Nac: Chapter 449 - Medical And Other Related Facilities

Link to law: http://www.leg.state.nv.us/nac/NAC-449.html
Published: 2015

[Rev. 12/7/2015 2:28:11 PM]

 

This chapter of NAC has changes

which have been adopted but have not been codified; you can see those changes

by viewing the following regulation(s) on the Nevada Register of Administrative

Regulations: R111-12, R022-14, R046-14, R121-14

[NAC-449 Revised Date: 4-14]

CHAPTER 449 - MEDICAL AND OTHER RELATED

FACILITIES

GENERAL PROVISIONS

449.002            Definitions.

449.0022          “Administrator” defined.

449.0024          “Affiliated facility” defined.

449.0026          “Agent” defined.

449.0028          “Bureau” defined.

449.0029          “Centers for Medicare and Medicaid

Services” defined.

449.003            “Deficiency” defined.

449.00305        “Division” defined.

449.0031          “Division of Welfare and Supportive

Services” defined.

449.0032          “Emergency” defined.

449.0034          “Facility” defined.

449.0042          “Holiday” defined.

449.0043          “Home for individual residential

care” defined.

449.0044          “Immediate and serious threat” and

“immediate jeopardy” defined.

449.0046          “Incident” defined.

449.0048          “License” defined.

449.0049          “Licensed dietitian” defined.

449.005            “Licensee” defined.

449.0052          “Medicaid” defined.

449.0054          “Medicare” defined.

449.0056          “Party” defined.

449.0058          “Person” defined.

449.006            “Recipient” defined.

449.0061          “Referral agency” defined.

449.0062          “Resident” defined.

449.0064          “Residential facility” defined.

449.0066          “Sanction” defined.

449.0068          “Services” defined.

449.007            “Survey” defined.

449.0072          “Treatment” defined.

449.008            Computation of time.

449.0085          Licensee prohibited from employing

or contracting with unlicensed person to provide certain nutrition services.

449.009            Control by Division over medical

records of medical facility or facility for dependent upon suspension of

license or cessation of operation: Authorized actions to remove, store and

protect records; facilities to pay cost of maintenance of records; notice

before destruction of records.

449.010            Severability.

449.0105          Adoption of certain publications by

reference; revision of publication after adoption.

GENERAL REQUIREMENTS FOR LICENSURE

449.011            Application for license.

449.0112          Investigation; prelicensure survey;

inspection for fire safety.

449.0114          Display of license; compliance with

law; transfer of real property; change in administrator, ownership, location or

services.

449.0115          Review of building plans for new

construction or remodeling by certain applicants: Required documents; payment

of fees and costs.

449.01153        Approval of building plans for

construction or remodeling of certain facilities: Period of validity.

449.01156        On-site advisory inspection of

facility: Written request; action by Division; fee.

449.0116          Renewal of license: Application;

validity of existing license pending decision on application; inspection of

facility; untimely filing or failure to file application.

449.0118          Denial, suspension or revocation of

license: Grounds.

449.0119          Denial, suspension or revocation of

license or endorsement: Appeals.

FEES

449.012            Definitions.

449.01205        “Agency to provide personal care

services in the home” defined.

449.0121          “Ambulatory surgical center”

defined.

449.01215        “Branch office” defined.

449.01219        “Community triage center” defined.

449.01225        “Facility for hospice care”

defined.

449.01227        “Facility for refractive surgery”

defined.

449.01228        “Facility for transitional living

for released offenders” defined.

449.01229        “Facility for treatment with

narcotics” defined.

449.0123          “Home health agency” defined.

449.01235        “Home office” defined.

449.0124          “Hospice care” defined.

449.01245        “Intermediate care facility for

persons with an intellectual disability or persons with a developmental

disability” defined.

449.0125          “Medication unit” defined.

449.01252        “Mobile unit” defined.

449.01255        “Nursing pool” defined.

449.0126          “Rural clinic” defined.

449.01265        “Rural hospital” defined.

449.0127          “Subunit agency” defined.

449.013            License and renewal fees to operate

ambulatory surgical center, home office or subunit agency of home health

agency, branch office of home health agency, rural clinic, obstetric center,

program of hospice care, independent center for emergency medical care, nursing

pool, facility for treatment with narcotics, medication unit, referral agency,

facility for refractive surgery, mobile unit and agency to provide personal

care services in the home; expiration of application for license.

449.016            License and renewal fees to operate

skilled nursing facility, hospital, rural hospital, intermediate care

facilities, residential facility for groups, facility for treatment of abuse of

alcohol or drugs, facility for hospice care, home for individual residential care,

facility for modified medical detoxification, community triage center facility

for treatment of irreversible renal disease, halfway house for recovering

alcohol and drug abusers and facility for transitional living for released

offenders; expiration of application for license; refund of certain fees.

449.0164          Fees for renewal of licenses for

certain facilities: Payment in two equal installments.

449.0168          Fees for modification of certain

licenses.

449.01685        Division authorized to charge and

collect fee from licensee to recover costs of investigating complaint if

complaint is substantiated.

449.0169          Department of Corrections to pay

fee to Division for certain services.

PROVISION OF HOSPICE CARE

General Provisions

449.017            Definitions.

449.0171          “Bereavement services” defined.

449.0172          “Facility for hospice care”

defined.

449.0173          “Governing body” defined.

449.0175          “Hospice care” defined.

449.0176          “Medical director” defined.

449.01765        “Palliative services” defined.

449.0177          “Patient” defined.

449.0178          “Terminally ill” defined.

Licensing

449.0181          Compliance with regulations

required for license to operate facility for hospice care.

449.0183          Report of change in ownership,

address or staff of program of hospice care.

Administration

449.0184          Governing body required; duties of

governing body and administrator.

Medical Services

449.0185          Requirements for program of hospice

care.

449.0186          Requirements for plan of care.

449.0187          Requirements for operation of

facility for hospice care.

449.0188          Continuity of service to patients

required.

FACILITIES FOR TREATMENT OF ABUSE OF ALCOHOL OR DRUGS

General Provisions

449.019            Definitions.

449.022            “Administrator” defined.

449.025            “Alcohol and drug abuse treatment”

defined.

449.030            “Case management services” defined.

449.031            “Client” defined.

449.034            “Detoxification” defined.

449.043            “Facility” defined.

449.044            “Facility for modified medical

detoxification” defined.

449.046            “Governing body” defined.

449.060            “Medically managed intensive

detoxification program” defined.

449.064            “Overall program” defined.

449.068            “Qualified social worker” defined.

449.069            “Residential program” defined.

449.072            “Social model detoxification

program” defined.

Licensing

449.079            Denial, revocation or suspension of

license if facility not certified by Division; appeal.

449.081            New construction or remodeling:

Submission and approval of building plans; prerequisites to approval of

licensing.

Administration and Personnel

449.085            Governing body; bylaws.

449.088            Policies and procedures.

449.091            Transfer of client to another

facility.

449.094            Money of clients.

449.098            Preparations for disasters;

reporting of fire or disaster.

449.102            Inventory and return of client’s

belongings.

449.105            Insurance.

449.108            General requirements for programs.

449.111            Administrator: Duties.

449.114            Employees: General requirements.

449.117            Employees: Proof of compliance with

provisions concerning tuberculosis.

Social Model Detoxification Programs

449.121            Certain facilities authorized to

offer program.

449.1214          General requirements.

449.1218          Program of ongoing quality

improvement.

Operation of Facility

449.123            General sanitary requirements.

449.126            Laundry requirements.

449.129            Design, construction, equipment and

maintenance.

449.132            Accommodations for clients.

449.135            Safety from fire.

449.141            Health services.

449.144            Medication.

449.147            Dietary services.

449.150            Records of clients.

449.153            Discrimination prohibited.

FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION

449.15311        Definitions.

449.15313        “Administrator” defined.

449.15315        “Client” defined.

449.15317        “Facility” defined.

449.15319        “Overall program” defined.

449.15321        “Program” defined.

449.15323        Proof of certification required;

revocation of license.

449.15325        Governing body; bylaws and policies.

449.15327        Policies and procedures for

services and operation of facility.

449.15329        Transfer of client.

449.15331        Handling of money of client.

449.15333        Inventory of belongings of client.

449.15335        Liability insurance.

449.15337        Program: Requirements; review.

449.15339        Responsibilities and duties of

administrator.

449.15341        Policies and procedures concerning

employees.

449.15343        Nursing services.

449.15345        Health services.

449.15347        Pharmaceutical services.

449.15349        Medication and biologicals.

449.15351        Dietary services.

449.15353        Records of clients.

449.15355        Safety and sanitation; temperature.

449.15357        Laundry requirements.

449.15359        New construction or remodeling:

Submission and approval of building plans; prerequisites to approval of

facility for licensure.

449.15361        Design, construction, equipment and

maintenance.

449.15363        Accommodations for clients.

449.15365        Safety from fire.

449.15367        Preparations for disasters;

reporting of fire or disaster.

449.15369        Discrimination prohibited.

FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS

General Provisions

449.154            Definitions.

449.15415        “DEA” defined.

449.1542          “Facility for treatment with

narcotics” defined.

449.1543          “Medical director” defined.

449.15435        “Medication unit” defined.

449.15438        “SAMHSA” defined.

449.1544          Division is state authority for

certain federal regulations.

Licensing

449.15445        License and federal certification

required to operate facility or unit.

449.1545          Filing requirements; recommendation

for certification.

449.15455        Investigation and prelicensure

survey.

449.1547          Suspension, revocation or

cancellation of license; provisional license; denial of application.

Operation

449.1548          General operational requirements.

449.15485        Continuing review of operations;

investigation of complaints.

HALFWAY HOUSES FOR RECOVERING ALCOHOL AND DRUG ABUSERS

449.1549          Definitions.

449.154901     “Administrator” defined.

449.154903     “Client” defined.

449.154905     “Facility” defined.

449.15491        Administrator: Qualifications.

449.154911     Administrator: General duties.

449.154913     General operational guidelines.

449.154915     Policies and procedures:

Establishment; maintenance of manual.

449.154917     Limitation on admissions.

449.154919     Health and sanitation.

449.154921     Laundry facilities.

449.154923     Kitchens; storage of food.

449.154925     Bedrooms; bedding.

449.154927     Use of certain areas as bedroom

prohibited.

449.154929     Bathrooms and toilet facilities;

toilet articles.

449.154931     Accommodations for residents with

restricted mobility.

449.154933     First aid.

449.154935     Medication.

449.154937     Telephones; listing of facility’s

telephone number.

449.154939     Notification to Bureau under certain

circumstances.

449.154941     Rights of clients.

449.154943     Client files: Maintenance; contents;

confidentiality.

449.154945     Safety from fire.

FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS

General Provisions

449.154951     Definitions.

449.154953     “Administrator” defined.

449.154955     “Facility” defined.

449.154957     “Resident” defined.

449.154959     “Supportive services” defined.

Administration

449.154961     Administrator: Qualifications.

449.154963     Administrator: General duties.

449.154965     Operation of facility.

449.154967     Policies and procedures.

449.154969     Preparations for disasters and other

emergencies.

Operation

449.154971     Limitation on number of admissions.

449.154973     Prerequisites to provision of

particular services.

449.154975     Sanitation, safety and comfort.

449.154977     Laundry facilities.

449.154979     Kitchens; preparation and storage of

food.

449.154981     Bedrooms and bedding.

449.154983     Use of certain areas as bedroom

prohibited.

449.154985     Bathrooms and toilet facilities;

toiletries.

449.154987     First aid.

449.154989     Medication.

449.154991     Telephones; listing of facility’s

telephone number.

449.154993     Notification of occurrence of

certain incidents.

449.154995     Rights of residents.

449.154997     Files for residents.

449.154999     Safety from fire.

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

449.15511        Definitions.

449.15513        “Caregiver” defined.

449.15515        “Director” defined.

449.15517        “Home” defined.

449.15519        “Protective supervision” defined.

449.15521        Director: Qualifications.

449.15523        Director: Duties.

449.15525        Requirements for safety and

sanitation of facility.

449.15527        Agreement between operator of home

and resident concerning rates; maintenance of records of residents.

449.15529        On-site survey of home by Bureau.

RESIDENTIAL FACILITIES FOR GROUPS

General Provisions

449.156            Definitions.

449.1565          “Administer” defined.

449.157            “Administrator” defined.

449.1575          “Board” defined.

449.1585          “Caregiver” defined.

449.1591          “Category 1 resident” defined.

449.1595          “Category 2 resident” defined.

449.1597          “Dietary supplement” defined.

449.1599          “Discharge” defined.

449.160            “Division” defined.

449.161            “Grade” defined.

449.164            “Hospice care” defined.

449.169            “Medical professional” defined.

449.170            “Placard” defined.

449.172            “Residential facility” defined.

449.173            “Residential facility which

provides care to persons with Alzheimer’s disease” defined.

449.175            “Severity and scope score” defined.

449.176            “Staff of a facility” defined.

449.178            “Transfer” defined.

Licensing

449.179            Submission and approval of plan for

new construction or remodeling; inspection; evidence of compliance.

449.180            Requirements for purchasing

licensed facility.

449.190            License: Contents; validity;

transferability; issuance of more than one type.

449.191            Denial, suspension or revocation of

endorsement: Grounds.

449.1915          Suspension or revocation of license

and endorsement if residential facility has been assigned grade of D on two or

more consecutive surveys or resurveys, or both.

Administration and Personnel

449.194            Responsibilities of administrator.

449.196            Qualifications and training of

caregivers.

449.197            Medical services may be provided

only by medical professional.

449.199            Staffing requirements; limitation

on number of residents; written schedule for each shift; direct supervision of

certain employees.

449.200            Personnel files.

449.202            Rights of staff members during

investigation of facility; duties of investigator.

General Operational Requirements

449.204            System of financial accounting;

insurance.

449.205            Advertising and promotional

materials.

449.208            Restrictions on conducting other

businesses or providing other services on premises.

449.209            Health and sanitation.

449.211            Automatic sprinkler systems.

449.213            Laundry and linen services.

449.216            Common areas; dining rooms.

449.217            Kitchens; storage of food; adequate

supplies of food; permits; inspections.

449.2175          Service of food; seating; menus;

special diets; nutritional requirements; dietary consultants.

449.218            Bedrooms: Floor space; windows and

doors; privacy; storage space; bedding; personal furnishings; lighting.

449.220            Bedroom doors.

449.221            Use of certain areas in facility as

bedroom prohibited.

449.222            Bathrooms and toilet facilities;

toilet articles.

449.224            Housing for staff members.

449.226            Safety requirements for residents

with restricted mobility or poor eyesight; water hazards; auditory systems for

bathrooms and bedrooms; access by vehicles.

449.227            Accommodations for residents with

restricted mobility.

449.229            Requirements and precautions

regarding safety from fire.

449.231            First aid and cardiopulmonary

resuscitation.

449.232            Telephones; emergency telephone

numbers for each resident; listing of facility’s telephone number.

449.241            Limitations on use of volunteers;

requirements concerning residents who volunteer to assist staff or perform

other duties.

449.258            Written policies for facility;

policy on visiting hours; residents’ mail; compliance with policies.

449.259            Supervision and treatment of

residents generally.

449.260            Activities for residents.

449.262            Provision of dental, optical and

hearing care and social services; report of suspected abuse, neglect, isolation

or exploitation; restrictions on use of restraints, confinement or sedatives.

449.267            Money and property of residents.

449.268            Rights of residents; procedure for

filing grievance, complaint or report of incident; investigation and response.

449.269            Discrimination prohibited.

Admitting, Transferring and Discharging Residents

449.2702          Written policy on admissions;

eligibility for residency.

449.2704          Disclosure of information

concerning rates and payment for services.

449.2706          Transfer of resident whose

condition deteriorates.

449.2707          Transfer of resident: Effective

date.

449.2708          Discharge of resident; notice of

discharge; issuance of notice to quit to resident for improper or harmful

behavior.

Restrictions on Admitting or Retaining Residents With Certain

Medical Needs or Conditions

449.271            Residents requiring gastrostomy

care or suffering from staphylococcus infection or other serious infection or

medical condition.

449.2712          Residents requiring use of oxygen.

449.2714          Residents requiring use of

intermittent positive pressure breathing equipment.

449.2716          Residents having colostomy or

ileostomy.

449.2718          Residents requiring manual removal

of fecal impactions or use of enemas or suppositories.

449.272            Residents requiring use of

indwelling catheter.

449.2722          Residents having unmanageable

condition of bowel or bladder incontinence; residents having manageable

condition of bowel or bladder incontinence.

449.2724          Residents having contractures.

449.2726          Residents having diabetes.

449.2728          Residents requiring regular

intramuscular, subcutaneous or intradermal injections.

449.2732          Residents requiring protective

supervision.

449.2734          Residents having tracheostomy or

open wound requiring treatment by medical professional; residents having

pressure or stasis ulcers.

449.2736          Procedure to exempt certain

residents from restrictions.

449.2738          Review of medical condition of

resident; relocation or transfer of resident having certain medical needs or

conditions.

Medical Services, Medical Records and Other Records Concerning

Residents

449.274            Medical care of resident after

illness, injury or accident; periodic physical examination of resident;

rejection of medical care by resident; written records.

449.2742          Administration of medication:

Responsibilities of administrator, caregivers and employees of facility.

449.2744          Administration of medication:

Maintenance and contents of logs and records.

449.2746          Administration of medication:

Restrictions concerning medication taken as needed by resident; written

records.

449.2748          Medication: Storage; duties upon

discharge, transfer and return of resident.

449.2749          Maintenance and contents of

separate file for each resident; confidentiality of information.

Special Types of Services and Facilities

449.275            Residential facility which provides

residents with hospice care: Responsibilities of staff; retention of resident

with special medical needs.

449.2751          Residential facility which provides

assisted living services: Application for endorsement; general requirements.

449.2754          Residential facility which provides

care to persons with Alzheimer’s disease: Application for endorsement; general

requirements.

449.2756          Residential facility which provides

care to persons with Alzheimer’s disease: Standards for safety; personnel

required; training for employees.

449.2758          Residential facility which provides

care for elderly persons or persons with disabilities: Training for caregivers.

449.2762          Residential facility which offers

or provides care for adults with intellectual disabilities or adults with

related conditions: Application for endorsement; training for caregivers.

449.2764          Residential facility which offers

or provides care for persons with mental illnesses: Application for

endorsement; training for employees.

449.2766          Residential facility which offers or

provides care for persons with chronic illnesses and debilitating diseases:

Application for endorsement; training for employees.

449.2768          Residential facility which provides

care to persons with dementia: Training for employees.

Deficiencies

449.27702        Determination of severity and scope

of deficiency; assignment of grade.

449.27704        Placard: Issuance and display;

failure to comply.

449.27706        Resurvey: Application and fee;

failure to comply.

BUSINESSES THAT PROVIDE REFERRALS TO RESIDENTIAL FACILITIES

FOR GROUPS

449.27811        Definitions.

449.27813        “Client” defined.

449.27817        “Financial assessment” defined.

449.27819        “Needs assessment” defined.

449.27821        “Residential facility for groups”

defined.

449.27823        License not required by certain

persons to make referrals; application for licensure.

449.27827        Requirements for employees.

449.27829        Responsibilities of referral

agency.

449.27831        Contract for services; fees;

maintenance of client records.

HOSPITALS

General Provisions

449.279            Definitions.

449.285            “General hospital” defined.

449.286            “Governing body” defined.

449.287            “Hospital” defined.

449.289            “Inpatient” defined.

449.297            “Outpatient” defined.

449.298            “Outpatient department” defined.

449.299            “Patient” defined.

449.300            “Restraint” defined.

Licensing and Administration

449.307            Applicability of license; coverage

against certain liabilities.

449.310            Limitation on number of patients;

annual on-site inspection not required under certain circumstances.

449.312            Change in ownership, use or

construction; correction of deficiencies.

449.313            Responsibilities and duties of

governing body; bylaws; appointment and duties of chief executive officer;

protocol for organ donations; annual operating budget.

449.314            Quality of care; scope of services.

449.3152          Quality improvement program.

449.3154          Construction, remodeling,

maintenance and change of use: General requirements; prerequisites to approval

of licensure.

449.3156          Compliance with certain guidelines

for design and construction; correction of deficiencies.

Policies and Procedures for Operation of Hospital

449.316            Physical environment: Safety and

well-being of patients; plan for emergency preparedness; safety management.

449.317            Risk management.

449.319            Requirements for personal needs of

patients.

449.322            Housekeeping and laundry services.

449.325            Prevention, control and

investigation of infections and communicable diseases.

449.327            Preparation, sterilization, storage

and distribution of sterile supplies and medical and surgical equipment.

449.329            Admission of patients.

449.331            Emergency services and medical

care; transfer agreements.

449.332            Discharge planning.

449.337            Dietary services: General

requirements.

449.338            Dietary services: Provision for

needs of patients; facilities; standards; permits; records.

449.3385          Dietary services: Personnel.

449.339            Dietary services: Nutritional

status of patients.

449.3395          Dietary services: Sanitary

conditions; supplies.

449.340            Pharmaceutical services.

449.343            Orders for medication and biologicals.

449.344            Administration of medication;

security.

449.346            Rehabilitative services.

449.349            Emergency services.

449.352            Social services.

449.355            Discrimination prohibited.

449.358            Medical staff.

449.361            Nursing services.

449.3622          Appropriate care of patients.

449.3624          Assessment of patients.

449.3626          Rights of patients.

449.3628          Protection of patients; use of

physical restraints.

449.363            Personnel policies concerning

employment, licensing and certification.

449.364            Obstetrical services:

Administration; staffing and equipment.

449.3645          Obstetrical services: Labor rooms;

delivery rooms; utility rooms; area for cleaning instruments.

449.365            Obstetrical services: Required

services.

449.3655          Obstetrical services: Transfer or

discharge of patient.

449.367            Obstetrical services: Nurseries.

449.370            Outpatient services.

449.371            Intensive care services.

449.373            Laboratory services; pathology

services; blood and blood products.

449.3735          Transfusions of blood.

449.374            Nuclear medicine services.

449.375            Records for nuclear medicine

services; authorization.

449.376            Radiological services.

449.377            Radiological therapeutic services.

449.379            Medical records.

449.382            Medical library.

449.385            Surgical services.

449.388            Anesthesia services.

449.389            Respiratory care services.

449.391            Dental services.

449.394            Psychiatric services.

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

449.395            Definitions.

449.39501        “Certificate” defined.

449.39502        “Client” defined.

449.39503        “Intermediary service organization”

defined.

449.39504        “Managing employer” defined.

449.39505        “Other responsible person” defined.

449.39506        “Personal assistance” defined.

449.39507        “Personal assistant” defined.

449.39508        “Guardian” interpreted.

Certification

449.3951          Form of application; written

verification for submission of fingerprints.

449.39511        Application for certificate and

renewal: Fees.

449.39512        Application for certificate and

renewal: Proof of insurance coverage.

449.39513        Applicability of certificate;

specification of primary location; records.

449.39514        Issuance of provisional

certificate.

Authorized Activities and General Requirements for Operation

449.39515        Operation of intermediary service

organization and agency to provide personal care services in the home.

449.39516        Duties and responsibilities.

449.39517        Personal assistants:

Qualifications; maintenance and availability of personnel files.

449.39518        Personal assistants: Results of

reports on criminal history.

449.39519        Client to serve as managing

employer and provide training to personal assistant; reporting of training to

organization.

449.3952          Additional training to be provided

by intermediary service organization.

449.39521        Visits and telephone interviews

with clients.

449.39522        Written statement of services

provided to clients.

449.39523        Discussion of services provided to

clients.

449.39524        Rights of person with a disability

receiving services.

Administrative Review and Hearings

449.39525        Request for administrative review

of complaint.

449.39526        Scheduling of administrative

review.

449.39527        Conduct of administrative review.

449.39528        Issuance of written decision

following administrative review.

449.39529        Request for hearing.

449.395295     Hearings: Scheduling; notice.

449.3953          Hearings: Representation; evidence;

rights of parties.

449.39531        Resolution of complaint.

449.39532        Final decision of hearing officer;

request for judicial review.

449.39533        Record of hearing.

449.39534        Provision of transcript of oral

proceedings of hearing.

Administrative Sanctions

449.39535        Definitions.

449.39536        “Ban on enrollment” defined.

449.39537        “Cluster” defined.

449.39538        “Compliance” defined.

449.39539        “De minimis violation” defined.

449.3954          “Major violation” defined.

449.39541        “Plan of correction” defined.

449.39542        “Resurvey” defined.

449.39543        “Severity and scope score” defined.

449.39544        “Subsequent violation” defined.

449.39545        Imposition of sanctions generally.

449.39546        Minimum sanction to be imposed.

449.39547        Available sanctions.

449.39548        Duration of sanctions.

449.39549        Notice of sanction; appointment of

temporary manager; ban on enrollment or suspension of certificate authorized in

certain circumstances.

449.3955          Imposition of one or more sanctions;

reporting of violations; presumption of de minimis violation.

449.39551        Severity and scope of violations to

be considered in determining sanctions to be imposed.

449.39552        Scope of violations: Survey of

organization; sampling of clients; use of scope relating to one client

authorized.

449.39553        Scope of violations: Use of scope;

basis for assessment.

449.39554        Scope of violations: Criteria for

evaluation.

449.39555        Severity of violations: Use of

severity scale; basis for assessment; criteria for evaluation.

449.39556        Subsequent violation on resurvey:

Rebuttable presumption; imposition of sanction.

449.39557        Determination of sanctions: Initial

assessment.

449.39558        Determination of sanctions:

Secondary factors to be considered.

449.39559        Determination of sanctions: Basis

for selection; restrictions upon service and monetary penalties presumed to be

most effective.

449.3956          Plan of correction: Development by

intermediary service organization; authority of Division when plan is not

acceptable; effect of failure to submit plan.

449.39561        Monetary penalties: Determination

of initial penalty; daily penalties; maximum total penalties.

AGENCIES TO PROVIDE PERSONAL CARE SERVICES IN THE HOME

General Provisions

449.396            Definitions.

449.3961          “Activities of daily living”

defined.

449.3962          “Agency” defined.

449.3963          “Attendant” defined.

449.3964          “Client” defined.

449.3965          “Personal care services” defined.

449.3966          “Representative of the client”

defined.

449.3967          “Service plan” defined.

449.3968          “Work station” defined.

Licensing

449.3971          Applicant required to submit

fingerprints to Central Repository for Nevada Records of Criminal History for

report on background.

449.3972          Location to which license applies;

agency to retain proof of liability coverage and compliance with certain

statutory provisions.

Administration and Personnel

449.3973          Qualifications and duties of

administrator; appointment of designee to act in administrator’s absence.

449.3974          Maintenance of policies and

procedures concerning qualifications, responsibilities and conditions of

employment for staff members.

449.3975          Attendants: Qualifications; annual

training.

449.3976          Attendants: Maintenance of

personnel file; evaluation of competency.

449.3977          Attendants: Required knowledge and

training.

449.3978          Attendants: Prohibition on

provision of certain types of services to clients.

Provision of Services

449.3979          Provision of written disclosure

statement to client upon acceptance for services by agency.

449.398            Rights of clients: Duties of

administrator; provision of written description to clients.

449.3981          Initial screening of client and

development or acceptance of service plan; requirements before providing

personal care to client.

449.3982          Supervisory home visits or

telephone calls required to ensure quality of care provided; documentation of

evaluation.

FACILITIES FOR CARE OF ADULTS DURING THE DAY

General Provisions

449.4061          Definitions.

Licensing

449.4063          Design, construction, equipment and

maintenance of facility: General requirements; prerequisites to approval for

licensure.

449.4065          Consultation with representative of

Division; notice of nonconformity.

449.4067          Operation in combination with other

medical facility or facility for the dependent.

449.4069          Insurance.

Operation of Facility

449.407            Advertising and promotional

materials.

449.4071          Policies and procedures;

accounting.

449.4072          Director and employees:

Qualifications and duties; physical and mental health.

449.40723        Supervision of clients; volunteers.

449.40725        Orientation and training of

employees and volunteers.

449.4073          Files concerning employees.

449.4074          Requirements of facility; health

and sanitation; medications; exits.

449.4075          Preparations for fires and other

emergencies; reporting of fire or disaster.

449.4076          First aid.

449.4077          Policy for admissions; retention of

signed copy.

449.4078          Requirements for admission;

designation of physician.

449.4079          Required services.

449.408            Housekeeping and maintenance.

449.4081          Administration of medication;

accidents or illnesses.

449.4082          Service of food; dietary

consultants.

449.4083          Discrimination prohibited.

449.40833        Summary of client’s care;

referrals.

449.40835        Records.

Medical and Ancillary Services

449.4084          Contract for provision by another

person.

449.4085          Provision by facility authorized.

449.4086          Evaluation of programs and

policies.

449.4087          Written assessments of clients.

449.4088          Plan of care; periodic assessment.

449.4089          Menus.

FACILITIES FOR REFRACTIVE SURGERY

449.450            “Facility” defined.

449.4504          Administrator: Appointment; duties;

qualifications.

449.4505          Administrator of facility that

performs intraocular lens implants: Duties.

449.4506          Staffing requirements; personnel

files.

449.4508          Maintenance of patient records.

449.451            Written policies and procedures.

449.4512          Program of quality improvement.

449.4514          Rights of patients; informed

consent.

449.4516          Equipment and supplies.

449.4518          Liability for use of leased

equipment.

449.4522          Sanitation and hygiene; space and

storage.

449.4524          Medical care of patients.

449.4526          Application for indemnification for

certain damages; claims against surety bond or substitute thereof.

FACILITIES FOR TREATMENT OF IRREVERSIBLE RENAL DISEASE

General Provisions

449.501            Definitions.

449.502            “Advanced practice registered

nurse” defined.

449.504            “Charge nurse” defined.

449.5045          “Competency” defined.

449.505            “Dialysis” defined.

449.5053          “Dialysis technician” defined.

449.5055          “Direct supervision” defined.

449.5065          “End-stage renal disease” defined.

449.507            “Facility” defined.

449.508            “Hemodialysis” defined.

449.510            “Immediate supervision” defined.

449.511            “Intermediate level disinfection”

defined.

449.513            “Licensed practical nurse” defined.

449.516            “Product water” defined.

449.517            “Supervision” defined.

449.519            “Training” defined.

Construction; Health and Safety

449.520            New construction or remodeling:

Notification; increase in number of stations for which facility is licensed.

449.5205          New construction or remodeling:

Submission of plans and specifications; minor changes; inspection.

449.522            Construction, space and design;

physical environment; restrictions for treatment of patients with hepatitis B.

449.5225          Safety and comfort of patients

during construction; imposition of more stringent design and space

requirements.

449.523            Safety requirements.

449.5235          Maintenance and repair of

equipment.

449.525            Water treatment system: General

requirements.

449.5255          Water treatment system: Chemical

testing of product water; records.

449.526            Water treatment system:

Microbiological testing of product water.

449.5265          Reuse of hemodialyzer; transport of

used dialyzer.

449.528            Adoption of more stringent

requirements for treatment of water and reuse of hemodialyzers.

449.5285          Sanitation: Precautions regarding

blood and bodily fluids.

449.529            Sanitation: Control of infections;

nonsmoking policy.

449.5295          Sanitation: Provision of sanitary

environment; walls, floors and ceilings; blood spills.

449.531            Sanitation: Disinfection of

dialysis machines; culturing dialysate; cleaning of machines and equipment;

handling of waste.

449.5315          Hepatitis B: Vaccinations for

certain staff members; postvaccination screening; adoption of related

provisions.

449.532            Hepatitis B: Vaccinations for

certain patients.

449.5325          Hepatitis B surface antigen:

Screening of patients; additional serologic screening.

449.534            Hepatitis B surface antigen:

Treatment of patients who test positive.

449.5345          Tuberculosis: Screening of staff

and patients.

Provision of Services

449.540            Program of quality assurance;

recordation of accidents and incidents; reporting of certain events.

449.5405          Rights of patients.

449.541            Interdisciplinary teams; plans for

care of patients.

449.5415          Preparations for emergencies and

disasters.

449.543            Pharmaceutical services.

449.5435          Nursing services; physicians and

other staff.

449.544            Nutrition services.

449.5445          Social services.

449.546            Patient care: Advanced practice

registered nurses and physician assistants; medical emergencies.

449.5465          Patient care: Licensed practical

nurses and dialysis technicians.

449.547            Self-dialysis: Provision of

training and certain services.

449.5475          Continuous ambulatory peritoneal

dialysis.

449.549            Continuous cycling peritoneal

dialysis.

449.5495          Patient services by contract;

laboratory.

Administration and Personnel

449.550            Governing body.

449.5505          Medical director.

449.552            Physicians.

449.5525          Orientation program for new

employees; continuing education.

449.553            Medical staff: Generally.

449.5535          Nurses.

449.555            Dietitians.

449.5555          Social workers.

449.556            Staff responsible for operating

water treatment system.

449.5565          Staff that repairs or maintains

equipment used to provide care to patients.

Clinical Records

449.558            Preparation and maintenance.

449.5585          Additional requirements.

449.559            Medical history and physical

examination.

449.5595          Transient patients.

449.561            Discharge or transfer of patients;

removal of records.

449.5615          Cessation of operation of facility.

Dialysis Technicians

449.570            General qualifications;

identification to be worn during training; provision of care; requirements to

act as preceptor.

449.5705          Qualification of technician

determined to be qualified before July 1, 2001.

449.571            Program of training: Curriculum;

duties of instructor; written examinations.

449.5715          Program of training: Qualifications

of instructors.

449.573            Program of training: Certain

persons authorized to provide instruction and serve as preceptor.

449.5735          Program of training: Required

hours.

449.574            Committee to review program of

training.

449.5745          Written list concerning knowledge

and skills.

449.576            Peritoneal dialysis: Additional

activities required.

449.5765          Cannulation or administration of

normal saline or heparin: Additional activities required.

449.577            Cannulation or administration of

normal saline, heparin or lidocaine: Verification and documentation of

competency required.

449.5775          Documentation of successful

completion of program of training; employment by another facility.

449.579            Patient care: Technicians must

demonstrate certain knowledge and competency.

449.5795          Prohibited acts.

PROVISION OF CERTAIN SPECIAL SERVICES

Obstetric Care

449.6113          Definitions.

449.61132        Authorized obstetric care.

449.61134        Eligible maternal patients.

449.61138        Denial of application for or

renewal of license; revocation or suspension of license.

449.6114          Design, construction, equipment and

maintenance of obstetric center: General requirements; prerequisites to

approval for licensure.

449.61142        Required facilities and services.

449.61144        Required emergency electrical

power.

449.61146        Requirements for birth room, toilet

and bathing facilities, hallways and doors, water supply and office-based

facilities.

449.61148        Governing body of obstetric center;

duties.

449.6115          Physician operator or advanced

practice registered nurse operator as licensee.

449.61152        Designation and responsibilities of

medical director; privileges of members of medical staff; provision of

consultation services with specialists.

449.61154        Medical records: Maintenance;

access.

449.61156        Medical records: Contents.

449.61158        Program for review of quality of

care.

449.6116          Miscellaneous requirements

concerning staff, provision of service and equipment.

449.61162        Requirements for transfer or

discharge of patient.

449.61164        Written protocol for discharge of

patient.

449.61166        Policies and procedures for control

of infectious agents and diseases; program to monitor health of employees.

449.61168        Laboratory services; transfer of

maternal patient who needs blood or blood products.

449.6117          Possession, distribution,

administration and storage of drugs and controlled substances.

449.61172        Anesthesia.

449.61174        Transfer of patient to hospital or

medical facility licensed to provide high-risk perinatal care.

449.61176        Death of patient; notification of

Division; provision of counseling.

449.61178        Required information to be provided

or made available to patient; complaints.

Open-Heart Surgery

449.612            Definitions.

449.612011     “Approval” defined.

449.612012     “Approved hospital” defined.

449.612014     “Cardiac surgery” defined.

449.612017     “Open-heart surgery” defined.

449.61202        Prerequisites to initial provision

of service.

449.61204        Form and contents of application

for approval to provide service.

449.61206        Notification of applicant upon

review of application; site inspection required.

449.61208        Composition and duties of site

inspection team.

449.6121          Hospital to pay costs of

inspection.

449.61212        Approval or denial of application;

period of validity of approval; cessation of performance of surgeries.

449.61214        Amount of surgery required

following approval.

449.61216        Provision of patient with preoperative

instruction.

449.61218        Surgical team: Composition;

privileges and qualifications of members; participation of qualified nurses.

449.6122          Qualifications of anesthesiologist.

449.61222        Qualifications of nurse in charge

of service.

449.61224        Perfusion team: Use required;

qualifications; approval of members by surgeon of record.

449.61226        Operating rooms: General

requirements.

449.61228        Operating rooms: Equipment and

staff.

449.6123          Intensive care facility: General

requirements.

449.61232        Intensive care facility: Staff.

449.61234        Intensive care facility: Equipment

and supplies.

449.61236        Orientation and continuing

education of personnel.

449.61238        Maintenance of blood bank.

449.6124          Maintenance of cardiac

catheterization laboratory.

449.61242        Maintenance of medical laboratory.

449.61244        Maintenance of facilities to

perform contrast studies and equipment to review films of operations.

449.61246        Maintenance of registry to record

results for each patient.

449.61248        Maintenance of program to follow

recovery of patient.

449.6125          Annual review and inspection of

hospital.

449.61252        Annual inspection of hospital:

Assessment of rate of mortality.

449.61254        Further review or on-site

inspection for failure to comply with provisions or for excessive rate of

mortality; notice; plan for compliance.

449.61256        Denial, suspension or revocation of

approval: Grounds; hearing.

Transplantation of Organs

449.6126          Definitions.

449.61262        Application for approval to provide

services.

449.61264        Evaluation of application for

approval.

449.61266        Duties of hospital providing

services.

449.61268        Revocation of approval.

449.6127          Notice of intent to deny

application or revoke approval; hearing.

INDEPENDENT CENTERS FOR EMERGENCY MEDICAL CARE

Licensing

449.61302        Limitations on issuance of license.

449.61306        Denial of application for license

or renewal of license.

449.61308        Compliance with regulations; ground

for suspension or revocation of license.

Administration and Personnel

449.6132          Requirement of governing body;

adoption of written rules.

449.61322        Exception to requirements of

governing body.

449.61324        Standards of care; policy for

authentication.

449.61326        Program to review quality of care;

contents of program.

449.61328        Integration into local emergency

medical system.

449.6133          Appointment and responsibilities of

administrator.

449.61332        Employment and duties of medical

director.

449.61334        Standards and procedures for

selection, treatment and retention of medical staff and members of allied health

professions.

449.61336        Rules for organization of medical

staff.

449.61338        Employment and duties of chief

nurse; size of on-duty nursing staff; limitation on scope of practice by person

who is not registered nurse; oversight of nursing staff.

Facilities

449.6135          Design, construction, equipment and

maintenance: General requirements; prerequisites to approval for licensure.

449.61352        Contents of center: Emergency

entrance; reception and waiting areas; treatment and examination rooms; space

for storage and maintenance of medical records and supplies.

449.61354        Contents of treatment rooms;

accessibility to person in wheelchair.

Medical Services and Medical Records

449.6137          Requirement for minimum level of

care in certain situations.

449.61372        Criteria for denial of care,

transfer or discharge of patient; compliance with state and federal laws.

449.61374        Laboratory services and reports;

procedures for storage and administration of tissue specimens, blood and blood

products; agreements with outside blood banks; review of blood transfusions and

reactions.

449.61376        Program for control of infection.

449.61378        Radiological services:

Availability; interpretation and reporting of films; storage and retention.

449.6138          Distribution and administration of

drugs and controlled substances.

449.61382        Medical records: Maintenance;

access; authorized release; completion after discharge.

449.61384        Contents of medical records.

INTERMEDIATE CARE FACILITIES

General Provisions

449.614            Definitions.

449.617            “Administrator” defined.

449.623            “Facility” defined.

449.629            “Intermediate care facility as a

distinct part of a health and care facility furnishing more than one level of

care” defined.

449.632            “Intermediate care facility for

persons with an intellectual disability or persons with a developmental

disability” defined.

449.635            “Licensee” defined.

449.638            “Long-term care facility” defined.

449.644            “Mixed facility” defined.

449.647            “New facility” defined.

449.650            “Nursing home” defined.

449.653            “Patient in an intermediate care

facility I” defined.

449.656            “Patient in an intermediate care

facility II” defined.

449.657            “Person with a developmental disability”

defined.

449.658            “Person with an intellectual

disability” defined.

449.659            “Resident” defined.

Licensing

449.668            Provisional licenses.

Administration and Personnel

449.671            Financing; liability insurance.

449.674            Administrator: Qualifications.

449.677            Employees: General requirements.

449.680            Employees: Health; physical

examinations.

449.681            Employees of facility which

provides care to persons with dementia: Continuing education.

Construction and Operation: Generally

449.685            Design, construction, equipment and

maintenance: General requirements; prerequisites to approval of facility for

licensure.

449.692            Sanitary requirements.

449.695            Laundry requirements.

449.698            Fire inspections; hazardous

conditions; operation of other business.

449.701            Preparations for emergencies;

reporting of fire or disaster.

449.704            Written policies and procedures for

facility; admission agreements; transfer agreements.

449.707            Money of residents.

449.710            Inventory of residents’ belongings.

449.713            Program requirements.

449.716            Dietary services.

449.719            Health services.

449.722            Pharmaceutical services.

449.725            Records.

449.728            Supervision by physician;

volunteers; advertising.

449.731            Discrimination prohibited.

Construction and Operation: Facilities for Persons With an

Intellectual Disability or Persons With a Developmental Disability

449.732            Definitions.

449.7322          “Facility” defined.

449.7324          “New facility” defined.

449.7326          Standards for construction,

remodeling or change in use of facility; fire alarms; emergency radio system;

submission and approval of building plans.

449.7328          Elevators.

449.733            Electrical systems.

449.7332          Mechanical systems.

449.7334          Doors, windows, ceilings, walls and

floors.

449.7336          Entrances and lobbies;

miscellaneous space.

449.7338          Dining and storage space.

449.7342          Facilities for employees and

volunteers.

449.7344          Areas for engineering and

maintenance.

449.7346          Janitors’ closets.

449.7348          Linen service.

449.735            Area for medical records.

449.7352          Nursing units.

449.7354          Service areas.

449.7356          Processing of waste.

449.736            Personnel.

449.737            Plan of care.

449.740            Corporal punishment; restraints.

449.743            Records.

COMMUNITY TRIAGE CENTERS

449.74311        Definitions.

449.74313        “Administrator” defined.

449.74315        “Facility” defined.

449.74317        “Governing body” defined.

449.74321        “Patient” defined.

449.74322        “Person with mental illness”

defined.

449.74323        “Program” defined.

449.74325        “Psychologist” defined.

449.74327        Governing body; bylaws and policies.

449.74329        Policies and procedures for

services and operation of facility.

449.74331        Transfer of patient.

449.74333        Handling of money of patient.

449.74335        Inventory of belongings of patient.

449.74337        Liability insurance.

449.74339        General requirements for programs

and services.

449.74341        Responsibilities and duties of

administrator.

449.74343        Policies and procedures concerning

employees.

449.74345        Nursing services.

449.74347        Health services.

449.74349        Mental health services.

449.74351        Pharmaceutical services.

449.74353        Medication and biologicals.

449.74355        Records of patients.

449.74357        Laundry requirements.

449.74359        Dietary services.

449.74361        New construction or remodeling:

Submission and approval of building plans; prerequisites to approval of

facility for licensure.

449.74363        Design, construction, equipment and

maintenance of facility.

449.74365        Entrances, lobbies and offices;

storage space.

449.74367        Patients’ rooms; toilet and bathing

facilities.

449.74369        Service areas; miscellaneous

requirements.

449.74371        Safety and sanitation.

449.74373        Preparations for disasters;

reporting of fire or disaster.

449.74375        Discrimination prohibited.

FACILITIES FOR SKILLED NURSING

General Provisions

449.744            “Facility for skilled nursing”

defined.

Licensing and Administration of Facility

449.74411        Applicability of license;

limitation on number of patients; coverage against certain liabilities.

449.74413        Change in ownership, use or

construction of facility.

449.74415        Responsibilities of governing body.

449.74417        Administrator of facility.

449.74419        Committee for quality assurance.

449.74421        Procedures for emergency or

disaster.

Admission, Transfer and Discharge of Patient

449.74423        Certain conditions for admission

prohibited.

449.74425        Admission of patient with mental

illness or an intellectual disability.

449.74427        Agreement with hospital for

transfer of patients.

449.74429        Transfer or discharge of patient.

449.74431        Summary of discharge.

Assessment of Patients and Plan of Care

449.74433        Comprehensive assessment of needs

of patient.

449.74435        Quarterly assessment of patient.

449.74437        Conduct of assessments.

449.74439        Comprehensive plan of care.

Medical Records

449.74441        Maintenance.

449.74443        Inspection.

Rights of Patients

449.74445        Generally.

449.74447        Communications with other persons;

examination of records by advocate.

449.74449        Notice to patients of rights,

services and charges.

449.74451        Charges to be consistent with

notice of charges.

449.74453        Notice to patients of programs

available for assistance in payment of services.

449.74455        Discrimination prohibited.

449.74457        Policies and procedures for advance

directives by patient; information to be furnished regarding physicians.

449.74459        Examination by patient of survey of

facility and plan of correction.

449.74461        Finances of patient: System for

maintenance and accounting.

449.74463        Finances of patient: Authorization

to withhold money.

449.74465        Sending and receiving mail.

449.74467        Performance of services for

facility by patient.

Quality of Care

449.74469        Standards of care.

449.74471        Administration of drugs.

449.74473        Program for control of infections.

449.74475        Vision and hearing.

449.74477        Pressure sores.

449.74479        Urinary problems.

449.74481        Range of motion.

449.74483        Mental or psychosocial behavior.

449.74485        Nasogastric tubes.

449.74487        Nutritional health; hydration.

449.74489        Physical or chemical restraint of

patients.

449.74491        Prohibition of certain practices

regarding patients; investigation of certain violations and injuries to

patients; unfit employees.

449.74493        Notification of changes or

condition of patient.

449.74495        Development of program of

activities.

449.74497        Daily activities of patient.

449.74499        Participation in activities.

Staff and Attending Physicians

449.74511        Personnel policies; personnel records.

449.74513        Medical director.

449.74515        Physicians.

449.74517        Nursing staff.

449.74519        Nursing assistants and nursing

assistant trainees.

449.74521        Other health care professionals.

449.74522        Employees of facility which

provides care to persons with dementia.

Provision of Services

449.74523        Social services.

449.74525        Dietary services.

449.74527        Specialized rehabilitative

services.

449.74529        Dental services.

449.74531        Pharmaceutical services.

449.74533        Laboratory services.

449.74535        Radiological and other diagnostic

services.

449.74537        Special services.

Physical Environment

449.74539        General requirements.

449.74543        Design, construction, equipment and

maintenance: General requirements; prerequisites to approval of facility for

licensure.

449.74549        Patients’ rooms.

NURSING POOLS

General Provisions

449.747            Definitions.

Licensing

449.7471          License required.

449.7473          Location to which license applies;

persons named in license; restrictions on use of license.

449.7474          Duties of licensee or applicant for

license.

Administration and Personnel

449.7475          Administrator: Qualifications and

duties.

449.7476          Director of professional services:

Qualifications and duties.

449.7477          Personnel policies: Maintenance and

availability.

449.7478          Requirements for contracts to

provide nursing services.

449.7479          Referral of patients when services

not available; provision of services; bonding of staff.

449.748            Duties of registered nurse;

provision of nursing care by practical nurse or nursing assistant.

449.7481          Annual evaluation of nursing pool

by licensee.

HOME HEALTH AGENCIES

General Provisions

449.749            Definitions.

Licensing and Inspection

449.752            License required.

449.758            Applicability of license; coverage

against certain liabilities.

449.761            Periodic inspections.

449.767            Action to enjoin operation without

license.

449.768            Applicant or licensee to maintain

home office in Nevada.

Administration and Personnel

449.770            Governing body; bylaws.

449.773            Administrator: Qualifications;

duties.

449.776            Director of professional services.

449.779            Professional advisory group.

449.782            Personnel policies.

449.785            Contracts for home health services.

449.787            Duty to provide skilled nursing

care and home health aide services; inclusion of additional services.

449.788            Services to patients.

449.791            Duties of personnel.

449.793            Evaluation by governing body;

periodic review of contracts, operations, policies and procedures.

Medical Services and Medical Records

449.794            Clinical records: General

requirements.

449.797            Contents of clinical records.

449.800            Medical orders.

FINANCIAL REPORTING

449.951            Definitions.

449.953            Annual fee for insurers: Amount;

notice; administrative fine for failure to pay.

449.957            Hospitals to file certain reports;

certification; exception; extension.

449.960            Hospitals to submit quarterly

financial and utilization report; certification; extension.

449.962            Facility for intermediate care or

facility for skilled nursing to submit quarterly financial and utilization

report; certification; extension.

449.9625          Institution to submit quarterly

financial and utilization report; certification; extension; exception.

449.963            Information concerning treated

patients: Submission; limitation on disclosure.

449.966            Notice of insufficiency of

submitted information.

449.969            Administrative fine for failing to

meet deadlines.

MOBILE UNITS

449.970            Definitions.

449.9701          “Independent facility” defined.

449.97012        “Mobile unit” defined.

449.97014        “Parent facility” defined.

449.97016        “Service site” defined.

449.97018        “Staging area” defined.

449.9702          Applicability of provisions.

449.97022        Licensure.

449.97024        Application for licensure.

449.97026        Design, construction, equipment,

maintenance and parking.

449.97028        Staging areas; disposal of

biohazards and waste.

449.9703          Compliance with certain statutes

and regulations.

449.97032        Compliance with regulations

relating to evaluation of quality of services.

449.97034        Written policies for operation of

unit; agreement with hospital or medical facility for transfer of patients

during emergencies.

449.97036        Rights of patients.

449.97038        Maintenance of schedule and records;

supplies and equipment; diagnostic radiological services; laboratory services.

449.9704          Occupancy; fire safety; exits; use

and maintenance of equipment; telecommunications device.

449.97042        Restrictions on operation; office

of independent facility; operation pursuant to contract.

SURGICAL CENTERS FOR AMBULATORY PATIENTS

General Provisions

449.971            Definitions.

449.9715          “Allied health profession” defined.

449.972            “Ambulatory surgical center”

defined.

449.9721          “Biohazardous waste” defined.

449.9722          “Biologic indicator test” defined.

449.9724          “Cleaning” defined.

449.9725          “Division” defined.

449.973            “Governing body” defined.

449.9731          “High-level disinfection” defined.

449.9732          “Implantable device” defined.

449.9733          “Invasive procedure” defined.

449.9735          “Licensee” defined.

449.9736          “Low-level disinfection” defined.

449.9738          “Multidose vial” defined.

449.974            “Patient” defined.

449.9741          “Physician” defined.

449.9742          “Registered nurse” defined.

449.97422        “Reprocess” defined.

449.97426        “Single-dose vial” defined.

449.97428        “Sterilization” defined.

449.9743          “Surgery” defined.

Licensing

449.9745          Center required to provide proof of

national accreditation; submission of reports to Division; application by

accrediting organization for recognition by State Board of Health.

449.9755          Investigation of applicant and

inspection of facility.

449.978            Effect of expiration of license.

449.9785          Conformance with regulations

required.

Administration

449.979            Governing body required.

449.9795          Duties of governing body.

449.980            Responsibilities of governing body.

449.9801          Procedures for granting privileges

to members of medical staff.

449.9805          Establishment of policy for

authentication.

449.981            Appointment and responsibilities of

administrator.

449.9811          Program for review of surgical

procedures and patient outcomes.

449.9812          Program for quality assurance.

449.9813          Committee for quality assurance.

449.9815          Maintenance.

449.982            Sanitation and housekeeping.

449.983            Protection from fire and other

disasters.

449.9832          Establishment of policies for

provision of services and care by persons under contract with or who are

otherwise not employed by center.

449.9835          Exemption from requirements for

governing body and administrator.

449.9837          Restrictions on operation of

ambulatory surgical center; maintenance of records.

449.9843          Compliance with certain standards,

laws, ordinances and codes; submission and approval of building plans;

prerequisites to approval of center for licensure.

Program for the Prevention and Control of Infections and

Communicable Diseases

449.98451        Adoption of guidelines by governing

body for establishment of program.

449.98452        General requirements of program.

449.98453        Program required to include

policies and procedures for prevention of exposure to blood-borne and other

potentially infectious pathogens.

449.98454        Program required to include

policies and procedures for single-dose vials and multidose vials.

449.98455        Sterilization and disinfection of

surgical instruments, items and equipment; training required for employees and

contractors responsible for sterilization or disinfection.

449.98456        Center required to designate

employee or enter into contract for overseeing and managing program;

qualifications and duties of employee or contractor.

449.98457        Mandatory training and evaluation

of employees and other persons.

Personnel

449.9855          Policies and requirements for

personnel.

449.9865          Medical staff.

449.988            Nursing staff.

Medical Records, Services and Facilities

449.9885          Medical records: Maintenance.

449.989            Medical records: Contents.

449.990            Medication and treatment.

449.9902          Emergency equipment and supplies.

449.9905          Pharmacist employed by or

contracted with center; records, storage and administration of drugs; center

required to obtain license to operate pharmacy.

449.991            Laboratory services.

449.992            Pathological services.

449.9925          Blood and derivatives of blood:

Procurement, storage, transfusion and administration; policies and procedures;

reporting of adverse reaction.

449.993            Diagnostic radiological services.

449.9935          Operating and recovery rooms;

endoscopy suite.

449.9937          Extended recovery units.

449.994            Records required before surgery;

report of surgery.

449.9945          Administration and record of

anesthesia.

449.9947          Register of surgeries performed in

operating rooms.

449.9955          Informing patient of rights,

services and cost.

449.996            Transfer of patients.

449.9965          Prohibited locations for construction

of center.

449.997            Conversion of hazardous building

into center prohibited.

RECEIVERS

449.9981          List of interested and qualified

persons.

449.99811        Experience.

449.99812        Authority.

449.99813        Compensation and payment of bond.

449.99814        Operation of facility.

ADMINISTRATIVE SANCTIONS

General Provisions

449.9982          Definitions.

449.99821        “Ban on admissions” defined.

449.99822        “Cluster” defined.

449.99823        “Compliance” and “substantially

correct the deficiency” defined.

449.99824        “Costs” defined.

449.99825        “De minimis deficiency” defined.

449.998253     “Division of Health Care Financing

and Policy” defined.

449.998255     “Facility” defined.

449.99826        “Immediate family” defined.

449.99827        “Initial deficiency” defined.

449.99828        “Major deficiency” defined.

449.99829        “Medicaid facility” defined.

449.9983          “Medicare facility” defined.

449.99832        “Monitor” defined.

449.99833        “New admission” defined.

449.99834        “Particular kinds of care,

treatment or services” defined.

449.99835        “Plan of correction” defined.

449.99836        “Provider agreement” defined.

449.99837        “Repeated deficiency” defined.

449.99838        “Resurvey” defined.

449.99839        “Severity and scope score” defined.

449.9984          “Subsequent deficiency” defined.

449.99841        “Temporary management” defined.

449.99843        Purposes of administrative

sanctions.

449.99844        Interpretation of provisions in

accordance with federal standards.

Imposition: Generally

449.9985          Authority of Division and Bureau.

449.99851        Requirement for imposition;

optional imposition.

449.99852        Requirement for imposition;

multiple sanctions.

449.99853        Imposition of one or more

sanctions; criteria for imposition of particular sanction.

449.99854        Imposition in lieu of or in

addition to recommendation to terminate provider agreement; duration of

sanctions.

449.99855        Imposition in emergencies:

Authority; notice.

449.99856        Deficiencies: Basis for imposition

of sanctions; reporting; presumption of de minimis deficiency.

449.99857        Classifications of severity and

scope of deficiencies: Use.

449.99858        Scope of violations: Evaluation of

representative sample of recipients; size of sample.

449.99859        Scope of deficiencies: Use of scope

scale; basis for assessment.

449.9986          Scope of deficiencies: Criteria for

evaluation.

449.99861        Severity of deficiencies: Use of

severity scale; basis for assessment; criteria for evaluation.

449.99862        Presumption when same deficiency

found on resurvey; imposition of sanction for subsequent deficiency.

449.99863        Available sanctions.

449.99864        Determination of appropriate

sanction: Procedure.

449.99865        Determination of appropriate

sanction: Initial assessment.

449.99866        Determination of appropriate

sanction: Consideration of secondary factors.

449.99867        Determination of appropriate

sanction: Basis for selection; presumption.

Plan of Correction

449.9987          Development and submission of plan;

authority of Bureau when plan is not acceptable; effect of failure to submit

plan.

Limitation on Occupancy of Residential Facility

449.99875        Purpose and scope of limitation;

imposition in addition to partial ban on admissions.

449.99876        Criteria for imposition.

449.99877        Duration and termination of

limitation.

449.99878        Notice of limitation: General

requirements; effect of noncompliance.

Ban on Admissions

449.9988          Purpose and scope of ban.

449.99881        Criteria for imposition.

449.99882        Duration and termination of ban.

449.99883        Notice of ban: General

requirements; effect of noncompliance.

Monitoring of Facility

449.99885        Authority of Bureau.

Monetary Penalties

449.99895        Imposition by Bureau; purpose;

applicable criteria.

449.99896        Criteria for imposition; imposition

of initial and daily penalties.

449.99897        Imposition of initial penalty

pending hearing or appeal; stay of payment of penalties pending appeal.

449.99898        Procedure for imposition; interest

on total penalty assessed.

449.99899        Determination of amount of

penalties.

449.999            Limitation on principal amount of

total daily penalty.

449.99901        Daily penalty: Computation

according to number of recipients.

449.99902        Increase in penalty for repeated

deficiencies or false compliance.

449.99903        Presumption regarding deficiencies

identified on resurvey.

449.99904        Reduction of penalty.

449.99905        Daily penalty: Effective beginning

date.

449.99906        Daily penalty: Date and period of

computation; notice to facility.

449.99907        Termination of daily penalties;

failure of Medicaid facility to remove immediate and serious threat after

appointment of temporary management.

449.99908        Time for payment of penalties.

449.99909        Assessment of interest on unpaid

balance of penalty.

449.9991          Recovery of costs for collection of

penalty.

449.99911        Failure to pay penalty: Suspension

of license of facility.

449.99912        Disposition of money collected.

Temporary Management

449.99915        Appointment of temporary manager

when there is immediate and serious threat: Notice; effect of failure to accept

manager and to remove threat.

449.99916        Appointment of temporary manager

when there is no immediate and serious threat: Notice.

449.99917        Temporary manager: Qualifications.

449.99918        Temporary manager: Authority.

449.99919        Effect of failure to agree to

appointment of or to relinquish authority to temporary manager.

449.9992          Events requiring termination of

management; initiation of judicial proceedings.

449.99921        Payment of costs and expenses.

Closure of Facility and Transfer of Residents

449.99925        Authority of Bureau.

449.99926        Requirements for notification.

449.99927        Appointment of temporary manager.

449.99928        Bureau to supervise or appoint

temporary manager to supervise transfer; imposition of other appropriate

sanctions.

449.99929        Determination of appropriate

placement of residents.

449.9993          Rights of appeal for transferred

residents.

Facilities Participating in Medicaid

449.99935        Authorized recommendations in

addition to available sanctions.

449.99936        Withholding of monetary penalties

from payments owed to facility.

449.99937        Denial of payments for new

admissions generally.

449.99938        Denial of payments for new

admissions who have certain specified diagnoses or special care needs.

449.99939        Suspension of payments for services

furnished to Medicaid recipient on or after date of deficiency.

OUTPATIENT FACILITIES: PERMIT FOR SERVICES OF GENERAL

ANESTHESIA, CONSCIOUS SEDATION AND DEEP SEDATION

General Provisions

449.9994          Definitions.

449.99941        “Bureau” defined.

449.999413     “Division” defined.

449.999415     “Inspection” defined.

449.999417     “Outpatient facility” defined.

449.999419     “Treatment” defined.

Permitting

449.99942        Application; general requirements;

proof of national accreditation; fee; period for validity; application required

for each location.

449.999421     Inspection by Division of applicant

and outpatient facility; prerequisite of satisfactory fire inspection.

449.999422     Term of permit; circumstances under

which permit deemed invalid.

449.999423     Renewal of permit: Application;

additional inspection by Division authorized; fees; untimely filing or failure

to file application.

449.999424     Outpatient facility required to

provide proof of national accreditation; submission of reports to Division;

application by accrediting organization for recognition by State Board of Health;

maintenance of list by Division of approved accrediting organizations.

449.999425     Display of permit; maintenance of

outpatient facility in compliance with law; notification of transfer of real

property; notification of change of ownership, location or services provided.

449.999426     Additional grounds for denial,

suspension or revocation of permit.

Program for the Prevention and Control of Infections and

Communicable Diseases

449.99943        Definitions.

449.999431     “Biologic indicator test” defined.

449.999432     “Cleaning” defined.

449.999433     “High-level disinfection” defined.

449.999434     “Implantable device” defined.

449.999435     “Invasive procedure” defined.

449.999436     “Low-level disinfection” defined.

449.999437     “Multidose vial” defined.

449.999438     “Reprocess” defined.

449.999439     “Single-dose vial” defined.

449.99944        “Sterilization” defined.

449.999441     Adoption of guidelines by holder of

permit for establishment of program.

449.999442     General requirements of program.

449.999443     Program required to include policies

and procedures for prevention of exposure to blood-borne and other potentially

infectious pathogens.

449.999444     Program required to include policies

and procedures for single-dose vials and multidose vials.

449.999445     Sterilization and disinfection of

surgical instruments, items and equipment; training required for employees and

contractors responsible for sterilization or disinfection.

449.999446     Outpatient facility required to

designate employee or enter into contract for overseeing and managing program;

qualifications and duties of employee or contractor.

449.999447     Mandatory training and evaluation of

employees and other persons.

449.999448     Establishment of additional policies

and guidelines by holder of permit to ensure health and safety of patients;

professional standards of practice; requirement of tuberculosis test for

employees and persons under contract with outpatient facility.

Administrative Sanctions

449.99945        Definitions.

449.999451     “Cluster” defined.

449.999452     “De minimis deficiency” defined.

449.999453     “Deficiency” defined.

449.999454     “Immediate and serious threat” and

“immediate jeopardy” defined.

449.999455     “Incident” defined.

449.999456     “Initial deficiency” defined.

449.999457     “Severity and scope score” defined.

449.999458     Purpose of sanctions.

449.999459     Grounds for denial, suspension or

revocation of permit.

449.99946        Appeal of denial, suspension or

revocation of permit or other sanction.

449.999461     Imposition of sanctions: Authority

of Division and Bureau.

449.999462     Imposition of sanctions: Requirement

for imposition; optional imposition; multiple sanctions; use of severity and

scope factors for particular sanction.

449.999463     Imposition of sanctions in

emergencies: Notice; authority; exception to notice requirement.

449.999464     Deficiencies: Basis for imposition

of sanctions; reporting; presumption of de minimis deficiency.

449.999465     Scope of violations: Evaluation of

representative sample of recipients; sample size.

449.999466     Scope of deficiencies: Use of scope

scale; basis for assessment.

449.999467     Scope of deficiencies: Criteria for

evaluation.

449.999468     Severity of deficiencies: Use of

severity scale; basis for assessment; criteria for evaluation.

449.999469     Presumption when same deficiency

found on subsequent inspection; imposition of sanction for subsequent

deficiency.

449.99947        Available sanctions.

449.999471     Determination of appropriate

sanction: Procedure.

449.999472     Determination of appropriate

sanction: Initial assessment.

449.999473     Determination of appropriate

sanction: Consideration of secondary factors.

449.999474     Determination of appropriate

sanction: Basis for selection; presumption for monetary penalties.

449.999475     Plan of correction: Development and

submission of plan; authority of Bureau when plan is not acceptable; effect of

failure to submit plan.

449.999476     Monetary penalties: Criteria for

imposition; imposition of initial and daily penalties; exception for de minimis

deficiency.

449.999477     Monetary penalties: Imposition of

initial penalty pending hearing or appeal; stay of payment of penalties pending

appeal.

449.999478     Monetary penalties: Procedure for

imposition; interest on total penalty assessed.

449.999479     Monetary penalties: Determination of

amount of penalties.

449.99948        Monetary penalties: Increase in

penalty for repeated deficiencies or falsely alleged compliance.

449.999481     Monetary penalties: Presumption

regarding deficiencies identified on subsequent inspection.

449.999482     Monetary penalties: Reduction of

penalty.

449.999483     Monetary penalties: Effective

beginning date.

449.999484     Monetary penalties: Date and period

of computation; notice to outpatient facility.

449.999485     Monetary penalties: Termination of

daily penalties.

449.999486     Monetary penalties: Time for

payment.

449.999487     Recovery of expenses incurred by

Bureau or Division for implementing and enforcing administrative penalties,

bringing actions for enforcement and collecting monetary penalties.

449.999488     Failure to pay monetary penalty:

Suspension of permit.

449.999489     Disposition of money collected.

REGISTRY OF ADVANCE DIRECTIVES FOR HEALTH CARE

449.9998          Definitions.

449.99981        “Advance directive” defined.

449.999811     “Advance directive locator” defined.

449.999812     “Agent” defined.

449.999813     “Authorization to change form”

defined.

449.999814     “Authorized provider” defined.

449.99982        “Provider access application and

agreement” defined.

449.999821     “Provider of health care” defined.

449.999822     “Registrant” defined.

449.999823     “Registrant’s file” defined.

449.999824     “Registration agreement” defined.

449.999825     “Registry” defined.

449.999826     “Request for registration access

form” defined.

449.99983        Secretary of State to prescribe

format of necessary forms, applications and agreements.

449.999831     Storage of electronic reproductions

of certain documents in registrant’s file in Registry; Internet access to

Registry.

449.999832     Filing of advance directive or

advance directive locator; issuance of registration card; registrant to keep

file current.

449.999833     Amendment, suspension or revocation

of advance directive or advance directive locator; precedence of documentation;

validity.

449.999834     Removal, deletion or replacement of

registrant’s file in Registry.

449.999835     Submission of authorization to

change form by agent must include declaration for agent to act on behalf of

registrant.

449.999836     Authorized provider: Submission of

application and agreement; issuance of unique identification number and access

code.

449.999837     Authorized provider: Establishment

of internal controls to limit access to unique identification number and access

code; training of employees; audit by Secretary of State authorized.

449.999838     Access to Registry and information

therein; confidentiality; record of access to registrant’s file.

 

GENERAL PROVISIONS

      NAC 449.002  Definitions. (NRS 449.0302)  As used

in NAC 449.002 to 449.99939,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.0022 to 449.0072,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99

& R132-99, 11-29-99; R051-02, 7-24-2002; R179-09, 7-22-2010; R090-12, 12-20-2012)

      NAC 449.0022  “Administrator” defined. (NRS 449.0302)  “Administrator”

means the person responsible for the day-to-day management of a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0024  “Affiliated facility” defined. (NRS 449.0302)  “Affiliated

facility” means a facility that owns, directly or indirectly, an equity

interest of 5 percent or more in the capital, the stock, the profits or the

assets of another facility or is, as a subcontractor, agent or otherwise,

responsible for the management or control of that facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0026  “Agent” defined. (NRS 449.0302)  “Agent”

means a person having actual or apparent authority to act on behalf of a

licensee.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0028  “Bureau” defined. (NRS 449.0302)  “Bureau”

means the Bureau of Health Care Quality and Compliance of the Division.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R179-09,

7-22-2010)

      NAC 449.0029  “Centers for Medicare and Medicaid Services” defined. (NRS 449.0302)  “Centers

for Medicare and Medicaid Services” means the Centers for Medicare and Medicaid

Services of the United States Department of Health and Human Services.

     (Added to NAC by Bd. of Health by R051-02, eff. 7-24-2002)

      NAC 449.003  “Deficiency” defined. (NRS 449.0302)

     1.  “Deficiency” means noncompliance with any

federal or state statute or of the rules or regulations of the Division or the

Centers for Medicare and Medicaid Services or conditions and standards of or

requirements for participation in the Medicare or Medicaid program pertaining

to a facility.

     2.  The term includes an incident concerning

a facility where there are no extenuating circumstances or where the facility

has made an inappropriate response to a complaint, including the failure to:

     (a) Prevent an incident from occurring, if the

incident could have been avoided;

     (b) Identify an incident;

     (c) Take action to correct an incident before the

identification of the incident by the Bureau; or

     (d) Implement a contingency plan if permanent

action to correct an incident has not been undertaken.

     3.  In determining whether an incident is a

deficiency, the right of the recipient to refuse treatment, where applicable,

shall be deemed an extenuating circumstance.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02,

7-24-2002)

      NAC 449.00305  “Division” defined. (NRS 449.0302)  “Division”

means the Division of Public and Behavioral Health of the Department of Health

and Human Services.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R094-06

& R098-06, 7-14-2006)—(Substituted in revision for NAC 449.0038)

      NAC 449.0031  “Division of Welfare and Supportive Services” defined. (NRS 449.0302)  “Division

of Welfare and Supportive Services” means the Division of Welfare and

Supportive Services of the Department of Health and Human Services.

     (Added to NAC by Bd. of Health, eff. 8-1-91)—(Substituted

in revision for NAC 449.0074)

      NAC 449.0032  “Emergency” defined. (NRS 449.0302)  “Emergency”

means a major deficiency that places one or more recipients in immediate

jeopardy. The term includes, without limitation, any fire, flood, contagious

infection, loss of utilities or inappropriate transfer of residents.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0034  “Facility” defined. (NRS 449.0302)  “Facility”

means a medical facility, facility for the dependent, home for individual

residential care or referral agency.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99

& R132-99, 11-29-99)

      NAC 449.0042  “Holiday” defined. (NRS 449.0302)  “Holiday”

means a day on which the offices of State Government are closed.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0043  “Home for individual residential care” defined. (NRS 449.0302)  “Home

for individual residential care” has the meaning ascribed to it in NRS 449.0105.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.0044  “Immediate and serious threat” and “immediate jeopardy” defined. (NRS 449.0302)  “Immediate

and serious threat” or “immediate jeopardy” means a situation in which

corrective action within 48 hours is necessary because the failure by a

facility to comply with a requirement for licensure, certification or

participation in Medicare or Medicaid has caused, or if uncorrected is likely

to cause, serious injury or harm, or even death, to a recipient.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0046  “Incident” defined. (NRS 449.0302)  “Incident”

means an action, practice or situation that appears to be inconsistent with a

federal or state statute, rule or regulation of the Division or the Centers for

Medicare and Medicaid Services or conditions and standards of or requirement

for participation in Medicare or Medicaid.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02,

7-24-2002)

      NAC 449.0048  “License” defined. (NRS 449.0302)  “License”

means all or part of any permit, certificate, approval, registration, charter

or similar grant of permission to operate issued to a facility by the Division.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0049  “Licensed dietitian” defined. (NRS 449.0302)  “Licensed

dietitian” has the meaning ascribed to it in NRS 640E.040.

     (Added to NAC by Bd. of Health by R090-12, eff. 12-20-2012)

      NAC 449.005  “Licensee” defined. (NRS 449.0302)  “Licensee”

means any person, corporation, partnership, voluntary association or other

public or private entity, including any governmental body, licensed to operate

a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0052  “Medicaid” defined. (NRS 449.0302)  “Medicaid”

means the program established pursuant to Title XIX of the Social Security Act,

42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of

medical care rendered on behalf of indigent persons.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0054  “Medicare” defined. (NRS 449.0302)  “Medicare”

means the program of health insurance for aged and disabled persons established

pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0056  “Party” defined. (NRS 449.0302)  “Party”

means each person or agency as defined in NRS 233B.035.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0058  “Person” defined. (NRS 449.0302)  “Person”

means a natural person, trust, estate, partnership, corporation, professional

association, governmental body or any other entity, public or private.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.006  “Recipient” defined. (NRS 449.0302)  “Recipient”

means a person receiving care, services or treatment from a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0061  “Referral agency” defined. (NRS 449.0302, 449.0305)  “Referral agency” means a

business that provides referrals to residential facilities for groups which is

subject to regulation pursuant to NRS

449.0305, including, without limitation, any business entity that engages

in the process of referring clients for compensation to residential facilities

for groups.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.0062  “Resident” defined. (NRS 449.0302)  “Resident”

means a person who resides in a residential facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0064  “Residential facility” defined. (NRS 449.0302)  “Residential

facility” means a facility operated 24 hours per day in which one or more

persons receiving care, treatment or services ordinarily remain for 24 hours a

day.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0066  “Sanction” defined. (NRS 449.0302)  “Sanction”

means a corrective measure or penalty that is imposed by the Bureau upon a

facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0068  “Services” defined. (NRS 449.0302)  “Services”

means medical or personal care, including necessary preparation of food,

laundry and housekeeping in the case of a residential facility and items such

as medical diagnosis and treatment, drugs and biologicals, supplies,

appliances, equipment, medical-social services and use of a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.007  “Survey” defined. (NRS 449.0302)

     1.  “Survey” means a regularly scheduled

inspection of a facility conducted by employees of the Bureau to verify the

facility’s compliance with the regulations of the Division, the Centers for

Medicare and Medicaid Services, eligibility for participation in the Medicare

or Medicaid programs and eligibility for licensure.

     2.  The term includes a follow-up inspection

to recertify a facility or evaluate compliance with a plan of correction or an

inspection made in response to a complaint.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02,

7-24-2002)

      NAC 449.0072  “Treatment” defined. (NRS 449.0302)  “Treatment”

means any medication, drug, test or procedure conducted or administered to

diagnose or remedy a physical or mental illness or condition.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.008  Computation of time. (NRS 449.0302)  For the

purposes of any computation of time required by NAC

449.002 to 449.99939, inclusive:

     1.  Any prescribed period of more than 5 days

includes Saturdays, Sundays and holidays.

     2.  Any prescribed period of 5 days or less

does not include Saturdays, Sundays or holidays.

     3.  If the date on which any action required

to be performed falls on a Saturday, Sunday or holiday, the time is extended

until the next day that is not a Saturday, Sunday or holiday.

     4.  The day of any act or event or on which

notice is received is not included in the computation.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0085  Licensee prohibited from employing or contracting with unlicensed

person to provide certain nutrition services. (NRS 449.0302)  A

licensee shall not employ or contract with a person to provide medical

nutrition therapy or nutrition services unless the person is licensed pursuant

to chapter 640E of NRS or exempt from

such licensure.

     (Added to NAC by Bd. of Health by R090-12, eff. 12-20-2012)

      NAC 449.009  Control by Division over medical records of medical facility or

facility for dependent upon suspension of license or cessation of operation:

Authorized actions to remove, store and protect records; facilities to pay cost

of maintenance of records; notice before destruction of records. (NRS 449.171)

     1.  If the Division takes control of the

medical records of a medical facility or a facility for the dependent pursuant

to NRS 449.171, the Division:

     (a) May remove any or all of the medical records

and store them in a manner that ensures the safety of the medical records.

     (b) May contract with a person or governmental

entity to ensure the safety of the medical records.

     (c) Shall determine the costs for maintaining the

medical records and require the medical facility or facility for the dependent,

as applicable, to pay those costs. The costs must be assessed beginning on the

date on which the Division obtains control of the medical records and ending on

the date on which the medical records are destroyed or returned to the facility

pursuant to subsection 3. The medical facility or facility for the dependent,

as applicable, shall pay the costs within 30 days after receipt of notice of

the amount owed.

     2.  If the Division contracts with a person

or governmental entity pursuant to paragraph (b) of subsection 1, the Division

shall ensure that the person or governmental entity complies with the

provisions of subsection 2 of NRS

449.171.

     3.  The Division may:

     (a) Unless a longer period is required by federal

law, destroy a medical record upon expiration of the period of retention

required by NRS 629.051; or

     (b) Return a medical record to the medical facility

or facility for the dependent, as applicable, if the license of the facility is

reinstated or the facility restores its operation.

     4.  If the Division determines that a medical

record in the control of the Division will be destroyed in accordance with

subsection 3, the Division shall, for a period of not less than 30 days, post

on an Internet website maintained by the Division and in other locations as

determined by the Division a notice informing the patients of the medical

facility or facility for the dependent, as applicable, how to obtain a medical

record before it is destroyed.

     5.  If a medical facility or facility for the

dependent fails to pay the amount owed pursuant to paragraph (c) of subsection

1, the Division may suspend or revoke the license of the medical facility or

facility for the dependent pursuant to NAC 449.0118.

     (Added to NAC by Bd. of Health by R114-10, eff. 12-20-2012)

      NAC 449.010  Severability. (NRS 449.0302)  If any

of the provisions of NAC 449.002 to 449.99939, inclusive, or any application thereof to

any person, thing or circumstance is held invalid, it is intended that such

invalidity not affect the remaining provisions, or their application, that can

be given effect without the invalid provision or application.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 17, eff. 3-27-76]

      NAC 449.0105  Adoption of certain publications by reference; revision of

publication after adoption. (NRS 449.0302)

     1.  The State Board of Health hereby adopts

by reference:

     (a) NFPA 101: Life Safety Code, in the form

most recently published by the National Fire Protection Association, unless the

Board gives notice that the most recent revision is not suitable for this State

pursuant to subsection 2. A copy of the code may be obtained from the National

Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at

the Internet address http://www.nfpa.org or by telephone at (800)

344-3555, for the price of $55.80 for members or $62 for nonmembers, plus $7.95

for shipping and handling.

     (b) NFPA 99: Standard for Health Care Facilities,

in the form most recently published by the National Fire Protection

Association, unless the Board gives notice that the most recent revision is not

suitable for this State pursuant to subsection 2. A copy of the standard may be

obtained from the National Fire Protection Association at 11 Tracy Drive, Avon,

Massachusetts 02322, at the Internet address http://www.nfpa.org or by

telephone at (800) 344-3555, for the price of $41.63 for members or $46.25 for

nonmembers, plus $7.95 for shipping and handling.

     (c) Guidelines for Design and Construction of

Hospital and Health Care Facilities, in the form most recently published by

the American Institute of Architects, unless the Board gives notice that the

most recent revision is not suitable for this State pursuant to subsection 2. A

copy of the guidelines may be obtained from the American Institute of

Architects at the AIA Store, 1735 New York Avenue, NW, Washington, D.C.

20006-5292, at the Internet address http://www.aia.org or by telephone

at (800) 242-3837, for the price of $52.50 for members or $75 for nonmembers,

plus $9 for shipping and handling.

     2.  The State Board of Health will review

each revision of the publications adopted by reference pursuant to subsection 1

to ensure its suitability for this State. If the Board determines that a

revision is not suitable for this State, the Board will hold a public hearing

to review its determination within 6 months after the date of the publication

of the revision and give notice of that hearing. If, after the hearing, the

Board does not revise its determination, the Board will give notice within 30

days after the hearing that the revision is not suitable for this State. If the

Board does not give such notice, the revision becomes part of the publication

adopted by reference pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R066-04, R067-04,

R068-04, R069-04, R073-04, R076-04 & R077-04, eff. 8-4-2004)

GENERAL REQUIREMENTS FOR LICENSURE

      NAC 449.011  Application for license. (NRS 449.0302, 449.040)  An application for a

license that is filed with the Division pursuant to NRS 449.040:

     1.  Must be complete and include proof of the

identity of the applicant that is acceptable to the Division.

     2.  In accordance with NRS 449.050, must be accompanied by

the appropriate application fee specified in NAC

449.002 to 449.99939, inclusive.

     3.  In establishing that the applicant is of

reputable and responsible character as required by NRS 449.040, must include personal

references and information concerning the applicant’s financial status and

business activities and associations in and out of this State during the

immediately preceding 3-year period. If the applicant is a firm, association,

organization, partnership, business trust, corporation or company, such

references and information must be provided with respect to the members thereof

and the person in charge of the facility or program for which application is

made.

     4.  In addition to the information required

by NRS 449.040 and any other

information specifically required for a particular license, must include:

     (a) Full, complete and accurate information

regarding the ownership of the facility or program and all changes to that

ownership that occur while the application is pending. The information must

include the name of:

          (1) Each natural person who is an owner of the

facility or program;

          (2) Each person who has a direct or indirect

ownership interest in the facility or program of 10 percent or more and who is

the owner, in whole or in part, of any mortgage, deed of trust, note or other

obligation secured in whole or in part by the facility or program or any of the

property or assets of the facility or program;

          (3) If the applicant is a corporation, each

officer and director; and

          (4) If the applicant is a partnership, each

partner.

     (b) The address of the applicant’s principal

office.

     (c) Evidence satisfactory to the Division that the

facility or program meets all applicable federal, state and local laws and

complies with all safety, health, building and fire codes. If there are any

differences between the state and local codes, the more restrictive standards

apply.

     (d) If required by NRS 439A.100, a copy of a letter

of approval issued by the Director of the Department of Health and Human

Services.

     (e) A copy of the certificate of occupancy, a copy

of the applicant’s business license and a copy of any special use permits

obtained in connection with the operation of the facility or program.

     (f) A copy of any property lease or rental

agreements concerning the facility or program.

     (g) If the applicant is a corporation, a copy of

its bylaws and articles of incorporation.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97;

A by R078-12, 12-20-2012)

      NAC 449.0112  Investigation; prelicensure survey; inspection for fire safety. (NRS 449.0302)

     1.  Upon receipt of a properly completed

application, proof of the identity of the applicant that is acceptable to the

Division and the appropriate fee, the Division shall conduct an investigation

concerning the premises, facilities, qualifications of personnel, methods of

operation and policies of the applicant and perform a prelicensure survey of:

     (a) The applicant; and

     (b) The facility, program plan and management plan,

as appropriate.

     2.  Before issuing a license, the Division

must receive a satisfactory report of inspection of the facility from the State

Fire Marshal or the local fire department.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97;

A by R078-12, 12-20-2012)

      NAC 449.0114  Display of license; compliance with law; transfer of real

property; change in administrator, ownership, location or services. (NRS 449.0302,

449.050)

     1.  Upon receipt of a license, the licensee

shall display the license at a conspicuous location within the facility.

     2.  During the term of the license, the

licensee shall continuously maintain the facility in conformance with the

provisions of NAC 449.002 to 449.99939, inclusive, and chapter 449 of NRS.

     3.  If there is a transfer of the real

property on which the facility is located, but no change in the operator of the

facility, the licensee shall, within 10 days, notify the Division of the

transfer in writing and provide the Division with a copy of any lease agreement

relating to the transfer.

     4.  If there is a change in the administrator

of the facility, the licensee shall notify the Division of the change within 10

days. The notification must provide evidence that the new administrator is

currently licensed pursuant to chapter 654

of NRS and the regulations adopted pursuant thereto. If the licensee fails to

notify the Division and submit an application for a new license within 10 days

after the change, the licensee shall pay to the Division a fee in an amount

equal to 150 percent of the fee required for a new application set forth in

subsection 1 of NAC 449.0168.

     5.  A licensee shall notify the Division

immediately of any change in the ownership of, the location of, or the services

provided at, the facility.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97;

A by R122-05, 11-17-2005)

      NAC 449.0115  Review of building plans for new construction or remodeling by

certain applicants: Required documents; payment of fees and costs. (NRS 439.150,

439.200, 449.0302)

     1.  An applicant for a license or the renewal

of a license to operate a medical facility or facility for the dependent who

wishes or is required to have building plans for new construction or remodeling

reviewed by the Division must:

     (a) Submit to the Division or have on file a

current application for a license or renewal of a license;

     (b) Pay to the Division any fees required for the

issuance or renewal of a license pursuant to NAC

449.013 or 449.016; and

     (c) Submit two complete sets of building plans for

new construction or remodeling prepared by a registered architect, registered

residential designer or licensed general contractor to the entity designated to

review such plans by the Division.

     2.  All costs incurred for the review of

building plans and any changes or revisions made to the plans must be borne by

the applicant and paid directly to the designee of the Division conducting the

review of the plans.

     3.  The costs required to be paid pursuant to

subsection 2 are not refundable and are in addition to the fees charged for the

issuance or renewal of the license pursuant to NAC

449.013 or 449.016.

     (Added to NAC by Bd. of Health, eff. 11-1-95; A by R035-97,

10-30-97; R129-99, 11-29-99, eff. 1-1-2000; R076-01, 10-18-2001; R067-04, R070-04

& R072-04, 8-4-2004; R076-04, 8-5-2004; R122-05, 11-17-2005; R051-06, 7-14-2006)

      NAC 449.01153  Approval of building plans for construction or remodeling of

certain facilities: Period of validity. (NRS 449.0302)  If the

Division approves building plans for the construction or remodeling of a

facility for modified medical detoxification, a facility for skilled nursing, a

facility for the care of adults during the day, a facility for the treatment of

abuse of alcohol or drugs, a hospital, a mobile unit, a residential facility

for groups or a surgical center for ambulatory patients, the approval is valid

for 42 months after it is issued, unless there has been:

     1.  A modification of the building plans;

     2.  A change in the ownership of the

facility; or

     3.  A change in the intended use of the

facility.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)

      NAC 449.01156  On-site advisory inspection of facility: Written request; action

by Division; fee. (NRS 439.150, 439.200, 449.0302)

     1.  A licensee or an applicant for the

issuance or renewal of a license whose building plans for the construction of a

facility have been reviewed pursuant to NAC 449.0115

may submit a written request to the Division for an on-site advisory inspection

to be conducted by the Division after at least 80 percent of the construction

of the facility is completed. The written request must include, without

limitation, the anticipated date on which 80 percent of the construction of the

facility will be completed.

     2.  If the Division receives a request

submitted pursuant to subsection 1, the Division shall determine its ability to

grant the request and shall issue a notice of that determination to the

licensee or applicant who submitted the request.

     3.  If the Division grants a request

submitted pursuant to subsection 1, the licensee or applicant who submitted the

request shall, before the Division conducts the on-site inspection, submit to

the Division a fee of:

     (a) Five hundred dollars, if the project is valued

at not more than $500,000;

     (b) One thousand dollars, if the project is valued

at more than $500,000 but not more than $1,000,000; or

     (c) Two thousand dollars, if the project is valued

at more than $1,000,000.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)

      NAC 449.0116  Renewal of license: Application; validity of existing license

pending decision on application; inspection of facility; untimely filing or

failure to file application. (NRS 439.150, 439.200, 449.0302, 449.050, 449.089)

     1.  Except as otherwise provided in

subsection 2, a licensee who wishes to renew his or her license must submit a

complete application for renewal to the Division on or before November 15 of

the calendar year in which the license expires. The existing license shall be

deemed valid until the submitted application for renewal is evaluated and a

final determination is made by the Division concerning whether to renew the

license. The Division may require an inspection of the facility to ensure that

it meets the requirements of NAC 449.002 to 449.99939, inclusive, before deciding whether to

renew a license.

     2.  A licensee who, without good cause, files

an application for the renewal of his or her license after the date set forth

in subsection 1 but on or before December 31 of the calendar year in which the

license expires and who wishes to renew the license must pay:

     (a) The fee required for the renewal of the license

pursuant to NAC 449.013 or 449.016,

as appropriate; and

     (b) An additional charge equal to one-half the

amount of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as

appropriate.

     3.  A licensee who fails to file an

application for the renewal of his or her license before the license expires is

not eligible to renew the license and, if he or she wishes to be licensed, must

submit an application for a new license.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97;

A by R065-04, 8-4-2004)

      NAC 449.0118  Denial, suspension or revocation of license: Grounds. (NRS 449.0302)  In

addition to the grounds set forth in NRS

449.160 and any other grounds specifically applicable to a particular

license, the Division may deny an application for a license or may suspend or

revoke a license upon any of the following grounds:

     1.  The failure or refusal of an applicant or

licensee to comply with any of the provisions of chapter 449 of NRS or the regulations

adopted by the State Board of Health.

     2.  The failure or refusal of an applicant or

licensee to comply with a reasonable order from the Division to remove a

resident from a facility or program.

     3.  Operating a facility or program without a

license, if a license is required before operating.

     4.  Accepting for care, at any given time,

more residents than the number specified in the license.

     5.  The failure or refusal of a licensee to

return an adequate plan of correction to the Division within 10 days after the

receipt by the licensee of a statement of deficiencies.

     6.  The failure or refusal to cooperate fully

with an investigation or inspection by the Bureau.

     7.  Misappropriation of the property of a

resident of a facility.

     8.  Abuse, neglect or exploitation of an

infirm person, a person with an intellectual disability or a person with a

disability, or of a person who is 60 years of age or older.

     9.  The failure of a medical facility or

facility for the dependent to pay the costs for the maintenance of the medical

records of the facility required pursuant to paragraph (c) of subsection 1 of NAC 449.009.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97;

A by R114-10, 12-20-2012)

      NAC 449.0119  Denial, suspension or revocation of license or endorsement:

Appeals. (NRS 449.0302, 449.170)  An applicant or licensee

who is aggrieved by an action of the Division relating to the denial,

suspension or revocation of a license or an endorsement may appeal pursuant to

the procedures set forth in NAC 439.300

to 439.395, inclusive.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97;

A by R119-10, 1-13-2011)

FEES

      NAC 449.012  Definitions. (NRS 449.0302, 449.0303)  As used in NAC 449.012 to 449.0169,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.01205 to 449.0127,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97;

A by R229-97, 4-15-98; R052-02 & R063-02, 7-24-2002; R065-04, 8-4-2004;

R051-06 & R095-06, 7-14-2006; R182-07, 1-30-2008)

      NAC 449.01205  “Agency to provide personal care services in the home” defined. (NRS 449.0302)  “Agency

to provide personal care services in the home” has the meaning ascribed to it

in NRS 449.0021.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.0121  “Ambulatory surgical center” defined. (NRS 449.0302)  “Ambulatory

surgical center” has the meaning ascribed to it in NAC

449.972.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01215  “Branch office” defined. (NRS 449.0302)  “Branch

office” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01219  “Community triage center” defined. (NRS 449.0302)  “Community

triage center” has the meaning ascribed to it in NRS 449.0031.

     (Added to NAC by Bd. of Health by R051-06, eff. 7-14-2006)

      NAC 449.01225  “Facility for hospice care” defined. (NRS 449.0302)  “Facility

for hospice care” has the meaning ascribed to it in NAC

449.0172.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97;

A by R123-99, 11-29-99)

      NAC 449.01227  “Facility for refractive surgery” defined. (NRS 449.0302)  “Facility

for refractive surgery” has the meaning ascribed to it in NRS 449.00387.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002;

A by R042-06, 7-14-2006)

      NAC 449.01228  “Facility for transitional living for released offenders”

defined. (NRS 449.0302)  “Facility

for transitional living for released offenders” has the meaning ascribed to it

in NRS 449.0055.

     (Added to NAC by Bd. of Health by R095-06, eff. 7-14-2006)

      NAC 449.01229  “Facility for treatment with narcotics” defined. (NRS 449.0302,

449.0303)  “Facility

for treatment with narcotics” has the meaning ascribed to it in NAC 449.1542.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)—(Substituted

in revision for NAC 449.0122)

      NAC 449.0123  “Home health agency” defined. (NRS 449.0302)  “Home

health agency” has the meaning ascribed to it in NAC

449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01235  “Home office” defined. (NRS 449.0302)  “Home

office” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0124  “Hospice care” defined. (NRS 449.0302)  “Hospice

care” has the meaning ascribed to it in NAC 449.0175.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01245  “Intermediate care facility for persons with an intellectual

disability or persons with a developmental disability” defined. (NRS 449.0302)  “Intermediate

care facility for persons with an intellectual disability or persons with a

developmental disability” has the meaning ascribed to it in NAC 449.632.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0125  “Medication unit” defined. (NRS 449.0302, 449.0303)  “Medication unit” has the

meaning ascribed to it in NAC 449.15435.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.01252  “Mobile unit” defined. (NRS 449.0302)  “Mobile

unit” has the meaning ascribed to it in NRS 449.01515.

     (Added to NAC by Bd. of Health by R063-02, eff. 7-24-2002)

      NAC 449.01255  “Nursing pool” defined. (NRS 449.0302)  “Nursing

pool” has the meaning ascribed to it in NRS 449.0153.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0126  “Rural clinic” defined. (NRS 449.0302)  “Rural

clinic” has the meaning ascribed to it in NRS 449.0175.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01265  “Rural hospital” defined. (NRS 449.0302)  “Rural

hospital” has the meaning ascribed to it in NRS 449.0177.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0127  “Subunit agency” defined. (NRS 449.0302)  “Subunit

agency” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.013  License and renewal fees to operate ambulatory surgical center,

home office or subunit agency of home health agency, branch office of home

health agency, rural clinic, obstetric center, program of hospice care,

independent center for emergency medical care, nursing pool, facility for

treatment with narcotics, medication unit, referral agency, facility for

refractive surgery, mobile unit and agency to provide personal care services in

the home; expiration of application for license. (NRS 439.150,

439.200, 449.0302, 449.0303, 449.0305, 449.050)

     1.  Except as otherwise provided in NAC 449.0168, an applicant for a license to operate

any of the following facilities, programs of hospice care or agencies must pay

to the Division the following nonrefundable fees:



     (a) An ambulatory

surgical center....................................................................





                    $9,784







     (b) A home office or

subunit agency of a home health agency........................





                      5,168







     (c) A branch office of

a home health agency...................................................





                      5,358







     (d) A rural clinic...............................................................................................





                      4,058







     (e) An obstetric

center......................................................................................





                      1,564







     (f) A program of

hospice care..........................................................................





                      7,054







     (g) An independent

center for emergency medical care..................................





                      4,060







     (h) A nursing pool............................................................................................





                      4,602







     (i) A facility for

treatment with narcotics........................................................





                      5,046







     (j) A medication unit........................................................................................





                      1,200







     (k) A referral agency........................................................................................





                      2,708







     (l) A facility for

refractive surgery...................................................................





                      6,700







     (m) A mobile unit.............................................................................................





                      2,090







     (n) An agency to

provide personal care services in the home..........................





                      1,374







     2.  An applicant for the renewal of such a

license must pay to the Division the following nonrefundable fees:



     (a) An ambulatory

surgical center.....................................................................





                   $4,892







     (b) A home office or

subunit agency of a home health agency........................





                     2,584







     (c) A branch office of

a home health agency....................................................





                     2,679







     (d) A rural clinic................................................................................................





                     2,029







     (e) An obstetric

center.......................................................................................





                       

782







     (f) A program of

hospice care...........................................................................





                     3,527







     (g) An independent

center for emergency medical care...................................





                     2,030







     (h) A nursing pool.............................................................................................





                     2,301







     (i) A facility for

treatment with narcotics.........................................................





                     2,523







     (j) A medication unit.........................................................................................





                       

600







     (k) A referral agency.........................................................................................





                     1,354







     (l) A facility for

refractive surgery....................................................................





                     3,350







     (m) A mobile unit..............................................................................................





                     1,045







     (n) An agency to

provide personal care services in the home...........................





                       

687





     3.  An application for a license is valid for

1 year after the date on which the application is submitted. If an applicant

does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations

adopted pursuant thereto within 1 year after the date on which the applicant

submits his or her application, the applicant must submit a new application and

pay the required fee to be considered for licensure.

     [Bd. of Health, Health Facility Fees Art. 1, eff. 1-20-77]—(NAC

A 7-22-87; 1-31-90; 9-1-93; 11-1-95; 10-3-96; R035-97 & R044-97, 10-30-97;

R229-97, 4-15-98; R105-98, 9-23-98; R132-99, 11-29-99; R123-01, 12-17-2001,

eff. 1-1-2002; R052-02 & R063-02, 7-24-2002; R050-02, 10-22-2002; R074-03,

10-22-2003; R065-04, 8-4-2004; R042-06 & R095-06, 7-14-2006; R182-07, 1-30-2008;

R060-10, 1-13-2011)

      NAC 449.016  License and renewal fees to operate skilled nursing facility,

hospital, rural hospital, intermediate care facilities, residential facility

for groups, facility for treatment of abuse of alcohol or drugs, facility for

hospice care, home for individual residential care, facility for modified

medical detoxification, community triage center facility for treatment of

irreversible renal disease, halfway house for recovering alcohol and drug

abusers and facility for transitional living for released offenders; expiration

of application for license; refund of certain fees. (NRS 439.150,

439.200, 449.0302, 449.050)

     1.  Except as otherwise provided in NAC 449.0168, an applicant for a license to operate

any of the following facilities must pay to the Division the following

nonrefundable fees:

 



 





             Fee per

              facility





             Fee per

         bed in the

              facility







 





 





 







     (a) A

skilled nursing facility...........................................................





              $2,252





                 $108







     (b) A

hospital, other than a rural hospital.......................................





              14,606





                   110







     (c) A

rural hospital..........................................................................





                9,530





                     62







     (d) An

intermediate care facility for persons with an intellectual disability or

persons with a developmental disability...........................





                2,018





                   280







     (e) An

intermediate care facility, other than an intermediate care facility for

persons with an intellectual disability or persons with a developmental

disability.......................................................................





                   946





                     72







     (f) Except

as otherwise provided in subsection 3, a residential facility for groups.................................................................................





                2,386





                   200







     (g) A

facility for the treatment of abuse of alcohol or drugs..........





                   782





                   190







     (h) A

facility for hospice care.........................................................





                3,988





                   352







     (i) A

home for individual residential care.......................................





                1,764





                   184







     (j) A

facility for modified medical detoxification..........................





                9,960





                   494







     (k) A

community triage center........................................................





                   782





                   136







     (l) A

facility for the treatment of irreversible renal disease............





                4,178





                   120







     (m) A

halfway house for recovering alcohol and drug abusers......





                2,800





                   368







     (n) A

facility for transitional living for released offenders.............





                3,990





                   146







     2.  An applicant for the renewal of such a

license must pay to the Division the following nonrefundable fees:



 





             Fee per

              facility





             Fee per

         bed in the

              facility







 





 





 







     (a) A

skilled nursing facility...........................................................





              $1,126





                   $54



 





     (b) A

hospital, other than a rural hospital.......................................





                7,303





                     55



 





     (c) A

rural hospital..........................................................................





                4,765





                     31



 





     (d) An

intermediate care facility for persons with an intellectual disability or

persons with a developmental disability...........................





                1,009





                   140



 





     (e) An

intermediate care facility, other than an intermediate care facility for persons

with an intellectual disability or persons with a developmental disability.......................................................................





                   473





                     46



 





     (f) Except

as otherwise provided in subsection 3, a residential facility for groups.................................................................................





                1,193





                   100



 





     (g) A

facility for the treatment of abuse of alcohol or drugs..........





                   391





                     95



 





     (h) A

facility for hospice care.........................................................





                1,994





                   176



 





     (i) A

home for individual residential care.......................................





                   500





                     92



 





     (j) A

facility for modified medical detoxification..........................





                4,980





                   247



 





     (k) A

community triage center........................................................





                   391





                     68



 





     (l) A

facility for the treatment of irreversible renal disease............





                2,089





                     60



 





     (m) A

halfway house for recovering alcohol and drug abusers......





                1,400





                   184



 





     (n) A

facility for transitional living for released offenders.............





                1,995





                     73



 

















     3.  An applicant for a license or for the renewal

of a license for a residential facility for groups shall pay a fee of $35 for

each bed in the facility if the facility is paid less than $1,000 per month for

services provided to each bed in the facility.

     4.  An application for a license is valid for

1 year after the date on which the application is submitted. If an applicant

does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations

adopted pursuant thereto within 1 year after the date on which he or she

submits his or her application, the applicant must submit a new application and

pay the required fee to be considered for licensure.

     5.  Pursuant to NRS 449.050, if an application for

a license to operate a facility for transitional living for released offenders

or the renewal of such a license is denied, any amount of a fee paid pursuant

to paragraph (n) of subsection 1 or paragraph (n) of subsection 2 that exceeds

the expenses and costs incurred by the Division must be refunded to the

applicant.

     [Bd. of Health, Health Facility Fees Art. 2, eff. 1-20-77]—(NAC

A 7-22-87; 8-31-89; 9-1-93; 11-1-95; R035-97 & R044-97, 10-30-97; R105-98,

9-23-98; R123-99 & R131-99, 11-29-99; R129-99, 11-29-99, eff. 1-1-2000;

R110-01, 11-21-2001; R050-02, 10-22-2002; R074-03, 10-22-2003; R065-04, 8-4-2004;

R051-06, 7-14-2006; R060-10, 1-13-2011)

      NAC 449.0164  Fees for renewal of licenses for certain facilities: Payment in

two equal installments. (NRS 439.150, 439.200, 449.0302, 449.050)  An applicant for the

renewal of a license for a residential facility for groups, a halfway house for

recovering alcohol and drug abusers, a home for individual residential care or

a facility for transitional living for released offenders may pay the fee

required for the renewal of his or her license in two equal installments if:

     1.  On or before November 1 of the calendar

year in which the license expires, the applicant submits a complete application

for the renewal of the license which includes, without limitation:

     (a) The first installment payment which is equal to

one-half the amount of the fee required for the renewal of the license pursuant

to NAC 449.013 or 449.016,

as appropriate;

     (b) An additional fee of $100 for the

administrative costs of billing and collecting such payments; and

     (c) A signed payment agreement and a confession of

judgment for the total amount of the second installment payment which may be

filed with a court of competent jurisdiction if the applicant fails to make the

second installment payment in accordance with the agreement;

     2.  On or before April 15 of the calendar

year for which the license is renewed, he or she submits the second installment

payment for the remainder of the fee required for the renewal of the license

pursuant to NAC 449.013 or 449.016,

as appropriate; and

     3.  The applicant has not failed to make a

payment in accordance with any other similar agreement.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004;

A by R095-06, 7-14-2006)

      NAC 449.0168  Fees for modification of certain licenses. (NRS 449.0302,

449.0305, 449.050)

     1.  Except as otherwise provided in

subsection 2, a holder of a license to operate a medical facility, facility for

the dependent, program of hospice care or referral agency who wishes or is

required pursuant to NAC 449.190, 449.307, 449.7473 or 449.758 to modify his or her license to reflect:

     (a) A change in the name of the facility, program

or agency;

     (b) A change of the administrator of the facility,

program or agency;

     (c) A change in the number of beds in the facility;

     (d) A change in the type of facility licensed or

the addition of another type of facility to be licensed;

     (e) A change in the category of residents who may

reside at the facility;

     (f) A change in the designation of a staging area

for a mobile unit or, if the mobile unit is operated by an independent

facility, a change in the address of the independent facility; or

     (g) A change in any of the services provided by an

agency to provide nursing in the home,

Ê must submit

an application for a new license to the Division and pay to the Division a fee

of $250.

     2.  An applicant who applies for a license

pursuant to paragraph (c) of subsection 1 because of an increase in the number

of beds in the facility must pay to the Division:

     (a) A fee of $250; and

     (b) A fee for each additional bed as follows:



          (1) If the

facility is an intermediate care facility for persons with an intellectual

disability or persons with a developmental disability......................................................





              $280







          (2) If the

facility is a residential facility for groups..............................................





                184







          (3) If the

facility is a facility for the treatment of abuse of alcohol or drugs.......





                190







          (4) If the

facility is a facility for hospice care.......................................................





                352







          (5) If the

facility is a home for individual residential care....................................





                266







          (6) If the

facility is a facility for modified medical detoxification.......................





                494







          (7) If the

facility is a hospital, other than a rural hospital.....................................





                110







          (8) If the

facility is a rural hospital........................................................................





                  62







          (9) If the

facility is a skilled nursing facility.........................................................





                108







          (10) If the

facility is an intermediate care facility, other than an intermediate care

facility for persons with an intellectual disability or persons with a

developmental disability..........................................................................................................................





                  92







          (11) If the

facility is a facility for the treatment of irreversible renal disease.......





                120







          (12) If the

facility is a halfway house for recovering alcohol and drug abusers...





                368







          (13) If the

facility is a facility for transitional living for released offenders........





                146







     3.  If the address of the home office of a

home health agency has not changed, a holder of a license to operate a subunit

agency or branch office of the home health agency who wishes or is required

pursuant to NAC 449.758 to modify his or her

license to reflect a change in the address of the subunit agency or branch

office of the home health agency must:

     (a) Submit an application for a new license to the

Division; and

     (b) Pay to the Division a fee of $250.

     4.  A fee paid pursuant to this section is

nonrefundable.

     5.  As used in this section:

     (a) “Administrator” means the person who is

responsible for the daily management of a medical facility, facility for the

dependent or program of hospice care.

     (b) “Independent facility” has the meaning ascribed

to it in NAC 449.9701.

     (c) “Staging area” has the meaning ascribed to it

in NAC 449.97018.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97;

A by R053-99, 9-27-99; R132-99, 11-29-99; R110-01, 11-21-2001; R063-02, 7-24-2002;

R050-02, 10-22-2002; R074-03, 10-22-2003; R123-05, 11-17-2005; R060-10, 1-13-2011)

      NAC 449.01685  Division authorized to charge and collect fee from licensee to

recover costs of investigating complaint if complaint is substantiated. (NRS 439.150,

439.200, 449.0302)

     1.  The Division may charge and collect a fee

from any licensee who is involved in a complaint submitted to the Division by a

consumer to recover the costs of investigating the complaint after the

investigation is completed and the complaint is substantiated. The fee will be

based upon the hourly rate established for each surveyor of health facilities

as determined by the budget of the Division.

     2.  As used in this section, “substantiated”

means supported or established by evidence or proof.

     (Added to NAC by Bd. of Health by R155-10, eff. 12-16-2010)

      NAC 449.0169  Department of Corrections to pay fee to Division for certain

services. (NRS 449.0302)

     1.  To the extent that money is appropriated

for this purpose, each institution of the Department of Corrections shall pay a

fee of $3,266 each year to the Division for the purpose of enabling the

Division to carry out its duties set forth in NRS 209.382, 444.330 and 446.885.

     2.  As used in this section, “institution”

has the meaning ascribed to it in NRS

209.071.

     (Added to NAC by Bd. of Health by R060-10, 1-13-2011,

eff. 7-1-2011)

PROVISION OF HOSPICE CARE

General Provisions

      NAC 449.017  Definitions. (NRS 449.0302)  As used

in NAC 449.017 to 449.0188,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.0171 to 449.0178,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06,

7-14-2006)

      NAC 449.0171  “Bereavement services” defined. (NRS 449.0302)  “Bereavement

services” means social and emotional support offered to the family of a patient

in a program of hospice care for at least 1 year following the death of the

patient.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0172  “Facility for hospice care” defined. (NRS 449.0302)  “Facility

for hospice care” has the meaning ascribed to it in NRS 449.0033.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99,

11-29-99)

      NAC 449.0173  “Governing body” defined. (NRS 449.0302)  “Governing

body” means the person or group of persons responsible for carrying out and

monitoring the administration of a program of hospice care or for the operation

of a facility for hospice care.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99,

11-29-99)

      NAC 449.0175  “Hospice care” defined. (NRS 449.0302)  “Hospice

care” has the meaning ascribed to it in NRS 449.0115.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0176  “Medical director” defined. (NRS 449.0302)  “Medical

director” means the physician who is responsible for acting as a medical

resource to an interdisciplinary team which provides hospice care.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.01765  “Palliative services” defined. (NRS 449.0302)  “Palliative

services” has the meaning ascribed to it in NRS 449.0156.

     (Added to NAC by Bd. of Health by R041-06, eff. 7-14-2006)

      NAC 449.0177  “Patient” defined. (NRS 449.0302)  “Patient”

means a person who is terminally ill and who is receiving hospice care.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0178  “Terminally ill” defined. (NRS 449.0302)  “Terminally

ill” has the meaning ascribed to it in NRS 449.0195.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06,

7-14-2006)

Licensing

      NAC 449.0181  Compliance with regulations required for license to operate

facility for hospice care. (NRS 449.0302)  The Division

shall not issue a license to operate a facility for hospice care unless the

program of hospice care which it provides complies with the requirements of NAC 449.017 to 449.0188,

inclusive.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99,

11-29-99)

      NAC 449.0183  Report of change in ownership, address or staff of program of

hospice care. (NRS 449.0302)  An

applicant for a license to administer a program of hospice care or a person

licensed to administer such a program shall immediately advise the Division of

any change in:

     1.  The ownership of the program;

     2.  The address of the principal office of

the program; or

     3.  The membership of the staff which

prevents the program from providing adequate hospice care to each patient.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

Administration

      NAC 449.0184  Governing body required; duties of governing body and

administrator. (NRS 449.0302)  Every

facility which provides a program of hospice care must have a governing body

which shall:

     1.  Appoint an administrator of the program

of hospice care. The administrator shall be available on a daily basis for

consultation with members of the interdisciplinary team of the program of

hospice care.

     2.  Ensure that all services provided by the

program of hospice care are consistent with accepted standards of practice for

the care of the patients.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

Medical Services

      NAC 449.0185  Requirements for program of hospice care. (NRS 449.0302)  A

program of hospice care must comply with the following requirements:

     1.  A qualified person must be available when

required to evaluate the dietary patterns of each patient and plan diets to

meet the individual nutritional needs of each patient.

     2.  Each patient must be advised regarding

the availability of pastoral care.

     3.  Bereavement services must be available to

each member of a patient’s family after the patient dies to provide appropriate

counseling.

     4.  Nursing care must be provided by a

registered nurse or under the supervision of a registered nurse.

     5.  A social worker must provide social

services to each patient in the program under the direction of the

interdisciplinary team.

     6.  The services of:

     (a) A physical therapist;

     (b) An occupational therapist; and

     (c) A speech and language pathologist,

Ê must be

provided when such services are prescribed for a patient by his or her

physician.

     7.  Home health aide and homemaker services

must be available to each patient and provided at intervals which meet the

needs of each patient. A registered nurse must:

     (a) Supervise the persons providing such services;

and

     (b) Prepare written instructions for the persons

providing such services which identify the duties they are to perform.

     8.  Arrangements must be made to provide any

medical supplies and appliances which are required by a patient, including any

drug or biological needed for palliative services.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06,

7-14-2006)

      NAC 449.0186  Requirements for plan of care. (NRS 449.0302)

     1.  The medical director of a program of

hospice care shall cause a written plan of care to be established for each

patient in the program. Any person who furnishes care for the patient shall

adhere to the plan.

     2.  A plan of care must:

     (a) Be established by the physician of the patient

or by the medical director of the program of hospice care, and the

interdisciplinary team which provides the hospice care;

     (b) Include an assessment of the needs of the

patient and identify the services required by the patient, which must include

the management of discomfort and relief of symptoms of the patient;

     (c) State the scope and frequency of each service

to be provided to the patient and members of his or her family; and

     (d) Be reviewed and updated at intervals that are

specified in the plan by the person who established the plan. The review must

be documented in writing.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0187  Requirements for operation of facility for hospice care. (NRS 449.0302)  A

facility for hospice care must comply with the following requirements:

     1.  A program of hospice care must be

provided for each inpatient pursuant to a written plan of care established pursuant

to NAC 449.0186.

     2.  Nursing services must be provided 24

hours per day in accordance with the plan of care for each patient.

     3.  Medication must be dispensed to each

patient according to the instructions of the patient’s physician or the medical

director.

     4.  Treatment must be administered to a

patient pursuant to the instructions of the physician of the patient or the

plan of care for the patient.

     5.  Each patient must be maintained in a

clean and well-groomed manner.

     6.  Each patient must be protected from

accidents, injuries and infections.

     7.  At least one registered nurse must be on

duty for each work shift, providing direct care to patients.

     8.  A written plan of the procedures to be

followed during a local disaster, a widespread disaster or a disaster which

occurs within the facility for hospice care must be adopted. The plan must:

     (a) Provide procedures designed to protect each

patient and to care for any casualty which may arise from such a disaster;

     (b) Be reviewed and the procedures set forth

therein rehearsed by all members of the staff at least once in each quarter of

the year; and

     (c) Be approved by the Division.

     9.  A private room with an adjoining bath

must be provided for each patient.

     10.  An anteroom, a room adjoining the room

of each patient or a private area must be provided and furnished with a bed and

chairs for use by the members of the patient’s family.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99,

11-29-99)

      NAC 449.0188  Continuity of service to patients required. (NRS 449.0302)  A person

licensed to administer a program of hospice care or to operate a facility for

hospice care shall maintain the continuity of service provided to each patient

pursuant to NAC 449.017 to 449.0188,

inclusive, during the term of his or her license.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R044-97,

10-30-97; R123-99, 11-29-99)

FACILITIES FOR TREATMENT OF ABUSE OF ALCOHOL OR DRUGS

General Provisions

      NAC 449.019  Definitions. (NRS 449.0302)  As used

in NAC 449.019 to 449.153,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.022 to 449.072,

inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Bd. of Health by R077-01,

10-18-2001)

      NAC 449.022  “Administrator” defined. (NRS 449.0302)  “Administrator”

means the person who is appointed by the governing body of a facility who has

primary responsibility for the operations of the overall program of the

facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 1 § 1.4, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.025  “Alcohol and drug abuse treatment” defined. (NRS 449.0302)  “Alcohol

and drug abuse treatment” means a program concerned with substance abuse

treatment directed towards achieving the mental and physical restoration of

alcohol and drug abusers.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 1 § 1.9, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.030  “Case management services” defined. (NRS 449.0302)  “Case

management services” means a multistep process by which clients may receive

assistance in accessing services, including, without limitation, services

concerning health, mental health, education, vocation, employment, legal

issues, child care, housing and aftercare for recovery from alcohol and drug

abuse.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.031  “Client” defined. (NRS 449.0302)  “Client”

means a resident or patient of a facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 1 § 1.8, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.034  “Detoxification” defined. (NRS 449.0302)  “Detoxification”

means the process of eliminating the toxic effects of alcohol and drugs from

the body.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 1 § 1.1.3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.043  “Facility” defined. (NRS 449.0302)  “Facility”

means a facility for the treatment of abuse of alcohol or drugs as defined in NRS 449.00455.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 1 § 1.1, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.044  “Facility for modified medical detoxification” defined. (NRS 449.0302)  “Facility

for modified medical detoxification” has the meaning ascribed to it in NRS 449.00385.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.046  “Governing body” defined. (NRS 449.0302)  “Governing

body” means a body that has the ultimate authority for the administration of

the overall program at a facility pursuant to NAC

449.085.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.060  “Medically managed intensive detoxification program” defined. (NRS 449.0302)  “Medically

managed intensive detoxification program” means a program which provides

24-hour medical monitoring of treatment and detoxification services in a

licensed hospital pursuant to NAC 449.279 to 449.394, inclusive, and which has life support systems

in place.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.064  “Overall program” defined. (NRS 449.0302)  “Overall

program” means all aspects of alcohol and drug abuse treatment, including

general fiscal management, fund-raising projects and the general long-term

goals of a facility which are defined in writing.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 1 § 1.10, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.068  “Qualified social worker” defined. (NRS 449.0302)  “Qualified

social worker” means a person who is licensed by the Board of Examiners for

Social Workers to practice as a social worker.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities

Art. 1 § 1.11, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)—(Substituted in

revision for NAC 449.073)

      NAC 449.069  “Residential program” defined. (NRS 449.0302)  “Residential

program” means a treatment program for alcohol and drug abuse which takes place

in a 24-hour residential setting and which encompasses organized services

staffed by designated addiction treatment personnel who provide a planned

regimen of client care.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.072  “Social model detoxification program” defined. (NRS 449.0302)  “Social

model detoxification program” means a treatment program that concentrates on

providing psychosocial services and nonmedical detoxification.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

Licensing

      NAC 449.079  Denial, revocation or suspension of license if facility not

certified by Division; appeal. (NRS 449.0302)

     1.  If a facility is not certified by the

Division pursuant to subsection 4 of NRS

458.025, the Division shall deny an application for a license or suspend or

revoke the license of the facility.

     2.  An applicant or licensee who wishes to

appeal an action of the Division relating to the denial, suspension or

revocation of a license may appeal the action pursuant to the procedures set

forth in NAC 439.300 to 439.395, inclusive.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 2 §§ 2.7-2.12, eff. 3-27-76; A and renumbered as §§ 2.7-2.11,

12-27-77]—(NAC A by R035-97 & R044-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.081  New construction or remodeling: Submission and approval of

building plans; prerequisites to approval of licensing. (NRS 449.0302)

     1.  Building plans for new construction or

remodeling must be submitted to the entity designated to review such plans by

the Division pursuant to the provisions of NAC

449.0115. Before the construction or remodeling may begin, the plans for

the construction or remodeling must be approved by the Division.

     2.  The Division shall not approve the

licensing of a facility until all construction has been completed and a survey

is conducted at the site.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 16, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R076-01 &

R077-01, 10-18-2001; R073-04, 8-4-2004)

Administration and Personnel

      NAC 449.085  Governing body; bylaws. (NRS 449.0302)

     1.  Every facility must have a governing body

which has the ultimate authority for the administration of the overall program.

     2.  The governing body shall adopt written

bylaws and policies that define the powers and duties of the governing body,

its committees, the administrator and any advisory group.

     3.  The bylaws and policies must:

     (a) Identify the overall goals.

     (b) Include an organizational chart.

     (c) Define the major lines of authority and areas

of responsibility within the treatment program.

     (d) Define the membership of the governing body,

the types of membership, the method of selection or appointment of members,

offices or committees and their terms of office.

     (e) Define the frequency of meetings of the

governing body and attendance requirements.

     4.  The duties of the governing body include,

but are not limited to, the following items:

     (a) Appointment of a qualified administrator with

authority and responsibilities appropriate to the requirements of the program;

     (b) Adoption, review and revision of the governing

body’s bylaws and policies;

     (c) Adoption of controls designed to achieve and

maintain maximum standards of service; and

     (d) Review and approval of an annual budget to

carry out the objectives of the program.

     5.  New facilities must show sufficient

resources to operate for 120 days.

     6.  The governing body shall retain the

ultimate responsibility for the overall program and its objectives.

     7.  The governing body shall meet at least

semiannually. Minutes must be kept of the meetings, including the date of the

meeting, those in attendance, topics discussed, decisions made and actions

taken, target dates for the implementation of recommendations and all program

reports.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R044-97, 10-30-97;

R077-01, 10-18-2001)

      NAC 449.088  Policies and procedures. (NRS 449.0302)

     1.  A facility must have written policies and

procedures available to members of the staff, clients and the public which

govern the operation of the facility and services provided by the facility.

     2.  The policies must:

     (a) Ensure that only those persons are accepted as

clients whose needs can be met by the facility directly or in cooperation with

community resources or other providers of treatment with which it is

affiliated.

     (b) Ensure that a client whose physical or mental

condition has changed to such an extent that the client can no longer be

adequately served by the facility will be transferred promptly to an

appropriate facility.

     (c) Set forth the rights of clients and members of

the staff and provide for the registration and disposition of complaints

without threat of discharge or reprisal against any employee or client.

     (d) Ensure that the admission agreement between the

administrator and the client does not permit the administrator or his or her

designee a power of attorney.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.091  Transfer of client to another facility. (NRS 449.0302)

     1.  Except in the case of an emergency, the

transfer of a client to another facility must not be effected until the client,

attending physician, if any, and responsible agency are notified in advance.

     2.  If a client is transferred to another

facility, information required for appropriate continuation of care must be

released to the receiving facility in compliance with the standards set forth

in 42 C.F.R. Part 2, which are hereby adopted by reference. A copy of the

standards may be obtained from the Division, free of charge, upon request.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.094  Money of clients. (NRS 449.0302)

     1.  If a facility handles a client’s money, a

written ledger account of all deposits, disbursements or other transactions

must be maintained. A record must be made available to the client at least

quarterly.

     2.  A client’s money must be given to the

client within 24 hours of his or her exit from the facility.

     3.  Large sums of money must be maintained in

a financial institution in the community where the facility is located in a

separate trustee account apart from the facility’s operational accounts and

must be clearly designated.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.098  Preparations for disasters; reporting of fire or disaster. (NRS 449.0302)

     1.  Each facility shall develop a written

plan for disasters which outlines procedures for members of the staff and

clients to follow in case of fire or another emergency and which provides for

meeting the needs of clients if the facility must be evacuated or is destroyed.

     2.  A simple floor plan showing the routes

for evacuating must be posted in prominent locations on each floor of each

facility.

     3.  Each facility shall conduct a disaster

drill at least annually, and a written record of each drill must be retained in

the facility for not less than 12 months after the drill is conducted.

     4.  The facility shall notify the Bureau of

the occurrence of a fire or disaster in the facility within 24 hours after the

facility becomes aware of the fire or disaster.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001;

R073-04, 8-4-2004)

      NAC 449.102  Inventory and return of client’s belongings. (NRS 449.0302)  If a

facility holds or stores a client’s belongings, there must be an inventory of

the belongings on admission, made a part of the client’s record, and updated as

needed. These belongings must be returned to the client upon his or her exit.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.105  Insurance. (NRS 449.0302)  Liability

insurance in a sufficient amount to protect clients, members of the staff,

volunteers, and visitors, must be maintained. A certificate of insurance must

be furnished to the Division. The certificate must include provision for 30

days notice to the Division of cancellation or the nonrenewal of the policies.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 3, eff. 3-27-76; A 3-30-77]

      NAC 449.108  General requirements for programs. (NRS 449.0302)

     1.  A residential program must be certified

by the Division pursuant to NAC 458.108

and must comply with any applicable regulations adopted pursuant to subsection

4 of NRS 458.025.

     2.  At the time of admission into a

residential program, there must be documentation indicating that the client has

been informed of:

     (a) The general nature and goal of the program;

     (b) The rules governing client conduct and the

infractions that can lead to disciplinary action or discharge from the program;

     (c) The treatment costs, if any, to be borne by the

client;

     (d) The client’s rights and responsibilities; and

     (e) Confidentiality laws, rules and regulations.

     3.  The program must be periodically

evaluated to ensure compliance with any applicable regulations adopted pursuant

to subsection 4 of NRS 458.025.

     4.  The facility must provide access to

medical, dental, psychological and rehabilitative services to meet the needs of

all its clients, to the extent possible, with assistance from available

community resources.

     5.  If a facility provides services through

outside sources, written arrangements must be made ensuring that the services

are supplied directly by, or under the supervision of, qualified persons.

     6.  The facility must provide case management

services as needed by the client either directly or by written agreement with a

qualified social worker, a registered nurse or a counselor certified or

licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors.

     7.  A plan for case management services must

be recorded in the client’s record and must be periodically evaluated in

conjunction with the client’s treatment plan.

     8.  Each facility shall review the program at

least annually. Areas reviewed must include, but need not be limited to,

appropriateness of admissions, lengths of stay, discharge planning, use of

services, and utilization of the components of the program and outside

services. Written reports of the reviews must be evaluated by the governing

body, administrator and such committees as they designate. Documentation of the

evaluation process must be maintained at the facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 4, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004;

R098-06, 7-14-2006)

      NAC 449.111  Administrator: Duties. (NRS 449.0302)

     1.  The administrator is responsible to the

governing body for the operation of the facility in accordance with established

policy.

     2.  The administrator shall:

     (a) Organize the administrative functions of the

program, delegate duties and establish a formal means of accountability on the

part of subordinates.

     (b) Ensure that a written manual defining program

policies and procedures is prepared, regularly revised and updated. The manual

must:

          (1) Contain all of the required written

policies, procedures, definitions, lists and other documentation required by NAC 449.019 to 449.153,

inclusive.

          (2) Be available to members of the staff at

all times at designated and convenient locations.

     (c) Appoint a person of majority age to act for him

or her during any absence.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 5, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.114  Employees: General requirements.

(NRS 449.0302)

     1.  A facility must have on duty, all hours

of each day, members of the staff sufficient in number and qualifications to

carry out policies, responsibilities and program continuity.

     2.  Each member of the counseling staff must

be:

     (a) A registered intern;

     (b) Certified or licensed by the Board of Examiners

for Alcohol, Drug and Gambling Counselors; or

     (c) A licensed mental health professional who has

experience with alcohol and drug abuse counseling.

     3.  The administrator or his or her appointee

must be present and responsible for the operations of the facility during

normal hours.

     4.  A facility must have written policies and

procedures for the recruitment, selection, promotion and termination of members

of the staff.

     5.  The facility must have written policies

and procedures covering wages and salaries, working hours, employee benefits,

vacation and sick leave, rules of conduct, and training and the development of

the staff.

     6.  The facility must provide an orientation

session to new employees. Documentation of the sessions must be maintained in

the employee’s personnel record.

     7.  There must be written policies and

procedures governing disciplinary actions which clearly define the mechanism

for suspension or dismissal of members of the staff as well as the procedures

for appeal.

     8.  Written job descriptions must be

maintained for all positions. A description must include:

     (a) The title of the job;

     (b) The tasks and responsibilities of the job;

     (c) The skills, education and experience necessary

for the job;

     (d) The relationship of the job to other jobs

within the program; and

     (e) The working conditions, location, shift,

materials and equipment to be used on the job.

Ê The job

description must accurately reflect the actual job situation and must be

reviewed annually or whenever a change in the job or qualifications occurs. Job

descriptions must be available on request to all members of the staff.

     9.  A personnel record must be maintained for

each employee. The record must contain:

     (a) The employment application;

     (b) Letters of recommendation;

     (c) Reference investigation records;

     (d) Verification of training, experience and, if

applicable, certification;

     (e) Documentation of attendance at the orientation

session for new employees;

     (f) Job performance evaluations;

     (g) Incident reports; and

     (h) Disciplinary actions taken.

     10.  Personnel records must be maintained in

a secure manner and must be available only to those persons authorized in written

policies and procedures. An employee must have access to his or her own records

upon request.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 6, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R098-06,

7-14-2006)

      NAC 449.117  Employees: Proof of compliance with provisions concerning

tuberculosis. (NRS 449.0302)  All

persons employed in a facility must have documentation showing that they are in

compliance with any applicable provisions of chapter

441A of NAC concerning tuberculosis.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 12, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

Social Model Detoxification Programs

      NAC 449.121  Certain facilities authorized to offer program. (NRS 449.0302)  A social

model detoxification program may be offered to clients in:

     1.  Residential programs that offer detoxification

services;

     2.  A licensed facility for modified medical

detoxification pursuant to NAC 449.15311 to 449.15369, inclusive; or

     3.  A medically managed intensive

detoxification program.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.1214  General requirements. (NRS 449.0302)

     1.  A facility that offers a social model

detoxification program:

     (a) Must have a physician, nurse practitioner,

registered nurse or physician assistant conduct a physical assessment and a

review of the general medical and drug history of a client within 24 hours

after the client is admitted to the facility to ensure that a social model

detoxification program is appropriate for the client.

     (b) Must not provide detoxification services for

clients who exhibit life-threatening symptoms of withdrawal from alcohol and

drug abuse.

     (c) Must develop and implement policies and

procedures that protect the safety and health of clients. The facility must

have these policies and procedures reviewed annually by a licensed physician

who is familiar with the symptoms of withdrawal from alcohol and drug abuse.

     (d) Must ensure that the observation of a client

during his or her treatment in the social model detoxification program is

reflected in the records of the client as deemed necessary by the policies and

procedures of that facility.

     2.  The staff of a facility that offers a

social model detoxification program must complete at least 6 hours of

additional education in the detoxification of alcohol and drug abusers, as

approved by the program of ongoing quality improvement pursuant to NAC 449.1218, every 2 years. Such education must

include instruction in:

     (a) Acute withdrawal symptoms from alcohol and drug

abuse; and

     (b) First-aid procedures for clients with seizures.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.1218  Program of ongoing quality improvement. (NRS 449.0302)

     1.  A social model detoxification program must

have a program of ongoing quality improvement designed to:

     (a) Monitor and evaluate, objectively and

systematically, the quality and appropriateness of client care;

     (b) Pursue opportunities to improve client care;

and

     (c) Resolve identified problems.

     2.  The program of ongoing quality

improvement must:

     (a) Establish written policies and procedures to

describe and document the monitoring and evaluation activities of the program

of ongoing quality improvement.

     (b) Include the participation of a medical

professional who is not required to be a member of the staff. For the purposes

of this paragraph, “medical professional” means a licensed physician, nurse

practitioner, physician assistant or registered nurse who is familiar with

clients suffering from acute withdrawal symptoms from alcohol and drug abuse.

     (c) In addition to the participation of a medical

professional pursuant to paragraph (b), include the participation of the

administrator and two staff members of the social model detoxification program.

     (d) Approve the 6 hours of additional education

required pursuant to NAC 449.1214 to ensure that

the additional education is appropriate.

     3.  The findings of the program of ongoing

quality improvement, including any conclusions, recommendations, actions taken

and the results of the actions taken, must be documented. All documentation

must be reported to the governing body and must be reflected in the minutes

annually.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

Operation of Facility

      NAC 449.123  General sanitary requirements. (NRS 449.0302)

     1.  Each facility must meet all state and

local environmental health standards.

     2.  A facility which provides dietary

services must have food service equipment of appropriate quality and type for

the type of food service program used by the facility. The equipment must

comply with all applicable provisions in chapter

446 of NAC.

     3.  All environmental health inspection

reports must be on file in the facility. Any deficiencies must be corrected

within 90 days and documented in the file.

     4.  Premises and equipment must be maintained

in a sanitary condition:

     (a) The facility must have the necessary cleaning

and maintenance equipment with sufficient storage areas and appropriate

procedures to maintain a clean and orderly establishment.

     (b) Janitorial supplies, including aerosols, must

be stored in areas separate from clean linen, food and other supplies.

     (c) The storage of dirty linen must be separate

from the storage of clean linen, food and other supplies.

     5.  The facility shall establish a policy

that prohibits clients from sharing items for personal use, such as combs,

toothbrushes, towels or bar soap.

     6.  Restrooms or lavatories for the staff

must be provided with soap dispensers and individual disposable towels.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 11, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.126  Laundry requirements. (NRS 449.0302)

     1.  A facility must maintain:

     (a) A laundry with equipment which is adequate for

the sanitary washing and finishing of linen and other washable goods; or

     (b) A written agreement with a commercial

establishment to provide laundry services for the facility.

     2.  The laundry must be situated in an area

which is separate from any area where food is stored, prepared or served. The

laundry must be well-lighted, ventilated, adequate in size to house the

equipment and maintained in a sanitary manner. The equipment must be kept in

good repair.

     3.  Soiled linen must be collected and

transported to the laundry in washable or disposable covered containers in a

sanitary manner.

     4.  Clean linen to be dried, ironed, folded,

transferred or distributed must be handled in a sanitary manner, specified in

writing.

     5.  Closets for storing linen and laundry

supplies must be provided and must not be used for any other purpose.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 11, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.129  Design, construction, equipment and maintenance. (NRS 449.0302)

     1.  A facility must be designed, constructed,

equipped and maintained in a manner that protects the health and safety of the

clients and personnel of the facility and members of the general public.

     2.  Each facility must comply with all

currently adopted life safety, fire, Division, local building and zoning codes.

If there is a difference between state and local codes, the more stringent

standards apply.

     3.  Facilities housing 17 or more clients

must meet the requirements of the chapter entitled “New Hotels and

Dormitories,” of the edition of NFPA 101: Life Safety Code, adopted by

reference pursuant to NAC 449.0105. Those

facilities housing not more than 16 clients must meet the requirements of the

chapter entitled “Lodging or Rooming Houses,” of the edition of NFPA 101:

Life Safety Code, adopted by reference pursuant to NAC

449.0105.

     4.  A facility is deemed to be in compliance

with the provisions of this section if:

     (a) The facility is licensed by May 30, 2001, and:

          (1) The use of the physical space in the

facility is not changed; and

          (2) There are no deficiencies in the

construction of the facility that are likely to cause serious injury, harm or

impairment to the health and welfare of the public; or

     (b) Before May 30, 2001, the facility has submitted

building plans to the entity designated to review such plans by the Division

pursuant to the provisions of NAC 449.0115 and:

          (1) The Division determines that the plans

comply with standards for construction in effect before May 30, 2001;

          (2) Construction of the facility is begun

before February 1, 2002;

          (3) The facility is constructed in accordance

with those standards; and

          (4) There are no deficiencies in the

construction of the facility that are likely to cause serious injury, harm or

impairment to the health and welfare of the public.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001;

R073-04, 8-4-2004; R098-06, 7-14-2006)

      NAC 449.132  Accommodations for clients. (NRS 449.0302)

     1.  No room or space in a facility may be

occupied for sleeping, living or dining which is accessible only by a ladder,

by folding stairs or through a trapdoor.

     2.  If a basement is used for living and

dining, at least one exit must be provided directly to the outside at ground

level. No facility may:

     (a) Be situated more than one story below the

ground.

     (b) Use any basement or space in a basement for

sleeping.

     3.  Each room of a facility used by clients

for sleeping must:

     (a) Be furnished with a bed, clean linen and

blankets; and

     (b) Not be less than 50 square feet per bed.

     4.  Toilet and bathing facilities must be

provided to clients in a manner that ensures their privacy during use and in an

adequate number to meet the needs of the clients.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.135  Safety from fire. (NRS 449.0302)

     1.  Portable fire extinguishers must be

installed throughout each facility at the direction of the fire authority

having jurisdiction. Each portable fire extinguisher available at a facility

must be inspected, recharged and tagged at least once each year by a person

certified by the State Fire Marshal to conduct such inspections.

     2.  Any facility with a kitchen range with an

upper surface of more than 15 square feet must provide the range with an

exhaust hood having an automatic fire protection system in accordance with the

chapter titled “Standards for Ventilation Control and Fire Protection of

Commercial Cooking Operations,” of the edition of NFPA 101: Life Safety Code,

adopted by reference pursuant to NAC 449.0105.

     3.  A portable room-heating device may be

used at a facility if the device:

     (a) Is located at least 2 feet from any combustible

material;

     (b) Is plugged directly into a wall socket;

     (c) Turns off automatically if it is tipped over;

and

     (d) Has no exposed heating elements.

     4.  Receptacles or outlets serviced by

extension cords are prohibited.

     5.  Rooms in which smoking is allowed by

direction of the facility or the fire authority must be provided with plainly

visible “Smoking Area” signs.

     6.  A facility must conduct fire drills at

least monthly and a written record of each drill conducted must be retained in

the facility for not less than 12 months after the drill is conducted.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001;

R073-04, 8-4-2004)

      NAC 449.141  Health services. (NRS 449.0302)

     1.  Facilities must provide access to health

services which ensure that each client receives treatment, prescribed

medication, adequate diets and other health services consistent with the

program administered by the facility.

     2.  Facilities must implement policies and

procedures designed to ensure the early detection of complications or

conditions considered to be common among drug abusers. These policies and

procedures must be developed in conjunction with and approved by a licensed

physician.

     3.  Before a client’s admission to a program

or facility, a general medical and drug history must be taken by a designated

member of the staff who is certified or licensed by the Board of Examiners for

Alcohol, Drug and Gambling Counselors or who is a licensed mental health

professional who has experience with alcohol and drug abuse counseling. Current

medical information must be provided on a form that has been approved by a

physician. The history must include, but is not limited to:

     (a) Drugs used in the past;

     (b) Drugs used recently;

     (c) Drugs of preference;

     (d) Frequently used drugs;

     (e) Drugs used in combination;

     (f) Dosages used;

     (g) Date of first usage;

     (h) Incidents of overdose, withdrawal or adverse

drug reactions; and

     (i) Previous history of treatment.

     4.  A program may accept medical history and

physical examination results from referral sources which were conducted not

more than 30 days before admission in lieu of personally taking a general

medical and drug history as required pursuant to subsection 3.

     5.  Each facility must be able to provide

directly, or through written arrangements, laboratory tests as requested by a

physician or federal regulations.

     6.  Facilities must implement written

policies and procedures that are reviewed by a licensed physician defining the

appropriate action to be taken when a medical emergency arises.

     7.  There must be one staff person in the

facility who is capable of providing cardiopulmonary resuscitation at all

times. Staff members providing cardiopulmonary resuscitation must be qualified

by the American Red Cross or another recognized agency.

     8.  Clients of residential programs must

undergo a tuberculin skin test that meets the requirements specified in chapter 441A of NAC.

     9.  Each facility shall maintain and have

readily available first-aid supplies. Staff members shall have evidence that

they have received training on the use of first-aid supplies.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 7, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R098-06, 7-14-2006)

      NAC 449.144  Medication. (NRS 449.0302)

     1.  In programs that permit the self-administration

of medication, there must be written policies and procedures governing this

activity. The policies must require that:

     (a) The decisions to permit self-administration be

based on individual needs.

     (b) The reasons for the permission be clearly

documented in the client’s case record.

     (c) All medications that are to be

self-administered be packaged in a manner complying with the Poison Prevention

Packaging Act of 1970, 15 U.S.C. §§ 1471 et seq., and all current regulations

stemming from that act.

     (d) The self-administration of prescription

medication be observed by a staff member who has been oriented to the program’s

policies and procedures on self-administration of prescription medication.

     (e) The self-administration of prescription medication

be permitted only when the medication is clearly labeled.

     (f) There be documentation in the client’s record

of the name of the medication, dose, route of administration, time and name of

the person observing the self-administration or the licensed staff member who

administered the medication.

     (g) Clients who receive medication for

self-administration be given instructions concerning the safe storage and usage

of the drugs and the appropriate emergency procedures to be followed if adverse

reactions occur.

     2.  Any unusual reaction to a medication by a

client must be documented in the client’s record and reported to the

appropriate physician as outlined in the policies of the facility.

     3.  Facilities must provide a locked storage

area for prescription medication that is to be self-administered by clients.

Such medication must be made available to clients at appropriate times and may

be dispensed only from a licensed pharmacy in accordance with all applicable

provisions of NRS and NAC.

     4.  Members of the staff may not administer

any medication unless licensed to do so.

     5.  All medication must be maintained in

locked storage. Controlled substances must be maintained in a locked box within

the locked storage. Medications requiring refrigeration must be kept in a

locked box inside the refrigerator separated from food and other items.

Disinfectants and medication for external use must be stored separately from

medications for internal use and from medications that can be injected. All

potent, poisonous or caustic drugs must be plainly labeled, stored and made

accessible only to authorized persons. All medication storage must be

maintained in accordance with the security requirements of federal, state and

local laws.

     6.  Narcotic treatment facilities may issue

methadone “takeouts” to a client in a facility without listing the strength of

the drug if the label shows:

     (a) The client’s name or other identifying code;

and

     (b) The 24-hour emergency telephone number for the narcotic

treatment facility.

     7.  Medication prescribed for a client must

not be allowed to be in the possession of another client.

     8.  Any unused prescription medication left

behind at a facility by a client must be destroyed by the administrator or his or

her designee in the presence of a witness, and a notation indicating that the

medication was destroyed must be made on the client’s record. At the time a

client is discharged or leaves the facility, medications that are currently

being self-administered must be sent, in the original container, with the

client or a responsible agent of the client.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 9, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.147  Dietary services. (NRS 449.0302)

     1.  Facilities must serve at least three

meals or their equivalent daily, at regular times, with not more than 14 hours

between a substantial evening meal and breakfast. A second serving must be

provided for those clients who desire one.

     2.  Menus must be planned and followed to

meet the nutritional needs of the clients in accordance with the recommended

dietary allowances of the Food and Nutrition Board of the Institute of Medicine

of the National Academies.

     3.  Therapeutic menus must be planned by a

licensed dietitian or must be reviewed and approved by the client’s attending

or staff physician.

     4.  Menus must be in writing, planned in

advance, dated and posted, and kept on file for 90 days. Any substitution must

be noted on the written menus so that the menu on file reflects what was

actually served.

     5.  Adequate facilities and equipment for the

preparation, serving, refrigeration and storage of food in a sanitary manner

must be provided.

     6.  A facility with more than 10 clients

must:

     (a) Comply with all applicable provisions of chapter 446 of NRS and the regulations

adopted pursuant thereto;

     (b) Obtain the necessary permits from the Division;

     (c) Maintain a report of each inspection concerning

the sanitation of the facility for at least 1 year after the date of the

inspection; and

     (d) Maintain a report of each corrective action taken

to address a deficiency noted in a report described in paragraph (c) for at

least 1 year after the date of the corrective action.

     7.  Clients needing special equipment,

implements or utensils to assist them while eating must have such items

provided.

     8.  If a facility operates on the cottage

plan, provision must be made for food service that assures hot, palatable

meals.

     9.  A licensed dietitian must be used as a

consultant on planning meals and serving food. Consultation each month is

required.

     10.  All facilities that contract with food

management companies must comply with the applicable regulations of the

Division as provided in chapter 446 of NAC.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 8, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R073-04,

8-4-2004; R155-10, 12-16-2010; R090-12, 12-20-2012)

      NAC 449.150  Records of clients. (NRS 449.0302)

     1.  Each facility must maintain an organized

system for clients’ records.

     2.  Clients’ records must be available to

members of the staff who have authority to review such records.

     3.  Clients’ records must be available to

representatives of the Division.

     4.  Clients’ records must contain:

     (a) Identification information;

     (b) Past medical and social history;

     (c) Copies of initial and periodic examinations;

     (d) Evaluations and progress notes; and

     (e) A review and any revisions of each plan of treatment.

     5.  There must be an overall plan of

treatment stated in quantifiable terms which outlines goals to be accomplished

through individually designed activities, therapies and treatments.

     6.  The plan of treatment must state what

service or person is responsible for treatment or services to the client.

     7.  Entries must be made describing

treatments and services rendered, medications administered, including those

that are self-administered, and any symptoms or other indications of illness or

injury, including the date, time and action taken regarding each incident.

     8.  Records must be adequately safeguarded

against destruction, loss or unauthorized use.

     9.  Records must be retained for at least 5

years following a client’s discharge.

     10.  A discharge plan, as determined by a

case management services assessment of the client, must be documented for each

client discharged from the facility. The discharge plan must be formulated upon

a client’s admission to the facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 10, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.153  Discrimination prohibited. (NRS 449.0302)

     1.  No facility may deny treatment to a

prospective client on the grounds of race, color, age, disability or national

origin.

     2.  No resident may be segregated, given

separate treatment, restricted in the employment of any advantage or privilege

enjoyed by others under the program or provided with any aid, treatment,

services or other benefits which are different or provided in a different

manner from that provided to others under the program, on the grounds of race,

color, age, disability or national origin.

     [Bd. of Health, Alcohol and Drug Abuse Treatment

Facilities Art. 15, eff. 3-27-76]—(NAC A 8-1-91; R077-01, 10-18-2001)

FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION

      NAC 449.15311  Definitions. (NRS 449.0302)  As used

in NAC 449.15311 to 449.15369,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.15313 to 449.15321,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15313  “Administrator” defined. (NRS 449.0302)  “Administrator”

means the person who is appointed by the governing body of a facility who has

primary responsibility for the overall operations of the program of the

facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15315  “Client” defined. (NRS 449.0302)  “Client”

means a resident or patient of a facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15317  “Facility” defined. (NRS 449.0302)  “Facility”

means a facility for modified medical detoxification as defined in NRS 449.00385.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15319  “Overall program” defined. (NRS 449.0302)  “Overall

program” means tasks that are commonly undertaken by a board of directors,

including, without limitation, general fiscal management, fund-raising projects

and establishing the general long-term goals of a facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15321  “Program” defined. (NRS 449.0302)  “Program”

means the program established pursuant to NAC

449.15337.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15323  Proof of certification required; revocation of license. (NRS 449.0302)

     1.  As a condition of the issuance of a

license to a facility, the facility shall provide proof that it is certified by

the Division.

     2.  If the Division revokes or does not renew

the certification of a facility, the Division shall revoke the license of the

facility subject to the appeals procedure set forth in NAC 439.300 to 439.395, inclusive.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15325  Governing body; bylaws and policies. (NRS 449.0302)

     1.  Each facility shall have a governing body

that has the ultimate authority for the administration of the overall program

of the facility.

     2.  The governing body shall adopt written

bylaws and policies that define the powers and duties of the governing body,

its committees, the administrator and any advisory group.

     3.  The bylaws and policies must:

     (a) Identify the overall goals of the facility;

     (b) Include, without limitation, an organizational

chart of the facility;

     (c) Define the major lines of authority and areas

of responsibility within the program of treatment provided by the facility;

     (d) Define the membership of the governing body,

the types of membership, the method of selection or appointment of members,

offices or committees and their terms of office; and

     (e) Define the frequency of meetings of the

governing body and attendance requirements.

     4.  The governing body shall:

     (a) Appoint a qualified administrator of the

facility with authority and responsibilities appropriate to the requirements of

the program;

     (b) Establish policies governing the

responsibilities, authority and duties of the administrator that are designed

to enable the administrator to perform the administrative and treatment

functions of the facility;

     (c) Appoint a medical director of the facility who

is responsible for the medical services provided at the facility;

     (d) Determine, in accordance with state law, which

categories of practitioners are eligible to be appointed to the medical staff

of the facility;

     (e) Appoint members to the medical staff of the

facility who are accountable to the governing body for the quality of medical

care provided to clients of the facility, taking into consideration any

recommendations of the existing members of the medical staff;

     (f) Review and revise the bylaws and policies of

the governing body;

     (g) Adopt controls designed to achieve and maintain

maximum standards of service; and

     (h) Review and approve an annual budget to carry

out the objectives of the program.

     5.  The governing body shall retain the

ultimate responsibility for the overall program and its objectives.

     6.  The governing body shall meet at least

semiannually. Minutes must be kept of the meetings, including, without

limitation, the date of each meeting, those in attendance, topics discussed,

decisions made and actions taken, and all program reports.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15327  Policies and procedures for services and operation of facility. (NRS 449.0302)

     1.  Each facility shall have written policies

and procedures available to members of the staff, clients and the public that

govern the operation of the facility and services provided by the facility.

     2.  The policies must:

     (a) Ensure that only those persons are accepted as

clients whose needs can be met by the facility directly or in cooperation with

community resources or other providers of treatment with which it is affiliated

or has contacts.

     (b) Ensure that a client whose physical or mental

condition has changed to such an extent that the client can no longer be

adequately served by the facility will be transferred promptly to an

appropriate facility. Written transfer agreements or other written provisions

with such other facilities must be maintained by the facility.

     (c) Set forth the rights of clients and members of

the staff and provide for the registration and disposition of complaints

without threat of discharge or reprisal against any employee or client.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15329  Transfer of client. (NRS 449.0302)

     1.  Except in the case of an emergency, the

transfer of a client must not be effected until the client, attending physician

of the client, if any, and responsible agency are consulted in advance.

     2.  Except as otherwise provided in

subsection 3, if a client is transferred to a hospital or other medical

facility, a summary of discharge containing a plan for continuation of care

must be prepared and forwarded to the receiving facility if the client or his or

her guardian consents to release such information to the receiving facility.

     3.  If a client is transferred to a hospital

or other medical facility as a result of a medical emergency, information

required for appropriate continuation of care must be released to the receiving

facility in compliance with the standards set forth in 42 C.F.R. Part 2.

     4.  The admission agreement must not allow

the licensee or his or her designee to be given power of attorney.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15331  Handling of money of client. (NRS 449.0302)

     1.  If a facility handles the money of a

client, a written ledger account of all deposits, disbursements or other

transactions must be maintained. A record must be made available to the client

at least quarterly.

     2.  The money of a client must be given to

the client within 24 hours after his or her exit from the facility.

     3.  Large sums of money must be maintained in

a financial institution in the community where the facility is located in a

separate trustee account apart from the operational accounts of the facility

and must be clearly designated.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15333  Inventory of belongings of client. (NRS 449.0302)  If a

facility holds or stores the belongings of a client, there must be an inventory

of the belongings on admission, made a part of the record of the client and

updated as needed. These belongings must be returned to the client upon his or

her exit.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15335  Liability insurance. (NRS 449.0302)  Liability

insurance in a sufficient amount to protect clients, members of the staff,

volunteers and visitors, must be maintained by each facility. A certificate of

insurance must be furnished to the Division. The certificate must include,

without limitation, provision for 30 days’ notice to the Division of

cancellation or the nonrenewal of a policy of insurance.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15337  Program: Requirements; review. (NRS 449.0302)

     1.  Each facility shall have a written

program outlining short-term and long-term objectives and goals. These goals

must be realistic, attainable, and clearly and operationally defined.

     2.  Each component of the program must

develop objectives that complement the goals of the program.

     3.  The Division shall:

     (a) Periodically evaluate the program;

     (b) Prepare a report of the evaluation; and

     (c) Distribute the report to the persons who manage

the program and make the report available to the members of the staff of the

facility and the Bureau of Licensure and Certification of the Division.

     4.  The facility shall provide for the medical,

dental and psychological services needed to fulfill the goals of the program

and meet the needs of all its clients to the extent that is possible, with

assistance from available community resources.

     5.  If a facility provides services through

outside sources, formal, written arrangements must be made ensuring that the

services are supplied directly by, or under the supervision of, qualified

persons.

     6.  Each facility shall provide case

management services as needed by a client through a social worker or a

registered nurse or by written agreement with a social worker or a registered

nurse.

     7.  A plan for case management must be

recorded in the records of a client and must be periodically evaluated in

conjunction with the treatment plan of the client.

     8.  Each facility shall review its general

program at least annually. Areas reviewed must include, without limitation,

appropriateness of admissions, lengths of stay, discharge planning, use of

services and utilization of the components of the program and outside services.

Written reports of the reviews must be evaluated by the governing body,

administrator and such committees as they designate. Documentation of the

evaluation process must be maintained at the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15339  Responsibilities and duties of administrator. (NRS 449.0302)

     1.  The administrator of a facility is

responsible to the governing body of the facility for the operation of the

facility in accordance with the policies and procedures of the facility.

     2.  The administrator shall:

     (a) Organize the administrative functions of the

program, delegate duties and establish a formal means of accountability on the

part of subordinates.

     (b) Ensure that a written manual defining the

policies and procedures of the program is prepared, regularly revised and

updated. The manual must:

          (1) Contain all policies and procedures of the

facility, including, without limitation, definitions and other documentation

required by NAC 449.15311 to 449.15369; and

          (2) Be available to members of the staff of

the facility at all times at designated and convenient locations.

     (c) Appoint a person who has attained the age of

majority to act for him or her during any extended absence.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15341  Policies and procedures concerning employees. (NRS 449.0302)

     1.  Each facility shall have on duty, all

hours of each day, members of the staff sufficient in number and qualifications

to carry out policies, responsibilities and program continuity.

     2.  All members of the counseling staff of a

facility shall be authorized by state law to provide alcohol and drug

counseling.

     3.  The administrator or his or her appointee

shall be present and responsible for the operations of the facility during

normal hours.

     4.  Each facility shall have written policies

and procedures for the recruitment, selection, promotion and termination of

members of the staff.

     5.  Each facility shall have written policies

and procedures concerning wages and salaries, working hours, employee benefits,

vacation and sick leave, rules of conduct, and training and development of the

staff.

     6.  Each facility shall provide an

orientation session to new employees. Documentation of the session must be

maintained in the personnel file of the employee.

     7.  Each facility shall have written policies

and procedures governing disciplinary actions that clearly define the mechanism

for the suspension or dismissal of members of the staff as well as the

procedures for appeal.

     8.  Each facility shall maintain a written

job description for each position at the facility. The job description must

accurately reflect the actual job situation and must be reviewed annually or

whenever a change in the responsibilities of the job or qualifications occurs.

Job descriptions must be available on request to all members of the staff. A

job description must include, without limitation:

     (a) The title of the job;

     (b) The tasks and responsibilities of the job;

     (c) The skills, education and experience necessary

for the job;

     (d) The relationship of the job to other jobs

within the program; and

     (e) The working conditions, location and shift of

the job, and the materials and equipment to be used on the job.

     9.  Each facility shall maintain a personnel

record for each employee of the facility. The record must include, without

limitation:

     (a) The employment application;

     (b) Letters of recommendation;

     (c) Records from any investigation of the employee;

     (d) Verification of training, experience and

certification;

     (e) Job performance evaluations;

     (f) Incident reports; and

     (g) Disciplinary actions taken.

     10.  Each facility shall maintain personnel

records in a secure manner and make them available only to those persons

authorized to receive personnel records in the written policies and procedures

of the facility. An employee must have access to his or her own file upon

request.

     11.  Each person employed in a facility shall

have a preemployment physical examination or certification of a 3-year health

record from a physician, and be tested for tuberculosis as required in chapter 441A of NAC.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15343  Nursing services. (NRS 449.0302)

     1.  Each facility shall have an organized

plan for nursing service that provides nursing services 24 hours per day. The

nursing services must be provided or supervised by a registered nurse in

compliance with state law, including, without limitation, chapter 632 of NRS and chapter 632 of NAC.

     2.  The nursing service shall have a

sufficient number of registered nurses, licensed practical nurses and other

personnel to provide nursing care to all clients as needed.

     3.  The facility shall ensure that the

nursing staff develops and keeps current a plan for nursing care for each

client.

     4.  The administrator shall appoint a chief

administrative nurse to direct the nursing service. The chief administrative

nurse must:

     (a) Be a registered nurse;

     (b) Be knowledgeable, skilled and competent in

clinical practice and the management of nurses;

     (c) Be authorized by state law to provide alcohol

and drug counseling; and

     (d) Comply with the provisions of chapter 632 of NRS and chapter 632 of NAC and follow professional

standards established for organized nursing services.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15345  Health services. (NRS 449.0302)

     1.  Each facility shall provide health

services which ensure that each client receives treatment, prescribed

medication, adequate diets and other health services consistent with the

program administered by the facility.

     2.  There must be policies and procedures

designed to ensure the early detection of complications or conditions

considered to be common among alcohol and drug abusers. The policies and

procedures must be developed with assistance from and approved by the medical

director of the facility.

     3.  Before a client is admitted to a

facility, a general medical and drug history of the client must be taken by a

physician or designated member of the nursing staff of the facility. The history

must include, without limitation:

     (a) Drugs used in the past;

     (b) Drugs used recently;

     (c) Drugs of preference;

     (d) Frequently used drugs;

     (e) Drugs used in combination;

     (f) Dosages used;

     (g) Date of first usage;

     (h) Incidents of overdose, withdrawal or adverse

drugs reactions; and

     (i) Previous history of treatment.

     4.  Except as otherwise provided in this

subsection, a physical examination and review of the medical and drug history

of a client must be conducted by a physician, registered nurse or physician

assistant within 48 hours after the client is admitted to a facility. If the

assessment performed by a physician or a member of the nursing staff before a

client is admitted to the facility concludes that a physical examination of the

client should be completed within less than 48 hours after the client is

admitted to the facility to ensure that the needs of the client are met, the

physical examination must be conducted within the time recommended in the

assessment.

     5.  Each facility must be able to provide

directly, or through written arrangements, laboratory tests as requested by a

physician or federal regulations.

     6.  Referral to an outside health resource

must be made only if the resource is able to accept the client. Any records

that accompany the client must be either expurgated of any sensitive material

or be available only to persons authorized to receive the information under the

direction of the physician or administrator. Except where an emergency that

threatens a life exists and except as otherwise provided in NAC 449.15329, no information may be released

without the prior consent of the client or his or her guardian.

     7.  Each facility shall have written policies

and procedures defining the appropriate action to be taken when a medical

emergency arises. The policies and procedures must be reviewed and approved by

the medical director of the facility.

     8.  Each member of the staff of a facility

must be qualified by the American Red Cross or another similar nationally

recognized agency to administer cardiopulmonary resuscitation.

     9.  Each client of a facility shall, within 5

days after admission, undergo a Mantoux tuberculin skin test. If the client has

no documented history of a two-step Mantoux tuberculin skin test and has not

had a single Mantoux tuberculin skin test within the 12 months preceding

admission to the facility, the client shall undergo a two-step Mantoux tuberculin

skin test.

     10.  First-aid supplies must be maintained

and readily available at each facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15347  Pharmaceutical services. (NRS 449.0302)

     1.  Each facility shall have a pharmacy

directed by a registered pharmacist or a drug room supervised by no less than a

currently licensed professional nurse. The pharmacy or drug room must be

administered in accordance with all applicable state and federal laws. The

facility shall have a full-time, part-time or consulting pharmacist who is

responsible for developing, supervising and coordinating all of the activities

of the pharmacy service.

     2.  Each facility shall have and implement

policies and procedures that minimize errors in the administration of drugs.

The medical director of the facility and the pharmacist who is responsible for

the pharmacy service shall approve the policies and procedures.

     3.  Drugs and biologicals must be controlled

and distributed in accordance with applicable standards of practice and state

and federal laws.

     4.  When a pharmacist is not available at the

facility, drugs and biologicals may be removed from the pharmacy or drug area

only by a member of the staff who is authorized to remove such substances by

the policies and procedures of the facility, which must be established in

accordance with state and federal laws.

     5.  Errors in administering a drug, adverse

reactions by a client to a drug and incompatibilities between a drug and a

client must be immediately reported to the attending physician of the client.

     6.  Abuses and losses of controlled

substances must be reported to the pharmacist who is responsible for the

pharmacy service, the administrator and the chief administrative nurse of the

facility, in accordance with all applicable state and federal laws.

     7.  Information relating to drug interactions

and information on drug therapy, side effects, toxicology, dosage indications

for use and routes of administration must be available to the professional

members of the staff of the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15349  Medication and biologicals. (NRS 449.0302)

     1.  Except as otherwise provided in

subsection 2, an order for medication or biologicals for a client must be in

writing and signed by the practitioner, or other appropriate professional

person authorized by state or federal law to order the medication or

biological, who is responsible for the care of the patient.

     2.  When a telephone or verbal order is used

to order medications or biologicals, the order must be:

     (a) Accepted only by a person who is authorized by

the policies and procedures of the facility, which must be consistent with

state law, to accept such an order; and

     (b) Signed or initialed by the prescribing

practitioner in accordance with the policies and procedures of the facility.

     3.  Each order for a medication or biological

must include, without limitation, the name of the medication or biological, and

the dosage, time or frequency of administration and route of administration of

the medication or biological.

     4.  Only a member of the staff of the

facility who is authorized by state law to administer medication or biologicals

may administer medication or biologicals at the facility.

     5.  Each facility shall have a system to

monitor and improve the process of administering medication and biologicals.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15351  Dietary services. (NRS 449.0302)

     1.  Facilities shall serve at least three

meals or their equivalent daily, at regular times, with not more than 14 hours

between a substantial evening meal and breakfast. A second serving must be

provided for those clients who desire one.

     2.  Menus must be planned and followed to

meet the nutritional needs of the clients in accordance with the recommended

dietary allowances recommended by the Food and Nutrition Board of the Institute

of Medicine of the National Academies.

     3.  Therapeutic menus must be planned by a

licensed dietitian or must be reviewed and approved by the attending physician

of the client or a staff physician.

     4.  Menus must be in writing, planned in

advance, dated and posted, and kept on file at the facility for at least 90

days. Any substitution must be noted on the written menu so that the menu on

file reflects what was actually served.

     5.  Adequate facilities and equipment for the

preparation, serving, refrigeration and storage of food in a sanitary manner

must be provided.

     6.  A facility with more than 10 clients

shall:

     (a) Comply with all applicable provisions of chapter 446 of NRS and the regulations

adopted pursuant thereto;

     (b) Obtain the necessary permits from the Division;

     (c) Maintain a report of each inspection concerning

the sanitation of the facility for at least 1 year after the date of the

inspection; and

     (d) Maintain a report of each corrective action

taken to address a deficiency noted in a report described in paragraph (c) for

at least 1 year after the date of the corrective action.

     7.  Clients needing special equipment,

implements or utensils to assist them while eating must have such items

provided.

     8.  If a facility operates on the cottage

plan, provision must be made for food service that ensures hot, palatable

meals.

     9.  A licensed dietitian must be used as a

consultant on planning meals and serving food. At least 4 hours of consultation

each month is required.

     10.  A facility that contracts with a food

management company shall comply with all applicable regulations of the State

Board of Health.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000; A by R069-04, 8-4-2004; R155-10, 12-16-2010; R090-12, 12-20-2012)

      NAC 449.15353  Records of clients. (NRS 449.0302)

     1.  Each facility shall maintain an organized

system for the records of clients.

     2.  The records of a client must be available

to professional members of the staff of the facility who are directly involved

with the client.

     3.  The records of clients must be available

to representatives of the Division.

     4.  The records of clients must include,

without limitation:

     (a) Identification information;

     (b) Past medical and social history;

     (c) Copies of initial and periodic examinations;

     (d) Evaluations and progress notes; and

     (e) Assessments and goals of the plan of treatment

of each client.

     5.  The plan of treatment must state what

service or person is responsible for providing treatment or services to the

client.

     6.  Entries must be made describing

treatments and services rendered, medications administered, and any symptoms or

other indications of illness or injury, including, without limitation, the

date, time and action taken regarding each incident.

     7.  Records must be adequately safeguarded

against destruction, loss or unauthorized use.

     8.  Records must be retained for at least 5

years after the discharge of a client from a facility.

     9.  A discharge plan, as determined by a case

management assessment of the client, must be documented for each client

discharged from the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15355  Safety and sanitation; temperature. (NRS 449.0302)

     1.  The premises and equipment of each

facility must be maintained in a safe, functional and sanitary condition. Each

facility shall have the necessary cleaning and maintenance equipment with

sufficient storage areas and appropriate procedures to maintain a clean and

orderly establishment. Janitorial supplies, including, without limitation,

aerosols, must be stored in areas separate from clean linen, food and other

supplies. The storage of dirty linen must be separate from the storage of clean

linen, food and other supplies.

     2.  Items for personal use, including,

without limitation, combs, toothbrushes, towels and bar soap, must not be

shared by clients.

     3.  Restrooms or lavatories for the staff of

a facility must be provided with soap dispensers and individual, disposable

towels.

     4.  Each facility shall ensure that the

environment of the facility is free of hazards that may cause accidents.

     5.  Each facility shall maintain an effective

program to control pests and rodents in order to ensure that the facility is

free from pests and rodents.

     6.  Each facility shall provide safe and

comfortable levels of temperature in the facility. The temperature of the

facility must be maintained at a level that is not less than 71 degrees

Fahrenheit and not more than 81 degrees Fahrenheit.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15357  Laundry requirements. (NRS 449.0302)

     1.  Each facility shall have the proper

equipment for the sanitary washing and finishing of linen and other washable

goods or shall maintain a written agreement with a commercial establishment to

provide laundry services.

     2.  The laundry area of a facility must be

situated in an area of the facility that is separate and apart from any room

where food is stored, prepared or served. The laundry area must be

well-lighted, ventilated, adequate in size to house equipment, maintained in a

sanitary manner and kept in good repair.

     3.  Soiled linen must be collected and

transported to the laundry in washable or disposable containers in a sanitary

manner. Soiled linen must not be transported through areas of the facility used

for preparing or serving food.

     4.  Clean linen to be dried, ironed, folded,

transferred or distributed must be handled in a sanitary manner in accordance

with a written plan maintained by the facility.

     5.  Closets for storing linen and laundry

supplies must be provided and must not be used for any other purpose.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15359  New construction or remodeling: Submission and approval of

building plans; prerequisites to approval of facility for licensure. (NRS 449.0302)

     1.  Except as otherwise provided in

subsection 4, before any new construction of a facility or any remodeling of an

existing facility is begun:

     (a) The facility must submit a copy of the building

plans for the new construction or remodeling to the entity designated to review

such plans by the Division pursuant to the provisions of NAC 449.0115. The entity’s review of those plans is

advisory only and does not constitute approval for licensure of the facility.

     (b) The building plans must be approved by the

Division.

     2.  The Bureau shall not approve a facility

for licensure until all construction is completed and a survey is conducted at

the site of the facility.

     3.  The Division shall not issue a license to

operate a facility until the Bureau has approved the construction of the

facility.

     4.  The provisions of subsection 1 do not

apply to plans for remodeling a facility if the remodeling is limited to

refurbishing an area within the facility, including, without limitation,

painting in the area, replacing flooring in the area, repairing windows in the

area or replacing window and wall coverings in the area.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000; A by R076-01, 10-18-2001; R069-04, 8-4-2004)

      NAC 449.15361  Design, construction, equipment and maintenance. (NRS 449.0302)

     1.  Each facility must be designed,

constructed, equipped and maintained in a manner that protects the health and

safety of the clients and personnel of the facility and members of the general

public.

     2.  Each facility shall comply with all

applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without

limitation, zoning ordinances; and

     (c) Environmental, life safety, fire, health and

local building codes,

Ê related to

the construction and maintenance of the facility. If there is a difference

between state and local requirements, the more stringent requirements apply.

     3.  Each facility shall comply with the

provisions of NFPA 101: Life Safety Code, as adopted by reference

pursuant to NAC 449.0105. Facilities housing 17 or

more clients shall meet the requirements of the chapter entitled “Hotel and

Dormitories,” of the edition of NFPA 101: Life Safety Code adopted by

reference pursuant to NAC 449.0105. Those

facilities housing not more than 16 clients shall meet the requirements of the

chapter entitled “Lodging or Rooming Houses,” of the edition of NFPA 101:

Life Safety Code adopted by reference pursuant to NAC

449.0105.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15363  Accommodations for clients. (NRS 449.0302)

     1.  No room or space of a facility may be

occupied for sleeping, living or dining that is accessible only by a ladder, by

folding stairs or through a trapdoor.

     2.  If a basement of a facility is used for

living and dining, at least one exit must be provided directly to the outside

at ground level. No facility may:

     (a) Be situated more than one story below the

ground; and

     (b) Use any basement or space in a basement for

sleeping.

     3.  Each room of a facility used by clients

for sleeping must:

     (a) Be provided and furnished with a bed, clean

linen and blankets;

     (b) Not be less than 60 square feet per bed; and

     (c) Not be used for sleeping by more than four

clients.

     4.  Toilet facilities and bathing facilities

must be provided to clients in a manner that ensures their privacy while

bathing and in an adequate number to meet the needs of the clients.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

      NAC 449.15365  Safety from fire. (NRS 449.0302)

     1.  Devices for the detection of combustion

other than heat detectors must be installed on the ceiling of each story of a

facility, in front of doors to stairways in a facility, and at not more than 30

feet apart in the corridors of all floors of a facility, including, without

limitation, the center. Smoke detectors must also be installed in the center of

any lounge or recreational area of a facility. The smoke detectors may be

single station units with an integral alarm.

     2.  Portable fire extinguishers must be

installed throughout each facility at the direction of the fire authority

having jurisdiction. Each portable fire extinguisher available at a facility

must be inspected, recharged and tagged at least once each year by a person

certified by the State Fire Marshal to conduct such inspections.

     3.  A portable room-heating device may be

used if the device:

     (a) Is located 2 feet or more from any combustible

material;

     (b) Is plugged directly into a wall socket;

     (c) Turns off automatically if tipped over; and

     (d) Has no exposed heating elements.

     4.  Receptacles or outlets serviced by

extension cords are prohibited in facilities.

     5.  Rooms in which smoking is allowed by

direction of the facility or the fire authority must be provided with plainly

visible “Smoking Area” signs.

     6.  Each facility shall conduct fire drills

at least monthly, and a written record of each drill conducted must be retained

in the facility for not less than 12 months after the drill is conducted.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15367  Preparations for disasters; reporting of fire or disaster. (NRS 449.0302)

     1.  Each facility shall develop a written

plan for disasters that outlines procedures for members of the staff and

clients to follow in case of fire or another emergency and provides for meeting

the needs of clients if the facility must be evacuated or is destroyed.

     2.  A simple floor plan showing the routes

for evacuating must be posted in prominent locations on each floor of the

facility.

     3.  The facility shall notify the Bureau of

the occurrence of a fire or disaster in the facility within 24 hours after the

facility becomes aware of the fire or disaster.

     4.  Each facility shall conduct a disaster

drill at least annually and retain a written record of the drill in the

facility for not less than 12 months after the drill is conducted.

     5.  Each facility shall adopt procedures to

ensure that water is available to the essential areas of the facility if there

is an interruption in the facility’s normal supply of water.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15369  Discrimination prohibited. (NRS 449.0302)

     1.  No facility that accepts a person for

treatment for whom all or part of the payment for treatment is made from the

money of the Division of Welfare and Supportive Services or any other agency

funded in whole or in part by federal money may deny treatment to a prospective

client on the grounds of race, color, national origin, age, gender or

disability.

     2.  No client may be segregated, given

separate treatment, restricted in the employment of any advantage or privilege

enjoyed by others under the program or provided with any aid, treatment,

services or other benefits which are different or provided in a different

manner from that provided to others under the program on the grounds of race,

color, national origin, age, gender or disability.

     3.  Employment practices of a facility,

including, without limitation, hiring, firing, the rate of remuneration,

assignments or work hours, may not be based on race, color, national origin,

age, gender or disability.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99,

eff. 1-1-2000)

FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS

General Provisions

      NAC 449.154  Definitions. (NRS 449.0302, 449.0303)  As used in NAC 449.154 to 449.15485,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.15415 to 449.15438,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

      NAC 449.15415  “DEA” defined. (NRS 449.0302, 449.0303)  “DEA” means the Drug

Enforcement Administration of the United States Department of Justice.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.1542  “Facility for treatment with narcotics” defined. (NRS 449.0302,

449.0303)  “Facility

for treatment with narcotics” means any person or any public or private

facility that provides a narcotic treatment program described in 42 C.F.R. Part

8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

      NAC 449.1543  “Medical director” defined. (NRS 449.0302, 449.0303)  “Medical director” means a

physician who is licensed to practice medicine in this State and who is

responsible for the administration of all medical services at a facility for

treatment with narcotics or a medication unit and for ensuring that the

facility or the medication unit complies with all applicable federal, state and

local laws and regulations.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.15435  “Medication unit” defined. (NRS 449.0302, 449.0303)  “Medication unit” means

any person or any public or private facility that:

     1.  Is established as part of or operates in

conjunction with a facility for treatment with narcotics but is separated

geographically from the facility for treatment with narcotics; and

     2.  Is limited to:

     (a) Administering or dispensing narcotics; and

     (b) Collecting specimens in accordance with chapter 652 of NRS for drug testing or

analysis relating to treatment with narcotics.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.15438  “SAMHSA” defined. (NRS 449.0302, 449.0303)  “SAMHSA” means the

Substance Abuse and Mental Health Services Administration of the United States

Department of Health and Human Services.

     (Added to NAC by Bd. of Health by R053-02, eff. 7-24-2002)

      NAC 449.1544  Division is state authority for certain federal regulations. (NRS 449.0302,

449.0303)  The

Division is the state authority for the purposes of 42 C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

Licensing

      NAC 449.15445  License and federal certification required to operate facility or

unit. (NRS 449.0302, 449.0303)

     1.  A person or a public or private facility

shall not operate or provide the services of a facility for treatment with

narcotics or represent that it operates or provides the services of a facility

for treatment with narcotics, unless the person or the public or private

facility is:

     (a) Licensed by the Division pursuant to NAC 449.154 to 449.15485,

inclusive, to operate the facility for treatment with narcotics; and

     (b) Certified by the SAMHSA pursuant to 42 C.F.R.

Part 8 to operate the facility for treatment with narcotics.

     2.  A person or a public or private facility

shall not operate or provide the services of a medication unit or represent

that it operates or provides the services of a medication unit, unless the

person or the public or private facility is:

     (a) Licensed by the Division pursuant to NAC 449.154 to 449.15485,

inclusive, to operate the medication unit and the facility for treatment with

narcotics that is associated with the medication unit; and

     (b) Certified by the SAMHSA pursuant to 42 C.F.R.

Part 8 to operate the medication unit and the facility for treatment with

narcotics that is associated with the medication unit.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

      NAC 449.1545  Filing requirements; recommendation for certification. (NRS 449.0302,

449.0303)

     1.  If a person or a public or private

facility wants to operate a facility for treatment with narcotics or a

medication unit, the person or the public or private facility must:

     (a) File with the SAMHSA an application for

certification pursuant to 42 C.F.R. Part 8;

     (b) File with the Bureau an application for a

license pursuant to NAC 449.011 and include with

the application:

          (1) If there is an accreditation body that has

been approved pursuant to 42 C.F.R. § 8.3, proof that the applicant has applied

for accreditation from such accreditation body; and

          (2) Any other information requested by the

Bureau; and

     (c) Demonstrate that the proposed facility for

treatment with narcotics or the proposed medication unit is able to comply with

the requirements set forth in NAC 449.1548.

     2.  A person or a public or private facility

must file an application for a license for each facility for treatment with narcotics

that it wants to operate, whether or not the person or the public or private

facility is already licensed to operate one or more other facilities for

treatment with narcotics.

     3.  A person or a public or private facility

must file an application for a license for each medication unit that it wants

to operate, whether or not the person or the public or private facility is

already licensed to operate one or more other medication units.

     4.  The Division may make a recommendation to

the SAMHSA that an applicant for certification of a facility for treatment with

narcotics or a medication unit be certified, if the applicant has:

     (a) Satisfied all the requirements for licensure by

the Division pursuant to NAC 449.154 to 449.15485, inclusive;

     (b) Submitted all items required pursuant to NAC 449.011; and

     (c) Provided satisfactory evidence to the Division

that the facility is in substantial compliance with the requirements of 42

C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

      NAC 449.15455  Investigation and prelicensure survey. (NRS 449.0302,

449.0303)

     1.  If an application for a license is filed

pursuant to NAC 449.1545, the Bureau shall conduct

pursuant to NAC 449.0112:

     (a) An investigation; and

     (b) A prelicensure survey.

     2.  The investigation and any prelicensure

survey conducted by the Bureau must include, but are not limited to, an

evaluation of whether the proposed facility for treatment with narcotics or the

proposed medication unit is able to comply with the requirements set forth in NAC 449.1548.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

      NAC 449.1547  Suspension, revocation or cancellation of license; provisional

license; denial of application. (NRS 449.0302, 449.0303)

     1.  The Division may suspend or revoke a

license issued pursuant to NAC 449.154 to 449.15485, inclusive, or cancel such a license and

issue a provisional license based upon any grounds for such action set forth in

NAC 449.002 to 449.99939,

inclusive, or chapter 449 of NRS.

     2.  The Division shall deny an application

for a license pursuant to NAC 449.1545 if the

SAMHSA denies an application for certification pursuant to 42 C.F.R. Part 8.

     3.  The Division shall suspend or revoke a

license issued pursuant to NAC 449.154 to 449.15485, inclusive, if the facility for treatment

with narcotics or the medication unit operates without certification from the

SAMHSA pursuant to 42 C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

Operation

      NAC 449.1548  General operational requirements.

(NRS 449.0302, 449.0303)  In addition to all other

requirements set forth in NAC 449.154 to 449.15485, inclusive, each facility for treatment

with narcotics and each medication unit shall:

     1.  Have a medical director who has a valid

and current license to practice medicine in this State;

     2.  Employ, contract with or allow a person

to act as an alcohol and drug abuse counselor only if the person is certified

by the Board of Examiners for Alcohol, Drug and Gambling Counselors to be such

a counselor;

     3.  Obtain and maintain with the State Board

of Pharmacy a valid and current registration relating to the use of narcotics;

     4.  Be in full compliance with all applicable

provisions of 42 C.F.R. Part 8, all other applicable federal laws and

regulations and all other requirements of the SAMHSA and the DEA;

     5.  Be in full compliance with all applicable

provisions of chapters 449 and 453 of NRS and in substantial compliance

with all applicable provisions of NAC 449.002 to 449.99939, inclusive, and chapter 453 of NAC;

     6.  Maintain records and documentation of

treatment pursuant to NRS 453.690;

     7.  Provide the Division and the State Board

of Pharmacy with access to all records and documentation relating to the

purchase, distribution and use of narcotics;

     8.  Comply with the rules of confidentiality

and privilege set forth in NRS

453.720;

     9.  Develop and maintain a system to ensure

that prospective and existing clients are not receiving narcotics from any

other facility for treatment with narcotics or any other medication unit; and

     10.  Comply with all applicable local laws

and regulations, including, but not limited to, zoning laws and regulations.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002; R098-06, 7-14-2006)

      NAC 449.15485  Continuing review of operations; investigation of complaints. (NRS 449.0302,

449.0303)

     1.  The operation of a facility for treatment

with narcotics or a medication unit is subject to continuing review by the

Division.

     2.  The Division shall investigate all

complaints against a facility for treatment with narcotics or a medication unit

directly or in conjunction with other federal, state or local governmental

agencies, including, but not limited to, the SAMHSA, the DEA, the State Board

of Pharmacy or the Division.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98;

A by R053-02, 7-24-2002)

HALFWAY HOUSES FOR RECOVERING ALCOHOL AND DRUG ABUSERS

      NAC 449.1549  Definitions. (NRS 449.0302)  As used

in NAC 449.1549 to 449.154945,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.154901, 449.154903

and 449.154905 have the meanings ascribed to

them in those sections.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154901  “Administrator” defined. (NRS 449.0302)  “Administrator”

means a person:

     1.  Whose name appears on a license issued by

the Bureau as administrator of record for a facility; and

     2.  Who is legally responsible for the

management of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154903  “Client” defined. (NRS 449.0302)  “Client”

means a person who is admitted to a facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154905  “Facility” defined. (NRS 449.0302)  “Facility”

means a halfway house for recovering alcohol and drug abusers as defined in NRS 449.008.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.15491  Administrator: Qualifications. (NRS 449.0302)  An

administrator must:

     1.  Be at least 21 years of age;

     2.  Have the tests and obtain the

certifications required by NAC 441A.375

for a person employed in a facility for the dependent; and

     3.  Maintain evidence that he or she

satisfies the requirements of this section in a file that is maintained on the

premises of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154911  Administrator: General duties. (NRS 449.0302)  An

administrator shall:

     1.  Post the license issued by the Bureau in

a conspicuous place within the facility.

     2.  Organize and manage the facility.

     3.  Establish policies, procedures and rules

for the operation of the facility, including, without limitation, the policies

and procedures required to be established by NAC

449.154915.

     4.  Ensure that the records of the facility

are maintained in accordance with the requirements of the policies, procedures

and rules for the operation of the facility established pursuant to subsection

3.

     5.  Ensure that the facility complies with

any applicable state statutes and regulations and local ordinances.

     6.  Ensure that the clients of the facility

are afforded the opportunity to exercise their individual rights in a manner

consistent with the rules of the facility.

     7.  Ensure that the facility is maintained in

a safe and clean condition.

     8.  Review and approve changes in the

policies and procedures established pursuant to subsection 3 at least annually.

This review must be signed and dated.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154913  General operational guidelines. (NRS 449.0302)  An

administrator shall ensure that:

     1.  Alcohol or drugs are not allowed on the

premises of the facility;

     2.  The policies, procedures and rules

established pursuant to NAC 449.154911 are

carried out;

     3.  Each client complies with those policies,

procedures and rules;

     4.  The facility provides an environment that

will facilitate the reintegration of the clients of the facility into the

community; and

     5.  The operation of the facility is not

compromised by a client who violates the policies, procedures or rules of the

facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154915  Policies and procedures: Establishment; maintenance of manual. (NRS 449.0302)

     1.  An administrator shall establish written

policies and procedures concerning:

     (a) The manner in which records of clients will be

maintained and protected against unauthorized use;

     (b) The disclosure of confidential information

about clients;

     (c) The criteria the facility will use to determine

whether to:

          (1) Admit a client to the facility; and

          (2) Discharge a client from the facility;

     (d) The discharge of a client for a violation of

the rules of the facility;

     (e) The discharge of a client for the use of

alcohol or drugs;

     (f) The rights and responsibilities of a client;

and

     (g) The evacuation of clients in case of fire or

other emergency as required by NAC 449.154945.

     2.  The administrator shall maintain a manual

of policies, procedures and rules of the facility that includes the policies

and procedures established pursuant to subsection 1. The manual must be

available on the premises of the facility at all times.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154917  Limitation on admissions. (NRS 449.0302)  An

administrator shall ensure that the facility does not admit more clients to the

facility than the number of beds for which it is licensed.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154919  Health and sanitation. (NRS 449.0302)

     1.  An administrator shall ensure that the

facility:

     (a) Has a safe and sufficient supply of water,

adequate drainage and an adequate system for the disposal of sewage; and

     (b) Complies with all local ordinances and state

and federal laws and regulations relating to zoning, sanitation, safety and

accessibility to persons with disabilities.

     2.  A container used to store garbage outside

of a facility must be kept reasonably clean and must be covered in such a

manner that rodents are unable to get inside the container. At least once each

week, the container must be emptied and the contents of the container must be

removed from the premises of the facility.

     3.  To the extent practicable, the premises

of the facility must be kept free from:

     (a) Offensive odors;

     (b) Hazards, including obstacles that impede the

free movement of clients within and outside the facility;

     (c) Insects and rodents; and

     (d) Accumulations of dirt, garbage and other refuse.

     4.  The administrator shall ensure that the

premises of the facility are clean and that the interior, exterior and

landscaping of the facility are well maintained.

     5.  All windows that are capable of being

opened in the facility and all doors that are left open to provide ventilation

for the facility must be screened to prevent the entry of insects.

     6.  The administrator shall ensure that

electrical lighting is maintained in the facility as necessary to ensure the

comfort and safety of the clients of the facility.

     7.  The temperature in the facility must be

maintained at a level that is not less than 68 degrees Fahrenheit and not more

than 82 degrees Fahrenheit.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154921  Laundry facilities. (NRS 449.0302)

     1.  An administrator shall ensure that

laundry facilities are provided in the facility commensurate with the number of

clients in the facility. At least one washer and at least one dryer must be

provided in the facility.

     2.  The laundry area in a facility must be

maintained in a sanitary manner. All the equipment in the laundry area must be

maintained in good working condition. All dryers must be ventilated to the

outside of the building.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154923  Kitchens; storage of food. (NRS 449.0302)

     1.  The kitchen in a facility and the

equipment in the kitchen must be clean and must allow for the sanitary

preparation of food. The equipment must be in good working condition.

     2.  Perishable food must be refrigerated at a

temperature of 40 degrees Fahrenheit or less. Frozen food must be kept at a

temperature of 0 degrees Fahrenheit or less.

     3.  Food must not be stored in any area in

which cleaning or pest control products are stored.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154925  Bedrooms; bedding. (NRS 449.0302)

     1.  A bedroom in a facility that is used by

more than one client must have at least 45 square feet of floor space for each

client who resides in the bedroom. A bedroom that is occupied by only one

client must have at least 80 square feet of floor space.

     2.  The arrangement of the beds and other

furniture in the bedroom must accommodate the clients occupying the bedroom in

comfort and safety.

     3.  A bed with a comfortable and clean

mattress must be provided for each client. The bed must be made with two clean

sheets, a blanket, a pillow and a bedspread. Linens must be changed at least

once each week and more often if the linens become dirty.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154927  Use of certain areas as bedroom prohibited. (NRS 449.0302)  A hall,

stairway, unfinished attic, garage, storage area or shed or other similar area

of a facility must not be used as a bedroom. Any other room must not be used as

a bedroom if it is used for any other purpose.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154929  Bathrooms and toilet facilities; toilet articles. (NRS 449.0302)

     1.  All bathrooms and toilet facilities in

the facility must be sufficiently lighted.

     2.  Each client must have his or her own

towels and washcloths. Paper towels may be used for hand towels. The towels and

washcloths must be changed as often as is necessary to maintain cleanliness,

but in no event less often than once each week. A soap dispenser that provides

liquid or granular soap may be used instead of individual bars of soap.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154931  Accommodations for residents with restricted mobility. (NRS 449.0302)  A

facility that has a client who uses a wheelchair or a walker must:

     1.  Have hallways, doorways and exits wide

enough to accommodate a wheelchair or walker; and

     2.  Have ramps at all primary exits.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154933  First aid. (NRS 449.0302)

     1.  A first-aid kit must be available at the

facility. The first-aid kit must include, without limitation:

     (a) A germicide safe for use by humans;

     (b) Sterile gauze pads;

     (c) Adhesive bandages, rolls of gauze and adhesive

tape;

     (d) Disposable gloves;

     (e) A shield or mask to be used by a person who is

administering cardiopulmonary resuscitation; and

     (f) A thermometer or other device that may be used

to determine the bodily temperature of a person.

     2.  Except for first aid in an emergency, no

treatment or medication may be administered to a client.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154935  Medication. (NRS 449.0302)

     1.  Except as otherwise provided in NAC 449.154933, an administrator or another client

shall not administer or assist in the administration of medication to a client.

     2.  Medication for self-administration may be

kept at the facility. That medication must:

     (a) Be disposed of immediately when it expires or

when a physician orders the medication to be discontinued;

     (b) Be stored and controlled in a manner that

protects the medication from unauthorized use; and

     (c) Not be used by more than one of the clients.

     3.  The provisions of paragraph (a) of

subsection 2 do not apply to over-the-counter medication.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154937  Telephones; listing of facility’s telephone number. (NRS 449.0302)  An

administrator shall ensure that:

     1.  The facility has at least one telephone

that is in good working condition in the facility; and

     2.  The telephone number of the facility is

listed in the telephone directory.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154939  Notification to Bureau under certain circumstances. (NRS 449.0302)  An

administrator shall notify the Bureau within 24 hours after the occurrence of

an incident that:

     1.  Involved significant harm to a client of

the facility if the client of the facility required medical treatment as a

result of the incident;

     2.  May cause imminent danger to the health

or safety of a client of the facility; or

     3.  May jeopardize the integrity of the

operation of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154941  Rights of clients. (NRS 449.0302)  An

administrator shall ensure that:

     1.  A client of the facility is not abused,

neglected or exploited by another client of the facility or any person who is

visiting the facility;

     2.  A client is not prohibited from speaking

to any person who advocates for the rights of the clients of the facility;

     3.  Each client is treated with respect and

dignity;

     4.  The facility provides a safe and

comfortable environment;

     5.  A client is not prohibited from

interacting socially in a manner that is consistent with the rules of the

facility;

     6.  To the extent practicable and in a manner

that is consistent with the rules of the facility, each client is allowed to

make his or her own decisions; and

     7.  The telephone number of the local office

of the Bureau and the name and telephone number of the administrator is

conspicuously posted on the premises of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154943  Client files: Maintenance; contents; confidentiality. (NRS 449.0302)

     1.  An administrator shall ensure that the

facility maintains a separate file for each client of the facility and retains

the file for at least 5 years after the client permanently leaves the facility.

The file must be kept locked in a location that is protected against

unauthorized use. Each file must contain the information obtained by the

facility that is related to the client, including, without limitation:

     (a) The full name, address, date of birth and

social security number of the client;

     (b) The address and telephone number of the

client’s physician and any next of kin or guardian of the client;

     (c) A statement of the allergies of the client, if

any, and any special diet or medication he or she requires;

     (d) Evidence of compliance with the provisions of NAC 441A.380;

     (e) A list of the rules of the facility that is

signed by the client; and

     (f) The name and telephone number of the vendors

and medical professionals that provide services for the client.

     2.  Except as otherwise provided in this

subsection, the file of the client must be kept confidential. The file of a

client must be made available upon request at any time to an employee of the

Bureau who is acting in his or her capacity as an employee of the Bureau.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

      NAC 449.154945  Safety from fire. (NRS 449.0302)

     1.  An administrator shall ensure that the

facility complies with the regulations adopted by the State Fire Marshal

pursuant to chapter 477 of NRS and any

local ordinances relating to safety from fire. The facility must be approved

for occupancy by the State Fire Marshal.

     2.  The administrator shall ensure that the

facility has a plan for the evacuation of clients in case of fire or other

emergency. The plan must be:

     (a) Understood by all clients;

     (b) Posted in a common area of the facility; and

     (c) Discussed with each client at the time of his

or her admission.

     3.  At least one portable fire extinguisher

must be available at the facility. Any portable fire extinguishers available at

the facility must be inspected, recharged and tagged at least once each year by

a person certified by the State Fire Marshal to conduct such inspections.

     4.  The administrator shall ensure that a

written policy on smoking is developed and carried out by the facility. The

policy must be:

     (a) Developed with the purpose of preventing a fire

caused by smoking in the facility; and

     (b) Posted in a common area of the facility.

     5.  Smoke detectors installed in a facility

must be maintained in proper operating condition at all times and must be

tested monthly. The results of the tests conducted pursuant to this subsection

must be recorded and maintained at the facility.

     6.  If a fire sprinkler system is installed

in a facility, the system must be maintained in proper operating condition at

all times and must be inspected in accordance with the provisions of NAC 477.460.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001,

eff. 1-1-2002)

FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS

General Provisions

      NAC 449.154951  Definitions. (NRS 449.0302)  As used

in NAC 449.154951 to 449.154999,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.154953 to 449.154959,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154953  “Administrator” defined. (NRS 449.0302)  “Administrator”

means a person:

     1.  Whose name appears on a license issued by

the Bureau as administrator of record for a facility; and

     2.  Who is legally responsible for the

management of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154955  “Facility” defined. (NRS 449.0302)  “Facility”

means a facility for transitional living for released offenders as defined in NRS 449.0055.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154957  “Resident” defined. (NRS 449.0302)  “Resident”

means a person who:

     1.  Is a person who has been released from

prison as that term is defined in subsection 2 of NRS 449.0055; and

     2.  Is admitted to a facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154959  “Supportive services” defined. (NRS 449.0302)

     1.  “Supportive services” mean services

provided by a facility, directly or indirectly through arrangements with other

providers, which are intended to assist a resident with reintegration into the

community.

     2.  Those services may include, without

limitation:

     (a) Referrals and the provision of information

concerning:

          (1) Health care, including mental health care;

          (2) Access to housing, benefits or employment;

          (3) Resume writing; and

          (4) Required counseling for sex offenders.

     (b) Training concerning:

          (1) Life skills;

          (2) Resume writing; and

          (3) Any other topic pursuant to the policies

of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

Administration

      NAC 449.154961  Administrator: Qualifications. (NRS 449.0302)  An

administrator must:

     1.  Be at least 21 years of age;

     2.  Have the physical examination or

certification required by paragraph (a) of subsection 3 of NAC 441A.375 for a person employed in a

facility for the dependent; and

     3.  Maintain evidence that he or she

satisfies the requirements of this section in a file that is maintained on the

premises of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154963  Administrator: General duties. (NRS 449.0302)  An

administrator shall:

     1.  Post the license issued by the Bureau in

a conspicuous place within the facility.

     2.  Organize and manage the facility.

     3.  Establish policies, procedures and rules

for the operation of the facility, including, without limitation, the policies

and procedures required to be established by NAC

449.154967.

     4.  Ensure that the records of the facility

are maintained in accordance with the requirements of the policies, procedures

and rules for the operation of the facility established pursuant to subsection

3.

     5.  Ensure that the facility complies with

any applicable state statutes and regulations and local ordinances.

     6.  Ensure that the residents of the facility

are afforded the opportunity to exercise their individual rights in a manner

consistent with the rules of the facility.

     7.  Ensure that the facility is maintained in

a safe and clean condition.

     8.  Review and approve changes in the

policies and procedures established pursuant to subsection 3 at least annually.

This review must be signed and dated.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154965  Operation of facility. (NRS 449.0302)  An

administrator shall ensure that:

     1.  Alcohol or drugs are not allowed on the

premises of the facility;

     2.  The policies, procedures and rules

established pursuant to NAC 449.154963 are

carried out;

     3.  Each resident complies with those

policies, procedures and rules;

     4.  The facility provides an environment that

will facilitate the reintegration of the residents of the facility into the

community; and

     5.  The operation of the facility is not

compromised by a resident who violates the policies, procedures or rules of the

facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154967  Policies and procedures. (NRS 449.0302)

     1.  An administrator shall establish written

policies and procedures concerning:

     (a) The manner in which records of residents will

be maintained and protected against unauthorized use;

     (b) The disclosure of confidential information

about residents;

     (c) The criteria the facility will use to determine

whether to:

          (1) Admit a resident to the facility; and

          (2) Discharge a resident from the facility;

     (d) The discharge of a resident for a violation of

the rules of the facility;

     (e) The discharge of a resident for the use of

alcohol or drugs;

     (f) The rights and responsibilities of a resident;

and

     (g) The evacuation of residents in case of fire or

other emergency as required by NAC 449.154999.

     2.  The administrator shall maintain a manual

of policies, procedures and rules of the facility that includes, without

limitation, the policies and procedures established pursuant to subsection 1.

The manual must be available on the premises of the facility at all times.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154969  Preparations for disasters and other emergencies. (NRS 449.0302)

     1.  An administrator shall develop a written

plan for disasters that outlines procedures for members of the staff of the

facility and residents of the facility to follow in case of a disaster or other

emergency. The plan must include, without limitation, provisions outlining

procedures to be followed with regard to:

     (a) Workplace threats and violence, bomb threats,

and the possession of firearms or explosives by a resident;

     (b) Medical emergencies;

     (c) Natural disasters typical of the particular

geographic area in which the facility is located; and

     (d) Other disasters, including, without limitation,

a power failure, an interruption in the normal supply of water to the facility

and threats by terrorists.

     2.  The plan must include, without

limitation, provisions concerning the provision of temporary shelter and other

services for residents of the facility who are required to evacuate the

facility because of a disaster.

     3.  The provisions of the plan must be

communicated to each member of the staff of the facility and each resident of

the facility.

     4.  Each facility shall conduct a drill for

evacuation of the facility at least once each quarter and shall ensure that

each shift of the staff of the facility participates in such a drill at least

annually.

     5.  Each facility shall retain a written

record of each drill conducted pursuant to subsection 4 on file at the facility

for not less than 12 months after the drill is conducted. The administrator

shall make such records available for inspection by the Division upon request.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

Operation

      NAC 449.154971  Limitation on number of admissions. (NRS 449.0302)  An

administrator shall ensure that the facility does not admit more residents to

the facility than the number of beds for which it is licensed.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154973  Prerequisites to provision of particular services. (NRS 449.0302)

     1.  In addition to satisfying the

requirements of NAC 449.011, an applicant for a

license to operate a facility must include with his or her application a

statement indicating whether he or she will be operating a facility:

     (a) That only provides a housing and living

environment;

     (b) That provides or arranges for the provision of

supportive services for residents of the facility to assist the residents with

reintegration into the community, in addition to providing a housing and living

environment; or

     (c) That provides or arranges for the provision of

alcohol and drug abuse programs, in addition to providing a housing and living

environment and providing or arranging for the provision of other supportive

services.

     2.  If the applicant wishes to operate a

facility described in paragraph (c) of subsection 1, the applicant must:

     (a) Obtain certification of its program pursuant to

subsection 4 of NRS 458.025 and

include evidence of that certification with his or her application; and

     (b) Satisfy the requirements set forth in NAC 449.019 to 449.153,

inclusive, for a facility for the treatment of abuse of alcohol or drugs.

     3.  If the applicant wishes to operate a

facility described in paragraph (b) or (c) of subsection 1 which has residents

who are under the supervision of a parole officer, the applicant must:

     (a) Obtain the approval of the Division of Parole

and Probation of the Department of Public Safety; and

     (b) Include evidence of that approval with his or

her application.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154975  Sanitation, safety and comfort. (NRS 449.0302)

     1.  An administrator shall ensure that the

facility:

     (a) Has a safe and sufficient supply of water,

adequate drainage and an adequate system for the disposal of sewage; and

     (b) Complies with all local ordinances and state

and federal laws and regulations relating to zoning, sanitation, safety and

accessibility to persons with disabilities.

     2.  A container used to store garbage outside

of a facility must be kept reasonably clean and must be covered in such a

manner that rodents are unable to get inside the container. At least once each

week, the container must be emptied and the contents of the container must be

removed from the premises of the facility.

     3.  To the extent practicable, the premises

of the facility must be kept free from:

     (a) Offensive odors;

     (b) Hazards, including obstacles that impede the

free movement of residents within and outside the facility;

     (c) Insects and rodents; and

     (d) Accumulations of dirt, garbage and other

refuse.

     4.  The administrator shall ensure that the

premises of the facility are clean and that the interior, exterior and

landscaping of the facility are well maintained.

     5.  All windows that are capable of being

opened in the facility and all doors that are left open to provide ventilation

for the facility must be screened to prevent the entry of insects.

     6.  The administrator shall ensure that

electrical lighting is maintained in the facility as necessary to ensure the

comfort and safety of the residents of the facility.

     7.  The temperature in the facility must be

maintained at a level that is not less than 68 degrees Fahrenheit and not more

than 82 degrees Fahrenheit.

     8.  The administrator shall ensure that any

pest control work performed at the facility is performed by a person licensed

to engage in pest control pursuant to chapter

555 of NRS.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154977  Laundry facilities. (NRS 449.0302)

     1.  An administrator shall ensure that

laundry facilities are provided in the facility commensurate with the number of

residents in the facility. At least one washer and at least one dryer must be

provided in the facility.

     2.  The laundry area in a facility must be

maintained in a sanitary manner. All the equipment in the laundry area must be

maintained in good working condition. All dryers must be ventilated to the

outside of the building.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154979  Kitchens; preparation and storage of food. (NRS 449.0302)

     1.  The kitchen in a facility and the

equipment in the kitchen must be clean and must allow for the sanitary

preparation of food. The equipment must be in good working condition.

     2.  Perishable food must be refrigerated at a

temperature of 40 degrees Fahrenheit or less. Frozen food must be kept at a

temperature of 0 degrees Fahrenheit or less.

     3.  Food must not be stored in any area in

which cleaning or pest control products are stored.

     4.  A facility with more than 10 residents

must:

     (a) Comply with applicable provisions of chapter 446 of NRS and the regulations

adopted pursuant thereto; and

     (b) Obtain the necessary permits from the Division.

     5.  The equipment used for cooking and

storing food in a facility with more than 10 residents must be inspected and

approved by the Division and the state and local fire safety authorities.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006;

A by R155-10, 12-16-2010)

      NAC 449.154981  Bedrooms and bedding. (NRS 449.0302)

     1.  A bedroom in a facility that is used by

more than one resident must have at least 50 square feet of floor space for

each resident who resides in the bedroom. A bedroom that is occupied by only

one resident must have at least 80 square feet of floor space.

     2.  The arrangement of the beds and other

furniture in the bedroom must accommodate the residents occupying the bedroom

in comfort and safety.

     3.  A bed with a comfortable and clean

mattress must be provided for each resident. The bed must be made with a

mattress cover, two clean sheets, a blanket, a pillow and a bedspread. Linens

must be changed at least once each week and more often if the linens become

dirty.

     4.  Each mattress used in a facility must

comply with the provisions of NRS

444.010 to 444.040,

inclusive, and the regulations adopted pursuant thereto.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154983  Use of certain areas as bedroom prohibited. (NRS 449.0302)  A hall,

stairway, unfinished attic, garage, storage area or shed or other similar area

of a facility must not be used as a bedroom. Any other room must not be used as

a bedroom if it is used for any other purpose.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154985  Bathrooms and toilet facilities; toiletries. (NRS 449.0302)

     1.  All bathrooms and toilet facilities in

the facility must be sufficiently lighted.

     2.  Each facility must have:

     (a) A flush toilet and lavatory for each four

residents; and

     (b) A tub or shower for each six residents.

     3.  Each resident must have his or her own

towels and washcloths. Paper towels may be used for hand towels. The towels and

washcloths must be changed as often as is necessary to maintain cleanliness,

but in no event less often than once each week. A soap dispenser that provides

liquid or granular soap may be used instead of individual bars of soap.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154987  First aid. (NRS 449.0302)

     1.  A first-aid kit must be available at the

facility. The first-aid kit must include, without limitation:

     (a) A germicide safe for use by humans;

     (b) Sterile gauze pads;

     (c) Adhesive bandages, rolls of gauze and adhesive

tape;

     (d) Disposable gloves;

     (e) A shield or mask to be used by a person who is

administering cardiopulmonary resuscitation; and

     (f) A thermometer or other device that may be used

to determine the bodily temperature of a person.

     2.  Except for first aid in an emergency, no

treatment or medication may be administered to a resident.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154989  Medication. (NRS 449.0302)

     1.  Medication for self-administration may be

kept at the facility. That medication must:

     (a) Except as otherwise provided in subsection 3,

be disposed of immediately when it expires or when a physician orders the

medication to be discontinued;

     (b) Be stored and controlled in a manner that

protects the medication from unauthorized use; and

     (c) Not be used by more than one of the residents.

     2.  Medication kept at the facility must be

controlled and distributed in a manner that is consistent with applicable state

and federal law.

     3.  The provisions of paragraph (a) of

subsection 1 do not apply to over-the-counter medication.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154991  Telephones; listing of facility’s telephone number. (NRS 449.0302)  An

administrator shall ensure that:

     1.  The facility has at least one telephone

that is in good working condition in the facility; and

     2.  The telephone number of the facility is

listed in the telephone directory.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154993  Notification of occurrence of certain incidents. (NRS 449.0302)

     1.  An administrator shall notify the Bureau

within 24 hours after the occurrence of an incident that:

     (a) Involved significant harm to a resident of the

facility if the resident of the facility required medical treatment as a result

of the incident;

     (b) May cause imminent danger to the health or

safety of a resident of the facility; or

     (c) May jeopardize the integrity of the operation

of the facility.

     2.  The administrator shall report to the

Division of Public and Behavioral Health any fire or other disaster that takes

place in the facility within 24 hours after the fire or other disaster occurs.

     3.  The administrator shall notify the

Division of Parole and Probation of the Department of Public Safety of the

occurrence of any of the incidents described in this section.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154995  Rights of residents. (NRS 449.0302)  An

administrator shall ensure that:

     1.  A resident of the facility is not abused,

neglected or exploited by another resident of the facility or any person who is

visiting the facility;

     2.  A resident is not prohibited from

speaking to any person who advocates for the rights of the residents of the

facility;

     3.  Each resident is treated with respect and

dignity;

     4.  The facility provides a safe and

comfortable environment;

     5.  A resident is not prohibited from

interacting socially in a manner that is consistent with the rules of the

facility;

     6.  To the extent practicable and in a manner

that is consistent with the rules of the facility, each resident is allowed to

make his or her own decisions;

     7.  The telephone number of the local office

of the Bureau and the name and telephone number of the administrator is

conspicuously posted on the premises of the facility; and

     8.  Each resident of the facility is allowed

to exercise his or her right to vote.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154997  Files for residents. (NRS 449.0302)

     1.  An administrator shall ensure that the

facility maintains a separate file for each resident of the facility and retains

the file for at least 5 years after the resident permanently leaves the

facility. The file must be kept locked in a location that is protected against

unauthorized use. Each file must contain the information obtained by the

facility that is related to the resident, including, without limitation:

     (a) The full name, address and date of birth of the

resident;

     (b) The address and telephone number of any next of

kin or guardian of the resident;

     (c) Evidence of compliance with the provisions of NAC 441A.380;

     (d) A list of the rules of the facility that is

signed by the resident; and

     (e) The name and telephone number of the parole

officer of the resident, if any.

     2.  Except as otherwise provided in this

subsection, the file of the resident must be kept confidential. The file of a

resident must be made available upon request at any time to an employee of the

Bureau who is acting in his or her capacity as an employee of the Bureau.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154999  Safety from fire. (NRS 449.0302)

     1.  An administrator shall ensure that the

facility complies with the regulations adopted by the State Fire Marshal

pursuant to chapter 477 of NRS and any

local ordinances relating to safety from fire.

     2.  A facility with more than 16 beds must be

equipped with a sufficient number of sprinklers to cover the entire area of the

facility.

     3.  The administrator shall ensure that the

facility has a plan for the evacuation of residents in case of fire or other

emergency. The plan must be:

     (a) Understood by all residents;

     (b) Posted in a common area of the facility; and

     (c) Discussed with each resident at the time of his

or her admission.

     4.  At least one portable fire extinguisher

must be available at the facility. Any portable fire extinguishers available at

the facility must be inspected, recharged and tagged at least once each year by

a person certified by the State Fire Marshal to conduct such inspections.

     5.  The administrator shall ensure that a

written policy on smoking is developed and carried out by the facility. The

policy must be:

     (a) Developed with the purpose of preventing a fire

caused by smoking in the facility; and

     (b) Posted in a common area of the facility.

     6.  Smoke detectors installed in a facility

must be maintained in proper operating condition at all times and must be

tested monthly. The results of the tests conducted pursuant to this subsection

must be recorded and maintained at the facility.

     7.  If an automatic fire sprinkler system is

installed in a facility, the system must be inspected:

     (a) Not less than once each calendar quarter by a

person who understands the manner in which the system operates and the manner

in which the system must be maintained; and

     (b) Not less than once each calendar year by a

person who is licensed to inspect such a system pursuant to the provisions of chapter 477 of NAC.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

      NAC 449.15511  Definitions. (NRS 449.0302)  As used

in NAC 449.15511 to 449.15529,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.15513 to 449.15519,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15513  “Caregiver” defined. (NRS 449.0302)  “Caregiver”

means a person who provides care, assistance and protective supervision to a

resident of a home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15515  “Director” defined. (NRS 449.0302)  “Director”

means a person:

     1.  Whose name appears on a license issued by

the Bureau as the director of record for a home; and

     2.  Who is legally responsible for the care

of the residents and the daily operation of the home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15517  “Home” defined. (NRS 449.0302)  “Home”

means a home for individual residential care.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15519  “Protective supervision” defined.

(NRS 449.0302)  “Protective

supervision” means supervision that protects the residents of a home from

potential danger to their physical and mental well-being.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15521  Director: Qualifications. (NRS 449.0302)  The

director of a home must:

     1.  Be at least 21 years of age and have a

high school diploma or its equivalent. A person who proposes to act as the

director of a home must provide the Bureau with evidence that he or she

satisfies the requirements of this subsection.

     2.  Possess the appropriate knowledge, skills

and abilities to meet the needs of the residents of the home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15523  Director: Duties. (NRS 449.0302)  The

director of a home shall:

     1.  Post the license to operate the home in a

conspicuous place within the home.

     2.  Ensure that the needs of each resident of

the home are assessed upon admission of the resident to the home, and that the

assessment is updated as the needs of the resident change. Such an assessment

must include:

     (a) Documentation of the abilities of the resident

to function independently; and

     (b) A complete list of the matters for which the

resident requires assistance.

     3.  Ensure that the residents of the home:

     (a) Are treated with dignity and respect and are

not abused, neglected or exploited; and

     (b) Receive:

          (1) The personal care they require;

          (2) A balanced daily diet that meets their

nutritional needs;

          (3) Protective supervision and adequate

services to maintain and enhance their physical, mental and emotional

well-being; and

          (4) The names of, and the telephone numbers

for the registration of complaints with, the Bureau and the Aging and

Disability Services Division of the Department of Health and Human Services.

     4.  Ensure that a caregiver, who is capable

of meeting the needs of the residents and has been trained in first aid and

cardiopulmonary resuscitation, is on the premises of the home at all times when

a resident is present.

     5.  Ensure that appropriate sanitary

procedures are carried out for the handling, cleaning and storage of linens and

personal laundry in the home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15525  Requirements for safety and sanitation of facility. (NRS 449.0302)

     1.  The interior and exterior of a home must

be clean and free of hazards and offensive odors.

     2.  A home must contain:

     (a) Appropriate and well-maintained furnishings;

     (b) At least one functional, portable fire

extinguisher;

     (c) A first-aid kit;

     (d) Equipment that is sufficiently clean and

adequate for the preparation, service and storage of food; and

     (e) Adequate areas and equipment to carry out

appropriate sanitary procedures for the handling, cleaning and storage of

linens and personal laundry.

     3.  The temperature of a home must be

maintained at levels that are comfortable and safe. Portable heaters are

prohibited in a home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15527  Agreement between operator of home and resident concerning rates;

maintenance of records of residents. (NRS 449.0302)  The

operator of a home shall:

     1.  Enter into a written agreement with each

resident of the home that sets forth the basic rate for the services of the

home and the charges for any optional services.

     2.  Maintain a separate, organized file for

each resident of the home and retain the file for 5 years after the resident

permanently leaves the home. Each file must include:

     (a) The full name, address, date of birth and

social security number of the resident;

     (b) The address and telephone number of the

resident’s physician and a person who is responsible for the resident;

     (c) A copy of the results of a general physical

examination of the resident conducted by his or her physician; and

     (d) A current copy of the assessment of the needs

of the resident conducted pursuant to NAC 449.15523.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15529  On-site survey of home by Bureau.

(NRS 449.0302)  The

Bureau shall conduct:

     1.  An initial on-site survey of a home:

     (a) After the Bureau receives a completed

application for a license to operate the home and the fee required pursuant to NAC 449.016; and

     (b) Before the issuance of a license to operate the

home.

     2.  Additional on-site surveys of a home not

less than once every 3 years after conducting the survey of the home pursuant

to subsection 1.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

RESIDENTIAL FACILITIES FOR GROUPS

General Provisions

      NAC 449.156  Definitions. (NRS 449.0302)  As used

in NAC 449.156 to 449.27706,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.1565 to 449.178,

inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Bd. of Health, 3-6-86;

R003-97, 10-30-97; R204-99, 2-10-2000; R071-04, 8-4-2004; R122-05, 11-17-2005;

R097-06, 7-14-2006)

      NAC 449.1565  “Administer” defined. (NRS 449.0302)  “Administer”

means the direct application of a drug or medicine referred to in NRS 454.181 to 454.371, inclusive, by injection,

inhalation, ingestion or any other means, to the body of a resident of a

residential facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.157  “Administrator” defined. (NRS 449.0302)  “Administrator”

means a person:

     1.  Who is licensed by the Nevada State Board

of Examiners for Administrators of Facilities for Long-Term Care pursuant to chapter 654 of NRS;

     2.  Whose name appears on a license issued by

the Bureau as administrator of record for a residential facility; and

     3.  Who is legally responsible for the care

of residents and the daily operation of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1575  “Board” defined. (NRS 449.0302)  “Board”

means the State Board of Health.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1585  “Caregiver” defined. (NRS 449.0302)  “Caregiver”

means an employee of a residential facility who provides care, assistance or

protective supervision to a resident of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1591  “Category 1 resident” defined. (NRS 449.0302)  “Category

1 resident” means:

     1.  In a residential facility with not more

than 10 residents, a resident who, without the assistance of any other person,

is physically and mentally capable of moving himself or herself from the room

in which the resident sleeps to outside the facility in 4 minutes or less; or

     2.  In a residential facility with more than

10 residents, a resident who, without the assistance of any other person, is

physically and mentally capable of moving himself or herself from the room in

which the resident sleeps to the other side of a smoke or fire barrier or

outside the facility, whichever is nearest, in 4 minutes or less.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1595  “Category 2 resident” defined. (NRS 449.0302)  “Category

2 resident” means:

     1.  In a residential facility with not more

than 10 residents, a resident who, without the assistance of any other person,

is not physically or mentally capable of moving himself or herself from the

room in which the resident sleeps to outside the facility in 4 minutes or less.

     2.  In a residential facility with more than

10 residents, a resident who, without the assistance of any other person, is

not physically or mentally capable of moving himself or herself from the room

in which the resident sleeps to the other side of a smoke or fire barrier or

outside the facility, whichever is nearest, in 4 minutes or less.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1597  “Dietary supplement” defined. (NRS 449.0302)  “Dietary

supplement” has the meaning ascribed to it in 21 U.S.C. 321(ff) as that section

existed on August 17, 1999.

     (Added to NAC by Bd. of Health by R204-99, eff. 2-10-2000)

      NAC 449.1599  “Discharge” defined. (NRS 449.0302)  “Discharge”

means the release of a resident from a residential facility which does not involve

a transfer.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

      NAC 449.160  “Division” defined. (NRS 449.0302)  “Division”

means the Division of Public and Behavioral Health of the Department of Health

and Human Services.

     (Added to NAC by Bd. of Health, eff. 3-6-86)

      NAC 449.161  “Grade” defined. (NRS 449.0302)  “Grade”

means a letter that is assigned to a residential facility by the Bureau based

on the severity and scope scores of the facility as determined by the Bureau.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.164  “Hospice care” defined. (NRS 449.0302)  “Hospice

care” has the meaning ascribed to it in NRS 449.0115.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.169  “Medical professional” defined. (NRS 449.0302)  “Medical

professional” means a physician or a physician assistant, nurse practitioner,

registered nurse, physical therapist, occupational therapist, speech

pathologist or practitioner of respiratory care who is trained and licensed to

perform medical procedures and care prescribed by a physician.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.170  “Placard” defined. (NRS 449.0302)  “Placard”

means a certificate issued to a residential facility by the Bureau that

includes the grade assigned to the facility by the Bureau.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.172  “Residential facility” defined. (NRS 449.0302)  “Residential

facility” means a residential facility for groups as defined in NRS 449.017.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.173  “Residential facility which provides care to persons with

Alzheimer’s disease” defined. (NRS 449.0302)  “Residential

facility which provides care to persons with Alzheimer’s disease” means a

residential facility that provides care and protective supervision for persons

with Alzheimer’s disease or a related disease, including, without limitation,

senile dementia, organic brain syndrome or other cognitive impairment.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.175  “Severity and scope score” defined. (NRS 449.0302)  “Severity

and scope score” has the meaning ascribed to it in NAC

449.99839.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.176  “Staff of a facility” defined. (NRS 449.0302)  “Staff

of a facility” means the administrator, caregivers and other employees of a

residential facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.178  “Transfer” defined. (NRS 449.0302)  “Transfer”

means the movement of a resident from a residential facility to another

facility for inpatient or residential care.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

Licensing

      NAC 449.179  Submission and approval of plan for new construction or

remodeling; inspection; evidence of compliance.

(NRS 449.0302)

     1.  Except for a residential facility with

less than 11 beds, before a residential facility is constructed or an existing

facility is remodeled, the facility must:

     (a) Submit the plan for construction or remodeling

to the entity designated to review such plans by the Division pursuant to the

provisions of NAC 449.0115;

     (b) Notify the Bureau of a tentative date for the

completion of the construction or remodeling; and

     (c) Obtain approval of the plan from the Division.

     2.  The plan for construction or remodeling

must include a description of the materials that will be used to complete the

project.

     3.  Before issuing a license to operate a

residential facility, the Bureau shall inspect the facility to ensure that it

complies with:

     (a) The provisions of NAC

449.156 to 449.27706, inclusive; and

     (b) The applicable zoning ordinances and regulations.

     4.  An applicant for a license to operate a

residential facility must submit to the Bureau with his or her application

evidence that the applicant and the facility are in compliance with the

provisions of NRS 449.001 to 449.240, inclusive, and NAC 449.156 to 449.27706,

inclusive.

     5.  The Bureau shall not perform the

inspection required pursuant to subsection 3 until the applicant has submitted

to the Bureau the application required pursuant to NRS 449.040, the fee required

pursuant to NAC 449.016 and the evidence required

pursuant to subsection 4.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R076-01, 10-18-2001; R071-04, 8-4-2004; R118-05, 11-17-2005)

      NAC 449.180  Requirements for purchasing licensed facility. (NRS 449.0302)  If an

applicant for a license to operate a residential facility desires to purchase a

currently licensed facility, the facility must comply with all current state

and local requirements relating to health and safety.

     [Bd. of Health, Group Care Facilities Appendix §§ 1,

1.1 & 2-2.7, eff. 10-13-77]—(NAC A 3-6-86; R003-97, 10-30-97)

      NAC 449.190  License: Contents; validity; transferability; issuance of more

than one type. (NRS 449.0302)

     1.  A license to operate a residential

facility must include:

     (a) The name of the administrator of the facility;

     (b) The name and address of the facility;

     (c) The type of facility;

     (d) The maximum number of residents authorized to

reside at the facility; and

     (e) The category of residents who may reside at the

facility.

     2.  The license becomes invalid if the

facility is moved to a location other than the location stated on the license.

The license may not be transferred to another owner.

     3.  A residential facility may be licensed as

more than one type of residential facility if the facility provides evidence

satisfactory to the Bureau that it complies with the requirements for each type

of facility and can demonstrate that the residents will be protected and

receive necessary care and services.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.191  Denial, suspension or revocation of endorsement: Grounds. (NRS 449.0302,

449.165)  In

addition to the grounds set forth in NRS

449.160 and NAC 449.1915, the Division may

deny an application for an endorsement made pursuant to NAC

449.2751 to 449.2768, inclusive, on a license

to operate a residential facility or may suspend or revoke an existing

endorsement based upon any of the following grounds:

     1.  The failure or refusal of an applicant or

licensee to comply with any of the provisions of chapter 449 of NRS or the regulations

adopted by the Board.

     2.  The failure or refusal of an applicant or

licensee to comply with a reasonable order from the Division to remove a

resident from a facility.

     3.  Providing services at the facility

without an endorsement, if an endorsement is required before providing those

types of services.

     4.  Accepting for care, at any given time,

more residents than the number specified in the license.

     5.  The failure or refusal of a licensee to

return an adequate plan of correction to the Division within 10 days after the

receipt by the licensee of a statement of deficiencies.

     6.  The failure or refusal to cooperate fully

with an investigation or inspection by the Bureau.

     7.  Misappropriation of the property of a

resident of a facility.

     8.  Abuse, neglect or exploitation of a

person who is infirm, a person with an intellectual disability, a person with a

disability or a person who is 60 years of age or older.

     9.  The residential facility has demonstrated

an inability to care for residents adequately, as demonstrated by a history of

deficiencies affecting the health or safety of residents or employees.

     10.  The license has been revoked or

suspended due to a failure to comply with the provisions of NAC 449.002 to 449.99939,

inclusive, or chapter 449 of NRS and

was subsequently reinstated within the immediately preceding year.

     (Added to NAC by Bd. of Health by R119-10, eff. 1-13-2011)

      NAC 449.1915  Suspension or revocation of license and endorsement if residential

facility has been assigned grade of D on two or more consecutive surveys or

resurveys, or both. (NRS 449.0302, 449.165)  In addition to the grounds

set forth in NRS 449.160 and NAC 449.0118, 449.191, 449.2751 and 449.27706,

the Division may suspend or revoke a license to operate a residential facility,

including any endorsement on the license, if the residential facility has been

assigned, pursuant to NAC 449.27702, a grade of D

on two or more consecutive surveys or resurveys, or both.

     (Added to NAC by Bd. of Health by R119-10, eff. 1-13-2011)

Administration and Personnel

      NAC 449.194  Responsibilities of administrator. (NRS 449.0302)  The

administrator of a residential facility shall:

     1.  Provide oversight and direction for the

members of the staff of the facility as necessary to ensure that residents

receive needed services and protective supervision and that the facility is in

compliance with the requirements of NAC 449.156 to 449.27706, inclusive, and chapter 449 of NRS.

     2.  Designate one or more employees to be in

charge of the facility during those times when the administrator is absent.

Except as otherwise provided in this subsection, employees designated to be in

charge of the facility when the administrator is absent must have access to all

areas of and records kept at the facility. Confidential information may be

removed from the files to which the employees in charge of the facility have

access if the confidential information is maintained by the administrator. The

administrator or an employee who is designated to be in charge of the facility

pursuant to this subsection shall be present at the facility at all times. The

name of the employee in charge of the facility pursuant to this subsection must

be posted in a public place within the facility during all times that the

employee is in charge.

     3.  Maintain in the facility, and make

available upon request, a copy of the provisions of NAC

449.156 to 449.27706, inclusive, and the

report of the latest investigation of the facility conducted by the Bureau

pursuant to NRS 449.0307.

     4.  Ensure that the records of the facility

are complete and accurate.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.196  Qualifications and training of caregivers. (NRS 449.0302)

     1.  A caregiver of a residential facility

must:

     (a) Be at least 18 years of age;

     (b) Be responsible and mature and have the personal

qualities which will enable him or her to understand the problems of elderly

persons and persons with disabilities;

     (c) Understand the provisions of NAC 449.156 to 449.27706,

inclusive, and sign a statement that he or she has read those provisions;

     (d) Demonstrate the ability to read, write, speak

and understand the English language;

     (e) Possess the appropriate knowledge, skills and

abilities to meet the needs of the residents of the facility; and

     (f) Receive annually not less than 8 hours of

training related to providing for the needs of the residents of a residential

facility.

     2.  If a resident of a residential facility

uses prosthetic devices or dental, vision or hearing aids, the caregivers

employed by the facility must be knowledgeable of the use of those devices.

     3.  If a caregiver assists a resident of a

residential facility in the administration of any medication, including,

without limitation, an over-the-counter medication or dietary supplement, the

caregiver must:

     (a) Before assisting a resident in the

administration of a medication, receive the training required pursuant to

paragraph (e) of subsection 6 of NRS

449.0302, which must include at least 16 hours of training in the

management of medication consisting of not less than 12 hours of classroom

training and not less than 4 hours of practical training, and obtain a

certificate acknowledging the completion of such training;

     (b) Receive annually at least 8 hours of training

in the management of medication and provide the residential facility with

satisfactory evidence of the content of the training and his or her attendance

at the training;

     (c) Complete the training program developed by the

administrator of the residential facility pursuant to paragraph (e) of

subsection 1 of NAC 449.2742; and

     (d) Annually pass an examination relating to the

management of medication approved by the Bureau.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004; R118-05, 11-17-2005; R119-10, 1-13-2011)

      NAC 449.197  Medical services may be provided only by medical professional. (NRS 449.0302)  A member

of the staff of a residential facility shall not provide medical services to a

resident of the facility unless the member of the staff is a medical

professional.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.199  Staffing requirements; limitation on number of residents; written

schedule for each shift; direct supervision of certain employees. (NRS 449.0302)

     1.  The administrator of a residential facility

shall ensure that a sufficient number of caregivers are present at the facility

to conduct activities and provide care and protective supervision for the

residents. There must be at least one caregiver on the premises of the facility

if one or more residents are present at the facility.

     2.  Except as otherwise provided in NAC 449.2756, the administrator of a residential

facility which has more than 20 residents shall ensure that at least one

employee is awake and on duty at the facility at all times. An additional

employee must be available to provide care within 10 minutes after being

informed that his or her services are needed.

     3.  A residential facility must not accept

residents in excess of the number of residents specified on the license issued

to the owner of the facility.

     4.  The administrator of a residential

facility shall maintain monthly a written schedule that includes the number and

type of members of the staff of the facility assigned for each shift. The

schedule must be amended if any changes are made to the schedule. The schedule

must be retained for at least 6 months after the schedule expires.

     5.  An employee of a residential facility who

is less than 18 years of age must be under the direct supervision of an

employee who is 18 years of age or older.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.200  Personnel files. (NRS 449.0302)

     1.  Except as otherwise provided in

subsection 2, a separate personnel file must be kept for each member of the

staff of a facility and must include:

     (a) The name, address, telephone number and social

security number of the employee;

     (b) The date on which the employee began his or her

employment at the residential facility;

     (c) Records relating to the training received by

the employee;

     (d) The health certificates required pursuant to chapter 441A of NAC for the employee;

     (e) Evidence that the references supplied by the

employee were checked by the residential facility; and

     (f) Evidence of compliance with NRS 449.122 to 449.125, inclusive.

     2.  The personnel file for a caregiver of a

residential facility must include, in addition to the information required

pursuant to subsection 1:

     (a) A certificate stating that the caregiver is

currently certified to perform first aid and cardiopulmonary resuscitation; and

     (b) Proof that the caregiver is 18 years of age or

older.

     3.  The administrator may keep the personnel

files for the facility in a locked cabinet and may, except as otherwise

provided in this subsection, restrict access to this cabinet by other employees

of the facility. Copies of the documents which are evidence that an employee

has been certified to perform first aid and cardiopulmonary resuscitation and

that the employee has been tested for tuberculosis must be available for review

at all times. The administrator shall make the personnel files available for

inspection by the Bureau within 72 hours after the Bureau requests to review

the files.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.202  Rights of staff members during investigation of facility; duties

of investigator. (NRS 449.0302)

     1.  Upon the request of the administrator of

a residential facility or any other member of the staff of the facility, a

person who is conducting an investigation of the facility pursuant to NRS 449.0307 shall:

     (a) Identify himself or herself and provide the

name and telephone number of his or her supervisor; and

     (b) Inform the administrator or other member of the

staff of the facility of the reason for the investigation.

     2.  The person who is conducting the

investigation shall:

     (a) Treat the members of the staff of the facility

in a professional and respectful manner;

     (b) Conduct an unbiased investigation; and

     (c) Provide to the administrator of the facility an

accurate report of the findings of the investigation, including a description

of each deficiency found and a citation to the section of NAC 449.002 to 449.99939,

inclusive, or chapter 449 of NRS which

has been violated.

     3.  After the investigation has been

completed, the person conducting the investigation shall, upon the request of a

member of the staff of the facility:

     (a) Provide the member of the staff of the facility

with the opportunity to:

          (1) Ask questions concerning the findings of

the investigation; and

          (2) Review with the person who conducted the

investigation the provisions of NAC 449.002 to 449.99939, inclusive, and chapter 449 of NRS that the investigator

believes were violated; and

     (b) Provide to the member of the staff of the

facility the details of any complaints received by the Division concerning the

facility, other than details that may reveal the identity of the person who

submitted the complaint.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

General Operational Requirements

      NAC 449.204  System of financial accounting; insurance. (NRS 449.0302)

     1.  A residential facility shall:

     (a) Maintain a recognized system of financial

accounting; and

     (b) Maintain a contract of insurance for protection

against liability to third persons in amounts appropriate for the protection of

residents, employees, volunteers and visitors to the facility.

     2.  A certificate of insurance must be

furnished to the Division as evidence that the contract required by subsection

1 is in force, and a license must not be issued until that certificate is

furnished. Each contract of insurance must contain an endorsement providing for

a notice of 30 days to the Bureau before the effective date of a cancellation

or nonrenewal of the policy.

     [Bd. of Health, Group Care Facilities §§ 5.1-5.4, eff.

12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.205  Advertising and promotional materials. (NRS 449.0302)  Advertising

and promotional materials for a residential facility must be accurate and not

misrepresent accommodations, services or programs offered by the facility.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97,

10-30-97)

      NAC 449.208  Restrictions on conducting other businesses or providing other

services on premises. (NRS 449.0302)  No other

business may be conducted or other services may be provided on the premises of

a residential facility if the business or services would interfere with the

operation of the facility or the care provided to the residents of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.209  Health and sanitation. (NRS 449.0302)

     1.  A residential facility must:

     (a) Have a safe and sufficient supply of water,

adequate drainage and an adequate system for the disposal of sewage; and

     (b) Comply with all local ordinances and state and

federal laws and regulations relating to zoning, sanitation, accessibility to

persons with disabilities and safety.

     2.  Containers used to store garbage outside

of the facility must be kept reasonably clean and must be covered in such a

manner that rodents are unable to get inside the containers. At least once each

week, the containers must be emptied and the contents of the containers must be

removed from the premises of the facility.

     3.  Containers used to store garbage in the

kitchen and laundry room of the facility must be covered with a lid unless the

containers are kept in an enclosed cupboard that is clean and prevents

infestation by rodents or insects. Containers used to store garbage in bedrooms

and bathrooms are not required to be covered unless they are used for food,

bodily waste or medical waste.

     4.  To the extent practicable, the premises

of the facility must be kept free from:

     (a) Offensive odors;

     (b) Hazards, including obstacles that impede the

free movement of residents within and outside the facility;

     (c) Insects and rodents; and

     (d) Accumulations of dirt, garbage and other

refuse.

     5.  The administrator of a residential

facility shall ensure that the premises are clean and that the interior,

exterior and landscaping of the facility are well maintained.

     6.  All windows that are capable of being

opened in the facility and all doors that are left open to provide ventilation

for the facility must be screened to prevent the entry of insects.

     7.  The facility must maintain electrical

lighting as necessary to ensure the comfort and safety of the residents of the

facility.

     8.  The temperature in the facility must be

maintained at a level that is not less than 68 degrees Fahrenheit and not more

than 82 degrees Fahrenheit.

     9.  If the door of a bathroom opens into any

room in which food or utensils for eating are handled or stored, the door must

close automatically.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99)

      NAC 449.211  Automatic sprinkler systems. (NRS 449.0302)

     1.  After January 14, 1997, the Division

shall withhold the issuance of an initial license to operate a residential facility

that does not have an automatic sprinkler system which complies with the

provisions of chapter 477 of NRS and

any local ordinances relating to the installation of automatic sprinkler

systems.

     2.  Except as otherwise provided in

subsection 3, a residential facility with less than seven residents that is

issued a license on or before January 14, 1997, shall install an automatic

sprinkler system that complies with the provisions of chapter 477 of NRS and any local

ordinances relating to the installation of automatic sprinkler systems if:

     (a) The ownership of the facility is transferred to

a new owner;

     (b) The number of beds in the facility is

increased;

     (c) The facility is currently authorized to admit

or retain category 1 residents only and wishes to apply for authorization to

admit or retain category 2 residents; or

     (d) The facility is not currently authorized to

admit or retain residents who suffer from Alzheimer’s disease or other related

dementia and the facility wishes to apply for authorization to admit or retain

such residents.

     3.  A residential facility with less than

seven residents that was issued its initial license on or before January 14,

1997, may not admit or retain a category 2 resident, unless an automatic

sprinkler system that complies with the provisions of chapter 477 of NRS and any local

ordinances relating to the installation of automatic sprinkler systems is

installed in the facility. Not more than one resident who is confined to a

wheelchair or who is required to use a walker may be admitted to such a

facility at any time unless such an automatic sprinkler system is installed in

the facility.

     4.  An automatic sprinkler system that has

been installed in a residential facility must be inspected:

     (a) Not less than once each calendar quarter by a

person who understands the manner in which the system operates and the manner

in which it should be maintained; and

     (b) Not less than once each calendar year by a

person who is licensed to inspect such a system pursuant to the provisions of chapter 477 of NAC.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.213  Laundry and linen services. (NRS 449.0302)

     1.  A residential facility shall:

     (a) Provide laundry and linen services on the

premises of the facility; or

     (b) Contract with a commercial laundry for the

provision of those services.

     2.  A residential facility that provides its

own laundry and linen services shall have accommodations which are adequate for

the proper and sanitary washing and finishing of linen and other washable

goods.

     3.  The laundry room in a residential

facility must be situated in an area which is separate from an area where food

is stored, prepared or served. The laundry must be adequate in size for the

needs of the facility and maintained in a sanitary manner. The laundry room

must contain at least one washer and at least one dryer. All the equipment must

be kept in good repair. All dryers must be ventilated to outside the building.

If a washer or dryer is located outside the residential facility, the washer or

dryer must be in a room or enclosure.

     4.  Clothes, bedding, linens and any other

materials laundered pursuant to subsection 1 must be made clean by the

laundering process. If a residential facility provides its own laundry and

linen services, the residential facility shall:

     (a) Make appropriate use of detergents, soaps, heat

or chemicals; and

     (b) Take precautions to ensure that no resident,

member of the staff of the facility or other person in the facility is harmed

by exposure to the detergents, soaps, heat or chemicals used in the laundering

process.

     [Bd. of Health, Group Care Facilities § 14.8, eff. 12-18-75;

A 5-7-82; §§ 14.8.1-14.10.2, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97;

R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.216  Common areas; dining rooms. (NRS 449.0302)

     1.  A residential facility must have at least

one centrally located common area in which residents may socialize and

participate in recreational activities. A common area may include, without

limitation, a living room, dining room, enclosed porch or solarium.

     2.  The common areas must be large enough to

accommodate those to be served without overcrowding the areas. A minimum area

of 15 square feet of total common area space per person must be provided.

     3.  All common areas must be furnished and

equipped with comfortable furniture.

     4.  The dining room must be of sufficient

size to accommodate all the residents comfortably. A minimum area of 10 square

feet per person must be provided.

     5.  The dining room must be conveniently

located near the kitchen to ensure the rapid and efficient serving of food.

     [Bd. of Health, Group Care Facilities §§ 15.1-15.2.3,

eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97)

      NAC 449.217  Kitchens; storage of food; adequate supplies of food; permits;

inspections. (NRS 449.0302)

     1.  The equipment in a kitchen of a

residential facility and the size of the kitchen must be adequate for the

number of residents in the facility. The kitchen and the equipment must be

clean and must allow for the sanitary preparation of food. The equipment must

be in good working condition.

     2.  Perishable foods must be refrigerated at

a temperature of 40 degrees Fahrenheit or less. Frozen foods must be kept at a

temperature of 0 degrees Fahrenheit or less.

     3.  Sufficient storage must be available for

all food and equipment used for cooking and storing food. Food that is stored

must be appropriately packaged.

     4.  The administrator of a residential facility

shall ensure that there is at least a 2-day supply of fresh food and at least a

1-week supply of canned food in the facility at all times.

     5.  Pesticides and other toxic substances

must not be stored in any area in which food, kitchen equipment, utensils or

paper products are stored. Soaps, detergents, cleaning compounds and similar

substances must not be stored in any area in which food is stored.

     6.  A residential facility with more than 10

residents shall:

     (a) Comply with the standards prescribed in chapter 446 of NAC; and

     (b) Obtain the necessary permits from the Division.

     7.  The equipment used for cooking and

storing food and for washing dishes in a residential facility with more than 10

residents must be inspected and approved by the Division and the state and

local fire safety authorities.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004; R155-10, 12-16-2010)

      NAC 449.2175  Service of food; seating; menus; special diets; nutritional

requirements; dietary consultants. (NRS 449.0302)

     1.  A residential facility shall have

adequate facilities and equipment for the preparation, service and storage of

food.

     2.  Tables and chairs must be of proper

height and of sufficient number to provide seating for the number of residents

authorized for the facility. They must be sturdy and have easily washable

surfaces. Chairs must be constructed so that they do not overturn easily.

     3.  Menus must be in writing, planned a week

in advance, dated, posted and kept on file for 90 days.

     4.  A resident who has been placed on a

special diet by a physician or licensed dietitian must be provided a meal that

complies with the diet. The administrator of the facility shall ensure that

records of any modifications to the menu to accommodate for special diets

prescribed by a physician or licensed dietitian are kept on file for at least

90 days.

     5.  Any substitution for an item on the menu

must be documented and kept on file with the menu for at least 90 days after

the substitution occurs. A substitution must be posted in a conspicuous place

during the serving of the meal.

     6.  Each meal must provide a reasonable

portion of the daily dietary allowances recommended by the Food and Nutrition

Board of the Institute of Medicine of the National Academies.

     7.  Meals must be nutritious, served in an

appropriate manner, suitable for the residents and prepared with regard for

individual preferences and religious requirements. At least three meals a day

must be served at regular intervals. The times at which meals will be served

must be posted. Not more than 14 hours may elapse between the meal in the

evening and breakfast the next day. Snacks must be made available between meals

for the residents who are not prohibited by their physicians from eating

between meals.

     8.  A resident must be served meals in his or

her bedroom for not more than 14 consecutive days if the resident is

temporarily unable to eat in the dining room because of an injury or illness.

The facility may serve meals to other residents in their rooms upon request. If

a meal is served to a resident in his or her room because the resident is

unable to eat in the dining room, the facility shall maintain a record of the

times and reasons for serving meals to the resident in his or her room.

     9.  A residential facility with more than 10

residents shall employ or otherwise obtain the services of a person to serve as

a consultant for the planning and serving of meals who:

     (a) Is a licensed dietitian; or

     (b) Is a graduate from an accredited college with a

major in food and nutrition and has 2 years of supervisory experience in a

medical facility or facility for the dependent or has participated in a course

of training for a supervisor of the service of food.

     10.  The person providing services pursuant

to subsection 9 shall provide those services not less than once each calendar

quarter. The administrator of the facility shall keep a written record of the

consultations on file at the facility. The consultations must include:

     (a) The development and review of weekly menus;

     (b) Training for the employees who work in the

kitchen;

     (c) Advice regarding compliance with the

nutritional program of the facility; and

     (d) Any observations of the person providing the

services regarding the preparation and service of meals in the facility to

ensure that the facility is in compliance with the nutritional program of the

facility.

     [Bd. of Health, Group Care Facilities §§ 12.1-12.8.1,

eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004; R090-12,

12-20-2012)

      NAC 449.218  Bedrooms: Floor space; windows and doors; privacy; storage space;

bedding; personal furnishings; lighting. (NRS 449.0302)

     1.  A bedroom in a residential facility that

is shared by two or three residents must have at least 60 square feet of floor

space for each resident who resides in the bedroom. A resident may not share a

bedroom with more than two other residents. A bedroom that is occupied by only

one resident must have at least 80 square feet of floor space.

     2.  Each bedroom in a residential facility

must have one or more windows to the outside that can be opened from the inside

of the room without the use of tools or a door to the outside which is at least

36 inches wide and can be opened from the inside.

     3.  The combined size of the panes of glass

of the windows in a bedroom in a facility that was issued a license on or after

January 14, 1997, must equal not less than 10 percent of the floor space in the

room.

     4.  The arrangement of the beds and other

furniture in the bedroom must provide privacy for and promote the safety of the

residents occupying the bedroom. Adjustable curtains, shades, blinds or similar

devices must be provided for visual privacy.

     5.  Each resident must be provided:

     (a) At least 10 square feet of space for storage in

a bedroom for each bed in the bedroom; and

     (b) At least 24 inches of space in a permanent or

portable closet for hanging garments.

     6.  A separate bed with a comfortable and

clean mattress must be made available for each resident. The bed must be at

least 36 inches wide. Two clean sheets, a blanket, a pillow and a bedspread

must be available for each bed. Linens must be changed at least once each week

and more often if the linens become dirty. Additional bedding, including protective

mattress covers, must be provided if necessary.

     7.  Upon the request of a resident, a

residential facility may authorize the resident to use personal furniture and

furnishings that comply with the requirements of subsection 6 if their use does

not jeopardize the health and safety of any of the residents of the facility.

     8.  There must be a light outside the

entrance to each bedroom to provide a resident with adequate lighting to reach

safely a switch for turning on a light fixture inside the bedroom. Upon the

request of a resident, bedside lighting must be provided.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.220  Bedroom doors. (NRS 449.0302)

     1.  A bedroom door in a residential facility

which is equipped with a lock must open with a single motion from the inside

unless the lock provides security for the facility and can be operated without

a key or any special knowledge.

     2.  A bedroom door must not be equipped with

a deadbolt lock or chain stop unless the door opens directly to the outside of

the facility. The doors of a bedroom and the doors of the closets in the

bedroom may be equipped with locks for use by residents if:

     (a) The doors may be unlocked with a single motion

from inside the bedroom or closet without the use of a key; and

     (b) The doors of the bedroom may be unlocked from

outside the room and the keys are readily available at all times.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.221  Use of certain areas in facility as bedroom prohibited. (NRS 449.0302)  A hall,

stairway, unfinished attic, garage, storage area or shed or other similar area

of a residential facility must not be used as a bedroom. Any other room must

not be used as a bedroom if it:

     1.  Can only be reached by passing through a

bedroom occupied by another resident; or

     2.  Is used for any other purpose.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.222  Bathrooms and toilet facilities; toilet articles. (NRS 449.0302)

     1.  Each residential facility with less than

seven residents that was issued an initial license before January 14, 1997,

must have bathroom facilities in sufficient number to accommodate the

residents, the members of the staff of the facility and other persons at the

facility.

     2.  Each residential facility that is issued

an initial license on or after January 14, 1997, must have:

     (a) A flush toilet and lavatory for each four

residents; and

     (b) A tub or shower for each six residents.

     3.  The bottoms of tubs and showers must have

surfaces that inhibit falling and slipping. Cabinets that are attached to the floor

or grab bars must be adjacent to the tubs, toilets and showers.

     4.  All bathrooms and toilet facilities must

be located convenient to sleeping, recreational and living areas. A bathroom

must have a window that can be opened or a vent to outside the facility.

     5.  Provision must be made for privacy in all

bathrooms and toilet facilities in rooms intended for use by more than one

person.

     6.  Bathroom doors that are equipped with

locks must open with a single motion from the inside without the use of a key.

If a key is required to open a lock from outside the bathroom, the key must be

readily available at all times.

     7.  Each resident must have his or her own

toilet articles and must be provided with toilet paper, individual towels and

washcloths. Paper towels may be used for hand towels. The towels and washcloths

must be changed as often as is necessary to maintain cleanliness, but in no

event less often than once each week. A soap dispenser may be used instead of

individual bars of soap.

     8.  All bathrooms and toilet facilities must

be sufficiently lighted, and night-lights must be provided in hallways that

lead from the bedrooms to the bathrooms and toilet facilities.

     [Bd. of Health, Group Care Facilities §§ 15.4-15.4.6

& 15.6, eff. 12-18-75; § 15.5, eff. 12-18-75; A 5-7-82]—(NAC A by R003-97,

10-30-97)

      NAC 449.224  Housing for staff members. (NRS 449.0302)

     1.  Bedrooms must be provided for any members

of the staff of a residential facility and their families who live at a

residential facility. The bedrooms must comply with the provisions of

subsections 2 to 8, inclusive, of NAC 449.218 and

the provisions of NAC 449.220 and 449.221.

     2.  Members of the staff of the facility and

their families who live at the facility shall be deemed residents of the

facility for the purposes of determining the number of toilets, lavatories and

tubs or showers the facility is required to have pursuant to NAC 449.222. All toilets, lavatories and tubs or

showers used by the members of the staff of the facility or their families must

comply with the provisions of NAC 449.222.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.226  Safety requirements for residents with restricted mobility or

poor eyesight; water hazards; auditory systems for bathrooms and bedrooms;

access by vehicles. (NRS 449.0302)

     1.  A resident of a residential facility who

uses a wheelchair or a walker must not be required to use a bedroom on a floor

other than the first floor of the facility that is entirely above the level of

the ground, unless the facility is designed and equipped in such a manner that

the resident can move between floors without assistance.

     2.  Stairways, inclines, ramps, open porches

and other areas that are potentially hazardous for residents who have poor

eyesight must be adequately lighted.

     3.  If a residential facility with a resident

who is mentally or physically disabled has a fishpond, pool, hot tub, jacuzzi

or other body of water on the premises of the facility, the body of water must

be fenced, covered or blocked in some other manner at all times when it is not

being used by a resident.

     4.  In a residential facility with more than

10 residents:

     (a) Each resident must be provided with, or the

bedroom and bathroom of each resident must be equipped with, an auditory system

that is monitored by a member of the staff of the facility.

     (b) An auditory system must be available for use in

the bathroom of each resident of the facility if the facility was issued its

initial license on or after January 14, 1997, so that a resident needing

assistance can alert a member of the staff of the facility of that fact from

the toilet and the shower.

     (c) A bathroom that is located in a common area of

the facility must be equipped with an auditory system that is monitored by a

member of the staff of the facility.

     5.  Residential facilities must be easily

accessible by vehicle in the case of an emergency.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99)

      NAC 449.227  Accommodations for residents with restricted mobility. (NRS 449.0302)  A

residential facility with a resident who uses a wheelchair or a walker shall:

     1.  Have hallways, doorways and exits wide

enough to accommodate a wheelchair or walker;

     2.  Have ramps to accommodate access to areas

used by residents; and

     3.  Provide assistance to such a resident at

all steps located inside the facility on the first floor that is entirely above

grade.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.229  Requirements and precautions regarding safety from fire. (NRS 449.0302)

     1.  The administrator of a residential

facility shall ensure that the facility complies with the regulations adopted

by the State Fire Marshal pursuant to chapter

477 of NRS and all local ordinances relating to safety from fire. The

facility must be approved for residency by the State Fire Marshal.

     2.  The Bureau shall notify the State Fire

Marshal or the appropriate local government, as applicable, if, during an

inspection of a residential facility, the Bureau knows of or suspects the

presence of a violation of a regulation of the State Fire Marshal or a local

ordinance relating to safety from fire.

     3.  An exit door in a residential facility

must not be equipped with a lock that requires a key to open it from the inside

unless approved by the State Fire Marshal or his or her designee.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.231  First aid and cardiopulmonary resuscitation. (NRS 449.0302)

     1.  Within 30 days after an administrator or

caregiver of a residential facility is employed at the facility, the

administrator or caregiver must be trained in first aid and cardiopulmonary

resuscitation. The advanced certificate in first aid and adult cardiopulmonary

resuscitation issued by the American Red Cross or an equivalent certification

will be accepted as proof of that training.

     2.  A first-aid kit must be available at the

facility. The first-aid kit must include, without limitation:

     (a) A germicide safe for use by humans;

     (b) Sterile gauze pads;

     (c) Adhesive bandages, rolls of gauze and adhesive

tape;

     (d) Disposable gloves;

     (e) A shield or mask to be used by a person who is

administering cardiopulmonary resuscitation; and

     (f) A thermometer or other device that may be used

to determine the bodily temperature of a person.

     3.  Except for first aid in an emergency, no

treatment or medication may be administered to a resident without the approval

of a physician.

     [Bd. of Health, Group Care Facilities §§ 16.9-16.12.3,

eff. 12-18-75; § 16.13, eff. 5-7-82]—(NAC A 3-6-86; R003-97, 10-30-97)

      NAC 449.232  Telephones; emergency telephone numbers for each resident;

listing of facility’s telephone number. (NRS 449.0302)

     1.  Each residential facility shall have a

telephone that the residents may use to make local calls.

     2.  A list of telephone numbers to be called

in case of an emergency for each resident must be located near the telephone.

The list must include the telephone number of the resident’s physician and the

telephone number of a friend of the resident or one of the members of the

resident’s family.

     3.  The telephone number of the facility must

be listed in the telephone directory under the name of the facility.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97,

10-30-97; R073-03, 1-22-2004)

      NAC 449.241  Limitations on use of volunteers; requirements concerning

residents who volunteer to assist staff or perform other duties. (NRS 449.0302)

     1.  Volunteers may be used to supplement the

services and programs of a residential facility, but may not be used to replace

members of the staff of the facility.

     2.  A resident may volunteer to help the

employees of the facility in a manner that does not create an unsafe condition

for the resident, other residents or the members of the staff of the facility.

     3.  A resident must not be required to

perform duties normally performed by the staff of the facility. If a resident

volunteers to perform such duties, the administrator of the facility shall

ensure that the resident’s records include a statement that the resident has

volunteered to perform those duties.

     4.  A resident who is performing duties

pursuant to this section must not be allowed access to confidential files.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97,

10-30-97)

      NAC 449.258  Written policies for facility; policy on visiting hours;

residents’ mail; compliance with policies. (NRS 449.0302)

     1.  Written policies for a residential

facility that comply with the provisions of NAC 449.156

to 449.27706, inclusive, must be developed.

     2.  A policy on visiting hours must be

established to promote contact by the residents with persons who are not

residents of the facility. The policy regarding visits must be flexible to

ensure that every resident has the opportunity to retain and strengthen ties

with family and friends.

     3.  Assurances must be provided that incoming

and outgoing mail for a resident will not be interfered with in any way, unless

written permission is obtained from the resident or his or her representative.

Permission obtained from the resident or the representative may specifically

state the type of mail that may be interfered with by the members of the staff

of the facility. Permission granted by a resident or the representative

pursuant to this subsection may be revoked by the resident at any time.

     4.  The employees of the facility shall

comply with the policies developed pursuant to this section.

     [Bd. of Health, Group Care Facilities §§ 11.1-11.7.1,

eff. 12-18-75]—(NAC A by R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.259  Supervision and treatment of residents generally. (NRS 449.0302)

     1.  A residential facility shall:

     (a) Provide each resident with protective

supervision as necessary;

     (b) Inform all caregivers of the required

supervision;

     (c) Provide each resident with the opportunity to

attend the religious service of his or her choice and participate in personal

and private pastoral counseling;

     (d) Permit a resident to rest in his or her room at

any time;

     (e) Permit a resident to enter or leave the

facility at any time if the resident:

          (1) Is physically and mentally capable of

leaving the facility; and

          (2) The resident complies with the rules

established by the administrator of the facility for leaving the facility;

     (f) Provide laundry services for each resident

unless a resident elects in writing to make other arrangements;

     (g) Ensure that each resident’s clothes are clean,

comfortable and presentable; and

     (h) Inform each resident or his or her

representative of the actions that the resident should take to protect the

resident’s valuables.

     2.  The administrator of a residential

facility may require a resident who leaves the facility to inform a member of

the staff of the facility upon his or her departure and return.

     3.  The employees of a residential facility

shall:

     (a) Treat each resident in a kind and considerate

manner; and

     (b) Respect each resident’s independence and

ability to make decisions on his or her own, whenever possible.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.260  Activities for residents. (NRS 449.0302)

     1.  The caregivers employed by a residential

facility shall:

     (a) Ensure that the residents are afforded an

opportunity to enjoy their privacy, participate in physical activities, relax

and associate with other residents;

     (b) Provide group activities that provide mental

and physical stimulation and develop creative skills and interests;

     (c) Plan recreational opportunities that are suited

to the interests and capacities of the residents;

     (d) Provide each resident with a written program of

activities;

     (e) Provide for the residents at least 10 hours

each week of scheduled activities that are suited to their interests and

capacities;

     (f) Encourage the residents to participate in the

activities scheduled pursuant to paragraph (e); and

     (g) Post, in a common area of the facility, a

calendar of activities for each month that notifies residents of the major

activities that will occur in the facility. The calendar must be:

          (1) Prepared at least 1 month in advance; and

          (2) Kept on file at the facility for not less

than 6 months after it expires.

     2.  The administrator of a residential

facility with at least 20 residents shall appoint a member of the staff of the

facility who will be responsible for the organization, conduct and evaluation

of activities for the residents. The person so appointed shall ensure that the

activities are suited to the interests and capacities of the residents.

     3.  The administrator of a residential

facility with 50 or more residents shall, in addition to appointing a member of

the staff of the facility pursuant to subsection 2, appoint such other members

of the staff as the administrator deems necessary to assist the person who is

responsible for conducting the activities.

     4.  A residential facility shall have areas

of sufficient size to conduct indoor and outdoor activities, including, without

limitation:

     (a) A common area that complies with the provisions

of NAC 449.216; and

     (b) An outdoor activity area that is easily

accessible for the residents and is safe from vehicular traffic.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.262  Provision of dental, optical and hearing care and social

services; report of suspected abuse, neglect, isolation or exploitation;

restrictions on use of restraints, confinement or sedatives. (NRS 449.0302)

     1.  The administrator of a residential

facility shall ensure that residents are provided with or are assisted in

obtaining dental and optical care, treatment for hearing and hearing impairment

and social services. The employees of the facility shall maintain a record of

the services or assistance provided pursuant to this subsection.

     2.  If an employee of the facility suspects

that a resident is being abused, neglected, isolated or exploited, the employee

shall report that fact in the manner prescribed in NRS 200.5093.

     3.  The members of the staff of a residential

facility shall not:

     (a) Use restraints on any resident;

     (b) Lock a resident in a room inside the facility;

or

     (c) Provide sedatives to a resident unless that

sedative has been prescribed for that resident by a physician to treat specific

symptoms. A caregiver shall make a record of the behavior of a resident who has

been prescribed a sedative.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.267  Money and property of residents.

(NRS 449.0302)

     1.  An employee of a residential facility

shall not handle a resident’s money without first being requested to do so in

writing by the resident or his or her representative.

     2.  An accurate record must be kept of all

money deposited with the facility for use by the resident, including

withdrawals. The record must include:

     (a) A separate accounting of the money held by the

facility on behalf of the resident;

     (b) Receipts for expenditures made by the facility

on behalf of the resident; and

     (c) A written acknowledgment by the resident for

each withdrawal of his or her money.

     3.  Unless a resident otherwise requests in

writing, all money in excess of $400 held by the facility on behalf of the

resident must be maintained in a financial institution in an account separate

from the facility’s operating accounts and must be clearly designated as such.

     4.  Each resident must have access to his or

her money held at the facility on his or her behalf during normal business

hours on each business day.

     5.  If a member of the staff of a residential

facility receives from a resident a request to make a withdrawal of money in

such an amount that the member of the staff has reason to believe that the

resident is being or has been exploited, the member of the staff shall report

the transaction to:

     (a) If the resident is 60 years of age or older:

          (1) The local office of the Aging and

Disability Services Division of the Department of Health and Human Services;

          (2) The local law enforcement agency;

          (3) The office for protective services for the

county in which the facility is located if that county has such an office; or

          (4) The toll-free telephone service designated

by the Aging and Disability Services Division pursuant to NRS 200.5093.

     (b) If the resident is less than 60 years of age:

          (1) The office for protective services for the

county in which the facility is located if that county has such an office; or

          (2) The local law enforcement agency if the

county in which the facility is located does not have an office for protective

services.

     6.  Except as otherwise provided in

subsection 7, an operator or employee of a residential facility shall not

accept appointment as a guardian or conservator of the estate of any resident,

become a substitute payee for any payments made to any resident or accept an

appointment as an attorney in fact for any resident.

     7.  If a resident whose only source of income

is in the form of monthly checks is legally determined to be unable to manage

his or her money and documentary evidence can be produced showing that efforts

to obtain a legal guardian have failed, the facility may be the substitute

payee on the checks. Records of all checks received, deposited or dispersed by

the facility must be maintained in the resident’s file.

     8.  Money that is held by a residential

facility on behalf of a resident must be returned to the resident or his or her

representative within 30 days after the resident is discharged from the

facility.

     9.  An employee of a residential facility

shall not borrow money from a resident.

     [Bd. of Health, Group Care Facilities §§ 11.15-11.19.1,

eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.268  Rights of residents; procedure for filing grievance, complaint or

report of incident; investigation and response.

(NRS 449.0302)

     1.  The administrator of a residential

facility shall ensure that:

     (a) The residents are not abused, neglected or

exploited by a member of the staff of the facility, another resident of the

facility or any person who is visiting the facility;

     (b) A resident is not prohibited from speaking to

any person who advocates for the rights of the residents of the facility;

     (c) The residents are treated with respect and

dignity;

     (d) The facility is a safe and comfortable

environment;

     (e) Residents are not prohibited from interacting

socially;

     (f) Residents are allowed to make their own

decisions whenever possible;

     (g) Residents are aware that they may file a

complaint or grievance with the administrator and that a resident who files

such a complaint receives a response in a timely manner;

     (h) A resident is informed as soon as practicable

that the resident is being moved to a new room or that he or she is receiving a

new roommate; and

     (i) Residents are afforded the opportunity to

initiate an advance directive or power of attorney for health care and that the

employees of the facility comply with the wishes contained in such a document.

     2.  The administrator of a residential

facility shall provide a procedure to respond immediately to grievances,

incidents and complaints. The procedure must include a method for ensuring that

the administrator or a person designated by the administrator is notified of

the grievance, incident or complaint. The administrator or a person designated

by the administrator shall personally investigate the matter. A resident who

files a grievance or complaint or reports an incident pursuant to this

subsection must be notified of the action taken in response to the grievance,

complaint or report or be given a reason why no action needs to be taken.

     3.  The employees of the facility shall

comply with the procedures adopted pursuant to subsection 2.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.269  Discrimination prohibited. (NRS 449.0302)

     1.  A resident of a residential facility

shall not be segregated or restricted in the enjoyment of any advantage or

privilege enjoyed by other residents, or provided with any assistance, service

or other benefit which is different or provided in a different manner from that

provided to other residents, on the ground of race, color, religion, national

origin or disability.

     2.  The facility’s policy regarding

nondiscrimination must be posted in a public area of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

Admitting, Transferring and Discharging Residents

      NAC 449.2702  Written policy on admissions; eligibility for residency. (NRS 449.0302)

     1.  Each residential facility shall have a

written policy on admissions which includes:

     (a) A statement of nondiscrimination regarding

admission to the facility and treatment after admission; and

     (b) The requirements for eligibility as a resident

of that type of facility.

     2.  A person who wishes to reside in a

residential facility with residents that require a higher category of care than

the person requires may reside in the facility if he or she is not otherwise

prohibited from residing in the facility.

     3.  A person who is admitted to a residential

facility must be at least 18 years of age.

     4.  Except as otherwise provided in NAC 449.275 and 449.2754,

a residential facility shall not admit or allow to remain in the facility any

person who:

     (a) Is bedfast;

     (b) Requires restraint;

     (c) Requires confinement in locked quarters; or

     (d) Requires skilled nursing or other medical

supervision on a 24-hour basis.

     5.  A person may not reside in a residential

facility if the person’s physician or the Bureau determines that the person

does not comply with the requirements for eligibility.

     6.  As used in this section:

     (a) “Bedfast” means a condition in which a person

is:

          (1) Incapable of changing his or her position

in bed without the assistance of another person; or

          (2) Immobile.

     (b) “Restraint” means:

          (1) A psychopharmacologic drug that is used

for discipline or convenience and is not required to treat medical symptoms;

          (2) A manual method for restricting a

resident’s freedom of movement or the resident’s normal access to his or her

body; or

          (3) A device or material or equipment which is

attached to or adjacent to a resident’s body that cannot be removed easily by

the resident and restricts the resident’s freedom of movement or the resident’s

normal access to his or her body.

     [Bd. of Health, Group Care Facilities § 7.1, eff. 12-18-75;

§§ 7.2-7.4.2, eff. 12-18-75; A 5-7-82; §§ 7.5-7.6.4, eff. 12-18-75]—(NAC A 3-6-86;

8-1-91; R003-97, 10-30-97; R073-03, 1-22-2004; R118-05, 11-17-2005)

      NAC 449.2704  Disclosure of information concerning rates and payment for

services. (NRS 449.0302)  The

administrator of a residential facility shall, upon request, make the following

information available in writing:

     1.  The basic rate for the services provided

by the facility;

     2.  The schedule for payment;

     3.  The services included in the basic rate;

     4.  The charges for optional services which

are not included in the basic rate; and

     5.  The residential facility’s policy on

refunds of amounts paid but not used.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97,

10-30-97; R052-99, 9-27-99)

      NAC 449.2706  Transfer of resident whose condition deteriorates. (NRS 449.0302)

     1.  If a resident’s condition deteriorates to

such an extent that:

     (a) The residential facility is unable to provide

the services necessary to treat the resident properly; or

     (b) The resident no longer complies with the

requirements for admission to the facility,

Ê the facility

shall plan for the transfer of the resident pursuant to NRS 449.700 and 449.705 to another facility that is

able to provide the services necessary to treat the resident properly.

     2.  A resident, his or her next of kin and

the responsible agency, if any, must be consulted and adequate arrangements

must be made to meet the resident’s needs through other means before he or she

permanently leaves the facility.

     [Bd. of Health, Group Care Facilities §§ 10.1-10.3,

eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.2707  Transfer of resident: Effective date. (NRS 449.0302)  The

transfer of a resident from a residential facility occurs:

     1.  Except as otherwise provided in

subsection 2, on the date that the resident is admitted to the facility to

which he or she is moved; or

     2.  If the resident is moved to a unit or

department of a hospital, other than the emergency department of the hospital,

on the date that the resident is accepted at the hospital for care or

observation.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

      NAC 449.2708  Discharge of resident; notice of discharge; issuance of notice to

quit to resident for improper or harmful behavior. (NRS 449.0302)

     1.  A resident may be discharged from a

residential facility without his or her approval if:

     (a) The resident fails to pay his or her bill

within 5 days after it is due;

     (b) The resident fails to comply with the rules or

policies of the facility; or

     (c) The administrator of the facility or the Bureau

determines that the facility is unable to provide the necessary care for the resident.

     2.  Except as otherwise provided in this

section, before a resident may be discharged from a residential facility

without his or her approval pursuant to this section, the facility must provide

the resident, his or her representative and the person who pays the bill on

behalf of the resident, if any, with written notice that the resident will be

discharged.

     3.  A residential facility shall discharge a

resident who is transferred pursuant to NRS 449.700 and 449.705 and admitted to another

facility for a higher level of care. Written notice pursuant to subsection 2

that the resident will be discharged is not required if the condition of the

resident necessitates immediate transfer to receive emergency care.

     4.  If the resident or any of his or her

visitors are engaging in behavior which is a threat to the mental or physical

health or safety of the resident or other persons in the facility, the facility

may issue a notice to quit to the resident. The notice to quit must include:

     (a) The reasons for its issuance, with specific

facts relating to the date, time and place of the incidents that posed a threat

to the physical or mental health or safety of the resident or other persons in

the facility; and

     (b) The names of persons who witnessed the

incidents and the circumstances under which the incidents occurred.

Ê If the

resident or his or her visitors do not comply with the notice to quit, the

resident may be discharged from the facility without his or her approval

pursuant to subsection 2.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004)

Restrictions on Admitting or Retaining Residents With

Certain Medical Needs or Conditions

      NAC 449.271  Residents requiring gastrostomy care or suffering from

staphylococcus infection or other serious infection or medical condition. (NRS 449.0302)  Except

as otherwise provided in NAC 449.2736, a person

must not be admitted to a residential facility or permitted to remain as a

resident of a residential facility if he or she:

     1.  Requires gastrostomy care;

     2.  Suffers from a staphylococcus infection

or other serious infection; or

     3.  Suffers from any other serious medical

condition that is not described in NAC 449.2712 to

449.2734, inclusive.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2712  Residents requiring use of oxygen. (NRS 449.0302)

     1.  A person who requires the use of oxygen

must not be admitted to a residential facility or be permitted to remain as a

resident of a residential facility unless he or she:

     (a) Is mentally and physically capable of operating

the equipment that provides the oxygen; or

     (b) Is capable of:

          (1) Determining his or her need for oxygen;

and

          (2) Administering the oxygen to himself or

herself with assistance.

     2.  The caregivers employed by a residential

facility with a resident who requires the use of oxygen shall:

     (a) Monitor the ability of the resident to operate

the equipment in accordance with the orders of a physician; and

     (b) Ensure that:

          (1) The resident’s physician evaluates

periodically the condition of the resident which necessitates his or her use of

oxygen;

          (2) Signs which prohibit smoking and notify

persons that oxygen is in use are posted in areas of the facility in which

oxygen is in use or is being stored;

          (3) Persons do not smoke in those areas where

smoking is prohibited;

          (4) All electrical equipment is inspected for

defects which may cause sparks;

          (5) All oxygen tanks kept in the facility are

secured in a stand or to a wall;

          (6) The equipment used to administer oxygen is

in good working condition;

          (7) A portable unit for the administration of

oxygen in the event of a power outage is present in the facility at all times

when a resident who requires oxygen is present in the facility; and

          (8) The equipment used to administer oxygen is

removed from the facility when it is no longer needed by the resident.

     3.  The administrator of a residential

facility shall ensure that the caregivers who may be required to administer

oxygen have demonstrated the ability to operate properly the equipment used to

administer oxygen.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2714  Residents requiring use of intermittent positive pressure breathing

equipment. (NRS 449.0302)

     1.  A person who requires the use of

intermittent positive pressure breathing equipment must not be admitted to a

residential facility or be permitted to remain as a resident of a residential

facility unless:

     (a) The resident is mentally and physically capable

of operating and disinfecting the equipment and is capable of determining when

its use is required; or

     (b) The equipment is operated by a medical

professional who has been trained to operate the equipment.

     2.  The caregivers employed by a residential

facility with a resident who requires the use of intermittent positive pressure

breathing equipment shall:

     (a) Monitor the ability of the resident to operate

the equipment in accordance with the orders of a physician; and

     (b) Ensure that:

          (1) The resident’s physician evaluates

periodically the condition of the resident which necessitates his or her use of

the equipment;

          (2) The equipment is operated by a medical

professional trained in the operation of the equipment if the resident requires

assistance;

          (3) The equipment is in good working

condition; and

          (4) The equipment is removed from the facility

when it is no longer needed by the resident.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2716  Residents having colostomy or ileostomy. (NRS 449.0302)

     1.  A person who has a colostomy or ileostomy

must not be admitted to a residential facility or be permitted to remain as a

resident of a residential facility unless:

     (a) The resident is mentally and physically capable

of properly caring for his or her colostomy or ileostomy, with or without

assistance, and the resident’s physician has stated in writing that the

colostomy or ileostomy is completely healed; or

     (b) The care for the colostomy or ileostomy is

provided by a medical professional who is trained to provide that care.

     2.  The caregivers employed by a residential

facility with a resident who has a colostomy or ileostomy shall ensure that:

     (a) All bags used by the resident are discarded

appropriately; and

     (b) Privacy is afforded to the resident when care

for the colostomy or ileostomy is being provided.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2718  Residents requiring manual removal of fecal impactions or use of

enemas or suppositories. (NRS 449.0302)

     1.  A person who requires the manual removal

of fecal impactions or the use of enemas or suppositories must not be admitted

to a residential facility or be permitted to remain as a resident of a

residential facility unless:

     (a) The resident is able to provide the care for

himself or herself; or

     (b) The care is administered according to the

written instructions of a physician by a medical professional who has been

trained to provide that care.

     2.  The caregivers employed by a residential

facility with a resident who requires the manual removal of fecal impactions or

the use of enemas or suppositories shall ensure that privacy is afforded to the

resident when that care is being provided.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R204-99, 2-10-2000)

      NAC 449.272  Residents requiring use of indwelling catheter. (NRS 449.0302)

     1.  A person who requires the use of an

indwelling catheter must not be admitted to a residential facility or be

permitted to remain as a resident of a residential facility unless:

     (a) The resident is physically and mentally capable

of caring for all aspects of the condition, with or without the assistance of a

caregiver;

     (b) Irrigation of the catheter is performed in

accordance with the physician’s orders by a medical professional who has been

trained to provide that care; and

     (c) The catheter is inserted and removed only in

accordance with the orders of a physician by a medical professional who has

been trained to insert and remove a catheter.

     2.  The caregivers employed by a residential

facility with a resident who requires the use of an indwelling catheter shall

ensure that:

     (a) The bag and tubing of the catheter are changed

by:

          (1) The resident, with or without the

assistance of a caregiver; or

          (2) A medical professional who has been

trained to provide that care;

     (b) Waste from the use of the catheter is disposed

of properly;

     (c) Privacy is afforded to the resident while care

is being provided; and

     (d) The bag of the catheter is emptied by a

caregiver who has received instruction in the handling of such waste and the

signs and symptoms of urinary tract infections and dehydration.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2722  Residents having unmanageable condition of bowel or bladder

incontinence; residents having manageable condition of bowel or bladder

incontinence. (NRS 449.0302)

     1.  A person who has an unmanageable

condition of bowel or bladder incontinence must not be admitted to a

residential facility or permitted to remain as a resident of a residential

facility.

     2.  A person who has a manageable condition

of bowel or bladder incontinence must not be admitted to a residential facility

or permitted to remain as a resident of a residential facility unless the

condition can be managed by:

     (a) The resident without the assistance of any

other person;

     (b) Requiring the resident to participate in a

structured bowel or bladder retraining program to assist the resident in

restoring a normal pattern of continence;

     (c) A program which includes scheduled toileting at

regular intervals; or

     (d) Requiring the resident to use products that

keep him or her clean and dry at all times.

     3.  The caregivers employed by a residential

facility with a resident who has a manageable condition of bowel or bladder

incontinence shall ensure that:

     (a) If the resident can benefit from scheduled

toileting, he or she is assisted or reminded to go to the bathroom at regular intervals;

     (b) The resident is checked during those periods

when he or she is known to be incontinent, including during the night;

     (c) The resident is kept clean and dry;

     (d) Retraining programs are designed by a medical

professional with training and experience in the care of persons with bowel or

bladder dysfunction;

     (e) The retraining programs established for a

resident are followed; and

     (f) Privacy is afforded to the resident when care

is being provided.

     4.  The caregivers employed by the facility

shall not:

     (a) Withhold fluids from a resident to control

incontinence; or

     (b) Have a resident catheterized to control

incontinence for the convenience of the employees of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2724  Residents having contractures. (NRS 449.0302)

     1.  A person who has contractures must not be

admitted to a residential facility or be permitted to remain as a resident of a

residential facility unless the contractures do not adversely affect the

ability of the resident to perform normal bodily functions and:

     (a) The resident is able to care for the

contractures without assistance; or

     (b) Supervision in caring for the contractures is

provided by a medical professional who is trained to provide such supervision.

     2.  The caregivers employed by a residential

facility with a resident who has contractures shall ensure that the performance

by the resident of any exercises to improve the resident’s range of motion or

any other exercises prescribed by a physician is supervised by a medical

professional who has been trained to provide such supervision.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2726  Residents having diabetes. (NRS 449.0302)

     1.  A person who has diabetes must not be

admitted to a residential facility or be permitted to remain as a resident of a

residential facility unless:

     (a) The resident’s glucose testing is performed by:

          (1) The resident himself or herself without

assistance; or

          (2) A medical laboratory licensed pursuant to chapter 652 of NRS; and

     (b) The resident’s medication is administered:

          (1) By the resident himself or herself without

assistance;

          (2) By a medical professional, or licensed

practical nurse, who is:

               (I) Not employed by the residential

facility;

               (II) Acting within his or her authorized

scope of practice and in accordance with all applicable statutes and

regulations; and

               (III) Trained to administer the

medication; or

          (3) If the conditions set forth in subsection

2 are satisfied, with the assistance of a caregiver employed by the residential

facility.

     2.  A caregiver employed by a residential

facility may assist a resident in the administration of the medication

prescribed to the resident for his or her diabetes if:

     (a) The resident’s physical and mental condition is

stable and is following a predictable course.

     (b) The amount of the medication prescribed to the

resident for his or her diabetes is at a maintenance level and does not require

a daily assessment.

     (c) A written plan of care by a physician or

registered nurse has been established that:

          (1) Addresses possession and assistance in the

administration of the medication for the resident’s diabetes; and

          (2) Includes a plan, which has been prepared

under the supervision of a registered nurse or licensed pharmacist, for

emergency intervention if an adverse condition results.

     (d) The medication prescribed to the resident for

his or her diabetes is not administered by injection or intravenously.

     (e) The caregiver has successfully completed

training and examination approved by the Division regarding the administration

of such medication.

     3.  The caregivers employed by a residential

facility with a resident who has diabetes shall ensure that:

     (a) Sufficient amounts of medicines, equipment to

perform tests, syringes, needles and other supplies are maintained and stored

in a secure place in the facility;

     (b) Syringes and needles are disposed of

appropriately in a sharps container which is stored in a safe place; and

     (c) The caregivers responsible for the resident

have received instruction in the recognition of the symptoms of hypoglycemia

and hyperglycemia by a medical professional who has been trained in the

recognition of those symptoms.

     4.  The caregivers employed by a residential

facility with a resident who has diabetes and requires a special diet shall

provide variations in the types of meals served and make available food

substitutions in order to allow the resident to consume meals as prescribed by

the resident’s physician. The substitutions must conform with the

recommendations for food exchanges contained in the Exchange Lists For Meal

Planning, published by the American Diabetes Association, Incorporated, and

the American Dietetic Association, which is hereby adopted by reference. A copy

of the publication may be obtained from the American Diabetes Association,

Incorporated, Order Fulfillment Department, P.O. Box 930850, Atlanta, Georgia

31193-0850, at a cost of $2.50.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.2728  Residents requiring regular intramuscular, subcutaneous or

intradermal injections. (NRS 449.0302)

     1.  A person who requires regular

intramuscular, subcutaneous or intradermal injections must not be admitted to a

residential facility or be permitted to remain as a resident of the facility

unless the injections are administered by:

     (a) The resident; or

     (b) A medical professional, or licensed practical

nurse, acting within his or her authorized scope of practice and in accordance

with all applicable statutes and regulations,

Ê who has been

trained to administer those injections.

     2.  The caregivers employed by a residential

facility with a resident who requires regular intramuscular, subcutaneous or

intradermal injections shall ensure that:

     (a) Sufficient amounts of medicines, equipment to

perform tests, syringes, needles and other supplies are maintained and stored

in a secure place in the facility; and

     (b) Syringes and needles are disposed of

appropriately in a sharps container which is stored in a safe place.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.2732  Residents requiring protective supervision. (NRS 449.0302)

     1.  Except as otherwise provided in

subsection 2, a person who requires protective supervision may not be admitted

to a residential facility or be permitted to remain as a resident of a

residential facility unless:

     (a) The resident is able to follow instructions;

     (b) The resident is able to make his or her needs

known to the caregivers employed by the facility;

     (c) The resident can be protected from harming

himself or herself and other persons; and

     (d) The caregivers employed by the facility can

meet the needs of the resident.

     2.  If a person who requires protective

supervision is unable to follow instructions or has difficulty making his or

her needs known to the employees of the facility, the person may be admitted to

the facility or be permitted to remain as a resident of the facility if the

facility complies with the provisions of NAC 449.2754

and 449.2756.

     3.  The administrator of a residential

facility with a resident who requires protective services shall ensure that:

     (a) The caregivers employed by the facility are

capable of providing the supervision for that resident without neglecting the

needs of the other residents of the facility; and

     (b) There is a written plan for providing protective

supervision for that resident.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2734  Residents having tracheostomy or open wound requiring treatment

by medical professional; residents having pressure or stasis ulcers. (NRS 449.0302)

     1.  A person who has a tracheostomy or an

open wound that requires treatment by a medical professional must not be

admitted to a residential facility or be permitted to remain as a resident of a

residential facility unless:

     (a) The wound is in the process of healing or the

tracheostomy is stable or can be cared for by the resident without assistance;

     (b) The care is provided by or under the

supervision of a medical professional who has been trained to provide that

care; or

     (c) The wound is the result of surgical

intervention and care is provided as directed by the surgeon.

     2.  If a person who has a pressure or stasis

ulcer or who is at risk of developing a pressure or stasis ulcer is admitted to

a residential facility or permitted to remain as a resident of a residential

facility:

     (a) The condition must have been diagnosed by a

physician;

     (b) The condition must be cared for by a medical

professional who is trained to provide care for and reassessment of that

condition; and

     (c) Before a caregiver provides care to the person

who has a pressure or stasis ulcer or who is at risk of developing a pressure

or stasis ulcer, the caregiver must receive training related to the prevention

and care of pressure sores from a medical professional who is trained to

provide care for that condition.

     3.  The administrator of the facility shall

ensure that records of the care provided to a person who has a pressure or

stasis ulcer pursuant to subsection 2 are maintained at the facility. The

records must include an explanation of the cause of the pressure or stasis

ulcer.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.2736  Procedure to exempt certain residents from restrictions. (NRS 449.0302)

     1.  The administrator of a residential

facility may submit to the Division a written request for permission to admit

or retain a resident who is prohibited from being admitted to a residential

facility or remaining as a resident of the facility pursuant to NAC 449.271 to 449.2734,

inclusive.

     2.  A written request submitted pursuant to

this section must include, without limitation:

     (a) Records concerning the resident’s current

medical condition, including updated medical reports, other documentation of

current health, a prognosis and the expected duration of the condition;

     (b) A plan for ensuring that the resident’s medical

needs can be met by the facility;

     (c) A plan for ensuring that the level of care

provided to the other residents of the facility will not suffer as a result of

the admission or retention of the resident who is the subject of the request;

and

     (d) A statement signed by the administrator of the

facility that the needs of the resident who is the subject of the written

request will be met by the caregivers employed by the facility.

     3.  A written request submitted to the Division

pursuant to this section must be received:

     (a) Before the administrator admits a resident; or

     (b) At the onset of a medical condition set forth

in NAC 449.271 to 449.2734,

inclusive.

     4.  A residential facility must receive the

permission requested pursuant to subsection 1 before the facility admits a

resident who is otherwise prohibited from being admitted to the facility

pursuant to NAC 449.271 to 449.2734,

inclusive.

     5.  A residential facility may retain a

resident who is otherwise prohibited from remaining as a resident of the

facility pursuant to NAC 449.271 to 449.2734, inclusive, for 10 days after the facility

submits to the Division the written request required pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R204-99, 2-10-2000)

      NAC 449.2738  Review of medical condition of resident; relocation or transfer

of resident having certain medical needs or conditions. (NRS 449.0302)

     1.  If, after conducting an inspection or

investigation of a residential facility, the Bureau determines that it is

necessary to review the medical condition of a resident, the Bureau shall

inform the administrator of the facility of the need for the review and the

information the facility is required to submit to the Bureau to assist in the

performance of the review. The administrator shall, within a period prescribed

by the Bureau, provide to the Bureau:

     (a) The assessments made by physicians concerning

the physical and mental condition of the resident; and

     (b) Copies of prescriptions for medication or

orders of physicians for services or equipment necessary to provide care for

the resident.

     2.  If the Bureau or the resident’s physician

determines that the facility is prohibited from caring for the resident

pursuant to NAC 449.271 to 449.2734,

inclusive, or is unable to care for the resident in the proper manner, the

administrator of the facility must be notified of that determination. Upon

receipt of such a notification, the administrator shall, within a period

prescribed by the Bureau, submit a plan to the Bureau for the safe and appropriate

relocation of the resident pursuant to NRS 449.700 to a place where the

proper care will be provided.

     3.  If an inspection or investigation reveals

that the conditions at a residential facility may immediately jeopardize the

health and safety of a resident, the administrator of the facility shall, as

soon as practicable, ensure that the resident is transferred to a facility

which is capable of properly providing for his or her care.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

Medical Services, Medical Records and Other Records

Concerning Residents

      NAC 449.274  Medical care of resident after illness, injury or accident;

periodic physical examination of resident; rejection of medical care by

resident; written records. (NRS 449.0302)

     1.  If a resident of a residential facility

becomes ill or is injured, the resident’s physician and a member of the

resident’s family must be notified at the onset of illness or at the time of

the injury. The facility shall:

     (a) Make all necessary arrangements to secure the

services of a licensed physician to treat the resident if the resident’s

physician is not available; and

     (b) Request emergency services when such services

are necessary.

     2.  A resident who is suffering from an

illness or injury from which the resident is expected to recover within 14 days

after the onset of the illness or the time of the injury may be cared for in

the facility. The decision as to the period within which the resident is

expected to recover from the illness or injury and the needs of the resident

must be made by the resident’s physician or, if he or she is unavailable, by

another licensed physician.

     3.  A written record of all accidents,

injuries and illnesses of the resident which occur in the facility must be made

by the caregiver who first discovers the accident, injury or illness. The

record must include:

     (a) The date and time of the accident or injury or

the date and time that the illness was discovered;

     (b) A description of the manner in which the

accident or injury occurred or the manner in which the illness was discovered;

and

     (c) A description of the manner in which the

members of the staff of the facility responded to the accident, injury or

illness and the care provided to the resident.

Ê This record

must accompany the resident if he or she is transferred to another facility.

     4.  The facility shall ensure that

appropriate medical care is provided to the resident by:

     (a) A caregiver who is trained to provide that

care;

     (b) An independent contractor who is trained to

provide that care; or

     (c) A medical professional.

     5.  Before admission and each year after

admission, or more frequently if there is a significant change in the physical

condition of a resident, the facility shall obtain the results of a general

physical examination of the resident by his or her physician. The resident must

be cared for pursuant to any instructions provided by the resident’s physician.

     6.  The members of the staff of the facility

shall:

     (a) Ensure that the resident receives the personal

care that he or she requires.

     (b) Monitor the ability of the resident to care for

his or her own health conditions and document in writing any significant change

in his or her ability to care for those conditions.

     7.  This section does not prohibit a resident

from rejecting medical care. If a resident rejects medical care, an employee of

the facility shall record the rejection in writing and request that the

resident sign that record as a confirmation of his or her rejection of medical

care. If the resident rejects medical care that a physician has directed the

facility to provide, the facility shall inform the resident’s physician of that

fact within 4 hours after the care is rejected. The facility shall maintain a

record of the notice provided to the physician pursuant to this subsection.

     8.  As used in this section, “significant

change” means a change in a resident’s condition that results in a category 1

resident becoming a category 2 resident or otherwise results in an increase in

the level of care required by the resident.

     [Bd. of Health, Group Care Facilities §§ 8.1-8.4, eff.

12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.2742  Administration of medication: Responsibilities of administrator,

caregivers and employees of facility. (NRS 449.0302)

     1.  The administrator of a residential

facility that provides assistance to residents in the administration of

medications shall:

     (a) Ensure that a physician, pharmacist or

registered nurse who does not have a financial interest in the facility:

          (1) Reviews for accuracy and appropriateness,

at least once every 6 months, the regimen of drugs taken by each resident of

the facility, including, without limitation, any over-the-counter medications

and dietary supplements taken by a resident; and

          (2) Provides a written report of that review

to the administrator of the facility.

     (b) Include a copy of each report submitted to the

administrator pursuant to paragraph (a) in the file maintained pursuant to NAC 449.2749 for the resident who is the subject of

the report.

     (c) Make and maintain a report of any actions that

are taken by the caregivers employed by the facility in response to a report

submitted pursuant to paragraph (a).

     (d) Develop and maintain a plan for managing the

administration of medications at the residential facility, including, without

limitation:

          (1) Preventing the use of outdated, damaged or

contaminated medications;

          (2) Managing the medications for each resident

in a manner which ensures that any prescription medications, over-the-counter

medications and nutritional supplements are ordered, filled and refilled in a

timely manner to avoid missed dosages;

          (3) Verifying that orders for medications have

been accurately transcribed in the record of the medication administered to

each resident in accordance with NAC 449.2744;

          (4) Monitoring the administration of

medications and the effective use of the records of the medication administered

to each resident;

          (5) Ensuring that each caregiver who

administers a medication is in compliance with the requirements of subsection 6

of NRS 449.0302 and NAC 449.196;

          (6) Ensuring that each caregiver who

administers a medication is adequately supervised;

          (7) Communicating routinely with the

prescribing physician or other physician of the resident concerning issues or

observations relating to the administration of the medication; and

          (8) Maintaining reference materials relating

to medications at the residential facility, including, without limitation, a

current drug guide or medication handbook, which must not be more than 2 years

old or providing access to websites on the Internet which provide reliable

information concerning medications.

     (e) Develop and maintain a training program for

caregivers of the residential facility who administer medication to residents,

including, without limitation, an initial orientation on the plan for managing

medications at the facility for each new caregiver and an annual training

update on the plan. The administrator shall maintain documentation concerning

the provision of the training program and the attendance of caregivers.

     (f) In his or her first year of employment as an

administrator of the residential facility, receive, from a program approved by

the Bureau, at least 16 hours of training in the management of medication

consisting of not less than 12 hours of classroom training and not less than 4

hours of practical training and obtain a certificate acknowledging completion

of such training.

     (g) After receiving the initial training required

by paragraph (f), receive annually at least 8 hours of training in the

management of medication and provide the residential facility with satisfactory

evidence of the content of the training and his or her attendance at the

training.

     (h) Annually pass an examination relating to the

management of medication approved by the Bureau.

     2.  Within 72 hours after the administrator

of the facility receives a report submitted pursuant to paragraph (a) of

subsection 1, a member of the staff of the facility shall notify the resident’s

physician of any concerns noted by the person who submitted the report. The

report must be reviewed and initialed by the administrator.

     3.  Before assisting a resident in the

administration of any medication, including, without limitation, any

over-the-counter medication or dietary supplement, a caregiver must obtain

written information describing the side effects, possible adverse reactions,

contraindications and toxicity of the medication.

     4.  Except as otherwise provided in this

subsection, a caregiver shall assist in the administration of medication to a

resident if the resident needs the caregiver’s assistance. A caregiver may

assist the ultimate user of controlled substances or dangerous drugs only if

the conditions prescribed in subsection 6 of NRS 449.0302 are met.

     5.  An over-the-counter medication or a

dietary supplement may be given to a resident only if the resident’s physician

has approved the administration of the medication or supplement in writing or

the facility is ordered to do so by another physician. The over-the-counter

medication or dietary supplement must be administered in accordance with the

written instructions of the physician. The administration of over-the-counter

medications and dietary supplements must be included in the record required

pursuant to paragraph (b) of subsection 1 of NAC

449.2744.

     6.  Except as otherwise provided in this

subsection, a medication prescribed by a physician must be administered as

prescribed by the physician. If a physician orders a change in the amount or

times medication is to be administered to a resident:

     (a) The caregiver responsible for assisting in the

administration of the medication shall:

          (1) Comply with the order;

          (2) Indicate on the container of the

medication that a change has occurred; and

          (3) Note the change in the record maintained

pursuant to paragraph (b) of subsection 1 of NAC

449.2744;

     (b) Within 5 days after the change is ordered, a

copy of the order or prescription signed by the physician must be included in

the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744; and

     (c) If the label prepared by a pharmacist does not

match the order or prescription written by a physician, the physician,

registered nurse or pharmacist must interpret that order or prescription and,

within 5 days after the change is ordered, the interpretation must be included

in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744.

     7.  If a resident refuses, or otherwise

misses, an administration of medication, a physician must be notified within 12

hours after the dose is refused or missed.

     8.  An employee of a residential facility

shall not draw medication into a syringe or administer an injection unless

authorized by law to do so.

     9.  If the medication of a resident is

discontinued, the expiration date of the medication of a resident has passed,

or a resident who has been discharged from the facility does not claim the

medication, an employee of a residential facility shall destroy the medication,

by an acceptable method of destruction, in the presence of a witness and note

the destruction of the medication in the record maintained pursuant to NAC 449.2744.

     10.  The administrator of a facility is

responsible for any assistance provided to a resident of the residential

facility in the administration of medication, including, without limitation,

ensuring that all medication is administered in accordance with the provisions

of this section.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R204-99, 2-10-2000; R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2744  Administration of medication: Maintenance and contents of logs

and records. (NRS 449.0302)

     1.  The administrator of a residential

facility that provides assistance to residents in the administration of

medications shall maintain:

     (a) A log for each medication received by the

facility for use by a resident of the facility. The log must include:

          (1) The type and quantity of medication

received by the facility;

          (2) The date of its delivery;

          (3) The name of the person who accepted the

delivery;

          (4) The name of the resident for whom the

medication is prescribed; and

          (5) The date on which any unused medication is

removed from the facility or destroyed.

     (b) A record of the medication administered to each

resident. The record must include:

          (1) The type of medication administered;

          (2) The date and time that the medication was

administered;

          (3) The date and time that a resident refuses,

or otherwise misses, an administration of medication; and

          (4) Instructions for administering the

medication to the resident that reflect each current order or prescription of

the resident’s physician.

     2.  The administrator of the facility shall

keep a log of caregivers assigned to administer medications that indicates the

shifts during which each caregiver was responsible for assisting in the

administration of medication to a resident. This requirement may be met by

including on a resident’s medication sheet an indication of who assisted the

resident in the administration of the medication, if the caregiver can be

identified from this indication.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004)

      NAC 449.2746  Administration of medication: Restrictions concerning medication

taken as needed by resident; written records. (NRS 449.0302)

     1.  A caregiver employed by a residential

facility shall not assist a resident in the administration of a medication that

is taken as needed unless:

     (a) The resident is able to determine his or her

need for the medication;

     (b) The determination of the resident’s need for

the medication is made by a medical professional qualified to make that

determination; or

     (c) The caregiver has received written instructions

indicating the specific symptoms for which the medication is to be given, the

exact amount of medication that may be given and the frequency with which the

medication may be given.

     2.  A caregiver who administers medication to

a resident as needed shall record the following information concerning the

administration of the medication:

     (a) The reason for the administration;

     (b) The date and time of the administration;

     (c) The dose administered;

     (d) The results of the administration of the

medication;

     (e) The initials of the caregiver; and

     (f) Instructions for administering the medication

to the resident that reflect each current order or prescription of the

resident’s physician.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004)

      NAC 449.2748  Medication: Storage; duties upon discharge, transfer and return

of resident. (NRS 449.0302)

     1.  Medication, including, without

limitation, any over-the-counter medication, stored at a residential facility

must be stored in a locked area that is cool and dry. The caregivers employed

by the facility shall ensure that any medication or medical or diagnostic

equipment that may be misused or appropriated by a resident or any other

unauthorized person is protected. Medications for external use only must be

kept in a locked area separate from other medications. A resident who is

capable of administering medication to himself or herself without supervision

may keep the resident’s medication in his or her room if the medication is kept

in a locked container for which the facility has been provided a key.

     2.  Medication stored in a refrigerator,

including, without limitation, any over-the-counter medication, must be kept in

a locked box unless the refrigerator is locked or is located in a locked room.

     3.  Medication, including, without

limitation, any over-the-counter medication or dietary supplement, must be:

     (a) Plainly labeled as to its contents, the name of

the resident for whom it is prescribed and the name of the prescribing

physician; and

     (b) Kept in its original container until it is

administered.

     4.  Except as otherwise provided in

subsection 5, when a resident is discharged or transferred from a residential

facility, all medications prescribed for the resident must be provided to the

resident or to the facility to which he or she is transferred.

     5.  If a resident is transferred to a

hospital or skilled nursing facility, the residential facility shall hold the

resident’s medications until the resident returns or for 30 days after the

transfer, whichever is less, unless the hospital or skilled nursing facility

requests the residential facility to provide the hospital or skilled nursing

facility with the medications. If the resident does not return within 30 days

after the transfer, the residential facility shall promptly dispose of any

remaining medications. Upon the return of the resident from the hospital or

skilled nursing facility, the residential facility shall, if there has been any

change in the resident’s medication regimen:

     (a) Contact a physician, within 24 hours after the

resident returns, to clarify the change; and

     (b) Document the physician contact in the record

maintained pursuant to paragraph (b) of subsection 1 of NAC

449.2744.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.2749  Maintenance and contents of separate file for each resident;

confidentiality of information. (NRS 449.0302)

     1.  A separate file must be maintained for

each resident of a residential facility and retained for at least 5 years after

he or she permanently leaves the facility. The file must be kept locked in a

place that is resistant to fire and is protected against unauthorized use. The

file must contain all records, letters, assessments, medical information and

any other information related to the resident, including, without limitation:

     (a) The full name, address, date of birth and

social security number of the resident.

     (b) The address and telephone number of the

resident’s physician and the next of kin or guardian of the resident or any

other person responsible for the resident.

     (c) A statement of the resident’s allergies, if

any, and any special diet or medication he or she requires.

     (d) A statement from the resident’s physician

concerning the mental and physical condition of the resident that includes:

          (1) A description of any medical conditions

which require the performance of medical services;

          (2) The method in which those services must be

performed; and

          (3) A statement of whether the resident is

capable of performing the required medical services.

     (e) Evidence of compliance with the provisions of chapter 441A of NRS and the regulations

adopted pursuant thereto.

     (f) The types and amounts of protective supervision

and personal services needed by the resident.

     (g) An evaluation of the resident’s ability to

perform the activities of daily living and a brief description of any

assistance he or she needs to perform those activities. The facility shall

prepare such an evaluation:

          (1) Upon the admission of the resident;

          (2) Each time there is a change in the mental

or physical condition of the resident that may significantly affect his or her

ability to perform the activities of daily living; and

          (3) In any event, not less than once each

year.

     (h) A list of the rules for the facility that is

signed by the administrator of the facility and the resident or a

representative of the resident.

     (i) The name and telephone number of the vendors

and medical professionals that provide services for the resident.

     (j) A document signed by the administrator of the

facility when the resident permanently leaves the facility.

     2.  The document required pursuant to

paragraph (j) of subsection 1 must indicate the location to which the resident

was transferred or the person in whose care the resident was discharged. If the

resident dies while a resident of the facility, the document must include the

time and date of the death and the dates on which the person responsible for

the resident was contacted to inform him or her of the death.

     3.  Except as otherwise provided in this

subsection, a resident’s file must be kept confidential. A resident’s file must

be made available upon request at any time to an employee of the Bureau who is

acting in his or her capacity as an employee of the Bureau.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004)

Special Types of Services and Facilities

      NAC 449.275  Residential facility which provides residents with hospice care:

Responsibilities of staff; retention of resident with special medical needs. (NRS 449.0302)

     1.  A residential facility that provides

services to a resident who elects to receive hospice care shall obtain a copy

of the plan of care required pursuant to NAC 449.0186

for that resident.

     2.  The members of the staff of the facility

shall:

     (a) Maintain at the facility a written record of

the care and services provided to a resident who receives hospice care; and

     (b) Report any deviation from the established plan

of care to the resident’s physician within 24 hours after the deviation occurs.

     3.  If the Division grants a request made

pursuant to NAC 449.2736 by the administrator of a

residential facility that provides hospice care, the residential facility may

retain a resident who:

     (a) Is bedfast, as defined in NAC 449.2702; or

     (b) Requires skilled nursing or other medical care

on a 24-hour basis.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004)

      NAC 449.2751  Residential facility which provides assisted living services:

Application for endorsement; general requirements. (NRS 449.0302)

     1.  Each residential facility that wishes to

provide assisted living services must apply to the Division to obtain an

endorsement on its license authorizing the residential facility to provide

assisted living services.

     2.  The Division may deny an application for

an endorsement that is made pursuant to subsection 1 or suspend or revoke an

existing endorsement granted pursuant to subsection 1:

     (a) Based upon the grounds set forth in NAC 449.191 or 449.1915;

or

     (b) If the residential facility for which the

applicant is applying or the residential facility which has an endorsement does

not satisfy the requirements set forth in this section or subsections 7 and 8

of NRS 449.0302.

     3.  If a residential facility provides

assisted living services, the written policies that the residential facility is

required to develop pursuant to NAC 449.258 must

include, without limitation, procedures to be followed:

     (a) To ensure that the residential facility

complies with the requirements set forth in subsections 7 and 8 of NRS 449.0302;

     (b) By the administrator to ensure that residents

of the residential facility whose physical or mental condition is significantly

changing over time are identified;

     (c) To obtain a medical professional to assess and

monitor, as necessary, but not less than once every quarter in each calendar

year, each resident of the residential facility whose physical or mental

condition is declining over time; and

     (d) To provide services to residents of the

residential facility pursuant to the assessment and monitoring performed

pursuant to paragraph (c).

     4.  The administrator of a residential

facility that provides assisted living services shall ensure that:

     (a) A medical professional is notified whenever

there has been a significant change in the physical or mental condition of a

resident of the residential facility whose physical or mental condition is

declining over time; and

     (b) The residential facility maintains a list of

resources for financial assistance and other social services that may decrease

the need for a resident of the residential facility whose physical or mental

condition is declining over time to move out of the residential facility.

     5.  The services provided by a residential

facility that provides assisted living services must include, without

limitation, services that will enable the residential facility to retain

residents who have the medical needs or conditions described in NAC 449.2712 to 449.2734,

inclusive, and 449.275.

     (Added to NAC by Bd. of Health by R097-06, eff. 7-14-2006;

A by R119-10, 1-13-2011)

      NAC 449.2754  Residential facility which provides care to persons with

Alzheimer’s disease: Application for endorsement; general requirements. (NRS 449.0302)

     1.  A residential facility which offers or

provides care for a resident with Alzheimer’s disease or related dementia must

obtain an endorsement on its license authorizing it to operate as a residential

facility which provides care to persons with Alzheimer’s disease. The Division

may deny an application for an endorsement or suspend or revoke an existing

endorsement based upon the grounds set forth in NAC

449.191 or 449.1915.

     2.  If a residential facility is authorized

to operate as a residential facility which provides care to persons with

Alzheimer’s disease and as another type of facility, the entire facility must

comply with the requirements of this section or the residents who suffer from

Alzheimer’s disease or other related dementia must be located in a separate

portion of the facility that complies with the provisions of this section.

     3.  A residential facility which provides

care to persons with Alzheimer’s disease may admit or retain a resident who

requires confinement in locked quarters.

     4.  A residential facility which provides

care to persons with Alzheimer’s disease must be administered by a person who:

     (a) Has not less than 3 years of experience in

caring for residents with Alzheimer’s disease or related dementia in a licensed

facility; or

     (b) Has a combination of education and training

that the Bureau determines is equivalent to the experience required pursuant to

paragraph (a).

     5.  The administrator of such a facility

shall prescribe and maintain on the premises of the facility a written

statement which includes:

     (a) The facility’s policies and procedures for

providing care to its residents;

     (b) Evidence that the facility has established

interaction groups within the facility which consist of not more than six

residents for each caregiver during those hours when the residents are awake;

     (c) A description of:

          (1) The basic services provided for the needs

of residents who suffer from dementia;

          (2) The activities developed for the residents

by the members of the staff of the facility;

          (3) The manner in which the behavioral

problems will be managed;

          (4) The manner in which the medication for

residents will be managed;

          (5) The activities that will be developed by

the members of the staff of the facility to encourage the involvement of family

members in the lives of the residents; and

          (6) The steps the members of the staff of the

facility will take to:

               (I) Prevent residents from wandering from

the facility; and

               (II) Respond when a resident wanders from

the facility; and

     (d) The criteria for admission to and discharge and

transfer from the facility.

     6.  The written statement required pursuant

to subsection 5 must be available for review by members of the staff of the

facility, visitors to the facility and the Bureau.

     7.  The administrator shall ensure that the

facility complies with the provisions of the statement required pursuant to

subsection 5.

     8.  The members of the staff of the facility

shall develop a program of activities that promotes the mental and physical

enhancement of the residents. The following activities must be conducted at

least weekly:

     (a) Activities to enhance the gross motor skills of

the residents;

     (b) Social activities;

     (c) Activities to enhance the sensory abilities of

the residents; and

     (d) Outdoor activities.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2756  Residential facility which provides care to persons with

Alzheimer’s disease: Standards for safety; personnel required; training for

employees. (NRS 449.0302)

     1.  The administrator of a residential

facility which provides care to persons with Alzheimer’s disease shall ensure

that:

     (a) Swimming pools and other bodies of water are

fenced or protected by other acceptable means.

     (b) Operational alarms, buzzers, horns or other

audible devices which are activated when a door is opened are installed on all

doors that may be used to exit the facility.

     (c) At least one member of the staff is awake and

on duty at the facility at all times.

     (d) Each employee of the facility who has direct

contact with and provides care to residents with any form of dementia,

including, without limitation, dementia caused by Alzheimer’s disease,

successfully completes the training and continuing education required pursuant

to NAC 449.2768.

     (e) Knives, matches, firearms, tools and other

items that could constitute a danger to the residents of the facility are

inaccessible to the residents.

     (f) The facility has an area outside the facility

or a yard adjacent to the facility that:

          (1) May be used by the residents for outdoor

activities;

          (2) Has at least 40 square feet of space for

each resident in the facility;

          (3) Is fenced; and

          (4) Is maintained in a manner that does not

jeopardize the safety of the residents.

Ê All gates

leading from the secured, fenced area or yard to an unsecured open area or yard

must be locked and keys for gates must be readily available to the members of

the staff of the facility at all times.

     (g) All toxic substances are not accessible to the

residents of the facility.

     2.  The training required pursuant to NAC 449.2768 may be used to satisfy the requirement

of paragraph (f) of subsection 1 of NAC 449.196 for

the year in which the training is received.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004; R071-04, 8-4-2004)

      NAC 449.2758  Residential facility which provides care for elderly persons or

persons with disabilities: Training for caregivers. (NRS 449.0302)

     1.  Within 60 days after being employed by a

residential facility for elderly persons or persons with disabilities, a

caregiver must receive not less than 4 hours of training related to the care of

those residents.

     2.  As used in this section, “residential

facility for elderly persons or persons with disabilities” means a residential

facility that provides care to elderly persons or persons with disabilities who

require assistance or protective supervision because they suffer from

infirmities or disabilities.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004)

      NAC 449.2762  Residential facility which offers or provides care for adults

with intellectual disabilities or adults with related conditions: Application

for endorsement; training for caregivers. (NRS 449.0302)

     1.  A residential facility which offers or

provides care and protective supervision for a resident with an intellectual

disability or a resident with a related condition must obtain an endorsement on

its license authorizing it to operate as a residential facility for adults with

intellectual disabilities. The Division may deny an application for an

endorsement or suspend or revoke an existing endorsement based upon the grounds

set forth in NAC 449.191 or 449.1915.

     2.  Within 60 days after being employed by a

residential facility for adults with intellectual disabilities, a caregiver

must receive not less than 4 hours of training related to the care of persons

with intellectual disabilities.

     3.  If a resident with an intellectual

disability is referred to the facility by a referring agency, the members of

the staff of the facility may conduct a program to modify the behavior of the

resident if that program is developed by the agency that referred the resident

to the facility.

     4.  As used in this section, “residential

facility for adults with intellectual disabilities” means a residential

facility that provides care and protective supervision for persons with

intellectual disabilities or persons with related conditions, including,

without limitation, birth trauma, anoxia, brain trauma or other genetic or

developmental disorders.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2764  Residential facility which offers or provides care for persons

with mental illnesses: Application for endorsement; training for employees. (NRS 449.0302)

     1.  A residential facility which offers or

provides care and protective supervision for a resident with mental illness

must obtain an endorsement on its license authorizing it to operate as a

residential facility for persons with mental illnesses. The Division may deny

an application for an endorsement or suspend or revoke an existing endorsement

based upon the grounds set forth in NAC 449.191 or 449.1915.

     2.  A person who provides care for a resident

of a residential facility for persons with mental illnesses shall, within 60

days after becoming employed at the facility, attend not less than 8 hours of

training concerning care for residents who are suffering from mental illnesses.

     3.  As used in this section, “residential

facility for persons with mental illnesses” means a residential facility that

provides care and protective supervision for persons with mental illnesses,

including, without limitation, schizophrenia, bipolar disorder, psychosis and

other related disorders.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R052-99, 9-27-99; R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2766  Residential facility which offers or provides care for persons

with chronic illnesses and debilitating diseases: Application for endorsement;

training for employees. (NRS 449.0302)

     1.  A residential facility which offers or

provides care and protective supervision for a resident with a chronic illness

or progressively debilitating disease must obtain an endorsement on its license

authorizing it to operate as a residential facility for persons with chronic

illnesses. The Division may deny an application for an endorsement or suspend

or revoke an existing endorsement based upon the grounds set forth in NAC 449.191 or 449.1915.

     2.  Within 60 days after being employed by a

residential facility for persons with chronic illnesses, an employee of the

facility shall obtain at least 4 hours of in-service training relating to the

care provided to such persons and in the actions necessary to control

infections.

     3.  Evidence of training received pursuant to

subsection 2 must be included in the employee’s personnel file.

     4.  As used in this section, “residential

facility for persons with chronic illnesses” means a residential facility that provides

care and protective supervision for persons with chronic illnesses or

progressively debilitating diseases, including, without limitation, acquired

immunodeficiency syndrome and cancer.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97;

A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2768  Residential facility which provides care to persons with

dementia: Training for employees. (NRS 449.0302, 449.094)

     1.  Except as otherwise provided in

subsection 2, the administrator of a residential facility which provides care

to persons with any form of dementia shall ensure that:

     (a) Each employee of the facility who has direct

contact with and provides care to residents with any form of dementia,

including, without limitation, dementia caused by Alzheimer’s disease,

successfully completes:

          (1) Within the first 40 hours that such an

employee works at the facility after he or she is initially employed at the

facility, at least 2 hours of training in providing care, including emergency

care, to a resident with any form of dementia, including, without limitation,

Alzheimer’s disease, and providing support for the members of the resident’s

family.

          (2) In addition to the training requirements

set forth in subparagraph (1), within 3 months after such an employee is

initially employed at the facility, at least 8 hours of training in providing

care to a resident with any form of dementia, including, without limitation,

Alzheimer’s disease.

          (3) If such an employee is licensed or

certified by an occupational licensing board, at least 3 hours of continuing

education in providing care to a resident with dementia, which must be

completed on or before the anniversary date of the first date the employee was

initially employed at the facility. The requirements set forth in this

subparagraph are in addition to those set forth in subparagraphs (1) and (2),

may be used to satisfy any continuing education requirements of an occupational

licensing board, and do not constitute additional hours or units of continuing

education required by the occupational licensing board.

          (4) If such an employee is a caregiver, other

than a caregiver described in subparagraph (3), at least 3 hours of training in

providing care to a resident with dementia, which must be completed on or

before the anniversary date of the first date the employee was initially

employed at the facility. The requirements set forth in this subparagraph are

in addition to those set forth in subparagraphs (1) and (2).

     (b) The facility maintains proof of completion of

the hours of training and continuing education required pursuant to this

section in the personnel file of each employee of the facility who is required

to complete the training or continuing education.

     2.  A person employed by a facility which

provides care to persons with any form of dementia, including, without

limitation, dementia caused by Alzheimer’s disease, is not required to complete

the hours of training or continuing education required pursuant to this section

if he or she has completed that training within the previous 12 months.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

Deficiencies

      NAC 449.27702  Determination of severity and scope of deficiency; assignment of

grade. (NRS 449.0302)

     1.  The Bureau shall determine:

     (a) The severity of a deficiency of a residential

facility in accordance with the provisions of NAC

449.99861; and

     (b) The scope of a deficiency of a residential

facility in accordance with the provisions of NAC

449.9986.

     2.  After the Bureau conducts a survey of a

residential facility, the Bureau shall add the severity and scope scores for

all deficiencies of the facility indicated in the survey and assign a grade to

the facility as follows:

 



Sum of Severity and Scope Scores





Grade







0

to 15 points





A







At

least 16 points but not more than 24 points, or any deficiency with a

severity level of 3 and a scope level of 3





B







At

least 25 points but not more than 34 points, or any deficiency with a

severity level of 4 and a scope level of 1





C







At

least 35 points, or any deficiency with a severity level of 4 and a scope

level of at least 2





D







 

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.27704  Placard: Issuance and display; failure to comply. (NRS 449.0302)

     1.  After the Bureau assigns a grade to a

residential facility pursuant to NAC 449.27702,

the Bureau shall issue a placard to the residential facility.

     2.  The administrator shall, within 24 hours

after receipt of the placard, display or cause the placard to be displayed

conspicuously in a public area of the residential facility.

     3.  If the placard is not displayed in

accordance with the provisions of subsection 2, the Bureau will assess against

the residential facility a deficiency with a severity and scope score equal to

the highest severity and scope score indicated in the most recent survey of the

facility conducted by the Bureau.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.27706  Resurvey: Application and fee; failure to comply. (NRS 439.150,

439.200, 449.0302)

     1.  If the Bureau issues a placard to a

residential facility that includes a grade of “B,” the administrator may submit

an application to the Bureau for a resurvey of the facility not later than 30

days after the facility receives the placard. The fee for an application for a

resurvey is $400 and must accompany the application.

     2.  If the Bureau issues a placard to a

residential facility that includes a grade of “C” or “D,” the administrator

must submit an application to the Bureau for a resurvey of the facility not

later than 30 days after the facility receives the placard. The fee for an

application for a resurvey is $600 and must accompany the application.

     3.  The Bureau may revoke the license of a

residential facility that is required to submit an application for a resurvey

pursuant to subsection 2 if the facility fails to submit the application in

accordance with the provisions of that subsection.

     4.  As used in this section, “resurvey” has

the meaning ascribed to it in NAC 449.99838.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005;

A by R155-10, 12-16-2010)

BUSINESSES THAT PROVIDE REFERRALS TO RESIDENTIAL FACILITIES

FOR GROUPS

      NAC 449.27811  Definitions. (NRS 449.0302, 449.0305)  As used in NAC 449.27811 to 449.27831,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.27813 to 449.27821,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27813  “Client” defined. (NRS 449.0302, 449.0305)  “Client” means a person

who is referred by a referral agency for compensation to a residential facility

for groups.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27817  “Financial assessment” defined. (NRS 449.0302, 449.0305)  “Financial assessment”

means an assessment to determine the intended source of payment by a client for

services which will be provided by a residential facility for groups for 6

months, including the eligibility status of the client for services as

determined by Medicaid and Medicare.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27819  “Needs assessment” defined. (NRS 449.0302, 449.0305)  “Needs assessment” means

an assessment of a client to document the abilities of the client to function

independently, including a complete list of the areas in which the client

requires assistance.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27821  “Residential facility for groups” defined. (NRS 449.0302,

449.0305)  “Residential

facility for groups” has the meaning ascribed to it in NRS 449.017.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27823  License not required by certain persons to make referrals;

application for licensure. (NRS 449.0302, 449.0305)

     1.  A licensed nurse or social worker working

in a medical facility or a facility for the dependent licensed by the Bureau

may make a referral for a client of the facility or program to a residential

facility for groups without first obtaining a license to operate as a referral

agency. A person employed by this State or the governing body of any county or

city within this State, who is employed in a position in which the person’s

duties require him or her to make referrals for clients to residential

facilities for groups, may make those referrals without first obtaining a

license to operate as a referral agency.

     2.  An applicant for a license to operate as

a referral agency must submit to the Division a completed application on a form

provided by the Division. The application for the initial license must include,

without limitation:

     (a) Evidence that the applicant has obtained a

contract of insurance for protection against liability to third persons which

may be incurred while operating as a referral agency; and

     (b) The physical address of the applicant where the

records of the referral agency will be maintained.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99;

A by R124-05, 11-17-2005)

      NAC 449.27827  Requirements for employees. (NRS 449.0302, 449.0305)

     1.  Employees of a referral agency must have

a working knowledge of the provisions of NRS and NAC that govern the licensing

of residential facilities for groups.

     2.  An employee of a referral agency who is

not licensed as a nurse, social worker, physician or physician assistant shall

not gather any information needed to complete a needs assessment or financial

assessment of a client, or engage in the process of referring a client to a

residential facility for groups.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27829  Responsibilities of referral agency. (NRS 449.0302,

449.0305)

     1.  A referral agency shall:

     (a) Complete a needs assessment and financial

assessment for each client and make referrals for the services that would best

meet the physical, psychosocial and financial needs and wishes of the client;

and

     (b) Submit to the residential facility for groups

to which a client is referred a copy of the needs assessment completed by the

referral agency for the client.

     2.  A referral agency shall not:

     (a) Accept any fee, inducement or incentive, for

any reason, from a residential facility for groups, or from any person or

entity associated with a residential facility for groups; or

     (b) Give a discharge planner, case manager, social

worker or any other person who has the responsibility of discharge planning, a

fee or incentive for prospective clients.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27831  Contract for services; fees; maintenance of client records. (NRS 449.0302,

449.0305)

     1.  Before a referral agency may provide any

services to a client, the referral agency must obtain a written contract from

the client or his or her legal representative to provide the services. The

contract must:

     (a) Be signed by a representative of the referral

agency and the person who is paying for the services or his or her

representative; and

     (b) Include, without limitation, a description of

the services to be provided pursuant to the contract and all fees associated

with the provision of those services.

     2.  If, within 30 days after a client is

admitted to a residential facility for groups, the referral of the client to

the residential facility for groups is determined by the facility, the Bureau

or a physician to be inappropriate, the referral agency shall:

     (a) Refund the full amount of the fee paid by the

client or his or her representative; or

     (b) Assist the client with an acceptable referral

to another residential facility for groups for no additional fee.

     3.  A referral agency shall not receive more

than one fee from a client within any 6-month period unless, during that

period, the client or his or her representative requests another referral by

the referral agency.

     4.  A referral agency shall maintain an

organized file for each client that includes, without limitation:

     (a) A copy of the needs assessment and financial

assessment completed by the referral agency for the client;

     (b) A copy of the completed contract to provide the

services to the client; and

     (c) Information outlining the process used by the

referral agency for determining the appropriate referral of the client.

Ê A referral

agency shall maintain its file of a client for at least 5 years at the place of

business of the referral agency.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

HOSPITALS

General Provisions

      NAC 449.279  Definitions. (NRS 449.0302)  As used

in NAC 449.279 to 449.394,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.285 to 449.300,

inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Bd. of Health by R050-99,

9-27-99)

      NAC 449.285  “General hospital” defined. (NRS 449.0302)  “General

hospital” means a hospital that is designated a general hospital pursuant to NRS 449.202.

     [Bd. of Health, Health Facilities Reg. Part I part Ch.

III, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.286  “Governing body” defined. (NRS 449.0302)  “Governing

body” means the person or group of persons, including a board of trustees,

board of directors or other body, in whom the final authority and

responsibility is vested for conduct of a hospital.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.287  “Hospital” defined. (NRS 449.0302)  “Hospital”

has the meaning ascribed to it in NRS

449.012.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.289  “Inpatient” defined. (NRS 449.0302)  “Inpatient”

means a person who has been formally admitted into a hospital for diagnosis or

treatment.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.297  “Outpatient” defined. (NRS 449.0302)  “Outpatient”

means a person who has been registered or accepted for care in a hospital but

who has not been formally admitted as an inpatient, and who does not remain in

the hospital for more than 48 hours.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.298  “Outpatient department” defined.

(NRS 449.0302)  “Outpatient

department” means that part of a hospital used for the treatment and diagnosis

of patients not residing in the hospital.

     [Bd. of Health, Health Facilities Reg. Part I part Ch.

III, eff. 10-9-69]

      NAC 449.299  “Patient” defined. (NRS 449.0302)  “Patient”

means a person who:

     1.  Is receiving diagnostic, therapeutic or

preventive health services; or

     2.  Is under observation or treatment for an

illness or injury, or under care during and after pregnancy.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.300  “Restraint” defined. (NRS 449.0302)  “Restraint”

means the control of the activity of a patient to protect the patient or others

from injury by the seclusion of the patient or the use of mechanical devices.

The term does not include the control of the activity of a patient by the use

of mechanical supports that are used in rehabilitative situations to achieve

proper body alignment.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

Licensing and Administration

      NAC 449.307  Applicability of license; coverage against certain liabilities. (NRS 449.0302)

     1.  A hospital must be operated and conducted

in the name designated on the license, with the name of the person responsible

for its operation also appearing on the face of the license. The license is not

transferable.

     2.  Each hospital must retain proof that it

is adequately covered against liabilities resulting from claims incurred in the

course of operation.

     3.  Except as otherwise provided in this

subsection, separate licenses are required for hospitals which are maintained

on separate premises even though the hospitals are under the same management.

The provisions of this subsection do not apply to outpatient departments,

clinics or separate buildings on the same grounds.

     4.  A separate license is not required for

the provision of special services within a hospital. This subsection does not

relieve a hospital to which a special service is being added from the

requirement of obtaining the approval of the Division to amend its license

pursuant to NRS 449.087 before

providing that service.

     [Bd. of Health, Health Facilities Reg. Part II Ch. II

§§ 1-4, eff. 10-9-69; A 8-26-74]—(NAC A by R044-97, 10-30-97; R050-99, 9-27-99;

R117-05, 11-17-2005)

      NAC 449.310  Limitation on number of patients; annual on-site inspection not

required under certain circumstances. (NRS 449.0302)

     1.  A hospital shall not have more patients

than the number of beds for which it is licensed, except in emergencies. If

there is an emergency, the hospital shall notify the Bureau.

     2.  If a hospital is accredited by the Joint

Commission on Accreditation of Healthcare Organizations or the American

Osteopathic Association, the Bureau is not required to make an annual on-site

inspection of the hospital.

     [Bd. of Health, Health Facilities Reg. Part II Ch. II

§§ 5-9, eff. 10-9-69; A 8-26-74]—(NAC A by R035-97, 10-30-97; R050-99, 9-27-99)

      NAC 449.312  Change in ownership, use or construction; correction of

deficiencies. (NRS 449.0302)

     1.  Upon a change in ownership, change of use

or change in construction, a hospital shall notify the Bureau of the changes

and identify all areas of noncompliance with the guidelines specified in NAC 449.3154 before the change in ownership, use or

construction may take place.

     2.  Upon a change of use or change in

construction, a hospital must come into compliance with the guidelines before

it may admit patients into the area in which the change is made.

     3.  The Bureau shall notify a hospital in

writing of the existence of any deficiencies and the hospital shall correct

those deficiencies within a reasonable amount of time. Except for major

deficiencies, including deficiencies which require structural alterations of a

building or a portion of a building, and except as otherwise provided in this

subsection, reasonable time for the purposes of this subsection shall be deemed

to be not more than 180 days. Upon written request and just cause shown, the

Bureau may grant an extension of the time in which a deficiency must be

corrected based on extenuating circumstances.

     4.  If the deficiencies are likely to cause

serious injury, serious harm or impairment to public health and welfare, the

hospital shall take immediate action to correct the deficiencies or the

hospital will not be allowed to continue to operate.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XVI subsec. F, eff. 10-9-69; A 8-26-74; Ch. II part § XI, eff. 10-9-69]—(NAC A

by R050-99, 9-27-99)

      NAC 449.313  Responsibilities and duties of governing body; bylaws;

appointment and duties of chief executive officer; protocol for organ

donations; annual operating budget. (NRS 449.0302)

     1.  A hospital shall have an effective

governing body which is legally responsible for the conduct of the hospital.

     2.  The governing body of a hospital shall

adopt a workable set of bylaws which must be in writing and available to all

members. The governing body shall:

     (a) Determine, in accordance with state law, which

categories of practitioners are eligible for appointment to the medical staff

of the hospital;

     (b) Appoint members to the medical staff after

considering the recommendations of the existing members of the medical staff;

     (c) Ensure that the medical staff has bylaws;

     (d) Approve the bylaws of the medical staff and any

other rules and regulations adopted by the medical staff;

     (e) Ensure that the medical staff is accountable to

the governing body for the quality of care which the medical staff provides to

patients; and

     (f) Ensure that the criteria for the selection of

members to the medical staff include competence, training, experience and

judgment.

     3.  The governing body shall appoint a

qualified chief executive officer using as its criteria the actual experience,

nature and duration of hospital administration and graduate work in hospital

administration of the appointee. Following his or her selection, the chief

executive officer is responsible for the management of the hospital and for

providing liaisons among the governing body, medical staff, nursing staff and

other departments, units and services within the hospital. The chief executive

officer shall keep the governing body fully informed of the conduct of the

hospital through regular written reports. The chief executive officer must be

allowed sufficient freedom from other responsibilities to provide adequate

attention to the administration and management of the hospital.

     4.  The governing body shall ensure, in

accordance with hospital policy, that:

     (a) Each patient is under the care of at least one

of the following persons:

          (1) A doctor of medicine or osteopathy.

          (2) A doctor of dental surgery or dental

medicine who is licensed to practice dentistry in this State and who is acting

within the scope of his or her license.

          (3) A doctor of podiatric medicine, but only

with respect to those functions which he or she is licensed to perform in this

State.

          (4) A doctor of optometry who is licensed to

practice optometry in this State.

          (5) A chiropractor who is licensed to provide

chiropractic services in this State, but only with respect to the treatment of

the spine by means of manual manipulation to correct a subluxation which is

demonstrated by X-ray to exist.

     (b) A doctor of medicine or osteopathy is on duty

or on call at all times.

     (c) A doctor of medicine or osteopathy is

responsible for the care of each patient with respect to any medical or

psychiatric problem that:

          (1) Is present when the patient is admitted

into the hospital or develops after the patient is admitted; and

          (2) Is not specifically within the scope of

practice of a doctor of dental surgery, dental medicine, podiatric medicine or

optometry, or of a chiropractor, as that scope of practice is defined by the

bylaws, rules and regulations of the medical staff.

     5.  To identify potential organ donors, a

hospital shall have written protocols that:

     (a) Ensure that the family of each potential donor

knows of its option to donate organs or tissues, or both, or to decline to make

such a donation; and

     (b) Encourage discretion and sensitivity with

respect to the circumstances, views and beliefs of the families of potential

donors.

     6.  A hospital in which organ transplants are

performed:

     (a) Must be a member of the Organ Procurement and

Transplantation Network established and operated in accordance with section 372

of the Public Health Service Act, 42 U.S.C. § 274; and

     (b) Shall abide by the rules and regulations of the

Organ Procurement and Transplantation Network.

     7.  A hospital shall have an overall

institutional plan which includes an annual operating budget that is prepared

according to generally accepted accounting principles. The annual operating

budget must include anticipated income and expenses, except that the hospital

is not required to identify item-by-item the components of each anticipated

income or expense.

     8.  The governing body is responsible for the

services furnished in the hospital, regardless of whether the services are

furnished by staff or pursuant to contracts. The hospital shall maintain a list

of contracted services which includes the scope and nature of the services

provided.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

1, eff. 10-9-69; A 8-26-74; ch. II § I, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.314  Quality of care; scope of services. (NRS 449.0302)

     1.  A hospital must be administered in a

manner that enables the hospital to use its resources effectively and

efficiently to meet the needs of and provide quality care to its patients. The

governing body of a hospital shall develop and provide services for the care of

its patients based on the identified needs of those patients.

     2.  The scope of services provided by each

department, unit or service within a hospital must be defined in writing and

must be approved by the administration and the medical staff of the hospital.

Each department, unit or service within a hospital shall provide patient care

in accordance with its scope of services. The policies and procedures of a

hospital and of each department, unit or service within the hospital must, to

the extent necessary, be integrated with the policies and procedures of the

other departments, units and services within the hospital.

     3.  The governing body of a hospital shall:

     (a) Ensure that the competence of all members of

the hospital staff is assessed, maintained, demonstrated and improved;

     (b) Provide an orientation process for persons

hired to work at the hospital that includes initial job training and

information; and

     (c) Assess the ability of the members of the

hospital staff to fulfill their specified responsibilities.

     4.  A hospital shall ensure that it is

staffed by a sufficient number of personnel, whose qualifications are

consistent with their job responsibilities, to provide care to the patients of

the hospital.

     5.  The chief executive officer of a hospital

is responsible for operating the hospital in accordance with the authority

conferred on him or her by the governing body.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3152  Quality improvement program. (NRS 449.0302)

     1.  The governing body of a hospital shall

ensure that the hospital has an effective, comprehensive quality improvement

program to evaluate the provision of care to its patients.

     2.  The quality improvement program must:

     (a) Be ongoing;

     (b) Include a written plan for carrying out the

program; and

     (c) Provide for the creation of a committee to

oversee the program.

     3.  All services related to patient care,

including services furnished by a contractor, must be evaluated by the

committee.

     4.  Nosocomial infections, medication therapy

and deaths occurring in the hospital must be evaluated by the committee.

     5.  All medical and surgical services

performed in the hospital must be evaluated by the committee as those services

relate to the appropriateness of the diagnosis and treatment.

     6.  The committee shall initiate an assessment

of a service or the provision of care when any statistical analysis detects an

undesirable variation in performance.

     7.  The committee shall take and document

appropriate remedial action to address deficiencies found through the quality

improvement program. The committee shall document the outcome of any remedial

action taken.

     8.  When the findings of an assessment relate

to the performance of an individual licensed practitioner, the medical staff

shall determine how such a finding will be used in any peer review, ongoing

monitoring and periodic evaluations of the competence of the practitioner. If

the findings of the assessment relate to the performance of a person who is not

a licensed practitioner, the director of the department, unit or service in which

that person works shall determine how the finding will be used in evaluating

the competence of the person.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3154  Construction, remodeling, maintenance and change of use: General

requirements; prerequisites to approval of licensure. (NRS 449.0302)

     1.  Except as otherwise provided in this

section, a hospital shall comply with the provisions of NFPA 101: Life

Safety Code, adopted by reference pursuant to NAC

449.0105.

     2.  Except as otherwise provided in this

section, any new construction, remodeling or change in the use of a hospital

must comply with the Guidelines for Design and Construction of Hospital and

Health Care Facilities, adopted by reference pursuant to NAC 449.0105, unless the remodeling is limited to

refurbishing an area of the hospital, including, without limitation, painting

the area, replacing the flooring in the area, repairing windows in the area and

replacing window or wall coverings in the area.

     3.  Except as otherwise provided in

subsection 4, a hospital shall meet all applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without

limitation, zoning ordinances; and

     (c) Life safety, environmental, health, fire and

local building codes,

Ê related to

the construction and maintenance of the hospital. If there are any differences

between the state and local codes, the more restrictive standards apply.

     4.  A hospital which is inspected and

approved by the State Public Works Division of the Department of Administration

in accordance with the provisions set forth in chapter 341 of NRS and chapter 341 of NAC is not required to comply with

any applicable local building codes related to the construction and maintenance

of the hospital.

     5.  A complete copy of the building plans for

new construction and remodeling of a hospital, drawn to scale, must be

submitted to the entity designated to review such plans by the Division of

Public and Behavioral Health pursuant to the provisions of NAC 449.0115. Before the construction or remodeling

may begin, plans for the construction or remodeling must be approved by the

Division of Public and Behavioral Health.

     6.  The Bureau shall not approve the

licensure of a hospital until all construction has been completed and a survey

is conducted at the site. The plan review is only advisory and does not

constitute prelicensing approval.

     7.  Notwithstanding any provision of this

section to the contrary, a hospital which was licensed on January 1, 1999,

shall be deemed to be in compliance with this section if the use of the

physical space in the hospital does not change and the existing construction of

the hospital does not have any deficiencies which are likely to cause serious

injury, serious harm or impairment to public health and welfare.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99;

A by R076-01, 10-18-2001; R068-04, 8-4-2004)

      NAC 449.3156  Compliance with certain guidelines for design and construction;

correction of deficiencies. (NRS 449.0302)

     1.  Notwithstanding any provision of NAC 449.3154 to the contrary, a hospital shall be

deemed to be in compliance with the provisions of the Guidelines for Design

and Construction of Hospital and Health Care Facilities, adopted by

reference pursuant to NAC 449.0105, if:

     (a) The hospital submitted architectural plans to

the Bureau on or before February 1, 1999;

     (b) The hospital began construction on or before

August 1, 1999;

     (c) The plans were determined by the Bureau to be

in compliance with the provisions of NAC 449.002 to

449.99939, inclusive, that were in effect on

December 1, 1998;

     (d) The hospital is built in accordance with those

provisions;

     (e) The use of the physical space in the hospital

has not changed; and

     (f) There are no deficiencies in the construction

of the hospital which are likely to cause serious injury, serious harm or

impairment to public health and welfare.

     2.  If there are deficiencies that are likely

to cause serious injury, serious harm or impairment to public health and

welfare, the hospital shall take immediate action to correct the deficiencies

or the hospital will not be allowed to continue to operate.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99;

A by R068-04, 8-4-2004)

Policies and Procedures for Operation of Hospital

      NAC 449.316  Physical environment: Safety and well-being of patients; plan for

emergency preparedness; safety management. (NRS 449.0302)

     1.  The buildings of a hospital must be

solidly constructed with adequate space and safeguards for each patient. The

condition of the physical plant and the overall hospital environment must be

developed and maintained in a manner so that the safety and well-being of

patients are ensured.

     2.  A hospital shall develop and carry out a

comprehensive plan for emergency preparedness which:

     (a) Addresses internal and external emergencies,

both local and widespread; and

     (b) Is based on current standards for disaster

management and fire safety.

     3.  A hospital shall ensure that the hospital

staff and patients are adequately protected from fire and other disasters. To

ensure that it has adequate fire protection, a hospital shall provide for the

installation of extinguishers, sprinkling devices, fire barriers and the

elimination of fire hazards.

     4.  The governing body shall analyze

identified issues relating to safety management within the environment of care

and develop or approve recommendations for addressing those issues. The

governing body shall carry out and monitor the effectiveness of the recommendations.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

II part subsec. A & subsec. E, eff. 10-9-69; A 8-26-74; Ch. II part § II,

eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.317  Risk management. (NRS 449.0302)  Each

hospital shall have in effect a comprehensive program for risk management and

shall designate one person to be responsible for the implementation and

maintenance of the program for risk management.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.319  Requirements for personal needs of patients. (NRS 449.0302)

     1.  A hospital shall provide patients access

to their belongings as is appropriate based on the needs of the patients and

the phase of treatment of the patients.

     2.  A hospital shall communicate and enforce

a nonsmoking policy throughout the hospital.

     3.  A hospital shall provide a clean and

comfortable bed and mattress for each patient. Bed linen, blankets, pillows,

washcloths and towels that are clean and in good condition must be provided to

each patient. A hospital shall have such systems as are necessary to ensure

that an adequate supply of clean linen is provided to each patient.

     4.  A hospital shall provide each inpatient

with necessary bedside equipment and supplies based on the needs of the

inpatient. The necessary equipment and supplies must include, without

limitation, a water pitcher and equipment for personal hygiene. The equipment

and supplies must be maintained in a sanitary manner.

     5.  In public areas and in areas in which

patient care is provided, a hospital shall:

     (a) Provide adequate and comfortable lighting

levels;

     (b) Provide comfortable and safe temperature

levels; and

     (c) Maintain comfortable sound levels.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

II part subsec. A, eff. 10-9-69; A 8-26-74; Ch. II part § II, eff. 10-9-69]—(NAC

A by R050-99, 9-27-99)

      NAC 449.322  Housekeeping and laundry services. (NRS 449.0302)

     1.  A hospital shall establish organized

housekeeping services planned, operated and maintained to provide a pleasant,

safe and sanitary environment. Adequate personnel, using accepted practices and

procedures, shall keep the hospital free from offensive odors, accumulations of

dirt, rubbish, dust and safety hazards.

     2.  Suitable equipment and supplies must be

provided for cleaning all surfaces. The equipment must be maintained in a safe,

sanitary condition. Storage areas, attics and cellars must be kept safe and

free from accumulations of extraneous materials such as refuse, discarded

furniture and equipment, and old newspapers. Combustibles such as cleaning rags

and compounds and hazardous substances must be labeled properly and stored in

safe places. Paper towels, tissues and similar supplies must be stored in a

manner to prevent their contamination before use.

     3.  Cleaning must be performed in a manner to

minimize the spread of pathogenic organisms. Floors must be cleaned regularly.

Polishes on floors must provide a nonslip finish. Throw or scatter rugs must

not be used except for nonslip entrance mats.

     4.  Housekeeping personnel must receive

adequate supervision. Continuous in-service training programs must be

established for housekeeping personnel.

     5.  A hospital shall develop and carry out

standards and systems for the operation of laundry services. Laundry services,

whether owned by the hospital or provided pursuant to a contract, must:

     (a) Maintain standards for a safe work environment

for employees;

     (b) Address issues relating to the control of

infections; and

     (c) Be operated in a manner that does not disrupt

the patient care provided by the hospital.

     6.  A hospital shall develop and carry out:

     (a) Standards and systems for the storage and

handling of clean linen and soiled linen; and

     (b) Written policies relating to the handling,

storage, transportation and processing of its linen.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

II part subsec. A, eff. 10-9-69; A 8-26-74; Ch. II part § II, eff. 10-9-69]—(NAC

A by R050-99, 9-27-99)

      NAC 449.325  Prevention, control and investigation of infections and

communicable diseases. (NRS 449.0302)

     1.  A hospital shall:

     (a) Provide a sanitary environment to avoid sources

and transmission of infections and communicable diseases; and

     (b) Develop and carry out an active program for the

prevention, control and investigation of infections and communicable diseases.

     2.  A hospital shall designate at least one

person as an infection control officer, who shall develop and carry out

policies governing the control of infections and communicable diseases.

     3.  The infection control officer of a

hospital shall:

     (a) Develop a system for identifying, reporting,

investigating and controlling infections and communicable diseases of patients

and personnel of the hospital; and

     (b) Maintain a record of incidents within the

hospital related to infection and communicable disease.

     4.  The chief executive officer, the medical

staff and the chief administrative nurse of a hospital:

     (a) Shall ensure that the quality improvement

program established pursuant to NAC 449.3152 and

the training program for the entire hospital address those problems identified

by the infection control officer of the hospital; and

     (b) Are responsible for the implementation of

successful corrective plans of action in affected problem areas.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

II part subsec. A & subsec. D, eff. 10-9-69; A 8-26-74; Ch. II part § II,

eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.327  Preparation, sterilization, storage and distribution of sterile

supplies and medical and surgical equipment. (NRS 449.0302)

     1.  To meet the ongoing needs of its

patients, a hospital shall:

     (a) Provide a designated area for the preparation,

sterilization and storage of sufficient sterile supplies and medical and

surgical equipment; and

     (b) Dispense the sterile supplies and equipment to

all departments, units and services within the hospital.

     2.  A hospital which prepares, sterilizes and

stores its supplies and equipment directly shall develop systems and standards

that are consistent with:

     (a) The standards for the control of infection

established by the infection control officer of the hospital;

     (b) The standards developed by the Occupational

Safety and Health Administration for the preparation, sterilization and storage

of such supplies and equipment; and

     (c) When applicable, the manufacturer’s guidelines

for the use and maintenance of the equipment.

     3.  If the supplies and equipment are

sterilized on the premises of a hospital, the process of sterilization must be

supervised by a person who has received specialized training in the operation

of the process of sterilization, including training in methods of testing the

process to verify the efficiency of the process of sterilization.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.329  Admission of patients. (NRS 449.0302)  A

hospital shall:

     1.  Develop and carry out policies and

procedures for admitting patients to the appropriate levels of care; and

     2.  Ensure that each patient, or the parent,

guardian or other person legally responsible for the patient, receives

information about the proposed care of the patient.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.331  Emergency services and medical care; transfer agreements. (NRS 449.0302)

     1.  A hospital shall develop and carry out

policies and procedures to ensure that emergency services and medical care are

provided in accordance with NRS

439B.410 and 450B.790 and

42 C.F.R. § 489.24 and to ensure compliance with the provisions of NRS 450B.795.

     2.  All general hospitals not having their

own long-term facility shall have transfer agreements with long-term care

facilities. Transfer agreements between facilities must be in writing and on

file at each facility concerned. The agreements must provide for:

     (a) The transfer of patients between facilities

whenever the need for transfer is medically determined; and

     (b) The exchange of appropriate medical and

administrative information between facilities.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XVI subsecs. A, B & D, eff. 10-9-69; Ch. II part § XI, eff. 10-9-69]—(NAC A

by R050-99, 9-27-99; R138-07, 1-30-2008)

      NAC 449.332  Discharge planning. (NRS 449.0302)

     1.  A hospital shall:

     (a) Have a process for discharge planning that

applies to all inpatients; and

     (b) Develop and carry out policies and procedures

regarding the process for discharge planning.

     2.  The process for discharge planning must

include the participation of registered nurses, social workers or other

personnel qualified, through education or experience, to perform discharge

planning.

     3.  A hospital shall, at the earliest

possible stage of hospitalization, identify each patient who is likely to

suffer adverse health consequences upon discharge if the patient does not

receive adequate discharge planning. The hospital shall provide for an

evaluation of the needs related to discharge planning of each patient so

identified.

     4.  An evaluation of the needs of a patient

relating to discharge planning must include, without limitation, consideration

of:

     (a) The needs of the patient for postoperative

services and the availability of those services;

     (b) The capacity of the patient for self-care; and

     (c) The possibility of returning the patient to a

previous care setting or making another appropriate placement of the patient

after discharge.

     5.  If the evaluation of a patient relating

to discharge planning indicates a need for a discharge plan, a discharge plan

must be developed under the supervision of a registered nurse, social worker or

other person qualified to perform discharge planning.

     6.  An evaluation of a patient relating to

discharge planning and a discharge plan for the patient may be requested by the

patient, a physician, a member of the family of the patient or the guardian of the

patient, if any.

     7.  If a hospital finds that a patient does

not need a discharge plan, the attending physician may still request a

discharge plan for the patient. If the attending physician makes such a

request, the physician shall collaborate as much as necessary with the hospital

staff in the development of the discharge plan.

     8.  Activities related to discharge planning

must be conducted in a manner that does not contribute to delays in the

discharge of the patient.

     9.  The evaluation of the needs of a patient

relating to discharge planning and the discharge plan for the patient, if any,

must be documented in his or her medical record.

     10.  The discharge plan must be discussed

with the patient or the person acting on behalf of the patient.

     11.  The patient, members of the family of

the patient and any other person involved in caring for the patient must be

provided with such information as is necessary to prepare them for the

posthospital care of the patient.

     12.  If, during the course of a patient’s

hospitalization, factors arise that may affect the needs of the patient

relating to his or her continuing care or current discharge plan, the needs of

the patient must be reassessed and the plan, if any, must be adjusted

accordingly.

     13.  A hospital shall arrange for the initial

implementation of the discharge plans of its patients.

     14.  If identified in a discharge plan,

referral of a patient to outpatient services or transfer of the patient to

another facility must be accomplished in a manner that meets the identified

needs of the patient, including the sharing of necessary medical information

about the patient with the receiving service or facility.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.337  Dietary services: General requirements. (NRS 449.0302)

     1.  A hospital shall provide each patient

with a nourishing, palatable, well-balanced diet that meets the daily

nutritional and dietary needs of the patient.

     2.  The menu for a patient must meet the

nutritional needs of the patient in accordance with:

     (a) Recognized dietary practices; and

     (b) The orders of the practitioners responsible for

the care of the patient.

     3.  A hospital shall ensure that not less

than three meals are served daily to patients and not more than 15 hours elapse

between the evening meal and breakfast served the following day.

     4.  Nourishment and feeding between meals

must be provided as required by diet prescription and must be available to each

patient unless otherwise ordered by the physician of the patient.

     5.  Except as otherwise provided in this

subsection, menus must be followed. A meal may vary from the planned menu if

the change is noted in writing in the records maintained by the dietary

services.

     6.  A hospital shall ensure that the food and

religious preferences of a patient are respected to the extent practicable and

that substitute food is available through the use of a selective menu or

substitutes from appropriate food groups.

     7.  A hospital shall ensure that persons who

are responsible for therapeutic diets have sufficient knowledge of food values

to make appropriate substitutions when necessary.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

V, eff. 10-9-69; Ch. II § V, eff. 10-9-69]—(NAC A by R035-97, 10-30-97; R050-99,

9-27-99)

      NAC 449.338  Dietary services: Provision for needs of patients; facilities;

standards; permits; records. (NRS 449.0302)

     1.  A hospital shall provide for the general

dietary needs of its patients, including the preparation of modified special

diets.

     2.  Adequate space for the preparation and

service of food must be provided. Equipment for the preparation and service of

food must be placed to provide aisles of sufficient width to permit easy

movement of personnel, mobile equipment and supplies.

     3.  Well-ventilated food storage areas of

adequate size must be provided.

     4.  Adequate space must be maintained to

accommodate equipment, personnel and procedures necessary for the proper

cleaning and sanitizing of dishes and other utensils.

     5.  Office or other suitable space must be

provided for the dietitian and dietetic service supervisor.

     6.  In providing for the preparation and

serving of food, a hospital shall:

     (a) Comply with the standards prescribed in chapter 446 of NRS and the regulations

adopted pursuant thereto;

     (b) Obtain the necessary permits from the Division;

     (c) Maintain a report of each inspection concerning

the sanitation of the hospital for at least 1 year after the date of the

inspection; and

     (d) Maintain a report of each corrective action

taken to address a deficiency noted in a report described in paragraph (c) for

at least 1 year after the date of the corrective action.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99;

A by R068-04, 8-4-2004; R155-10, 12-16-2010)

      NAC 449.3385  Dietary services: Personnel. (NRS 449.0302)

     1.  A hospital shall maintain an organized

dietary service that is staffed by an adequate number of personnel. The

hospital shall ensure that personnel are on duty to provide dietary services

for at least 12 hours each day and that the personnel are competent to perform

their duties as outlined in their job descriptions. The dietary service must be

integrated with the other departments, units and services within the hospital.

     2.  The dietary service must be under the

direction of a licensed dietitian or other professional person who:

     (a) Is qualified in the field of institutional

management, nutritional sciences or hotel restaurant management;

     (b) Has completed an academic program in culinary

arts; or

     (c) Is certified as a dietary manager by the

Association of Nutrition & Foodservice Professionals and has additional

work experience with medical and therapeutic diets.

     3.  The director of the dietary service may

be employed on a full-time or part-time basis, or as a consultant.

     4.  A hospital shall have on staff a licensed

dietitian or a consultant who is licensed as a dietitian who shall provide

in-service training for all dietetic service personnel and maintain a record of

the in-service training provided which includes a description of the subjects

covered by the training, the date that the training was given, the duration of

the training and a list of the persons who attended the training.

     5.  Personnel of the dietary service must:

     (a) Be trained in basic techniques of food

sanitation;

     (b) While working in the dietary service, be clean

and wear clean clothing, including a cap or hairnet, or both; and

     (c) Be excluded from duty when affected by a skin

infection or communicable disease.

     6.  If an employee of the dietary service has

a beard or moustache, or both, which is not closely cropped, the employee shall

cover the beard or moustache, or both, while on duty.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99;

A by R068-04, 8-4-2004; R090-12, 12-20-2012)

      NAC 449.339  Dietary services: Nutritional status of patients. (NRS 449.0302)

     1.  A hospital shall carry out a program for the

systematic nutritional risk-screening of its patients to detect actual and

potential malnutrition at an early stage.

     2.  A hospital shall ensure that each patient

maintains acceptable parameters of nutritional status, including, without

limitation, body weight and protein levels, unless the patient’s clinical

condition demonstrates that the maintenance of those parameters is not

possible.

     3.  A patient who is fed by an enteral

feeding system must receive the appropriate treatment and services to prevent

complications to the extent possible.

     4.  Parenteral nutrition support must be used

to nourish a patient who meets clinical guidelines that are developed in

accordance with nationally recognized standards of practice and approved by the

medical staff of the hospital.

     5.  A patient must receive a therapeutic diet

when it is determined that he or she has a nutritional problem.

     6.  The director of the dietary service shall

develop and carry out policies and procedures for nutritional care and dietetic

services. The policies and procedures must be readily available to nursing,

dietary and medical staff. The director shall evaluate the policies and

procedures for nutritional care and services provided by the dietary service on

a regular basis and revise those policies and procedures as necessary.

     7.  If it is determined that the nutritional

status of a patient is at risk, nutritional care for that patient must be:

     (a) Planned and provided based on an assessment of

his or her nutritional status by a licensed dietitian or the attending

physician, or both; and

     (b) Integrated into his or her plan of care.

Ê The response

of the patient must be monitored and reassessed as needed.

     8.  Pertinent dietary information must be

included in a patient’s transfer records or discharge records, or both, to

ensure continuity of nutritional care.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99;

A by R090-12, 12-20-2012)

      NAC 449.3395  Dietary services: Sanitary conditions; supplies. (NRS 449.0302)

     1.  A hospital shall store, prepare,

distribute and serve food under sanitary conditions.

     2.  A hospital shall maintain on its premises

at least a 1-week supply of staple foods and at least a 2-day supply of

perishable foods. The supplies must be appropriate to meet the requirements of

the menu. All food must be of good quality and procured from sources approved

or considered satisfactory by federal, state and local authorities. Food that

is contained in a container or can that:

     (a) Is unlabeled, if the contents of the container

or can are not readily identifiable without opening the container or can;

     (b) Is rusty, leaking or broken; or

     (c) Has dents or swelling,

Ê is not

acceptable and must not be maintained.

     3.  All kitchens and kitchen areas in a

hospital must be kept clean, kept free from litter and rubbish, and protected

from rodents, roaches, flies and other insects. The hospital shall take such

measures as are necessary for preventive pest control. All utensils, counters,

shelves and equipment must be kept clean, maintained in good repair, and free

from breaks, corrosions, open seams, cracks and chipped areas. Plastic ware,

china and glassware that is unsightly, unsanitary or hazardous because of

chips, cracks or loss of glaze must be discarded.

     4.  After each use, utensils used for eating

or drinking or used in the preparation of food or drink must be cleaned and

disinfected, or discarded.

     5.  Kitchen sinks must not be used for

washing hands. Separate facilities for washing hands, which includes soap,

running water and individual towels, must be provided.

     6.  Kitchen wastes that are not disposed of

by mechanical means must be:

     (a) Kept in containers which:

          (1) Are leak proof;

          (2) Are made of nonabsorbent materials; and

          (3) Can be tightly closed; and

     (b) Disposed of as frequently as necessary to

prevent a nuisance or unsightliness.

     7.  Ice which is used in connection with food

or drink must be from a sanitary source and must be handled and dispensed in a

sanitary manner.

     8.  A person other than personnel of the

dietary service may not be in the kitchen area unless the person is required to

be there in the performance of his or her duties.

     9.  Equipment of the type and in the amount

necessary for the proper preparation, service and storage of food and for

proper dishwashing must be provided and maintained in good working order.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.340  Pharmaceutical services. (NRS 449.0302)

     1.  A hospital shall have a pharmacy directed

by a registered pharmacist, who may be a full-time, part-time or consulting

pharmacist, or a drug room supervised by no less than a currently licensed

professional nurse. If a hospital has an organized pharmaceutical service, the

full-time, part-time or consulting pharmacist shall develop, supervise and

coordinate all the activities of the service.

     2.  The pharmacy and area for drug storage

must be administered in accordance with all applicable state and federal laws.

     3.  Except as otherwise provided in this

subsection, the medical staff shall develop policies and procedures to minimize

errors in the administration of the drugs. The medical staff may designate the

organized pharmaceutical service of the hospital to develop the policies and

procedures required by this subsection.

     4.  The pharmaceutical service of a hospital

shall have an adequate number of personnel to ensure quality pharmaceutical

services, including emergency services.

     5.  Drugs and biologicals must be controlled

and distributed in a manner which is consistent with applicable state and

federal laws.

     6.  When a pharmacist is not available, drugs

and biologicals may be removed from the pharmacy or storage area only by

personnel designated by the policies of the medical staff and pharmaceutical

service, which must be established in accordance with all applicable state and

federal laws, to remove the drug or biological.

     7.  Errors in administering a drug to a

patient, adverse reactions by a patient to a drug and incompatibilities between

a drug and patient must be immediately reported to the attending physician of

the patient and, if appropriate, to the committee that oversees the quality

improvement program established pursuant to NAC

449.3152.

     8.  Abuses and losses of controlled

substances must be reported, in accordance with all applicable state and

federal laws, to the person responsible for the pharmaceutical service and the

chief executive officer of the hospital.

     9.  Information relating to drug

interactions, drug therapy, side effects, toxicology, dosage indications for

use and routes of administration must be made available to the professional

members of the hospital staff.

     10.  A formulary system must be established

by the medical staff to ensure the provision of quality pharmaceuticals at

reasonable costs.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

VII subsecs. A-C, eff. 10-9-69; Ch. II part § VII, eff. 10-9-69]—(NAC A by R050-99,

9-27-99)

      NAC 449.343  Orders for medication and biologicals. (NRS 449.0302)

     1.  Except as otherwise provided in this

section, an order for medication or biologicals for a patient must be in

writing and signed by the practitioner, or other appropriate professional

person authorized by state or federal law to order the medication or

biological, who is responsible for the care of the patient.

     2.  When a telephone or verbal order is used

to order medications or biologicals, the order must be:

     (a) Accepted only by a person who is authorized by

the policies and procedures of the medical staff, which must be consistent with

state law, to accept such an order; and

     (b) Signed or initialed by the prescribing

practitioner in accordance with hospital policy.

     3.  An order for a medication or a biological

must include the name of the medication or biological and the dosage, time or

frequency of administration and route of administration of the medication or

biological.

     4.  Medication and biologicals that are not

specifically prescribed as to time or number of doses must be automatically

stopped after a reasonable time that has been predetermined by the medical

staff for that medication or biological.

     5.  Emergency medications approved by the

medical staff or advisory physician must be kept readily available in the

pharmacy or drug room and in compliance with all federal, state and local laws.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

VII subsecs. D-H, eff. 10-9-69; Ch. II part § VII, eff. 10-9-69]—(NAC A by R050-99,

9-27-99)

      NAC 449.344  Administration of medication; security. (NRS 449.0302)

     1.  Only members of the hospital staff who

are legally authorized to administer medications may do so.

     2.  Security of all medications must be

maintained in accordance with applicable state law.

     3.  The quality improvement program

established pursuant to NAC 449.3152 must include

a system of security to monitor and improve the process of administering

medications.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.346  Rehabilitative services. (NRS 449.0302)

     1.  Rehabilitative services are those

activities used in restoring, maintaining and improving the physical and mental

well-being of a patient. A hospital shall provide rehabilitative services

consistent with its overall role in the treatment of a patient by or under the

supervision of persons professionally licensed in this State to render such

services.

     2.  If a hospital provides rehabilitative

services, including, without limitation, physical therapy, occupational

therapy, audiology or speech pathology, the services must be organized and

staffed to ensure the health and safety of the patients. The organization of

the services must be appropriate to the scope of the services offered.

     3.  The director of the rehabilitative

services must have the necessary knowledge, experience and capabilities to

supervise and administer properly the services provided.

     4.  Rehabilitative services provided by a

hospital in accordance with this section must be provided by persons who meet

the qualifications specified by the medical staff.

     5.  Rehabilitative services must be furnished

to each patient in accordance with his or her written plan of treatment. The

services must be provided pursuant to the order of a practitioner who is

authorized by the medical staff to order such services, and those orders must

be incorporated into the record of the patient.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XII, eff. 10-9-69; Ch. II § VIII, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.349  Emergency services. (NRS 449.0302)

     1.  A hospital shall meet the emergency needs

of its patients in accordance with nationally recognized standards of practice.

     2.  If a hospital does not have an emergency

department on-site, the policies and procedures for meeting the emergency needs

of patients must be under the direction of a qualified member of the medical

staff.

     3.  If a hospital provides emergency services

through an emergency department:

     (a) The services must be organized under the direct

supervision of a qualified member of the medical staff;

     (b) The services must be integrated with the other

departments, units and services within the hospital; and

     (c) The policies and procedures governing the

provision of medical care in the emergency department must be established by

and are the continuing responsibility of the medical staff.

     4.  A hospital shall have sufficient medical

and nursing personnel who are qualified in emergency medical care to carry out

the written emergency procedures of, and to meet the emergency needs

anticipated by, the hospital.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XIV, eff. 10-9-69; Ch. II § IX, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.352  Social services. (NRS 449.0302)

     1.  A hospital shall have effective written

policies and procedures for the provision of social services by the hospital

staff.

     2.  Social services must be provided or

supervised in accordance with chapter

641B of NRS by a professional, qualified social worker who is appropriately

trained and has adequate experience to meet the social and emotional needs of

the patients and their families. If the social worker does not have the

educational and experiential requirements of a qualified social worker, an

ongoing plan for consultation between the social worker and a qualified social

worker must be developed.

     3.  A hospital shall provide to each patient

access to related social services based on the assessed needs of the patient.

     4.  As used in this section, “qualified

social worker” means a licensed social worker who has had at least 1 year of

actual work experience in a hospital setting.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XV, eff. 10-9-69; Ch. II § X, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.355  Discrimination prohibited. (NRS 449.0302)  A

hospital shall not discriminate in the admission of, or the provision of

services to, a person on the basis of his or her race, color, religion,

national origin, age, gender, disability or ability to pay.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XVI subsec. E, eff. 10-9-69; Ch. II part § XI, eff. 10-9-69]—(NAC A by R050-99,

9-27-99)

      NAC 449.358  Medical staff. (NRS 449.0302)

     1.  A hospital shall have a well-organized

medical staff that operates in accordance with the bylaws approved by the

governing body.

     2.  The medical staff must be appointed by

the governing body and be composed of:

     (a) Doctors of medicine or osteopathy; and

     (b) To the extent authorized by state law, other

practitioners.

     3.  The medical staff shall periodically

conduct appraisals of its members.

     4.  The members of the medical staff shall

examine the credentials of candidates for membership to the medical staff and

make recommendations to the governing body on the appointment of those

candidates to the medical staff.

     5.  The medical staff is accountable to the

governing body for the quality of the medical care provided to the patients of

the hospital.

     6.  If the medical staff has an executive

committee, a majority of the members of the executive committee must be doctors

of medicine or osteopathy.

     7.  The responsibility for the organization

and conduct of the medical staff must be assigned only to a doctor of medicine

or osteopathy.

     8.  The medical staff shall adopt and enforce

bylaws to carry out its responsibilities. The bylaws must:

     (a) Be approved by the governing body of the

hospital.

     (b) Include a statement of the duties and

privileges for each category of the medical staff, including, without

limitation, active status and courtesy privileges.

     (c) Describe the organization of the medical staff.

     (d) Describe the qualifications that a candidate

for membership to the medical staff must have before the medical staff will

consider the recommendation of the candidate for membership.

     (e) Include criteria for determining the privileges

to be granted to individual practitioners and a procedure for applying the

criteria to persons requesting privileges.

     (f) Include a requirement that a physical

examination and medical history be done on each patient not more than 7 days

before or more than 48 hours after the patient is admitted into the hospital by

a member of the medical staff who is a doctor of medicine or osteopathy.

     9.  The medical staff shall attempt to secure

autopsies in all cases in which the death of the patient is unusual or is of

legal, medical or educational interest. The medical staff shall:

     (a) Specifically define a mechanism for documenting

permission to perform an autopsy;

     (b) Establish a system for notifying the members of

the medical staff and the attending physician when an autopsy is to be

performed; and

     (c) Ensure that all autopsies performed in the

hospital are authorized pursuant to NRS

451.010.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

III, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.361  Nursing services. (NRS 449.0302)

     1.  A hospital shall have a well-organized

plan that provides for 24-hour nursing services. The nursing services must be

furnished or supervised by a registered nurse.

     2.  The governing body and the hospital shall

ensure that the nursing services provided at the hospital are provided in

accordance with all applicable federal and state laws and regulations.

     3.  The nursing service shall have a

sufficient number of licensed registered nurses, licensed practical nurses and

other personnel to provide nursing care to all patients as needed. A sufficient

number of registered nurses and other members of the nursing staff must be on

duty at all times to ensure that proper care is provided to each patient. A

person who is not a registered nurse may be assigned to care for a patient, if:

     (a) The extent of care provided by the person is

consistent with his or her education and experience and is within his or her

scope of practice; and

     (b) The person is supervised by a registered nurse

while providing that care.

     4.  A hospital shall have a system for

determining the nursing needs of each patient. The system must include

assessments made by a registered nurse of the needs of each patient and the

provision of staffing based on those assessments.

     5.  The plan for providing nursing services

must include a plan of administrative authority and a delineation of

responsibilities for patient care.

     6.  A hospital shall ensure that the nursing

staff develops and keeps current a plan for nursing care for each inpatient.

     7.  The nursing services must be under the

direct supervision of a chief administrative nurse. The chief administrative

nurse must be knowledgeable, skilled and competent in clinical practice and

nursing management. The chief administrative nurse shall direct and supervise

the nursing services in compliance with chapter

632 of NRS and nationally recognized professional standards for organized

nursing services.

     8.  The chief administrative nurse shall

define the policies, procedures and standards relating to the provision of

nursing services and shall ensure that the members of the nursing staff carry

out those policies, procedures and standards. The policies, procedures and

standards must be documented and accessible to each member of the nursing staff

in written or electronic form. The chief administrative nurse must approve each

element of the policies, procedures and standards before the element may be

used or put into effect.

     9.  A hospital shall ensure that its patients

receive proper treatment and care provided by its nursing services in

accordance with nationally recognized standards of practice and physicians’

orders.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

IV, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.3622  Appropriate care of patients. (NRS 449.0302)

     1.  Each patient must receive, and the

hospital shall provide or arrange for, individualized care, treatment and

rehabilitation based on the assessment of the patient that is appropriate to

the needs of the patient and the severity of the disease, condition, impairment

or disability from which the patient is suffering.

     2.  The governing body shall ensure that each

person’s role in providing care to a patient is determined by:

     (a) The professional skills, competence and

credentials of the person providing care;

     (b) The care or rehabilitation to be provided to

the patient;

     (c) The policies of the hospital; and

     (d) The relevant required licensure or

certification, regulation, privileges, scope of practice and job description of

the person.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3624  Assessment of patients. (NRS 449.0302)

     1.  To provide a patient with the appropriate

care at the time that the care is needed, the needs of the patient must be

assessed continually by qualified hospital personnel throughout the patient’s

contact with the hospital. The assessment must be comprehensive and accurate as

related to the condition of the patient.

     2.  Each patient must be reassessed according

to hospital policy:

     (a) When there is a significant change in the

patient’s condition;

     (b) When there is a significant change in the

patient’s diagnosis; or

     (c) To determine the patient’s response to the care

that he or she is receiving.

     3.  The hospital shall ensure that the

hospital staff develop and keep current a plan of care for each inpatient based

on the assessed needs of the inpatient.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3626  Rights of patients. (NRS 449.0302)  A

governing body shall develop and carry out policies and procedures that protect

and support the rights of patients as set forth in NRS 449.700 to 449.730, inclusive.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3628  Protection of patients; use of physical restraints. (NRS 449.0302)

     1.  A governing body shall develop and carry

out policies and procedures that prevent and prohibit:

     (a) Verbal, sexual, physical and mental abuse of

patients; and

     (b) The involuntary seclusion of a patient without

clinical justification for that seclusion.

     2.  The governing body shall develop and

carry out policies and procedures that prevent and prohibit neglect and

misappropriation of the personal property of a patient.

     3.  The governing body shall develop policies

and procedures for the identification and investigation of neglect and abuse of

patients.

     4.  The governing body shall develop and

carry out organizational policies and procedures that limit the use of physical

restraints on patients to only those situations in which the use of physical

restraints is appropriate and for which there is adequate clinical

justification.

     5.  The governing body shall ensure that the

use of any physical restraints on a patient is initiated only pursuant to a

physician’s order or protocols approved by the medical staff and the hospital

administration.

     6.  If the use of physical restraints is

permitted pursuant to approved protocols, the approved protocols must include:

     (a) A thorough assessment of the patient before the

use of physical restraints is initiated;

     (b) A provision that requires the initiation of the

use of the physical restraints by a registered nurse or other authorized person

according to hospital policy;

     (c) A provision for notifying the physician within

12 hours after the use of the physical restraints is initiated;

     (d) A requirement that a verbal or written order of

the physician be obtained and entered into the medical record of the patient;

and

     (e) A requirement that the continued use of

physical restraints beyond the first 24 hours be authorized by the physician

through the renewal of the original order. The issuance of an order for the

continued use of physical restraints on a patient must occur no less often than

once each calendar day.

     7.  Organizational policies and procedures,

protocols, physician’s orders and the individual needs of a patient must be

used to establish the frequency, nature and extent of monitoring of a patient

upon whom physical restraints are being used.

     8.  The hospital shall have a process for

quality improvement to identify appropriate opportunities for reducing the use

of physical restraints. The process for quality improvement must include areas

for measurement and assessment to identify opportunities to reduce the risks

associated with the use of physical restraints through the introduction of

preventive strategies, innovative alternatives to the use of physical

restraints and improvements to the process of using physical restraints.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.363  Personnel policies concerning employment, licensing and

certification. (NRS 449.0302)

     1.  A hospital shall have written policies

concerning the qualifications, responsibilities and conditions of employment

for each type of hospital personnel, including the licensure and certification

of each employee when required by law.

     2.  The written policies must be reviewed and

updated as needed and must be made available to the members of the hospital

staff.

     3.  Personnel policies must provide for:

     (a) The orientation of all health personnel to the

policies and objectives of the hospital; and

     (b) The maintenance of records of current employees

which confirm that the personnel policies are being followed.

     4.  The hospital shall have evidence of a

current license or certification on file at the hospital for each person

employed by the hospital, or under contract with the hospital, who is required

to be licensed or certified by law to perform his or her job.

     5.  The hospital shall ensure that the health

records of its employees contain documented evidence of surveillance and

testing of those employees for tuberculosis in accordance with chapter 441A of NAC.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.364  Obstetrical services: Administration; staffing and equipment. (NRS 449.0302)

     1.  If a hospital provides obstetric

services, the obstetric services must be provided through an obstetric

department which is well-organized and sufficiently staffed to ensure the

health and safety of the patients.

     2.  The obstetric department must be under

the direction and supervision of a qualified member of the medical staff. The

director of the obstetric department is responsible for the quality of medical

care provided to patients by the obstetric department and for the review of the

professional practices of the medical staff within the obstetric department,

including, without limitation:

     (a) The delineation of the privileges accorded to

members of the medical staff and members of allied health professional persons

in the obstetric department; and

     (b) The reappraisal and appointment of each such

member.

     3.  A roster of the privileges relating to

the provision of obstetric services of each member of the medical staff must be

kept in the files of the obstetric department. The roster must specify the

privileges awarded to each member.

     4.  A hospital shall ensure that the

obstetric department has adequate staffing and equipment, including, without

limitation:

     (a) A sufficient number of registered nurses,

trained in perinatal care of a maternal patient and in newborn care, who are on

duty at all times to ensure that proper care is provided to each patient;

     (b) Appropriate equipment maintained in good

working order;

     (c) Drugs and oxygen necessary to provide obstetric

care to a maternal patient and a newborn;

     (d) Appropriate clinical laboratory services

available to provide safe obstetric care according to the needs of the patient

and medical staff of the department; and

     (e) Sufficient personnel on the premises and

immediately available for each delivery of a newborn who:

          (1) Are trained and experienced in performing

cardiopulmonary resuscitation on adults and newborns; and

          (2) Have successfully completed the Neonatal

Resuscitation Program endorsed by the American Academy of Pediatrics and the

American Heart Association.

     5.  A hospital shall ensure that the

obstetric department has the capability of providing:

     (a) Initial evaluation of the risk-status of each

patient needing obstetric services, including the appropriateness of admitting

the patient; and

     (b) Support of patients in labor.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XI subsec. D pars. 1-8, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.3645  Obstetrical services: Labor rooms; delivery rooms; utility rooms;

area for cleaning instruments. (NRS 449.0302)

     1.  Each hospital which has an organized

obstetric service shall have at least one labor room, with the need for

additional labor rooms to be determined by the amount of use of the labor room.

     2.  Each hospital shall have at least one

properly equipped delivery room, with the need for additional delivery rooms to

be determined by the amount of use of the delivery room. The delivery room must

have:

     (a) An emergency call system that is operable

without the use of hands and an adequate signal system.

     (b) Emergency sterilizing facilities to support the

delivery area.

     (c) A heated bassinet and warmer, and resuscitation

equipment for newborns which is readily available.

     (d) A device for easy, positive identification of a

newborn before the newborn is removed from the delivery room.

     (e) Adequate storage space for sterile supplies and

equipment.

     (f) Sinks and dispensers which are equipped with

foot, knee or elbow controls or an alternative method of control.

     3.  A hospital shall have a clean utility

room with adequate storage for cleaning supplies and other cleaning equipment

needed for the delivery and labor rooms.

     4.  Major cleaning of instruments and other

utensils used in the delivery or labor room must take place in a specified

cleanup area or holding area for soiled materials.

     (Added to NAC by Bd. Health by R050-99, eff. 9-27-99)

      NAC 449.365  Obstetrical services: Required services. (NRS 449.0302)

     1.  An obstetric department of a hospital

shall provide services for labor, delivery, newborn care and recovery care, and

shall maintain the areas in which these services are provided in a safe and

clean manner.

     2.  The obstetric department must be equipped

with those items needed to provide obstetrical care and emergency procedures in

life-threatening situations to a mother or her baby.

     (Added to NAC by Bd. Health by R050-99, eff. 9-27-99)

      NAC 449.3655  Obstetrical services: Transfer or discharge of patient. (NRS 449.0302)

     1.  No person may be transferred or

discharged from an obstetric department of a hospital unless:

     (a) The transfer or discharge is appropriate based

on a risk assessment of the patient;

     (b) A physician determines that the patient is not

in active labor; or

     (c) A physician determines that the medical needs

of the patient exceed the capability of the obstetric department.

     2.  The criteria for the transfer of a

patient must be in writing and included in the manual for policies and

procedures of the obstetric department.

     3.  A patient in the obstetric department may

be transferred only to a hospital capable of providing a higher level of

obstetrical and neonatal care and for which there are written documents which

verify that the receiving hospital agrees to accept emergency patients without

regard to their ability to pay.

     4.  The obstetric department shall establish

written protocols for the discharge of patients from the hospital, which

include, without limitation:

     (a) The provision of instructions to the mother

regarding the care and feeding of her newborn;

     (b) Plans for the examination of the mother and

newborn after discharge;

     (c) The provision of instructions to the mother

regarding the availability of consultation services by telephone or home visit,

as needed or requested by the mother; and

     (d) The criteria and conditions under which a

patient or newborn should be considered for transfer. Such a determination must

be made by a qualified member of the medical staff and the criteria and

conditions must be included in the written policies and procedures of clinical

practices for the obstetric department. The written policies must be reviewed

periodically by a qualified member of the medical staff and a review of all such

transfers must be included in the quality improvement program established

pursuant to NAC 449.3152.

     (Added to NAC by Bd. Health by R050-99, eff. 9-27-99)

      NAC 449.367  Obstetrical services: Nurseries.

(NRS 449.0302)

     1.  An obstetric department shall have a

nursery which is organized under the direction of a qualified member of the

medical staff.

     2.  Nurseries must be completely equipped for

any neonatal emergencies.

     3.  The total number of bassinets in a

nursery service must be at least equal to the number of beds for postpartum

patients.

     4.  A separate storage room must be available

to support the requirements of the entire nursery.

     5.  The following must be made available for

each unit for infants:

     (a) A bassinet for each infant with storage space

for the infant’s supplies, such as diapers, shirts and thermometers.

     (b) Incubators for infants needing supplemental

oxygen, heat or humidity and for all infants with a low birth weight.

     (c) A scale for weighing babies.

     (d) Oxygen.

     6.  If a nursery for premature infants

exists, it must be designed to provide for maximum observation and supervision

and must include:

     (a) An electrical outlet for each incubator located

in the nursery; and

     (b) Oxygen for every incubator.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XI subsec. D pars. 9-13, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.370  Outpatient services. (NRS 449.0302)

     1.  If a hospital provides outpatient

services, the services must meet the needs of the patients in accordance with

nationally recognized standards of practice.

     2.  A hospital shall ensure that its

outpatient unit is appropriately organized and integrated with inpatient

services.

     3.  A hospital which provides outpatient

services shall:

     (a) Assign a person to be responsible for the

outpatient unit;

     (b) Have sufficient numbers of professional and

nonprofessional personnel available to provide the outpatient services; and

     (c) Ensure that nursing services provided in the

outpatient unit are provided under the direction of a registered nurse.

     4.  Equipment and supplies necessary to meet

the anticipated needs of the outpatients must be readily available and in good

working order.

     5.  The outpatient unit shall have a

sufficient number of examination and treatment rooms for the outpatient service

based on the volume and nature of work performed.

     6.  Laboratory, radiology and pharmaceutical

services must be readily available to the outpatient unit.

     7.  If outpatient surgery is performed in the

outpatient unit, the basic facilities that must be available to perform the

surgery include, without limitation:

     (a) A fully equipped and staffed operating room and

postanesthesia recovery area;

     (b) Means of control against hazards of infection,

electrical or mechanical fire, and explosion;

     (c) Sterile supplies that are readily available to

meet the needs of the outpatients; and

     (d) Equipment and instrumentation for anesthesia

and emergency cardiopulmonary resuscitation.

     8.  If beds are provided in an outpatient

unit, the number of outpatient beds must not be included in the licensed bed

capacity of the hospital. Inpatients may not occupy an outpatient bed. An

outpatient shall not remain in an outpatient bed for more than 48 consecutive

hours.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XIII, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.371  Intensive care services. (NRS 449.0302)

     1.  If a hospital provides intensive care

services, the services must be well-organized and provided in accordance with

nationally recognized standards of practice.

     2.  An intensive care unit must be under the

direction of a qualified member of the medical staff.

     3.  Written policies and procedures must be

developed and maintained by the director of the intensive care unit, in

consultation with other appropriate health-care professionals and the

administration of the hospital. The administration and medical staff of the

hospital must approve procedures to be used by the intensive care unit when

approval of such procedures is appropriate.

     4.  The responsibility and the accountability

of the intensive care unit to the medical staff and administration must be set

forth in writing by the director of the intensive care unit.

     5.  Whenever a patient is present in the

intensive care unit, a registered nurse, with training and experience in

intensive care nursing, shall supervise the nursing care and nursing management

of the intensive care service.

     6.  All licensed nurses working in an

intensive care unit must:

     (a) Have training and experience in intensive care

nursing; or

     (b) Work under the direct supervision of a

registered nurse who has training and experience in intensive care nursing.

     7.  The hospital shall establish a system for

determining the nursing needs of each patient in the intensive care unit that

includes an assessment made by a registered nurse trained in critical care of

the patient’s needs and the provision of staffing based on that assessment.

     8.  The hospital shall follow the written

policies for the plans for nurse staffing, which are dependent upon the acuity

level of the patients in the intensive care unit, to ensure that the needs of

the patients are met.

     9.  A respiratory therapist or respiratory

technician, physical therapist and other supportive personnel must be available

depending upon the requirements of the intensive care unit.

     10.  The equipment and supplies for the

intensive care unit must be adequate to meet the needs of the patients in the

intensive care unit.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.373  Laboratory services; pathology services; blood and blood

products. (NRS 449.0302)

     1.  Each hospital shall maintain or have

available adequate laboratory services to meet the needs of its patients and

medical staff. Each hospital shall ensure that all laboratory services provided

to its patients are provided by a medical laboratory licensed pursuant to chapter 652 of NRS.

     2.  Laboratory services must be available 24

hours a day, 7 days a week, including holidays.

     3.  While a patient is under the care of a

hospital, all laboratory testing must be performed:

     (a) In the laboratories of the hospital;

     (b) By a reference laboratory that is certified

pursuant to 42 U.S.C. § 263a; or

     (c) In accordance with NRS 652.217.

     4.  The director of a laboratory that

provides laboratory services to a hospital shall establish procedures to ensure

that patients who have been transfused with blood or blood products which have

tested positive for the human immunodeficiency virus are promptly notified of

that fact.

     5.  Each laboratory which provides laboratory

services to a hospital shall provide for the proper receipt and reporting of

tissue specimens. All reports of tissue specimens must be signed by a

pathologist. The medical staff of the hospital and a pathologist shall

determine which tissue specimens require a macroscopic (gross) examination and

which require both macroscopic and microscopic examinations.

     6.  If provided in a hospital, pathology

services must be under the supervision of a pathologist in a full-time, regular

part-time or regular consultative basis and he or she shall participate in

staff, departmental and clinicopathologic conferences.

     7.  Facilities for the procurement,

safekeeping and transfusion of blood and blood products must be provided in

each hospital, or readily available, with adequate control and supervision by

an authorized physician. The refrigerator for the storage of blood must have an

adequate recording thermograph and temperature alarm system, must be regularly

inspected and must be otherwise safe and adequate to prevent the deterioration

of the blood and blood products.

     8.  If the hospital depends on outside blood

banks, there must be an agreement governing the procurement, transfer and

availability of blood which is reviewed and approved by the medical staff,

administration and governing body. Provision must be made for prompt blood

typing, cross-matching and investigation of transfusion reactions. A committee

of the medical staff, or its equivalent, shall review all transfusions of blood

or blood derivatives, and blood or blood derivative reactions, occurring in the

hospital and make recommendations concerning policies governing these

practices.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

VIII, eff. 10-9-69]—(NAC A 10-22-93; R050-99, 9-27-99)

      NAC 449.3735  Transfusions of blood. (NRS 449.0302)

     1.  To perform a transfusion of blood safely

and efficiently, hospital personnel shall follow the policies and procedures

developed by the hospital, with input from the medical staff, for performing a

transfusion of blood.

     2.  Hospital personnel may administer blood

only within the scope of their practice and after they have been trained to

administer blood.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.374  Nuclear medicine services. (NRS 449.0302)

     1.  If a hospital provides nuclear medicine

services, those services must meet the needs of the patients receiving those services

in accordance with nationally recognized standards of practice.

     2.  The nuclear medicine services must be

under the supervision of a doctor of medicine or osteopathy who is qualified in

nuclear medicine. The director of the nuclear medicine services is responsible

for the medical direction of those services.

     3.  The qualifications, training, functions

and responsibilities of the personnel of the nuclear medicine services must be

specified by the administration of the hospital and approved by the medical

staff.

     4.  Radioactive materials used in providing

nuclear medicine services must be prepared, labeled, used, transported, stored

and disposed of in accordance with nationally recognized standards of practice.

     5.  In-house preparation of radiopharmaceuticals

must be made by, or under the direct supervision of, an appropriately trained

registered pharmacist or a doctor of medicine or osteopathy.

     6.  A radionuclide must be stored, used and

disposed of in accordance with the requirements set forth in chapter 459 of NAC.

     7.  If laboratory tests are performed in the

nuclear medicine services, the services must meet the applicable requirements

for laboratory services specified in 42 C.F.R. § 482.27.

     8.  Equipment and supplies used for the

nuclear medicine services must be appropriate for the types of nuclear medicine

services offered by the hospital and must be maintained for safe and efficient

performance. The equipment must be:

     (a) Maintained in safe operating condition; and

     (b) Inspected, tested and calibrated at least

annually by persons who are qualified to do such inspections, tests and

calibrations.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.375  Records for nuclear medicine services; authorization. (NRS 449.0302)

     1.  A hospital shall maintain signed and

dated reports of nuclear medicine interpretations, consultations and

procedures.

     2.  The hospital shall maintain nuclear

medicine reports, or copies thereof, for at least 5 years after the date on

which the report was made.

     3.  A practitioner approved by the medical

staff to interpret diagnostic procedures must sign and date his or her

interpretation of the tests.

     4.  The hospital shall maintain records of

the receipt and disposition of radiopharmaceuticals.

     5.  Nuclear medicine services may be ordered

only by a practitioner whose scope of licensure and defined staff privileges

authorize the practitioner to make such orders.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.376  Radiological services. (NRS 449.0302)

     1.  A hospital shall have diagnostic

radiological facilities available. If therapeutic services are also provided,

they, as well as the diagnostic services, must meet professionally approved

standards for safety and personnel qualifications.

     2.  The hospital shall maintain or have

available radiological services according to the needs of the patients.

     3.  Radiological services, particularly

ionizing radiological procedures, must be conducted in a manner that monitors

and controls hazards so that safety is maintained for patients and personnel.

     4.  Proper safety precautions must be

maintained against radiation hazards, including, without limitation:

     (a) Adequate shielding for patients, personnel and

facilities; and

     (b) Appropriate storage, use and disposal of

radioactive materials.

     5.  Equipment used for providing radiological

services must be periodically inspected, and any hazards identified in the

inspection must be promptly corrected.

     6.  Radiological technicians and other

persons who work with radiation must be checked periodically by the use of

exposure meters or badge tests for the amount, if any, of radiation exposure.

     7.  Radiological services must be provided

only upon the order of:

     (a) A practitioner who has clinical privileges or

is authorized by state law to order such services; or

     (b) Other practitioners authorized by the medical

staff and governing body to order such services.

     8.  A qualified full-time, part-time or

consulting radiologist shall supervise the ionizing radiological services and

shall interpret only those radiological tests that are determined by the

medical staff to require the specialized knowledge of the radiologist.

     9.  Only personnel designated as qualified

personnel by the medical staff may use radiologic equipment and administer

radiological procedures.

     10.  Records of radiology services provided

to patients must be maintained.

     11.  A radiologist or other practitioner who

performs radiology services shall sign any report of his or her interpretation.

     12.  A hospital shall maintain the following

information for at least 5 years:

     (a) Copies of reports and printouts of radiology

services; and

     (b) Films, scans and other image records of

radiology services that have been provided.

     13.  As used in this section, “radiologist”

means a doctor of medicine or osteopathy who is qualified by education and

experience in radiology.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

IX, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.377  Radiological therapeutic services. (NRS 449.0302)

     1.  If a hospital provides radiological

therapeutic services, the services must meet professionally nationally

recognized standards for safety and personnel qualifications.

     2.  A radiological therapeutic department

must be under the direction of a physician who is:

     (a) Certified or eligible for certification in

therapeutic radiology by the American Board of Radiology; or

     (b) Certified or eligible for certification in

radiology by the American Board of Radiology and has 2 years of full-time

experience in radiation therapy.

     3.  Other personnel who may provide

radiological therapeutic services, on a full-time, part-time or consultative

basis, depending on the activity of the department, include:

     (a) A radiological physicist who is certified in

radiological physics or in therapeutic radiological physics by the American

Board of Radiology;

     (b) A dosimetrist, or treatment plan technologist,

who is a qualified and experienced radiation therapy technologist and who has

at least 1 year of additional clinical training in dosimetry;

     (c) A certified therapeutic radiological

technologist; and

     (d) Appropriate support personnel, including

licensed nurses, as required by the patient load.

     4.  Written policies and procedures must be

developed and maintained by the director of the department in consultation with

other appropriate health professional persons and the administration of the

hospital.

     5.  Radiation therapy must be given only

under the direction of a radiation therapist.

     6.  All cancer patients accepted for curative

radiation must have adequate histological substantiation of diagnosis, unless

convincing alternative evidence for diagnosis is presented.

     7.  Documentation of the initial evaluation

and treatment plan of each patient, and dosimetry, clinical, technical and

follow-up notes on each patient, must be maintained.

     8.  Adequate communication must be maintained

between the department and the referring physicians, including periodic review

of case management, complications and treatment results.

     9.  Calibration and operation of equipment

for radiation therapy must meet the requirements specified in chapter 459 of NAC.

     10.  Radiation protection for patients and

staff must comply with the requirements specified in chapter 459 of NAC.

     11.  Periodic follow-ups of a patient

following the completion of his or her treatment must be coordinated with the

physician who referred the patient.

     12.  Equipment and supplies for the

radiological therapeutic services must conform to the requirements specified in

chapter 459 of NAC.

     13.  The rooms in which radiation therapy

machines are used must be of adequate size to permit the easy use of the

machines by patients on stretchers. Shielding of those rooms must meet the

requirements specified in chapter 459 of NAC.

     14.  Sufficient examination rooms must be

available to accommodate all patients receiving the therapeutic services.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.379  Medical records. (NRS 449.0302)

     1.  A hospital shall maintain a medical

record for each person evaluated or treated in the hospital.

     2.  The organization of the medical records

service at the hospital must be appropriate to the scope and complexity of the

services performed at the hospital. A hospital shall employ adequate personnel

to ensure prompt completion, filing and retrieval of the medical records.

     3.  Medical records must be accurately

written, promptly completed, properly filed and retained, and accessible. A

hospital shall use a system for author identification and record maintenance

that ensures the integrity of the authentication of the record and protects the

security of all entries to a medical record.

     4.  Except as otherwise provided in this

subsection, medical records must be retained in their original form or in a

legally reproduced form for at least 5 years. The medical staff may identify

specific items in a medical record that must be kept for at least 10 years. The

hospital shall have a system for coding and indexing its medical records. The

system must allow for the timely retrieval of information by diagnosis and

procedure to support studies evaluating the medical care provided at the

hospital.

     5.  A hospital must have a procedure for

ensuring the confidentiality of the medical records of its patients.

Information from or copies of medical records may be released only to

authorized persons, and the hospital shall ensure that unauthorized persons cannot

gain access to or alter the medical records of its patients. Original medical

records may be released by the hospital only in accordance with state or

federal law, court orders or subpoenas.

     6.  A medical record must include

information:

     (a) Demonstrating the justification for the

admission and continued hospitalization of a patient;

     (b) Supporting the diagnosis of the patient; and

     (c) Describing the progress of the patient and his

or her response to the medications and services received during his or her

hospitalization.

     7.  All entries to a medical record must be

legible and complete, and authenticated and dated promptly by the person who is

responsible for ordering, providing or evaluating the service provided. In

authenticating a medical record, the person shall include his or her name and

discipline. Authentication may include the signature or written initials of the

person or a computer entry by the person.

     8.  All medical records must document the

following information, as appropriate:

     (a) Evidence that a physical examination, including

a history of the health of the patient, was performed on the patient not more

than 7 days before or more than 48 hours after his or her admission into the

hospital.

     (b) The diagnosis of the patient at the time of

admission.

     (c) The results of all consultative evaluations of

the patient and the appropriate findings by clinical and other staff involved

in caring for the patient.

     (d) Documentation of any complications suffered by

the patient, infections acquired by the patient while in the hospital and

unfavorable reactions by the patient to drugs and anesthesia administered to

the patient.

     (e) Properly executed informed consent for all

procedures and treatments specified by the medical staff, or federal or state

law, as requiring written patient consent.

     (f) All orders of practitioners, nursing notes,

reports of treatment, records of medication, radiology and laboratory reports,

vital signs and other information necessary to monitor the condition of the

patient.

     (g) A discharge summary that includes a description

of the outcome of the hospitalization, disposition of the case and the

provisions for follow-up care that have been provided to the patient.

     (h) The final diagnosis of the patient.

     9.  The medical record of a patient must be

completed not later than 30 days after the date on which he or she is

discharged.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

VI, eff. 10-9-69; A 8-26-74]—(NAC A by R050-99, 9-27-99)

      NAC 449.382  Medical library. (NRS 449.0302)  A

hospital shall have a medical library to meet the requirements of the facility,

with access to current periodicals on clinical services which are offered.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

X, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.385  Surgical services. (NRS 449.0302)

     1.  If a hospital provides surgical services,

the services must be well-organized and provided in accordance with nationally

recognized standards of practice. If outpatient surgical services are offered,

the services must be consistent in quality, in accordance with the complexity

of the services, with similar services provided to inpatients.

     2.  The operating rooms must be supervised by

an experienced registered nurse or a doctor of medicine or osteopathy.

     3.  A licensed practical nurse or a surgical

or operating room technician may act as a scrub nurse or scrub technician only

under the direct supervision of a registered nurse.

     4.  Circulating duties in an operating room

must be performed by a qualified registered nurse, who shall not perform

circulating duties in more than one operating room at a time.

     5.  Surgical privileges must be delineated

for all practitioners performing surgery in accordance with the competency of

each practitioner. A hospital shall maintain a roster of practitioners that

specifies the surgical privileges accorded to each practitioner.

     6.  Policies governing surgical care must be

designed by the medical staff to ensure the achievement and maintenance of high

standards of medical practice and patient care.

     7.  Except in emergency cases and except as

otherwise provided in this subsection, a complete history and physical work-up

must be completed and placed in a patient’s chart before the patient undergoes

surgery. A patient may undergo surgery before his or her complete history or

physical work-up is placed in his or her chart if the complete history or

physical work-up has been dictated but not yet recorded and a statement of that

fact and an admission note have been placed in the patient’s chart by the

practitioner who admitted the patient.

     8.  Except in emergency cases, an informed

consent form properly executed by a patient for the surgery must be placed in

his or her chart before the surgery is performed.

     9.  Each surgical suite must have readily

available and in good working condition:

     (a) A call system;

     (b) A cardiac monitor;

     (c) A resuscitator;

     (d) A defibrillator;

     (e) An aspirator; and

     (f) A tracheotomy set.

     10.  A hospital shall make adequate provision

for immediate postoperative care.

     11.  The operating room register must be complete

and up-to-date at all times.

     12.  Immediately following surgery on a

patient, the surgeon shall write or dictate an operative report, which must be

included in the medical record of the patient, describing the techniques used,

findings and tissues removed or altered. The surgeon shall sign the report.

     13.  The medical staff shall define which

surgeries require the presence of a first assistant. A list of the surgeries

that require the presence of a first assistant must be readily available to the

surgical staff of the hospital.

     14.  A registered nurse or operating room

technician may serve as a first assistant if:

     (a) The medical staff has not otherwise required

that the first assistant in a surgery be a physician; and

     (b) The medical staff has designated the nurse or

technician as having sufficient training to assist in the procedure adequately

and properly.

     15.  A hospital shall establish and carry out

policies and procedures relating to the cleaning and sanitation of a surgical

suite.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XI subsec. A, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.388  Anesthesia services. (NRS 449.0302)

     1.  If a hospital furnishes anesthesia services,

the services must be provided in a well-organized manner under the direction of

a qualified doctor of medicine or osteopathy. The service is responsible for

all anesthesia administered in the hospital.

     2.  The organization of the anesthesia

service must be appropriate to the scope of the services offered by the

hospital. Anesthesia may only be administered by:

     (a) A qualified anesthesiologist;

     (b) A doctor of medicine or osteopathy, other than

an anesthesiologist;

     (c) A dentist, oral surgeon or podiatrist who is

legally authorized, under state law, to administer anesthesia; or

     (d) A certified registered nurse anesthetist who is

under the direction of the operating practitioner or of an anesthesiologist who

is immediately available if needed. This paragraph does not affect the

requirements for qualification as a certified registered nurse anesthetist as

specified in chapter 632 of NRS, and

any regulations adopted pursuant thereto.

     3.  Anesthesia services must be consistent

with the needs and resources of the hospital. Policies on anesthesia procedures

must include the delineation of preanesthesia and postanesthesia

responsibilities. The policies must ensure that each patient receives:

     (a) A preanesthesia evaluation by a person

qualified to administer anesthesia, as set forth in subsection 2, that must be

performed within 48 hours before surgery.

     (b) An intraoperative anesthesia record.

     (c) For inpatients, a postanesthesia follow-up

report by the person who administered the anesthesia. The follow-up report must

be written not later than 48 hours after the surgery.

     (d) For outpatients, a postanesthesia evaluation

for proper anesthesia recovery, performed in accordance with the policies and

procedures approved by the medical staff.

     4.  If the hospital does not have a

department of anesthesia, the department of surgery is responsible for the

organization and implementation of the policies and procedures relating to the

provision of anesthesia services.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XI subsec. B, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.389  Respiratory care services. (NRS 449.0302)  A

hospital shall meet the needs relating to respiratory care of its patients in

accordance with nationally recognized standards of practice. If the hospital

has a unit to provide respiratory care services:

     1.  The director of the unit must be a doctor

of medicine or osteopathy who has the knowledge, experience and capabilities to

supervise and administer the respiratory care services properly. The director

may serve on a full-time or part-time basis.

     2.  The hospital shall ensure that there are

an adequate number of respiratory therapists, respiratory therapy technicians

and other personnel who meet the qualifications, which must be consistent with

state law, specified by the medical staff to provide respiratory care services.

     3.  Personnel qualified to perform specific

procedures relating to the provision of respiratory care services and the

amount of supervision required for such personnel to carry out specific

procedures must be designated in writing.

     4.  If blood gases or other clinical

laboratory tests are performed in the respiratory care unit, the unit must meet

the requirements for clinical laboratories with respect to management, adequacy

of facilities, proficiency testing and quality control.

     5.  Respiratory care services must be

provided only upon and in accordance with the orders of a doctor of medicine or

osteopathy.

     6.  Diagnostic studies and treatment

modalities relating to respiratory care must be recorded in the patient’s

medical record, including, without limitation:

     (a) The type of diagnostic or therapeutic procedures

used;

     (b) The dates and times of the use of such

procedures; and

     (c) The effects of such procedures, including

adverse reactions.

     7.  The unit shall have sufficient types and

quantities of equipment to provide for the appropriate inhalation of the

several gases, aerosols and such other modalities required for the anticipated

nature and variety of procedures that will be performed in the unit. Equipment

must be calibrated in accordance with the manufacturer’s instructions and

records of such calibrations must be maintained.

     8.  The unit shall have sufficient space for:

     (a) The storage of necessary equipment;

     (b) Work areas for:

          (1) Cleaning, sterilizing and repairing

equipment; and

          (2) Performing studies of pulmonary function

and blood analyses, if such studies and analyses are performed in the unit; and

     (c) Office space for the personnel of the unit.

     9.  The unit shall establish and carry out

procedures for the safe handling and storage of medical gas cylinders. Only

certified persons and persons trained by the hospital may transfer gas from one

cylinder to another. Such a transfer must be completed in accordance with

safety protocols.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.391  Dental services. (NRS 449.0302)

     1.  If a hospital provides dental services,

the services must be well-organized and provided in accordance with nationally

recognized standards of practice.

     2.  The dental service must be under the

direct supervision of a dentist, who has overall responsibilities for the

dental service.

     3.  Dental hygienists, dental assistants or

dental laboratory technicians may be employed by the hospital if the dental

hygienist, assistant or laboratory technician works under the direct supervision

of a dentist.

     4.  Members of the dental staff must be

currently licensed in this State for the positions to which they are appointed.

     5.  Patients admitted for dental services

must be admitted by the dentist, either to the department of dentistry or, if

there is no department, to an organized clinical service.

     6.  Equipment and supplies necessary to meet

the anticipated dental needs of patients must be available.

     7.  Equipment for the sterilization of

instruments and supplies must be provided directly in the dental service or

through another department, unit or service within the hospital.

     8.  If the dental service offers primary

dental care, the dental service must:

     (a) Have adequate space to provide that care; and

     (b) Facilities for dental radiography.

     9.  There must be specific bylaws concerning

the dental staff written in combination with the bylaws of the medical staff or

as separate dental bylaws.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XI subsec. C, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.394  Psychiatric services. (NRS 449.0302)

     1.  A general hospital which has a designated

area set aside for use on a continuous basis for the treatment and care of

psychiatric patients is deemed to operate a psychiatric service and shall

comply with the requirements in this section.

     2.  A licensed physician may render

psychiatric care in any licensed general hospital on a short term or emergency

basis.

     3.  A hospital shall develop and carry out

policies and procedures for the provision of psychiatric treatment and

behavioral management services that are consistent with NRS 449.765 to 449.786, inclusive, to ensure that

the treatment and services are safely and appropriately used. The hospital

shall ensure that the policies and procedures protect the safety and rights of

the patient.

     4.  The medical direction of the psychiatric

unit and the psychiatric services provided by the hospital must be under the

direct supervision of a qualified member of the medical staff.

     5.  All nursing services provided with regard

to the provision of psychiatric care must be provided under the direction of a

registered nurse.

     6.  A consulting medical staff composed of

qualified persons in appropriate specialties must be available at all times to

the patients in the psychiatric unit.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I §

XI subsec. E, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

INTERMEDIARY SERVICE ORGANIZATIONS

REVISER’S NOTE.

      NAC 449.395 to 449.39561, inclusive, have been codified in chapter 449 of NAC in accordance with section 38 of chapter

41, Statutes of Nevada 2013, at page 146, which authorized the related

provisions of chapter 427A of NAC to be

renumbered and moved to chapter 449 of NAC.

 

General Provisions

      NAC 449.395  Definitions. (NRS 449.4308, 449.4311, 449.4327)  As used in NAC 449.395 to 449.39561,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.39501 to 449.39508,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.800)

      NAC 449.39501  “Certificate” defined. (NRS 449.4308, 449.4311, 449.4327)  “Certificate” means a

certificate to operate an intermediary service organization issued by the

Division pursuant to the provisions of NRS 449.4304 to 449.4339, inclusive, and NAC 449.395 to 449.39524,

inclusive.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.803)

      NAC 449.39502  “Client” defined. (NRS 449.4308, 449.4311, 449.4327)  “Client” means a person

with a disability who seeks or receives personal assistance in his or her home

or other location where a person with a disability receives personal

assistance, including, without limitation, a place of employment of the person

with a disability, or other responsible person who seeks or obtains such

assistance on behalf of a person with a disability.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.804)

      NAC 449.39503  “Intermediary service organization” defined. (NRS 449.4308,

449.4311, 449.4327)

     1.  “Intermediary service organization” has

the meaning ascribed to it in NRS

449.4304.

     2.  The term does not include an organized

group of persons composed of the family and friends of a person needing

personal assistance that employs or contracts with persons to provide such

assistance if:

     (a) The organization of the group of persons is set

forth in a written document that is made available for review by the Division

upon request; and

     (b) The personal assistance is provided to only one

person or to members of a family who reside at the same residence.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.806)

      NAC 449.39504  “Managing employer” defined. (NRS 449.4308, 449.4311, 449.4327)  “Managing employer” means

the person who selects, sets the schedule for and directs the training of a

personal assistant.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.807)

      NAC 449.39505  “Other responsible person” defined. (NRS 449.4308,

449.4311, 449.4327)  “Other responsible person”

has the meaning ascribed to it in NRS

449.4308.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.808)

      NAC 449.39506  “Personal assistance” defined. (NRS 449.4308, 449.4327)  “Personal assistance” has

the meaning ascribed to it in NRS

449.4308.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.809)

      NAC 449.39507  “Personal assistant” defined. (NRS 449.4308, 449.4327)  “Personal assistant” has

the meaning ascribed to it in NRS

449.4308.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.810)

      NAC 449.39508  “Guardian” interpreted. (NRS 449.4308, 449.4327)  As used in subparagraph

(2) of paragraph (a) of subsection 2 of NRS 449.4308, the Division will

interpret the term “guardian” to include, without limitation, any person who is

legally responsible for a person with a disability who suffers from a cognitive

impairment.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.813)

Certification

      NAC 449.3951  Form of application; written verification for submission of

fingerprints. (NRS 449.4311, 449.4321, 449.4327)

     1.  The Division will prescribe the form for

an application to apply for a certificate.

     2.  An applicant for a certificate must

submit with his or her application written verification, on a form prescribed

by the Division, stating that the fingerprints of the applicant were taken and

directly forwarded electronically or by another means to the Central Repository

for Nevada Records of Criminal History and that the applicant has given written

permission to the law enforcement agency or other authorized entity taking the

fingerprints to submit the fingerprints to the Central Repository for

submission to the Federal Bureau of Investigation for a report on the

applicant’s background and to such other law enforcement agencies as the

Division deems necessary.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008;

A by Aging & Disability Services Div. by R015-12, 9-14-2012)—(Substituted

in revision for NAC 427A.815)

      NAC 449.39511  Application for certificate and renewal: Fees. (NRS 449.4311,

449.4314, 449.4319)

     1.  An applicant for a certificate must pay

to the Division, at the time of application, a nonrefundable fee of $2,748.

     2.  An applicant for the renewal of a

certificate must pay to the Division, at the time of application for renewal, a

nonrefundable fee of $1,374.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.816)

      NAC 449.39512  Application for certificate and renewal: Proof of insurance

coverage. (NRS 449.4311, 449.4327)  An applicant for a

certificate and for the renewal of a certificate must provide to the Division

with the initial application for a certificate, with the application for

renewal of a certificate and at such other times upon request of the Division,

proof that the intermediary service organization maintains adequate insurance

coverage against liabilities resulting from claims incurred in the course of

operation. Such insurance coverage must include, without limitation:

     1.  Workers’ compensation insurance pursuant

to chapters 616A to 617, inclusive, of NRS for each personal

assistant employed by the intermediary service organization;

     2.  Commercial general liability insurance in

an amount not less than $2,000,000 in general aggregate coverage and not less

than $1,000,000 per claim; and

     3.  Insurance coverage for employee

dishonesty in an amount not less than $25,000 per claim.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.817)

      NAC 449.39513  Applicability of certificate; specification of primary location;

records. (NRS 449.4311, 449.4318, 449.4327)

     1.  Each certificate must be separate and

issued to a specific person or persons to operate the intermediary service

organization. The name of the person responsible for the operation of an

intermediary service organization must appear on the face of the certificate.

     2.  Each certificate must specify the primary

location for the operation of an intermediary service organization, but a

separate certificate is not required for each location where the intermediary

service organization conducts business.

     3.  If an intermediary service organization

conducts business at more than one location, all records required to be

maintained by the intermediary service organization, including, without

limitation, records of each client, personnel files and operational records,

must be maintained at the primary location specified on the certificate.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.818)

      NAC 449.39514  Issuance of provisional certificate. (NRS 449.4324)

     1.  The Division may issue a provisional

certificate to an intermediary service organization pursuant to NRS 449.4324 if the Division

determines that the intermediary service organization is substantially, but not

fully, in compliance with NRS

449.4304 to 449.4339,

inclusive, and NAC 449.395 to 449.39561, inclusive.

     2.  A provisional certificate issued pursuant

to subsection 1:

     (a) Expires 90 days after its issuance unless,

within the 90-day period, the Division issues a nonprovisional certificate to

the intermediary service organization.

     (b) Is nonrenewable.

     3.  The Division will provide in writing to

each intermediary service organization which is issued a provisional

certificate pursuant to subsection 1 the conditions that the intermediary

service organization must meet before the Division will issue a nonprovisional

certificate.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.819)

Authorized Activities and General Requirements for

Operation

      NAC 449.39515  Operation of intermediary service organization and agency to

provide personal care services in the home. (NRS 449.4308, 449.4327)

     1.  A person may operate an intermediary

service organization and an agency to provide personal care services in the

home if the person:

     (a) Maintains separate records and clients for the

intermediary service organization and the agency to provide personal care

services in the home; and

     (b) Distinguishes between the services to be

provided by the intermediary service organization and the personal care

services provided by the agency to provide personal care services in the home.

     2.  As used in this section, “agency to

provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.820)

      NAC 449.39516  Duties and responsibilities. (NRS 449.4308, 449.4327)

     1.  An intermediary service organization

shall ensure that each client of the intermediary service organization and

personal assistant employed by the intermediary service organization is aware

of and understands:

     (a) The rights and responsibilities of the client;

     (b) The ethical responsibilities of the personal

assistant, including, without limitation, any responsibilities concerning the

confidentiality of client information;

     (c) The training requirements for the personal

assistant as set forth in NAC 449.39519;

     (d) The policies and procedures to be used by the

personal assistant for the control of infections, including, without

limitation, the policies and procedures of the intermediary service

organization and the universal precautions as defined in NAC 441A.195;

     (e) The respective responsibilities of the personal

assistant and the client to properly document the needs of the person with a

disability and to properly document the provision of personal assistance to

that person;

     (f) The procedures that the personal assistant will

follow when responding to medical and nonmedical emergencies of the person with

a disability;

     (g) The provisions of NRS 629.091 and the appropriate

procedures that must be followed when providing assistance to a person with a

disability pursuant to that section; and

     (h) The procedures for a client to appeal the

termination, reduction or suspension of services by the intermediary service

organization.

     2.  An intermediary service organization

shall:

     (a) Remain open for operation during regular

business hours;

     (b) Maintain a telephone line at the location of

the intermediary service organization that is listed on its certificate, which

must be published in a public telephone directory;

     (c) Have a federal taxpayer identification number;

     (d) Maintain all business licenses required by

state and local law;

     (e) Maintain a written policy concerning the manner

in which complaints from clients will be documented and resolved and a log

which lists all complaints filed by clients; and

     (f) Maintain a written policy concerning the

procedures for a client to appeal the termination, reduction or suspension of

services by the intermediary service organization.

     3.  If an intermediary service organization

withholds any money from a personal assistant which must be forwarded to

another person, including, without limitation, insurance premiums, fees

required to be paid by the intermediary service organization pursuant to state

or federal law on behalf of the personal assistant or money withheld at the

request of the personal assistant, the intermediary service organization must

transfer such money to the person designated for receipt of the money by the

date required for such transfer.

     4.  An intermediary service organization may:

     (a) Employ personal assistants to provide specific

medical, nursing or home health care services for a person with a disability

pursuant to NRS 629.091; and

     (b) At the request of a client, assist in the

development of a plan of care for a person with a disability.

     5.  An intermediary service organization

shall not serve as the managing employer of a personal assistant.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.821)

      NAC 449.39517  Personal assistants: Qualifications; maintenance and availability

of personnel files. (NRS 449.4308, 449.4327, 449.4329, 449.433)

     1.  Each personal assistant employed by an

intermediary service organization must:

     (a) Be at least 18 years of age;

     (b) Demonstrate the ability to meet the needs of

the person with a disability as outlined by the client;

     (c) Demonstrate the ability to communicate

effectively with the client;

     (d) Obtain certification to perform first aid and

cardiopulmonary resuscitation within 120 days after the date on which the

personal assistant begins employment with the intermediary service

organization;

     (e) Be in good health as certified by a physician

and must not be infected with any communicable disease that may be contagious;

and

     (f) If the personal assistant transports a person

with a disability in a motor vehicle, maintain motor vehicle liability

insurance.

     2.  An intermediary service organization

shall serve as the employer of record for and shall maintain a personnel file

for each personal assistant employed by the intermediary service organization.

Each personnel file must include, without limitation:

     (a) The name, address and telephone number of the

personal assistant;

     (b) The date on which the personal assistant began

employment with the intermediary service organization;

     (c) Proof that the personal assistant meets the

qualifications set forth in subsection 1;

     (d) Evidence that the intermediary service

organization has submitted the personal assistant’s fingerprints to the Central

Repository for Nevada Records of Criminal History or the results of the

criminal history report prepared by the Central Repository, as applicable; and

     (e) Documentation submitted by the client pursuant

to NAC 449.39519 of the training received by the

personal assistant as required pursuant to that section.

     3.  An intermediary service organization

shall, upon the request of the Division, make available to the Division all

personnel files, including, without limitation, any personnel files that are

maintained electronically.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.822)

      NAC 449.39518  Personal assistants: Results of reports on criminal history. (NRS 449.4308,

449.4327, 449.4329)  Upon receiving a report

concerning any records of criminal history of a personal assistant from the

Central Repository for Nevada Records of Criminal History pursuant to

subsection 4 of NRS 449.4329,

an intermediary service organization shall provide to the client who selected

the personal assistant the results of the report on the criminal history of the

personal assistant.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.823)

      NAC 449.39519  Client to serve as managing employer and provide training to

personal assistant; reporting of training to organization. (NRS 449.4308,

449.4327)

     1.  The client of an intermediary service

organization must serve as the managing employer of the personal assistant and

must be responsible for the selection and termination of the personal

assistant.

     2.  Each client shall ensure that:

     (a) The personal assistant selected to provide

services to the person with a disability under the direction of the client

completes the training required pursuant to this section; and

     (b) The personal assistant is able to safely

perform the services required to meet the needs of the person with a

disability.

     3.  Each client shall ensure that the

personal assistant:

     (a) Receives instruction from the client or a

person designated by the client at the location where the personal assistant

will provide services to the person with a disability;

     (b) Within 120 days after being employed by the

intermediary service organization, receives not less than 16 hours of training

which must include, without limitation:

          (1) The rights of a client, including, without

limitation, confidentiality of client information and state and federal laws

relating to confidentiality;

          (2) First aid and cardiopulmonary

resuscitation;

          (3) Universal precautions, as defined in NAC 441A.195, and the control of

infection, including, without limitation, information on bloodborne pathogens

and infection control procedures;

          (4) Body mechanics, transferring and mobility,

including, without limitation, typical body movements, range of motion,

prevention of back injury and potential fall hazards;

          (5) Household safety and accident prevention,

including, without limitation, the preparation of a home for safety and

accident prevention;

          (6) Basic communication skills, including, without

limitation, techniques for sharing information with persons who require

alternative modes of communication;

          (7) Information concerning advance directives

as defined in NRS 449.905;

          (8) General awareness of issues relating to

aging and disabilities, sensory, physical and cognitive disabilities,

behavioral interventions targeted to specific populations, and the philosophy

and principles of independent living; and

          (9) The prevention of abuse, neglect and

exploitation of a person with a disability, including, without limitation,

identifying and reporting the full range of serious occurrences, and reporting

of suspected cases of abuse, neglect or exploitation in the manner prescribed

in NRS 200.5093, 200.50935 and 632.472; and

     (c) Receives not less than 8 hours of training

during each year of employment thereafter concerning such topics as determined

by the client.

     4.  The client shall submit to the

intermediary service organization documentation which includes, without

limitation:

     (a) The content of the training provided to the

personal assistant pursuant to this section;

     (b) The date on which the training was completed;

     (c) The number of hours of training provided to the

personal assistant; and

     (d) A certificate indicating successful completion

of the training.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.824)

      NAC 449.3952  Additional training to be provided by intermediary service

organization. (NRS 449.4308, 449.4327)  An intermediary service

organization shall make available to a personal assistant employed by the

intermediary service organization all training required pursuant to NAC 449.39519 and, at the request of a client, such

additional training for a personal assistant as necessary to support the plan

of care for the person with a disability, including, without limitation:

     1.  General training for the personal

assistant;

     2.  Protocols for a personal assistant,

including, without limitation, the rights and responsibilities of a client and

of a personal assistant;

     3.  The manner in which to groom and dress

the person with a disability;

     4.  Procedures for bathing and maintaining

proper hygiene for a person with a disability, including, without limitation,

bed-bath and tub-bath techniques;

     5.  Caring for the bowel, bladder and skin of

a person with a disability, including, without limitation, information

concerning caring for a catheter, the identification and control of infection,

common bowel problems, the early recognition of skin problems, the prevention

of pressure sores and the routine inspection of skin;

     6.  Assistive technology, including, without

limitation, examples of assistive technology, how assistive technology can be

used by the personal assistant and resources from which assistive technology

may be obtained;

     7.  Nutrition and food preparation,

including, without limitation, information about preparing balanced meals,

addressing special dietary needs or restrictions, guidelines for hydration and

the proper handling and storage of food; and

     8.  The manner in which to maintain health

records, including, without limitation, illustrations of how information should

be conveyed in a written or dictated form to assure confidentiality and a means

to ensure that the person with a disability receives services as outlined in

the plan of care.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.825)

      NAC 449.39521  Visits and telephone interviews with clients. (NRS 449.4308,

449.4327)

     1.  Except as otherwise provided in

subsection 3, an intermediary service organization shall, not less than once

every 6 months, conduct a visit of the residence of the person with a

disability or perform a telephone interview with the client to monitor the

quality of care received by the person with a disability.

     2.  The intermediary service organization

shall document each visit or telephone interview conducted pursuant to

subsection 1. Such documentation must include, without limitation:

     (a) The date of the visit or telephone interview;

     (b) Whether the plan of care is meeting the needs

of the person with a disability;

     (c) Whether the personal assistant has received

sufficient training to provide the services for the person with a disability;

and

     (d) Whether there have been changes in the health

status of the person with a disability.

     3.  A client may decline to receive a visit

or a telephone interview pursuant to subsection 1 by providing to the

intermediary service organization a written waiver declining the visit or

telephone interview. An intermediary service organization shall retain a copy

of a written waiver in the record of the client.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.826)

      NAC 449.39522  Written statement of services provided to clients. (NRS 449.4308,

449.4327)

     1.  An intermediary service organization

shall provide to each client for his or her signature a written statement which

contains a description of the services provided by the intermediary service

organization. The statement must include, without limitation:

     (a) An easily understandable statement that it is

not within the scope of services provided by the intermediary service

organization to manage the medical and health conditions of a person with a

disability;

     (b) The qualifications and required training for

personal assistants;

     (c) The amount that will be charged for the

services provided by the intermediary service organization;

     (d) A description of billing methods, acceptable

payment methods and due dates for payments, and the policy for notifying the

client of any increase in the amount that will be charged for the services

provided by the intermediary service organization;

     (e) Criteria, circumstances or conditions which may

result in the termination of services by the intermediary service organization,

the procedures for notifying the client of such termination and the procedures

for appealing such termination;

     (f) The manner in which the intermediary service

organization may be contacted during all hours when services are being provided

to a person with a disability; and

     (g) Information about the rights of a client of the

intermediary service organization and the procedures for filing a grievance.

     2.  A copy of the signed statement must be

maintained by the intermediary service organization in the records of the

client maintained by the intermediary service organization.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.827)

      NAC 449.39523  Discussion of services provided to clients. (NRS 449.4308,

449.4327)

     1.  An intermediary service organization

shall discuss with each potential client before providing services:

     (a) The planned training to be provided by the

intermediary service organization to the personal assistant;

     (b) The responsibilities of the intermediary

service organization; and

     (c) A contingency plan in the event that a personal

assistant fails to report for a scheduled visit with the person with a

disability.

     2.  The information discussed pursuant to

subsection 1 and the result of that discussion must be documented and

maintained in the records of the client maintained by the intermediary service

organization.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.828)

      NAC 449.39524  Rights of person with a disability receiving services. (NRS 449.4308,

449.4327)

     1.  An intermediary service organization

shall ensure that a person with a disability who receives services from the

intermediary service organization or, as applicable, other responsible person

acting on his or her behalf:

     (a) Has the right to select the personal assistant

of his or her choice;

     (b) Has the right to choose community-based care or

institutional care;

     (c) Receives services from the intermediary service

organization without regard to race, color, creed, national origin, sex or

disability;

     (d) Is treated with respect, receives recognition

of his or her individuality and is free from physical, verbal or psychological

abuse;

     (e) Is allowed to make informed decisions regarding

the care of the person with a disability and to participate in the development

of a plan of care;

     (f) Receives a description of advance directives,

as defined in NRS 449.905, and

information on how to obtain an advance directive;

     (g) Has the right to appeal any termination,

reduction or suspension of services by the intermediary service organization

and to receive a written explanation of decisions of the intermediary service

organization relating to the provision of services;

     (h) Receives confidential treatment of personal,

medical and financial information;

     (i) Has access to any records maintained by the

intermediary service organization relating to the care of the person with a

disability;

     (j) Is informed of the primary contact person for

the intermediary service organization, the person with whom a grievance may be

filed with the intermediary service organization and the process to follow when

filing a grievance with the intermediary service organization; and

     (k) Receives timely responses to a concern

expressed to the intermediary service organization regarding the provision of

services by the intermediary service organization.

     2.  Each person with a disability who

receives services from the intermediary service organization or, as applicable,

other responsible person acting on his or her behalf must be provided with a

written list of the rights set forth in subsection 1.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.829)

Administrative Review and Hearings

      NAC 449.39525  Request for administrative review of complaint. (NRS 449.4337)

     1.  An applicant for a certificate to operate

an intermediary service organization or a person who is certified to operate an

intermediary service organization may submit a written request to the

Administrator or the Administrator’s designee for an administrative review of a

complaint if the complainant:

     (a) Has a legitimate grievance with any action of

the Division in the certification process; and

     (b) Has not resolved the grievance through informal

negotiations with an officer of the Division.

     2.  Not later than 30 days after the

occurrence of the action that is the cause of the grievance of the complainant,

a request for an administrative review must be mailed by registered or certified

mail, return receipt requested, to the Administrator or the Administrator’s

designee.

     3.  A request for an administrative review

must include:

     (a) The date of the occurrence of the action which

is the cause of the grievance of the complainant;

     (b) A statement of the complaint, including each

issue that the complainant considers relevant to the complaint;

     (c) A statement of each resolution of the complaint

offered by the complainant;

     (d) Citations to the statutes or regulations, if

any, which pertain to the complaint;

     (e) A statement which supports the position of the

complainant;

     (f) The mailing address and telephone number of the

complainant; and

     (g) The signature of the complainant and the date

of the signature.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.830)

      NAC 449.39526  Scheduling of administrative review. (NRS 449.4337)  The

Administrator or the Administrator’s designee shall conduct an administrative

review at a time and place which is reasonable for the parties. Unless

otherwise scheduled to accommodate the complainant, the Administrator or the

designee shall conduct an administrative review within 10 days after the

Administrator or the designee receives a request for an administrative review

pursuant to NAC 449.39525.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.831)

      NAC 449.39527  Conduct of administrative review.

(NRS 449.4337)  An

administrative review must be:

     1.  Conducted informally without attorneys or

witnesses.

     2.  Based on the record available, except

that the complainant may, upon the complainant’s request, appear and present

additional facts.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.832)

      NAC 449.39528  Issuance of written decision following administrative review. (NRS 449.4337)

     1.  Not later than 15 days after an

administrative review, the Administrator or the Administrator’s designee shall

issue a written decision, including the findings of fact and conclusions of law

concerning the complaint and any appropriate orders.

     2.  The Division will mail the written

decision to the complainant by registered or certified mail, return receipt

requested, or a representative of the Division may personally deliver the

decision to the complainant and read it to the complainant. If the decision is

personally delivered to the complainant, the complainant shall date and sign a

copy of the decision as an acknowledgment of the receipt.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.833)

      NAC 449.39529  Request for hearing. (NRS 449.4337)

     1.  Not later than 15 days after receipt of a

written decision on a complaint, a complainant may submit a written request to

the Administrator for a hearing on the complaint. The request must be mailed to

the Administrator by certified or registered mail, return receipt requested.

     2.  The written request for a hearing must

include a copy of the original complaint filed by the complainant.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.834)

      NAC 449.395295  Hearings: Scheduling; notice. (NRS 449.4337)

     1.  Not later than 30 days after the

Administrator receives a written request for a hearing, a hearing officer

appointed by the senior hearing officer of the Hearings Division of the

Department of Administration shall conduct a hearing at a time and location

that is reasonable for the parties. The hearing officer must not have any

personal involvement in the complaint.

     2.  Not less than 10 days before the date of

the hearing, the Division of Public and Behavioral Health will, in accordance

with NRS 233B.121, provide to

all parties notice of the time, date and place of the hearing.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.835)

      NAC 449.3953  Hearings: Representation; evidence; rights of parties. (NRS 449.4337)

     1.  The complainant may be represented at the

hearing by an attorney or another person designated by the complainant.

     2.  The hearing officer is not bound by the

technical rules of evidence. Decisions concerning the admissibility of evidence

must be made in accordance with NRS

233B.123.

     3.  Each party must be granted the

opportunity to present the party’s case, examine and cross-examine witnesses,

and rebut evidence.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.8355)

      NAC 449.39531  Resolution of complaint. (NRS 449.4337)  Unless

otherwise provided by statute, a complaint may be resolved by arbitration,

mutual agreement of the parties, settlement, consent decree or default of a

party.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.836)

      NAC 449.39532  Final decision of hearing officer; request for judicial review. (NRS 449.4337)

     1.  A final decision by a hearing officer on

a complaint must be in writing or stated in the record. A final decision must

include findings of fact and conclusions of law. Findings of fact must include

a statement of the facts which support the findings.

     2.  Not more than 30 days after a final

decision is made, a party may appeal the final decision of the hearing officer

and request judicial review pursuant to NRS 233B.130 to 233B.150, inclusive.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.837)

      NAC 449.39533  Record of hearing. (NRS 449.4337)  The

record of the hearing must include:

     1.  The transcript of the oral testimony

provided at the hearing;

     2.  All pleadings and motions filed by the

parties;

     3.  Any rulings made by the hearing officer,

including rulings on offers of proof;

     4.  Evidence that was admitted;

     5.  Facts which were officially noticed by

the hearing officer; and

     6.  Any other decision, opinion or report of

the hearing officer.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.838)

      NAC 449.39534  Provision of transcript of oral proceedings of hearing. (NRS 449.4337)  Upon

request of a party, the Division will provide a transcript of the oral

proceedings of the hearing. The Division may require payment of the cost

incurred for providing the transcript.

     (Added to NAC by Aging & Disability Services Div.

by R197-09, eff. 7-22-2010)—(Substituted in revision for NAC 427A.839)

Administrative Sanctions

      NAC 449.39535  Definitions. (NRS 449.4336)  As used

in NAC 449.39535 to 449.39561,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.39536 to 449.39544,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.840)

      NAC 449.39536  “Ban on enrollment” defined. (NRS 449.4336)  “Ban on

enrollment” means a prohibition on the provision of services to clients who are

newly enrolled.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.841)

      NAC 449.39537  “Cluster” defined. (NRS 449.4336)  “Cluster”

means a violation that involves the same or similar kinds of services as one or

more other violations.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.842)

      NAC 449.39538  “Compliance” defined. (NRS 449.4336)  “Compliance”

means that no major violation is present and that effective steps have been

taken to resolve all violations.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.843)

      NAC 449.39539  “De minimis violation” defined. (NRS 449.4336)  “De

minimis violation” means a violation rated at a severity level of one or two

and at a scope level of one or two.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.844)

      NAC 449.3954  “Major violation” defined. (NRS 449.4336)  “Major

violation” means a violation with a severity and scope score of five or more.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.845)

      NAC 449.39541  “Plan of correction” defined. (NRS 449.4336)  “Plan of

correction” means a plan developed by the intermediary service organization and

approved by the Division that:

     1.  Describes the actions to be taken by the

intermediary service organization to correct one or more violations; and

     2.  Specifies the date by which those

violations will be corrected.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.846)

      NAC 449.39542  “Resurvey” defined. (NRS 449.4336)  “Resurvey”

means a survey conducted after the initial survey to evaluate compliance with a

plan of correction.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.847)

      NAC 449.39543  “Severity and scope score” defined. (NRS 449.4336)  “Severity

and scope score” means the sum of the numerical levels of severity and scope

assigned to a violation.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.848)

      NAC 449.39544  “Subsequent violation” defined. (NRS 449.4336)  “Subsequent

violation” means a violation found on a resurvey.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.849)

      NAC 449.39545  Imposition of sanctions generally. (NRS 449.4336)

     1.  The Division will impose at least one

administrative sanction against an intermediary service organization for each

violation by the intermediary service organization with a severity level of

four and for each violation with a severity and scope score of six or more as

determined pursuant to the provisions of NAC

449.39551 to 449.39555, inclusive.

     2.  The Division may impose sanctions if

violations of a severity level of three or less or a severity and scope score

of less than six are identified.

     3.  The Division will minimize the time

between identification of a violation and the imposition of a sanction for the

violation.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.855)

      NAC 449.39546  Minimum sanction to be imposed. (NRS 449.4336)  The Division

will impose at least one sanction upon any intermediary service organization

that has a violation with a severity level of four or a severity and scope

score of six or more as determined pursuant to the provisions of NAC 449.39551 to 449.39555,

inclusive. More than one of these sanctions may be imposed at the discretion of

the Division.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.856)

      NAC 449.39547  Available sanctions. (NRS 449.4321, 449.4335, 449.4336)

     1.  The Division may apply one or more

sanctions as provided in NRS

449.4335, including, without limitation:

     (a) The imposition of a plan of correction as

directed by the Division;

     (b) The imposition of a ban on enrollment;

     (c) Monitoring of the intermediary service

organization by the Division;

     (d) The assessment of monetary penalties in an

amount set forth in NAC 449.39561;

     (e) The requirement that the intermediary service

organization be managed temporarily by a person appointed by the Division; and

     (f) The denial, suspension or revocation of the

certificate.

     2.  If the Division chooses to impose a

particular sanction, it must be applied according to the severity and scope

factors established in NAC 449.39551 to 449.39555, inclusive.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.857)

      NAC 449.39548  Duration of sanctions. (NRS 449.4336)  Sanctions

applied pursuant to NAC 449.39535 to 449.39561, inclusive, may be imposed until

substantial compliance is achieved or, if compliance is not achieved, until the

day before termination of the certificate becomes effective.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.858)

      NAC 449.39549  Notice of sanction; appointment of temporary manager; ban on

enrollment or suspension of certificate authorized in certain circumstances. (NRS 449.4335,

449.4336)

     1.  The Division will give notice of a

sanction to the holder of a certificate by certified mail as required pursuant

to NRS 449.4337.

     2.  If there is an immediate and serious

threat to the health and safety of any person with a disability served by an

intermediary service organization, the Division may appoint a temporary manager

to remove the threat.

     3.  The Division may, in an emergency, impose

a ban on enrollment or may suspend a certificate upon transmitting notice of

such sanction to the holder of the certificate by certified mail.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.859)

      NAC 449.3955  Imposition of one or more sanctions; reporting of violations;

presumption of de minimis violation. (NRS 449.4336)

     1.  The Division may apply one or more

sanctions on the basis of violations found during surveys or investigations of

complaints conducted by the Division.

     2.  Violations must be reported to the

intermediary service organization and any client of the intermediary service

organization who may be affected by the violation. The report to the intermediary

service organization must specify the violations found and the severity and

scope score for each violation determined by the Division pursuant to the

provisions of NAC 449.39551 to 449.39555, inclusive.

     3.  Any violation for which a severity and

scope score is not specified is presumed to be a de minimis violation.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.860)

      NAC 449.39551  Severity and scope of violations to be considered in determining

sanctions to be imposed. (NRS 449.4336)  In

determining the sanctions to be imposed, the Division will consider the

severity and scope of the violations according to the classifications of

severity and scope described in NAC 449.39551 to 449.39555, inclusive.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.861)

      NAC 449.39552  Scope of violations: Survey of organization; sampling of clients;

use of scope relating to one client authorized.

(NRS 449.4336)

     1.  In determining the scope of a violation

by an intermediary service organization, a survey of an intermediary service

organization must evaluate a representative sample of clients of the

intermediary service organization. The sample must consist of at least:

 



Number of

clients





Minimum

number of clients in sample







 





 







1 - 9................................................................................................





                All clients







10 - 40............................................................................................





                      10







41 - 75............................................................................................





                      15







76 - 100..........................................................................................





                      20







101 - 175........................................................................................





                      25







176 - 250........................................................................................





                      30







251 - 350........................................................................................





                      35







351 - 450........................................................................................





                      40







451 or more....................................................................................





                      50





 

     2.  In determining the scope of a violation

involving particular kinds of services, the sampling of clients must evaluate a

representative sample of clients of the intermediary service organization

receiving or requiring the particular kinds of services.

     3.  The Division may review more than the

minimum number of clients and determine the scope based on the number of

clients actually reviewed.

     4.  If the Division investigates a specific

complaint relating to a client, the Division may use only that client as the

sample. The scope of any violation determined pursuant to this subsection must

be a scope level of one.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.862)

      NAC 449.39553  Scope of violations: Use of scope; basis for assessment. (NRS 449.4336)

     1.  The scope scale must be used to assess

the scope of a particular violation by the intermediary service organization.

     2.  The basis for the assessment is the

actual or potential harm to clients as shown by:

     (a) The frequency of the violation;

     (b) The number or percentage of clients affected;

     (c) The number or percentage of staff involved; and

     (d) The pattern or lack of pattern of the

violations.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.863)

      NAC 449.39554  Scope of violations: Criteria for evaluation. (NRS 449.4336)

     1.  The scope of the violations must be

evaluated using the criteria prescribed in this section.

     2.  A violation with a scope level of one

consists of one or a few unrelated incidents in the sample surveyed. A

violation is of this scope if it involves 20 percent or less of the clients

sampled.

     3.  A violation has a scope level of two if

the Division identifies a pattern of incidents involving the intermediary

service organization, including, without limitation, any violations involving

clients who require particular kinds of services. The number or percentage of

clients or staff involved in the violation or the repeated occurrences of the

violation in short succession may also establish a pattern by indicating a

reasonable degree of predictability of similar incidents. A violation is also

of this scope if it involves more than 20 percent but not more than 50 percent

of the clients sampled.

     4.  A violation has a scope level of three if

it occurs in a sufficient number or percentage of clients or staff or with

sufficient regularity over time that it may be considered systemic or pervasive

in or by the intermediary service organization. A violation is also of this

scope if it involves more than 50 percent of the clients sampled.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.864)

      NAC 449.39555  Severity of violations: Use of severity scale; basis for

assessment; criteria for evaluation. (NRS 449.4336)

     1.  The severity scale must be used to assess

the severity of a particular violation pertaining to the intermediary service

organization. The basis for the assessment must be the actual or potential harm

to a person with a disability or, as applicable, other responsible person

acting on his or her behalf.

     2.  Violations with a severity level of one

concern requirements promulgated primarily for administrative purposes. No harm

is likely to occur to a person with a disability. No negative impact has

occurred or is likely to occur. The ability of a person with a disability to

achieve the highest practicable physical, mental or psychosocial well-being has

not been and is not likely to be compromised.

     3.  Violations with a severity level of two

indirectly threaten the health, safety, rights, security, welfare or well-being

of a person with a disability or, as applicable, other responsible person

acting on his or her behalf. A potential for harm, as yet unrealized, exists.

If continued over time:

     (a) A negative impact on or a violation of one or

more rights of a person with a disability or, as applicable, other responsible

person acting on his or her behalf would occur or would be likely to occur; or

     (b) The ability of one or more persons with

disabilities to achieve the highest practicable physical, mental or

psychosocial well-being would be or would likely be compromised.

     4.  Violations with a severity level of three

create a condition or incident in the operation of an intermediary service

organization that directly or indirectly threatens the health, safety, rights,

security, welfare or well-being of a person with a disability or, as

applicable, other responsible person acting on his or her behalf. A negative

impact on the health, safety, rights, security, welfare or well-being of one or

more persons with disabilities or, as applicable, other responsible person

acting on his or her behalf has occurred or can be predicted with substantial

probability to occur, or the ability of persons with disabilities to achieve

the highest practicable physical, mental or psychosocial well-being has been or

is about to be compromised and requires intervention and correction of the

violation. Violation of a partial or complete ban on enrollment imposed on an

intermediary service organization or failure to implement a directed plan of

correction is presumed to be a violation of this severity level.

     5.  Violations with a severity level of four

create a condition or incident that has resulted in or can be predicted with

substantial probability to result in death or serious harm to a person with a

disability. As used in this subsection, “serious harm” includes serious mental

harm, serious impairment of bodily functions, serious dysfunction of any bodily

organ or part, life-threatening harm or death.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.865)

      NAC 449.39556  Subsequent violation on resurvey: Rebuttable presumption;

imposition of sanction. (NRS 449.4336)  If the

same violation is found on a resurvey, there is a rebuttable presumption that

the violation continued through the period between the survey and resurvey. A

sanction may be imposed for a subsequent violation only if the resurvey is made

and the violation is again actually found to be present.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.866)

      NAC 449.39557  Determination of sanctions: Initial assessment. (NRS 449.4336)  The

Division will initially assess individual violations or clusters of violations

according to the following initial factors:

     1.  The presence or absence of an immediate

and serious threat to the health and safety of persons with disabilities who

receive services from the intermediary service organization or, as applicable,

other responsible person acting on his or her behalf; and

     2.  The severity of the violation.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.867)

      NAC 449.39558  Determination of sanctions: Secondary factors to be considered. (NRS 449.4336)  After

the initial assessment, the Division will consider the following secondary

factors in determining the sanction to impose:

     1.  The relationship of one violation or

cluster of violations to other violations;

     2.  The history of previous compliance by the

intermediary service organization generally and specifically with reference to

the violations in issue;

     3.  Whether the violations are directly

related to the services received by a person with a disability from the

intermediary service organization; and

     4.  The corrective and long-term compliance

outcomes desired.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.868)

      NAC 449.39559  Determination of sanctions: Basis for selection; restrictions

upon service and monetary penalties presumed to be most effective. (NRS 449.4336)  The

selection of a sanction must be based upon the nature of the violations or

cluster of violations and the sanction most likely to correct those violations.

Absent evidence to the contrary, restrictions upon service and monetary

penalties are presumed to be the most effective sanctions for violations that

do not cause an immediate and serious threat to clients.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.869)

      NAC 449.3956  Plan of correction: Development by intermediary service

organization; authority of Division when plan is not acceptable; effect of

failure to submit plan. (NRS 449.4336)

     1.  The intermediary service organization

shall develop a plan of correction for each violation and submit the plan to

the Division for approval within 10 days after receipt of the notice of

violations from the Division pursuant to NAC

449.39549. The plan of correction must include specific requirements for

corrective action, which must include the time within which the violations are

to be corrected.

     2.  If the plan of correction is not

acceptable to the Division, the Division may direct the intermediary service

organization to resubmit a plan of correction or the Division may develop a

directed plan of correction with which the intermediary service organization

must comply.

     3.  Failure to submit the plan of correction

to the Division within 10 days after receipt of the notice of violations

constitutes a separate violation subject to monetary penalties pursuant to NAC 449.39561 with severity and scope rated at the

same levels as the highest violation identified on the notice of violations.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.870)

      NAC 449.39561  Monetary penalties: Determination of initial penalty; daily

penalties; maximum total penalties. (NRS 449.4335, 449.4336)

     1.  In determining the amount of an initial

monetary penalty, the Division will consider the severity alone if the severity

level is four. In determining the amount of the monetary penalty where the

severity level is less than four, the severity and scope score must be

considered.

     2.  For initial violations with a severity

level of four, an initial monetary penalty of up to $1,000 per violation may be

imposed.

     3.  For initial violations with a severity

level of three and a scope level of three, a monetary penalty of up to $800 per

violation may be imposed.

     4.  For initial violations with a severity

level of three and a scope level of two or less, an initial monetary penalty of

up to $400 per violation may be imposed.

     5.  For initial violations with a severity

level of two and a scope level of three, an initial monetary penalty of up to

$200 per violation may be imposed. The payment of this monetary penalty must be

suspended if the facility has corrected the violations within the time

specified in the plan of correction approved by the Division.

     6.  Except as otherwise provided in

subsection 7, in addition to any monetary penalty imposed pursuant to this

section, the Division may impose a monetary penalty of not more than $10 per

client per day for each day the violation continues.

     7.  The total monetary penalties imposed by

the Division pursuant to this section must not be more than $1,000 per day for

each violation, together with interest thereon at a rate of 10 percent per

annum.

     (Added to NAC by Bd. of Health by R167-07, eff. 1-30-2008)—(Substituted

in revision for NAC 427A.871)

AGENCIES TO PROVIDE PERSONAL CARE SERVICES IN THE HOME

General Provisions

      NAC 449.396  Definitions. (NRS 449.0302)  As used

in NAC 449.396 to 449.3982,

inclusive, the words and terms defined in NAC 449.3961

to 449.3968, inclusive, have the meanings ascribed

to them in those sections.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3961  “Activities of daily living” defined. (NRS 449.0302)  “Activities

of daily living” means the activities listed in NRS 449.0021.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3962  “Agency” defined. (NRS 449.0302)  “Agency”

means an agency to provide personal care services in the home as defined in NRS 449.0021.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3963  “Attendant” defined. (NRS 449.0302)  “Attendant”

means a person who is employed by or retained pursuant to a contract by an

agency for the purpose of providing personal care services to a client.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3964  “Client” defined. (NRS 449.0302)  “Client”

means an elderly person or a person with a disability who desires the provision

of personal care services in the home in which the person lives.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3965  “Personal care services” defined.

(NRS 449.0302)  “Personal

care services” means the nonmedical services described in NRS 449.0021.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3966  “Representative of the client” defined. (NRS 449.0302)  “Representative

of the client” means the spouse of a client, a parent or stepparent of a client

who is a minor, the legal guardian of a client and any other person required by

law to provide medical support to a client.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3967  “Service plan” defined. (NRS 449.0302)  “Service

plan” means a plan which includes a written description of the needs of a

client for personal care services and which specifies the tasks that an

attendant is authorized to provide for the client.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3968  “Work station” defined. (NRS 449.0302)  “Work

station” means a satellite office of an agency that is established for the sole

purposes of providing a location where copies of records may be sent to an

agency and providing a location from which an attendant may work to serve a

geographic area outside the geographic area in which the attendant normally

works.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

Licensing

      NAC 449.3971  Applicant required to submit fingerprints to Central Repository

for Nevada Records of Criminal History for report on background. (NRS 239B.010,

449.0302)

     1.  In addition to the requirements set forth

in NAC 449.011, each applicant for a license to

operate an agency shall submit to the Central Repository for Nevada Records of

Criminal History two complete sets of fingerprints for submission to the

Federal Bureau of Investigation for its report.

     2.  The Central Repository for Nevada Records

of Criminal History shall determine whether the applicant has been convicted of

a crime listed in paragraph (a) of subsection 1 of NRS 449.174 and immediately inform

the administrator of the agency, if any, and the Division of whether the

applicant has been convicted of such a crime.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3972  Location to which license applies; agency to retain proof of

liability coverage and compliance with certain statutory provisions. (NRS 449.0302)

     1.  Except as otherwise provided in this

subsection, each license issued to operate an agency is separate and distinct

and is issued to a specific person to operate the agency at a specific

location. A person may operate an agency at multiple work stations if the

agency maintains the records for the clients, attendants, other members of the

staff of the agency and operations of the agency at the specific location

designated on the license.

     2.  The name of the person who is designated

as responsible for the conduct of the agency must appear on the face of the

license.

     3.  Each agency must retain:

     (a) Proof that it is adequately covered against

liabilities resulting from claims incurred in the course of operation; and

     (b) Proof of compliance with NRS 449.065 and 449.067.

     4.  The proof of liability coverage and

compliance with state statute required by subsection 3 must be verified at the

time the agency submits its initial application to the Division for a license

and upon request by the Division.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

Administration and Personnel

      NAC 449.3973  Qualifications and duties of administrator; appointment of

designee to act in administrator’s absence. (NRS 449.0302)

     1.  The administrator of an agency must:

     (a) Be at least 18 years of age;

     (b) Have a high school diploma or its equivalent;

     (c) Be responsible and mature and have the personal

qualities which will enable the administrator to understand the problems of

elderly persons and persons with disabilities;

     (d) Understand the provisions of this chapter and chapter 449 of NRS; and

     (e) Demonstrate the ability to read, write, speak

and understand the English language.

     2.  The administrator of an agency shall

represent the licensee in the daily operation of the agency and shall appoint a

person to exercise his or her authority in the administrator’s absence. The

responsibilities of an administrator include, without limitation:

     (a) Employing qualified personnel and arranging for

their training;

     (b) Ensuring that only trained attendants are

providing services to a client of the agency and that such services are

provided in accordance with the functional assessment of the client, the

service plan established for the client and the policies and procedures of the

agency;

     (c) Developing and implementing an accounting and

reporting system that reflects the fiscal experience and current financial

position of the agency;

     (d) Negotiating for services provided by contract

in accordance with legal requirements and established policies of the agency;

     (e) Providing oversight and direction for

attendants and other members of the staff of the agency as necessary to ensure

that the clients of the agency receive needed services;

     (f) Developing and implementing policies and

procedures for the agency, including, without limitation, policies and

procedures concerning terminating the personal care services provided to a

client;

     (g) Designating one or more employees of the agency

to be in charge of the agency during those times when the administrator is

absent; and

     (h) Demonstrating to the Division upon request that

the agency has sufficient resources and the capability to satisfy the requests

of each client of the agency related to the provision of the personal care

services described in the service plan to the client.

     3.  Except as otherwise provided in this

subsection and subsection 4 of NAC 449.3976, an

employee designated to be in charge of the agency when the administrator is

absent must have access to all records kept at the agency. Confidential

information may be removed from a file to which an employee designated to be in

charge of the agency has access if the confidential information is maintained

separately by the administrator.

     4.  The administrator of an agency shall

ensure that:

     (a) The clients of the agency are not abused,

neglected or exploited by an attendant or another member of the staff of the

agency, or by any person who is visiting the client when an attendant or

another member of the staff of the agency is present; and

     (b) Suspected cases of abuse, neglect or

exploitation of a client are reported in the manner prescribed in NRS 200.5093 and 632.472.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3974  Maintenance of policies and procedures concerning qualifications,

responsibilities and conditions of employment for staff members. (NRS 449.0302)  An

agency shall maintain written policies and procedures concerning the

qualifications, responsibilities and conditions of employment for each

attendant and other members of the staff of the agency. The written policies

and procedures must be reviewed and revised as needed. The written policies and

procedures must be made available to the attendants and other members of the

staff of the agency upon hire and whenever revisions are made to those policies

and procedures. At a minimum, the policies and procedures must:

     1.  Provide descriptions of the duties and

responsibilities of attendants;

     2.  Provide descriptions of any activities

that attendants are prohibited from engaging in, including, without limitation:

     (a) Making a long distance telephone call that is

personal in nature:

          (1) On a telephone owned by or provided by a

client; or

          (2) While on duty providing personal care

services to a client;

     (b) Loaning, borrowing or accepting gifts of money

or personal items from a client;

     (c) Accepting or retaining money or gratuities from

a client, other than money needed for the purchase of groceries or medication

for the client; and

     (d) Becoming the legal guardian of a client or

being named as an attorney-in-fact in a power of attorney executed by the

client;

     3.  Set forth the rights of clients;

     4.  Set forth any requirements relating to

ethics governing attendants and other members of the staff of the agency,

including, without limitation, any requirements concerning the confidentiality

of client information;

     5.  Provide for the prevention, control and

investigation of infections and communicable diseases;

     6.  Provide a description of the personal

care services that are provided by the agency to clients;

     7.  Provide a description of the manner in

which the agency assigns attendants to provide personal care services to

clients and any supervision of those services that will be provided by the

agency;

     8.  Provide for documentation of the needs of

each client and the personal care services that are provided to the client;

     9.  Set forth the emergency responses of the

agency to both medical and nonmedical situations;

     10.  Set forth the roles of the agency and

any coordination that the agency will provide with services provided by other

community service agencies;

     11.  Provide for periodic evaluations of the

performance of attendants and other members of the staff of the agency;

     12.  Provide for the maintenance of current

personnel records which confirm that the policies and procedures are being

followed; and

     13.  Set forth any other specific information

that is necessary based on the needs of any special populations served by the

agency.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3975  Attendants: Qualifications; annual training. (NRS 449.0302)  Each

attendant of an agency must:

     1.  Be at least 18 years of age;

     2.  Be responsible and mature and have the

personal qualities which will enable the attendant to understand the problems

of elderly persons and persons with disabilities;

     3.  Understand the provisions of this chapter

and chapter 449 of NRS;

     4.  Demonstrate the ability to read, write,

speak and communicate effectively with the clients of the agency;

     5.  Demonstrate the ability to meet the needs

of the clients of the agency; and

     6.  Receive annually not less than 8 hours of

training related to providing for the needs of the clients of the agency.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3976  Attendants: Maintenance of personnel file; evaluation of

competency. (NRS 449.0302)

     1.  A separate personnel file must be kept

for each attendant of an agency and must include, without limitation:

     (a) The name, address and telephone number of the

attendant;

     (b) The date on which the attendant began working

for the agency;

     (c) Documentation that the attendant has had the

tests or obtained the certificates required by NAC 441A.375;

     (d) Evidence that the references supplied by the

attendant were checked by the agency;

     (e) Evidence of compliance with NRS 449.123 by the administrator of

the agency or the person licensed to operate the agency with respect to the

attendant;

     (f) Proof that, within 6 months after the attendant

began working for the agency, the attendant obtained a certificate in first aid

and cardiopulmonary resuscitation issued by the American National Red Cross or

an equivalent certificate approved by the Division;

     (g) Proof that the attendant is at least 18 years

of age;

     (h) Proof of possession by the attendant of at

least the minimum liability insurance coverage required by state law if the

attendant will be providing transportation to a client in a motor vehicle; and

     (i) Documentation of all training attended by and

performance evaluations of the attendant.

     2.  The documentation described in paragraph

(i) of subsection 1 must include, without limitation, for each training course

attended by the attendant:

     (a) A description of the content of the training

course;

     (b) The date on which the training course was

attended;

     (c) The number of hours of the training course;

     (d) The name and signature of the instructor of the

training course; and

     (e) A certificate indicating that the training

course was successfully completed by the attendant.

     3.  The administrator or the administrator’s

designee shall evaluate the competency of an attendant in each competency area

required by the agency if the attendant provides written proof of his or her

current or previous training in that competency area. After the initial

evaluation, any additional training provided to the attendant may be limited to

areas in which the attendant needs to improve his or her competency.

     4.  The administrator may keep the personnel

files of the agency in a locked cabinet and may, except as otherwise provided

in this subsection, restrict access to this cabinet by attendants and other

members of the staff of the agency. The administrator shall make the personnel

files, including, without limitation, any electronic files, available for

review by the Division upon request.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3977  Attendants: Required knowledge and training. (NRS 449.0302)

     1.  Each attendant of an agency shall:

     (a) Obtain a working knowledge of the provisions of

this chapter which govern the licensing of agencies before providing personal

care services to the clients of the agency. The agency must provide a copy of

those provisions to an attendant before the attendant may provide personal care

services to the clients of the agency.

     (b) Participate in and complete a training program

before independently providing personal care services to the clients of the

agency. The training program must include an opportunity for the attendant to

receive on-the-job instruction provided to clients of the agency, as long as

the administrator of the agency or the administrator’s designee provides

supervision during this instruction to determine whether the attendant is able

to provide personal care services successfully and independently to the client.

     (c) Receive training:

          (1) In the written documentation of:

               (I) Personal care services provided to

the clients of the agency; and

               (II) Verification of time records.

          (2) In the rights of clients, including,

without limitation, training in methods to protect client confidentiality

pursuant to state and federal regulations.

          (3) Related to the special needs of elderly

persons and persons with disabilities, including, without limitation, training

in the sensory, physical and cognitive changes related to the aging process.

          (4) Related to communication skills,

including, without limitation, active listening, problem solving, conflict

resolution and techniques for communicating through alternative modes with

persons with communication or sensory impairments.

          (5) In first aid and cardiopulmonary

resuscitation. A certificate in first aid and cardiopulmonary resuscitation

issued by the American National Red Cross or an equivalent certificate will be

accepted as proof of that training.

          (6) That is specifically related to the

personal care services provided by the agency, including, as applicable,

training in the following topics:

               (I) Duties and responsibilities of

attendants and the appropriate techniques for providing personal care services;

               (II) Recognizing and responding to

emergencies, including, without limitation, fires and medical emergencies;

               (III) Dealing with adverse behaviors;

               (IV) Nutrition and hydration, including,

without limitation, special diets and meal preparation and service;

               (V) Bowel and bladder care, including,

without limitation, routine care associated with toileting, routine maintenance

of an indwelling catheter drainage system such as emptying the bag and

positioning, routine care of colostomies such as emptying and changing the bag,

signs and symptoms of urinary tract infections, and common bowel problems,

including, without limitation, constipation and diarrhea;

               (VI) Skin care, including, without

limitation, interventions that prevent pressure sores, routine inspections of

the skin and reporting skin redness, discoloration or breakdown to the client

or a representative of the client and to the administrator of the agency or the

administrator’s designee;

               (VII) Methods and techniques to prevent

skin breakdown, contractures and falls;

               (VIII) Hand washing and infection

control;

               (IX) Body mechanics, mobility and

transfer techniques, including, without limitation, simple nonprescribed range

of motion; and

               (X) Maintenance of a clean and safe

environment.

     2.  Each attendant of an agency must be

evaluated and determined to be competent by the agency in the required areas of

training set forth in paragraph (c) of subsection 1.

     3.  Each attendant of an agency must have

evidence of successful completion of a training program that includes the areas

of training set forth in paragraph (c) of subsection 1 within the 12 months

immediately preceding the date on which the attendant first begins providing

care to a client.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3978  Attendants: Prohibition on provision of certain types of services

to clients. (NRS 449.0302)

     1.  The administrator of an agency shall

ensure that each attendant working for the agency is working within the

attendant’s scope of service and conducts himself or herself in a professional

manner. An attendant is prohibited from providing any of the services listed in

subsection 2 to a client.

     2.  The services an attendant must not

provide to a client include, without limitation:

     (a) Insertion or irrigation of a catheter;

     (b) Irrigation of any body cavity, including,

without limitation, irrigation of the ear, insertion of an enema or a vaginal

douche;

     (c) Application of a dressing involving

prescription medication or aseptic techniques, including, without limitation,

the treatment of moderate or severe conditions of the skin;

     (d) Administration of injections of fluids into

veins, muscles or the skin;

     (e) Administration of medication, including,

without limitation, the insertion of rectal suppositories, the application of a

prescribed topical lotion for the skin and the administration of drops in the

eyes;

     (f) Performing physical assessments;

     (g) Monitoring vital signs;

     (h) Using specialized feeding techniques;

     (i) Performing a digital rectal examination;

     (j) Trimming or cutting toenails;

     (k) Massage;

     (l) Providing specialized services to increase the

range of motion of a client;

     (m) Providing medical case management, including, without

limitation, accompanying a client to the office of a physician to provide

medical information to the physician concerning the client or to receive

medical information from the physician concerning the client; and

     (n) Any task identified in chapter 632 of NRS and the regulations

adopted by the State Board of Nursing as requiring skilled nursing care,

including, without limitation, any services that are within the scope and

practice of a certified nursing assistant.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

Provision of Services

      NAC 449.3979  Provision of written disclosure statement to client upon

acceptance for services by agency. (NRS 449.0302)

     1.  When a person is accepted as a client by

an agency, the agency shall:

     (a) Provide a written disclosure statement to the

client;

     (b) Require the client or a representative of the

client to sign the written disclosure statement; and

     (c) Ensure that a copy of the written disclosure

statement is incorporated into the record of the client.

     2.  The written disclosure statement must

include a description of and information concerning the personal care services

offered by the agency, including, without limitation:

     (a) A statement which is easily understandable to

the client indicating that it is not within the scope of the license of the

agency to manage the medical and health conditions of clients should the

conditions become unstable or unpredictable;

     (b) The qualifications and training requirements

for the attendants who provide personal care services to the clients of the

agency;

     (c) The charges for the personal care services

provided by the agency;

     (d) A description of billing methods, payment

systems, due dates for bills for personal care services and the policy for

notifying clients of increases in the costs of personal care services provided

by the agency;

     (e) The criteria, circumstances or conditions which

may result in the termination of personal care services by the agency and the

policy for notifying clients of such termination of personal care services;

     (f) Procedures for contacting the administrator of

the agency or the administrator’s designee during all hours in which personal

care services are provided and the on-call policy of the agency; and

     (g) Information concerning the rights of clients and

the grievance procedure of the agency.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.398  Rights of clients: Duties of administrator; provision of written

description to clients. (NRS 449.0302)

     1.  The administrator of an agency shall

ensure that a client is not prohibited from speaking to any person who

advocates for the rights of the clients of the agency.

     2.  The administrator of an agency shall

establish and enforce a procedure to respond to grievances, incidents and

complaints concerning the agency in accordance with the written policies and

procedures of the agency. The procedure established and enforced by the

administrator must include a method for ensuring that the administrator or the

administrator’s designee is notified of each grievance, incident or complaint.

The administrator or his or her designee shall personally investigate the

matter in a timely manner. A client who files a grievance or complaint or

reports an incident concerning the agency must be notified of the action taken

in response to the grievance, complaint or report or must be given a reason why

no action was taken.

     3.  The administrator of an agency shall

ensure that the agency is in compliance with NRS 449.700 to 449.730, inclusive.

     4.  The agency shall develop a written

description of the rights of clients and provide a copy to each client or a

representative of the client upon initiation of the service plan established

for the client. A signed and dated copy of the receipt of this information by

the client or a representative of the client must be maintained in the record

of the client.

     5.  The written description of the rights of

clients developed pursuant to subsection 4 must include, without limitation, a

statement that each client has the right:

     (a) To receive considerate and respectful care that

recognizes the inherent worth and dignity of each client;

     (b) To participate in the development of the

service plan established for the client and to receive an explanation of the

personal care services provided pursuant to the service plan and a copy of the

service plan;

     (c) To receive the telephone number of the Bureau

which may be contacted for complaints;

     (d) To receive notification of any authority of the

Division to examine the records of the client as related to the regulation and

evaluation of the agency by the Division;

     (e) To receive from the agency, within the limits

set by the service plan established for the client and within the program

criteria, responses to reasonable requests for assistance; and

     (f) To receive information, upon request,

concerning the policies and procedures of the agency, including, without

limitation, the policies and procedures of the agency relating to charges,

reimbursements and determinations concerning service plans.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3981  Initial screening of client and development or acceptance of

service plan; requirements before providing personal care to client. (NRS 449.0302)

     1.  The administrator of an agency or the

administrator’s designee shall conduct an initial screening to evaluate each

prospective client’s requests for personal care services and to develop a

service plan for the client or to accept a service plan established for the

client.

     2.  The initial screening and the development

or acceptance of a service plan must be documented. The documentation must be

dated and signed by the person who conducted the initial screening and

developed or accepted the service plan.

     3.  The agency shall complete the following

tasks before providing the personal care services outlined in the service plan

established for the client and as often as necessary if the service plan is

revised:

     (a) Evaluate whether the agency has sufficient

resources and the capability to satisfy the requests of the client and to

provide the client with the personal care services described in the service

plan;

     (b) Review the service plan with the client,

including, without limitation, the schedule for the provision of personal care

services to the client, the procedure to follow if an attendant fails to

provide personal care services in accordance with the service plan, the hiring

and training policies of the agency, the responsibilities of the agency, the

procedure for filing a grievance or complaint and any personal care services

that an attendant is prohibited from providing pursuant to NAC 449.3978;

     (c) Review the procedure to be followed if an

attendant does not appear for a scheduled visit and the procedure to be

followed if an additional visit from an attendant is required;

     (d) Ensure that the personal care services

requested by the client are services which assist the client with the

activities of daily living; and

     (e) Ensure that the agency is coordinating the

personal care services that it will be providing to the client with the care

and services available to the client from other organizations and persons.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.3982  Supervisory home visits or telephone calls required to ensure

quality of care provided; documentation of evaluation. (NRS 449.0302)

     1.  The administrator of an agency or the

administrator’s designee shall conduct supervisory home visits or telephone

calls to the home of each client of the agency to ensure that quality personal

care services are provided to the client.

     2.  Each supervisory visit and each telephone

call must be documented. The documentation must be dated and signed by the

administrator or the administrator’s designee. Each supervisory visit and each

telephone call must consist of an evaluation of whether:

     (a) Appropriate and safe techniques have been used

in the provision of personal care services to the client;

     (b) The service plan established for the client has

been followed;

     (c) The service plan established for the client is

meeting the personal care needs of the client;

     (d) The attendant providing personal care services

to the client has received sufficient training relating to the personal care

services that the attendant is providing to the client; and

     (e) It is necessary for the administrator or the

administrator’s designee to follow up with the attendant or client concerning

any problems in the personal care services being provided to the client or the

service plan established for the client that are identified as the result of

the supervisory visit or telephone call.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

FACILITIES FOR CARE OF ADULTS DURING THE DAY

General Provisions

      NAC 449.4061  Definitions. (NRS 449.0302)  As used

in NAC 449.4061 to 449.4089,

inclusive, unless the context otherwise requires:

     1.  “Division” means the Division of Public

and Behavioral Health of the Department of Health and Human Services.

     2.  “Facility” means a facility for the care

of adults during the day as defined in NRS 449.004.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

Licensing

      NAC 449.4063  Design, construction, equipment and maintenance of facility:

General requirements; prerequisites to approval for licensure. (NRS 449.0302)

     1.  A facility must be designed, constructed,

equipped and maintained in a manner that protects the health and safety of the

clients and personnel of the facility and members of the general public.

     2.  A facility shall comply with all

applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without

limitation, zoning ordinances; and

     (c) Environmental, health, fire and local building

codes,

Ê related to

the construction and maintenance of the facility. If there is a difference

between state and local requirements, the more stringent requirements apply.

     3.  Except as otherwise provided in

subsection 5, before any new construction of a facility or any remodeling of an

existing facility is begun:

     (a) The facility must submit building plans for the

new construction or remodeling to the entity designated to review such plans by

the Division pursuant to the provisions of NAC

449.0115. The entity’s review of those plans is advisory only and does not

constitute approval for the licensing of the facility.

     (b) The building plans for the construction or

remodeling must be approved by the Division.

     4.  The Bureau shall not approve a facility

for licensure until all construction is completed and a survey is conducted at

the site of the facility.

     5.  The provisions of subsection 3 do not

apply to plans for remodeling a facility if the remodeling is limited to

refurbishing an area within the facility, including, without limitation,

painting the area, replacing the flooring in the area, repairing windows in the

area, and replacing window or wall coverings in the area.

     (Added to NAC by Bd. of Health, eff. 6-23-86; A by R076-01,

10-18-2001; R074-04, 8-4-2004)

      NAC 449.4065  Consultation with representative of Division; notice of

nonconformity. (NRS 449.0302)

     1.  A representative of the Division will be

available upon request for consultation to assure compliance with applicable

regulations.

     2.  If a licensed facility does not conform

to any requirement for licensing, the Division will issue a written notice

specifying the nature of the nonconformity and set a time within which the

facility must conform.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4067  Operation in combination with other medical facility or facility

for the dependent. (NRS 449.0302)  A

facility must not be operated in combination with any other medical facility or

facility for the dependent unless it is licensed as a separate and distinct

unit.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4069  Insurance. (NRS 449.0302)

     1.  A facility must maintain a contract of

insurance for protection against liability to third persons in amounts

appropriate for the protection of clients, employees, volunteers and visitors

to the facility.

     2.  A certificate of insurance must be

furnished to the Division as evidence that a contract is in force, and a

license will not be issued until that certificate is furnished.

     3.  Each contract of insurance must contain

an endorsement providing for a notice of 30 days to the Division before the

effective date of a cancellation or nonrenewal of the policy.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

Operation of Facility

      NAC 449.407  Advertising and promotional materials. (NRS 449.0302)  Advertising

and promotional materials for the facility must be accurate and represent the

accommodations, programs or other services actually offered by the facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4071  Policies and procedures; accounting. (NRS 449.0302)

     1.  Every facility must have a written policy

concerning:

     (a) Admission, discharge and care of clients;

     (b) Employees of the facility; and

     (c) Fiscal and administrative procedures for the

facility,

Ê which must be

evaluated at least once a year.

     2.  The system of accounting and financial

reporting used by a facility must reflect the fiscal experience and current

financial position of the facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4072  Director and employees: Qualifications and duties; physical and

mental health. (NRS 449.0302)

     1.  Each facility must have the number and

kind of employees required by the physical characteristics of the facility, the

number of clients and the services provided.

     2.  The director of a facility:

     (a) Must be responsible and mature and have the

personal qualities which will enable him or her to understand the problems of

aged and infirm adults.

     (b) Must be at least 21 years of age.

     (c) Must have a high school diploma or its

equivalent.

     (d) Shall designate an acting director, who is

similarly qualified, to act when the director is absent from the facility.

     3.  Every employee of the facility:

     (a) Must be in good physical and mental health.

     (b) Shall provide the Division:

          (1) Upon his or her initial employment, with

the results of a physical examination conducted within the preceding 6 months,

or with a copy of the employee’s medical records for the preceding 3 years,

certified by a physician.

          (2) Upon his or her initial employment, with a

negative report of a tuberculin test conducted within the preceding 6 months.

Thereafter, a tuberculin test must be completed every 2 years. If the report of

the tuberculin test is positive, the employee shall provide an X-ray film of

his or her chest.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.40723  Supervision of clients; volunteers. (NRS 449.0302)

     1.  A client must be supervised by an

employee of the facility at all times during the operating hours of the

facility. The employee shall report a change in any physical, mental, emotional

or social function of the client to the director of the facility. These reports

must be included in the client’s file.

     2.  The facility may use volunteers or

outside consultants or services to meet the needs of its clients.

     3.  A volunteer shall conform to the same

standards and requirements as a paid employee who performs a similar function,

except that a volunteer is only required to provide the results of a tuberculin

test and not the results of a complete physical examination.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.40725  Orientation and training of employees and volunteers. (NRS 449.0302)  All

employees and volunteers at the facility:

     1.  Shall participate in a program of general

orientation to inform them of the programs, policies and services of the

facility;

     2.  Must receive a copy of the facility’s

policies and procedures; and

     3.  Must receive training at the facility on

a regular basis, but not less than 12 hours per year.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4073  Files concerning employees. (NRS 449.0302)  A

separate file must be maintained and kept current on each employee. The file

must include the following:

     1.  The employee’s:

     (a) Name, address and telephone number;

     (b) Social security number;

     (c) Date of birth;

     (d) Date of employment;

     (e) Educational qualifications; and

     (f) Application for employment.

     2.  The name of a person to notify in case of

an emergency.

     3.  Records of the employee’s experience

related to his or her work.

     4.  Reports of periodic evaluations of the

employee.

     5.  All required health certificates.

     6.  A record of any communicable illness

which caused the employee to be absent from work.

     7.  Records of all accidents at the facility

involving the employee.

     8.  The date of termination of employment and

the reason for the employee’s discharge or resignation.

     9.  Records of the employee’s training at the

facility.

     10.  Verification of any license held by the

employee.

     11.  Proof that the employee received the

required orientation at the facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4074  Requirements of facility; health and sanitation; medications;

exits. (NRS 449.0302)

     1.  The facility must:

     (a) Provide proper access for each client to all

activities and services;

     (b) Have furniture and equipment appropriate for

use by the clients;

     (c) Have free local telephone service available for

use by clients;

     (d) Have sufficient space to accommodate a full

range of activities and services;

     (e) Provide for each client at least 40 square feet

of space inside the facility excluding areas for maintenance of the facility;

     (f) Contain offices sufficient to permit employees

to work effectively and without interruption;

     (g) Provide adequate space for storage of supplies;

     (h) Provide at least one toilet for every 10

clients;

     (i) Have sufficient areas for parking and the safe

delivery and pick-up of clients; and

     (j) Provide secure space for the temporary storage

of the property of clients.

     2.  The facility and its grounds must be

safe, clean and accessible to all clients.

     3.  Medications and prescriptions must be

stored in an appropriate, locked container or area.

     4.  Each facility must have at least two

well-identified exits.

     5.  Stairs, ramps and interior floors must

have surfaces or carpets which inhibit falling or slipping.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4075  Preparations for fires and other emergencies; reporting of fire

or disaster. (NRS 449.0302)

     1.  Each facility must have a plan in case of

a fire or other emergency. The plan must be:

     (a) Understood by all employees;

     (b) Posted in a conspicuous place; and

     (c) Reviewed at least once a year.

     2.  A drill for evacuation must be conducted

at least once each month. Each facility shall retain a written record of the

drill on file at the facility for not less than 12 months after the drill is

conducted. Fire extinguishers must be inspected periodically, and training must

be provided for employees of the facility in procedures to be followed in case

of a fire or other emergency.

     3.  A facility shall notify the Bureau of the

occurrence of a fire or disaster in the facility within 24 hours after the

facility becomes aware of the fire or disaster.

     (Added to NAC by Bd. of Health, eff. 6-23-86; A by R074-04,

8-4-2004)

      NAC 449.4076  First aid. (NRS 449.0302)  A

first-aid kit must be available at the facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4077  Policy for admissions; retention of signed copy. (NRS 449.0302)

     1.  A facility’s written policy on admissions

must include:

     (a) A statement of nondiscrimination regarding

admission to the facility and treatment after admission; and

     (b) The requirements for eligibility as a client.

     2.  A copy of the policy must be signed by

the director of the facility and the client and retained in the client’s file.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4078  Requirements for admission; designation of physician. (NRS 449.0302)

     1.  Each client shall, before being admitted

to the facility, provide the facility with:

     (a) The results of a physical examination conducted

by a physician, physician assistant or advanced practice registered nurse

within the preceding 6 months;

     (b) A summary of the client’s medical history

prepared by a physician, physician assistant or registered nurse, within the

preceding 6 months;

     (c) A statement from the client’s physician which

indicates that the facility is an appropriate setting for the client; and

     (d) Any special dietary requirements.

     2.  Each client shall designate a physician

to be called in case of emergency. The facility must make all necessary

arrangements to secure the services of a licensed physician for a client if his

or her own physician is not available.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4079  Required services. (NRS 449.0302)  The

facility must:

     1.  Provide each client with such assistance

as necessary for the activities of daily living;

     2.  Provide activities for a client which are

suited to his or her interests and capacities;

     3.  Observe the health of the client and

notify his or her next of kin, guardian, or other person responsible for the

client of any significant change in his or her physical or mental condition;

     4.  Establish procedures for the

administration of medication to clients, either directly by the client or by an

employee at the facility;

     5.  Provide fluids to clients as necessary to

prevent dehydration;

     6.  Have at least one employee on the

premises at all times who is trained to administer first aid and

cardiopulmonary resuscitation;

     7.  Provide information to a client about

other local, state and federal agencies in the area that may be able to assist

the client and his or her family; and

     8.  Prepare a monthly calendar of activities

at the facility and distribute the calendar to clients and their families.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.408  Housekeeping and maintenance. (NRS 449.0302)  Each

facility must have adequate and regular services for housekeeping and the

maintenance of the facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4081  Administration of medication; accidents or illnesses. (NRS 449.0302)

     1.  If the facility accepts a client who

cannot administer his or her own medication, an employee licensed to administer

medications must administer the medication to the client.

     2.  The next of kin or guardian or other

person responsible for the client must be notified immediately in case of any

accident, injury or illness involving the client.

     3.  Each client must be treated with dignity

and respect and not subjected to verbal or physical abuse of any kind.

     4.  Restraints or sedatives in lieu of

restraints may not be used or given to any client, except by a physician’s

order.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4082  Service of food; dietary consultants. (NRS 449.0302)

     1.  Adequate facilities and equipment for the

preparation, service and storage of food must be provided and meet the

standards of the Division.

     2.  The dining area must be separated from

the area used to prepare food.

     3.  Tables and chairs must be of proper

height and of sufficient number to provide seating for the number of clients

authorized for the facility. They must be sturdy and have easily washable

surfaces. Chairs must be constructed so that they do not overturn easily.

Tables must be designed to accommodate persons in wheelchairs.

     4.  Meals must be served by employees who

have received training in the sanitary preparation and handling of food.

     5.  Each meal must provide one-third of the

daily nutritional allowances recommended by the Food and Nutrition Board of the

Institute of Medicine of the National Academies.

     6.  Any client who is in the facility for 5

hours or more a day must be served a meal. If he or she is in the facility for

more than 6 hours in any day, additional nourishment must be provided.

     7.  Meals must be served in a manner suitable

for the client and prepared with regard for individual preferences and

religious requirements. Special diets and nourishment must be provided as

ordered by the client’s physician. If meals are prepared within the facility,

the facility must consult with a licensed dietitian for at least 4 hours each

month on the planning and serving of meals. If meals are prepared outside of

and delivered to the facility, the facility shall develop and provide an

alternative for any client on a special diet. The facility shall not accept a

client who requires a special diet if it cannot develop an alternative which

conforms to the client’s prescribed diet.

     (Added to NAC by Bd. of Health, eff. 6-23-86; A by R090-12,

12-20-2012)

      NAC 449.4083  Discrimination prohibited. (NRS 449.0302)

     1.  A client shall not be segregated or

restricted in the enjoyment of any advantage or privilege enjoyed by other

clients or provided with any assistance, service or other benefit which is

different or provided in a different manner from that provided to others on the

ground of race, color or national origin.

     2.  The facility’s policy regarding

nondiscrimination must be posted in a public area of the facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.40833  Summary of client’s care; referrals. (NRS 449.0302)  When a

client permanently discontinues his or her use of a facility, the client must

receive a:

     1.  Written summary of his or her care at the

facility, including any recommendations for care in the future; and

     2.  Referral to any other agency in the

community for service, as appropriate.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.40835  Records. (NRS 449.0302)

     1.  Each facility must have a written policy

regarding the records of clients. The policy must include a description of the

procedures governing the use and removal of records and the release of

information contained in the records.

     2.  An individual file must be maintained for

each client and retained for 5 years after the client permanently discontinues

his or her use of the facility. Each such file must be kept in a locked place

which is resistant to fire and must be available only to authorized persons.

The file must contain all records, letters and other information related to the

client, including:

     (a) The client’s forms for application and

enrollment;

     (b) The client’s medical information;

     (c) The client’s full name, address, race,

religion, occupation, date of birth and social security number;

     (d) The telephone number of the client’s physician

and home address and telephone number of his or her next of kin or guardian or

other person responsible for him or her; and

     (e) Any signed authorizations for medical treatment

for the client or the release of his or her medical information.

     3.  All records and reports in the client’s

file must be typewritten or legibly written in ink and dated and signed by the

person responsible for the files.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

Medical and Ancillary Services

      NAC 449.4084  Contract for provision by another person. (NRS 449.0302)

     1.  A medical or ancillary service not

directly provided by the facility may be provided by another person pursuant to

a contract.

     2.  The contract must:

     (a) Be in writing;

     (b) Designate the service provided, the manner in

which it will be provided and the geographical area to be served;

     (c) Describe the manner in which the person

providing the service will be supervised;

     (d) Describe how the service will be coordinated

with other services at the facility;

     (e) Require the person providing the service to

furnish his or her clinical notes and observations of a client for the file of

the client;

     (f) Specify the method of determining charges for

the service and the method for reimbursement by the facility;

     (g) Specify the period of the contract and how

frequently it is to be reviewed; and

     (h) Assure that the service and any person

providing the service meet the same qualifications as required for employees of

and services provided by a facility.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4085  Provision by facility authorized.

(NRS 449.0302)  A

facility which otherwise meets the requirements of NAC

449.4061 to 449.4084, inclusive, may provide

medical or ancillary services if the requirements of NAC

449.4086 to 449.4089, inclusive, are met.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4086  Evaluation of programs and policies. (NRS 449.0302)

     1.  Every facility must have a written plan

for the annual evaluation of its programs and policies. The plan must describe

the:

     (a) Schedule for the annual evaluation;

     (b) Subjects covered by the evaluation; and

     (c) Methods to be used in conducting the

evaluation.

     2.  The evaluation must include an assessment

of the:

     (a) Success of the programs offered at the

facility;

     (b) Efficiency and effectiveness of the facility’s

programs, including the extent to which a program is economical in terms of

tangible benefits produced by the money spent; and

     (c) Relation of the facility’s programs to other

services in the community and the availability of long-term care.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4087  Written assessments of clients. (NRS 449.0302)  Upon

admission, an initial written assessment must be made of any person admitted to

the facility. Within 30 days after admission, another written assessment must

be completed which must include:

     1.  An evaluation of the client’s physical

and mental health;

     2.  A history of the client’s social

development;

     3.  A list of formal and informal systems for

emotional support which are available to the client;

     4.  An evaluation of the tasks required for

daily living that can be performed by the client;

     5.  A list of programs for financial

assistance which are available to the client; and

     6.  The plan for care of the client.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4088  Plan of care; periodic assessment. (NRS 449.0302)

     1.  A written plan of care must be prepared

for each client that provides a balance of activities to meet the client’s

needs and interests. The client, his or her next of kin or guardian or other

person responsible for the client and other providers of service to him or her

may contribute to the development and carrying out of the plan. A copy of the

plan must be included in the client’s file.

     2.  Each plan must include:

     (a) An evaluation of the client’s strengths and

needs;

     (b) The objectives of the plan for care;

     (c) The activities recommended to achieve those

objectives;

     (d) Any recommendations for therapy or referrals to

other providers of services;

     (e) A schedule for achieving the objectives of the

plan with provisions for review of the plan; and

     (f) An evaluation of the client’s nutritional

requirements.

     3.  An assessment of each client’s needs in

relation to his or her plan of care must be conducted at least once every 3

months and included in the client’s file.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

      NAC 449.4089  Menus. (NRS 449.0302)  Menus

for meals served must be in writing, planned a week in advance, dated, posted

and kept in the files for 6 months. Any substitutions must be noted on the

written menu so that the menu in the file reflects what was actually served.

     (Added to NAC by Bd. of Health, eff. 6-23-86)

FACILITIES FOR REFRACTIVE SURGERY

      NAC 449.450  “Facility” defined. (NRS 449.0302)  As used

in NAC 449.450 to 449.4526,

inclusive, unless the context otherwise requires, “facility” means a facility

for refractive surgery as defined in NRS 449.00387.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002;

A by R042-06, 7-14-2006)

      NAC 449.4504  Administrator: Appointment; duties; qualifications. (NRS 449.0302)

     1.  A licensee of a facility shall appoint an

administrator to be legally responsible for:

     (a) The daily operation of the facility; and

     (b) Compliance with the applicable provisions of NAC 449.002 to 449.99939,

inclusive, and chapter 449 of NRS.

     2.  The administrator of a facility must:

     (a) Be at least 21 years of age;

     (b) Have at least 1 year of administrative

experience in a health care setting;

     (c) Have experience in the administration and

supervision of personnel; and

     (d) Possess such knowledge of the practice of medicine

as to enable him or her to be conversant in surgical protocols.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4505  Administrator of facility that performs intraocular lens

implants: Duties. (NRS 449.0302)  The

administrator of a facility that performs intraocular lens implants shall:

     1.  Ensure that equipment and supplies are

sufficient so that intraocular lens implants are performed in a manner that

will not endanger the health and safety of the patient;

     2.  Ensure that all persons in the surgical

area use aseptic techniques;

     3.  Provide suitable equipment for the rapid

and routine sterilization of operating room materials;

     4.  Develop appropriate protocols that include

a list of equipment, materials and supplies necessary to carry out the

procedure properly;

     5.  Develop protocols for the provision of

services in case of emergency and ensure that all personnel are appropriately

trained in those protocols; and

     6.  Ensure that each circulating nurse in the

operating room is a registered nurse.

     (Added to NAC by Bd. of Health by R042-06, eff. 7-14-2006)

      NAC 449.4506  Staffing requirements; personnel files. (NRS 449.0302)  The

administrator of a facility shall ensure that:

     1.  The facility is adequately staffed with

qualified personnel who:

     (a) Meet the needs of and ensure the safety of each

person who visits the facility; and

     (b) Satisfy any applicable statutory requirements

for the provision of care.

     2.  The facility employs at least one

full-time registered nurse licensed pursuant to chapter 632 of NRS to supervise and

manage the care provided to patients in the facility.

     3.  At least one registered nurse who is

employed by the facility is present in the facility at all times that any

patient is present in the facility.

     4.  Each member of the staff who provides

patient care is adequately trained in emergency procedures and is currently

certified to perform first aid and cardiopulmonary resuscitation. At least one

member of the staff who is trained in emergency procedures and who has obtained

the advanced certificate in first aid and adult cardiopulmonary resuscitation

issued by the American Red Cross or an equivalent certification must be present

in the facility whenever any patient is present in the facility.

     5.  A separate personnel file is established

and maintained for each member of the staff of the facility that includes:

     (a) Proof of any training relating to emergency

response required by the facility pursuant to the policies and procedures

established by the facility pursuant to NAC 449.451;

     (b) Such health records as are required by chapter 441A of NAC which include evidence

that the member of the staff employed by the facility or under contract with

the facility has had a skin test for tuberculosis in accordance with NAC 441A.375; and

     (c) Evidence that the member of the staff employed

by the facility or under contract with the facility has obtained any license,

certificate or registration, and possesses the experience and qualifications,

required for the position held by that person.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002;

A by R042-06, 7-14-2006)

      NAC 449.4508  Maintenance of patient records. (NRS 449.0302)

     1.  The administrator of a facility shall

ensure that the facility establishes and maintains a record of each patient

admitted to the facility which includes an assessment of the health needs of

the patient and a description of any health care services provided to the

patient at the facility.

     2.  Each record must be:

     (a) Protected against loss, destruction or

unauthorized use;

     (b) Kept confidential, except as otherwise provided

by law; and

     (c) Maintained for a period of 5 years after the

date the patient is discharged from the facility.

     3.  If the facility closes, the administrator

shall notify the Bureau of the disposition of its records.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.451  Written policies and procedures.

(NRS 449.0302)

     1.  The administrator of a facility shall

ensure that the facility has written policies and procedures available to

members of the staff, patients and the public which govern the operation of the

facility and services provided by the facility.

     2.  The policies and procedures must set

forth, without limitation:

     (a) The scope of services offered by the facility,

the cost of those services and the procedures for the payment of fees and

obtaining a refund of any deposited fees;

     (b) The business hours of the facility and the care

that is available at the facility during emergencies and after the normal

business hours of the facility;

     (c) The criteria for admission to and discharge

from the facility;

     (d) The qualifications required for each member of

the staff of the facility and the scope of the duties of each member of the staff

of the facility;

     (e) The appropriate action to be taken when an

emergency arises in the facility and the equipment and medication that is

required to be available at the facility for such an emergency;

     (f) The manner in which the equipment and physical

environment of the facility will be maintained in accordance with the

requirements set forth in NAC 449.4516 and 449.4522;

     (g) The conduct and responsibility of a patient

relating to his or her treatment;

     (h) The right of a patient to refuse to participate

in experimental research;

     (i) The procedure for filing a complaint or

grievance at the facility;

     (j) The rights of a patient and the procedure for

informing each patient of his or her rights;

     (k) The manner in which the records of a patient

will be maintained and protected; and

     (l) The manner in which medication will be

administered and dispensed to a patient admitted to the facility in accordance

with the laws of this State and federal law.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4512  Program of quality improvement. (NRS 449.0302)  The

administrator of a facility shall ensure that the facility has a program of

quality improvement in place which:

     1.  Monitors and evaluates the quality of

patient care;

     2.  Evaluates methods to improve patient

care;

     3.  Identifies and corrects deficiencies; and

     4.  Reviews and resolves grievances of

patients and maintains documentation of the resolutions of those grievances.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4514  Rights of patients; informed consent. (NRS 449.0302)  The

administrator of a facility shall ensure that:

     1.  Each patient admitted to the facility is

treated with respect, consideration and dignity.

     2.  Each patient admitted to the facility is

provided appropriate privacy.

     3.  Each patient admitted to the facility is

informed of his or her rights as a patient in accordance with the provisions of

NRS 449.730. The patient must be

informed, at the time of his or her admission, of the services available, the

estimated cost of those services and the policy of the facility relating to

obtaining a refund of any fees that were deposited with the facility. If a

patient is unable to understand his or her rights, they must be explained to

the patient’s legal guardian, next of kin or the agency financially responsible

for his or her care.

     4.  Each patient admitted to the facility is

given the opportunity to participate in decisions relating to his or her health

care, unless the patient is unable to do so because of his or her medical

condition.

     5.  An informed consent properly executed by

a patient admitted to the facility or by his or her legal guardian is obtained

before any surgery is performed. The informed consent must authorize, by name,

the person performing the surgery to perform that surgery and must name or

describe the surgical procedure to be performed. Any expectations, risks or

complications relating to the surgery or alternatives to the surgery that are

discussed with the patient must be set forth in the informed consent.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4516  Equipment and supplies. (NRS 449.0302)

     1.  The administrator of a facility shall

ensure that:

     (a) The facility is adequately equipped;

     (b) Any equipment used in the facility is periodically

inspected and, if appropriate, tested, calibrated, serviced or repaired

according to the manufacturer’s instructions to ensure that the equipment is

functioning properly;

     (c) All equipment and supplies used in the facility

are used in accordance with the manufacturer’s instructions;

     (d) Such records are maintained as required to

ensure that appropriate inspections and maintenance of all equipment used in

the facility are periodically accomplished by an appropriately qualified

person;

     (e) Each laser used in the facility meets the

requirements of any applicable federal standards set forth in 21 C.F.R. Part

1040; and

     (f) Appropriate evidence of compliance with 21

C.F.R. Part 1040 is maintained for each laser at the facility.

     2.  The administrator of the facility shall

ensure that policies and procedures are established and implemented for each

laser used in the facility which include, without limitation:

     (a) A safety program concerning the use of the

laser; and

     (b) Education and training of each person who

operates the laser, including, without limitation, requirements that each

member of the staff be adequately trained in the use and safety of each laser

used in patient care and that the administrator ensure that proof of any

required training is maintained at the facility.

     3.  The administrator of the facility shall

ensure that a safe environment for the use of lasers is provided, including,

without limitation, ensuring that:

     (a) Only authorized persons are allowed in

treatment areas;

     (b) Door and window coverings are used where

appropriate;

     (c) Protective eyewear is used, when appropriate,

by persons who operate a laser;

     (d) Laser components which have direct contact with

a patient are appropriately disinfected or sterilized;

     (e) Records concerning the maintenance of each

laser in the facility are maintained; and

     (f) Each laser in the facility is visually

inspected and tested before each use.

     4.  The administrator of the facility shall

ensure that appropriate fire protection concerning the use of each laser is

provided, including, without limitation, the immediate availability of:

     (a) Fire extinguishers which are inspected at least

once a year and determined to be appropriate for electrical fires by a person

who is certified by the State Fire Marshal to conduct such inspections;

     (b) Water for the protection of the patient; and

     (c) Noncombustible materials, supplies and

solutions, as appropriate.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4518  Liability for use of leased equipment. (NRS 449.0302)  If a

licensee leases a laser or other equipment to another ophthalmologist for the

surgical treatment of patients by photorefractive keratectomy and laser in situ

keratomeleusis, the licensee remains responsible for the services performed by

the other ophthalmologist in the facility.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4522  Sanitation and hygiene; space and storage. (NRS 449.0302)

     1.  The administrator of a facility shall

ensure that all parts of the facility, including its premises and equipment,

are maintained in a neat and clean condition which is free of insects, rodents,

litter and rubbish. Policies and procedures must be established and implemented

for cleaning, sanitizing or sterilizing equipment and supplies.

     2.  The administrator of the facility shall

ensure that the facility has a clean, comfortable waiting room with adequate

space for any family member or caregiver of the patient being treated. A

separate bathroom must be maintained for the exclusive use of patients and

their family members or caregivers. Provisions for the safe storage of

valuables must be made available for the use of the patient.

     3.  The operating room must be distinctly

separate and segregated from any other area, including, without limitation, the

waiting room, examination room, administrative area, physician’s office and

staff lounge.

     4.  The facility must have sufficient space for

the care and storage of instruments and supplies.

     5.  The facility must have adequate systems

for ventilation and the control of temperature.

     6.  All medications must be stored,

administered and maintained in accordance with the requirements of the laws of

this State and federal law.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4524  Medical care of patients. (NRS 449.0302)

     1.  The administrator of a facility shall

ensure that:

     (a) Only local anesthesia and oral medication which

is administered to a patient to relieve anxiety in the patient, if the

medication is not given in a dosage which is sufficient to induce in a patient

a controlled state of depressed consciousness or unconsciousness similar to the

state produced pursuant to the administration of general anesthesia, deep

sedation or conscious sedation, are used at the facility.

     (b) An appropriate and current history, including a

list of current medications, dosages, physical examination and pertinent

preoperative diagnostic studies, is incorporated into the patient’s medical

record before surgery.

     (c) Surgical procedures are performed only by an

ophthalmologist licensed pursuant to chapter

630 of NRS or a doctor of osteopathy licensed pursuant to chapter 633 of NRS.

     (d) A preoperative evaluation is conducted

immediately before the surgical procedure by the ophthalmologist, licensed

pursuant to chapter 630 of NRS, or the

doctor of osteopathy, licensed pursuant to chapter

633 of NRS, who will be performing the surgery.

     (e) Emergency equipment and medications as required

by the policies and procedures established by the facility pursuant to NAC 449.451 are available, and properly stored and

maintained at the facility.

     (f) Outdated medications are destroyed in

accordance with the requirements of the laws of this State and federal law.

     (g) Protocols are established and implemented for

instructing patients in self-care after surgery, including, without limitation,

written instructions to be given at the time of discharge.

     (h) A follow-up examination of a patient is

conducted by an ophthalmologist licensed pursuant to chapter 630 of NRS, a doctor of

osteopathy licensed pursuant to chapter

633 of NRS or a collaborating optometrist as provided in NRS 636.374 within 24 hours after

the procedure. Documentation of the results of this examination must be

included as part of the permanent medical record of the patient.

     2.  As used in this section:

     (a) “Conscious sedation” means a minimally

depressed level of consciousness, produced by a pharmacologic or

nonpharmacologic method or a combination thereof, in which the patient retains

the ability independently and continuously to maintain an airway and to respond

appropriately to physical stimulation and verbal commands.

     (b) “Deep sedation” means a controlled state of

depressed consciousness, produced by a pharmacologic or nonpharmacologic method

or a combination thereof, and accompanied by a partial loss of protective

reflexes and the inability to respond purposefully to verbal commands.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002)

      NAC 449.4526  Application for indemnification for certain damages; claims against

surety bond or substitute thereof. (NRS 449.0302)

     1.  A person who has sustained damages as a

result of the bankruptcy of or any breach of contract by a facility may file an

application for indemnification with the Administrator of the Division. The

Administrator of the Division shall return an incomplete application to the

applicant.

     2.  An application filed pursuant to

subsection 1 must include a copy of the court order or settlement agreement

which indicates a determination that the patient sustained damages as a result

of a breach of contract or bankruptcy of a facility, proof of the identity of

the patient or patient’s legal representative that is acceptable to the

Division and a statement of the patient or patient’s legal representative which

includes the following information:

     (a) A brief description of the damages sustained by

the patient as a result of the bankruptcy of or any breach of contract by the

facility;

     (b) The date that the damages were sustained and

the amount of damages claimed; and

     (c) The name and address of the facility in which

the patient sustained damage.

     3.  The Division may bring an action for

interpleader against all claimants upon the surety bond or substitute thereof

filed or deposited pursuant to NRS

449.068 or 449.069, as

applicable. If the Division brings such an action, the Division shall publish

notice of the action at least once each week for 2 weeks in a newspaper of

general circulation in the county in which the facility has its principal place

of business. The Division may deduct its costs of the action, including the

costs of publication of the notices, from the amount of the surety bond or

substitute thereof.

     4.  All claims against the surety bond or

substitute thereof have equal priority. If the surety bond or substitute

thereof is insufficient to pay all the claims in full, the claims must be paid

pro rata.

     5.  If no claims have been filed against the

surety bond or substitute thereof deposited with the Division within 12 months

after the license of the facility expires or is revoked, the Division shall

release the surety bond or substitute thereof to the facility and shall not

consider any claim filed by a patient against the surety bond or substitute

thereof after that time.

     6.  If one or more claims have been filed

against the surety bond or substitute thereof within 12 months after the

license of the facility expires or is revoked, the proceeds must not be

released to the facility or distributed to any patient earlier than 18 months

after the license of the facility expires or is revoked.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002;

A by R078-12, 12-20-2012)

FACILITIES FOR TREATMENT OF IRREVERSIBLE RENAL DISEASE

General Provisions

      NAC 449.501  Definitions. (NRS 449.0302)  As used

in NAC 449.501 to 449.5795,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.502 to 449.519,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.502  “Advanced practice registered nurse” defined. (NRS 449.0302)  “Advanced

practice registered nurse” has the meaning ascribed to it in NAC 632.020.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.504  “Charge nurse” defined. (NRS 449.0302)  “Charge

nurse” has the meaning ascribed to it in NAC

632.033.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5045  “Competency” defined. (NRS 449.0302)  “Competency”

means the demonstrated ability to carry out a specified task or activity with

reasonable skill and safety in accordance with the prevailing standard of

practice of the community in which the task or activity is carried out.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.505  “Dialysis” defined. (NRS 449.0302)  “Dialysis”

means the method by which a dissolved substance is removed from the body of a

patient by diffusion, osmosis and convection from one fluid compartment to

another fluid compartment across a semipermeable membrane.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5053  “Dialysis technician” defined. (NRS 449.0302)  “Dialysis

technician” means a person, other than a registered nurse or physician, who

provides dialysis care under the direct supervision of a registered nurse or

physician.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5055  “Direct supervision” defined. (NRS 449.0302)  “Direct

supervision” means the supervision of a task or activity that is provided by a

qualified person who is present on the premises of a facility during the period

in which the task or activity is performed at the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5065  “End-stage renal disease” defined. (NRS 449.0302)  “End-stage

renal disease” means a stage of renal impairment that is irreversible and

permanent and requires a kidney transplantation or regular course of dialysis

to preserve the life of the person who has the disease.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.507  “Facility” defined. (NRS 449.0302)  “Facility”

means a facility for the treatment of irreversible renal disease as defined in NRS 449.0046.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.508  “Hemodialysis” defined. (NRS 449.0302)  “Hemodialysis”

means dialysis of the blood.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.510  “Immediate supervision” defined.

(NRS 449.0302)  “Immediate

supervision” means the supervision of a task or activity that is provided by a

person who:

     1.  Is present on the premises of a facility

during the period in which the task or activity is performed at the facility;

and

     2.  Directly observes the task or activity.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.511  “Intermediate level disinfection” defined. (NRS 449.0302)  “Intermediate

level disinfection” means to treat a surface using a chemical germicide or

other disinfectant that, when used in accordance with the instructions of the

manufacturer of the chemical germicide or other disinfectant or the guidelines

established by the facility concerning the chemical germicide or other

disinfectant, inactivates microorganisms other than bacterial endospores,

including, without limitation:

     1.  Viruses;

     2.  Fungi; and

     3.  Bacteria that are actively growing,

including tubercle bacteria.

Ê The term

includes any bleach or any disinfectant that consists of 70 percent or more of

ethanol or isopropanol.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.513  “Licensed practical nurse” defined. (NRS 449.0302)  “Licensed

practical nurse” means a nurse who may collect data and perform a skill,

intervention or other duty in accordance with the provisions of NAC 632.242.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.516  “Product water” defined. (NRS 449.0302)  “Product

water” means the effluent that is obtained from the final component of the

water treatment system of a facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.517  “Supervision” defined. (NRS 449.0302)  “Supervision”

means the guidance and direction provided by a qualified person for the

accomplishment of a task or activity, including the initial direction and

periodic inspection by that person of the actual accomplishment of the task or

activity.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.519  “Training” defined. (NRS 449.0302)  “Training”

means to learn a task or activity through experience or instruction that is

received during employment at a facility by a person who is capable of learning

that task or activity through education or experience.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

Construction; Health and Safety

      NAC 449.520  New construction or remodeling: Notification; increase in number

of stations for which facility is licensed. (NRS 449.0302, 449.050)

     1.  A facility shall notify the Bureau in

writing at least 30 days before beginning any construction, renovation or

modification of the physical plant of the facility.

     2.  A facility must obtain the approval of

the Bureau before increasing the number of stations for which the facility is

licensed. If a facility intends to increase the number of those stations, the

facility must, at least 30 days before the proposed date to increase the number

of stations, submit to the Bureau an application for a new license. The

application must be submitted on a form approved by the Bureau and include:

     (a) Evidence satisfactory to the Bureau that:

          (1) The facility has reviewed the availability

of the members of the staff of the facility and, if necessary, has increased

the number of positions on the staff to accommodate the proposed increase in

the number of stations; and

          (2) The water treatment system of the facility

is sufficient to ensure the availability of water that is safe for the proposed

increase in the number of stations; and

     (b) A fee of $250.

     3.  If a facility submits an application

pursuant to the provisions of this section, the Bureau may, before considering

the application, conduct an inspection of the facility to determine compliance

with those provisions.

     4.  If the Bureau approves an application

pursuant to the provisions of this section, the facility shall, not later than

21 days after commencing the use of the stations for which the application was

approved, submit to the Bureau a written report concerning the chemical

analysis and bacteriologic cultures of the product water of the stations. The

written report must be prepared and submitted in accordance with the provisions

of the most recently published edition of the American National Standard,

Water Treatment Equipment for Hemodialysis Applications, which is hereby

adopted by reference. A copy of the publication may be obtained from the

Association for the Advancement of Medical Instrumentation, 1110 North Glebe

Road, Suite 220, Arlington, Virginia 22201, for the price of $45 for members

and $90 for nonmembers.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.5205  New construction or remodeling: Submission of plans and

specifications; minor changes; inspection. (NRS 449.0302)

     1.  To determine compliance with the

provisions of NAC 449.501 to 449.5795, inclusive, each facility may submit to the

Bureau for its approval any plans and specifications concerning the

construction of a new facility or any alteration, addition, conversion,

modernization or renovation of an existing building of the facility. The plans

and specifications must be submitted in accordance with the provisions of this

section.

     2.  A facility may request the Bureau to

review any minor alterations or remodeling changes to the facility that, as

determined by the Bureau, do not:

     (a) Alter any load-bearing partitions, change any

functional operation or affect the fire safety of the facility; or

     (b) Add any additional stations to the facility.

Ê A request

submitted pursuant to the provisions of this subsection must be set forth in

writing and include a brief description of the minor alterations or changes

proposed by the facility.

     3.  If a facility submits any preliminary

plan or specification for a project pursuant to the provisions of this section,

the plan or specification must include information that is sufficient to

determine the extent of the proposed project and to ensure compliance with the

provisions of NAC 449.501 to 449.5795, inclusive, concerning the design and space

of the project.

     4.  If a facility submits any final drawings

or specifications pursuant to the provisions of this section, the drawings or

specifications must include a complete set of the drawings or specifications.

Any working drawings submitted pursuant to the provisions of this subsection

must:

     (a) Be of sufficient quality to ensure that a clear

and distinct print may be obtained of the drawings;

     (b) Include accurate dimensions of the project for

which the drawings are made; and

     (c) Include any required explanatory notes,

schedules or legends.

     5.  The Bureau shall, upon completion of any

construction, renovation or remodeling of a facility, conduct an inspection of

the facility to ensure compliance with the provisions of NAC

449.501 to 449.5795, inclusive, concerning the

design and space of the facility. The inspection must be conducted at a time

and date established by the Bureau.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.522  Construction, space and design; physical environment;

restrictions for treatment of patients with hepatitis B. (NRS 449.0302)

     1.  The Bureau shall consider a facility to

be in compliance with the provisions of NAC 449.501

to 449.5795, inclusive, relating to the

construction, space or design of the facility if:

     (a) The facility was licensed on or before July 1,

2001; and

     (b) The existing construction of the facility does

not have any deficiencies that are likely to cause serious injury, harm or

impairment to the health and welfare of the members of the general public. If

such a deficiency occurs, the facility must correct the deficiency before the

facility may continue to operate.

     2.  Each facility shall provide a physical

environment that protects the health and safety of the patients and members of

the staff of the facility and the members of the general public. The premises

and any structures located on the premises of the facility that are used by a

patient of the facility, including, without limitation, any stairwell, corridor

or passageway, must satisfy the provisions of any applicable local building or

fire safety code relating to the requirements for the design and space of the

premises and structures.

     3.  If a facility provides treatment for a

patient who has tested positive for hepatitis B, the facility shall treat the

patient with a designated machine, blood pressure cuff, sink and any other

equipment that is appropriate for providing treatment to the patient.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5225  Safety and comfort of patients during construction; imposition of

more stringent design and space requirements. (NRS 449.0302)

     1.  If any construction occurs in or near an

area of the facility that is occupied by a patient of the facility, the

facility shall ensure the safety and comfort of the patient during the

construction.

     2.  A facility may impose more stringent design

and space requirements than the requirements set forth in NAC 449.501 to 449.5795,

inclusive.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.523  Safety requirements. (NRS 449.0302)

     1.  Each facility shall install a system for

lighting the facility that is capable of providing sufficient illumination to

allow safe evacuation from each building of the facility during an emergency at

the facility. Each battery pack system used by the facility must be maintained

and tested at least once each month. If a facility maintains a backup

generator, the generator must be installed, tested and maintained in accordance

with the instructions of the manufacturer of the generator. The facility shall

document the testing of the generator at least once every 6 months.

     2.  A facility must not be located in or

adjacent to a building that is considered a high hazard building and meets the

requirements of group H of Volume I of the Uniform Building Code, 1997

edition, which is hereby adopted by reference. A copy of those provisions may

be obtained from the International Conference of Building Officials, 5360

Workman Mill Road, Whittier, California 90601, for the price of $67.50.

     3.  Each facility must be equipped with smoke

detectors that are maintained in proper operating condition at all times. The

smoke detectors must be tested in accordance with the specifications of the

manufacturer of the smoke detectors.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5235  Maintenance and repair of equipment. (NRS 449.0302)

     1.  Any equipment that is used by a facility,

including any equipment used for backup, must be maintained free from any

defect that may be hazardous to the patients or members of the staff of the

facility or any visitors to the facility. Any maintenance or repair of the

equipment must be performed by a member of the staff of the facility who is

qualified to conduct the maintenance or repair or by contract personnel.

     2.  Each facility shall ensure that each

person employed on the staff of the facility is able to identify any equipment

that malfunctions and report the malfunction to the appropriate person for

repair.

     3.  If any medical equipment of a facility

malfunctions, the equipment:

     (a) Must be removed immediately from service at the

facility; and

     (b) Must not be returned to service at the facility

unless the malfunction is identified and corrected.

     4.  Each facility shall maintain written

evidence of any activity concerning repair or maintenance that occurs at the

facility.

     5.  If any repair or alteration is made to

any equipment or system of a facility, the facility must test the equipment or

system to ensure proper operation of the equipment or system before the

equipment or system is returned to service at the facility.

     6.  Each facility shall comply with the

provisions of 21 U.S.C. § 360i(b) concerning the reporting of a device, as

defined in 21 U.S.C. § 321(h), that has or may have caused or contributed to

the injury or death of a patient of the facility.

     7.  Each facility shall develop and comply

with a written policy concerning preventative maintenance to ensure that all

equipment which is used by the facility to treat a patient or which is provided

by the facility for use by the patient in the patient’s residence receives

electrical safety inspections, if appropriate, and maintenance at least

annually or more often if recommended by the manufacturer of the equipment. Any

maintenance conducted pursuant to the provisions of this subsection may be

provided by a qualified member of the staff of the facility or by contract

personnel.

     8.  Each facility shall ensure that at least

one complete dialysis machine is available for use at the facility as a backup

machine for every 14 dialysis machines used by the facility.

     9.  If a facility provides treatment for a

pediatric patient, the facility shall use equipment and supplies, including,

without limitation, blood pressure cuffs, dialyzers and blood tubing, that are

appropriate for treating that patient.

     10.  Any appliance or other electrical

equipment of a facility must be grounded in accordance with the provisions of

section 7-5.1 of NFPA 99: Standard for Health Care Facilities, 1999

edition, which is hereby adopted by reference. A copy of those provisions may

be obtained from the National Fire Protection Association, 11 Tracy Drive,

Avon, Massachusetts 02322, for the price of $40.25.

     11.  A facility shall not use any electrical

extension cord or cable in any portion of the permanent electrical wiring of

the facility.

     12.  Each facility shall maintain emergency

equipment and supplies that are immediately accessible in any area of the facility

which is used to treat the patients of the facility. Such equipment and

supplies include:

     (a) Oxygen;

     (b) Ventilatory assistance equipment, including

airways, manual breathing bag and mask;

     (c) Suction equipment;

     (d) Any supplies specified by the medical director

of the facility; and

     (e) If pediatric patients are treated, the

appropriate type and size of emergency equipment and supplies required by

subsection 9.

     13.  Each facility shall establish and comply

with a written policy for periodically testing and maintaining all emergency

equipment used by the facility. The members of the staff of the facility shall

properly maintain the equipment and maintain a written record of the testing

and maintenance of that equipment.

     14.  If a facility uses a central delivery

system for bicarbonate dialysate, the system must be:

     (a) Drained at the end of each day of treatment;

and

     (b) Cultured at least once each week to identify

any potential bacterial contamination. If the results of a culture conducted

pursuant to the provisions of this paragraph indicate the presence of more than

2,000 colony forming units per milliliter, the facility shall disinfect and

reculture the system.

     15.  As used in this section, “pediatric

patient” means a person who is not more than 14 years of age and is under the

care of a facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.525  Water treatment system: General requirements. (NRS 449.0302)

     1.  The design for the water treatment system

of a facility must be:

     (a) Based on considerations of the source of water

for the facility; and

     (b) Prepared by a person who, as determined by the

Bureau, has obtained education, training or experience in the design of

dialysis systems.

     2.  If a facility does not obtain water from

a public water system, any water used by the facility for medical treatment

must be subjected to a bacteriological analysis conducted by the appropriate

health authority or by a commercial laboratory that is certified by the

Division. An analysis must be conducted pursuant to the provisions of this

subsection at least once every 3 months.

     3.  The area in which the water treatment

system of a facility is located must be of sufficient size to allow for the

maintenance, testing and repair of the equipment. If any dialysate is mixed in

the area, the area must be of sufficient size to house and allow for the mixing

of the dialysate and for the maintenance, testing and repair of any equipment used

to mix the dialysate.

     4.  Each component of the water treatment

system of a facility must be arranged and maintained in such a manner as to

ensure that the amount of bacterial and chemical contaminants in the product

water does not exceed the standards for hemodialysis water quality relating to

hemodialysis systems and maximum level of chemical contaminants set forth in

the American National Standard, Water Treatment Equipment for

Hemodialysis Applications, adopted by reference pursuant to the provisions

of NAC 449.520.

     5.  Each facility shall prepare and comply

with a written policy concerning the operation of the water treatment system of

the facility. The written policy must include guidelines for the operation of

each component of the water treatment system. The facility shall:

     (a) Ensure that each person who operates those

components is aware of the guidelines and operates those components in

accordance with those guidelines; and

     (b) Establish and maintain in the area in which

those components are located written procedures describing the actions to be

taken if the guidelines are not complied with.

     6.  Except as otherwise provided in this

subsection, the water treatment system of a facility must be equipped with

reverse osmosis membranes or deionization tanks and not less than two carbon

tanks arranged in series. If the source of water for the water treatment system

is obtained from a private supply that does not use chlorine or chloramine, the

water treatment system must be equipped with reverse osmosis membranes or deionization

tanks and not less than one carbon tank.

     7.  If the water treatment system of a

facility is equipped with reverse osmosis membranes, the membranes must satisfy

the requirements relating to reverse osmosis set forth in the American

National Standard, Water Treatment Equipment for Hemodialysis Applications,

adopted by reference pursuant to the provisions of NAC

449.520.

     8.  If the water treatment system of a

facility is equipped with a deionization system, the system must satisfy the

requirements relating to regenerated or reconstituted devices and deionization

set forth in the American National Standard, Water Treatment

Equipment for Hemodialysis Applications, adopted by reference pursuant to

the provisions of NAC 449.520.

     9.  Each carbon tank that is used in the

water treatment system of the facility must:

     (a) Contain acid-washed 30-mesh or smaller carbon

placed in series with a minimum empty bed contact time of 3 minutes for each

tank or bank of tanks; and

     (b) Include a testing port that is located between

the tanks or bank of tanks. The facility shall, at least once each day before

providing treatment to any patient of the facility, test water from the port to

determine the amount of chlorine and chloramine in the water. The initial test

each treatment day for chlorine and chloramine must be conducted not less than

15 minutes after the water treatment system is started for that day.

     10.  If the results of a test conducted

pursuant to the provisions of subsection 9 indicate the presence of more than

0.5 parts per million of chlorine or 0.1 parts per million of chloramine in the

water that is obtained from the port between the initial tank and the final

tank of the water treatment system, the facility shall replace the initial tank

and conduct a test of the water from the final exit of the water treatment

system. If the results of that test indicate the presence of chlorine or

chloramine in an amount that is greater than the requirements specified in this

subsection, the facility shall immediately terminate any dialysis treatment

provided to a patient of the facility and notify the medical director of the

facility of the results of the test.

     11.  If a facility uses a water softener in

the water treatment system of the facility, the water softener must have the

capacity to treat a sufficient amount of water to supply the facility for the

entire treatment day.

     12.  If a facility uses a cartridge filter in

the water treatment system of the facility, the cartridge filter must be made

of material that does not leach surfactants, formaldehyde or other material

that was used to manufacture the material.

     13.  If a facility uses a cartridge filter housing

during disinfectant procedures, the housing must include a mechanism to clear

the lower portion of the housing of the disinfecting agents. Each cartridge

filter housing must be opaque.

     14.  The water treatment system of the

facility must be:

     (a) Continuously monitored during the treatment of

a patient of the facility; and

     (b) Protected by audible and visual alarms that are

capable of being seen and heard in the dialysis treatment area if the quality

of the water used in the water treatment system falls below the standards

established by the facility for the water treatment system or the manufacturer

of the water treatment system.

     15.  If the deionization tanks of the water

treatment system of a facility do not follow a reverse osmosis system, standards

for the rate of rejection of the membranes must ensure that the lowest rate

accepted will provide product water in compliance with the maximum level of

chemical contaminants set forth in the American National Standard, Water

Treatment Equipment for Hemodialysis Applications, adopted by reference

pursuant to the provisions of NAC 449.520.

     16.  Each facility shall maintain a written

record of the operation of the water treatment system for each treatment day.

The written record must include the guidelines established by the facility for

operating each component of the system and any action taken during that day if

the operation of a component was not within the guidelines established by the

facility for that component.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.5255  Water treatment system: Chemical testing of product water;

records. (NRS 449.0302)

     1.  Except as otherwise provided in this

section, each facility shall, at least once every 6 months, conduct a chemical

test of a sample of the product water of the water treatment system of the

facility. The results of any test conducted pursuant to the provisions of this

section must indicate that the quality of the product water satisfies the

requirements relating to maximum level of chemical contaminants set forth in

the American National Standard, Water Treatment Equipment for

Hemodialysis Applications, adopted by reference pursuant to the provisions

of NAC 449.520.

     2.  A facility shall conduct a chemical test

pursuant to the provisions of this section if substantial changes are made to

the water treatment system or if the percent of rejection of a reverse osmosis

system decreases 5 percent or more from the percent of rejection measured at

the time the water sample for the preceding chemical test was taken. If a

facility uses a water treatment system that is portable, the facility shall, at

least once each year, conduct a chemical test of the product water in accordance

with the provisions of this section.

     3.  The records maintained by a facility

concerning the operation of the facility must include:

     (a) The results of each test conducted pursuant to

the provisions of this section and NAC 449.525 and 449.526; and

     (b) Evidence satisfactory to the Bureau that the

medical director of the facility reviewed the results of those tests and

required corrective action to be taken if indicated by those results.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.526  Water treatment system: Microbiological testing of product water. (NRS 449.0302)

     1.  Each facility shall, at least once each

month or immediately after any repair or change is made to the water product

treatment system of the facility, conduct a microbiological test of the product

water. The results of any test conducted pursuant to the provisions of this

section must indicate that the quality of the product water satisfies the

requirements relating to hemodialysis systems set forth in the American

National Standard, Water Treatment Equipment for Hemodialysis

Applications, adopted by reference pursuant to the provisions of NAC 449.520.

     2.  Sample sites selected by the facility to

conduct the test must include the beginning of the distribution piping, the

product water in the reuse room of the facility and the end of the distribution

piping. If the results of the test do not satisfy the requirements specified in

subsection 1, the facility shall immediately disinfect and reculture the water

treatment system. If, after the water treatment system is disinfected and

recultured, the results of the test do not satisfy those requirements, the

facility shall determine the source of the contamination by immediately

reculturing:

     (a) The sample sites;

     (b) Each patient station of the facility;

     (c) Each tank of the water treatment system that is

used to store water;

     (d) All water that is used to mix dialysate; and

     (e) The product water obtained from the final

component of the water treatment system.

     3.  A calibrated loop must not be used to

conduct a test pursuant to the provisions of this section. As used in this

subsection, “calibrated loop” means a mechanism that is used to:

     (a) Draw a sample of water from the water treatment

system of a facility; and

     (b) Conduct a test of that water for the presence

of chemicals, bacteria or other impurities.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.5265  Reuse of hemodialyzer; transport of used dialyzer. (NRS 449.0302)

     1.  If a facility reuses any hemodialyzer in

providing treatment to a patient of the facility, the facility shall:

     (a) Ensure that the reuse of the hemodialyzer is

conducted in accordance with the provisions of the American National

Standard, Water Treatment Equipment for Hemodialysis Applications,

adopted by reference pursuant to the provisions of NAC

449.520.

     (b) Ensure that each transducer protector used

during the treatment is:

          (1) Replaced, if it becomes wet during the

treatment; and

          (2) Used only for one treatment.

     (c) Ensure that, in any area of the facility in

which the reuse occurs, the supply of water in that area incorporates a

mechanism to prevent any chemical agents from flowing into the water

distribution system of the facility.

     (d) Ensure that any ventilation system installed in

an area specified in paragraph (c):

          (1) Is connected to an exhaust system that:

               (I) Leads to the outside of the building

in which the room is located; and

               (II) Is separate from the exhaust system

of the building;

          (2) Has an exhaust fan that is located at the

discharge end of the ventilation system;

          (3) Has a system of exhaust ducts that is

constructed of material that is noncombustible and resistant to corrosion; and

          (4) Has an exhaust outlet that is located

above the level of the roof of the building to which the exhaust outlet is

attached, and if more than one exhaust outlet is installed, the facility shall

ensure that each of those outlets is arranged in such a manner as to minimize

any recirculation of exhaust air into the building.

     (e) Adopt and comply with a policy that sets forth

the criteria for reuse, including the number of reuses allowed by the facility.

     (f) Ensure that access to an area of the facility

specified in paragraph (c) is restricted to persons who are authorized by the

facility to enter that area.

     (g) Before providing treatment to the patient:

          (1) Consider and address the health and safety

of the patient if he or she is sensitive to disinfectant solution residuals;

          (2) Provide to the patient information

regarding the policy of reuse for the facility and the opportunity to submit

and receive a response to questions concerning the reuse; and

          (3) Obtain written consent for the reuse from

the patient or legal representative of the patient.

     2.  A facility shall not transport any

dialyzer that has been used in the treatment of a patient of the facility or

allow a person to transport that dialyzer for reprocessing to a location that

is off the premises of the facility unless the facility:

     (a) Requires the use of automated equipment at that

location to reprocess the dialyzer;

     (b) Remains responsible for the entire process of

reuse;

     (c) Adopts and complies with a policy which ensures

that the transfer and transportation of any used or reprocessed dialyzer to and

from the location does not increase the contamination of the dialyzer, the

environment or any member of the staff of the facility; and

     (d) Allows an employee of the Bureau to enter the

off-site reprocessing site as part of any inspection of the facility conducted

by the Bureau.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.528  Adoption of more stringent requirements for treatment of water

and reuse of hemodialyzers. (NRS 449.0302)  A

facility may adopt more stringent requirements for the treatment of water and

the reuse of hemodialyzers than the requirements set forth in NAC 449.525 to 449.5265,

inclusive.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5285  Sanitation: Precautions regarding blood and bodily fluids. (NRS 449.0302)

     1.  Any activity relating to the care of a

patient of a facility must be provided in accordance with the provisions of 29

C.F.R. § 1910.1030(d)(1)-(3), relating to bloodborne pathogens.

     2.  Each member of the staff of the facility

shall wash his or her hands immediately before and after each contact with a

patient that may expose the member of the staff to any blood or fluids of the

body of the patient. The location and arrangement of any area of the facility

that is used for washing hands must permit ease of access and proper use.

     3.  A sink that is used for washing hands

must be readily accessible in each area of the facility that is used to care

for patients of the facility. Each fixture and lavatory located in that area

must be trimmed with valves which may be operated without the use of hands.

There must be sufficient clearance for the operation of blade-type handles, if

those handles are used.

     4.  Provisions for drying hands must be

included in any area of the facility that is used for washing hands.

     5.  If a patient of a facility or a member of

the patient’s family intends to assist a member of the staff of the facility in

conducting a procedure that may cause the patient or member of the patient’s

family to come into contact with any blood or bodily fluids, the member of the

staff of the facility shall, before the procedure is conducted:

     (a) Explain to the patient or member of the

patient’s family the potential risks associated with blood and any products of

blood; and

     (b) Provide to the patient or member of the

patient’s family the appropriate equipment to protect the patient or member of

the patient’s family from those risks.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.529  Sanitation: Control of infections; nonsmoking policy. (NRS 449.0302)

     1.  Each facility shall designate a person to

monitor and coordinate the activities occurring at the facility concerning the

control of infections at the facility.

     2.  Each facility shall develop and maintain

a system to identify, monitor and record the occurrence of infections at the

facility. The system must be reviewed as a part of the program to ensure the

quality of the facility conducted pursuant to the provisions of NAC 449.540. The record maintained by a facility

pursuant to the provisions of this subsection must include any trends, corrective

actions and improvement actions taken by the facility.

     3.  Each facility shall establish and comply

with a policy concerning nonsmoking at the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5295  Sanitation: Provision of sanitary environment; walls, floors and

ceilings; blood spills. (NRS 449.0302)

     1.  Each facility shall provide a sanitary

environment that minimizes or prevents transmission of infectious diseases at

the facility.

     2.  The base of each wall that is located in

any area of a facility which is subject to frequent cleaning with water or any

other liquid must be:

     (a) Tightly sealed to the floor and the wall to

ensure that the base of the wall is impervious to the water or other liquid;

and

     (b) Constructed without any voids that may harbor

insects.

     3.  The material that is used for the surface

of the floors of a facility must be easily cleanable and have resistance to

wear that is appropriate for the location of the material in the facility. In

each area of the facility that is subject to cleaning with water or any other

liquid, the material must not be physically affected by germicidal or cleaning

solutions.

     4.  The finish on the interior of each wall

of a facility must be washable and, in the immediate area of any plumbing

fixtures, must be smooth and resistant to moisture.

     5.  Each joint of a structural element of a

facility and each floor or wall that is penetrated by a pipe, duct or conduit

must be tightly sealed to reduce the possibility of entry by rodents or insects

into the joint, floor or wall.

     6.  Each ceiling or ceiling structure that is

exposed in an area of a facility which is regularly occupied by patients, staff

or visitors of the facility must be finished to ensure that the ceiling or

structure is cleanable with equipment which is used in daily housekeeping

activities. If any tile that is located in the ceiling of any room of a

facility becomes stained with blood, the facility shall clean or replace the

tile immediately or as soon as practicable after the tile becomes stained.

     7.  A facility shall not use a ceiling fan in

any area of the facility that is used to treat a patient of the facility.

     8.  Each spillage of blood that occurs at a

facility must be cleaned immediately or as soon as practicable after the

spillage occurs using a disposable cloth and an appropriate chemical

disinfectant. If a blood spill occurs:

     (a) The surface of the area must be subjected to

intermediate level disinfection in accordance with the instructions of the

manufacturer of the disinfectant that is used to clean the spill, if a

commercial liquid chemical disinfectant is used; or

     (b) If chlorine bleach or any other solution of

sodium hypochlorite is used to clean the spill, the solution must consist of

not less than 1 percent of sodium hypochlorite. Each surface that is cleaned

with the chlorine bleach or other solution must be compatible with that

solution.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.531  Sanitation: Disinfection of dialysis machines; culturing

dialysate; cleaning of machines and equipment; handling of waste. (NRS 449.0302)

     1.  Each facility shall periodically

disinfect each active and backup dialysis machine in accordance with the policy

of the facility concerning the disinfection of those machines. Any disinfection

conducted pursuant to the provisions of this subsection must achieve at least

intermediate level disinfection.

     2.  Each facility shall, at least once each

month:

     (a) Randomly collect a sample of dialysate from a

dialysis machine that is used by the facility; and

     (b) Conduct a culture of the sample.

Ê The results

of a culture conducted pursuant to the provisions of this subsection must not

exceed 2,000 colony forming units per milliliter. A hemodialysis machine that

is used by a patient of a facility at his or her residence must be cultured at

least once each month until results not exceeding 2,000 colony forming units

per milliliter are obtained for 3 consecutive months. If those results are obtained,

quarterly samples must be cultured.

     3.  Immediately after each patient shift but

before the next patient shift, the staff of the facility shall clean the

exterior of each machine that is used for dialysis, treatment chairs,

tourniquets and hemostats. Any blood pressure cuff that becomes contaminated

with blood must be removed from service, disinfected and allowed to dry before

it is returned to service at the facility.

     4.  Each facility shall comply with the

requirements concerning the handling of waste from health care related

facilities that are established by this State or by any local government which

has authority to regulate that activity at the facility.

     5.  All sewage or liquid waste must be

disposed of in a municipal sewerage system or a septic tank system for which a

permit has been obtained by the facility pursuant to state law or local

regulations.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5315  Hepatitis B: Vaccinations for certain staff members;

postvaccination screening; adoption of related provisions. (NRS 449.0302)

     1.  If any member of the staff of a facility

is susceptible to hepatitis B and has not been vaccinated for that disease, the

facility shall offer vaccination for the disease to that member of the staff in

accordance with the provisions of 29 C.F.R. § 1910.1030(f)(1) and (2), relating

to bloodborne pathogens. If a member of the staff of a facility is vaccinated

pursuant to the provisions of this subsection, a written record of the vaccination

must be included in the health record of the member of the staff maintained by

the facility.

     2.  Each facility shall establish and comply

with a policy to conduct postvaccination screening of each member of the staff

of the facility. The serologic screening must be conducted within 60 days after

the final dose of vaccine is administered to the member of the staff of the

facility. Any additional screening and follow-up must be based upon the results

of the testing for the hepatitis B surface antigen.

     3.  The provisions of Appendices I and II of

the National Surveillance of Dialysis-Associated Diseases in the United

States, 1993 edition, are hereby adopted by reference. A copy of those

provisions may be obtained free of charge from the Public Health Service,

Centers for Disease Control and Prevention, National Center for Infectious

Diseases, Hospital Infections Program, Mail Stop C01, Atlanta, Georgia 30333.

If a facility determines pursuant to subsection 2 that a member of the staff of

the facility is a responder as defined in Appendix II of those provisions, the

facility shall not require the member of the staff to submit to further

screening pursuant to subsection 2. If the facility determines that a member of

the staff of the facility is a nonresponder as defined in that appendix, the

facility shall ensure that the member of the staff is tested at least once

every 6 months pursuant to that subsection.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.532  Hepatitis B: Vaccinations for certain patients. (NRS 449.0302)

     1.  If advised by and with the consent of a

patient’s attending nephrologist, each facility shall offer hepatitis B vaccine

to each patient who is susceptible to hepatitis B.

     2.  Each facility shall, upon request by a

patient of the facility, make available to the patient a publication or other

information concerning the risks and benefits of receiving the vaccine for

hepatitis B.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5325  Hepatitis B surface antigen: Screening of patients; additional

serologic screening. (NRS 449.0302)

     1.  Each candidate for dialysis at a facility

must, if practicable, be screened for the hepatitis B surface antigen before

being admitted to the facility. The screening may be performed at any time

within 30 days before the person is admitted to the facility.

     2.  Additional serologic screening must be

based on the antigen or antibody status of the patient, as follows:

     (a) If the patient tests negative for the hepatitis

B surface antigen, the facility shall screen the patient at least once each

month.

     (b) If the patient tests positive for the hepatitis

B surface antigen or anti-hepatitis B surface antigen, the facility may screen

the patient less than once each month if the policy of the facility concerning

the screening of that patient complies with the provisions of Appendices I and

II of the National Surveillance of Dialysis-Associated Diseases in the

United States, adopted by reference pursuant to the provisions of NAC 449.5315.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.534  Hepatitis B surface antigen: Treatment of patients who test

positive. (NRS 449.0302)

     1.  If a patient of a facility tests positive

for the hepatitis B surface antigen, the facility shall provide treatment for

the patient:

     (a) On a machine that is dedicated for patients who

test positive for the hepatitis B surface antigen; and

     (b) In an area of the facility that includes:

          (1) A sink for washing hands;

          (2) A work area;

          (3) An amount of equipment and supplies that

is sufficient to care for the patient; and

          (4) Sufficient space to prevent contamination

of any other patient of the facility.

     2.  A patient specified in subsection 1 must

be dialyzed on equipment that is dedicated for patients who test positive for

the hepatitis B surface antigen.

     3.  If a patient specified in subsection 1 is

discharged from the facility, all equipment that is provided for that patient

pursuant to the provisions of subsection 2 must be given intermediate level

disinfection before the equipment is used for a patient who tests negative for

the hepatitis B surface antigen.

     4.  If a patient is admitted to a facility

for treatment before a test for the hepatitis B surface antigen is conducted,

the facility shall provide treatment to that patient as if he or she had tested

positive for that antigen. The facility shall not treat the patient on a

machine that is used for a patient of the facility who has tested positive for

the antigen.

     5.  If a facility uses a central delivery

system, the facility shall treat a patient specified in subsection 4 on a

designated machine. The facility may not reuse the dialyzer for that machine

until the results of testing for that patient are known by the facility. The dialysis

machine used by the patient must be given intermediate level disinfection

before the machine may be used by any other patient of the facility.

     6.  The facility shall obtain the results of

testing for a patient specified in subsection 4 not later than 7 days after the

patient is admitted to the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5345  Tuberculosis: Screening of staff and patients. (NRS 449.0302)

     1.  A facility shall screen each member of

the staff of the facility to determine whether the member has tuberculosis. The

facility shall screen each member of the staff:

     (a) Upon commencement of employment at the facility

or upon receiving privileges as a member of the medical staff of the facility;

or

     (b) Before the member of the staff has any physical

contact with a patient of the facility.

Ê The screening

must be conducted in accordance with the provisions of NAC 441A.375.

     2.  A facility shall screen each patient of

the facility for tuberculosis if indicated by the presence of risk factors for

tuberculosis or if the patient experiences any sign or symptom of tuberculosis.

The screening must be performed after any possible exposure by a patient of the

facility to active laryngeal or pulmonary tuberculosis.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

Provision of Services

      NAC 449.540  Program of quality assurance; recordation of accidents and

incidents; reporting of certain events. (NRS 449.0302)

     1.  Each facility shall:

     (a) Conduct a systematic and comprehensive review

of the facility and the care provided to each patient of the facility; and

     (b) Adopt and comply with a program to ensure the

quality of the facility. The program must be based on information concerning

the facility provided to the facility by the End-Stage Renal Disease Network.

     2.  The facility shall demonstrate through

quality assurance activities that the members of the staff of the facility

have:

     (a) Evaluated the care and services provided by the

facility to the patients of the facility;

     (b) Established goals concerning the treatment of

those patients;

     (c) Identified any available opportunities to

improve the care and services provided to those patients;

     (d) Developed and carried out a plan to improve the

care and services specified in paragraph (c); and

     (e) Evaluated the effectiveness of the plan

specified in paragraph (d) until a resolution of any problems is obtained.

     3.  Each core staff member of the facility

shall actively participate in the quality assurance activities conducted pursuant

to the provisions of this section. As used in this subsection, “core staff

member” means the medical director, supervising nurse, dietitian, social worker

and administrator of a facility.

     4.  Not less than once each quarter, each

facility shall conduct a meeting concerning the quality of the facility. The

facility shall:

     (a) Prepare written minutes of each meeting held;

and

     (b) Maintain the written minutes in the business

office of the facility.

     5.  If an accident or incident occurs at a

facility, including, without limitation, any error in providing medication to a

patient of the facility or any adverse reaction of a patient to a drug

administered to the patient at the facility, the facility shall immediately

prepare a written record of the accident or incident. A written record prepared

pursuant to this subsection must be maintained by the facility and be made

available for review by the Bureau.

     6.  A facility shall report each of the

following events to the Bureau within 7 days after the event occurs:

     (a) Each accident or incident concerning a patient

of the facility that:

          (1) Occurs during dialysis treatment of the

patient; and

          (2) Results in the death of the patient or

requires the admission of the patient to a hospital overnight;

     (b) The occurrence of any fire at the facility; or

     (c) If a member of the staff of the facility or a

patient of the facility converts to positive for the hepatitis B surface

antigen.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5405  Rights of patients. (NRS 449.0302)

     1.  In addition to the requirements set forth

in NRS 449.700 to 449.730, inclusive, each facility

shall adopt and comply with a policy which ensures that each patient of the

facility is:

     (a) Treated with respect, dignity and complete

recognition of the individuality and personal requirements of the patient;

     (b) Provided with sufficient privacy during

treatment to ensure that any unwarranted exposure of the patient does not occur

and to ensure confidentiality of the clinical record of that patient;

     (c) Provided with a safe and comfortable

environment for receiving any treatment provided by the facility;

     (d) Provided with information concerning the

patient’s treatment in a manner which ensures that the patient or the legal

representative of the patient understands that information;

     (e) Informed by a physician of the medical status

of the patient;

     (f) Informed about all modalities and settings for

the treatment of end-stage renal disease;

     (g) Informed about and participates in, if

requested by the patient, each aspect of care, including, without limitation,

the right to refuse treatment and the medical consequences of refusing that

treatment;

     (h) Aware of any services that are available to the

patient at the facility and the charges for those services; and

     (i) Informed about any reuse of dialysis supplies

by the facility, including hemodialyzers. If any brochures or other printed

materials are used to describe the facility or any services provided by the

facility, the facility shall ensure that the brochures or other printed

materials include a statement specifying the policy of the facility concerning

the reuse of those supplies.

     2.  Each facility shall ensure that each

patient of the facility:

     (a) Receives a reasonable response by the facility

to any request or requirement of the patient for treatment or service in

accordance with any applicable law or regulation and within the capacity of the

facility to provide the requested treatment or service;

     (b) Is transferred only for:

          (1) A medical reason;

          (2) The welfare of the patient or any other

patient or member of the staff of the facility; or

          (3) The nonpayment of fees owed by the patient

to the facility;

     (c) Is provided with information concerning advance

directives and the provisions of NRS

450B.400 to 450B.590,

inclusive, concerning do-not-resuscitate identification and do-not-resuscitate

orders; and

     (d) Is fully informed of:

          (1) The rights specified in this subsection;

and

          (2) All rules established by the facility

concerning the conduct and responsibilities of the patient during the period he

or she is a patient of the facility.

     3.  Upon admission of a patient to a

facility, the facility shall provide to the patient or his or her legal

representative a written copy of the patient’s rights and responsibilities. A

copy of those rights and responsibilities must be posted:

     (a) In the waiting room or other area of the

facility to which the members of the general public have access; and

     (b) In close proximity to the license of the

facility.

     4.  A facility shall not transfer or

discharge a patient of the facility for the nonpayment of fees by the patient unless

the facility notifies the patient in writing of the intent of the facility to

transfer or discharge the patient. The written notice must include a statement

indicating the amount of the fees owed by the patient to the facility.

     5.  Upon admitting a patient to a facility,

the facility shall provide to the patient a written statement that informs the

patient of the manner in which he or she may file a complaint against the

facility. The statement must include, without limitation:

     (a) A statement indicating that the patient may

direct such a complaint to the Bureau or file the complaint with the Division;

and

     (b) The telephone number of the local office of the

Division.

     6.  Except as otherwise provided in

subsection 7, if a facility has admitted more than eight patients who read the

same language other than English, all written information provided by the

facility to any of those patients pursuant to the provisions of this section

must be written in that other language.

     7.  In lieu of providing written information

in a language other than English pursuant to the provisions of subsection 6, a

facility may use the services of an interpreter to provide that information to

a patient specified in that subsection if, as determined by the Bureau, the

facility maintains written documentation which indicates that the information

conveyed by the interpreter to the patient was sufficient to ensure the ability

of the patient to participate in the decisions made concerning his or her

treatment at the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.541  Interdisciplinary teams; plans for care of patients. (NRS 449.0302)

     1.  Each facility shall establish and comply

with a policy which specifies that the services provided to each patient of the

facility are coordinated using an interdisciplinary team. The interdisciplinary

team must consist of:

     (a) The primary dialysis physician of the patient;

     (b) A registered nurse;

     (c) A social worker; and

     (d) A licensed dietitian.

     2.  Each interdisciplinary team specified in

subsection 1 shall develop a written, individualized and comprehensive plan to

provide care to the patient for whom the plan is prepared. The plan must:

     (a) Specify the services that are required to

address the medical, psychological, social and functional needs of the patient;

and

     (b) Include a statement setting forth the

objectives for providing treatment to the patient.

     3.  Each plan for the care of a patient

prepared pursuant to the provisions of subsection 2 must include:

     (a) If required to ensure the provision of safe

care for the patient, evidence of coordination with any other provider of

service for the patient, including a hospital, long-term care facility, an

agency that provides residential or community support services, or a provider

of transportation; and

     (b) Evidence indicating that:

          (1) The provisions of the plan were disclosed

to the patient or his or her legal representative; and

          (2) The patient or his or her legal

representative was provided an opportunity to participate in and discuss the

preparation of the plan.

     4.  Each plan for the care of a patient must

be:

     (a) Prepared within 30 days after the patient is

admitted to the facility; and

     (b) Revised at least once every 6 months or

immediately after the occurrence of any change in the medical, nutritional or

psychosocial condition of the patient.

     5.  Each member of the interdisciplinary team

shall periodically evaluate the progress of the patient toward achieving the

objectives specified in the plan. Any action taken by a member of the

interdisciplinary team, if the objectives are not achieved, must be documented

and included in the clinical record of the patient.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.5415  Preparations for emergencies and disasters. (NRS 449.0302)

     1.  Each facility shall adopt a written

procedure to be followed by each patient and member of the staff of the

facility if any emergency occurs at the facility, including, without

limitation, any fire, equipment failure, power outage, medical emergency or

natural disaster that may threaten the health or safety of any patient or

member of the staff of the facility or any member of the general public.

     2.  Each facility shall prepare a plan for

obtaining emergency medical services that are available for use by the

facility.

     3.  Each facility shall employ personnel who

are qualified to operate emergency equipment at the facility and to provide

emergency care at the facility. The personnel must be available to operate the

emergency equipment and provide emergency care during each period in which

treatment is provided to a patient of the facility. A charge nurse who is

qualified to provide basic cardiopulmonary life support must be present at the

facility and available in the treatment area during any period in which a

patient of the facility is present in that area. Each member of the clinical

staff of the facility must maintain current certification and competency in

basic cardiopulmonary life support.

     4.  Each facility shall enter into an

agreement with at least one hospital that provides acute dialysis service,

inpatient care and other hospital services to the patients of the facility. The

agreement must include:

     (a) Documentation from the hospital indicating that

the patients of the facility will be accepted and treated during any emergency

that occurs at the facility; and

     (b) Reasonable assurances that:

          (1) The transfer or referral of a patient will

occur between the hospital and the facility if the transfer or referral is

determined to be medically appropriate by the attending physician of the

patient;

          (2) The exchange of medical and other

information necessary or useful in the care and treatment of the patient

transferred will occur within 1 working day after the transfer or referral of

the patient; and

          (3) All personal property belonging to and

transferred with the patient will be accounted for and protected from theft,

loss or damage.

     5.  Each facility shall establish and comply

with a written plan to protect each patient of the facility if a fire occurs at

the facility. The written plan must include:

     (a) Provisions concerning the evacuation of each

person from each building of the facility during a fire; and

     (b) A diagram that specifies the routes to be taken

to evacuate each of those buildings. A copy of each diagram prepared pursuant

to the provisions of this paragraph must be posted in a conspicuous place in

the building for which the diagram is prepared.

     6.  Each facility shall, not less than once

each quarter, conduct a fire drill at the facility. The facility shall rotate

the occurrence of the fire drills to ensure that each patient shift

participates in a fire drill at least once each year. Each fire drill must

include the use of alarms and equipment and a discussion with the patients,

visitors, employees and members of the staff of the facility concerning

evacuation from each building of the facility. After conducting a fire drill,

the facility shall prepare and maintain a written report concerning the fire

drill. The written report must include evidence that the members of the staff

and the patients of the facility participated in the fire drill.

     7.  Each facility shall ensure that each

member of the staff of the facility is familiar with the location of all

equipment that is used to suppress fires at the facility. The equipment must be

located in such a manner that a person is not required to travel more than 75

feet from any location in the facility to reach the equipment.

     8.  Each facility shall prepare and comply

with a written plan concerning preparation for any disaster that may occur at

the facility. The plan must:

     (a) Be based on an assessment of the probability

and type of disaster in each region and the local resources available to the

facility;

     (b) Include procedures that are designed to:

          (1) Minimize the harm to the patients and

members of the staff of the facility; and

          (2) Ensure the safe operation of the facility

during a disaster; and

     (c) Include provisions concerning:

          (1) The assignment of responsibilities for

each member of the staff of the facility during a disaster, including the

assignment of direction and control of the facility;

          (2) The maintenance of equipment used for

communication during a disaster;

          (3) The use of warning systems; and

          (4) Evacuation from and closure of the

facility because of a disaster.

     9.  Each facility shall adopt written

procedures to ensure that water is available to the essential areas of the

facility if there is an interruption in the facility’s normal supply of water.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.543  Pharmaceutical services. (NRS 449.0302)

     1.  Each facility shall provide

pharmaceutical services in accordance with accepted professional principles and

any applicable federal and state statutes and regulations.

     2.  Medication may be administered to a

patient of a facility only if the medication is ordered by:

     (a) The patient’s physician;

     (b) A physician assistant; or

     (c) An advanced practice registered nurse.

     3.  Any verbal or telephone order for

medication must be received by a licensed nurse and countersigned by the

physician of the patient for which the order was received.

     4.  Any medication that is maintained by a

facility at the site of the facility must be:

     (a) Placed in a container that is of sufficient

size to store the medication; and

     (b) Stored in a manner which ensures that the

medication is not accessible to a person who is not authorized by the facility

to obtain the medication. Any refrigerator that is used to store the medication

must be maintained at a temperature that is appropriate for that medication.

     5.  Each facility shall maintain a supply of

medications that, as determined by the medical director of the facility, is

sufficient to satisfy the requirements of each patient of the facility during

an emergency at the facility.

     6.  Any medication that is prepared for

administration to a patient of a facility must be prepared in an area of the

facility that includes a work counter and a sink. The area must be located in a

portion of the facility that prohibits any contamination of the medication.

     7.  If any medication is prepared for a

patient of a facility and the medication is not administered to the patient

immediately after it is prepared, the medication must be labeled with the:

     (a) Name of the patient;

     (b) Name of the medication;

     (c) Dosage prepared;

     (d) Initials of the person who prepared the

medication; and

     (e) Date on which the medication was prepared.

     8.  Except as otherwise provided in this

subsection, any medication that is prepared for a patient of a facility must be

administered by the person who prepared the medication. A dialysis technician

who is qualified in accordance with the provisions of NAC

449.5705 to 449.5775, inclusive, may

administer intravenous normal saline, intravenous heparin and subcutaneous

lidocaine as part of a routine treatment of hemodialysis.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5435  Nursing services; physicians and other staff. (NRS 449.0302)

     1.  Each facility shall provide nursing

services to each patient of the facility to prevent or reduce complications and

to maximize the functional status of the patient.

     2.  Each facility shall employ a full-time

registered nurse to supervise and manage the care provided to patients of the

facility.

     3.  The registered nurse employed pursuant to

the provisions of subsection 2 shall:

     (a) Conduct an assessment of a patient during the

admission of the patient to the facility;

     (b) Conduct an assessment of a patient if requested

by the patient or if required because of a change in the medical status of the

patient;

     (c) Participate in a team review of the progress of

the patient pursuant to the provisions of NAC 449.541;

     (d) Recommend changes in treatment, if appropriate,

based on the immediate requirements of the patient;

     (e) Facilitate communication between the patient,

the patient’s family and each member of the interdisciplinary team established

for the patient to ensure the delivery of care required for the patient;

     (f) Provide oversight and direction to dialysis

technicians and licensed practical nurses; and

     (g) Participate in activities conducted by the

facility to ensure the quality of the facility.

     4.  Each facility shall ensure that a

registered nurse or a physician is present at the site of the facility and

available to the treatment area to provide care at all times during which

treatment is provided to a patient of the facility in that area.

     5.  Nursing services at the facility must be

provided or supervised by a registered nurse. The registered nurse may be the

charge nurse of the facility. Each facility shall ensure that a sufficient

number of registered nurses, licensed practical nurses and other qualified

persons are available to satisfy the requirements for nursing care of each

patient of the facility.

     6.  Each facility shall ensure that a

sufficient number of the members of the staff of the facility are available at

the site of the facility to provide care directly to each patient of the

facility and to satisfy the requirements of each of those patients.

     7.  A licensed nurse or dialysis technician

shall evaluate each patient before and after treatment is provided to the

patient in accordance with the policy of the facility and the amount of

training received by the licensed nurse or dialysis technician.

     8.  A registered nurse shall conduct an

initial nursing assessment of each patient of the facility at the time the

patient receives his or her first treatment at the facility. The assessment

must be completed by the registered nurse within 2 weeks after the beginning of

that treatment.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.544  Nutrition services. (NRS 449.0302)

     1.  Each facility shall provide nutrition

services to each patient of the facility and the provider of care for that

patient to maximize the nutritional status of the patient.

     2.  The licensed dietitian for a patient of a

facility shall:

     (a) Conduct an assessment of the nutrition of the

patient;

     (b) Participate in a team review of the progress of

the patient in accordance with the provisions of NAC

449.541;

     (c) After consulting with the physician of the

patient, recommend a therapeutic diet for the patient based on:

          (1) The cultural preferences of the patient;

          (2) Changes in the treatment of the patient;

and

          (3) The nutritional requirements of the

patient;

     (d) Except as otherwise provided in subsection 7:

          (1) Counsel the patient and the provider of

care for that patient, if required, concerning any diet prescribed for the

patient at the facility; and

          (2) Monitor the patient’s adherence and

response to that diet;

     (e) Refer the patient for assistance with any

resources that are available to the patient, including, without limitation,

financial assistance, community resources or assistance at the residence of the

patient;

     (f) Participate in activities conducted at the

facility to ensure the quality of the facility; and

     (g) Monitor the nutritional status of the patient

to determine the need for intervention and follow-up by the facility. In making

that determination, the licensed dietitian shall consider:

          (1) Changes in the weight of the patient;

          (2) The chemistry of the blood of the patient;

          (3) The adequacy of the dialysis treatment

provided to the patient; and

          (4) Changes in the medication prescribed for

the patient.

     3.  Each facility shall collect data to

assess the nutritional status of a patient of the facility not later than 2

weeks after the patient is admitted to the facility or immediately after the

patient receives seven treatments at the facility, whichever occurs later. A

comprehensive assessment of the nutritional status of the patient must be

completed within 30 days after the patient is admitted to the facility or

immediately after the patient receives 13 treatments at the facility, whichever

occurs later. Such an assessment must include a determination by the dietitian

of the degree to which the patient understands the diet prescribed for him or

her by the facility.

     4.  Each facility shall, annually or more

often if required by the circumstances concerning the treatment of the patient,

revise the comprehensive assessment of the nutritional status of each patient

specified in subsection 3.

     5.  Each facility shall employ or contract

with a licensed dietitian to provide nutrition services for each patient of the

facility. If a facility provides treatment for 100 or more patients, the

facility shall ensure that one full-time equivalent licensed dietitian is

available at the facility.

     6.  Nutrition services must be available at

each facility during scheduled periods for treatment. The facility may require

a patient to obtain an appointment with a licensed dietitian before receiving

those services.

     7.  The provisions of paragraph (d) of subsection

2 do not apply to a correctional institution.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.5445  Social services. (NRS 449.0302)

     1.  Each facility shall provide social

services to each patient of the facility and to the provider of care for the

patient, if required. The facility shall ensure that the social services

support and maximize the adjustment, social functioning and rehabilitation of

each patient of the facility.

     2.  The social worker shall:

     (a) Conduct a psychosocial evaluation of each

patient of the facility;

     (b) Participate in a team review of the progress of

the patient in accordance with the provisions of NAC

449.541;

     (c) Recommend changes in the treatment of the

patient based on the psychosocial requirements of the patient;

     (d) Except as otherwise provided in subsection 7,

provide casework and group work services to the patient and, if needed, to

members of his or her family concerning the problems associated with treating

end-stage renal disease;

     (e) Except as otherwise provided in subsection 7,

identify public agencies that may provide social services for the patient or

other resources that are available to the patient and assist the patient and

each member of his or her family in the use of those resources; and

     (f) Participate in activities conducted at the

facility to ensure the quality of the facility.

     3.  Each facility shall ensure that the

initial contact between the social worker and each patient of the facility

occurs and is documented in writing not more than 2 weeks after the patient is

admitted to the facility or immediately after the patient receives seven

treatments at the facility, whichever occurs later. A comprehensive

psychosocial assessment of the patient must be completed within 30 days after

the patient is admitted to the facility or immediately after the patient

receives 13 treatments at the facility, whichever occurs later.

     4.  Each facility shall, annually or more

often if required by the circumstances concerning the treatment of the patient,

revise the comprehensive psychosocial assessment of each patient specified in

subsection 3.

     5.  Each facility shall employ or contract with

a social worker to meet the psychosocial requirements of each patient of the

facility. If a facility provides treatment for 100 or more patients, the

facility shall ensure that one full-time equivalent social worker is available

at the facility.

     6.  Social services must be available at each

facility during scheduled periods for treatment. The facility may require a

patient to obtain an appointment with a social worker before receiving those

services.

     7.  The provisions of paragraphs (d) and (e)

of subsection 2 do not apply to a correctional institution.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.546  Patient care: Advanced practice registered nurses and physician

assistants; medical emergencies. (NRS 449.0302)

     1.  If an advanced practice registered nurse

or a physician assistant provides treatment for a patient of a facility, the

facility shall ensure that there is evidence of communication with the treating

physician of the patient if the advanced practice registered nurse or physician

assistant changes any order for treatment in accordance with the provisions of chapter 630 or 632 of NRS.

     2.  An advanced practice registered nurse or

a physician assistant specified in subsection 1 may not replace the treating

physician of the patient concerning:

     (a) Participation in planning for the care of the

patient; or

     (b) Activities conducted at the facility to ensure

the quality of the facility.

     3.  If a medical emergency occurs concerning

a patient of a facility, the treating physician for that patient:

     (a) Must be immediately notified; and

     (b) Shall direct the provision of care for the

patient during the emergency.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5465  Patient care: Licensed practical nurses and dialysis technicians. (NRS 449.0302)

     1.  The provisions of NAC

449.501 to 449.5795, inclusive, do not

prohibit a licensed practical nurse from practicing in accordance with the

regulations adopted by the State Board of Nursing. If a licensed practical

nurse acts in the capacity of a licensed practical nurse during the treatment

of a patient of a facility, the licensed practical nurse must be certified to

give intravenous injections by a board that is approved by the State Board of

Nursing.

     2.  A member of the staff of a facility who

acts in the capacity of a dialysis technician at the facility must be qualified

in accordance with the provisions of NAC 449.5705

to 449.5775, inclusive. If the facility determines

that the member of the staff is not qualified pursuant to those provisions, the

facility shall not allow the member of the staff to act in the capacity of a

dialysis technician until the member of the staff becomes qualified pursuant to

those provisions.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.547  Self-dialysis: Provision of training and certain services. (NRS 449.0302)

     1.  If a facility provides training to a

patient of the facility concerning the performance of dialysis by the patient,

a licensed nurse who has at least 12 months of experience in the applicable

dialysis modality, including hemodialysis or peritoneal dialysis, must be

responsible for training the patient and each member of the family of the

patient who intends to assist the patient in conducting the dialysis. The

licensed nurse shall supervise all other members of the staff of the facility

who assist in providing that training.

     2.  If a patient of a facility performs

dialysis for himself or herself at the patient’s residence, the facility shall

provide the following services to the patient:

     (a) A yearly physical examination;

     (b) Monthly communication from a member of the

staff of the facility by:

          (1) Telephone;

          (2) Visits to the facility by the patient; or

          (3) Visits to the patient’s residence by a

member of the staff;

     (c) A visit to the facility at least once every 3

months;

     (d) Communication with the appropriate member of

the interdisciplinary team that is established for the patient pursuant to the

provisions of NAC 449.541;

     (e) Routine laboratory work in accordance with the

policy of the facility; and

     (f) A method by which the patient may contact a

member of the staff of the facility, including the primary physician of the

patient, at any time if an emergency concerning the condition of the patient

occurs.

     3.  If a patient of a facility performs

hemodialysis for himself or herself at the patient’s residence, the facility

shall provide the following services to the patient:

     (a) Surveillance of the patient’s home adaptation,

including provisions for visits to his or her residence;

     (b) Consultation with a registered nurse, social

worker and licensed dietitian;

     (c) A system for maintaining a record of treatment

that ensures continuity of care for the patient;

     (d) Installation and maintenance of the equipment

required to perform the hemodialysis;

     (e) Testing and appropriate treating of the water

used for the hemodialysis; and

     (f) Ordering of supplies on a continual basis.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.5475  Continuous ambulatory peritoneal dialysis. (NRS 449.0302)  If a

facility provides continuous ambulatory peritoneal dialysis for a patient of

the facility, the facility shall provide the following services to the patient:

     1.  Consultation with a registered nurse, social

worker and licensed dietitian;

     2.  A system for maintaining a record of

treatment that ensures continuity of care for the patient; and

     3.  Ordering of supplies on a continual

basis.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.549  Continuous cycling peritoneal dialysis. (NRS 449.0302)  If a

facility provides continuous cycling peritoneal dialysis to a patient of the

facility, the facility shall provide the following services to the patient:

     1.  Surveillance of the patient’s home

adaptation, including provisions for visits to his or her residence;

     2.  Consultation with a registered nurse,

social worker and licensed dietitian;

     3.  A system for maintaining a record of

treatment that ensures continuity of care for the patient;

     4.  Installation and maintenance of the

equipment required to perform the dialysis; and

     5.  Ordering of supplies on a continual

basis.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.5495  Patient services by contract; laboratory. (NRS 449.0302)

     1.  If a facility provides services to a

patient of the facility by contract, the facility remains responsible for

supervising the treatment of the patient and providing adequate care for the

patient in accordance with the provisions of NAC

449.501 to 449.5795, inclusive.

     2.  If a facility maintains a laboratory for

use by the facility, the laboratory must be licensed in accordance with the

provisions of chapter 652 of NRS.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

Administration and Personnel

      NAC 449.550  Governing body. (NRS 449.0302)

     1.  Each facility shall establish a governing

body that is legally responsible for developing and carrying out the policies

of the facility regarding the management and operation of the facility.

     2.  The policies established and carried out

pursuant to the provisions of subsection 1 must include, without limitation:

     (a) The governance of the governing body;

     (b) The care and safety of the patients of the

facility;

     (c) The general operation of the facility; and

     (d) The protection of the personal and property

rights of each patient of the facility.

     3.  The governing body shall:

     (a) Receive and act upon any recommendation

submitted to the governing body by a member of the staff of the facility;

     (b) Appoint a medical director for the facility

pursuant to the provisions of NAC 449.5505; and

     (c) Ensure that the facility complies with all

state and local statutes, ordinances and regulations that apply to the

facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5505  Medical director. (NRS 449.0302)

     1.  The medical director of a facility:

     (a) Must be certified in nephrology or pediatric

nephrology or be eligible for that certification by a board that is approved by

the American Medical Association; or

     (b) During the 5 years immediately preceding July

1, 2001, must have served for at least 12 months as the director of a dialysis

program.

     2.  The medical director shall:

     (a) Develop objectives for the treatment of

patients of the facility based on a review of data assessed through activities

conducted at the facility to ensure the quality of the facility;

     (b) Ensure that each licensed nurse and dialysis

technician employed at the facility has received adequate training;

     (c) Monitor the care and treatment provided to each

patient of the facility; and

     (d) Develop and carry out each policy that the

facility is required to establish pursuant to the provisions of NAC 449.501 to 449.5795,

inclusive.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.552  Physicians. (NRS 449.0302)

     1.  Each patient of a facility must be under

the care of a physician who is a member of the medical staff of the facility.

     2.  If a patient of the facility receives

pediatric dialysis at the facility, the treatment provided to the patient must

be supervised by a pediatric nephrologist or a pediatrician. If a pediatric

nephrologist is not available to serve as the primary physician for the

patient, an adult nephrologist may serve as the primary physician for the

patient if a direct patient evaluation is prepared by a pediatric nephrologist

or a pediatrician at the initiation of care for the patient and annually until

the patient reaches 6 years of age.

     3.  Each patient who receives treatment at

the facility must be evaluated at least once each month by a physician who is a

member of the medical staff of the facility. If a patient of the facility

performs dialysis for himself or herself at the patient’s residence, the

patient must be examined by such a physician at least once every 3 months. The

record of any examination conducted pursuant to the provisions of this

subsection must include evidence of:

     (a) A monthly assessment concerning any new or

recurrent problems; and

     (b) A review of the adequacy of the treatment

provided to the patient.

     4.  Each facility shall ensure that at least

one physician who is a member of the medical staff of the facility is

available, in person or by telecommunication, 24 hours each day to patients and

members of the staff of the facility.

     5.  Any order concerning the treatment of a

patient of a facility must be prepared in writing and signed by the physician

preparing the order. If a physician prepares a routine order for treatment, the

order must:

     (a) Be revised at least annually; and

     (b) Include a statement indicating the:

          (1) Duration of treatment;

          (2) Dialyzer to be used for that treatment;

          (3) Rate of the flow of blood for the patient

during that treatment;

          (4) Target weight of the patient; and

          (5) Medications required for the patient,

including heparin.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5525  Orientation program for new employees; continuing education. (NRS 449.0302)

     1.  Each facility shall develop and carry out

a program to orient and familiarize each new employee of the facility with:

     (a) The policies and operation of the facility; and

     (b) The responsibilities of the position for which

the employee is employed by the facility.

     2.  Each new member of the staff of a

facility who will provide care directly to patients of the facility must be

allowed a sufficient period to become familiar with the facility. The orientation

program provided by the facility for each of those new members must:

     (a) Be at least 2 weeks in duration, if the new

member has experience concerning the performance of dialysis; and

     (b) Include 2 weeks of training concerning the

direct care of patients of the facility, if the new member has no experience

concerning the performance of dialysis.

     3.  If a facility employs a licensed nurse

who has no experience concerning the performance of dialysis, the orientation

program provided by the facility to that nurse must be at least 6 weeks in

duration and must include training in the following subjects:

     (a) Fluid, electrolyte and acid-base balance;

     (b) Kidney disease and the treatment of that

disease;

     (c) Dietary management of kidney disease;

     (d) Principles of dialysis;

     (e) Dialysis technology;

     (f) Techniques for performing venipuncture;

     (g) Care of the dialysis patient;

     (h) Psychological, social, financial and physical

complications of long-term dialysis;

     (i) Prevention of hepatitis and other diseases; and

     (j) Risks and benefits of reusing hemodialyzers, if

the facility reuses any hemodialyzer in providing treatment to a patient of the

facility.

     4.  Each facility shall ensure that each

member of the staff of the facility who provides care to a patient of the

facility completes a course of continuing education concerning end-stage renal

disease. The course must be at least 5 hours in duration and must be completed

annually by each such member of the staff of the facility. The course may be

provided by a member of the staff of the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.553  Medical staff: Generally. (NRS 449.0302)

     1.  Each physician who is a member of the

medical staff of a facility must be licensed to practice medicine in this

State.

     2.  The membership of the medical staff of a

facility may include a nephrologist or any other physician who has training or

demonstrated experience in providing care for a patient who is diagnosed with

end-stage renal disease.

     3.  If a facility employs an advanced

practice registered nurse or a physician assistant:

     (a) The advanced practice registered nurse must be

qualified in accordance with the provisions of chapter 632 of NRS; and

     (b) The physician assistant must be qualified in

accordance with the regulations adopted by the Board of Medical Examiners.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5535  Nurses. (NRS 449.0302)

     1.  Each nurse employed by a facility must be

licensed to practice nursing in this State.

     2.  Except as otherwise provided in

subsection 3, each nurse of a facility who is assigned charge responsibilities

must:

     (a) Be a registered nurse; and

     (b) Have at least 6 months of experience as a nurse

in performing hemodialysis or in providing nursing care for a patient with

permanent kidney failure. The experience required pursuant to the provisions of

this paragraph must be obtained within the 2 years immediately preceding the

date on which the nurse is assigned charge responsibilities by the facility.

     3.  The provisions of paragraph (b) of

subsection 2 do not apply to a registered nurse who holds a current certificate

in nephrology nursing or hemodialysis issued by a board that is nationally

recognized.

     4.  Each charge nurse of a facility shall:

     (a) Make daily assignments based on the

requirements of each patient of the facility for treatment;

     (b) Provide immediate supervision of the care

provided to each of those patients;

     (c) Conduct an assessment of a patient of the

facility if required by the circumstances concerning the treatment of the

patient; and

     (d) Communicate with the patient’s physician and

the social worker and licensed dietitian of the facility concerning the

treatment of the patient.

     5.  If a facility provides training

concerning self-care for patients of the facility, a registered nurse who has

at least 12 months of experience in performing dialysis and experience in the

applicable dialysis modality must:

     (a) Be responsible for training the patient and

each member of the family of the patient who intends to assist the patient in

providing care for the patient; and

     (b) Supervise other members of the staff of the

facility who assist in providing that training.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.555  Dietitians. (NRS 449.0302)  Each

dietitian employed by a facility must be a licensed dietitian.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.5555  Social workers. (NRS 449.0302)  Each

social worker employed by a facility must:

     1.  Be licensed as a social worker in this

State and hold a master’s degree in social work from a graduate school of

social work that is accredited by the Council on Social Work Education; or

     2.  Have worked for at least 2 years as a

social worker, 1 year of which was in a facility or transplantation program

before September 1, 1976, and have established a consultative relationship with

a social worker who has a master’s degree in social work from a graduate school

of social work that is accredited by the Council on Social Work Education.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.556  Staff responsible for operating water treatment system. (NRS 449.0302)

     1.  Each member of the staff of a facility

who is responsible for operating the water treatment system of the facility

must demonstrate to the satisfaction of the Bureau that he or she understands

the risks to patients of exposure to water that has not been treated by the

water treatment system. The facility shall, for each of those members, prepare

and maintain at the facility a written record of the training provided to those

members concerning the safe operation of the water treatment system of the

facility.

     2.  A facility shall not allow a person to

repair or replace any component of the water treatment system of the facility

unless the person is qualified to repair or replace the component pursuant to

the provisions of NAC 449.5565. If the facility

allows a person who is qualified pursuant to those provisions to repair or

replace any component of the water treatment system of the facility, the

facility shall prepare and maintain at the facility a written record of the

training, education and experience of the person.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5565  Staff that repairs or maintains equipment used to provide care to

patients. (NRS 449.0302)  A

facility shall not allow a member of the staff of the facility to repair or

maintain any equipment of the facility that is used to provide care to a

patient of the facility unless the member has completed a course of instruction

and demonstrated competency in repairing or maintaining that equipment. The

course must include instruction in the following subjects:

     1.  The prevention of the transmission of

hepatitis through any equipment that is used for dialysis;

     2.  The requirements for safety of systems

that are used to deliver dialysate;

     3.  The control of bacteria;

     4.  Standards for water quality; and

     5.  The repair and maintenance of equipment

used for dialysis or other equipment used by the facility to provide care to a

patient of the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

Clinical Records

      NAC 449.558  Preparation and maintenance. (NRS 449.0302)

     1.  Each facility shall establish a system

for preparing and maintaining a clinical record for each patient of the

facility. The system must be developed to ensure that the care provided to each

patient of the facility is:

     (a) Completely and accurately documented;

     (b) Readily available for retrieval by the

facility; and

     (c) Systematically organized to facilitate the

compilation and retrieval of information.

     2.  If the facility maintains any clinical

record on microfilm, optical disc or by any other electronic means, the

facility shall ensure that the clinical record is available for review by the

Bureau within 48 hours after the facility receives a request for the clinical

record from the Bureau.

     3.  All information concerning the medical

history or care provided to or treatment received by a patient at the facility

must be:

     (a) Maintained in the clinical record of the

patient; and

     (b) Protected by the facility against theft, loss

or damage.

     4.  Each facility shall establish an area in

which to store the clinical records of the facility. The area must be separate

from any area of the facility that is used to provide treatment for patients of

the facility and must have adequate space for reviewing, dictating, sorting or

recording the information included in the clinical records. If a facility uses

an optical disc, microfilm or any other electronic means to create or maintain

a clinical record, the area used to store the clinical record must have adequate

space for transcribing the information created or maintained on the optical

disc, microfilm or by any other electronic means. If the facility determines

that the clinical record of a patient of the facility is active, the facility

shall store the active clinical record at the site of the facility.

     5.  Each facility shall ensure that:

     (a) The clinical record of a patient of the

facility remains confidential and is retained in accordance with the provisions

of NRS 629.051; and

     (b) Each entry or other information that is placed

in the clinical record regarding the delivery of care to the patient is not

altered without evidence and explanation of that alteration. A signature stamp

must not be used to authenticate an entry in the clinical record of a patient

of the facility.

     6.  If a facility determines that a clinical

record is inactive, the facility shall store that clinical record. The facility

may store the record on microfilm, optical disc or by any other electronic

means and may store the clinical record at a location other than at the site of

the facility if the facility ensures that:

     (a) The clinical record remains secure from

unauthorized access at that location; and

     (b) The record is readily retrievable for review by

the Division.

     7.  Each clinical record must include:

     (a) Information concerning the identity of the

patient for whom the clinical record is prepared;

     (b) Each written notice provided to the patient at

the facility and each written consent obtained from the patient at the

facility;

     (c) Each order prepared by a physician at the

facility concerning the patient;

     (d) Each progress note prepared by the facility

concerning the patient;

     (e) A list that specifies all problems incurred

concerning the treatment and care of the patient;

     (f) The physical and medical history of the

patient;

     (g) Each assessment concerning the patient prepared

by a registered nurse, social worker or licensed dietitian employed by the

facility;

     (h) The record of each medication administered by

the facility to the patient:

          (1) During treatment at the facility; or

          (2) For use at his or her residence;

     (i) The record of each transfusion received by the

patient at the facility;

     (j) Each laboratory report prepared or received by

the facility concerning the patient;

     (k) Each diagnostic study concerning the patient

that is ordered by the attending nephrologist;

     (l) Each appropriate record of hospitalization;

     (m) Each record of consultation with the patient

that is requested by the attending nephrologist;

     (n) If practicable, the record of creation and

revision of access for each dialysis treatment provided to the patient;

     (o) Each plan prepared by the facility concerning

the care of the patient, including the plan developed for the patient pursuant

to the provisions of NAC 449.541 and all amendments

to that plan;

     (p) Evidence indicating that the facility has

complied with the provisions of NAC 449.501 to 449.5795, inclusive, concerning the furnishing of

educational materials to the patient;

     (q) Each record of the daily treatment received by

the patient at the facility; and

     (r) A discharge summary, if the patient is

discharged from the facility.

     8.  As used in this section, “progress note”

means a note or other written statement that:

     (a) Is signed and dated by a member of the staff of

a facility; and

     (b) Summarizes the facts concerning the care

provided to a patient of the facility and the response of the patient to that

care for the period specified in the note or other written statement.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.5585  Additional requirements. (NRS 449.0302)

     1.  In addition to the provisions of NAC 449.558, the clinical record of each patient of a

facility must include:

     (a) An accurate assessment of the progress of the

patient, including all changes in the medical status of the patient;

     (b) The results of each diagnostic test concerning

the patient that is requested by the attending nephrologist;

     (c) Consultation reports; and

     (d) All unusual occurrences concerning the care and

treatment of the patient.

     2.  Each member of the interdisciplinary team

established pursuant to the provisions of NAC 449.541

shall prepare a written record concerning the progress of the patient. The

written record must be prepared at least once every 6 months or more often if

required by a change in the medical, nutritional or psychosocial condition of

the patient.

     3.  The condition of each patient of a

facility and the response of the patient to treatment must be noted on the

daily treatment record of the patient.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.559  Medical history and physical examination. (NRS 449.0302)  Each

facility shall prepare a medical history of each patient of the facility and

conduct a physical examination of the patient. The medical history and physical

examination must be completed within 30 days before the patient is admitted to

the facility or within 2 weeks after he or she is admitted to the facility.

Before the patient receives his or her first treatment at the facility, the

physician for the patient must notify the charge nurse for the facility of the

diagnoses, medications, hepatitis status, allergies and prescription for

dialysis of the patient. All information provided by the physician to the

charge nurse pursuant to the provisions of this section must be included in the

clinical record of the patient.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5595  Transient patients. (NRS 449.0302)

     1.  The clinical record of each transient

patient of a facility must include:

     (a) Each order for the treatment of the patient at

the treating facility;

     (b) Each laboratory report ordered by the treating

facility concerning the patient that is prepared within 30 days after receiving

treatment at the treating facility, including hepatitis B antigen status;

     (c) The most recent patient care plan and treatment

records received from the home facility of the patient; and

     (d) All records received from the home facility

concerning the care and treatment of the patient.

     2.  As used in this section, “transient

patient” means a patient of a facility who:

     (a) Is not a resident of the community in which the

facility is located; and

     (b) Does not receive treatment at the facility for

more than 6 weeks.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.561  Discharge or transfer of patients; removal of records. (NRS 449.0302)

     1.  If a patient of a facility is discharged

from the facility, the facility shall, within 30 days after the patient is

discharged, prepare a discharge summary concerning the patient. The discharge

summary must specify the disposition of the patient and include:

     (a) A diagnosis of the patient or, if the patient has

died, the cause of death;

     (b) The date of the discharge or, if the patient

has died, the date and location of his or her death;

     (c) If the patient receives a kidney transplant or

is relocated, information concerning the kidney transplant or relocation; and

     (d) If the patient is discharged for a reason other

than kidney transplantation or death, the reason for the discharge.

     2.  All clinical records prepared or

maintained by a facility are the property of the facility and must not be

removed from the area in which the clinical records are stored except pursuant

to a subpoena or order of a court or to preserve the clinical records if a

disaster or other emergency occurs at the facility.

     3.  If a patient of a facility is transferred

to another facility, the facility from which the patient is transferred shall

provide to the other facility a copy of the clinical record of the patient. The

copy of the clinical record must include:

     (a) The most recent orders for dialysis treatment;

     (b) The last three records of treatment;

     (c) The most recent hepatitis status of the

patient;

     (d) The most recent plan of care concerning the

patient; and

     (e) If the patient is transferred to an outpatient

facility, the most recent medical history and physical examination of the

patient and the assessment of each member of the interdisciplinary team

established for the patient pursuant to the provisions of NAC 449.541.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5615  Cessation of operation of facility. (NRS 449.0302)  If a

facility ceases to operate, the facility shall:

     1.  Ensure the preservation of the clinical

records of the facility; and

     2.  Not more than 30 days after the facility

ceases to operate, notify the Bureau in writing of the location of the clinical

records of the facility. The written notice must include the name and address

of the custodian of the clinical records.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

Dialysis Technicians

      NAC 449.570  General qualifications; identification to be worn during

training; provision of care; requirements to act as preceptor. (NRS 449.0302)

     1.  A person may not act as a dialysis

technician at a facility unless he or she is qualified in accordance with the

provisions of NAC 449.5705 to 449.5775, inclusive.

     2.  If a dialysis technician receives

training in any area of a facility in which treatment is provided to a patient

of the facility, the dialysis technician shall, during the period in which he

or she is located in that area, wear a tag or similar device that identifies

the dialysis technician. The tag or similar device must be worn in a visible

manner.

     3.  Until a dialysis technician becomes

qualified in accordance with the provisions of NAC

449.5705 to 449.5775, inclusive, the dialysis

technician may provide care to a patient of a facility only if the care is

provided:

     (a) As part of the training received by the

dialysis technician at the facility; and

     (b) Under the immediate supervision of a registered

nurse or preceptor who is assigned for that purpose by the facility.

     4.  A person shall not act as a preceptor for

a facility unless he or she:

     (a) Is a licensed nurse or dialysis technician who

has at least 6 months of experience in performing hemodialysis obtained within

the 24 months immediately preceding the date the person becomes a preceptor for

the facility;

     (b) Obtains a recommendation from the supervising

nurse of the facility to be a preceptor; and

     (c) Files with the facility a current written list

concerning his or her knowledge and skills that is prepared in accordance with

the provisions of NAC 449.5745.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5705  Qualification of technician determined to be qualified before

July 1, 2001. (NRS 449.0302)

     1.  If a person completes an orientation

program of a facility pursuant to the provisions of NAC

449.5525 and has been determined by the facility to be qualified to provide

dialysis treatment before July 1, 2001, the person may qualify as a dialysis

technician if he or she:

     (a) Except as otherwise provided in subsection 2,

passes the written examination specified in NAC 449.571

and demonstrates competency by obtaining a written list concerning his or her

knowledge and skills prepared in accordance with the provisions of NAC 449.5745; or

     (b) Demonstrates to the satisfaction of an

instructor or supervising nurse for the facility that the person is competent

to assume the responsibilities of a dialysis technician and obtains from the

instructor or supervising nurse a written list concerning his or her knowledge

and skills prepared in accordance with the provisions of NAC 449.5745.

     2.  In lieu of passing the written

examination pursuant to the provisions of paragraph (a) of subsection 1, a

dialysis technician who is certified as a dialysis technician by a nationally

recognized testing organization may provide a copy of that certification to the

facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.571  Program of training: Curriculum; duties of instructor; written

examinations. (NRS 449.0302)

     1.  Each program for training a dialysis

technician provided by a facility must consist of a written curriculum that

specifies the objectives for each portion of the course.

     2.  The written curriculum must include at

least the following subjects:

     (a) Introduction to dialytic therapies, including:

          (1) The history of dialysis;

          (2) Definitions and terminology;

          (3) Communication skills;

          (4) Ethics and confidentiality;

          (5) The multidisciplinary process;

          (6) The roles of the members of an

interdisciplinary team established pursuant to the provisions of NAC 449.541; and

          (7) Information concerning renal organizations

and resources;

     (b) The principles of hemodialysis, including:

          (1) The principles of dialysis;

          (2) Access to the circulatory system; and

          (3) Anticoagulation, local anesthetics and

normal saline;

     (c) Understanding a person who suffers from kidney

failure, including:

          (1) Basic renal anatomy, physiology and

pathophysiology;

          (2) The effect of renal failure on the systems

of the body;

          (3) The symptoms and findings related to the

uremic state;

          (4) The modes of renal replacement therapy,

including kidney transplantation;

          (5) Basic renal nutrition;

          (6) Basic psychosocial aspects of end-stage

renal disease;

          (7) The medications commonly administered to a

patient who is diagnosed with end-stage renal disease, including the manner of

administering and the effects of those medications;

          (8) Confidentiality of the personal and

clinical records of a patient of a facility;

          (9) Professional conduct;

          (10) The rights and responsibilities of a

patient of a facility; and

          (11) Rehabilitation of a patient of a

facility;

     (d) Procedures relating to dialysis, including:

          (1) Using aseptic techniques;

          (2) The technical aspects of dialysis,

operation and monitoring of equipment, and the commencement and termination of

dialysis;

          (3) Delivering dialysis treatment adequately

and circumstances that may result from inadequate treatment;

          (4) Observing and reporting the reaction of a

patient to treatment;

          (5) Monitoring glucose and hemoglobin or

hematocrit monitoring;

          (6) Emergency procedures and responses,

including cardiopulmonary resuscitation, the management of an air embolism, and

the proper response to line separation and hemolysis;

          (7) External and internal disasters, fire,

natural disasters and preparation for an emergency; and

          (8) Safety, control of quality and improvement

of quality;

     (e) Information concerning devices used for

hemodialysis, including:

          (1) The theory and practice of conventional,

high efficiency and high flux dialysis;

          (2) Dialysate composition, options,

indications, complications and safety;

          (3) Monitoring and safety; and

          (4) Disinfecting equipment;

     (f) The treatment of water, including:

          (1) Standards for water treatment used for

dialysis as described in the American National Standard, Water

Treatment Equipment for Hemodialysis Applications, adopted by reference

pursuant to the provisions of NAC 449.520;

          (2) Systems and devices;

          (3) Monitoring; and

          (4) The risk of harm to a patient who uses

untreated water;

     (g) If the facility reuses water, information

concerning the reprocessing of water, including:

          (1) Principles of reuse;

          (2) Safety, control of quality, standard

precautions and water treatment; and

          (3) Standards for reuse as described in the American

National Standard, Water Treatment Equipment for Hemodialysis

Applications, adopted by reference pursuant to the provisions of NAC 449.520;

     (h) Providing instruction for a patient of a

facility, including:

          (1) The role of the technician in supporting

the goals of the patient concerning education; and

          (2) The principles of adult education;

     (i) Safety and the control of infection, including:

          (1) The risk of harm to a patient from

nosocomial infections and from accidents and errors in providing treatment;

          (2) Standard precautions, aseptic and sterile

techniques, and proper handling of a specimen;

          (3) Basic bacteriology and epidemiology;

          (4) The risk of harm to an employee of a

facility resulting from exposure to blood and chemicals; and

          (5) Electrical, fire, disaster and

environmental safety and hazardous substances; and

     (j) The assurance and improvement of quality,

including:

          (1) The role of the dialysis technician in

activities concerning the assurance of quality;

          (2) The principles of the assurance and

improvement of quality; and

          (3) The importance of the assurance of quality

to ensure that safe dialysis treatments are provided to each patient of the

facility.

     3.  In addition to the requirements set forth

in subsection 2, if a dialysis technician intends to assist in providing

training or treatment to a patient of the facility who receives peritoneal

dialysis, the program of training for the dialysis technician must include the

following subjects:

     (a) The principles of peritoneal dialysis;

     (b) Sterile techniques;

     (c) The systems for the delivery of peritoneal

dialysis;

     (d) The symptoms of peritonitis; and

     (e) The complications of peritoneal dialysis.

     4.  In addition to the requirements set forth

in subsection 2, if a dialysis technician intends to cannulate a dialysis

access during the treatment of a patient of the facility or administer normal

saline, heparin or lidocaine to that patient, the program of training for the

dialysis technician must include the following subjects:

     (a) Access to circulation, including:

          (1) Fistula: creation, development, placement

of needles and prevention of complications;

          (2) Grafts: materials used, creation,

placement of needles and prevention of complications; and

          (3) Symptoms to report;

     (b) Safe administration of medications, including:

          (1) Identifying the patient;

          (2) Ensuring the proper administration of

medication;

          (3) Measuring the correct dose;

          (4) Ascertaining the correct route to

administer the dose; and

          (5) Ensuring the correct time to administer

the dose;

     (c) Administration of normal saline, including:

          (1) The reasons for administration;

          (2) Potential complications;

          (3) The limits of administration; and

          (4) Information to report and record;

     (d) Administration of heparin, including:

          (1) The reasons for administration;

          (2) The methods of administration;

          (3) The preparation of an ordered dose;

          (4) Potential complications; and

          (5) Information to report and record; and

     (e) Administration of lidocaine, including:

          (1) The reasons for administration;

          (2) The method of administration;

          (3) The preparation of an ordered dose;

          (4) Potential complications and risks; and

          (5) Information to report and record.

     5.  The instructor of a course of training

provided to a dialysis technician shall:

     (a) Maintain a roster of attendance for each

dialysis technician enrolled in the course; and

     (b) At least once each week during the course,

evaluate each dialysis technician enrolled in the course to determine the

progress of the dialysis technician in completing the course.

     6.  Except as otherwise provided in subsection

7, each dialysis technician specified in subsection 5 must complete a written

examination. The examination must include each of the subjects specified in

subsections 2 and 3. If the dialysis technician intends to cannulate a dialysis

access during the treatment of a patient of the facility or administer normal

saline, heparin or lidocaine to that patient, the examination must include the

subjects specified in subsection 4. To pass the written examination, the

dialysis technician must achieve a score of not less than 80 percent on each of

the subjects required to be included in the written examination pursuant to the

provisions of this subsection.

     7.  The provisions of subsection 6 do not

apply to a dialysis technician who is certified as a dialysis technician by an

organization that is approved by the Bureau.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R075-04, 8-5-2004)

      NAC 449.5715  Program of training: Qualifications of instructors. (NRS 449.0302)  Each

instructor who provides instruction pursuant to a program of training specified

in NAC 449.571 must be:

     1.  A physician who is qualified as a medical

director in accordance with the provisions of NAC

449.5505;

     2.  A registered nurse who:

     (a) Has at least 12 months of experience in

performing hemodialysis obtained within the 2 years immediately preceding the

date he or she begins instruction pursuant to the program; and

     (b) Has provided to the facility a current written

list concerning his or her knowledge and skills that is prepared pursuant to

the provisions of NAC 449.5745;

     3.  A registered nurse who provides

instruction for a course of training for a dialysis technician at an accredited

college or university; or

     4.  A licensed dietitian or social worker who

provides instruction within his or her area of expertise.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001;

A by R090-12, 12-20-2012)

      NAC 449.573  Program of training: Certain persons authorized to provide

instruction and serve as preceptor. (NRS 449.0302)  If a

licensed nurse or dialysis technician has at least 1 year of experience in

performing hemodialysis and has filed with the facility a current written list

concerning his or her knowledge and skills prepared in accordance with the

provisions of NAC 449.5745, the licensed nurse or

dialysis technician may:

     1.  Assist in providing instruction to a

dialysis technician at the facility; and

     2.  Serve as a preceptor at the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5735  Program of training: Required hours. (NRS 449.0302)

     1.  Except as otherwise provided in

subsection 2, each program of training specified in NAC

449.571 must consist of at least 80 hours of education in the classroom and

200 hours of directly supervised clinical training for each dialysis technician

who is enrolled in the program.

     2.  A program of training for a dialysis

technician who has experience in providing care directly to a patient of a

facility may consist of not less than 80 hours of combined education in the

classroom and clinical training if the dialysis technician demonstrates to the

satisfaction of the facility that he or she is competent to provide that care.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.574  Committee to review program of training. (NRS 449.0302)  Each

facility shall appoint a committee to review the training provided pursuant to

a program of training specified in NAC 449.571. The

membership of the committee must consist of at least the medical director,

supervising nurse and chief technician of the facility. The committee shall:

     1.  Review the records of each dialysis

technician enrolled in the program, including:

     (a) The results of each examination taken by the

dialysis technician pursuant to the provisions of NAC

449.571; and

     (b) Each written list concerning the knowledge and

skills of the dialysis technician prepared pursuant to the provisions of NAC 449.5745;

     2.  Receive and consider all comments

concerning the dialysis technician submitted to the committee by an instructor

or preceptor; and

     3.  Verify that the dialysis technician has

successfully completed the program of training.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5745  Written list concerning knowledge and skills. (NRS 449.0302)  The

supervising nurse or a registered nurse of a facility who qualifies as an

instructor for the facility shall complete a written list to determine the

knowledge and skills of each dialysis technician in performing the following

activities:

     1.  Assembling supplies required to provide

treatment to a patient of the facility;

     2.  Preparing dialysate according to

procedure and dialysis prescription;

     3.  Assembling and preparing the dialysis

extracorporeal circuit;

     4.  Securing the correct dialyzer for the

patient;

     5.  Installing and rinsing the dialyzer and

all required tubing for the dialyzer;

     6.  Testing monitors and alarms, conductivity

and, if applicable, testing for the presence or absence of residual sterilants;

     7.  Setting monitors and alarms in accordance

with the protocols of the facility and the instructions of the manufacturer of

the monitor or alarm;

     8.  Obtaining predialysis vital signs, weight

and temperature of a patient of the facility in accordance with the protocols

of the facility and, after obtaining that information, notifying the

supervising nurse or registered nurse of all unusual findings;

     9.  Inspecting the dialysis access of the

patient for patency and, after cannulation is performed and heparin is

administered, initiating dialysis in accordance with the patient’s

prescription, observing universal precautions and reporting all unusual

findings to the supervising nurse or registered nurse;

     10.  Adjusting the rate of the flow of blood

in accordance with the protocols of the facility and the prescription of the

patient;

     11.  Calculating and setting the dialysis

machine to allow the removal of fluid at a rate established in accordance with

the protocols of the facility and the prescription of the patient;

     12.  Monitoring the patient and equipment

during treatment, responding appropriately to the requirements of the patient

and to machine alarms, and reporting all unusual occurrences to the supervising

nurse or registered nurse;

     13.  Changing the rate of the removal of

fluid, placing the patient in the Trendelenburg position and administering

replacement normal saline as directed by:

     (a) The supervising nurse or registered nurse;

     (b) An order of a physician; or

     (c) The protocols of the facility;

     14.  Documenting all findings and actions in

accordance with the protocols of the facility;

     15.  Describing the appropriate response to:

     (a) Emergencies relating to dialysis, including,

without limitation, cardiac or respiratory arrest, needle displacement or

infiltration, clotting, blood leaks or air emboli; and

     (b) Nonmedical emergencies, including, without

limitation, power outages or equipment failures;

     16.  Discontinuing dialysis and establishing

hemostasis, including:

     (a) Inspecting, cleaning and dressing the dialysis

access of the patient in accordance with the protocols of the facility; and

     (b) Reporting all unusual findings or occurrences

to the supervising nurse or registered nurse;

     17.  Obtaining and recording the temperature,

weight and postdialysis vital signs of the patient and reporting all unusual

findings to the supervising nurse or registered nurse;

     18.  Discarding supplies and sanitizing the

equipment and treatment chair in accordance with the protocols of the facility;

     19.  Communicating all emotional, medical,

psychological or nutritional concerns of the patient to the supervising nurse

or registered nurse;

     20.  Obtaining current certification in

cardiopulmonary resuscitation; and

     21.  Maintaining professional conduct, good

communication skills and confidentiality concerning the care of the patients of

the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.576  Peritoneal dialysis: Additional activities required. (NRS 449.0302)  In

addition to the written list required pursuant to the provisions of NAC 449.5745, if a dialysis technician who is

enrolled in a course of training pursuant to the provisions of NAC 449.571 intends to provide training or treatment

for a patient of the facility who receives peritoneal dialysis, each of the

following activities must be completed satisfactorily by the dialysis technician:

     1.  Assisting patients in ordering supplies;

     2.  Performing an exchange of dialysate by

draining and refilling the peritoneal space with dialysate, including

procedures for conducting a continuous ambulatory peritoneal dialysis exchange

and the commencement or discontinuation of continuous cycling peritoneal

dialysis;

     3.  Observing peritoneal effluent;

     4.  Recognizing and understanding the

appropriate observations to report;

     5.  Collecting a specimen of dialysate;

     6.  Performing a change of transfer tubing;

and

     7.  Setting up and operating the equipment

required to conduct continuous cycling peritoneal dialysis.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5765  Cannulation or administration of normal saline or heparin:

Additional activities required. (NRS 449.0302)  In

addition to the written list required pursuant to the provisions of NAC 449.5745, if a dialysis technician who is

enrolled in a course of training pursuant to the provisions of NAC 449.571 intends to cannulate a dialysis access of

a patient of the facility or administer normal saline and heparin to that

patient, each of the following activities must be completed satisfactorily by

the dialysis technician:

     1.  Cannulation, including:

     (a) Inspecting the dialysis access of the patient

for patency;

     (b) Preparing the skin;

     (c) Using aseptic techniques;

     (d) Placing needles correctly;

     (e) Establishing blood access;

     (f) Replacing needles;

     (g) Recognizing the circumstances under which a

call for assistance may be required; and

     (h) Securing needles;

     2.  The administration of heparin, including:

     (a) Checking the prescription of the patient;

     (b) Preparing the dose;

     (c) Labeling the prepared syringe;

     (d) Administering the dose; and

     (e) Observing the patient for complications

experienced by the patient;

     3.  The administration of normal saline,

including:

     (a) Understanding unit protocol;

     (b) Checking the prescription of the patient;

     (c) Recognizing signs of hypertension experienced

by the patient;

     (d) Notifying the registered nurse;

     (e) Administering normal saline; and

     (f) Rechecking vital signs; and

     4.  The administration of lidocaine,

including:

     (a) Checking the prescription of the patient;

     (b) Identifying the correct vial of medication for

the patient;

     (c) Preparing the dose;

     (d) Administering the dose; and

     (e) Observing the patient for complications

experienced by the patient.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.577  Cannulation or administration of normal saline, heparin or

lidocaine: Verification and documentation of competency required. (NRS 449.0302)  If a

dialysis technician intends to cannulate a dialysis access during the treatment

of a patient of the facility or administer normal saline, heparin or lidocaine,

the medical director of the facility must, before the dialysis technician

performs those tasks at the facility, verify and document whether the dialysis

technician is competent to perform those activities.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5775  Documentation of successful completion of program of training;

employment by another facility. (NRS 449.0302)

     1.  A facility shall issue to each dialysis

technician who successfully completes a program of training and receives an

evaluation of his or her competency provided to him or her by the facility

pursuant to the provisions of NAC 449.5705 to 449.5775, inclusive, a document indicating that the

dialysis technician has successfully completed the program of training.

     2.  Each document issued pursuant to the

provisions of subsection 1 must include a statement indicating that the program

for which the document is issued satisfies the requirements of NAC 449.5705 to 449.5775,

inclusive.

     3.  A document issued pursuant to the

provisions of subsection 1 may be accepted by any other facility that employs

the dialysis technician. The document may be accepted only for 6 months after

the date on which the document is issued. If the dialysis technician is

employed by any other facility after that date, the dialysis technician shall

obtain from the facility that employs the dialysis technician a written list concerning

his or her knowledge and skills prepared in accordance with the provisions of NAC 449.5745.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.579  Patient care: Technicians must demonstrate certain knowledge and

competency. (NRS 449.0302)  A

dialysis technician who provides care directly to a patient of a facility must

demonstrate knowledge of and competency to carry out the responsibilities

specified in NAC 449.5705 to 449.5775, inclusive.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

      NAC 449.5795  Prohibited acts. (NRS 449.0302)  A

dialysis technician of a facility shall not:

     1.  Initiate the provision of education for

any patient of the facility;

     2.  Alter any treatment that is ordered for a

patient of the facility, including shortening the period for providing

treatment to the patient;

     3.  Administer any medication to a patient of

the facility other than the administration of normal saline, heparin or

lidocaine during the regular course of treatment for the patient;

     4.  Administer any blood or products of blood

to a patient of the facility;

     5.  Perform a venipuncture other than a

venipuncture at the point of access for dialysis;

     6.  Perform an arterial puncture; or

     7.  Accept the order of a physician.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)

PROVISION OF CERTAIN SPECIAL SERVICES

Obstetric Care

      NAC 449.6113  Definitions. (NRS 449.0302)  As used

in NAC 449.6113 to 449.61178,

inclusive, unless the context otherwise requires:

     1.  “Licensed advanced practice registered

nurse” means an advanced practice registered nurse who is licensed pursuant to chapter 632 of NRS and who has

specialized training in midwifery approved by the State Board of Nursing.

     2.  “Licensed physician” means a physician

licensed pursuant to chapter 630 or 633 of NRS.

     3.  “Maternal patient” means a woman admitted

to an obstetric center in accordance with NAC

449.61134 who has had a normal uncomplicated prenatal course, as determined

by adequate prenatal care, and the prospect for a normal, uncomplicated birth,

as defined by the criteria established by the American College of Obstetricians

and Gynecologists and by reasonable and generally accepted clinical standards

for maternal and fetal health.

     4.  “Obstetric care” means the care which is

provided, in accordance with NAC 449.6113 to 449.61178, inclusive, immediately before, during and

for not more than 24 hours after delivery to a maternal patient:

     (a) Who has completed at least 36 weeks of

gestation and not more than 42 weeks of gestation; and

     (b) Whose condition is reasonably expected to

result in a normal and uncomplicated vaginal birth.

     5.  “Obstetric center” has the meaning

ascribed to it in NRS 449.0155.

     (Added to NAC by Bd. of Health, eff. 7-19-96; A by R044-97,

10-30-97)

      NAC 449.61132  Authorized obstetric care. (NRS 449.0302)  Obstetric

care provided at an obstetric center must be limited to:

     1.  Care provided immediately before, during

and for not more than 24 hours after a vaginal birth to a maternal patient, if

the care provided to the maternal patient does not include general or regional

anesthesia; and

     2.  Assessment of a maternal patient before

the completion of 36 weeks of gestation, for preterm labor or premature rupture

of membranes and the initiation of appropriate treatment according to established

written protocols.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61134  Eligible maternal patients. (NRS 449.0302)  A woman

may be a maternal patient at an obstetric center if:

     1.  She has completed at least 36 weeks and

not more than 42 weeks of gestation;

     2.  She has no major medical problems;

     3.  She has no previous history of major

uterine wall surgery, cesarean section, or other obstetrical complications

which are likely to recur;

     4.  She has parity of under six unless a

justification for a variation is documented by the medical director for the

obstetric center;

     5.  She is not less than 15 years or more

than 40 years of age and is not a nullipara, unless the medical director has

reviewed the age and parity of the maternal patient and approves the admission

of the maternal patient on a case-by-case basis;

     6.  She has no significant signs or symptoms

of:

     (a) Pregnancy-induced hypertension;

     (b) Polyhydramnios or oligohydramnios;

     (c) Abruptio placenta;

     (d) Chorioamnionitis;

     (e) Multiple gestation;

     (f) Intrauterine growth retardation;

     (g) If there is fetal distress, amniotic fluid

which is stained with meconium;

     (h) Fetal distress;

     (i) Substance abuse;

     (j) Placenta previa;

     (k) Diabetes mellitus; or

     (l) Anemia;

     7.  While in active labor, she demonstrates

no significant signs or symptoms of:

     (a) Intrapartum hemorrhage;

     (b) Active Herpes Simplex II of the genitals; or

     (c) Malpresentation of the fetus including breech

presentation;

     8.  She is in labor and progressing normally

according to the established protocols of the obstetric center and the medical

staff of the obstetric center;

     9.  Her membranes were not ruptured more than

24 hours before her admission to the obstetric center;

     10.  She has no evidence of an infection;

     11.  Her pregnancy is appropriate for a

setting where analgesia is limited; and

     12.  Her pregnancy is appropriate for a

setting where anesthesia is limited to a local infiltration of the perineum or

a pudendal block.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61138  Denial of application for or renewal of license; revocation or

suspension of license. (NRS 449.0302)

     1.  An application for a license or the

renewal of a license may be denied if the facility, personnel or equipment

fails to meet the requirements of NAC 449.002 to 449.99939, inclusive, or if cause or circumstance

exists that may, in the opinion of the Division, threaten or have the potential

to threaten the safety or health of the public.

     2.  A license may be revoked or summarily

suspended in accordance with NAC 449.002 to 449.99939, inclusive, and chapters 233B and 449 of

NRS if the facility, personnel or equipment fails to meet the requirements of NAC 449.002 to 449.99939,

inclusive, or if cause or circumstance exists that may, in the opinion of the

Division, threaten or have the potential to threaten the safety or health of

the public.

     (Added to NAC by Bd. of Health, eff. 7-19-96; A by R044-97,

10-30-97)

      NAC 449.6114  Design, construction, equipment and maintenance of obstetric

center: General requirements; prerequisites to approval for licensure. (NRS 449.0302)

     1.  An obstetric center must be designed,

constructed, equipped and maintained in a manner that protects the health and

safety of the patients and personnel of the obstetric center and members of the

general public.

     2.  An obstetric center shall comply with all

applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without

limitation, zoning ordinances;

     (c) Environmental, health and local building codes;

and

     (d) Fire and safety codes, including, without

limitation, those codes relating to ingress and egress of occupants, placement

of smoke alarms, fire extinguishers or sprinkler systems, and fire escape

routes,

Ê related to

the construction and maintenance of the obstetric center. If there is a difference

between state and local requirements, the more stringent requirements apply.

     3.  Except as otherwise provided in

subsection 4, before any new construction of an obstetric center or any

remodeling of an existing obstetric center is begun, the obstetric center must

submit building plans for the new construction or remodeling to the entity

designated to review such plans by the Division pursuant to the provisions of NAC 449.0115. The entity’s review of those plans is

advisory only and does not constitute approval for the licensing of the

obstetric center. The Bureau shall not approve an obstetric center for

licensure until all construction is completed and a survey is conducted at the

site of the obstetric center.

     4.  An obstetric center is not required to

submit plans for remodeling to the entity designated to review such plans by

the Division pursuant to the provisions of NAC

449.0115 if the remodeling is limited to refurbishing an area within the

obstetric center, including, without limitation, painting the area, replacing

the flooring in the area, repairing windows in the area, and replacing window

or wall coverings in the area.

     (Added to NAC by Bd. of Health, eff. 7-19-96; A by R035-97,

10-30-97; R076-01, 10-18-2001; R072-04, 8-4-2004)

      NAC 449.61142  Required facilities and services.

(NRS 449.0302)

     1.  An obstetric center shall provide:

     (a) Services for labor, delivery, newborn and

recovery care for not more than 24 hours after delivery.

     (b) Areas for labor, delivery, newborn and recovery

which are in a safe and clean environment in accordance with all applicable

local, state and federal laws.

     (c) Areas for:

          (1) Maintenance and documentation of medical

records of each maternal patient by physicians and nurses;

          (2) Patient and family education;

          (3) Treatment and examination of a maternal

patient and newborn baby;

          (4) Cleaning and storage of instruments and

equipment which are located separately from the other areas of the obstetric

center;

          (5) Secure storage of drugs; and

          (6) Family visitation.

     (d) Simple nourishment for the maternal patient by

providing:

          (1) A separate area for appropriate storage of

food which may be provided to the maternal patient by her family; or

          (2) Food prepared by the obstetric center. If

food is prepared by the obstetric center, the obstetric center must comply with

all applicable local, state and federal laws relating to the preparation of

food by a medical facility.

     2.  An obstetric center must be equipped with

those items needed to provide low-risk obstetrical care without general

anesthesia and initial emergency procedures for life-threatening events to a

maternal patient and newborn baby, including, but not limited to:

     (a) Sterile supplies for delivering and caring for

a newborn baby;

     (b) Equipment for performing pelvic examinations;

     (c) Sphygmomanometers and stethoscopes, in adult

and infant sizes;

     (d) Fetoscopes, doppler and electronic fetal

monitors;

     (e) Supplies for measuring sugar and protein in

urine;

     (f) Needles and syringes;

     (g) Solutions and supplies for parenteral

administration of fluids;

     (h) Emergency drugs and equipment for the

resuscitation of an adult and a newborn baby;

     (i) Equipment for suctioning an airway, in

appropriate sizes for adults and newborn babies;

     (j) Protective gear for personnel of the obstetric

center who may be exposed to body fluids of the maternal patient and the

newborn baby;

     (k) Equipment or other approved methods for warming

solutions and blankets; and

     (l) Oxygen and apparatus for administering oxygen,

in appropriate sizes for adults and newborn babies.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61144  Required emergency electrical power. (NRS 449.0302)  An

obstetric center must have adequate emergency electrical power:

     1.  By procuring batteries or an

electricity-producing generator with sufficient fuel which is capable of

providing power for 2 hours or more to:

     (a) All lights in the obstetric center; and

     (b) All equipment in the obstetric center with the

exception of the wall outlets located in a reception or waiting area.

     2.  By having the source of emergency power

serviced on a regular basis and documenting that service in the records of

maintenance of the obstetric center.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61146  Requirements for birth room, toilet and bathing facilities,

hallways and doors, water supply and office-based facilities. (NRS 449.0302)

     1.  Each birth

room in an obstetric center must:

     (a) Be maintained in a condition which is adequate

and appropriate to provide for the equipment, staff, supplies and any emergency

procedures required during the period of labor, delivery and recovery for the

physical and emotional care of the maternal patient, any person accompanying

the maternal patient for support and the newborn baby;

     (b) Have at least 256 square feet with a minimum

room dimension of 16 feet;

     (c) Be located so as to provide unimpeded, rapid

access to an exit of the building which will accommodate emergency

transportation vehicles and equipment; and

     (d) Have facilities immediately available to the

birth room for the washing of hands.

     2.  The obstetric center shall provide toilet

and bathing facilities for use by a maternal patient, including:

     (a) A toilet and lavatory maintained in or adjacent

to the vicinity of the birth room; and

     (b) A shower which is clean and in good repair.

     3.  Hallways and doors which provide entry

into, exit from and access within the obstetric center and birth rooms must be

of adequate width and configuration to accommodate the maneuvering of a

stretcher from an ambulance, a wheelchair and other emergency equipment.

     4.  The obstetric center must have an

adequate supply of hot and cold running water under pressure for human

consumption and other purposes relating to the care of the maternal patient and

newborn baby.

     5.  If office-based prenatal or other health

care is provided at the obstetric center, the consultation and examining rooms

for that care must be separate from the birth rooms.

     (Added to NAC by Bd. of

Health, eff. 7-19-96; A by R072-04, 8-4-2004)

      NAC 449.61148  Governing body of obstetric center; duties. (NRS 449.0302)

     1.  Except as otherwise provided in NAC 449.6115, each obstetric center must have a

governing body that is chaired by a principal in the organization which is

operating the obstetric center or the licensee with legal authority for the

operation of the obstetric center.

     2.  The governing body shall ensure that:

     (a) Each maternal patient of the obstetric center

receives care from:

          (1) A licensed physician or a licensed

advanced practice registered nurse; and

          (2) A registered nurse licensed pursuant to chapter 632 of NRS who has 2 years or

more of experience in labor and delivery;

     (b) At least one licensed physician or licensed

advanced practice registered nurse, who is approved by the medical director of

the obstetric center to provide care at the obstetric center, is present at the

time of delivery;

     (c) At least one registered nurse licensed pursuant

to chapter 632 of NRS with 2 years of

documented experience in labor and delivery in a general or obstetrical hospital,

who is approved by the medical director to provide care at the obstetric

center, is on the premises during the time pre- and postdelivery care is

provided;

     (d) An annual operating budget and a plan for

capital expenditures for the obstetric center are established;

     (e) The obstetric center is adequately staffed and

equipped;

     (f) There is documentation in the files of the

obstetric center of the qualifications of each consultant under contract with

and each member of the staff employed by the obstetric center;

     (g) The obstetric center adopts, enforces and

annually reviews written policies and procedures, which must be approved by the

governing board, relating to the operation of and the provisions of care by the

obstetric center;

     (h) The obstetric center’s protocols for treatment,

assessments for risk status and criteria for the transfer of a maternal patient

or a newborn baby are approved by a licensed physician who is:

          (1) Currently certified by the American Board

of Obstetrics and Gynecology, or an equivalent organization; and

          (2) Currently practicing in the specialty of

obstetric care, including routinely delivering newborn babies and caring for

maternal patients;

     (i) A licensed physician who is currently certified

by the American Board of Obstetrics and Gynecology is readily available as a

consultant, in person or by telephone, during all hours of operation of the

obstetric center; and

     (j) The obstetric center files the appropriate

records of births and deaths.

     3.  The governing body shall establish a

policy for authentication that:

     (a) Authorizes the use of rubber stamps, except on

records documenting the medical care provided to a maternal patient and newborn

baby, and prohibits the use of any stamp by any person other than the person whose

signature the stamp represents;

     (b) Approves a method for identifying the person

making an entry in any record or chart; and

     (c) Requires that the entry include the

professional title of the person making the entry and the date and time that

entry is made.

     4.  The governing body shall appoint a person

to administer the obstetric center who is responsible for:

     (a) The daily operation of the obstetric center;

     (b) Reporting the pertinent activities concerning

the obstetric center to the governing body at regular intervals;

     (c) Appointing a person responsible for the

obstetric center in the absence of the person appointed by the governing board;

and

     (d) Planning for the services provided by the

obstetric center and the operation of the obstetric center.

     5.  The governing body shall ensure that the

obstetric center maintains insurance for:

     (a) Nonmedical liability in an amount of $50,000 or

more; and

     (b) Medical liability in an amount of $1,000,000 or

more.

     6.  The governing body shall require each medical

practitioner who practices in the obstetric center to carry liability insurance

in an amount of $1,000,000 or more.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.6115  Physician operator or advanced practice registered nurse operator

as licensee. (NRS 449.0302)

     1.  If the licensee is a physician operator

or an advanced practice registered nurse operator, the obstetric center

operated by the licensee is not required to have a governing body or an

administrator. In such a case, the licensee is responsible for complying with

the provisions of NAC 449.6113 to 449.61178, inclusive.

     2.  As used in this section:

     (a) “Advanced practice registered nurse operator”

means a licensed advanced practice registered nurse who is operating an

obstetric center for the purpose of delivering the babies of and providing

medical care to his or her own maternal patients.

     (b) “Physician operator” means a licensed physician

who is operating an obstetric center for the purpose of delivering the babies

of and providing medical care to his or her own maternal patients.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61152  Designation and responsibilities of medical director; privileges

of members of medical staff; provision of consultation services with

specialists. (NRS 449.0302)

     1.  An obstetric center shall designate a licensed

physician who is currently certified by the American Board of Obstetrics and

Gynecology, or an equivalent organization, and practicing obstetrics including

the delivery of newborn babies and providing care to maternal clients, to serve

as the medical director of the obstetric center. The medical director is

responsible for:

     (a) The development and implementation of policies

related to the care of a maternal patient;

     (b) The coordination of medical care at the

obstetric center; and

     (c) The development of, the maintenance of and the

assurance of compliance with a written plan to provide medical care in a

licensed medical facility that can provide a higher level of care to each

maternal patient and newborn baby under the care of the obstetric center when

the needs of the maternal patient or newborn baby exceed the capability of the

obstetric center.

     2.  The medical director is responsible for

the quality of medical care provided to each maternal patient and newborn baby

under the care of the obstetric center and for the review of the ethical and

professional practices of the medical staff, including, but not limited to:

     (a) The selection of members of the medical staff;

     (b) The delineation of the privileges accorded by

the obstetric center to members of the medical staff and members of allied

health professions who provide services at the obstetric center;

     (c) The reappraisal and appointment of each member

of the staff; and

     (d) The procedure to appeal the withdrawal or

denial of any privilege of a member of the staff.

     3.  A roster of the privileges of each member

of the medical staff of the obstetric center must be kept in the files of the

obstetric center specifying the privileges awarded to that member.

     4.  The obstetric center shall maintain and

document each agreement to provide consultation services which the obstetric

center enters into with a:

     (a) Physician certified by the American Board of

Obstetrics and Gynecology, or an equivalent organization; or

     (b) Physician certified by the American Board of

Pediatrics, or an equivalent organization,

Ê who has

admitting privileges in his or her specialty at an appropriate licensed medical

facility that can provide a higher level of care to a maternal patient or

newborn baby than the obstetric center can provide.

     5.  Each member of the medical staff of the

obstetric center must agree to abide by the rules of the obstetric center and NAC 449.6113 to 449.61178,

inclusive.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61154  Medical records: Maintenance; access. (NRS 449.0302)

     1.  An obstetric center shall maintain the

records for each maternal patient admitted for care in the obstetric center in

accordance with accepted professional practice.

     2.  Only authorized personnel may have access

to medical records of the obstetric center. Information contained in a medical

record of a maternal patient must not be released without the written consent

of the maternal patient or guardian except:

     (a) As required by law; or

     (b) As otherwise provided by the agreement on

admission.

     3.  A medical record must be in a format that

may be readily and legibly reproduced when needed or requested.

     4.  A licensee who ceases operation shall

notify the Division of the arrangements made for access to and the safe

preservation of medical records in the custody of the licensee.

     5.  Medical records must not be removed from

the obstetric center except upon the issuance of an order by a court of

competent jurisdiction.

     6.  A complete copy of the medical record for

each maternal patient transferred from the obstetric center must be sent with

the maternal patient to the facility receiving that patient.

     7.  The medical record of a maternal patient

discharged from the obstetric center must be completed within 20 days after the

date that the maternal patient is discharged from the obstetric center.

     8.  Each medical record must be protected

against loss, destruction and unauthorized use.

     9.  The medical record of a maternal patient

must be retained for 5 years or more after the date that the maternal patient

is discharged from the obstetric center.

     (Added to NAC by Bd. of Health, eff. 7-19-96; A by R044-97,

10-30-97)

      NAC 449.61156  Medical records: Contents. (NRS 449.0302)  The

medical record of a maternal patient which is on file with the obstetric center

must be completed, authenticated, accurate and current, and must include:

     1.  A complete identification of the maternal

patient including information about the next of kin of the patient and the

person or agency legally or financially responsible for the patient.

     2.  A statement concerning the admission and

diagnosis of the maternal patient.

     3.  The medical history of the maternal

patient.

     4.  Evidence of informed consent given for

the care of the maternal patient.

     5.  Any clinical observation of the maternal

patient, including, but not limited to, the notes of a physician, a nurse or

any other professional person in attendance.

     6.  A report of all prescribed tests and

examinations.

     7.  Confirmation of the original diagnosis,

or the diagnosis at the time of discharge.

     8.  A summary of discharge prepared in

accordance with the established policy of the obstetric center, and any

provisions made for continuing care or follow-up of the maternal patient after

discharge.

     9.  If the maternal patient has died while

under the care of the obstetric center, documentation of the death which must

be signed by the physician of record.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61158  Program for review of quality of care. (NRS 449.0302)  An

obstetric center shall establish a program for the review of the quality of

care provided by the obstetric center. The program must include, without

limitation:

     1.  Documentation in the medical records of

the maternal patient and newborn baby of the care provided as appropriate to

the condition of the maternal patient or newborn baby, and the results or

outcome of that care;

     2.  The time of admission and the time that

the maternal patient was examined by a licensed physician or a licensed advanced

practice registered nurse;

     3.  A statement which describes the condition

of the maternal patient at the time that the patient is discharged from the

obstetric center;

     4.  The instructions given to the maternal

patient upon discharge and documentation of the maternal patient’s

understanding of those instructions;

     5.  For each maternal patient and newborn

baby who is transferred to another hospital or medical facility, the reason for

the transfer, the method of transfer, the time that the transfer was requested

and the time that the maternal patient or newborn baby was discharged from the

obstetric center;

     6.  Documentation of any incident of unusual

occurrence or deviation from the usual standards of practice of patient care,

any error in the administration of medications, any intrapartum infection of

either maternal patient or newborn baby, and any morbidity or mortality; and

     7.  Documentation about the newborn babies

delivered at the obstetric center, including, but not limited to:

     (a) The number of deliveries;

     (b) Any birth weight of less than 2500 grams;

     (c) Any Apgar scores of newborn babies delivered at

the obstetric center which are less than 6 after 5 minutes;

     (d) Any congenital defect of a newborn baby; and

     (e) Any perinatal complication of a maternal client

or newborn baby.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.6116  Miscellaneous requirements concerning staff, provision of service

and equipment. (NRS 449.0302)  An

obstetric center must:

     1.  Have on the premises at least one

registered nurse licensed pursuant to chapter

632 of NRS with experience in perinatal care of a maternal patient and

newborn baby when a maternal patient is on the premises receiving pre- and

postdelivery care;

     2.  Have at least two attendants present at

all times during each delivery, one of whom must be a licensed physician or a

licensed advanced practice registered nurse;

     3.  Have the capacity of providing initial

evaluation of risk status, appropriateness of admission and support of maternal

patients in labor;

     4.  Maintain on-site equipment, drugs, oxygen

and appropriately trained and educated personnel needed to provide obstetric

care to a maternal patient and newborn baby;

     5.  Have appropriate clinical laboratory

services available for use to provide safe obstetric care according to the

needs of the maternal patient and medical staff of the obstetric center; and

     6.  Have at least two persons who are trained

and experienced in performing cardiopulmonary resuscitation in adults and

newborn babies on the premises and immediately available during each delivery.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61162  Requirements for transfer or discharge of patient. (NRS 449.0302)

     1.  A maternal patient or newborn baby, as

appropriate, may not be transferred from an obstetric center unless the

transfer is appropriate based on the risk assessment of the maternal patient or

newborn baby and the member of the medical staff determines that:

     (a) The maternal patient is at high risk for a

complicated labor or delivery and does not meet the criteria for a low-risk,

uncomplicated labor and delivery; or

     (b) The medical needs of the maternal patient or

newborn baby exceed the capability of the obstetric center to provide the

necessary care.

     2.  A maternal patient or newborn baby, as

appropriate, may not be discharged from the obstetric center unless the

discharge is appropriate based on the risk assessment of the maternal patient

or newborn baby and a member of the medical staff determines that:

     (a) If the maternal patient has not given birth,

the maternal patient is not in active labor; or

     (b) The maternal patient has had a normal low-risk,

uncomplicated birth and that further medical problems or complications

resulting from the birth are not anticipated.

     3.  The criteria for the transfer of a

maternal patient or newborn baby must be written and included in the manual for

the policy and procedure of the obstetric center.

     4.  If a maternal patient or newborn baby

must be transferred, the maternal patient or newborn baby must be transferred

to a hospital or other medical facility which is capable of providing a higher

level of obstetrical and neonatal care and with which the obstetric center has

a written agreement that acknowledges that the hospital or medical facility

agrees to accept emergency maternal patients without regard to their ability to

pay.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61164  Written protocol for discharge of patient. (NRS 449.0302)  An

obstetric center shall establish written protocols for the discharge of a

maternal patient from the obstetric center which must include, without

limitation:

     1.  Instructions to the maternal patient

regarding care and feeding of the newborn baby.

     2.  Examination of the maternal patient and

newborn baby after discharge from the obstetric center.

     3.  Instructions regarding the availability

of consultation services by telephone as needed or desired by the maternal

patient.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61166  Policies and procedures for control of infectious agents and

diseases; program to monitor health of employees. (NRS 449.0302)

     1.  The obstetric center shall establish such

policies and procedures as are necessary for the control of infectious agents

and disease. The policies and procedures must:

     (a) Include a method of disposal, cleaning and

treatment of equipment, linens, and supplies contaminated with blood or bodily

fluids; and

     (b) Be in conformance with universal precautions

established by the Centers for Disease Control and Prevention and with all

applicable local, state and federal laws.

     2.  The obstetric center shall establish a

program to monitor the health of each employee of the obstetric center. The

program must include, but not be limited to:

     (a) Annual testing for tuberculosis; and

     (b) Documentation as to whether the employee has

had:

          (1) Rubella and, if so, when the employee had

rubella.

          (2) A vaccination for rubella and, if so, when

the employee had the vaccination.

     3.  A copy of the precautions established by

the Centers for Disease Control and Prevention of the United States Department

of Health and Human Services may be obtained for a cost of $46, plus shipping

and handling, from:

 

The National Technical

Information Service of the

Centers for Disease

Control and Prevention

Research Department

5285 Port Royal Road

Springfield, Virginia

22161

Reference No.

PB86133022

(703) 487-4870

 

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61168  Laboratory services; transfer of maternal patient who needs blood

or blood products. (NRS 449.0302)

     1.  An obstetric center must maintain or have

available adequate laboratory services to meet the needs of its maternal

patients, newborn babies and medical staff. The obstetric center shall ensure

that all laboratory services provided to its maternal patients and newborn

babies are provided by a medical laboratory licensed pursuant to chapter 652 of NRS.

     2.  Laboratory services must be available

during all hours of operation of the obstetric center as necessary to meet the

needs of the maternal patients, newborn babies and medical staff.

     3.  If work is performed by an outside

laboratory, the original report must be from a laboratory licensed pursuant to chapter 652 of NRS and contained in the

medical record of the maternal patient. If services are provided by an outside

laboratory, the conditions, procedures and availability of work performed must

be in writing and available within the obstetric center.

     4.  Upon the receipt of a laboratory report,

an obstetric center shall promptly:

     (a) File a laboratory report in the appropriate

medical record; and

     (b) Notify the physician or advanced practice

registered nurse who requested the report that the report has been received and

filed in the medical record of the maternal patient.

     5.  A report of a tissue specimen must be

signed by a pathologist. The medical staff of the obstetric center and a

pathologist must determine whether a tissue specimen requires a macroscopic

examination, or a macroscopic and microscopic examination.

     6.  If a maternal patient needs blood or

blood products, the maternal patient must be transferred to a licensed hospital

which has the capability of providing perinatal services.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.6117  Possession, distribution, administration and storage of drugs and

controlled substances. (NRS 449.0302)

     1.  An obstetric center shall ensure that

drugs and controlled substances are possessed, distributed and administered by

members of the medical staff in the obstetric center in conformance with all

applicable federal, state and local laws.

     2.  All drugs and controlled substances

distributed at an obstetric center must be possessed and distributed by a

licensed physician or a licensed advanced practice registered nurse in

accordance with his or her registration from the State Board of Pharmacy and

the Drug Enforcement Administration of the Department of Justice. The licensed

physician or licensed advanced practice registered nurse shall establish and

maintain a list of drugs and controlled substances which are available for use

by the licensed physician or licensed advanced practice registered nurse for

maternal patients and newborn babies in the obstetric center.

     3.  An obstetric center shall establish a

policy to ensure quality control and dispensing of drugs and controlled

substances. The obstetric center must have a specific area for storing the

drugs and controlled substances which include, without limitation, locked

storage for drugs, double-locked storage for controlled substances and locked

refrigerated storage. A facility for washing hands must be provided near the

area in which the drugs and controlled substances are to be distributed.

     4.  A drug or controlled substance may not be

administered at an obstetric center without an order from a licensed physician

or a licensed advanced practice registered nurse. An order for the

administration of a drug or controlled substance must be entered into the

medical record of the maternal patient and be signed by the physician or

advanced practice registered nurse who made the order. The order must include

the name of the drug, dosage, time or frequency of administration, and if other

than oral, the route of administration.

     5.  The obstetric center shall provide a

separate refrigerator for the storage of drugs and controlled substances. The

temperature in the refrigerator must be maintained between 36 degrees

Fahrenheit, or 2 degrees Centigrade, and 46 degrees Fahrenheit, or 8 degrees

Centigrade. The temperature of the room in which the drugs and controlled

substances that are not refrigerated are stored must not exceed 86 degrees

Fahrenheit, or 30 degrees Centigrade.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61172  Anesthesia. (NRS 449.0302)

     1.  An obstetric center may have the

capability of providing anesthesia limited to local anesthesia for pudendal

blocks and episiotomy repair.

     2.  A local anesthetic may be administered

only by a licensed physician or a licensed advanced practice registered nurse.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61174  Transfer of patient to hospital or medical facility licensed to

provide high-risk perinatal care. (NRS 449.0302)

     1.  An obstetric center must have a written

agreement with at least:

     (a) One hospital or medical facility licensed to

provide high-risk perinatal care; and

     (b) One transportation service which can provide a

vehicle with equipment appropriate to the needs of a maternal patient or

newborn baby during a transfer for the obstetric center,

Ê that assures

the expedient transfer of a maternal patient or newborn baby in accordance to

established written protocols of the obstetric center when a maternal patient

or newborn baby requires care beyond the capability of the obstetric center or

a maternal patient is deemed to have a condition or the potential for such a

condition that would result in an abnormal or complicated delivery.

     2.  The medical director of the obstetric

center shall:

     (a) Determine the criteria and conditions under

which a maternal patient or newborn baby should be considered for transfer. The

criteria and conditions must be included in the written policy and procedures

for the obstetric center.

     (b) Annually review those criteria and conditions.

     3.  An obstetric center must establish

written procedures to determine the level of care and the mode of

transportation required to ensure that the maternal patient and newborn baby

receive expeditious and safe care appropriate to the needs of the maternal

patient or newborn baby during the transfer.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61176  Death of patient; notification of Division; provision of

counseling. (NRS 449.0302)

     1.  An obstetric center shall notify the

Division of the death of any maternal patient or newborn baby which occurs at

the obstetric center. The notification must be made not later than 24 hours

after the death of a maternal patient or newborn baby.

     2.  An obstetric center shall establish a

process pursuant to which appropriate counseling will be provided to staff of

the obstetric center, a maternal patient and the family of a maternal patient

when a death occurs within the obstetric center.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

      NAC 449.61178  Required information to be provided or made available to patient;

complaints. (NRS 449.0302)

     1.  The obstetric center shall take such

action as is necessary to inform the maternal patient, both orally and in

writing, in language which the maternal patient understands, of the rights of

the maternal patient as listed in NRS

449.700, 449.710 and 449.720, risks, alternatives of

care and benefits in using the obstetric center.

     2.  The maternal patient has a right to be

fully informed in a language the maternal patient understands about her health

status, her medical conditions, the health status of her baby, and the

existence of any known complications or risks.

     3.  A maternal patient may inspect her

medical record, or any portion of the record, and, upon request, purchase

standard photocopies of the record at a cost not to exceed 60 cents per page.

     4.  An obstetric center shall provide, within

its written policies, a procedure for the registration of complaints by the

maternal patient without threat of discrimination or reprisal. A complaint may

include, but is not limited to, a grievance concerning the treatment that was

received by the maternal patient and a grievance concerning treatment that was

not provided.

     5.  The obstetric center must inform the

maternal patient that she has the right to file a complaint relating to the

care which the patient receives from the obstetric center with:

     (a) The Division;

     (b) The Board of Medical Examiners; and

     (c) The State Board of Nursing.

     6.  The obstetric center shall provide the

maternal patient with names, addresses and telephone numbers of the agencies

listed in subsection 5.

     (Added to NAC by Bd. of Health, eff. 7-19-96)

Open-Heart Surgery

      NAC 449.612  Definitions. (NRS 449.0302)  As used

in NAC 449.612 to 449.61256,

inclusive, unless the context otherwise requires, the words and terms defined

in NAC 449.612011 to 449.612017,

inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A 8-1-91;

R107-98, 3-18-99)

      NAC 449.612011  “Approval” defined. (NRS 449.0302)  “Approval”

means the approval granted by the Division to a hospital authorizing the

hospital to perform open-heart surgery.

     (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

      NAC 449.612012  “Approved hospital” defined. (NRS 449.0302)  “Approved

hospital” means a hospital that has obtained approval from the Division to

perform open-heart surgery.

     (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

      NAC 449.612014  “Cardiac surgery” defined. (NRS 449.0302)  “Cardiac

surgery” means an operation performed on the heart or on the blood vessels

connected to the heart in which access to the area of interest is provided by

means of an incision in the wall of the thorax or for which the use of a

heart-lung bypass machine is required.

     (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

      NAC 449.612017  “Open-heart surgery” defined. (NRS 449.0302)  “Open-heart

surgery” means any cardiac surgery requiring the use of a heart-lung bypass

machine.

     (Added to NAC by Bd. of Health by R107-98, eff. 3-18-99)

      NAC 449.61202  Prerequisites to initial provision of service. (NRS 449.0302)  A

hospital that desires to provide a new service for the performance of

open-heart surgery must make application to the Division requesting approval of

the service. A hospital shall not provide such a service until the Division has

given its approval in writing.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61204  Form and contents of application for approval to provide service. (NRS 449.0302)

     1.  The application for approval must include

a statement describing:

     (a) The qualifications of the personnel of the

hospital to perform open-heart surgery;

     (b) The facilities and equipment to be used in

performing open-heart surgery; and

     (c) The manner in which the facilities and

personnel of the hospital meet or exceed the requirements of NAC 449.612 to 449.61256,

inclusive.

     2.  The application must contain a statement

by the chief of cardiac service for the hospital that the hospital has the

facilities, equipment, personnel, staffing, policies and procedures required to

perform surgeries at or above the rate required by NAC

449.61214.

     3.  The application must contain a statement

by the chief operating officer of the hospital that the hospital is committed

to maintaining the support personnel and equipment required to perform

surgeries at or above the rate required by NAC

449.61214.

     4.  The application must indicate whether the

hospital will, if its application is approved, perform open-heart surgery on

infants or children.

     5.  The Division shall prescribe a uniform

form of application.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.61206  Notification of applicant upon review of application; site

inspection required. (NRS 449.0302)

     1.  Within 10 days after it receives an

application for approval from a hospital, the Division shall notify the

hospital, in writing, whether the application is complete. If the application

is incomplete, the Division shall inform the applicant which parts of the

application are deficient. If the application is complete, the Division shall

notify the applicant of the composition of the site inspection team, the date

of the team’s visit to the site and the scheduled date for the team to present

its findings to the Division. The Division shall notify the applicant of any

changes in this timetable as they occur.

     2.  The application must not be approved by

the Division until the findings of the site inspection team verify that the

hospital complies with the requirements of NAC 449.612

to 449.61256, inclusive.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61208  Composition and duties of site inspection team. (NRS 449.0302)  The site

inspection team:

     1.  Must be composed of:

     (a) A cardiothoracic surgeon;

     (b) A cardiologist;

     (c) A cardiac intensive care nurse;

     (d) An administrator of a hospital at which

open-heart surgery is currently performed;

     (e) A surveyor of health facilities from the

Division; and

     (f) If the hospital indicated in its application

that it would perform open-heart surgery on infants or children, a pediatric

cardiologist.

     2.  Shall review the service of the hospital

for open-heart surgery and make findings concerning:

     (a) The adequacy of the equipment of the hospital

for use in such surgery.

     (b) Whether the personnel of the hospital meet the

requirements of NAC 449.612 to 449.61256, inclusive.

     (c) The adequacy of the size of the staff available

to perform open-heart surgery at the hospital.

     (d) The adequacy and appropriateness of the

policies and procedures adopted by the hospital relating to the service.

     (e) Whether the hospital has sufficient facilities,

staff and equipment to perform open-heart surgeries at the rate required by NAC 449.61214.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.6121  Hospital to pay costs of inspection. (NRS 449.0302)  The

costs incurred in connection with any inspection required by the provisions of NAC 449.612 to 449.61256,

inclusive, must be paid by the hospital affected.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61212  Approval or denial of application; period of validity of

approval; cessation of performance of surgeries. (NRS 449.0302)

     1.  Within 15 working days after it receives

the findings of the site inspection team, the Division shall approve or notify

the hospital of its intention to disapprove the application.

     2.  An approval issued pursuant to this

section is valid until it is revoked or suspended pursuant to NAC 449.61256.

     3.  A hospital that ceases to perform

open-heart surgeries shall notify the Division in writing within 30 days after

the last surgery is performed. If a hospital has notified the Division in

writing that it is ceasing to perform open-heart surgeries and subsequently

decides that it desires to begin performing open-heart surgery again, it must

reapply for approval pursuant to the provisions of NAC 449.612

to 449.61256, inclusive.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.61214  Amount of surgery required following approval. (NRS 449.0302)  After

approval of a service for open-heart surgery is granted, such surgeries must be

performed in an approved hospital at the following rates:

     1.  Not less than 80 operations during the

first 12 months after approval.

     2.  Not less than 150 operations during the

second 12-month period after approval.

     3.  Not less than 200 operations during the

third and each succeeding 12-month period after approval.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61216  Provision of patient with preoperative instruction. (NRS 449.0302)  On

specific orders from the patient’s physician, a cardiac surgical nurse shall

provide each nonemergent cardiac surgical patient with preoperative instruction

concerning the proposed surgical procedure and the general course of his or her

treatment.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61218  Surgical team: Composition; privileges and qualifications of

members; participation of qualified nurses. (NRS 449.0302)

     1.  A surgical team assigned to each

open-heart surgery at an approved hospital must be composed of a cardiovascular

surgeon who will be the primary surgeon and at least one other person chosen by

the primary surgeon who must be a:

     (a) Cardiovascular surgeon;

     (b) Vascular surgeon;

     (c) General surgeon;

     (d) Person who is authorized by the medical staff

of the approved hospital to assist in such surgeries; or

     (e) A senior surgical resident who is enrolled in a

medical training program accredited by the Accreditation Council for Graduate

Medical Education.

     2.  The primary surgeon must be certified or

eligible for certification by the American Board of Thoracic Surgery.

     3.  A person who is authorized to assist in

the surgery pursuant to paragraph (d) of subsection 1 must be accorded the

privileges of a member of the allied health professions by the medical staff of

the approved hospital. The medical staff shall:

     (a) Establish criteria for authorizing persons to

assist in open-heart surgery that are consistent with current professional

standards; and

     (b) Reevaluate those criteria at least once every 2

years.

     4.  A team of open-heart surgical nurses

whose training has been verified by the head nurse shall participate in each

operation.

     5.  As used in this section, “medical staff”

means the medical staff organized by an approved hospital pursuant to NAC 449.358.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.6122  Qualifications of anesthesiologist. (NRS 449.0302)  Anesthesia

during open-heart surgery at an approved hospital must be administered by an anesthesiologist

who:

     1.  Is certified by or who is eligible for

certification by the American Board of Anesthesiologists; and

     2.  Has special training or experience in the

administration of anesthesia in open-heart surgery.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61222  Qualifications of nurse in charge of service. (NRS 449.0302)  The

registered nurse in charge of the service for open-heart surgery at an approved

hospital must:

     1.  Have not less than 2 years of operating

room nursing experience and not less than 1 year of current experience in

open-heart surgery; and

     2.  Be permanently assigned to that service.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61224  Perfusion team: Use required; qualifications; approval of members

by surgeon of record. (NRS 449.0302)

     1.  An approved hospital shall use a

perfusion team, which must include a senior perfusionist who is responsible for

the supervision of all perfusion services provided by the team.

     2.  The senior perfusionist must be certified

by the American Board of Cardiovascular Perfusionists. The other perfusionists

of the heart-lung bypass machine must be certified or eligible for

certification by the Board.

     3.  The senior perfusionist and the other

perfusionists must:

     (a) Be trained in:

          (1) Aseptic techniques required in an

operating room;

          (2) Perfusion physiology; and

          (3) The use of monitoring equipment; and

     (b) Have a general understanding of commonly

performed cardiac surgical procedures.

     4.  The cardiac surgeon of record shall

approve each perfusionist involved with the surgeon’s patients as being

competent to operate the heart-lung bypass machine properly before allowing

that person to operate the machine during open-heart surgery.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61226  Operating rooms: General requirements. (NRS 449.0302)

     1.  An approved hospital shall maintain two

fully equipped operating rooms, one dedicated to and another available for

services for open-heart surgery. Each operating room must have a minimum

clearance of 400 square feet, exclusive of fixed cabinets and built-in shelves.

Entry to the operating rooms must be limited to persons participating in the

service.

     2.  The ventilation and temperature control

systems of each operating room must be able to provide a minimum of 15 air

changes per hour in the operating room and maintain the air temperature between

70°F and 75°F, with a relative humidity between 50 and 60 percent.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61228  Operating rooms: Equipment and staff. (NRS 449.0302)

     1.  Each operating room designated or

available for open-heart surgery must be equipped with:

     (a) A heart-lung bypass machine.

     (b) Proper suction and plumbing outlets for heat

exchangers for the heart-lung bypass machine.

     (c) An adequate supply of electrical power,

including, without limitation, standby emergency electrical power.

     (d) Surgical instruments.

     (e) A device to conserve blood.

     (f) An electronic warmer for blood.

     (g) Monitors to review the electrocardiogram and

the pressure in two channels of blood flow.

     (h) Operating lights which are sufficiently bright

to illuminate the inside of body cavities and sufficiently maneuverable to

illuminate two operating fields on a patient simultaneously.

     (i) A defibrillating apparatus.

     2.  The operating room must have available:

     (a) A complete set of pump oxygenator equipment.

     (b) Facilities and appropriate support personnel

for the use of an intra-aortic balloon.

     3.  Each operating room designated for

open-heart surgery must be provided with the number of surgical nurses,

technicians and ancillary personnel needed to staff the equipment and stations

required in performing general surgical operations.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.6123  Intensive care facility: General requirements. (NRS 449.0302)

     1.  An approved hospital shall maintain an

intensive care facility within the hospital. The facility must:

     (a) Have accommodations which can isolate patients;

     (b) Have a sufficient system for controlling

temperature to maintain comfortable conditions for the patients and members of

the hospital’s staff; and

     (c) Be equipped to provide continuous

electrocardiographic monitoring of each patient in the facility.

     2.  Each bed in the intensive care facility

must be equipped with:

     (a) Outlets for suction and oxygen; and

     (b) Adequate lighting for illuminating minor

surgical procedures.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61232  Intensive care facility: Staff. (NRS 449.0302)

     1.  The administration of intensive care

units in an approved hospital for patients recovering from or awaiting

open-heart surgery must be under the direction of a qualified physician

approved by the cardiac surgeon.

     2.  A nursing supervisor must be permanently

assigned to the intensive care units designated for cardiac surgery patients.

The supervisor must have not less than 2 years of experience in intensive care

nursing and not less than 1 year of current experience in intensive care

nursing of patients recovering from open-heart surgery.

     3.  The nursing supervisor and the surgical

team shall:

     (a) Provide organized training and continuing

in-service education to each nurse; and

     (b) Determine that each nurse is qualified to

perform services related to postcardiac surgery,

Ê before

assigning the nurse without direct supervision to full-time or periodic duty in

the intensive care units.

     4.  One nurse on each shift must be

designated as the nurse in charge for the intensive care units. There must be

one nurse for not more than two cardiac surgery patients in the intensive care

units for the first 24 hours after surgery.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61234  Intensive care facility: Equipment and supplies. (NRS 449.0302)

     1.  The following equipment must be

immediately available to the intensive care facility:

     (a) A laryngoscope.

     (b) Endotracheal tubes.

     (c) Respirators.

     (d) Hypothermia equipment.

     (e) Tracheostomy sets.

     (f) Thoracotomy sets.

     (g) A board for massaging a closed chest.

     (h) An external pacemaker.

     (i) An external defibrillator.

     (j) Respiratory support equipment.

     (k) Intravenous drip counters.

     (l) An intravenous diffusion pump.

     (m) Equipment which can remotely monitor, record

and play back electrocardiographs and count extra systole pulses.

     (n) An open-heart set with sternal spreader, staple

remover, internal defibrillatory paddles, wire cutters and sufficient sutures

and clamps.

     (o) An intra-aortic balloon pump.

     (p) An ambu bag.

     2.  There must be a supply of appropriate

medicines stored within the intensive care facility.

     3.  Tele-transmitters and electronic rate

counters must be used for patients with heart pacemakers while they are in the

intensive care facility.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61236  Orientation and continuing education of personnel. (NRS 449.0302)  An

approved hospital shall provide, under the direction of the cardiac surgeon, an

orientation program and a program of continuing education for surgical nurses,

technicians and any personnel who participate in the service for open-heart

surgery.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61238  Maintenance of blood bank. (NRS 449.0302)  An

approved hospital shall maintain a blood bank which operates 24 hours a day

under the direction of qualified specialists. These persons must be able to

supply blood and blood derivatives to surgical teams assigned to open-heart

surgery.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.6124  Maintenance of cardiac catheterization laboratory. (NRS 449.0302)

     1.  An approved hospital shall maintain a

cardiac catheterization laboratory which operates 24 hours a day under the

direction of a qualified specialist.

     2.  The laboratory must be located in the

hospital and must have sufficient equipment to perform:

     (a) Hemodynamic studies;

     (b) Preoperative elective studies;

     (c) Postoperative elective studies; and

     (d) Emergency procedures.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61242  Maintenance of medical laboratory. (NRS 449.0302)  An

approved hospital shall maintain a medical laboratory which operates 24 hours a

day. The laboratory must have sufficient equipment to:

     1.  Perform standard laboratory tests;

     2.  Make pH determinations; and

     3.  Analyze samples for blood-gas and

electrolytes.

     (Added to NAC by Bd. of

Health, eff. 8-31-89)

      NAC 449.61244  Maintenance of facilities to perform contrast studies and

equipment to review films of operations. (NRS 449.0302)  An

approved hospital shall maintain:

     1.  Facilities in which contrast studies of

the cardiovascular system may be performed.

     2.  Film projectors and a proper filing

system so that surgeons may review films of cardiac catheterization operations

at any time.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61246  Maintenance of registry to record results for each patient. (NRS 449.0302)  A

registry must be maintained at an approved hospital and used for recording the

results of open-heart surgery for each patient. This registry must include or

indicate, for each such patient:

     1.  The patient’s patient identification

number.

     2.  The patient’s race.

     3.  The patient’s age.

     4.  The patient’s sex.

     5.  Any history of hypertension, smoking,

diabetes mellitus, cerebrovascular disease, coronary bypass, myocardial

infarction, chronic obstructive pulmonary disease or renal disease.

     6.  The period during which the surgery is

performed.

     7.  The period during which the heart-lung

bypass machine is used.

     8.  The period during which a crossclamp is

in place.

     9.  The patient’s ASA acquity classification.

     10.  The patient’s New York Heart Association

functional classification.

     11.  A record of any angioplasty performed or

thrombolytic therapy.

     12.  A record of any use of an intra-aortic

balloon pump.

     13.  Whether the patient is an elective,

emergency or transfer case.

     14.  The number of days he or she is

intubated.

     15.  The number of days he or she is in the

cardiac surgery unit.

     16.  The length of the patient’s hospital

stay.

     17.  The location to which he or she is

discharged.

     18.  A record of his or her 30-day follow-up

examination.

     19.  A record of his or her ventricular

function (ejection fraction).

     20.  The description of the surgical

procedure and, if applicable, the number of vessels involved and the type of

graft (mammary or saphenous).

     21.  A record of any complications,

including:

     (a) Additional surgery for bleeding;

     (b) Peri-operative myocardial infarction;

     (c) Infections of the sternum, leg or intra-aortic

balloon pump site; or

     (d) Stroke.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61248  Maintenance of program to follow recovery of patient. (NRS 449.0302)  An

approved hospital shall maintain a comprehensive program for following the

recovery and progress of the patient toward his or her optimum condition of

health. The condition of the patient must be assessed after discharge from the

hospital by the surgeon or his or her designee.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.6125  Annual review and inspection of hospital. (NRS 449.0302)  Unless

the hospital has notified the Division that it has ceased to perform open-heart

surgeries, a surveyor of health facilities from the Division shall review each

approved hospital annually to verify that the hospital is complying with the

provisions of NAC 449.612 to 449.61256, inclusive.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.61252  Annual inspection of hospital: Assessment of rate of mortality. (NRS 449.0302)

     1.  As a part of the annual inspection of

each approved hospital, the Division shall perform a detailed review of the

patient files relating to all mortalities at the hospital.

     2.  In assessing whether a hospital’s

adjusted rate of mortality is acceptable for the purposes of NAC 449.612 to 449.61256,

inclusive, the inspection team shall fully consider, among other things, the

age and sex of the patient, the acuity of the patient’s illness and the information

contained in the registry maintained pursuant to NAC

449.61246.

     3.  As used in this section, “mortality”

means the death of any patient who dies within 30 days after undergoing

open-heart surgery.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61254  Further review or on-site inspection for failure to comply with

provisions or for excessive rate of mortality; notice; plan for compliance. (NRS 449.0302)

     1.  If the review conducted pursuant to NAC 449.6125 discloses that the hospital is not in

full compliance with the provisions of NAC 449.612

to 449.61256, inclusive, or if a facility’s

adjusted rate of mortality, after considering the factors enumerated in NAC 449.61252, is considered excessive, the Division

may, at the expense of the hospital, require:

     (a) A second review; or

     (b) An on-site inspection,

Ê conducted by

one or more of the persons specified in NAC 449.61208.

When the Division has completed its final review or inspection pursuant to this

subsection, it shall notify the hospital in writing of the violations and the

recommendations for improvements in the hospital’s service made by the person

or persons who conducted the review or inspection pursuant to this subsection.

     2.  Within 30 days after it receives the

notice, the hospital shall reply to the Division in writing, indicating the

measures to be taken to achieve compliance with the provisions of NAC 449.612 to 449.61256,

inclusive, and to carry into effect the recommendations made by the person or

persons who conducted the review or inspection pursuant to subsection 1.

     3.  If the Division determines that the

hospital’s plan is satisfactory, all of the corrective actions proposed by the

hospital must be completed within 90 days after the Division has received the

plan. After that time, the Division may require another review of the hospital

pursuant to NAC 449.6125 or a review or inspection

conducted pursuant to subsection 1 of this section.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R107-98,

3-18-99)

      NAC 449.61256  Denial, suspension or revocation of approval: Grounds; hearing. (NRS 449.0302)

     1.  The Division may deny, suspend or revoke

its approval because of the failure of the hospital affected to comply with any

provision of NAC 449.612 to 449.61256, inclusive.

     2.  The Division shall advise the hospital

affected in writing whenever it intends:

     (a) To deny an application for approval or for

renewal of approval;

     (b) To revoke approval; or

     (c) To order a hospital to cease and desist

providing services for open-heart surgery.

     3.  The hospital affected may request a

hearing on the proposed action of the Division. The hearing must be conducted

in accordance with the procedures set forth in NAC 439.300 to 439.395, inclusive.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R044-97,

10-30-97)

Transplantation of Organs

      NAC 449.6126  Definitions. (NRS 449.0302)  As used

in NAC 449.6126 to 449.6127,

inclusive, unless the context otherwise requires:

     1.  “Approval” means the approval granted by

the Division to a hospital authorizing it to provide a service for the

transplantation of organs.

     2.  “Transplantation of organs” means the

implantation of one or more organs from the body of a human being into the body

of another as a substitute for one or more abnormally functioning organs of the

recipient.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A 8-1-91)

      NAC 449.61262  Application for approval to provide services. (NRS 449.0302)  An

application for approval submitted pursuant to NRS 449.087 must include:

     1.  A statement of the kinds of organs that

are to be transplanted;

     2.  Proof that the hospital is a member of

the United Network for Organ Sharing;

     3.  A letter of commitment from the hospital

to accept all patients eligible for the service;

     4.  A statement signed by the chief operating

officer of the hospital that the hospital is committed to providing a service

for the transplantation of organs and that an adequate budget will be

maintained to ensure that the service is provided continuously for not less

than 3 years;

     5.  A statement signed by the administrator

of the hospital that:

     (a) The hospital will, in testing for

histocompatibility in connection with the service, use a laboratory accredited

by the American Society for Histocompatibility and Immunogenetics; and

     (b) The hospital maintains letters of agreement or

contracts with one or more members of the Association of Organ Procurement

Organizations or hospital-based organizations for the procurement of organs

that comply with the standards of ethics and criteria for membership adopted by

the Association of Organ Procurement Organizations, except that the hospital is

not required to be a nonprofit institution; and

     6.  If approval for the service is required

by NRS 439A.100, a copy of the

letter of approval from the Director of the Department of Health and Human

Services.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61264  Evaluation of application for approval. (NRS 449.0302)

     1.  The Division will evaluate the

application to determine whether it conforms with the requirements of NAC 449.6126 to 449.6127,

inclusive. If the Division finds that the application is incomplete, it will

inform the applicant which parts of the application are deficient.

     2.  If the application is found to be

complete and in compliance with the provisions of NAC

449.6126 to 449.6127, inclusive, approval will

be given to the hospital, effective for 5 years.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61266  Duties of hospital providing services. (NRS 449.0302)  A

hospital that provides services for the transplantation of organs shall:

     1.  Supply the Division with the same

information from the patient registry that is provided to the United Network

for Organ Sharing, at the time that information is provided.

     2.  Comply with the representations required

by NAC 449.61262.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.61268  Revocation of approval. (NRS 449.0302)

     1.  The Division may revoke its approval if:

     (a) The hospital fails to comply with any provision

of NAC 449.6126 to 449.6127,

inclusive;

     (b) The United Network for Organ Sharing suspends

or terminates the membership of the hospital; or

     (c) The hospital resigns its membership in the United

Network for Organ Sharing.

     2.  If the Division revokes its approval, the

hospital affected may not reapply for approval for 2 years after the date of

the revocation.

     (Added to NAC by Bd. of Health, eff. 8-31-89)

      NAC 449.6127  Notice of intent to deny application or revoke approval; hearing. (NRS 449.0302)

     1.  If the Division intends to deny an

application for approval or to revoke its approval, it shall so advise the

hospital affected in writing.

     2.  The hospital may request a hearing on the

proposed action of the Division. The hearing must be conducted in accordance

with the procedures set forth in NAC

439.300 to 439.395, inclusive.

     (Added to NAC by Bd. of Health, eff. 8-31-89; A by R044-97,

10-30-97)

INDEPENDENT CENTERS FOR EMERGENCY MEDICAL CARE

Licensing

      NAC 449.61302  Limitations on issuance of license. (NRS 449.0302)  The

Division shall not issue a license to operate an independent center for

emergency medical care unless the center:

     1.  Is located more than 30 minutes by ground

transportation from a facility which is licensed to provide a higher level of

emergency medical care; and

     2.  Routinely provides limited emergency

medical care or holds itself out to the general public as a facility which

provides limited emergency medical care.

     (Added to NAC by Bd. of Health, eff. 11-1-95; A by R044-97,

10-30-97)

      NAC 449.61306  Denial of application for license or renewal of license. (NRS 449.0302)  An

application for a license to operate an independent center for emergency

medical care or for the renewal of the license may be denied if the center,

employees of the center or equipment within the center do not meet the

requirements of NAC 449.61302 to 449.61384, inclusive, or, in the opinion of the

Division, threaten or potentially threaten the health or safety of the general

public.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61308  Compliance with regulations; ground for suspension or revocation

of license. (NRS 449.0302)  For the

duration of his or her license to operate an independent center for emergency

medical care, a licensee shall continuously maintain the center in compliance

with the provisions of NAC 449.61302 to 449.61384, inclusive. Any violation of those

provisions is a ground for the suspension or revocation of the license.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

Administration and Personnel

      NAC 449.6132  Requirement of governing body; adoption of written rules. (NRS 449.0302)

     1.  Except as otherwise provided in NAC 449.61322, each independent center for emergency

medical care must have a governing body. The chair of the governing body must

be a person who is a principal in the organization of the center with legal

authority for the operation of the center.

     2.  The governing body shall adopt written

rules which:

     (a) Prescribe criteria for the selection of the

members and officers of the governing body, their terms of office and duties;

     (b) Specify the frequency of the meetings of the

governing body;

     (c) Require the annual review and approval of the

rules by the governing body; and

     (d) Require the recordation of the minutes of the

meetings of the governing body and provide for the availability of the minutes

to all members of the body.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61322  Exception to requirements of governing body. (NRS 449.0302)

     1.  If the licensee of an independent center

for emergency medical care is a physician operator, the center operated by the

licensee is not required to have a governing body or an administrator. In the

absence of a governing body or an administrator, the licensee is responsible

for complying with the provisions of NAC 449.61302

to 449.61384, inclusive.

     2.  As used in this section, “physician

operator” means any physician or group of physicians:

     (a) Licensed pursuant to the provisions of chapter 630 or 633 of NRS; and

     (b) Operating an independent center for emergency

medical care.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61324  Standards of care; policy for authentication. (NRS 449.0302)

     1.  The governing body of an independent

center for emergency medical care or, if there is no governing body, the

medical director, shall ensure that:

     (a) Each patient of the center receives care which

is supervised by a physician licensed pursuant to the provisions of chapter 630 or 633 of NRS;

     (b) Each patient of the center has a comfortable

and clean environment which protects him or her from injury or accident;

     (c) At least one physician and one registered nurse

are on the premises of the center during all hours of its operation;

     (d) An annual operating budget and plan for capital

expenditures are established;

     (e) The center is adequately staffed and equipped;

and

     (f) The center maintains documents concerning the

qualifications of all consultants under contract with the center and all

employees of the center.

     2.  The governing body or, if there is no

governing body, the medical director, shall establish a policy for

authentication that:

     (a) Authorizes the use of rubber stamps and

prohibits the use of any stamp by any person other than the person whose

signature the stamp represents;

     (b) Approves a method for identifying the person

making an entry in any record or chart; and

     (c) Requires that the professional title of the

person making such an entry and the date of that entry is included with the entry.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61326  Program to review quality of care; contents of program. (NRS 449.0302)  Each

independent center for emergency medical care shall establish a program to

review the quality of care provided at the center. The program must designate

which person or group of persons will review the quality of care. The program

must include, without limitation, a review of:

     1.  The documentation in the medical records

of a patient which describes the medical care provided to the patient and the

results of that care;

     2.  The time of arrival and the time the

patient was seen by a provider of medical care at the center;

     3.  The medical condition of the patient when

he or she was discharged from the center;

     4.  The appropriateness of the instructions

given to the patient upon his or her discharge and the documentation that the

patient understood the instructions; and

     5.  If a patient is transferred to another

medical center or facility, the appropriateness of the transfer, the method of

transfer, the date and time the transfer was requested and the date and time

the patient was discharged from the center.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61328  Integration into local emergency medical system. (NRS 449.0302)  Each

independent center for emergency medical care shall take all action necessary

to ensure that it is integrated into the local emergency medical system for

providing treatment for trauma. The integration with the local system must

include:

     1.  The capability to communicate with

ambulances, air ambulances, agency vehicles and hospitals in accordance with

the local health authority as defined in NRS 450B.077;

     2.  Written agreements with hospitals which

are licensed to provide acute medical and trauma care for the transfer of

patients; and

     3.  A system to maintain information on each

patient treated at the center which includes the external cause of injury to a

patient as classified in the index of international classification of diseases.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.6133  Appointment and responsibilities of administrator. (NRS 449.0302)  Except

as otherwise provided in NAC 449.61322, the

governing body of an independent center for emergency medical care shall

appoint a person to administer the center. The administrator is responsible

for:

     1.  The daily operation of the center;

     2.  Serving, along with any committee

appointed for the purpose of serving, as a liaison between the governing body,

the medical staff and all the departments of the center;

     3.  Reporting the pertinent activities of the

center to the governing body at regular intervals;

     4.  Appointing a person responsible for the

center in the absence of the administrator; and

     5.  Planning for the services provided by the

center and the operation of the center.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61332  Employment and duties of medical director. (NRS 449.0302)  Each

independent center for emergency medical care shall employ a physician to serve

as medical director of the center. Except as otherwise provided in NAC 449.61322, the director is answerable to the

governing body for the quality of medical care provided to patients and the

ethical and professional practices of the members of the medical staff. The

director shall:

     1.  Create and carry out policies for the

care of patients; and

     2.  Coordinate medical care at the center.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61334  Standards and procedures for selection, treatment and retention

of medical staff and members of allied health professions. (NRS 449.0302)

     1.  Each independent center for emergency

medical care shall adopt standards and procedures for:

     (a) The selection of members of the medical staff

of the center;

     (b) The privileges which will be accorded to

members of the medical staff and members of allied health professions who

provide services at the center;

     (c) Appealing the withdrawal or denial of any

privilege; and

     (d) The reappraisal and appointment of each member

of the medical staff.

     2.  A roster which specifies the privileges

accorded each member of the medical staff must be kept in the files of the

center.

     3.  Each member of the medical staff shall

abide by the rules of the center and NAC 449.61302

to 449.61384, inclusive.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61336  Rules for organization of medical staff. (NRS 449.0302)  The

medical staff of an independent center for emergency medical care must be

organized under a set of rules approved by the governing body or, if there is

no governing body, by the medical director. The rules must include:

     1.  An outline which describes the

organization of the medical staff;

     2.  A statement concerning the qualifications

which a member of the medical staff must possess to practice at the center;

     3.  A policy concerning the requirements for

meetings of the medical staff, including the minimum number of meetings each

member of the staff must attend each year;

     4.  A provision requiring, except in a

medical emergency, the informed consent of a patient or his or her legal

representative for a surgical procedure;

     5.  A requirement that if a patient is

treated for dental or podiatric care at the center, a physician who is

responsible for the medical care of the patient must be in attendance

throughout the patient’s care at the center; and

     6.  A requirement that if any member of an

allied health profession provides services at the center, his or her entries on

the medical record of a patient must be verified by his or her signature.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

      NAC 449.61338  Employment and duties of chief nurse; size of on-duty nursing

staff; limitation on scope of practice by person who is not registered nurse;

oversight of nursing staff. (NRS 449.0302)

     1.  Each independent center for emergency

medical care shall employ a chief nurse who is a registered nurse and is

responsible for the supervision and evaluation of the nursing staff and its

activities. The chief nurse shall:

     (a) Establish job descriptions for the nursing

staff of the center;

     (b) Provide for the orientation and training of the

nursing staff;

     (c) Evaluate the performance of the nursing staff;

and

     (d) Assign nurses.

     2.  A sufficient number of members of the

nursing staff must be on duty at all times during the operation of the center

to ensure:

     (a) That proper care is provided to each patient;

and

     (b) The immediate availability of a registered

nurse for the care of any patient.

     3.  A person who is not a registered nurse

may be assigned to care for a patient to the extent consistent with his or her

education, experience and authorized scope of practice.

     4.  The governing body or, if there is no

governing body, the medical director, shall ensure the adequacy of treatment,

medications and care provided by the nursing staff.

     (Added to NAC by Bd. of Health, eff. 11-1-95)

Facilities

      NAC 449.6135  Design, construction, equipment and maintenance: General

requirements; prerequisites to approval for licensure. (NRS 449.0302)

     1.  An independent center for emergency

medical care must be designed, constructed, equipped and maintained in a manner

that protects the health and safety of the patients and personnel of the

independent center for emergency medical care and members of the general

public.

     2.  An independent center for emergency

medical care shall comply with all applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without

limitation, zoning ordinances; and

     (c) Environmental, health, fire and local building

codes,

Ê related to

the construction and maintenance of the independent center for emergency

medical care. If there is a difference between state and local requirements,

the more stringent requirements apply.

     3.  Except as otherwise provided in

subsection 4, before any new construction of an independent center for

emergency medical care or any remodeling of an existing independent center for

emergency medical care is begun, the independent center for emergency medical

care must submit building plans for the ne