reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2200 - GENERAL STANDARDS OF ADMINISTRATION › Section 13D .2206 - MEDICAL DIRECTOR

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall designate a physician to serve as medical director.
(b) The medical director shall be responsible
				  for implementation of patient care policies and coordination of medical care in
				  the facility.
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority Eff. July 13, 1995;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2200 - GENERAL STANDARDS OF ADMINISTRATION › Section 13D .2207 - PATIENT RIGHTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall enforce the Nursing Facility Patient's Bill of Rights as described in
				  G.S.
				  131E-115 through
				  G.S.
				  131E-127.
(b) In matters of patient abuse, neglect or
				  misappropriation the definitions shall have the meaning defined in Rule.2001 of
				  this Subchapter.
Authority
					 G.S.
					 131E-104;
					 131E-131;
Eff.
					 January 1, 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2200 - GENERAL STANDARDS OF ADMINISTRATION › Section 13D .2208 - SAFETY

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility shall have detailed written
				  plans and procedures to meet potential emergencies and disasters, including but
				  not limited to fire, severe weather and missing patients or
				  residents.
(b) The plans and
				  procedures shall be made available upon request to local or regional emergency
				  management offices.
(c) The
				  facility shall provide training for all employees in emergency procedures upon
				  employment and annually.
(d) The
				  facility shall conduct unannounced drills using the emergency
				  procedures.
(e) The facility shall
				  ensure that:
(1) the patients' environment
				  remains as free of accident hazards as possible; and
(2) each patient receives adequate
				  supervision and assistance to prevent accidents.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2200 - GENERAL STANDARDS OF ADMINISTRATION › Section 13D .2210 - REPORTING AND INVESTIGATING ABUSE, NEGLECT OR MISAPPROPRIATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A facility shall take measures to prevent
				  patient abuse, patient neglect, or misappropriation of patient property,
				  including orientation and instruction of facility staff on patients' rights and
				  the screening of and requesting of references for all prospective
				  employees.
(b) A facility shall
				  ensure that the Division of Health Service Regulation is notified within 24
				  hours of the facility's becoming aware of any allegation against health care
				  personnel of any act listed in
				  G.S.
				  131E-256(a)(1).
(c) A facility shall investigate allegations
				  of any act listed in
				  G.S.
				  131E-256(a)(1), shall
				  document all information pertaining to such investigation, and shall take the
				  necessary steps to prevent further incidents while the investigation is in
				  progress.
(d) A facility shall
				  ensure that the report of investigation is printed or typed and sent to the
				  Division of Health Service Regulation within five working days of the
				  allegation. The report shall include:
(1) the
				  date and time of the alleged incident;
(2) the patient's full name and room
				  number;
(3) details of the
				  allegation and any injury;
(4)
				  names of the accused and any witnesses;
(5) names of the facility staff who
				  investigated the allegation;
(6)
				  results of the investigation; and
(7) any corrective action that was taken by
				  the facility.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2200 - GENERAL STANDARDS OF ADMINISTRATION › Section 13D .2211 - PERSONNEL STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall employ the types and numbers of qualified staff, professional and
				  non-professional, necessary to provide for the health, safety and proper care
				  of patients.
(b) Each employee
				  shall be assigned duties consistent with his or her job description and with
				  his or her level of education and training.
(c) Professional staff shall be licensed,
				  certified or registered in accordance with applicable state laws.
(d) The facility shall provide orientation
				  regarding facility policies and procedures for all staff upon
				  employment.
(e) The facility shall
				  train all staff periodically in accordance with their job duties.
(f) The facility shall maintain an individual
				  personnel record for each employee, including verification of
				  credentials.
(g) The facility shall
				  have a written agreement with any nursing personnel agency providing staff to
				  the facility and shall orient agency staff as to facility policies and
				  procedures.
Authority
					 G.S.131E-104;
Eff.
					 January 1, 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2200 - GENERAL STANDARDS OF ADMINISTRATION › Section 13D .2212 - QUALITY ASSURANCE COMMITTEE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  administrator shall establish a quality assessment and assurance committee that
				  consists of the director of nursing, a physician designated by the facility, a
				  pharmacist and at least three other staff members.
(b) The committee shall meet at least
				  quarterly.
(c) The committee shall
				  develop and implement appropriate plans of action which will correct identified
				  quality care problems.
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority Eff. July 13, 1995;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2301 - PATIENT ASSESSMENT AND PLAN OF CARE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) At the time
				  each patient is admitted, the facility shall ensure medical orders are
				  available for the patient's immediate care and that, within 24 hours, a nursing
				  assessment of immediate needs is completed by a registered nurse and measures
				  implemented as appropriate.
(b) The
				  facility shall perform, within 14 days of admission and at least annually, a
				  comprehensive, accurate, documented assessment of each patient's capability to
				  perform daily life functions. This comprehensive assessment shall be
				  coordinated by a registered nurse and shall include at least the following:
(1) current medical diagnoses;
(2) medical status measurements, including
				  current cognitive status, stability of current conditions and diseases, vital
				  signs, and abnormal lab values and diagnostic tests that are a part of the
				  medical history;
(3) the patient's
				  ability to perform activities of daily living, including the need for staff
				  assistance and assistive devices, and the patient's ability to make
				  decisions;
(4) presence of
				  neurological or muscular deficits;
(5) nutritional status measurements and
				  requirements, including but not limited to height, weight, lab work, eating
				  habits and preferences, and any dietary restrictions;
(6) special care needs, including but not
				  limited to pressure sores, enteral feedings, specialized rehabilitation
				  services or respiratory care;
(7)
				  indicators of special needs related to patient behavior or mood, interpersonal
				  relationships and other psychosocial needs;
(8) facility's expectation of discharging the
				  patient within the three months following admission;
(9) condition of teeth and gums, and need and
				  use of dentures or other dental appliances;
(10) patient's ability and desire to take
				  part in activities, including an assessment of the patient's normal routine and
				  lifetime preferences;
(11)
				  patient's ability to improve in functional abilities through restorative
				  care;
(12) presence of visual,
				  hearing or other sensory deficits; and
(13) drug therapy.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2302 - NURSING SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall designate a registered nurse to serve as the director of nursing on a
				  full-time basis.
(b) The director
				  of nursing shall be responsible for the administering of nursing
				  services.
(c) The director of
				  nursing may serve also as nurse-in-charge, only if the average daily occupancy
				  is less than 60.
(d) The director
				  of nursing shall not serve as administrator, assistant administrator or acting
				  administrator during an employment vacancy in the administrator
				  position.
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority Eff. July 13, 1995;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2303 - NURSE STAFFING REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				  facility shall provide licensed nursing staff sufficient to accomplish the
				  following:
(1) patient needs
				  assessment;
(2) patient care
				  planning; and
(3) supervisory
				  functions in accordance with the levels of patient care advertised or offered
				  by the facility.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2304 - NURSE AIDES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A facility
				  shall employ or contract individuals as nurse aides in compliance with N.C.
				  General Statute 131E, Article 15 and facilities certified for Medicare or
				  Medicaid participation shall also comply with 42 CFR Part 483 which is
				  incorporated by reference, including subsequent amendments. The Code of Federal
				  Regulations may be accessed at
				  http://www.access.gpo.gov/nara/cfr/waisidx_08/42cfr483_08
(b) A facility shall provide to the
				  Department, upon request, verification of in-service training and of past or
				  present employment of any nurse aide employed by the facility.
Authority
					 G.S.
					 131E-104;
					 131E-255;
					 143B-165;
					 42 U.S.C.
					 1395;
					 42 U.S.C. 1396;
Eff.
					 January 1, 1996;
Amended Eff. July 1, 2012;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2306 - MEDICATION ADMINISTRATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  facility shall ensure that medications are administered in accordance with
				  applicable occupational licensure regulations and manufacturer's
				  recommendations.
(b) The facility
				  shall ensure that each patient's drug regimen is free from drugs used in
				  excessive dose or duplicative therapy, for excessive duration or without
				  indications for the prescription of the drug. Drugs shall not be used without
				  monitoring or in the presence of adverse conditions that indicate the drugs'
				  usage should be modified or discontinued. As used in this Paragraph:
(1) "Excessive dose" means the total amount
				  of any medication (including duplicate therapy) given at one time or over a
				  period of time that is greater than the amount recommended by the manufacturer
				  for a resident's age and condition.
(2) "Excessive Duration" means the medication
				  is administered beyond the manufacturer's recommended time frames or
				  facility-established stop order policies or without either evidence of
				  additional therapeutic benefit for the resident or clinical evidence that would
				  warrant the continued use of the medication.
(3) "Duplicative Therapy" means multiple
				  medications of the same pharmacological class or category or any medication
				  therapy that replicates a particular effect of another medication that the
				  individual is taking.
(4)
				  "Indications for the prescription" means a documented clinical rationale for
				  administering a medication that is based upon an assessment of the resident's
				  condition and therapeutic goals and is consistent with manufacturer's
				  recommendations.
(5) "Monitoring"
				  means ongoing collection and analysis of information (such as observations and
				  diagnostic test results) and comparison to baseline data in order to:
(A) Ascertain the individual's response to
				  treatment and care, including progress or lack of progress toward a therapeutic
				  goal;
(B) Detect any complications
				  or adverse consequences of the condition or of the treatments; and
(C) Support decisions about modifying,
				  discontinuing, or continuing any interventions.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2307 - DENTAL CARE AND SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  facility shall ensure that routine and emergency dental services are available
				  for all patients.
(b) The facility
				  shall, if necessary, assist the patient in making appointments and obtaining
				  transportation to the dentist's office.
Authority
					 G.S.
					 131E-104;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2308 - ADULT CARE HOME PERSONNEL REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  administrator of a combination home shall designate a person to be in charge of
				  the adult care home residents at all times. The nurse-in-charge of the nursing
				  facility may also serve as supervisor-in-charge of the domiciliary
				  beds.
(b) If adult care home beds
				  are located in a separate building or a separate level of the same building,
				  there shall be a person on duty in the adult care home portion of the facility
				  at all times.
Authority
					 G.S.
					 131E-104;
RRC Objection due to
					 lack of statutory authority Eff. July 13, 1995;
Eff. January 1,
					 1996;
Amended Eff. July 1, 2012;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2300 - PATIENT AND RESIDENT CARE AND SERVICES › Section 13D .2309 - CARDIO-PULMONARY RESUSCITATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Each facility shall develop and implement a Cardio-Pulmonary Resuscitation
				  (CPR) policy.
(b) The policy shall
				  be communicated to all residents or their responsible party prior to
				  admission.
(c) Upon admission each
				  resident or his or her responsible party must acknowledge in writing having
				  received a copy of the policy.
(d)
				  The policy shall designate an outside emergency medical service provider to be
				  immediately notified whenever an emergency occurs.
(e) The policy shall designate the level of
				  CPR that is available using terminology defined by the American Heart
				  Association. American Heart Association terminology is as follows:
(1) Heartsaver CPR;
(2) Heartsaver Automatic External
				  Defibrillator (AED);
(3) Basic Life
				  Support (BLS); or
(4) Advanced
				  Cardiac Life Support (ACLS).
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2400 - MEDICAL RECORDS › Section 13D .2401 - MAINTENANCE OF MEDICAL RECORDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  facility shall establish a medical records service. It shall be directed,
				  staffed and equipped to ensure:
(1) records
				  are processed, indexed and filed accurately;
(2) records are stored in such a manner as to
				  provide protection from loss, damage or unauthorized use;
(3) records contain sufficient information to
				  identify the patient plus a record of all assessments; plan of care;
				  pre-admission screening, if applicable; records of implementation of plan of
				  care; progress notes; and record of discharge, including a discharge summary
				  signed by the physician; and
(4)
				  records are readily accessible by authorized personnel.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2400 - MEDICAL RECORDS › Section 13D .2402 - PRESERVATION OF MEDICAL RECORDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A facility
				  shall keep medical records on file for five years following the discharge of an
				  adult patient.
(b) Not withstanding
				  Paragraph (c) of this Rule, if the patient is a minor when discharged from the
				  nursing facility, the records shall be kept on file until his or her 19th
				  birthday and for the additional time specified in
				  G.S.
				  1-17(b) for commencement of
				  an action on behalf of a minor.
(c)
				  If a facility discontinues operation, the licensee shall inform the Division of
				  Health Service Regulation where its records are stored. For five years after a
				  facility discontinues operations, records shall be stored with a business
				  offering medical record storage and retrieval services.
(d) All medical records are confidential. A
				  facility shall comply with 42 CFR Parts 160, 162 and 164 of the Health
				  Insurance Portability and Accountability Act.
(e) At the time of the inspection, a facility
				  shall inform the surveyor of the name of any patient who has denied the
				  Department access to his or her medical record pursuant to
				  G.S.
				  131E-105.
Authority
					 G.S.
					 131E-104;
					 131E-105;
Eff.
					 January 1, 1996.
Amended Eff. November 1, 2014;
Readopted Eff. July 1, 2016.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2500 - PHYSICIAN'S SERVICES › Section 13D .2501 - AVAILABILITY OF PHYSICIAN'S SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  facility shall ensure each patient's care is supervised by a physician and that
				  provisions are made for emergency physicians when attending physicians are
				  unavailable. The names and telephone numbers of the designated physicians shall
				  be posted at each nurse's station.
(b) Patients shall be seen by a physician at
				  least once every 30 days for the first 90 days and at least every 60 days
				  thereafter. Following the initial visit, the physician may delegate this
				  responsibility to a physician assistant or nurse practitioner every other
				  visit. A physician's visit is considered timely if the visit occurs not later
				  than 10 days after the visit was required.
(c) Physicians shall review the patient's
				  medical plan of care, write or dictate and sign progress notes; and sign and
				  date all current orders at each visit.
(d) Medical orders, given orally by the
				  physician, nurse practitioner or physician assistant, shall be given only to a
				  licensed nurse or other licensed professional who by law is allowed to accept
				  physician's orders, except orders for therapeutic diets which shall be given
				  either to a dietitian or licensed nurse. The record of each telephone order
				  shall include the name of physician giving the order, or other person legally
				  authorized to prescribe, date and time of order, content of order and name of
				  person receiving the order. The physician, or other person legally authorized
				  to prescribe, who gives oral orders shall sign the orders within five
				  days.
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority and ambiguity Eff. July 13, 1995;
Eff.
					 January 1, 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2500 - PHYSICIAN'S SERVICES › Section 13D .2502 - PRIVATE PHYSICIAN

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Each patient or
				  legal representative shall be allowed to select his or her private physician
				  except in those facilities affiliated with medical teaching programs and having
				  written policies requiring all patients to participate in the medical teaching
				  program.
(b) The private physician
				  shall fulfill given requirements as determined by applicable state and federal
				  regulations, and the facility's policies and procedures pertaining to physician
				  services.
(c) The facility shall
				  have the right, after informing the patient, to seek an alternative physician,
				  when requirements are not being met and to ensure that the patient is provided
				  with appropriate, adequate care and treatment.
Authority
					 G.S.
					 131E-104;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2500 - PHYSICIAN'S SERVICES › Section 13D .2503 - USE OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				  Any facility that employs nurse practitioners or physician assistants shall
				  maintain the following information for each nurse practitioner and physician
				  assistant:
(1) verification of current
				  approval to practice as a nurse practitioner by the Medical Board and Board of
				  Nursing for each practitioner, or verification of current approval to practice
				  as a physician assistant by the Medical Board for each physician assistant;
				  and
(2) a copy of the job
				  description or contract signed by the nurse practitioner or physician assistant
				  and the supervising physicians.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2500 - PHYSICIAN'S SERVICES › Section 13D .2504 - LABORATORY AND RADIOLOGY SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
The facility shall provide or obtain clinical laboratory
					 and radiology services to ensure that each patient's needs are met. Such
					 services shall include the following:
(1) provision of laboratory and radiology
				  services within the facility or by contractual agreement;
(2) diagnostic testing to be done only in
				  accordance with a medical order;
(3) reports to be dated once filed in the
				  patient's medical record;
(4)
				  notification of the physician, nurse practitioner or physician assistant
				  regarding findings; and
(5)
				  assistance in arranging transportation for the patient when testing must be
				  done other than in the facility.
Authority
					 G.S.
					 131E-104;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2500 - PHYSICIAN'S SERVICES › Section 13D .2505 - BRAIN INJURY LONG TERM CARE PHYSICIAN SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) For
				  facility patients located in designated brain injury long-term care units,
				  there shall be an attending physician who is responsible for the patient's
				  specialized care program. The intensity of the program requires that there
				  shall be direct patient contact by a physician at least once per week and more
				  often as the patient's condition warrants. Each patient's interdisciplinary,
				  rehabilitation program shall be developed and implemented under the supervision
				  of a physiatrist (a physician trained in physical medicine and rehabilitation)
				  or a physician of equivalent training and experience.
(b) If a physiatrist or physician of
				  equivalent training or experience is not available on a weekly basis to the
				  facility, the facility shall provide for weekly medical management of the
				  patient by another physician. In addition, oversight for the patient's
				  interdisciplinary, long-term care program shall be provided by a qualified
				  consultant physician who visits patients monthly, makes recommendations for and
				  approves the interdisciplinary care plan, and provides consultation as
				  requested to the physician who is managing the patient on a weekly
				  basis.
(c) The attending physician
				  shall actively participate in individual case conference or care planning
				  sessions and shall review and sign discharge summaries and records within 15
				  days of a patient discharge. When patients are to be discharged to either
				  another health care facility or a residential setting, the attending physician
				  shall ensure that the patient has been provided with a discharge plan which
				  incorporates optimum utilization of community resources and post discharge
				  continuity of care and services.
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority Eff. July 13, 1995;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2500 - PHYSICIAN'S SERVICES › Section 13D .2506 - REPEALED - PHYSICIAN SERVICES FOR VENTILATOR DEPENDENT PATIENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority and ambiguity Eff. July 13, 1995;
Eff.
					 January 1, 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22, 2015;
Repealed Eff.
					 January 1, 2021.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2601 - AVAILABILITY OF PHARMACEUTICAL SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  facility shall provide pharmaceutical services under the supervision of a
				  pharmacist, including procedures that ensure the accurate acquiring, receiving
				  and administering of all drugs and biologicals.
(b) The facility shall be responsible for
				  obtaining drugs, therapeutic nutrients and related products prescribed or
				  ordered by a physician for patients in the facility.
(c) To ensure that drug therapy is rational,
				  safe and effective, a pharmaceutical care assessment shall be conducted in the
				  facility at least every 31 days for each patient. All new admissions shall
				  receive a pharmaceutical care assessment at the time of the pharmacist's next
				  visit or within 31 days, whichever comes first. This assessment shall include
				  at least:
(1) a review of the patient's
				  diagnoses, history and physical, discharge summary, diet, vital signs, current
				  physician's orders, laboratory values, progress notes, interdisciplinary care
				  plans and medication administration records; and
(2) the pharmacist's progress notes in the
				  patient's medical record which reflect the results of this assessment and, if
				  necessary, recommendations for change based on desired drug outcomes.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2602 - PHARMACY PERSONNEL

Current through Register Vol. 39, No. 2, July 15, 2024
(a) If the
				  pharmacist is an employee of the facility and performs vending or clinical
				  services, an up-to-date job description and personnel file shall be
				  maintained.
(b) If pharmaceutical
				  vending or clinical services are contracted, there shall be a current written
				  agreement for each service which includes a statement of responsibilities for
				  each party.
(c) The facility shall
				  keep, or be able to make available, a copy of the current license of the
				  pharmacists.
Authority
					 G.S.
					 131E-104;
					 131E-117;
Eff.
					 January 1, 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2603 - ADMINISTRATIVE RESPONSIBILITIES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				  pharmacist shall report any potential drug therapy irregularities or
				  discrepancies in drug accountability and administration with recommendations
				  for change to the director of nursing and the attending physician.
				  Recommendations shall be communicated to the health care professionals in the
				  facility who have the authority to effect a change. These reports shall be
				  submitted monthly following the pharmacist's pharmaceutical care
				  assessments.
(b) The administrator
				  shall ensure documentation of action taken relative to the pharmacist's
				  reports.
Authority
					 G.S.
					 131E-104;
					 131E-117;
Eff.
					 January 1, 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2604 - DRUG PROCUREMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall not possess a stock of prescription drugs for general or common use
				  except as permitted by the North Carolina Board of Pharmacy and as follows:
(1) for all intravenous and irrigation
				  solutions in single unit quantities exceeding 49 ml. and related equipment for
				  the use and administration of such;
(2) diagnostic agents;
(3) vaccines;
(4) drugs designated for inclusion in an
				  emergency kit approved by the facility's Quality Assurance Committee;
(5) water for injection; and
(6) normal saline for injection.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2605 - DRUG STORAGE AND DISPOSITION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				  facility shall ensure that drug storage areas are clean, secure, well lighted
				  and well ventilated; that room temperature is maintained between 59 degrees F.
				  and 86 degrees F.; and that the following conditions are met:
(1) All drugs shall be maintained under
				  locked security except when under the direct physical supervision of a nurse or
				  pharmacist.
(2) Drugs requiring
				  refrigeration shall be stored in a refrigerator containing a thermometer and
				  capable of maintaining a temperature range of 2 degrees C. to 8 degrees C. (36
				  degrees F. to 46 degrees F.) Drug containers must be placed in another
				  container separate from non-drug items when stored in a refrigerator.
(3) Drugs intended for topical use, except
				  for ophthalmic, otic and transdermal medications, shall be stored in an area
				  separate from the drugs intended for oral and injectable use.
(4) Drugs that are outdated, discontinued or
				  deteriorated shall be removed from the facility within five days.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2606 - PHARMACEUTICAL RECORDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A facility
				  shall ensure that accurate records of the receipt, use and disposition of drugs
				  are maintained and readily available.
(b) A facility shall ensure accountability of
				  controlled substances as defined by the Disposal of Unused Controlled
				  Substances From Nursing Home as described in
				  10A NCAC
				  26E .0406, which is hereby incorporated by
				  reference including subsequent amendments. These Rules can be accessed online
				  at
http://reports.oah.state.nc.us/ncac.asp
.
Authority
					 G.S.
					 131E-104;
					 131E-117;
RRC
					 objection due to lack of statutory authority Eff. July 13, 1995;
Eff. January 1, 1996;
Amended Eff. July 1, 2012;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2600 - PHARMACEUTICAL SERVICES › Section 13D .2607 - EMERGENCY DRUGS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A facility
				  shall maintain a supply of emergency drugs in compliance with
				  10A NCAC
				  26E.0408 which is hereby incorporated by
				  reference including subsequent amendments. This Rule can be accessed online at
http://reports.oah.state.nc.us/ncac.asp
.
(b) Emergency drugs shall be
				  stored in a portable container sealed with an easily breakable closure which
				  cannot be resealed or reused and shall be readily accessible for use.
(c) Emergency drug kits shall be stored in a
				  locked storage cabinet or room out of sight of patients and the general public.
				  If stored in a locked area the kits shall be accessible to all licensed nursing
				  personnel.
(d) All emergency drugs
				  and quantity to be maintained shall be approved by the Quality Assurance
				  Committee as defined in
				  10A NCAC
				  13D.2212.
(e) If emergency drug items require
				  refrigerated storage, they shall be stored in a separate sealed container
				  within the medication refrigerator. The container shall be labeled to indicate
				  the emergency status of the enclosed drug and sealed as indicated in Paragraph
				  (b) of this Rule.
(f) An accurate
				  inventory of emergency drugs and supplies shall be maintained with each
				  emergency drug kit.
(g) A facility
				  shall examine the refrigerated and non-refrigerated emergency drug supply at
				  least every 90 days and make any necessary changes at that time.
(h) The facility shall have written policies
				  and procedures which are enforced to ensure that in the event the sealed
				  emergency drug container is opened and contents utilized, steps are taken to
				  replace the items used.
(i) The
				  availability of a controlled substance in an emergency kit shall be in
				  compliance with the North Carolina Controlled Substances Act and Regulations
				  (10A
				  NCAC 26E) which is hereby incorporated by
				  reference including subsequent amendments. These Rules can be accessed online
				  at
http://reports.oah.state.nc.us/ncac.asp
.
Authority
					 G.S.
					 131E-104;
					 131E-117;
RRC
					 objection due to lack of statutory authority Eff. July 13, 1995;
Eff. January 1, 1996;
Amended Eff. July 1, 2012;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2700 - DIETARY SERVICES › Section 13D .2701 - PROVISION OF NUTRITION AND DIETETIC SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A facility
				  shall ensure that each patient is provided with a palatable diet that meets his
				  or her daily nutritional and specialized nutritional needs.
(b) The facility shall designate a person to
				  be known as the director of food service who shall be responsible for the
				  facility's dietetic service and for supervision of dietetic service
				  personnel.
(c) Based on a
				  resident's assessment, the nursing home must ensure that a patient maintains
				  nutritional status, such as body weight and protein levels, unless the
				  patient's clinical condition demonstrates that it is not possible.
(d) There shall be sufficient personnel
				  employed to meet the nutritional needs of all patients in the areas of
				  therapeutic diets, food preparation and service, principles of sanitation, and
				  resident's preferences as related to food services.
(e) The facility shall ensure that menus are
				  followed which meet the nutritional needs of patients in accordance with the
				  recommended dietary allowances of the Food and Nutrition Board of the National
				  Research Council, National Academy of Sciences which are incorporated by
				  reference, including subsequent amendments. Copies of this publication may be
				  obtained by contacting The National Academy Press, 500 Fifth St. N.W.,
				  Washington, D.C. 20001 or accessing it at
http://www.nap.edu/catalog.php?record_id=1349
.
				  Menus shall:
(1) be planned at least 14 days
				  in advance,
(2) provide for
				  substitutes of similar nutritive value for patients who refuse food that is
				  served, and
(3) be provided to
				  patients orally or written through such methods as posting and daily
				  announcements.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2800 - ACTIVITIES, RECREATION AND SOCIAL SERVICES › Section 13D .2801 - ACTIVITY SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall provide a program of activities that is on-going and in accordance with
				  the comprehensive assessment, and that promotes the interests, as well as
				  physical, mental and psychosocial well-being, of each patient.
(b) The administrator shall designate an
				  activities director who shall be responsible for activity and recreational
				  services for all patients and who shall have appropriate management authority.
				  The director shall:
(1) be a recreation
				  therapist or be eligible for certification as a therapeutic recreation
				  specialist by a recognized accrediting body; or
(2) have two years of experience in a social
				  or recreation program within the last five years, one of which was full-time in
				  a patient activities program in a health care setting; or
(3) be an occupational therapist or
				  occupational therapy assistant; or
(4) be certified by the National
				  Certification Council for Activity Professionals; or
(5) have completed an activities training
				  course approved by the State.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2800 - ACTIVITIES, RECREATION AND SOCIAL SERVICES › Section 13D .2802 - SOCIAL SERVICES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The facility
				  shall provide medically-related social services to attain or maintain the
				  highest practicable physical, mental and psychosocial well-being of each
				  resident.
(b) The administrator
				  shall designate an employee to be responsible full-time for social
				  services.
(c) A facility with more
				  than 120 nursing beds shall employ on a full time basis, a social worker who
				  has:
(1) a Bachelors' degree in social work
				  or a Bachelors' degree in human services field, including but not limited to
				  sociology special education, rehabilitation counseling and psychology;
				  and
(2) one year of supervised
				  social work experience in a health care setting working directly with
				  patients.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2900 - SPECIAL REQUIREMENTS › Section 13D .2901 - REPORT OF DEATH

Current through Register Vol. 39, No. 2, July 15, 2024
The facility shall have a written plan to be followed in
					 case of patient death. The plan shall provide for the following:
(1) collection of data needed for the death
				  certificate as required by
				  G.S.
				  130A-117;
(2) recording time of death;
(3) pronouncement of death in accordance with
				  facility policy;
(4) notification
				  of the attending physician responsible for signing the death
				  certificate;
(5) documented
				  notification of next of kin or legal guardian;
(6) authorization and release of the body to
				  a funeral home.
Authority
					 G.S.
					 131E-104;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .2900 - SPECIAL REQUIREMENTS › Section 13D .2902 - PETS

Current through Register Vol. 39, No. 2, July 15, 2024
When facility policies permit pets in the facility, the
					 following conditions shall be met:
(1)
				  The facility policy shall not be in violation of any local health ordinances
				  regarding pet health and control.
(2) Pets shall not be permitted to enter
				  areas where food is being prepared.
Authority
					 G.S.
					 131E-104;
Eff. January 1,
					 1996;
Pursuant to
					 G.S.
					 150B-21.3A, rule is necessary without
					 substantive public interest Eff. March 22,
					 2015.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .3000 - SPECIALLY DESIGNATED UNITS › Section 13D .3001-.3002

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
					 G.S.
					 131E-104;
RRC objection due to
					 lack of statutory authority Eff. July 13, 1995 (Rule.3002);
Eff.
					 January 1, 1996;
Repealed Eff. January 1,
					 2013.
North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 13 - NC MEDICAL CARE COMMISSION › Subchapter D - RULES FOR THE LICENSING OF NURSING HOMES › Section .3000 - SPECIALLY DESIGNATED UNITS › Section 13D .3003 - VENTILATOR ASSISTED CARE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) For the
				  purpose of this Rule, ventilator assisted individuals, means as defined in the
				  federal State Operations Manual, Appendix PP - Guidance to Surveyors for Long
				  Term Care Facilities, herein incorporated by reference including subsequent
				  amendments and editions. Copies of the State Operations Manual may be accessed
				  free of charge online at
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf
.
(b) Facilities having
				  patients who are ventilator assisted individuals shall:
(1) administer respiratory care in accordance
				  with 42 CFR Part 483.25(i), and the federal State Operations Manual
				  F695;
(2) administer respiratory
				  care in accordance with the scope of practice for respiratory therapists
				  defined in
				  G.S.
				  90-648; and
(3) provide pulmonary services from a
				  physician who has training in pulmonary medicine. The physician shall be
				  responsible for respiratory services and shall:
(A) establish with the respiratory therapist
				  and nursing staff, ventilator policies and procedures, including emergency
				  procedures;
(B) assess each
				  ventilator assisted patient's status at least monthly with corresponding
				  progress notes;
(C) respond to
				  emergency communications 24 hours a day; and
(D) participate in individual care
				  planning.