902 KAR 20:051.
Operation and services; intermediate care.
RELATES TO: KRS
216B.010-216B.130, 216B.990
STATUTORY AUTHORITY:
KRS 216B.042, 216B.105, 311.560(3), (4), 314.011(8), 314.042(8), 320.210(2), EO
96-862
NECESSITY, FUNCTION,
AND CONFORMITY: KRS 216B.042 and 216B.105 mandate that the Cabinet for Health
Services regulate health facilities and health services. This administrative
regulation establishes licensure requirements for the operation of and services
provided by intermediate care facilities. Executive Order 96-862, effective
July 2, 1996, reorganizes the Cabinet for Human Resources and places the Office
of Inspector General and its programs under the Cabinet for Health Services.
Section 1.
Definitions. (1) "Activities of daily living" means activities of
self-help (e.g., being able to feed, bathe and/or dress oneself), communication
(e.g., being able to place phone calls, write letters and understanding
instructions) and socialization (e.g., being able to shop, being considerate of
others, working with others and participating in activities).
(2)
"Administrator" means a person who is licensed as a nursing home
administrator pursuant to KRS 216A.080.
(3)
"Facility" means an intermediate care facility.
(4)
"License" means an authorization issued by the cabinet for the
purpose of operating an intermediate care facility and offering intermediate
care services.
(5) "PRN
medications" means medications administered as needed.
(6) "Qualified
dietician" or "nutritionist" means:
(a) A person who has
a bachelor of science degree in foods and nutrition, food service management,
institutional management or related services and has successfully completed a
dietetic internship or coordinated undergraduate program accredited by the
American Dietetic Association (ADA) and is a member of the ADA or is registered
as a dietician by ADA; or
(b) A person who has
a master's degree in nutrition and is a member of ADA or is eligible for
registration by ADA; or
(c) A person who has
a bachelor of science degree in home economics and three (3) years of work
experience with a registered dietician.
(7)
"Restraint" means any pharmaceutical agent or physical or mechanical
device used to restrict the movement of a patient or the movement of a portion
of a patient's body.
Section 2. Scope of
Operations and Services. Intermediate care facilities are establishments with
permanent facilities including inpatient beds. Services provided include
twenty-four (24) hour supervision of patients, services including physician,
nursing, pharmaceutical, personal care, activities and residential services.
Patients in an intermediate care facility must have a physical or mental
condition that requires intermittent nursing services along with continuous
supervision of the activities of daily living.
Section 3.
Administration and Operation. (1) Licensee. The licensee shall be legally
responsible for the facility and for compliance with federal, state and local
laws and regulations pertaining to the operation of the facility.
(2) Administrator.
(a) All facilities
shall have an administrator who is responsible for the operation of the
facility and who shall delegate such responsibility in his absence. The
administrator shall not be the nursing services supervisor in a facility with
more than sixty (60) beds.
(b) The licensee
shall contract for professional and supportive services not available in the
facility as dictated by the needs of the patient. The contract shall be in
writing.
(3) Administrative
records.
(a) The facility
shall maintain a bound, permanent, chronological patient registry showing date
of admission, name of patient, and date of discharge.
(b) The facility
shall require and maintain written recommendations or comments from consultants
regarding the program and its development on a per visit basis.
(c) Menu and food
purchase records shall be maintained.
(d) A written report
of any incident or accident involving a patient (including medication errors or
drug reactions), visitor or staff shall be made and signed by the administrator
or nursing service supervisor, and any staff member who witnessed the incident.
The report shall be filed in an incident file.
(4) Policies. The
facility shall establish written policies and procedures that govern all
services provided by the facility. The written policies shall include:
(a) Patient care and
services to include physician, nursing, pharmaceutical (including medication
stop orders policy), and residential services.
(b) Adult and child
protection. The facility shall have written policies which assure the reporting
of cases of abuse, neglect or exploitation of adults and children pursuant to
KRS Chapters 209 and 620.
(c) Use of
restraints. The facility shall have a written policy that addresses the use of
restraints and a mechanism for monitoring and controlling their use.
(d) Missing patient
procedures. The facility shall have a written procedure to specify in a
step-by-step manner the actions which shall be taken by staff when a patient is
determined to be lost, unaccounted for or on other unauthorized absence.
(5) Patient rights.
Patient rights shall be provided for pursuant to KRS 216.510 to 216.525.
(6) Admission.
(a) Patients shall
be admitted only upon the referral of a physician. The facility shall admit
only persons who have a physical or mental condition which requires
intermittent nursing services and continuous supervision of activities of daily
living. The facility shall not admit persons whose care needs exceed the
capability of the facility.
(b) Upon admission the
facility shall obtain the patient's medical diagnosis, physician's orders for
the care of the patient and the transfer form. Within seventy-two (72) hours
after admission the facility shall obtain a medical evaluation from the
patient's physician including current medical findings, medical history and
physical examination. The medical evaluation may be a copy of the discharge
summary or history and physical report from a hospital or long-term facility if
done within fourteen (14) days prior to admission.
(c) Before admission
the patient and a responsible member of his family or committee shall be
informed in writing of the established policies of the facility including fees,
reimbursement, visitation rights during serious illness, visiting hours, type of
diets offered and services rendered.
(d) The facility
shall provide and maintain a system for identifying each patient's personal
property and facilities for safekeeping of his declared valuables. Each
patient's clothing and other property shall be reserved for his own use.
(7) Discharge
planning. The facility shall have a discharge planning program to assure the
continuity of care for patients being transferred to another health care
facility or being discharged to the home.
(8) Transfer and
discharge. The facility shall comply with the requirements of 900 KAR 2:050
when transferring or discharging residents.
(a) The facility
shall have written transfer procedures and agreements for the transfer of
patients to other health care facilities which can provide a level of inpatient
care not provided by the facility. Any facility which does not have a transfer
agreement in effect but which documents a good faith attempt to enter into such
an agreement shall be considered to be in compliance with the licensure
requirement. The transfer procedures and agreements shall specify the
responsibilities each institution assumes in the transfer of patients and
establish responsibility for notifying the other institution promptly of the
impending transfer of a patient and arrange for appropriate and safe
transportation.
(b) When the
patient's condition exceeds the scope of services of the facility, the patient,
upon physician's orders (except in cases of emergency), shall be transferred
promptly to a hospital or a skilled nursing facility, or services shall be
contracted for from another community resource.
(c) When changes and
progress occur which would enable the patient to function in a less structured
and restrictive environment, and the less restrictive environment cannot be
offered at the facility, the facility shall offer assistance in making
arrangements for patients to be transferred to facilities providing appropriate
services.
(d) Except in an
emergency, the patient, his next of kin, or guardian, if any, and the attending
physician shall be consulted in advance of the transfer or discharge of any
patient.
(e) When a transfer
is to another level of care within the same facility, the complete medical
record or a current summary thereof shall be transferred with the patient.
(f) If the patient
is transferred to another health care facility or home to be cared for by a
home health agency, a transfer form shall accompany the patient. The transfer
form shall include at least: physician's orders (if available), current
information relative to diagnosis with history of problems requiring special
care, a summary of the course of prior treatment, special supplies or equipment
needed for patient care, and pertinent social information on the patient and
his family.
(9) Tuberculosis
testing. All employees and patients shall be tested for tuberculosis in
accordance with the provisions of 902 KAR 20:200, Tuberculosis testing in long
term care facilities.
(10) Personnel.
(a) Job
descriptions. Written job descriptions shall be developed for each category of
personnel, to include qualifications, lines of authority and specific duty
assignments.
(b) Employee
records. Current employee records shall be maintained and shall include a
resume of each employee's training and experience, evidence of current
licensure or registration where required by law, health records, records of
in-service training and ongoing education, and the employee's name, address and
Social Security number.
(c) Staffing
requirements.
1. The facility
shall have adequate personnel to meet the needs of the patients on a
twenty-four (24) hour basis. The number and classification of personnel
required shall be based on the number of patients and the amount and kind of
personal care, nursing care, supervision and program needed to meet the needs
of the patients as determined by medical orders and by services required by
this administrative regulation.
2. When the staff to
patient ratio does not meet the needs of the patients, the Division for
Licensing and Regulation shall determine and inform the administrator in
writing how many additional personnel are to be added and of what job
classification and shall give the basis for this determination.
3. A responsible
staff member shall be on duty and awake at all times to assure prompt,
appropriate action in cases of injury, illness, fire or other emergencies.
4. Volunteers shall
not be counted to make up minimum staffing requirements.
5. Supervision of
nursing services shall be by a registered nurse or licensed practical nurse
employed on the day shift seven (7) days per week. The supervisor shall have
training in rehabilitative nursing. When a licensed practical nurse serves as
the supervisor, consultation shall be provided by a registered nurse at regular
intervals, not less than four (4) hours weekly. The responsibilities of the
nursing services supervisor shall include:
a. Developing and
maintaining nursing service objectives, standards of nursing practice, nursing
procedure manuals, and written job descriptions for each level of nursing
personnel.
b. Recommending to
the administrator the number and levels of nursing personnel to be employed,
participating in their recruitment and selection and recommending termination
of employment when necessary.
c. Assigning and
supervising all levels of nursing care.
d. Participating in
planning and budgeting for nursing care.
e. Participating in
the development and implementation of patient care policies.
f. Coordinating
nursing services with other patient care services.
g. Participating in
the screening of prospective patients in terms of required nursing services and
nursing skills available.
h. Assuring that a
written monthly assessment of the patient's general condition is completed.
i. Assuring that the
establishment, review and modification of nursing care plans for each patient
is done by licensed nursing personnel.
j. Assuring that all
medications are administered by licensed personnel or by other personnel who
have completed a state-approved training program.
k. Assuring that a
monthly review of each patient's medications is completed and notifying the
physician when changes are appropriate.
6. The facility
shall employ a licensed pharmacist on a full-time, part-time or consultant
basis to direct pharmaceutical services.
7. Each facility
shall have a full-time person designated by the administrator, responsible for
the total food service operation of the facility and on duty a minimum of
thirty-five (35) hours each week.
8. Each facility
shall designate a person for the following areas who will be responsible for:
a. Medical records;
b. Arranging for
social services; and
c. Developing and
implementing the activities program and therapeutic recreation.
9. Supportive
personnel, consultants, assistants and volunteers shall be supervised and shall
function within the policies and procedures of the facility.
(d) Health
requirements. No employee contracting an infectious disease shall appear at
work until the infectious disease can no longer be transmitted.
(e) Orientation
program. The facility shall conduct an orientation program for all new
employees to include review of all facility policies (that relate to the duties
of their respective jobs), services and emergency and disaster procedures.
(f) In-service training.
1. All employees
shall receive in-service training and ongoing education to correspond with the
duties of their respective jobs.
2. All nursing
personnel shall receive in-service or continuing education programs at least
quarterly.
(11) Medical
records.
(a) The facility
shall develop and maintain a system of records retention and filing to insure
completeness and prompt location of each patient's record. The records shall be
held confidential. The records shall be in ink or typed and shall be legible.
Each entry shall be dated and signed. Each record shall include:
1. Identification
data including the patient's name, address and Social Security number (if
available); name, address and telephone number of referral agency; name and
telephone number of personal physician; name, address and telephone number of
next of kin or other responsible person; and date of admission.
2. Admitting medical
evaluation by a physician including current medical findings, medical history,
physical examination and diagnosis. (The medical evaluation may be a copy of
the discharge summary or history and physical report from a hospital, skilled
nursing facility if done within fourteen (14) days prior to admission.)
3. Dated and signed
orders for medication, diet, and therapeutic services.
4. Physician's
progress notes describing significant changes in the patient's condition,
written at the time of each visit.
5. Findings and
recommendations of consultants.
6. A medication
sheet which contains the date, time given, name of each medication dosage, name
of prescribing physician, advanced practice registered nurse,
therapeutically-certified optometrist, or physician assistant, and name of
person who administered the medication.
7. Nurse's notes
indicating changes in patient's condition, actions, responses, attitudes,
appetite, etc. Nursing personnel shall make notation of response to
medications, response to treatments, mode and frequency of PRN medications
administered, condition necessitating administration of PRN medication,
reaction following PRN medication, visits by physician and phone calls to the
physician, medically prescribed diets and preventive, maintenance or
rehabilitative nursing measures.
8. Written
assessment of the patient's monthly general condition.
9. Reports of
dental, laboratory and x-ray services (if applicable).
10. Changes in
patient's response to the activity and therapeutic recreation program.
11. A discharge
summary, signed and dated by the attending physician within one (1) month of
discharge from the facility.
(b) Retention of
records. After patient's death or discharge the completed medical record shall
be placed in an inactive file and retained for five (5) years or, in case of a
minor, three (3) years after the patient reaches the age of majority under
state law, whichever is the longest.
Section 4. Provision
of Services. (1) General requirements.
(a) Patient care
equipment. There shall be a sufficient quantity of patient care equipment of
satisfactory design and in good condition to carry out established patient care
procedures. The equipment shall include:
1. Wheelchairs with
brakes;
2. Walkers;
3. Bedside rails;
4. Bedpans and
urinals (permanent or disposable);
5. Emesis basins and
wash basins (permanent or disposable);
6. Footstools;
7. Bedside commodes;
8. Foot cradles;
9. Foot boards;
10.
Under-the-mattress bed boards;
11. Trapeze frames;
12. Transfer board;
and
13. An autoclave for
sterilization of nursing equipment and supplies or an equivalent alternate
method of sterilization.
(b) Infection
control and communicable diseases.
1. There shall be
written infection control policies, which are consistent with the Centers for
Disease Control guidelines including:
a. Policies which
address the prevention of disease transmission to and from patients, visitors
and employees, including:
(i) Universal blood
and body fluid precautions;
(ii) Precautions for
infections which can be transmitted by the airborne route; and
(iii) Work
restrictions for employees with infectious diseases.
b. Policies which
address the cleaning, disinfection, and sterilization methods used for
equipment and the environment.
2. The facility
shall provide in-service education programs on the cause, effect, transmission,
prevention and elimination of infections for all personnel responsible for
direct patient care.
3. Sharp wastes.
a. Sharp wastes,
including needles, scalpels, razors, or other sharp instruments used for
patient care procedures, shall be segregated from other wastes and placed in
puncture resistant containers immediately after use.
b. Needles shall not
be recapped by hand, purposely bent or broken, or otherwise manipulated by
hand.
c. The containers of
sharp wastes shall either be incinerated on or off site, or be rendered
nonhazardous by a technology of equal or superior efficacy, which is approved
by both the Cabinet for Health Services and the Natural Resources and
Environmental Protection Cabinet.
4. Disposable waste.
a. All disposable
waste shall be placed in suitable bags or closed containers so as to prevent
leakage or spillage, and shall be handled, stored, and disposed of in such a
way as to minimize direct exposure of personnel to waste materials.
b. The facility
shall establish specific written policies regarding handling and disposal of
all wastes.
c. The following
wastes shall be disposed of by incineration, autoclaved before disposal, or
carefully poured down a drain connected to a sanitary sewer: blood, blood
specimens, used blood tubes, or blood products.
d. Any wastes
conveyed to a sanitary sewer shall comply with applicable federal, state, and
local pretreatment regulations.
5. Patients infected
with the following diseases shall not be admitted to the facility unless the
patient's attending physician certifies in writing that the condition of the
patient is not communicable to others in the long-term care environment:
anthrax, campylobacteriosis, cholera, diphtheria, hepatitis A, measles,
pertussis, plague, poliomyelitis, rabies (human), rubella, salmonellosis, shigellosis,
typhoid fever, yersiniosis, brucellosis, giardiasis, leprosy, psittacosis, Q
fever, tularemia, and typhus. If an attending physician is in doubt regarding
the communicability of a patient's condition, he may contact the Department for
Health Services.
6. A facility may
admit a noninfectious tuberculosis patient under continuing medical supervision
for his tuberculosis disease.
7. Patients with
active tuberculosis may be admitted to the facility whose isolation facilities
and procedures have been specifically approved by the cabinet.
8. If, after
admission, a patient is suspected of having a communicable disease that would
endanger the health and welfare of other patients the administrator shall
assure that a physician is contacted and that appropriate measures are taken on
behalf of the patient with the communicable disease and the other patients.
(c) Use of
restraints.
1. No restraints
shall be used except as permitted by KRS 216.515(6).
2. Restraints that
require lock and key shall not be used.
3. Restraints shall
be applied only by appropriately trained personnel.
4. Restraints shall
not be used as a punishment, as discipline, as a convenience for the staff, or
as a mechanism to produce regression.
(2) Physician
services. All patients shall be under the medical supervision of a licensed
physician. These services shall include:
(a) Physician's
visit for medical evaluation as often as necessary and in no case less often
than every sixty (60) days, unless justified and documented by the attending
physician in the patient's medical report.
(b) Physician
services for medical emergencies available on a twenty-four (24) hour, seven
(7) days-a-week basis.
(3) Nursing
services. Nursing services shall include:
(a) The
establishment of a nursing care plan for each patient. Each plan shall be
reviewed and modified as necessary, or at least quarterly. Each plan shall
include goals and nursing care needs;
(b) Rehabilitative
nursing care to achieve and maintain the highest degree of function, self-care
and independence. Rehabilitative measures shall be practiced on a twenty-four
(24) hour, seven (7) day week basis. Those procedures requiring medical
approval shall be ordered by the attending physician. Rehabilitative measures
shall include:
1. Positioning and
turning. Nursing personnel shall encourage and assist patients in maintaining
good body alignment while standing, sitting, or lying in bed.
2. Exercises.
Nursing personnel shall assist patients in maintaining maximum joint range of
motion or active range of motion.
3. Bowel and bladder
training. Nursing personnel shall make every effort to train incontinent
patients to gain bowel and bladder control.
4. Training in
activities of daily living. Nursing personnel shall encourage and when
necessary teach patients to function at their maximum level in appropriate
activities of daily living for as long as, and to the degree that, they are
able.
5. Ambulation.
Nursing personnel shall assist and encourage patients with daily ambulation
unless otherwise ordered by the physician.
(c) Administration
of medications including oral, rectal, hypodermic, and intramuscular;
(d) Written monthly
assessment of the patient's general condition by licensed nursing personnel;
(e) Treatments such
as: enemas, irrigations, catheterizations, applications of dressings or
bandages, supervision of special diets;
(f) The recording of
any changes, as they occur, in the patient's condition, actions, responses,
attitudes, appetite, etc.
(g) Implementing a
regular program to prevent decubiti with emphasis on the following:
1. Procedures to
maintain cleanliness of the patient, his clothes and linens shall be followed
each time the bed or the clothing is soiled. Rubber, plastic, or other type of
linen protectors shall be properly cleaned and completely covered to prevent
direct contact with the patient.
2. Special effort
shall be made to assist the patient in being up and out of bed as much as his
condition permits, unless medically contraindicated. If the patient cannot move
himself, he shall have his position changed as often as necessary but not less
than every two (2) hours.
(4) Pharmaceutical
services.
(a) The facility
shall provide appropriate methods and procedures for obtaining, dispensing, and
administering drugs and biologicals, developed with the advice of a licensed
pharmacist or a pharmaceutical advisory committee which includes one (1) or
more licensed pharmacists.
(b) If the facility
has a pharmacy department, a licensed pharmacist shall be employed to
administer the pharmacy department.
(c) If the facility
does not have a pharmacy department, it shall have provision for promptly
obtaining prescribed drugs and biologicals from a community or institutional
pharmacy holding a valid pharmacy permit issued by the Kentucky Board of
Pharmacy, pursuant to KRS 315.035.
(d) An emergency
medication kit approved by the facility's professional personnel shall be kept
readily available. The facility shall maintain a record of what drugs are in
the kit and document how the drugs are used.
(e) Medication
requirement and services.
1. All medications
administered to patients shall be ordered in writing by the prescribing
physician, advanced practice registered nurse as authorized in KRS 314.011(8)
and 314.042(8), therapeutically-certified optometrist in the practice of
optometry as defined in KRS 320.210(2), or physician assistant as authorized in
KRS 311.560(3) and (4). Oral orders shall be given only to a licensed nurse or
pharmacist, immediately reduced to writing, and signed. Medications not
specifically limited as to time or number of doses, when ordered, shall be automatically
stopped in accordance with the facility's written policy on stop orders. A
registered nurse or the pharmacist shall review each patient's medical profile
monthly. Medications shall be reviewed at least quarterly by the attending or
staff physician. The patient's attending physician shall be notified of stop
order policies and contacted promptly for renewal of such orders so that continuity
of the patient's therapeutic regimen is not interrupted. Medications shall be
released to patients on discharge or visits only after being labeled
appropriately and on the written authorization of the physician.
2. Administration of
medications. All medications shall be administered by licensed nurses or
personnel who have completed a state-approved training program, from a state
approved training provider. Each dose administered shall be recorded in the
medical record. Intramuscular injections shall be administered by a licensed
nurse or a physician. If intravenous injections are necessary they shall be
administered by a licensed physician or registered nurse.
a. The nursing
station shall have items required for the proper administration of medications.
b. Medications
prescribed for one (1) patient shall not be administered to any other patient.
c.
Self-administration of medications by patients shall not be permitted except on
special order of the patient's physician and a predischarge program under the
supervision of a licensed nurse.
d. Medication errors
and drug reactions shall be immediately reported to the patient's physician and
pharmacist and an entry thereof made in the patient's medical record as well as
on an incident report.
3. The facility
shall provide up-to-date medication reference texts for use by the nursing
staff (e.g., Physician's Desk Reference).
4. Labeling and
storing medications. All medications shall be plainly labeled with the
patient's name, the name of the drug, strength, name of pharmacy, prescription
number, date, physician name, caution statements and directions for use except
where accepted modified unit dose systems conforming to federal and state laws
are used. The medications of each patient shall be kept and stored in their
original containers and transferring between containers shall be prohibited.
All medicines kept by the facility shall be kept in a locked place and the
persons in charge shall be responsible for giving the medicines and keeping
them under lock and key. Medications requiring refrigeration shall be kept in a
separate locked box of adequate size in the refrigerator in the medication
area. Drugs for external use shall be stored separately from those administered
by mouth and injection. Provisions shall also be made for the locked separate
storage of medications of deceased and discharged patients until such
medication is surrendered or destroyed in accordance with federal and state
laws and regulations.
5. Controlled
substances. Controlled substances shall be kept under double lock (e.g., in a
locked box in a locked cabinet). There shall be a controlled substances record,
in which is recorded the name of the patient; the date, time, kind, dosage,
balance remaining and method of administration of all controlled substances;
the name of the physician who prescribed the medications; and the name of the
nurse who administered it, or staff who supervised the self-administration. In
addition, there shall be a recorded and signed Schedule II controlled
substances count daily, and Schedule III, IV and V controlled substances count
once per week by those persons who have access to controlled substances. All
controlled substances which are left over after the discharge or death of the
patient shall be destroyed in accordance with 21 CFR 1307.21.
(5) Personal care
services.
(a) All facilities
shall provide services to assist patients to achieve and maintain good personal
hygiene including the level of assistance necessary with:
1. Bathing of the
body to maintain clean skin and freedom from offensive odors. In addition to
assistance with bathing, the facility shall provide soap, clean towels, and
wash cloths for each patient. Toilet articles such as brushes and combs shall
not be used in common.
2. Shaving.
3. Cleaning and
trimming of fingernails and toenails.
4. Cleaning of the
mouth and teeth to maintain good oral hygiene as well as care of the lips to
prevent dryness and cracking. All patients shall be provided with tooth
brushes, a dentifrice, and denture containers, when applicable.
5. Washing,
grooming, and cutting of hair.
(b) The staff shall
encourage and assist the patients to dress in their own street clothing (unless
otherwise indicated by the physician).
(6) Dental services.
The facility shall assist patients in obtaining dental services. Conditions
necessitating dental services shall be noted and such dental procedures and
services provided shall be recorded in the patient's record.
(7) Social services.
The facility shall provide or arrange for social services as needed by the
patient.
(a) Social services
shall be integrated with other elements of the plan of care.
(b) A plan for such
care shall be recorded in the patient's record and periodically evaluated in
conjunction with the patient's total plan of care.
(c) Social services
records shall be maintained as an integral part of case record maintained on
each patient.
(8) Activities and
therapeutic recreation.
(a) All facilities
shall provide a program to stimulate physical and mental abilities to the
fullest extent, to encourage and develop a sense of usefulness and self respect
and to prevent, inhibit or correct the development of symptoms of physical and
mental regression due to illness or old age. The program shall provide sufficient
variety to meet the needs of the various types of patients in the facility.
When possible, the patient shall be included in the planning of activities.
(b) All facilities
shall meet the following program requirements:
1. Staff. A person
designated by the administrator shall be responsible for the program.
2. A program shall
be developed for each patient and shall be incorporated in the patient's plan
of care and revised according to the patient's needs. Changes in his response
to the program shall be recorded in the medical record.
3. There shall be a
planned and supervised activity period each day. The schedule shall be current
and posted.
4. The program shall
be planned for group and individual activities, both within and outside of the
facility, weather permitting.
5. The person
responsible for activities shall maintain a current list of patients on which
precautions are noted regarding a patient's condition that might restrict or
modify his participation in the program.
6. A living or
recreation room and outdoor recreational space shall be provided for patients
and their guests.
7. The facility
shall provide supplies and equipment for the activities program.
8. Reading
materials, radios, games and TV sets shall be provided for the patients.
9. The program may
include religious activities for each patient if it is the desire of the
patient to participate. Requests from a patient to be seen by a clergyman shall
be acted upon as soon as possible, and an area of private consultation shall be
made available.
10. The facility shall
allow the patient to leave the facility to visit, shop, attend church, or other
social activities provided this does not endanger his health or safety.
(9) Transportation.
(a) If
transportation of patients is provided by the facility to community agencies or
other activities, the following shall apply:
1. Special provision
shall be made for patients who use wheelchairs.
2. An escort or
assistant to the driver shall be provided in transporting patients to and from
the facility if necessary for the patient's safety.
(b) The facility
shall arrange for appropriate transportation in case of medical emergencies.
(10) Residential
care services. All facilities shall provide residential care services to all
patients including: room accommodations, housekeeping and maintenance services,
and dietary services. All facilities shall meet the following requirements
relating to the provision of residential care services.
(a) Room
accommodations.
1. Each patient
shall be provided a standard size bed at least thirty-six (36) inches wide,
equipped with substantial springs, a clean comfortable mattress, a mattress
cover, two (2) sheets and a pillow, and such bed covering as is required to
keep the patients comfortable. Rubber or other impervious sheets shall be placed
over the mattress cover whenever necessary. Beds occupied by patients shall be
placed so that no patient may experience discomfort because of proximity to
radiators, heat outlets, or by exposure to drafts.
2. The facility
shall provide window coverings, bedside tables with reading lamps (if
appropriate), comfortable chairs, chest or dressers with mirrors, a night
light, and storage space for clothing and other possessions.
3. Patients shall
not be housed in unapproved rooms or unapproved detached buildings.
4. Basement rooms
shall not be used for sleeping rooms for patients.
5. Patients may have
personal items and furniture when it is physically feasible.
6. There shall be a
sufficient number of tables provided that can be rolled over a patient's bed or
be placed next to a bed to serve patients who cannot eat in the dining room.
7. Each living room
or lounge area and recreation area shall have an adequate number of reading
lamps, and tables and chairs or settees of sound construction and satisfactory design.
8. Dining room
furnishings shall be adequate in number, well constructed and of satisfactory
design for the patients.
9. Each patient
shall be permitted to have his own radio and television set in his room unless
it interferes with or is disturbing to other patients.
(b) Housekeeping and
maintenance services.
1. The facility
shall maintain a clean and safe facility free of unpleasant odors. Odors shall
be eliminated at their source by prompt and thorough cleaning of commodes,
urinals, bedpans and other obvious sources.
2. An adequate
supply of clean linen shall be on hand at all times. Soiled clothing and linens
shall receive immediate attention and shall not be allowed to accumulate.
Clothing or bedding used by one (1) patient shall not be used by another until
it has been laundered or dry cleaned.
3. Soiled linen
shall be placed in washable or disposable containers, transported in a sanitary
manner and stored in separate, well-ventilated areas in a manner to prevent
contamination and odors. Equipment or areas used to transport or store soiled
linen shall not be used for handling or storing of clean linen.
4. Soiled linen
shall be sorted and laundered in the soiled linen room in the laundry area.
Hand-washing facilities with hot and cold water, soap dispenser and paper
towels shall be provided in the laundry area.
5. Clean linen shall
be sorted, dried, ironed, folded, transported, stored and distributed in a
sanitary manner.
6. Clean linen shall
be stored in clean linen closets on each floor, close to the nurses' station.
7. Personal laundry
of patients or staff shall be collected, transported, sorted, washed and dried
in a sanitary manner, separate from bed linens.
8. Patients'
personal clothing shall be laundered by the facility as often as is necessary.
Patients' personal clothing shall be laundered by the facility unless the
patient or the patient's family accepts this responsibility. Patients capable
of laundering their own personal clothing and wishing to do so may, instead, be
provided the facilities to do so. Patient's personal clothing laundered by the
facility shall be marked to identify the patient-owner and returned to the
correct patient.
9. Maintenance. The
premises shall be well kept and in good repair. Requirements shall include:
a. The facility
shall insure that the grounds are well kept and the exterior of the building,
including the sidewalks, steps, porches, ramps and fences are in good repair.
b. The interior of
the building including walls, ceilings, floors, windows, window coverings,
doors, plumbing and electrical fixtures shall be in good repair. Windows and
doors shall be screened.
c. Garbage and trash
shall be stored in areas separate from those used for the preparation and
storage of food and shall be removed from the premises regularly. Containers
shall be cleaned regularly.
d. A pest control
program shall be in operation in the facility. Pest control services shall be
provided by maintenance personnel of the facility or by contract with a pest
control company. The compounds shall be stored under lock.
(c) Dietary
services. The facility shall provide or contract for food service to meet the
dietary needs of the patients including modified diets or dietary restrictions
as prescribed by the attending physician. When a facility contracts for food
service with an outside food management company, the company shall provide a
qualified dietician on a full-time, part-time or consultant basis to the
facility. The qualified dietician shall have continuing liaison with the medical
and nursing staff of the facility for recommendations on dietetic policies
affecting patient care. The company shall comply with all of the appropriate
requirements for dietary services in this administrative regulation.
1. Therapeutic
diets. If the designated person responsible for food service is not a qualified
dietician or nutritionist, consultation by a qualified dietician or qualified
nutritionist shall be provided.
2. Dietary staffing.
There shall be sufficient food service personnel employed and their working
hours, schedules of hours, on duty and days off shall be posted. If any food
service personnel are assigned duties outside the dietary department, the
duties shall not interfere with the sanitation, safety or time required for
regular dietary assignments.
3. Menu planning.
a. Menus shall be
planned, written and rotated to avoid repetition. Nutrition needs shall be met
in accordance with the current recommended dietary allowances of the Food and
Nutrition Board of the National Research Council adjusted for age, sex and
activity, and in accordance with physician's orders.
b. Meals shall
correspond with the posted menu. Menus must be planned and posted one (1) week
in advance. When changes in the menu are necessary, substitutions shall provide
equal nutritive value and the changes shall be recorded on the menu and kept on
file for thirty (30) days.
c. The daily menu
shall include daily diet for all modified diets served within the facility
based on an approved diet manual. The diet manual shall be a current manual
with copies available in the dietary department, that has the approval of the
professional staff of the facility. The diet manual shall indicate nutritional
deficiencies of any diet. The dietician shall correlate and integrate the dietary
aspects of the patient care with the patient and patient's chart through such
methods as patient instruction, recording diet histories and participation in
rounds and conferences.
4. Food preparation
and storage.
a. There shall be at
least a three (3) day supply of food to prepare well balanced palatable meals.
b. Food shall be
prepared with consideration for any individual dietary requirement. Modified
diets, nutrient concentrates and supplements shall be given only on the written
orders of a physician, advanced practice registered nurse as authorized in KRS
314.011(8) and 314.042(8), or physician assistant as authorized in KRS
311.560(3) and (4).
c. At least three
(3) meals per day shall be served with not more than a fifteen (15) hour span
between the substantial evening meal and breakfast. Between-meal snacks to
include an evening snack before bedtime shall be offered to all patients.
Adjustments shall be made when medically indicated.
d. Foods shall be
prepared by methods that conserve nutritive value, flavor and appearance and
shall be attractively served at the proper temperatures, and in a form to meet
the individual needs. A file of tested recipes, adjusted to appropriate yield
shall be maintained. Food shall be cut, chopped or ground to meet individual
needs. If a patient refuses foods served, nutritional substitutions shall be
offered.
e. All opened
containers or leftover food items shall be covered and dated when refrigerated.
5. Serving of food.
When a patient cannot be served in the dining room, trays shall be provided for
bedfast patients and shall rest on firm supports such as overbed tables. Sturdy
tray stands of proper height shall be provided for patients able to be out of
bed.
a. Correct
positioning of the patient to receive his tray shall be the responsibility of
the direct patient care staff. Patients requiring help in eating shall be
assisted.
b. Adaptive
self-help devices shall be provided to contribute to the patient's independence
in eating.
6. Sanitation. All
facilities shall comply with all applicable provisions of KRS 219.011 to KRS
219.081 and 902 KAR 45:005.
Section 5.
Separability. If any clause, sentence, paragraph, section or part of these
administrative regulations shall be adjudged by any court of competent jurisdiction
to be invalid, the judgment shall not affect, impair or invalidate the
remainder thereof, but shall be confined in its operation to the clause,
sentence, paragraph, section or part thereof, directly involved in the
controversy in which the judgment was rendered. (8 Ky.R. 406; Am. 900; eff.
4-7-82; 11 Ky.R. 832; eff. 12-11-84; 13 Ky.R. 365; eff. 9-4-86; 1151; eff.
2-10-87; 16 Ky.R. 2496; 17 Ky.R. 76; eff. 7-18-90; 1590; eff. 12-18-90; 24
Ky.R. 2233; 25 Ky.R. 328; eff. 8-17-98; TAm eff. 3-11-2011.)
