Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 82 - General Licensure Requirements › Section 19 CSR 30-82.020 - Classification of Rules

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule adds to the classification of the
				  standards for long-term care facilities as cited in chapters 13 CSR 15-12, 13
				  CSR 15-14, 13 CSR 15-15 and 13 CSR 15-16 and as required in section 198.085.1,
				  RSMo.
(1) All rules relating
				to long-term care facilities licensed by the Division of Aging, other than
				those rules which are informational in character, shall be followed by a
				notation at the end of each rule, section, subsection or pertinent part. This
				notation shall consist of a Roman numeral(s). These Roman numerals refer to the
				class (either class I, class II or class III) of standard as designated in
				section 198.085.1, RSMo and will be used when that rule, section, subsection or
				portion of a rule carrying the notation is violated by the facility.
(2) In those instances where a particular
				rule, section, subsection or portion of a rule is followed by a notation
				consisting of more than one (1) Roman numeral, the lower classification shall
				be applied unless the division can show that the higher classification is
				merited because of the extent of the violation, the violations effect on
				residents or the impact when combined with other deficiencies. The division, on
				the Statement of Deficiency, shall indicate for the operator which
				classification has been applied and if the higher one is used, for what
				reason.
(3) A violation of a class
				I standard is one which would present either an imminent danger to the health,
				safety or welfare of any resident or a substantial probability that death or
				serious physical harm would result. If a violation of a class I standard is not
				immediately corrected, or corrective action instituted, the division shall
				proceed as required under section
				198.029,
				RSMo. The division shall also take all other necessary steps to protect the
				health, safety or welfare of a resident which may include: initiation of
				license revocation action under section
				198.036,
				RSMo; initiation of an action under section
				198.067,
				RSMo; injunctive relief or assessment of a civil penalty, initiation of an
				action under section 198.070.6, RSMo; protection of residents from further
				abuse or neglect; initiation of an action under section
				198.105
				or
				198.108,
				RSMo for appointment of a receiver; and appointment of a monitor under section
				198.103,
				RSMo.
(4) A violation of a class II
				standard is one which has a direct or immediate relationship to the health,
				safety or welfare of any resident, but which does not create any imminent
				danger. When a violation is noted, the operator shall either correct the
				violation immediately or prior to the time of the reinspection or shall be
				correcting it in accordance with the time schedules set out in the operator's
				approved plan of correction, as provided for under section 198.026.2, RSMo. If
				not, or the plan of correction is not approved and the violation not corrected,
				the violation will constitute substantial noncompliance under the Omnibus
				Nursing Home Act. After review by the division director or his/her designee,
				the division may initiate any action authorized by law, including those
				provided for in sections
				198.026,
				198.036,
				198.067,
				198.070.6, 198.103, 198.105 and 198.108, RSMo. Where specific standards are set
				out in sections 198.003-198.186, RSMo and are not otherwise classified, those
				standards will be treated as class II standards.
(5) A violation of a class III standard is
				one which has an indirect or a potential impact on the health, safety or
				welfare of any resident. When a violation is noted, the operator shall either
				correct the violation immediately or prior to the time of the reinspection, or
				shall be correcting it in accordance with the time schedules set out in the
				operator's approved plan of correction as provided for under section
				198.026,
				RSMo. If not, if the plan of correction is not approved and the violation not
				corrected, a point value of one (1) point each will be noted for violations of
				each distinct class III standard not corrected; however, the points will not be
				assessed if there are five (5) or fewer class III standards violated.
(A) If the points total twenty (20) or more
				points, the facility will be deemed to be in substantial noncompliance under
				the Omnibus Nursing Home Act and the division may initiate any action as
				authorized by law, including issuance of a notice of noncompliance, as provided
				under section
				198.026,
				RSMo.
(B) If the points total less
				than twenty (20) points, the points will remain on the facility's record until
				the time the violations are corrected and are noted as corrected during a
				reinspection. If during the reinspection a class III standard violated in the
				prior inspection continues to be violated, the previously assessed points will
				be doubled unless the operator immediately corrects the violation. If after the
				reinspection the points for all previously noted and left uncorrected
				violations of distinct class III standards total twenty (20) or more, the
				facility will be deemed to be in substantial noncompliance under the Omnibus
				Nursing Home Act and the division may take action as provided under section
				198.026,
				RSMo.
(C) The division shall not
				revoke an operator's license to operate a long-term care facility for
				violations of class III standards unless-
1.
				The uncorrected violations taken all together present either an imminent danger
				to the health, safety or welfare of any resident or a substantial probability
				of death or serious physical harm; or
2. The operator or his/her agent knowingly
				acted or knowingly omitted any duty which would materially and adversely affect
				the health, safety, welfare or property of a resident.
(D) Points will not be assessed for class III
				violations if the operator can show that the violation had been corrected since
				it was initially noted, that the operator made a good faith effort, as judged
				by the division, to stay in compliance and that the violation again occurred
				for reasons beyond the operator's control.