assesses:
1.
The ability of licensed and attendant staff to meet the needs of the resident
population.
2.
The degree to which the health needs of the residents are met through direct
observation of residents, interviews with residents and staff, and
examination of clinical records.
3.
The quality and quantity of medical care being rendered, and that
physician’s orders are being carried out appropriately. (May request the
services of a consulting physician to evaluate this aspect).
4.
The nutritional status of the residents; examines the adequacy and
appropriateness of diets.
5.
Other resident needs, including grooming and hygiene, recreation, and
restorative nursing.
133
R. 06/01/2022
6.
The availability and adequacy of appropriate nursing supplies and
equipment.
f.
May recommend the removal of residents requiring a level of care greater than the
available nursing services.
g.
Work closely with the Director of Nursing in evaluation the status of residents.
h.
Communicate with residents’ families and other interested parties to address
concerns for the health, safety or welfare of the residents.
i.
Evaluate the social services activity of the home.
1007 ASSISTANCE WITH DUTIES OF THE RECEIVER TO STAFF
Immediately upon completion of the assessment in Section 1006 above, but in no event
more than 72 hours after appointment, the Department shall assist the Receiver to:
a.
Conduct an orientation meeting with staff to discuss identified problems, present
status of the operation, apparent priorities, establish a plan of operation and
receivership goals. Contract personnel will attend if appropriate.
b.
Coordinate assignment of staff to receivership activities.
c.
Distribute reports and other information regarding receivership action to facility
supervisory personnel.
d.
Interview persons who maintain inventories (food, medical supplies, etc.) to
assure adequacy of supplies on hand.
e.
Interview medical director, director of nursing, heads of housekeeping,
maintenance, food service, laundry, etc., to address adequacy of services and
environmental conditions of the facility.
f.
Meet all department heads to:
1. Explain the need and purpose of the receivership.
2. Discuss identified problems.
3. Assess the strengths of the group and the facility.
4. Present a plan of operation including apparent priorities and tentative
goals.
5. Explain style of leadership; expectations.
134
R. 06/01/2022
6. Encourage and elicit free and open expression, noting their feelings,
concerns.
7. Announce weekly department head group meetings.
1008 ASSISTANCE WITH RESPONSIBILITIES OF RECEIVER TO RESIDENTS,
GUARDIANS AND FAMILIES
Immediately upon completion of assessment in Section 1006 above, but in no event more
than 72 hours after appointment the Department shall assist the receiver to:
a.
Meet with the residents/guardians, their families and/or interested parties to:
1.
Explain purpose and necessity of receivership.
2.
Identify persons who will operate the facility, and present plans of
operation.
3.
Describe expected goals and end results.
4.
Assure residents and their families of care and continuing concern for their
needs, health and welfare and identify the person to be contacted if they
have questions.
5.
Ask for their support and patience during the course of the receivership
action.
b.
Prepare notice to families, responsible parties and guardians of residents
explaining:
1.
Purpose and necessity of receivership action.
2.
Expected goals of receivership and end results.
3.
The assurance of continuing care and concern for the residents.
4.
The need for continued support and concern for the residents.
5.
Identify a person to contact for information.
1009 LONG RANGE RESPONSIBILITIES OF RECEIVER
Upon appointment, the department shall assist in taking appropriate action with regard to
the on-going operation of the facility. That action shall include:
135
R. 06/01/2022
a.
Meet regularly with other staff.
b.
Convey copies of reports to the Director as scheduled.
c.
Meet with facility department heads to plan for achieving goals to remedy identified
code violation, to mutually review causes and ways to overcome past and present
problems, and to promise open communication and support between them. Agrees
to other meetings as necessary.
d.
Receive required reports from department heads as scheduled.
e.
Keep daily log of activities and observations for incorporation into written weekly
reports to Director.
f.
Hold regular department head meetings – weekly to start, with an agenda that
includes:
1.
Information from receivership team administrator.
2.
Information from department heads.
3.
Free exchange of comments.
g.
Monitor closely the ongoing operation of the facility.
1.
By daily presence on floors and in departments, keep up the morale and
confidence of employees and residents.
2.
Evaluate and document performance of staff.
3.
Review security of the facility and changes locks as necessary.
4.
Consistently work toward the correction of any code violations.
5.
Monitor and control admission policies.
6.
Recommend to the Director any immediate changes in staff and/or staffing
patterns necessary to the safety, health and welfare of the residents.
h.
Review the current resident care program in light of available skills and ability of
the staff to meet the needs of residents. Consider the need to close the home to
additional admissions, the need to transfer residents from the facility. Make the
appropriate recommendations to the Director.
i.
Continuously monitor staffing in relocation to the quantity and types of skills.
136
R. 06/01/2022
j.
If the facility is permitted to continue to accept admissions, review applications for
admission, considering skills required for proper care in relation to skills available
at the home.
k.
Evaluate the operation of the nursing department, beginning with problems
identified as existing code violations and observations made by the pre-
receivership team.
l.
Assist the Director of Nursing in the preparation, promotion and implementation of
remedial actions.
1.
Evaluate the effectiveness of selected remedial programs on a continuing
basis.
2.
Report progress toward correction of violations and other problems to
receivership team administrator on a regular basis.
m.
Monitor all phases of the nursing department and all services pertaining to the care
of the residents including:
1.
Medical Care
A.
Frequency of physician’s visits
B.
Physician’s responsiveness to emergencies or changes in residents’
condition
C.
Effectiveness of nurse/physician relationships
D.
Appropriate and timely reporting by nursing staff of emergencies
and/or significant physical changes to attending physicians
E.
Evaluation of the role served by the facility’s medical director
2.
Care Delivery System
A.
Medication System
i.
Proper and effective methods of order transcription
ii.
Effective pharmacy service
iii.
Accuracy in administration
iv.
Accurate recordkeeping
137
R. 06/01/2022
v.
Proper methods of disposal of outdated or discontinued
medication
vi.
Prompt renewal of medication orders
B.
Treatment Systems
i.
Adequacy and appropriateness of treatment supplies
ii.
Provision of treatments as ordered by the physician
iii.
Proper recording
iv.
Utilization of proper techniques
v.
Charting of effectiveness of prescribed treatment
C.
Restorative Therapies
i.
Comprehensive orders
ii.
Proper follow-through
iii.
Appropriate and accurate records
D.
Restorative Nursing
i.
Activities of daily living retraining being provided
ii.
Staff promotion of self-care to extent possible
iii.
Nursing staff follow-through on therapeutic restorative
programs
iv.
All residents up and dressed as possible
3.
Accident/Incident Management
A.
Proper care and follow-up provided by nursing staff
B.
Physicians notified appropriately
C.
Medical director reviewing all reports
D.
Comprehensive charting and accident reports available
138
R. 06/01/2022
4.
Record Management
A.
Medical records complete and in good order
B.
Charting by nursing staff meaningful
C.
All reports available in record
D.
Closed records complete and in good order
5.
Laboratory and Other Contract Services
A.
Responsive on a timely basis
B.
Reports available promptly
C.
Current orders available for tests and treatment rendered
D.
Physicians promptly notified of test results
6.
Dignity of Residents
A.
Residents treated by nursing staff with courtesy and respect
B.
Resident rights known to all nursing staff and maintained
consistently
7.
Inservice Programming
A.
Appropriate to the needs of the staff
B.
Appropriate planning and scheduling
C.
Adequate orientation and training of new staff members being
provided
8.
Supply and Equipment Procurement
A.
Supplies and equipment available and adequate to meet the needs
of the patient census
B.
Supplies and equipment maintained in sanitary condition and good
working order
1010 REPORTING OF PROGRESS OF RECEIVER
139
R. 06/01/2022
a.
The Receiver shall report to the court, the Department, the owner and administrator
licensee on the progress of the receivership action before the receivership can be
concluded and at such times as directed by the court, and prior to engaging in any
function, duty or activity for which a statutorily mandated report is required. The
preparation of the final report on all aspects of a receivership action is coordinated
by the Director.
b.
The report details all activities and their expenditures during the receivership. It
clearly identifies whether the objectives of the receivership have been achieved;
i.e., to restore the home’s capabilities to meet patient needs, or to close the home.
If the objective has not been achieved, it clearly identifies what additional actions
are necessary and an estimate of how much time is required to complete them.
c.
The receiver shall forward a report to the Director for review, advice and assistance.
d.
If the Court determines and orders the facility is to continue operation, the receiver
shall:
1.
Prepare department heads for change in administration. Provide information
and instructions as needed, together with a timetable for activities and
required final reports. Such reports are to include a brief summary statement
to the receivership team administrator, including statistics and numbers
where appropriate, an assessment of strengths and weaknesses and
recommendations of the department head.
2.
Meet all employees, each shift, to prepare them for the change in
administration, giving dates of action and names. Thank them for
cooperation and personal efforts.
3.
Meet with, or arranges for meetings, as needed, with residents and their
families to prepare them for upcoming changes, giving dates of action and
names. Thanks them for their patience and cooperation.
4.
Notify families and responsible parties to inform them of the approaching
changes.
5.
Request and receive concluding reports from all members of the
receivership team, and compile final report and forward to Director.
6.
On day of transition of control, collect all keys, records, books, etc., from
each member of the receivership team. Turn these items over to the
incoming administration.
7.
Remain available to new administration to ease turnover process.
140
R. 06/01/2022
8.
Take and record a complete inventory. Provides report to receivership
team administrator.
9.
Bring all records up to date; makes final reconciliation of books.
10.
Be available to new financial officer, if any, to assist in an orderly
transition.
e.
If the Court determines and orders the facility to be closed, upon receipt of the
decision for closure, along with instructions regarding needed information and
procedures, the receiver shall:
1.
Inform other members of the receivership team of the decision for closure
and the responsibilities they will assume during the closure process.
2.
Prepare department heads for closing, giving information and instruction as
needed, together with timetable for actions. Instruct on final report as
required, including brief summary statements.
3.
Meet with all employees, each shift, giving general outline of concluding
activities; ask their cooperation to the end.
4.
Hold concluding meetings with each department head, collecting all final
reports, etc.
5.
Receive and act upon instructions regarding storage of files and records,
disposition of capital goods, equipment, building, etc.
6.
Take final inventory.
7.
Bring all records up to date and close books.
8.
Conclude all accounts, pay all bills, collect all accounts receivable.
9.
Under the direction of the Director, close all bank accounts, and oversee
the transfer of residents’ funds to the receiving facilities.
10.
Work with the facility staff in preparing residents and the families of
residents for the impending closure of the facility.
11.
Seek additional nursing staff to assist in the transfer, if necessary.
12.
Work with social service staff and the families of residents in securing
appropriate placement in other facilities.
141
R. 06/01/2022
13.
Participate in the actual transfer process, assuring the proper transfer of
records, etc.
14.
Oversee the closure of the nursing department and nursing areas, seeing to
the proper closure and storage of records.
1011 QUALIFICATIONS AND MAINTENANCE OF LIST FOR RECEIVER
a.
Through consultation with the long-term care industry associations, professional
organizations, consumer groups and health-care management corporations, the
Department shall maintain a list of receivers. This list shall be updated semi-
annually. To be placed on the list, individuals must:
1.
Be in good physical health.
2.
Demonstrate an understanding or working knowledge of applicable laws,
rules.
3.
In addition to 1 and 2 above, individuals placed on the list shall:
A.
Possess a current, valid Arkansas Nursing Home Administrator’s
license;
B.
Possess a degree in business finance, management, health-care or a
related field and one (1) year work experience in the degreed field
provided; an individual not possessing a college degree but having
five (5) years experience in the above fields may substitute such
experience for the requisite degree; or,
C.
Possess one year of experience in working with the elderly in
programs or fields such as patient care, social work, or advocacy and
having successfully completed a baccalaureate degree in
management program or field; or possess a license in that program
or field; or have two (2) years full-time working experience in the
Arkansas long-term care industry in a management capacity.
1012 DEPARTMENT TO FURNISH RECEIVER WITH COPY OF LEGAL
PROCEEDING
a.
Upon appointment of a receiver for a facility by a court, the Department shall
inform the individual of all legal proceedings to date which concern the facility.
b.
The receiver may request that the Director of the Department authorize
expenditures from monies appropriated, pursuant to Ark. Code Ann. § 20-10-916
of the Act, if incoming payments from the operation of the facility are less than the
costs incurred by the receiver.
142
R. 06/01/2022
1013 MANDATED PATIENT TRANSFER
a.
In the case of Department ordered patient transfers, the receiver may:
1.
Assist in providing for the orderly transfer of all residents in the facility to
other suitable facilities, or make other provisions for their continued health.
2.
Assist in providing for transportation of the resident, his medical records
and his belongings if he is transferred or discharged; assist in locating
alternative placement; assist in preparing the resident for transfer; and
permit the resident’s legal guardian to participate in the selection of the
resident’s new location.
3.
Unless emergency transfer is necessary, explain alternative placements to
the resident and provide orientation to the place chosen by the resident or
resident’s guardian.
1014-1999 RESERVED
143
R. 06/01/2022
2000 INFORMAL DISPUTE RESOLUTION
When a long term care facility does not agree with deficiencies cited on a Statement of
Deficiencies, the facility may request an IDR meeting of the deficiencies in lieu of, or in addition
to, a formal appeal. The Informal Dispute Resolution (IDR) process is governed by Act 1108 of
2003, codified at Ark. Code Ann. § 20-10-1901 et seq.
The request for an informal dispute resolution of deficiencies does not stay the requirement for
submission of an acceptable plan of correction and allegation of compliance within the required
time frame or the implementation of any remedy, and does not substitute for an appeal.
2001 REQUESTING AN INFORMAL DISPUTE RESOLUTION
A written request for an informal dispute resolution must be made to the Arkansas Department
of Health, Health Facility Services, 5800 West 10th, Suite 400, Little Rock, AR 72204 within ten
calendar days of the receipt of the Statement of Deficiencies from the Office of Long Term Care.
The request must:
1.
List all deficiencies the facility wishes to challenge; and,
2.
Contain a statement whether the facility wishes the IDR meeting to be conducted by
telephone conference, by record review, or by a meeting in which the parties appear before
the impartial decision maker.
2002 MATTERS WHICH MAY BE HEARD AT IDR
The IDR is limited to deficiencies cited on a Statement of Deficiencies. Issues that may not be
heard at an IDR include, but are not limited to:
1.
The scope and severity assigned the deficiency by the Office of Long Term Care, unless
the scope and severity allege substandard quality of care or immediate jeopardy;
2.
Any remedies imposed;
3.
Any alleged failure of the survey team to comply with a requirement of the survey
process;
4.
Any alleged inconsistency of the survey team in citing deficiencies among facilities; and,
5.
Any alleged inadequacy or inaccuracy of the IDR process.
2003 APPEAL OF IDR RESULTS
If a Medicaid certified facility is not satisfied with the results of the informal dispute
resolution, it may request a hearing before the Long Term Care Facility Advisory Board
144
R. 06/01/2022
within the 60 day time frame for appeal. If the facility chooses, it may by-pass the informal
dispute resolution process and appeal directly to the board within the 60 day appeal period.
Requests must be submitted in writing to:
Chairman
Long Term Care Facility Advisory Board
P.O. Box 8059, Slot S409
Little Rock, AR 72203-8059
Medicare and Medicare/Medicaid certified facilities may request a hearing by either the
Associate Regional Administrator in the Dallas office of the Health Care Financing
Administration or the Departmental Appeals Board at the addresses below at any point
within the 60 day time frame for appeals.
HCF-2
Associate Regional Administrator
Division of Health Standards and Quality
Centers for Medicare and Medicaid Services
1200 Main Tower Building
Dallas, TX 75202
Department of Health and Human Services
Departmental Appeals Board, MS 6127
Civil Remedies Division
330 Independence Avenue, S.W.
Cohen Building - Room G-644
Washington, D.C. 20201
If the facility chooses to appeal to either of these agencies, a copy of the appeal should also be
forwarded to the OLTC.
2004-2999 RESERVED
145
R. 06/01/2022
3000 RESIDENTS' RIGHTS
3001 The facility shall have written policies and procedures defining the rights and responsibilities
of residents. The policies shall present a clear statement defining how residents are to be
treated by the facility, its personnel, volunteers, and others involved in providing care.
3002 A copy of the synopsis of the residents' bill of rights must be prominently displayed within
the facility.
3003 Each resident admitted to the facility is to be fully informed of these rights and of all rules
governing resident conduct and responsibilities. The facility is to communicate these
expectations/rights during the period of not more than two weeks before or five working
days after admission, unless medically contraindicated in writing. The facility shall obtain
a signed acknowledgement from the resident, his guardian or other person responsible for
the resident. The acknowledgement is maintained in the resident's medical record.
3004 Appropriate means shall be utilized to inform non-English speaking, deaf, or blind residents
of the residents' rights.
3005 Residents' Rights shall be deemed appropriately signed if:
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.
Residents 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.
Residents capable of understanding but acknowledges with other mark (X): Mark
must be acknowledged by two witnesses.
3006 Staff members must fully understand all residents’ rights.
3007 Facility staff will be provided a copy of residents’ rights. Staff shall complete a written
acknowledgement stating they have received and read the residents' rights. A copy of the
acknowledgement shall be placed in each employee’s personnel file.
3008 The facility's policies and procedures regarding residents' rights and responsibilities will be
formally included in ongoing staff development program for all personnel, including new
employees.
146
R. 06/01/2022
3009 Each resident admitted to the facility will be fully informed, prior to or at the time of
admission, and as need arises during residency, of services available in the facility and any
charges for services. Residents have the right to choose, at their own expense, a personal
physician and pharmacist.
3010 The facility shall make available to all residents a schedule of the kinds of services and
articles provided by the facility. A schedule of charges for services and supplies not
included in the facility's basic per diem rate shall be provided at the time of admission. This
schedule shall be updated should any change be made.
3011 Each resident admitted to the facility shall be fully informed by a physician of his medical
condition. The resident shall be afforded the opportunity to participate in the planning of
his total medical care and may refuse experimental treatment.
3012 Total resident care includes medical care, nursing care, rehabilitation, restorative therapies,
and personal cleanliness in a safe and clean environment. Residents shall be advised by
appropriate professional providers of alternative courses of care and treatments and the
consequences of such alternatives when such alternatives are available.
3013 A resident may be transferred or discharged only for:
a.
Medical reasons;
b.
His welfare or the welfare of other residents;
c.
The resident presents a danger to the safety or health of other residents;
d.
Because the resident no longer needs the services provided by the facility;
e.
Non-payment for his stay; or,
f.
The facility ceases operation.
The resident shall be given reasonable written notice to ensure orderly transfer or
discharge.
3014 The term "transfer" applies to the movement of the resident from facility to another facility.
3015 "Medical reasons" for transfer or discharge shall be based on the resident's needs and are to
be determined and documented by a physician. That documentation shall become a part of the
resident's permanent medical record.
3016 "Reasonable notice of transfer or discharge" means the decision to transfer or discharge a
resident shall be discussed with the resident and the resident will be told the reason(s) and
147
R. 06/01/2022
alternatives available. A minimum of thirty (30) days written notice must be given.
Transfer for the welfare of the resident or other residents may be affected immediately if
such action is documented in the medical record.
3017 An appeals process for residents objecting to transfer or discharge shall be developed by the
facility, in accordance with Ark. Code Ann. § 20-10-1005 as amended. The process shall
include:
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 right
to appeal the decision to the Director within seven (7) calendar days. The resident
must be assisted by the facility in filing the written objection to transfer or
discharge.
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.
3018 The facility shall provide preparation and orientation to resident designed to ensure a safe
and orderly transfer or discharge.
3019 The facility must provide reasonable written notice of change in room or roommate.
3020 Each resident admitted to the facility will be encouraged and assisted to exercise all
constitutional and legal rights as a resident and as a citizen including the right to vote, and
the facility shall make reasonable accommodations to ensure free exercise of these rights.
Residents may voice grievances or recommend changes in policies or services to facility
staff or to outside representatives of their choice, free from restraint, coercion,
discrimination, or reprisal.
3021 Residents shall have the right to free exercise of religion including the right to rely on
spiritual means for treatment.
3022 Complaints or suggestions made to the facility's staff shall be responded to within ten
(10) days. Documentation of such response will be maintained by the facility administrator
or his designee.
3023 Each resident may retain and use personal clothing and possessions as space and rules permit.
3024 A representative resident council shall be established in each facility. The resident council's
duties shall include:
a.
Review of policies and procedures required for implementation of resident rights.
148
R. 06/01/2022
b.
Recommendation of changes or additions in the facility's policies and procedures,
including programming.
c.
Representation of residents in their complaints to the Office of Long Term Care
or any other person or agency.
d.
Assist in identification of problems and orderly resolution of same.
3025 The facility administrator shall designate a staff coordinator and provide suitable
accommodations within the facility for the residents' council. The staff coordinator shall
assist the council in scheduling regular meetings and preparing written reports of meetings
for dissemination to residents of the facility. The staff coordinator may be excluded from
any meeting of the council.
3026 The facility shall inform residents' families of the right to establish a family council within
the facility. The establishment of such council shall be encouraged by the facility. This
family council shall have the same duties and responsibilities as the resident council and
shall be assisted by the staff coordinator designated to assist the resident council.
3027 Each resident admitted to the facility may manage his personal financial affairs, or if the
resident request such affairs be managed by the facility, an accounting shall be maintained
in accordance with applicable rules.
3028 Residents shall be free from mental and physical abuse, chemical and physical restraints
(except in emergencies) unless authorized, in writing, by a physician, and only for such
specified purposes and limited time as is reasonably necessary to protect the resident from
injury to himself or others.
3029 Mental abuse includes humiliation, harassment, and threats of punishment or deprivation.
3030 Physical abuse refers to corporal punishment or the use of restraints as a punishment.
3031 Drugs shall not be used to limit, control, or alter resident behavior for convenience of staff.
3032 Physical restraint includes the use of devices designed or intended to limit residents' total
mobility.
3033 Physical restraints are not to be used to limit resident mobility for the convenience of staff,
as a means of punishment, or when not medically required to treat the resident's medical
symptoms. If a resident's behavior is such that it will result in injury to himself or others
any form of physical restraint utilized shall be in conjunction with a treatment procedure
designed to modify the behavioral problems for which the resident is restrained and only
after failure of therapy designed or intended to modify the threatening behavior.
149
R. 06/01/2022
3034 The facility's written policy and procedures governing the use of restraint shall specify which
staff members may authorize the use of restraints and must clearly specify the following:
a.
Orders shall indicate the specific reasons for the use of restraints.
b.
Use of restraints must be temporary and the resident will not be restrained for an
indefinite or unspecified amount of time.
c.
Application of restraints shall not be allowed for longer than 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 restraints shall be checked at least every thirty (30) minutes by
appropriately trained staff. A written record of this activity shall be maintained in
the resident's medical record. The opportunity for motion and exercise shall be
provided for a period of not less than ten (10) minutes during each two (2) hours in
which restraints are employed, except at night.
e.
Reorder, extensions or re-imposition of restraints shall occur only upon review of
the resident's condition by the physician, and shall be documented in the physician's
progress notes.
f.
The use of restraints shall not be employed as punishment, the convenience of staff,
or a substitute for supervision.
g.
Mechanical restraints must be employed in such manner as to avoid physical injury
to the resident and provide a minimum of discomfort.
h.
The practice of locking residents behind doors or other barriers also constitutes
physical restraint and must conform to the policies and procedures for the use of
restraints.
3035 Each resident is assured confidential treatment of his personal and medical records. Residents
may approve or refuse the release of such records to any individual except in case of a
transfer to another health care institution, or as required by law or third party payment
contract.
3036 Each resident will be treated with consideration, respect, and full recognition of dignity and
individuality, including privacy in treatment and care for personal needs.
3037 Staff shall display respect for residents when speaking with, caring for, or talking about
residents, and shall seek to engage in the constant affirmation of resident individuality and
dignity as a human being.
150
R. 06/01/2022
3038 Schedules of daily activities shall provide maximum flexibility and allow residents to
exercise choice in participation. Residents' individual preferences regarding such things as
menus, clothing, religious activities, friendships, activity programs, and entertainment will
be elicited and respected by the facility.
3039 Residents shall be examined or treated in a manner that maintains and ensures privacy. A
closed door or a drawn curtain shall shield the resident from passers-by. People not
involved in the care of the residents are not to be present during examination or treatment
without the residents' consents.
3040 Privacy will be afforded residents during toileting, bathing, and other activities of personal
hygiene.
3041 Residents may associate or communicate privately with persons of their choice, and may
send or receive personal mail unopened, unless medically contraindicated and documented
by the physician in the medical record.
3042 Policies and procedures shall permit residents to receive visits from anyone they wish;
provided a particular visitor may be restricted for the following reasons:
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.
3043 Decisions to restrict a visitor shall be reviewed and evaluated each time the resident's plan of
care or medical orders are reviewed by the physician or nursing staff, or at the resident's
request.
3044 Accommodations will be provided for residents to allow them to receive visitors in
reasonable comfort and privacy.
3045 Residents are allowed to manage their own personal financial affairs.
3046 Should the facility manage the resident's personal financial affairs, this authorization must be
in writing and shall be signed appropriately as follows:
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
151
R. 06/01/2022
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 with a mark (X) then two witnesses are required.
3047
The facility shall have written policies and procedures for the management of client trust
accounts.
3048 An employee shall be designated to be responsible for resident accounts.
3049 The facility shall establish and maintain a system that assures full and complete
accounting of residents' personal funds using generally accepted accounting principles.
3050
The facility shall not commingle resident funds with any other funds other than resident
funds.
3051 The facility system of accounting includes written receipts for funds received by or
deposited with the facility, and disbursements made to or for the resident.
3052 All personal allowance monies received by the facility are placed in a collective checking
account.
3053 The checking account will be reconciled on a monthly basis.
3054 Any cost incurred for this account shall not be charged to the resident.
3055 Any interest earned from this account shall not be charged to the resident.
3056 When appropriate individual savings accounts shall be opened for residents in accordance
with Social Security rules governing savings accounts.
3057 A cash fund specifically for petty cash shall be maintained in the facility to accommodate
the small cash requirement of residents.
3058 The facility shall, at the resident's request, keep on deposit personal funds over which the
resident has control. Should the resident request these funds, they are given to him on
request with receipts maintained by the facility and a copy to the resident.
3059 The financial record must be available to the resident and his/her guardian, and
responsible party.
3060 If the facility makes financial transactions on a resident's behalf, the resident, guardian, or
responsible party shall receive an itemized accounting of disbursements and current
balances at least quarterly.
3061
A copy of the resident's quarterly statement shall be maintained in the facility.
152
R. 06/01/2022
SYNOPSIS OF RESIDENTS' BILL OF RIGHTS
This facility must ensure and protect the human rights of every individual in residence and to that
end will provide a clean, healthy attractive environment wherein the resident will receive treatment
without discrimination as to race, color, religion, sex, national origin or source of payment. Upon
request, every resident has the right to the name and function of persons providing them service
and the identification of other health care facilities, nursing homes, hospitals and other institutions
that may provide them with service.
THE RESIDENT HAS THE RIGHT TO:
Be fully informed before, or at admission, of his rights and responsibilities as a resident.
Know immediately of any changes or amendments to those rights and responsibilities.
Be fully informed prior to or at admission and during stay, of services available in the facility
and of related charges of services.
Reasonable notice of any changes in the costs or availability of services.
AS A RESIDENT, YOU HAVE THE RIGHT TO:
Choose, at your own expense, a personal physician and pharmacist.
Be fully informed by a physician of your health and medical condition unless the physician
documents in your medical record that such knowledge is contraindicated.
Be given the opportunity to participate in planning your total care and medical treatment.
Be given the opportunity to refuse treatment.
Be given the opportunity to refuse to participate in experimental research.
Receive rehabilitative and restorative therapies.
Be advised by physician or appropriate professional staff of alternative courses of care and
treatments and their consequences.
Receive medical care, nursing care and personal cleanliness in a safe and clean environment.
WELCOME
INFORMATION
MEDICAL CONDITION AND TREATMENT
153
R. 06/01/2022
AS A RESIDENT, YOU ARE ENCOURAGED OR WILL BE ASSISTED TO:
Exercise all constitutional and legal rights as a resident and as a citizen, including the right to
vote.
Voice grievances and recommend changes in nursing home policies and services to facility
staff and to outside representatives of your choice, free from restraint, interference, coercion,
discrimination or reprisal. All complaints and suggestions made to the nursing home must be
responded to.
Exercise your religious beliefs including the right to rely on spiritual means for treatment.
Participate in the Resident Council and be informed of its activities and recommendations to
the facility.
EVERY RESIDENT HAS THE RIGHT TO KNOW:
You will be transferred or discharged only for: medical reasons, for your welfare or that of
others, you no longer need the services, the facility ceases operations, or for non-payment.
Except in emergency the facility must give you a thirty (30) day written notice of transfer or
discharge. You shall be given reasonable notice of change of room or roommate within the
facility.
Transfer and discharge shall be discussed with you and you shall be told the reason and
alternatives that are available.
There is an appeals process for residents objecting to transfer or discharge.
You shall be provided preparation and orientation to ensure a safe and orderly transfer or
discharge.
You shall be given reasonable notice of change of room or roommate change in the facility.
AS A RESIDENT YOU HAVE THE RIGHT TO:
Manage your personal financial affairs, or delegate that management to a responsible party.
Delegate that management or a part thereof to the nursing home and receive at least a
quarterly report of transactions made on your behalf.
EXERCISING RIGHTS
TRANSFER, DISCHARGE, AND CHANGE OF ACCOMMODATION
FINANCIAL AFFAIRS
154
R. 06/01/2022
AS A RESIDENT YOU HAVE THE RIGHT TO BE:
Free from mental and physical abuse (Mental abuse includes humiliation, harassment, and
threats of punishment or deprivation. Physical abuse refers to corporal punishment and the use
of restraints as a punishment.).
Free from chemical and physical restraints except when authorized in writing by a physician
for a specific and limited period of time and only to protect you from injury to yourself or
others.
EVERY RESIDENT HAS THE RIGHT TO:
Considerate and respectful care. Every resident will be treated with consideration, respect and
full recognition of his dignity and individuality.
Privacy during treatment and care of personal needs. People not involved in the care of
residents shall not be present without the consent from the resident during examinations and
treatment.
Know that he is assured confidential treatment of all information contained in his medical
records and that his or his legal appointee's written consent is required for the release of
information to persons not otherwise authorized to receive it.
Know that photographs and interviews shall not be released without written consent of the
resident or his responsible party.
Privacy during visits with spouse.
Share a room, in the case of married residents, unless medically contraindicated by a physician
in writing.
Every resident has the right to refuse work. No resident is required to perform any service for
the nursing home.
AS A RESIDENT, YOU HAVE THE RIGHT TO:
FREEDOM FROM ABUSE AND RESTRAINTS
WORK
ACTIVITIES
155
R. 06/01/2022
Participate in activities of social, religious, and community groups unless medically
contraindicated in writing by your physician.
Refuse to participate in activities.
Be provided a schedule of daily activities that allow flexibility in what you will do and when
you will do it.
Individual preferences regarding such things as food, clothing, religious activities, friendships,
activity programs and entertainment. Such preferences shall be elicited and respected by the
nursing home staff.
EVERY RESIDENT HAS THE RIGHT TO:
Associate and communicate privately with persons of his choice, and send and receive personal
mail unopened unless medically contraindicated and documented by the physician in the
medical record.
Space to receive visitors in reasonable comfort and privacy.
Retain and use personal possessions and clothing as space permits.
IF YOU FEEL YOUR RIGHTS HAVE BEEN VIOLATED BY THE LONG TERM CARE
FACILITY CALL THE OFFICE OF LONG TERM CARE AT 501-682-8430 OR YOUR
LOCAL NURSING HOME OMBUDSMAN AT THE LOCAL AREA AGENCY ON
AGING (LISTED IN YOUR TELEPHONE DIRECTORY) OR THE ADULT
PROTECTIVE SERVICES AT 501-682-8491.
PERSONAL POSSESSIONS
156
R. 06/01/2022
4000
FINES AND SANCTIONS
4001 Definitions
As used in these rules, the following definitions will apply, unless the context requires
otherwise.
a.
"Agency" means the Division of Medical Services.
b.
"Act" means a bodily movement, and includes speech and the conscious
possession or control of property.
c.
The verb "act" means either to perform an act or to omit to perform an act.
d.
"Actor" includes, where appropriate, a person who possesses something or who
omits to act.
e.
"Civil Penalties" are an assessment of financial fines against licensee for
violations of rules.
f.
"Conduct" means an act or omission and its accompanying mental state.
g.
"Department" is the Department of Human Services.
h.
"Director" is the Director of the Office of Long Term Care.
i.
"Element of the offense" means the conduct, the attendant circumstances, and the
result of that conduct that:
1.
Is specified in the definition of the offense; or,
2.
Establishes the kind of culpable mental state required for commission of
the offense; or,
3.
Negates an excuse or justification for the conduct.
j.
"Executive Director" is the Director of the Arkansas Department of Human
Services.
k.
"Facility/Licensee" is a long term care facility which is required to be licensed
under Ark. Code Ann. § 20-10-224.
l.
"Knowingly" means a person acts knowingly with respect to his conduct or the
attendant circumstances when he is aware that his conduct is of that nature or that
such circumstances exist. A person acts knowingly with respect to a result of his
157
R. 06/01/2022
conduct when he is aware that it is practically certain that his conduct will cause
such a result.
m.
"Law" includes statutes and court decisions.
n.
"Negligently" means a person acts negligently with respect to attendant
circumstances or a result of his conduct when he should be aware of a substantial
and unjustifiable risk that the circumstances exist or the result will occur. The risk
must be of such a nature and degree that the actor's failure to perceive it, considering
the nature and purpose of his conduct and the circumstances known to him, involves
a gross deviation from the standard of care that a reasonable person would observe
in the actor's situation.
o.
"Omission" means a failure to perform and act, the performance of which is
required by law.
p.
"Person", "actor", "defendant", "he", or "him" includes any natural person and,
where appropriate, an organization as that term is defined in Ark. Code Ann. § 5-
2-501(1).
q.
"Physical harm or physical injury" means the impairment of physical condition or
the infliction of substantial pain.
r.
"Possess" means to exercise actual dominion, control, or management over a
tangible object.
s.
"Purposely" means a person acts purposely with respect to his conduct or a result
thereof when it is his conscious object to engage in conduct of that nature or to
cause such a result.
t.
"Reasonably believes" or "reasonable belief" means the belief that an ordinary,
prudent man would form under the circumstances in question and one not recklessly
or negligently formed.
u.
“Recklessly” means a person acts recklessly with respect to attendant
circumstances or a result of his conduct when he consciously disregards a
substantial and unjustifiable risk that the circumstances exist or the result will
occur. The risk must be of a nature and degree that disregard thereof constitutes a
gross deviation from the standard of care that a reasonable person would observe
in the actor’s situation.
v.
"Regulation" means:
1.
Any state or federal regulation pertaining to licensure of a long term care
facility.
158
R. 06/01/2022
2.
Any state or federal regulation relating to Title XIX Medicaid certification.
w.
"Serious physical harm" means physical injury that creates a substantial risk of
death or that causes protracted disfigurement, protracted impairment of health, or
loss or protracted impairment of the function of any bodily member or organ.
x.
"Statute" includes the Constitution and any statute of this state, any ordinance of a
political subdivision of this state, and any rule lawfully adopted by an agency of
this state.
y.
"Violation" means:
1.
Class A violations create a condition or occurrence relating to the operation
and maintenance of a long term care facility resulting in death or serious
physical harm to a resident or creating a substantial probability that death
or serious physical harm to a resident will result therefrom.
2.
Class B violations create a condition or occurrence relating to the operation
and maintenance of a long term care facility which directly threatens the
health, safety, or welfare of a resident.
3.
Class C violations shall relate to administrative and reporting requirements
that do not directly threaten the health, safety, or welfare of a resident.
4.
Class D violations shall relate to the timely submittal of statistical and
financial reports to the Office of Long Term Care. The failure to timely
submit a statistical or financial report shall be considered a separate Class
D classified violation during any month or part thereof of noncompliance.
In addition to any civil money penalty which may be imposed, the director
is authorized after the first month of a Class D violation to withhold any
further reimbursement to the long term care facility until the statistical and
financial report is received by the Office of Long Term Care.
4002 Civil Penalties
The following listed civil penalties pertaining to classified violations may be assessed by
the Director against long term care facilities. In the case of Class A violations, the following
civil penalties shall be assessed at the amount outlined in these rules. In the case of Class
B, C, or D violations, the Director, in his discretion, may elect to assess the following civil
penalties or may allow a specified period of time for correction of said violation.
a.
Class A violations are subject to a civil penalty not to exceed two thousand five
hundred dollars ($2,500) for the first violation. A second Class A violation
occurring within a six-month period from the first violation shall result in a civil
159
R. 06/01/2022
penalty of five thousand dollars ($5,000). The third Class A violation occurring
within a six-month period from the first violation shall result in proceedings being
commenced for termination of the facility's Medicaid agreement and may result in
proceedings being commenced for revocation of the licensure of the facility.
b.
Class B violations are subject to a civil penalty not to exceed one thousand dollars
($1,000). A second Class B violation occurring within a six-month period shall be
subject to a civil penalty of two thousand dollars ($2,000). A third Class B violation
occurring within a six-month period from the first violation shall result in
proceedings being commenced for termination of the facility's Medicaid agreement
and may result in proceedings being commenced for revocation of the licensure of
the facility. All Class B violations shall be based on a point system as contained in
these rules.
c.
Class C violations are subject to a civil penalty not to exceed five hundred dollars
($500) for each violation. Each subsequent Class C violation within a six-month
period from the first violation shall subject the facility to a civil money penalty
double that of the preceding violation until a maximum of one thousand dollars
($1,000) per violation is reached. All Class C violations shall be based on a point
system as contained in these rules.
d.
Class D violations are subject to a civil penalty not to exceed two hundred fifty
dollars ($250) for each violation. Each subsequent Class D violation occurring
within a six-month period from the first violation shall subject the facility to a civil
penalty double that of the preceding violation until a maximum of five hundred
dollars ($500) is reached. All Class D violations shall be based on a point system
as contained in these rules.
e.
In no event may the aggregate civil penalties assessed for violations in any one (1)
month exceed five thousand dollars ($5,000).
4003 Factors in Assessment of Civil Penalties
In determining whether a civil penalty is to be assessed and in affixing the amount of the
penalty to be imposed, the Director shall consider:
a.
The gravity of the violation including the probability that death or serious physical
harm to a resident will result or has resulted;
b.
The severity and scope of the actual or potential harm;
c.
The extent to which the provisions of the applicable statutes or rules were violated;
d.
The "good faith" exercised by the licensee. Indications of good faith include, but
are not limited to:
160
R. 06/01/2022
1.
Awareness of the applicable statutes and rules and reasonable diligence in
securing compliance;
2.
Prior accomplishments manifesting the licensee's desire to comply with the
requirements;
3.
Efforts to correct; and,
4.
Any other mitigating factors in favor of the licensee.
e.
Any relevant previous violations committed by the licensee; and,
f.
The financial benefit to the licensee of committing or continuing the violation.
The Director shall assign value points to conditions or occurrences and said value points
shall represent a base to which the above considerations shall be applied by the Director
prior to assessment of monetary civil penalty. Each value point shall represent a base
assessment of one dollar ($1.00).
4004 Right to Assess Civil Penalties not Merged in Other Remedies
Assessment of a civil penalty provided in this section shall not affect the right of the Office
of Long Term Care to take other such action as may be authorized by law or regulation.
4005 Class A Violations
a.
Class A violations are:
1.
Violations which create a condition or occurrence relating to the operation
and maintenance of a long term care facility which results in death or serious
harm to a resident; or,
2.
Violations which create a condition or occurrence relating to the operation
and maintenance of a long term care facility which creates a substantial
probability that death or serious physical harm to a resident will result from
the violation.
b.
The following Class A violations and the points assigned to each are provided and
are subject to the conditions set out in Section 4003:
1.
Death of a Resident (2,500)
Any condition or occurrence relating to the operation of a long-term care
facility in which the conduct, act or omission of a person or actor
161
R. 06/01/2022
purposely, knowingly, recklessly or negligently results in the death of a
resident shall be a Class A violation.
2.
Serious Physical Harm to a Resident (2,500)
Any condition or occurrence relating to the operation of a long term care
facility in which the conduct, act or omission of a person or actor purposely,
knowingly, recklessly or negligently results in serious physical harm to a
resident shall be a Class A violation.
3.
Probability of Death or Serious Physical Harm
The following conduct, acts or omissions, when not resulting in death or
serious physical harm, but which create a substantial probability that death
or serious physical harm to a resident will result therefrom are conditions or
occurrences relating to the operation of a long term care facility which are
Class A violations.
A
Poisonous Substances
Two thousand five hundred (2,500) points shall be assigned when a
facility fails to provide proper storage of poisonous substances.
B
Falls by Residents
One thousand five hundred (1,500) points shall be assigned when a
facility fails to maintain require direct care staffing, or a safe
environment and this failure directly causes a fall by a resident.
(Examples: equipment not properly maintained, or a fall due to
personnel not responding to patient requests for assistance.)
C
Assaults
Two thousand five hundred (2,500) points shall be assessed when a
facility fails to maintain required direct care staffing or measures are
not taken when it is known that a resident is combative and
assaultive with other residents, and this failure causes an assault
upon a resident of the facility by another resident. A Class A
violation shall also exist when a facility fails to perform adequate
screening of personnel and this failure causes an assault upon a
resident by an employee of the facility.
D
Permanent Injury to an Extremity
Two thousand two hundred fifty (2,250) points shall be assigned
when a facility personnel improperly apply physical restraints
162
R. 06/01/2022
contrary to published rules or fail to check and release restraints as
directed by physician's orders or rules.
E
Nosocomial Infection
Two thousand five hundred (2,500) points shall be assigned when a
facility does not follow or meet nosocomial infection control
standards as outlined by rules or as ordered by the physician.
F
Medical Services
Two thousand five hundred (2,500) points shall be assigned when a
facility fails to secure proper medical assistance or orders from a
physician.
G
Decubitus Ulcers
Two thousand five hundred (2,500) points shall be assigned when a
facility does not take decubitus ulcer measures as ordered by the
physician and such failure results in death or serious injury to a
resident, or facility personnel fail to notify the physician of such
ulcers.
H
Treatments
Two thousand five hundred (2,500) points when facility personnel
perform treatment(s) contrary to a physician's order and such
treatment results in death or serious injury to the resident.
I
Medications
Two thousand five hundred (2,500) points shall be assigned when
facility personnel knowingly withhold medication from a resident as
ordered by a physician and such withholding of medication(s)
results in death or serious injury to a resident, or the facility
personnel fail to order and/or stock medication(s) prescribed by the
physician and the failure to order and/or stock medication(s) results
in death or serious injury to the resident.
J
Elopement
One thousand eight hundred and fifty (1,850) points shall be
assigned when a facility does not provide necessary supervision of
residents to prevent a resident from wandering away from the facility
and such failure results in death or serious injury to a resident, or a
facility does not provide adequate measures to ensure
163
R. 06/01/2022
that residents with an elopement history do not wander away from
the facility. (Examples of preventative measures include but are not
limited to documentation that an elopement history has been
discussed with the family of the resident, alarms have been placed
on exit doors, personnel have been trained to make additional efforts
to watch the resident with such history, and the physician of such a
resident has been made aware of such history.)
K
Failure to Provide Heating or Air Conditioning
Two thousand five hundred (2,500) points shall be assigned when a
facility fails to reasonably maintain its heating and air conditioning
system as required byrule . Isolated incidents of breakdown or power
failure shall not be considered a Class A violation under this section.
L
Natural Disaster/Fire
Two thousand (2,000) points shall be assigned when a facility does
not train staff in fire/disaster procedures as required by rules or when
staffing requirements are not met.
M
Life Safety Code System
Two thousand five hundred (2,500) points shall be assigned when a
facility fails to maintain the required life safety code systems.
Isolated incidents of breakdown shall not be considered a Class A
violation under this section if the facility has immediately notified
the Office of Long Term Care upon discovery of the problem and
has taken all necessary measures to correct the problem.
4006 Class B Violations
a.
The following conduct, acts or omissions, when not resulting in death or serious
physical harm to a resident, or the substantial probability thereof, but creates a
condition or occurrence relating to the operation and maintenance of a long term
care facility which directly threatens the health, safety or welfare of a resident.
1.
Nursing Techniques
One thousand (1,000) points shall be assigned when:
A.
Medications or treatments are improperly administered or withheld
by nursing personnel.
164
R. 06/01/2022
B.
There is a failure to feed residents who are unable to feed
themselves.
C.
There is a failure to change or irrigate catheters as ordered by a
physician or use irrigation sets and solutions which are outdated or
not protected from contamination.
D.
There is a failure to obtain physician orders for the use, type and
duration of restraints, or the improper application of a physical
restraint, or failure of facility personnel to check and release the
restraint as specified in rules.
E.
Staff knowingly fails to answer call lights.
F.
There is a failure to turn or reposition residents as ordered by a
physician or as specified in regulation.
G.
There is a failure to provide rehabilitative nursing as ordered by a
physician or as specified in regulation.
2.
Poisonous Substances
Seven hundred and fifty (750) points shall be assigned when a facility fails
to provide proper storage of poisonous substances and this failure threatens
the health, safety, or welfare of a resident.
3.
Falls by Residents
Seven hundred and fifty (750) points shall be assigned when a facility fails
to maintain required direct care staffing, or a safe environment and this
failure directly threatens the health, safety, or welfare of a resident.
4.
Assaults
One thousand (1,000) points shall be assigned when a facility fails to
maintain required direct care staffing or measures are not taken when it is
known that a resident is combative and assaultive with other residents and
these measures threaten the health, safety, or welfare of a resident.
5.
Improper Use of Restraints
One thousand (1,000) points shall be assigned when facility personnel apply
physical restraints contrary to published rules or fail to check and release
restraints as directed by physician's order or rules and such failure threatens
the health, safety, or welfare of a resident.
165
R. 06/01/2022
6.
Medical Services
One thousand (1,000) points shall be assigned when a facility fails to secure
proper medical assistance or orders from a physician and this failure
threatens the health, safety, or welfare of a resident.
7.
Decubitus Ulcers
One thousand (1,000) points shall be assigned when a facility does not take
decubitus ulcer measures as ordered by the physician and such failure
threatens the health, safety, or welfare of a resident, or facility personnel
fail to notify the physician of such ulcers and this failure threatens the
health, safety, or welfare of a resident.
8.
Treatments
One thousand (1,000) points shall be assigned when facility personnel
perform treatments contrary to a physician's order and such treatment
threatens the health, safety, or welfare of a resident.
9.
Medications
One thousand (1,000) points shall be assigned when facility personnel
withhold physician ordered medication(s) from a resident and such
withholding threatens the health, safety, or welfare of a resident, or facility
personnel fail to order or stock medication(s) prescribed by the physician
and this failure threatens the health, safety, or welfare of a resident.
10.
Elopement
One thousand (1,000) points shall be assigned when a facility does not
provide necessary supervision of residents to prevent a resident from
wandering away from the facility and such failure threatens the health,
safety, or welfare of a resident, or a facility does not provide adequate
measures to ensure that residents with a history of elopement do not wander
away from the facility and such failure threatens the health, safety, or
welfare of a resident.
11.
Food on Hand
One thousand (1,000) points shall be assigned when there is an insufficient
amount of food on hand in the facility to meet the menus for the next twenty-
four (24) hour period and this failure threatens the health, safety, or welfare
of a resident.
12.
Nursing Equipment/Supplies
166
R. 06/01/2022
One thousand (1,000) points shall be assigned if equipment and supplies to
care for a resident as ordered by a physician are not provided, or if the
facility does not have sufficient equipment and supplies for residents as
specified by rule and these conditions threaten the health, safety, or welfare
of a resident or residents.
13.
Falls
Seven hundred and fifty (750) points shall be assigned when it is determined
that falls occurred in a facility as a result of the facility's failure to maintain
required direct care staffing or a safe environment as set forth in rule and
this failure threatens the health, safety, or welfare of a resident.
14.
Call System
One thousand (1,000) points shall be assigned when a facility fails to
maintain a resident call system or the call system is not functioning for a
period of twenty-four (24) hours. If call system cords are not kept within
reach of resident then it will be determined that the facility has failed to
maintain a resident call system and this failure threatens the health, safety,
or welfare of a resident.
15.
Heating and Air Conditioning
One thousand (1,000) points shall be assigned when a facility fails to
maintain its heating and air conditioning system as required by rule and such
failure threatens the health, safety, or welfare of a resident. Isolated
incidents of breakdown or power failure shall not be considered a Class B
violation under this section.
16.
Dietary Allowance
Seven hundred and fifty (750) points shall be assigned when it is determined
that the minimum dietary needs of a resident are not being met as ordered
by the physician.
17.
Resident Rights
Seven hundred fifty (750) points shall be assigned when facility personnel
fail to inform a resident of his Resident Rights as outlined in rule, or facility
personnel fail to allow a resident to honor or exercise any of his rights as
outlined in regulation or statute.
18.
Sanitation
167
R. 06/01/2022
Seven hundred and fifty (750) points shall be assigned when it is determined
that rules relating to sanitation are not met.
19.
Administrator
Seven hundred fifty (750) points shall be assigned when it is determined
that a facility does not have a licensed administrator as required by
regulation.
20.
Director of Nurses
Seven hundred and fifty (750) points shall be assigned when it is determined
that a facility does not have a Director of Nursing (DON) as required by
regulation for five or more consecutive days.
4007 Class C Violations
a.
Class C violations are related to administrative and reporting requirements that do
not directly threaten the health, safety, or welfare of a resident.
b.
The following examples of Class C violations and the points assigned to each are
provided for illustrative purposes and are subject to the conditions set out in
Section 4003.
1.
Quarterly Staffing Reports
Three hundred and fifty (350) points shall be assigned when a facility does
not submit quarterly staffing reports within ten (10) days following the
deadline given for submission of these reports.
2.
Overbedding
Five hundred (500) points shall be assigned when a facility is found to
exceed their licensed bed capacity.
3.
False Reporting
Five hundred (500) points shall be assigned when it has been determined
that a report, physician orders, nurses notes, or other documents or records
which the facility is required to maintain has been intentionally falsified.
4.
Resident Trust Funds
Five hundred (500) points shall be assigned when it is determined that the
facility's records reflect that resident trust funds have been
168
R. 06/01/2022
misappropriated by facility personnel or if the resident has been charged for
items for which the facility must provide at not cost to the resident.
5.
Denied Access to Facility
Five hundred (500) points shall be assigned when it is determined that
personnel from the Arkansas Department of Human Services, the United
States Department of Health and Human Services, or any other agency
personnel authorized to have access to any long term care facility have been
denied access to the facility, or any facility document or record.
6.
Reporting of Unusual Occurrences/Accidents
Five hundred (500) points shall be assigned when it has been determined
that any facility did not report any unusual occurrences or accidents in a
timely manner as mandated by rule.
7.
Posting of Survey Results
Five hundred (500) points shall be assigned when it has been determined
that a facility failed to post, in the appropriate manner, the results of any
survey, sanction, or survey/sanction cover letter issued by the Department.
8.
Residents' Council
Five hundred (500) points shall be assigned when a facility fails to comply
with the establishment and operation of a Residents' Council as defined by
rule or statute.
4008 Class D Violations
a.
Class D violations are defined as the failure of any long term care facility to submit
in a timely manner a statistical or financial report as required by rule.
b.
All Class D violations shall be assigned two hundred and fifty (250) points.
4009 Notification of Violations
a.
If upon inspection or investigation the Office of Long Term Care determines that a
licensed long term care facility is in violation of any sanction rule herein described,
any federal or state law or regulation, then it shall promptly serve by certified mail
or other means that gives actual notice, a notice of violation upon the licensee when
the violation is a classified violation as described in Ark. Code Ann. § 20-10-205.
169
R. 06/01/2022
b.
Each notice of violation shall be prepared in writing and shall specify the exact
nature of the classified violation, the statutory provision or specific rule alleged to
have been violated, the facts and grounds constituting the elements of the
classification, and the amount of the civil penalty assessed by the Director, if any.
c.
The notice of violation issued to a long term care facility by the Director of the
Office of Long Term Care shall be classified according to the nature of the violation
and shall indicate the classification on the face thereof as follows.
d.
The notice shall also inform the licensee of the right to a hearing under Ark. Code
Ann. § 20-10-208 when civil penalties are imposed, and the right to a hearing under
Ark. Code Ann. § 20-10-303 with regards to licensure and certification.
The request for a hearing under Ark. Code Ann. § 20-10-208 must be received by
the Executive Director of the Arkansas Department of Human Services within ten
(10) working days after receipt by the facility of the Notice of Violation.
The request for a hearing under Ark. Code Ann. § 20-10-303 must be in writing
and must be submitted to the chairman of the Long Term Care Facility Advisory
Board.
e.
The Department shall provide a fair and impartial hearing officer for appeals.
4010 Hearings on the Imposition of Civil Money Penalties
a.
A licensee may contest the imposition of civil penalty by sending a written request
for hearing to the Executive Director of the Arkansas Department of Human
Services who shall designate a Hearing Officer to preside over the case and make
findings of fact and conclusions of law in the form of a recommendation to the
Executive Director of the Arkansas Department of Human Services.
b.
The Executive Director of the Arkansas Department of Human Services shall
review the case and make the final determination or remand the case to the Hearing
Officer for further findings of law or facts.
c.
The request for hearings must be received by the Executive Director of the Arkansas
Department of Human Services within ten (10) working days after receipt by the
facility of the Notice of Violation.
d.
The Hearing Officer shall commence the hearing within forty-five (45) days of
receipt of the request for hearing.
e.
The Executive Director of the Arkansas Department of Human Services shall issue
a final decision within ten (10) working days after the close of the hearing.
170
R. 06/01/2022
f.
Assessments shall be delivered to the Office of Long Term Care within ten (10)
working days of the receipt of the Notice of Violation or within ten (10) working
days of receipt of the final determination by the Executive Director of the Arkansas
Department of Human Services in contested cases. Checks should be made payable
to the State of Arkansas.
g.
Facilities failing to pay duly assessed civil penalties shall be subject to a
corresponding reduction in succeeding Medicaid vendor payment or initiation of
proceedings to revoke the facility's license or both.
h.
All monies collected by the licensing agency pursuant to these rules shall be
deposited in the Long Term Care Trust Fund as specified in Ark. Code Ann. § 20-
10-205.
4011 Denial of Admissions
a.
The Director may deny Medicaid payment for new admissions to a long term care
facility issued a Class A or B violation until such time the Director determines that
such facility has corrected the violation and is in substantial compliance with all
applicable rules.
b.
If a denial of payment is place into effect, the Director shall notify the Administrator
of the facility in writing by certified mail or other means which gives actual notice,
that denial of payment for new admissions shall continue until the Director makes
a determination that the facility has corrected the violation and is in substantial
compliance with all applicable rules.
c.
The facility may request an immediate hearing by sending a written request to the
Executive Director of the Arkansas Department of Human Services. The
Department shall provide a fair and impartial Hearing Officer within ten (10) days
of receipt of such request.
171
R. 06/01/2022
APPENDIX A
RULES OF ORDER FOR ALL APPEALS BEFORE THE LONG TERM CARE
FACILITY ADVISORY BOARD
1.
The Long Term Care Facility Advisory Board shall hear all appeals by licensed long term
care facilities, long term care administrators, or other parties regulated by the Office of
Long Term Care with regards to licensure and certification under the authority of Section
II of Act 58 of 1969 as amended by Act 28 or 1979 (Ark. Stat. Ann §82-2211).
2.
All appeals shall be made in writing to the Chairman of the Board within thirty (30) days
of receipt of notice of intended action. The notice shall include the nature of intended
action, rule allegedly violated, and the nature of the evidence supporting allegation and set
forth with particularity asserted basis for the appeal with supporting documentation
attached and set forth with particularity those asserted violations, discrepancies, and dollar
amounts which the appellant contends are in compliance with all rules.
3.
Appeals must be heard by the Board within sixty (60) days following date of Chairman's
receipt of written appeal unless otherwise agreed by both parties. The Chairman shall notify
the party or parties of the date, time, and place of the hearing at least seven (7) working
days prior to the hearing date.
4.
Preliminary motions must be made in writing and submitted to the Chairman and/or hearing
officer with service to opposing party at least three (3) days prior to hearing date unless
otherwise directed by the Chairman of hearing officer.
5.
All papers filed in any proceeding shall be typewritten on white paper using one side of the
paper only and will be double-spaced. They shall bear a caption clearly showing the title
of the proceeding in connection with which they are filed together with the docket number
if any. All papers shall be signed by the party or his authorized representative or attorney
and shall contain his address and telephone number. All papers shall be served either on
the Legal Department of Social Services, the attorney for the party, or if no attorney for the
party, service shall be made on the party.
6.
The Chairman of the Board shall act as Chairman in all 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 and/or Board may request legal
counsel and staff assistance in the conduct of the hearing and in the formal preparation of
their decision.
7.
A majority of the members of the Board shall constitute a quorum for all appeals.
8.
If the appellant fails to appear at a hearing, the Board may dismiss the hearing and render
a decision based on the evidence available.
9.
Any dismissal may be rescinded by the Board if the appellant makes application to the
Chairman in writing within ten (10) calendar days after the mailing of the decision,
172
R. 06/01/2022
showing good cause for his failure to appear at the hearing. All parties shall be notified
in writing of an order granting or denying any application to vacate a decision.
10.
Any party may appear at the hearing and be heard through an attorney at law or through a
designated representative. All persons appearing before the Board shall conform to the
standards of conduct practiced by attorneys before the courts of the State.
11.
Each party shall have the right to call and examine parties and witnesses; to introduce
exhibits; to question opposing witnesses and parties on any matter relevant to the issued;
to impeach any witness regardless of which party first called him to testify; and to rebut
the evidence against which party first called him to testify; and to rebut the evidence against
him.
12.
Testimony shall be taken only on oath or affirmation under penalty of perjury.
13.
Irrelevant, immaterial, and unduly repetitious evidence shall be excluded. Any other oral
or documentary evidence, not privileged, may be received if it is of a type commonly relied
upon by reasonably prudent men in the conduct of their affairs. Objections to evidentiary
offers may be made and shall be noted of record. When a hearing will be expedited, and
the interests of the parties will not be substantially prejudiced, any part of the evidence may
be received in written form.
14.
The Chairman or hearing officer shall control the taking of evidence in a manner best suited
to ascertain the facts and safeguard the rights of the parties. The Office of Long Term Care
shall present its case first.
15.
A party shall arrange for the presence of his witnesses at the hearing.
16.
Any member of the Board may question any party or witness.
17.
A complete record of the proceedings shall be made. A copy of the record may be
transcribed and reproduced at the request of a party to the hearing provided he bears the
cost thereof.
18.
Written notice of the time and place of a continued or further hearing shall ge given, except
that when a continuance or further hearing is ordered during a hearing, oral notice of the
time and place of the hearing may be given to each party present at the hearing.
19.
In addition to these rules, the hearing provisions of the Administrative Procedure Act (Ark.
Stat. Ann §5-701 et. seq.) shall apply.
20.
At the conclusion of testimony and deliberations by the Board, the Board shall vote on
motions for disposition of the appeal. After reaching a decision by majority vote, the Board
may direct that findings of fact and conclusions of law be prepared to reflect the Board's
recommendations to the Commissioner of Social Services. At this discretion and for good
cause the Commissioner of Social Services shall have the right to accept, reject or modify
a recommendation, or to return the recommendation to the Board for further consideration
for a more conclusive recommendation. All decisions shall be based on
173
R. 06/01/2022
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 Commissioner of Social
Services shall be rendered in writing to the appellant.
21.
All decisions of the Commissioner may be reviewed by a court of competent jurisdiction
as provided under the Administrative Procedure Act.
