nursing home regulations

(ii) Alternate sources of energy to maintain.

(ii) Meets the requirements set forth in paragraph (b) of this section (excepting paragraph (b)(2)(i) of this section). (8) After a violation is detected, the operating organization must ensure that all reasonable steps identified in its program are taken to respond appropriately to the violation and to prevent further similar violations, including any necessary modification to the operating organization's program to prevent and detect criminal, civil, and administrative violations under the Act. The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at 483.70(e). (n) Specialized services needed in a NF. Staff means those individuals with responsibility for managing a resident's health or participating in an emergency safety intervention and who are employed by the facility on a full-time, part-time, or contract basis. For information on the availability of this material at NARA, call 202-741-6030, or go to: (h) Standard: Documentation of dental services. The facility may charge the resident for requested services that are more expensive than or in excess of covered services in accordance with 489.32 of this chapter. (v) Except as otherwise provided in this section, ICF-IIDs must meet the applicable provisions and must proceed in accordance with the Health Care Facilities Code (NFPA 99 and Tentative Interim Amendments TIA 12-2, TIA 12-3, TIA 12-4, TIA 12-5 and TIA 12-6). (ii) Causes another individual to certify a material and false statement in a resident assessment is subject to a civil money penalty of not more than $5,000 as adjusted annually under 45 CFR part 102 for each assessment. (a) Within 24 hours after the use of restraint or seclusion, staff involved in an emergency safety intervention and the resident must have a face-to-face discussion. (3) Transmission of data and reports to the State agency that conducts surveys to ensure compliance with Medicare and Medicaid participation requirements, for purposes related to this function. (B) Within the last 2 years, due to the mental disorder, experienced an episode of significant disruption to the normal living situation, for which supportive services were required to maintain functioning at home, or in a residential treatment environment, or which resulted in intervention by housing or law enforcement officials. (a) Clinical staff trained in the use of emergency safety interventions must be physically present, continually assessing and monitoring the physical and psychological well-being of the resident and the safe use of restraint throughout the duration of the emergency safety intervention. (ii) Designing programs that meet the client's needs. (ii) Provides justification satisfactory to the Secretary that a longer time period was necessary. (1) The facility must ensure that a resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain. (c) Discharge planning(1) Discharge planning process. (3) Upon receipt of facility data from CMS, ensure that a facility resolves errors. (2) Testing. (C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section. (b) Service consultation. (i) Specify all facility approved interventions to manage inappropriate client behavior; (ii) Designate these interventions on a hierarchy to be implemented, ranging from most positive or least intrusive, to least positive or most intrusive; (iii) Insure, prior to the use of more restrictive techniques, that the client's record documents that programs incorporating the use of less intrusive or more positive techniques have been tried systematically and demonstrated to be ineffective; and. Copies may be obtained from the American Association on Intellectual Disability, 1719 Kalorama Rd., NW., Washington, DC 20009. (b) Standard: Compliance with Federal, State, and local laws.

If specialized rehabilitative services such as but not limited to physical therapy, speech-language pathology, occupational therapy, respiratory therapy, and rehabilitative services for a mental disorder and intellectual disability or services of a lesser intensity as set forth at 483.120(c), are required in the resident's comprehensive plan of care, the facility must. (2) The pharmacist must report any irregularities in clients' drug regimens to the prescribing physician and interdisciplinary team. A fully sprinklered long term care facility is one that has all areas sprinklered in accordance with National Fire Protection Association 13 Standard for the Installation of Sprinkler Systems without the use of waivers or the Fire Safety Evaluation System. (e) The State's PASARR program must use at least the evaluative criteria of 483.130 (if one or both determinations can easily be made categorically as described in 483.130) or of 483.132 and 483.134 or 483.136 (or, in the case of individuals with both MI and IID, 483.132, 483.134 and 483.136 if a more extensive individualized evaluation is required). (d) Governing body. (2) If the facility does not maintain an in-house dental service, the facility must obtain a dental summary of the results of dental visits and maintain the summary in the client's living unit. (e) Respect and dignity. (1) If the history and physical examination are not performed by a physician, then a physician must review and concur with the conclusions. (i) Allow an aide to choose between a written and an oral examination; (ii) Address each course requirement specified in 483.152(b); (iii) Be developed from a pool of test questions, only a portion of which is used in any one examination; (iv) Use a system that prevents disclosure of both the pool of questions and the individual competency evaluations; and. (2) The facility may develop a comprehensive care plan in place of the baseline care plan if the comprehensive care plan. (7) For the maintenance of comfortable sound levels. (42 CFR 483.25), Ensure that the resident receives adequate supervision and assistive devices to prevent accidents. (4) A resident who has been able to eat enough alone or with assistance is not fed by enteral methods unless the resident's clinical condition demonstrates that enteral feeding was clinically indicated and consented to by the resident; and. (B) If application of the Health Care Facilities Code required under paragraph (j)(5)(iv) of this section would result in unreasonable hardship for the ICF-IID, CMS may waive specific provisions of the Health Care Facilities Code, but only if the waiver does not adversely affect the health and safety of clients. 552(a) and 1 CFR part 51. (i) The facility must provide a resident or family group, if one exists, with private space; and take reasonable steps, with the approval of the group, to make residents and family members aware of upcoming meetings in a timely manner. (Thus, emergency placement of a client into a time-out room is not allowed.). In-service training must. (4) Facility data retention requirements. (v) Conveyance upon discharge, eviction, or death. (3) Drugs and biologicals packaged in containers designated for a particular client must be immediately removed from the client's current medication supply if discontinued by the physician. The NF must provide mental health or intellectual disability services which are of a lesser intensity than specialized services to all residents who need such services. (iv) If the facility does not provide laboratory services on site, it must have an agreement to obtain these services from a laboratory that meets the applicable requirements of part 493 of this chapter. (g) Each order for restraint or seclusion must include. (4) The provisions of paragraph (f)(3) of this section may be modified only if, in the judgment of the State survey agency, Court decrees, State law or regulations provide for equivalent client protection and consultation. (42 CFR 483.25), Ensure that residents do not develop pressure sores and, if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing. Additionally, the Children's Health Act of 2000 (Pub. (ii) The State may choose not to apply the preadmission screening program under paragraph (k)(1) of this section to the admission to a nursing facility of an individual. (ii) Include the appropriate accessory and cautionary instructions, as well as the expiration date, if applicable. Except as provided in 483.45(e)(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order. (2) When required. (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the ICF/IID efforts to contact such officials and, when applicable, of its participation in collaborative and cooperative planning efforts. (3) The facility must maintain records of the receipt and disposition of all controlled drugs. (6) Notify promptly the client's parents or guardian of any significant incidents, or changes in the client's condition including, but not limited to, serious illness, accident, death, abuse, or unauthorized absence. If, since an individual's most recent completion of a training and competency evaluation program, there has been a continuous period of 24 consecutive months during none of which the individual provided nursing or nursing-related services for monetary compensation, the individual must complete a new training and competency evaluation program or a new competency evaluation program. (i) The facility must post the nurse staffing data specified in paragraph (e)(1) of this section on a daily basis at the beginning of each shift.

(iv) The resident's medical record includes documentation that indicates, at a minimum, the following: (A) That the resident or resident's representative was provided education regarding the benefits and potential side effects of influenza immunization; and. (e) Standard: Heating and ventilation. (a) Infection prevention and control program. (6) Very brief and finite stays of up to a fixed number of days to provide respite to in-home caregivers to whom the individual with MI or IID is expected to return following the brief NF stay. Supervised practical training means training in a laboratory or other setting in which the trainee demonstrates knowledge while performing tasks on an individual under the direct supervision of a registered nurse or a licensed practical nurse; (i) Students do not perform any services for which they have not trained and been found proficient by the instructor; and. (b) If the resident's treatment team physician is available, only he or she can order restraint or seclusion. (iii) TIA 12-3 to NFPA 99, issued August 9, 2012. (2) The facility must keep confidential all information contained in the clients' records, regardless of the form or storage method of the records. (2) Include strategies for addressing emergency events identified by the risk assessment. (iii) Not request or require residents or potential residents to waive potential facility liability for losses of personal property. (v) Ensuring that the LTC facility staff provides orientation in the policies and procedures of the facility, including patient rights, appropriate forms, and record keeping requirements, to hospice staff furnishing care to LTC residents. (b) Individuals with intellectual disability. (f) Self-determination.

It must integrate clients who have ambulation deficits or who are deaf, blind, or have seizure disorders, etc., with others of comparable social and intellectual development. (4) Nurse aides who receive an offer of employment from a facility not later than 12 months after completing a nurse aide training and competency evaluation program or competency evaluation program. (4) For nurse aides providing services to individuals with cognitive impairments, also address the care of the cognitively impaired. The preadmission screening and annual resident review process must result in determinations based on a physical and mental evaluation of each individual with mental illness or intellectual disability, that are described in 483.112 and 483.114.

(1) Use lead-free paint inside the facility; and. (3) The facility must maintain a record of incidents and corrective actions related to infections. (3) The facility must designate and use a specially constituted committee or committees consisting of members of facility staff, parents, legal guardians, clients (as appropriate), qualified persons who have either experience or training in contemporary practices to change inappropriate client behavior, and persons with no ownership or controlling interest in the facility to. (b) A resident has appeal rights when he or she is transferred from, (1) A certified bed into a noncertified bed; and.

(1) Staff must report any serious occurrence involving a resident to both the State Medicaid agency and the State-designated Protection and Advocacy system by no later than close of business the next business day after a serious occurrence. Any applicant for admission to a NF who has MI or IID and who does not require the level of services provided by a NF, regardless of whether specialized services are also needed, is inappropriate for NF placement and must not be admitted. (iv) Identify mechanical supports, if needed, to achieve proper body position, balance, or alignment.

(4) The resident has the right to receive notices orally (meaning spoken) and in writing (including Braille) in a format and a language he or she understands, including; (i) Required notices as specified in this section. (xi) If the client's individual program plan is being successfully implemented by facility staff, professional program staff meeting the qualifications of paragraph (b)(5) (i) through (x) of this section are not required. Comprehensive dental diagnostic services include. The facility must ensure the rights of all clients. (1) The facility must take actions aimed at performance improvement and, after implementing those actions, measure its success, and track performance to ensure that improvements are realized and sustained. (c) Residents who do not require NF services but require specialized services for MI or IID(1) Long term residents. (c) Data interpretation(1) The State must ensure that a licensed psychologist identifies the intellectual functioning measurement of individuals with IID or a related condition. The governing body must. Sexual abuse is non-consensual sexual contact of any type with a resident. (1) Nurses providing services in the facility must have a current license to practice in the State. (4) Each LTC facility providing hospice care under a written agreement must ensure that each resident's written plan of care includes both the most recent hospice plan of care and a description of the services furnished by the LTC facility to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, as required at 483.25. (i) Determine whether the nurse aide training and competency evaluation program meets the course requirements of 483.152: (ii) Determine whether the nurse aide competency evaluation program meets the requirements of 483.154; and. (2) Be free of potentially hazardous conditions such as unprotected light fixtures and electrical outlets. (a) Notification to Individual. (iii) Has been deemed or determined competent as provided in 483.150(a) and (b). (b) Program design and scope. (4) A physician may not delegate a task when the regulations specify that the physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies. The PASARR determinations of whether an individual requires the level of services provided by a NF and whether specialized services are needed, (1) For individuals with mental illness, must be made by the State mental health authority and be based on an independent physical and mental evaluation performed by a person or entity other than the State mental health authority; and.

(b) Policies and procedures. Follow-up procedures must be in place to provide the information to the individual directly at the appropriate time. (ii) Communicating with hospice representatives and other healthcare providers participating in the provision of care for the terminal illness, related conditions, and other conditions, to ensure quality of care for the patient and family.

If a referral does not occur within 3 days, the facility must provide documentation of what they did to ensure the resident could still eat and drink adequately while awaiting dental services and the extenuating circumstances that led to the delay; (4) Must have a policy identifying those circumstances when the loss or damage of dentures is the facility's responsibility and may not charge a resident for the loss or damage of dentures determined in accordance with facility policy to be the facility's responsibility; and. (vi) Provision for the appropriate expression of behavior and the replacement of inappropriate behavior, if applicable, with behavior that is adaptive or appropriate. (C) Adaptation to change. (n) Bed rails. (i) Before offering the pneumococcal immunization, each resident or the resident's representative receives education regarding the benefits and potential side effects of the immunization; (ii) Each resident is offered a pneumococcal immunization, unless the immunization is medically contraindicated or the resident has already been immunized; (A) That the resident or resident's representative was provided education regarding the benefits and potential side effects of pneumococcal immunization; and. (C) A list of names, addresses (mailing and email), and telephone numbers of all pertinent State regulatory and informational agencies, resident advocacy groups such as the State Survey Agency, the State licensure office, the State Long-Term Care Ombudsman program, the protection and advocacy agency, adult protective services where state law provides for jurisdiction in long-term care facilities, the local contact agency for information about returning to the community and the Medicaid Fraud Control Unit; and. If an ICF/IID is part of a healthcare system consisting of multiple separately certified healthcare facilities that elects to have a unified and integrated emergency preparedness program, the ICF/IID may choose to participate in the healthcare system's coordinated emergency preparedness program. The comprehensive care plan must describe the following: (i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under 483.24, 483.25, or 483.40; and. (i) Medical records. (iii) An individual who holds at least a bachelor's degree in a professional category specified in paragraph (b)(5) of this section. (6) A State must adopt revisions to the RAI that are specified by CMS. If any changes in this edition of the Code are incorporated by reference, CMS will publish a document in the Federal Register to announce the changes.

(iv) File in the resident's clinical record signed and dated reports of x-ray and other diagnostic services. (9) The resident has the right to have reasonable access to and privacy in their use of electronic communications such as email and video communications and for Internet research. (iii) Reconciliation of all pre-discharge medications with the resident's post-discharge medications (both prescribed and over-the-counter). (h) All training programs and materials used by the facility must be available for review by CMS, the State Medicaid agency, and the State survey agency. (7) Orientation for transfer or discharge. An individual is a new admission if he or she is admitted to any NF for the first time or does not qualify as a readmission. (5) The discharging hospital if the individual is seeking NF admission from a hospital. (B) A physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section. (i) Post in a place readily accessible to residents, and family members and legal representatives of residents, the results of the most recent survey of the facility. Fully sprinklered. (h) State MDS system and database requirements. (b) Within 24 hours after the use of restraint or seclusion, all staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, must conduct a debriefing session that includes, at a minimum, a review and discussion of. (i) Provide or obtain radiology and other diagnostic services only when ordered by a physician; physician assistant; nurse practitioner or clinical nurse specialist in accordance with State law, including scope of practice laws. (c) Reporting of deaths. (a) Standard: Governing body.

(ii) Direct outside ventilation by means of windows, air conditioning, or mechanical ventilation. (8) When a sprinkler system is shut down for more than 10 hours, the LTC facility must: (i) Evacuate the building or portion of the building affected by the system outage until the system is back in service, or. (2) Transmitting data. LTC facilities that maintain an onsite fuel source to power emergency generators must have a plan for how it will keep emergency power systems operational during the emergency, unless it evacuates.

(2) A comprehensive drug history including current or immediate past use of medications that could mask symptoms or mimic mental illness. The ICF/IID must do the following: (i) Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based. (1) Sections 1819(a), (b), (c), (d), and (f) of the Act provide that, (i) Skilled nursing facilities participating in Medicare must meet certain specified requirements; and.

A facility must be licensed under applicable State and local law. A facility must maintain all resident assessments completed within the previous 15 months in the resident's active record and use the results of the assessments to develop, review, and revise the resident's comprehensive plan of care. (3) After specifying an instrument, the State must provide periodic educational programs for facility staff to assist with implementation of the RAI. The State in which the individual is a State resident (or would be a State resident at the time he or she becomes eligible for Medicaid), as defined in 435.403 of this chapter, must pay for the PASARR and make the required determinations, in accordance with 431.52(b). The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency plan. To ensure that residents receive proper treatment and care to maintain mobility and good foot health, the facility must, (i) Provide foot care and treatment, in accordance with professional standards of practice, including to prevent complications from the resident's medical condition(s) and. (i) Documentation in the resident's medical record must include: (A) The basis for the transfer per paragraph (c)(1)(i) of this section. The State PASARR system must maintain records of evaluations and determinations, regardless of whether they are performed categorically or individually, in order to support its determinations and actions and to protect the appeal rights of individuals subjected to PASARR; and. (c) Standard: Storage space in bedroom. (F) Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident. (d) Standard: Program implementation. If the resident is a minor as defined in this subpart: (a) The facility must notify the parent(s) or legal guardian(s) of the resident who has been restrained or placed in seclusion as soon as possible after the initiation of each emergency safety intervention. (2) Under no circumstances exceed 4 hours for residents ages 18 to 21; 2 hours for residents ages 9 to 17; or 1 hour for residents under age 9. (4) Any complications resulting from the intervention. (a) Sufficient staff. (vii) NFPA 101, Life Safety Code, 2012 edition, issued August 11, 2011; A facility must develop, implement, and maintain an effective training program for all new and existing staff; individuals providing services under a contractual arrangement; and volunteers, consistent with their expected roles. (g) Use of outside resources. (a) Attestation of facility compliance. In addition to compliance with the regulations set forth in this subpart, facilities are obliged to meet the applicable provisions of other HHS regulations, including but not limited to those pertaining to nondiscrimination on the basis of race, color, or national origin (45 CFR part 80); nondiscrimination on the basis of disability (45 CFR part 84); nondiscrimination on the basis of age (45 CFR part 91); nondiscrimination on the basis of race, color, national origin, sex, age, or disability (45 CFR part 92); protection of human subjects of research (45 CFR part 46); and fraud and abuse (42 CFR part 455) and protection of individually identifiable health information (45 CFR parts 160 and 164). (4) Professional program staff must participate in on-going staff development and training in both formal and informal settings with other professional, paraprofessional, and nonprofessional staff members. (e) Successful completion of the competency evaluation program. Subject to the timeframes prescribed in 413.343(b) of this chapter, a facility must conduct a comprehensive assessment of a resident in accordance with the timeframes specified in paragraphs (b)(2) (i) through (iii) of this section. (c) Mobility. The facility must provide special eating equipment and utensils for residents who need them and appropriate assistance to ensure that the resident can use the assistive devices when consuming meals and snacks. In addition to all of the other requirements in paragraphs (a), (b), (c), and (e) of this section, operating organizations that operate five or more facilities must also include, at a minimum, the following components in their compliance and ethics program: (1) A mandatory annual training program on the operating organization's compliance and ethics program that meets the requirements set forth in 483.95(f). zana infermieristicamente poultry

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