Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-036 - Daily Staffing Log for Nursing Facilities

Current through Register Vol. 49, No. 6, June, 2024
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 Chief
				Administrative Officer in the Office of Long Term Care
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 Medical Services.
Drug
means (a) articles recognized in
				the Official United States Pharmacopeia, Official Homepathic Pharmacopeia of
				the United States, or Official National Formulary, or any supplement to any of
				them; and (b) articles intended for use in the diagnosis, cure mitigation,
				treatment, or prevention of disease in man or other animal; and (c) articles
				(other than food) intended to affect the structure or any function of the body
				of man or other animals; and (d) articles specified in clause (a), (b) or (c);
				but does not include devices or their components, parts or accessories.
Drug Administration
is an act
				restricted to nursing personnel as defined in Nurses Practice Act 432 or 1971,
				in which a single dose of a prescribed drug or biological is given to a
				patient. This activity includes the removal of the dose from a previously
				dispensed, properly labeled container, verifying it with the prescriber's
				orders, giving the individual dose to the proper patient, and recording the
				time and dose given.
Drug Dispensing
is an act restricted
				to a pharmacist which involves the issuance of one or more doses of a
				medication in a container other than the original, with such new containers
				being properly labeled by the dispenser as to content and/or directions for use
				as directed by the prescriber. This activity also includes the compounding,
				counting, and transferring of medication from one labeled container to
				another.
Existing Facilities
are those
				facilities which were in operation, or those proposed facilities which began
				construction or renovation of a building under final plans approved by the
				Division prior to adoption of these regulations.
Fire Resistance Rating
shall mean the
				time in hours or fractions thereof that materials or their assemblies will
				resist fire exposure as determined by fire test conducted in accordance with
				recognized standards.
Governing Body
shall mean the
				individuals or group in whom the ultimate authority and legal responsibility is
				vested for conduct of the nursing home.
Institution
is any facility requiring
				licensure under these regulations.
Intermediate Care Facility (ICF)
is a
				nursing home licensed by Arkansas Social Services as meeting the Intermediate
				Care Facility regulations. It is a health facility or a distinct part of a
				hospital or Skilled Nursing Facility staffed, organized, operated, and
				maintained to provide 24hour long term inpatient care and other restorative
				services under nursing supervision.
Legend Drugs
are drugs, which because
				of their toxicity or other potentiality for harmful effect, or the method of
				their use, or the collateral measures necessary to their use, are not safe for
				use except under the supervision of a practitioner licensed by law to
				administer such drugs, or shall be dispensed only on prescription by the
				pharmacist. Such drugs bear the label "Caution: Federal Law Prohibits
				Dispensing Without Prescription."
License
shall mean the basic document
				issued by the Division permitting the operation of nursing homes. This document
				constitutes the authority to receive patients and to perform the services
				included within the scope of these regulations.
Licensed Bed Capacity
shall mean the
				exact number of beds for which license application has been made and
				granted.
Licensee
shall mean any state,
				municipality, political subdivision, institution, public, or private
				corporation, association, individual, partnership or any other entity to whom a
				license is issued for the purpose of operating the nursing home, who shall
				assume primary responsibility for complying with approved standards for the
				institution.
New Construction
means those
				facilities which are constructed or renovated for the purpose of operating an
				institution according to architectural plans approved by the Division
				subsequent to adoption of these rules.
Nursing Home
shall mean and be
				construed to include any buildings, structure, agency, institution, or other
				place for the reception, accommodation, board, care, or treatment of two or
				more unrelated individuals, who, because of physical or mental infirmity are
				unable to sufficiently or properly care for themselves, and for which
				reception, accommodation, board, care, and treatment, a charge is made,
				provided the term "Nursing Home" shall not include the offices of private
				physicians and surgeons, boarding homes, or hospitals, or institutions operated
				by the Federal Government. (Section 2, Act 141 of 1961 as amended)
Nursing Home Classification
shall mean
				the level of care the nursing home is capable of rendering such as Skilled
				Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility
				for the Mentally Retarded.
Long Term Care Facility Advisory Board
shall mean the Long Term Care Facility Advisory Board as established under Act
				28 of 1979.
O.T.C. Drugs are commonly referred to as "over-the-counter," or
				patient medication that may be provided without prescription.
Patient
(interchangeable with
				resident) shall mean any individual who is being treated by a physician or
				whose health is being supervised by a physician while residing within the
				respective facility.
Patient Unit
is an area designated to
				accommodate an individual patient bed, bedside cabinet, chair, reading light,
				and other necessary equipment placed at the bedside for the proper care and
				comfort of a patient.
Provisional Licensure
is a temporary
				grant of authority to the purchaser to operate an existing long-term care
				facility upon application for licensure to the Office of Long Term Care.
Restorative Nursing or Rehabilitative
				Nursing
shall mean measures directed toward prevention of
				deterioration in normal body alignment, and muscle tone, restoration of the
				resident to full activity insofar as his or her health problems permit and
				maintaining a state in which his or her total need for care is minimal.
Restraint
is any device or instrument
				used to limit, restrict, or hold patients under control, not including safety
				vests or other instruments such as bed rails used for the safety and
				positioning of patients. Personal safety devices and postural support devices
				that restrict movement are considered restraints.
Sanitation
is the process of promoting
				hygiene and preventing disease by maintaining sanitary conditions.
Skilled Nursing Facility (SNF)
is a
				nursing home, or a distinct part of another facility, licensed by the Office of
				Long Term Care as meeting the skilled nursing facility licensure regulations. A
				health facility which provides skilled nursing care and supportive care on a
				24-hour basis to residents whose primary need is for availability of skilled
				nursing care on an extended basis.
Qualified Social Worker
is a person
				who is registered by the State Board of Social Work and is a graduate of a
				school of social work accredited or approved by the council on Social Work
				Education.
State Health Officer
shall mean the
				Director of the Arkansas Department of Health, Secretary of the State Board of
				Health.
Sterile
the state of being free from
				all forms of micro-organisms.
Unit Dose Medication System
shall mean
				a system in which single doses of drugs are prepackaged and pre-labeled in
				accordance with all applicable laws and regulations governing these practices
				and made available separated by resident and by dosage time. The system
				includes all equipment and records deemed necessary and used in making the
				doses available to the resident in an accurate and safe manner. A pharmacist
				shall be in charge of and responsible for the system.
Guardian
shall mean a court appointed
				person who by law is responsible for a patient's affairs.
Responsible Party
shall mean the
				person who is accountable for the patient's affairs but who has not been
				appointed by the court.
Routine
means the regular performance
				of a particular task.
Abbreviations
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 regulations 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
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 ($0.10) per patient bed, or Ten Dollars ($10),
				whichever is greater. This fee shall be paid to the State Treasury. If the
				license is denied, the fee will be returned to the applicant. Facilities
				operated by any unit or division of state or local government shall be exempted
				from payment of a licensing fee. Application shall be signed by the owner if
				individually owned, by one partner if owned under partnership, by two officers
				of the board if operated under corporation, church or non-profit association,
				and incase of a governmental unit, by the head of the governmental entity
				having jurisdiction over it. Applicants shall set forth the full name and
				address of the institutions for which license is sought, the names of the
				persons in control, a signed statement by a registered nurse indicating
				responsibility for nursing services of the home, and such other information as
				the Division may require.
In these instances where a distinct part of a facility is to be
				licensed as a Skilled Nursing Facility and the remainder of the facility is to
				be licensed under some other category,
separate applications must
				be filed for each license and separate licensure fees fill be required with
				each application.
Each home applying for and receiving a license must furnish the
				following information:
* The identity of each person directly or indirectly having an
				ownership interest of five (5) percent or more in such nursing home.
* In case such nursing home is organized as a corporation, the
				identify of each officer and director of the corporation.
* In case such nursing home is organized as a partnership, the
				identity of each partner.
* Identity of owners of building and equipment leased including
				ownership breakdown of leasing entity.
203
RENEWAL OF APPLICATION FOR
			 LICENSURE
Application for annual license renewal shall be postmarked no
				later than January 2nd of the succeeding calendar
				year. License applications for existing institutions shall be subject to a
				penalty of one dollar ($1) per day after January 2nd
				of the succeeding year.
204
ISSUANCE OF LICENSE
License shall be effective on a calendar year basis and shall
				expire on December 31st of each year. License shall
				be issued only for the premises and persons in the application and shall not be
				assignable or transferable.
205
DENIAL, REVOCATION, OR SUSPENSION
			 OF LICENSE
The Division is empowered to deny, suspend, or revoke licenses
				on any of the following grounds:
205.1
			 Violation of any of the provisions of Act 28 of 1979 or the rules and
			 regulations 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 regulations.
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 regulations.
205.4 Failure to comply with the provisions
			 of Act 58 or 1969 and the rules and regulations promulgated thereunder. (Note:
			 The aforementioned act requires the licensure of nursing home
			 administrators.)
206
NOTICE AND PROCEDURE ON HEARING PRIOR TO DENIAL, SUSPENSION, OR
			 REVOCATION OF LICENSE
Whenever the Division decides to deny, suspend, or revoke a
				license, it shall send to the applicant or licensee a notice stating the
				reasons for the action by certified mail. The applicant or licensee may appeal
				such notice to the Long Term Care Facility Advisory Board as permitted by
				Arkansas Statute Annotated §82-211. Procedures for appeal to the Long Term
				Care Facility Advisory Board are incorporated in these regulations as Appendix
				A.
207
APPEALS TO
			 COURTS
Any applicant or licensee who considers himself injured in his
				person, business, or property by final agency action shall be entitled to
				judicial review thereof. Proceedings for review shall be made by filing a
				petition in the Circuit Court of any county in which the petitioner does
				business or in the Circuit Court of Pulaski County within thirty (30) days
				after service upon the petitioner of the agency's final decision. All petitions
				for judicial review shall be in accordance with the Administrative Procedures
				Act Arkansas Statute Annotated §5-713.
208
PENALTIES
Any person, partnership, association, or corporation,
				establishing, conducting, managing, or operating any institution within the
				meaning of this act (§§ 82-327 -- 82-354), without first obtaining a
				license therefor as herein provided, or who violates any provision of this act
				or regulations lawfully promulgated hereunder shall be guilty of a misdemeanor,
				and upon conviction thereof shall be liable to a fine of not less than
				Twenty-Five Dollars ($25) nor more than One-Hundred Dollars ($100) for the
				first offense and not less than One-Hundred Dollars ($100) nor more than
				Five-Hundred Dollars ($500) for each subsequent offense, and each day such
				institution shall operate after a first conviction shall be considered a
				subsequent offense. (Section 27, Act 414 of 1961)
209
INSPECTION
All institutions to which these rules and regulations apply
				shall be subject to inspection for reasonable cause at any time by the
				authorized representation of the Division.
210
COMPLIANCE
An initial license will not be issued until the applicant has
				demonstrated to the satisfaction of the Division that the facility is in
				substantial compliance with the licensing standards set forth in these
				regulations.
211
NONCOMPLIANCE
When noncompliance of the licensing standards are detected
				during surveys, licensees will be notified of the violations and will be
				requested to provide a plan of correction with a timetable for corrections. If
				an item of noncompliance is of a serious nature that affects the health and
				safety of patients and is not promptly corrected, action will be taken to
				suspend or revoke the facility's license.
212
VOLUNTARY CLOSURE
Any nursing home, or related institution, that voluntarily
				closes must meet the regulations for new construction to be eligible for
				re-licensure.
213
EXCEPTION TO LICENSING STANDARDS
The Division reserves the right to make temporary exceptions to
				these standards where it is determined that the health and welfare of the
				community requires the services of the institution. Exceptions will be limited
				to unusual circumstances and the safety and well-being of the residents will be
				carefully evaluated prior to making such exceptions.
Overbeds will be authorized only in cases of emergency. An
				emergency exits when it can be demonstrated that the resident's health or
				safety would be placed in immediate jeopardy if relocation were not
				accomplished. A fire, natural disaster (e.g., tornado, flood, etc.) or other
				catastrophic event that necessitates resident relocation will be considered an
				emergency. The Office of Long Term Care must be contacted for prior
				authorization of the overbed, and all authorizations must be in writing.
214
PROVISIONAL
			 LICENSURE
Subject to the requirements below, a provisional license shall
				be issued to the Applicant and new operator of the long-term care facility when
				the Office of Long Term Care has received the Application for Licensure to
				Conduct a Long Term Care Facility. A provisional license shall be effective
				from the date the Office of Long-Term Care provides notice to the Applicant and
				new operator, until the date the long-term care license is issued. With the
				exception of Medicaid or Medicare provider status, a provisional license
				confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
1. The purchaser and the seller of the
			 long-term care facility shall provide the Office of Long Term Care with written
			 notice of the change of ownership at least thirty (30) days prior to the
			 effective date of the sale.
2. The
			 Applicant and new operator of the long-term care facility shall provide the
			 Office of Long Term Care with the application for licensure, including all
			 applicable fees.
3. The Applicant
			 and new operator of the long-term care facility shall provide the Office of
			 Long Term Care with evidence of transfer of operational control signed by all
			 applicable parties.
A provisional license holder may operate the facility under a
				new name, whether fictitious or otherwise. For purposes of this section, the
				term new name means a name that is different than the name under which the
				facility was operated by the prior owner, and the term "operate" means that the
				provisional license holder may hold the facility out to the public using the
				new name. Examples include, but are not limited to, signage, letterhead,
				brochures or advertising (regardless of media) that bears the new name.
In the event that the provisional license holder operates the
				facility under a new name, the facility shall utilize the prior name in all
				communications with the Office of Long Term Care until such time as the license
				is issued. Such communications include, but are not limited to, incident
				reports, notices, Plans of Correction, and MDS submissions. Upon the issuance
				of the license, the facility shall utilize the new name in all communications
				with the Office of Long Term Care.
215-299
RESERVED