902 KAR 20:051. Operation and services; intermediate care

Link to law: http://www.lrc.ky.gov/kar/902/020/051.htm
Published: 2015

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      902 KAR 20:051.

Operation and services; intermediate care.



216B.010-216B.130, 216B.990


KRS 216B.042, 216B.105, 311.560(3), (4), 314.011(8), 314.042(8), 320.210(2), EO



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).


"Administrator" means a person who is licensed as a nursing home

administrator pursuant to KRS 216A.080.


"Facility" means an intermediate care facility.


"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.


"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


      (3) Administrative


      (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


      (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


      (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


      (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


      (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


      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


      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


      (11) Medical


      (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


      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;


Under-the-mattress bed boards;

      11. Trapeze frames;

      12. Transfer board;


      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


      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


      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


      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


      (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.


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


      (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


      (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


      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


      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


      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


      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.)