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Rule 3701-16-01 | Definitions.
As used in rules 3701-16-01 to 3701-16-18 of the
Administrative Code: (A) "Accommodations" means
housing, meals, laundry, housekeeping, transportation, social or recreational
activities, maintenance, security, or similar services that are not personal
care services or skilled nursing care. (B) "Activities of daily
living" means walking and moving, bathing, grooming, toileting, oral
hygiene, hair care, dressing, eating, and nail care. (C) "Administrator" means the
person responsible for the daily operation of the residential care facility.
The administrator and the operator may be the same person. (D) "Bedroom" means a room used
by a resident or residents for sleeping purposes that is either a resident unit
or a portion of a resident unit. (E) "Complex therapeutic diets"
has the same meaning as "therapeutic diet" as that term is defined in
paragraph (OO) of this rule (F) "County home" and
"district home" mean an entity operated under Chapter 5155. of the
Revised Code. (G) "Department" means the
department of health. (H) "Developmental delay" means
that a child has not reached developmental milestones expected for his or her
chronological age as measured by qualified professionals using appropriate
diagnostic instruments and/or procedures. (1) Delay shall be
demonstrated in one or more of the following developmental areas: adaptive
behavior, physical developmental or maturation (fine and gross motor skills;
growth) cognition; social or emotional development; and sensory development;
or (2) An established risk
involving early aberrant development related to diagnosed medical disorders,
such as infants and toddlers who are on a ventilator, are adversely affected by
drug exposure, or have a diagnosed medical disorder or physical or mental
condition known to result in developmental delay such as Down
syndrome. (I) "Developmental diagnosis"
means a severe, chronic disability that is characterized by the
following: (1) It is attributable to
a mental or physical impairment or a combination of mental and physical
impairments, other than a mental impairment solely caused by mental illness as
that term is defined in division (A) of section 5122.01 of the Revised
Code. (2) It is manifested
before age twenty-two. (3) It is likely to
continue indefinitely. (4) It results in one of
the following: (a) In the case of a person under three years of age, at
least one developmental delay or an established risk; (b) In the case of a person at least three years of age but
under six years of age, at least two developmental delays or an established
risk. (c) In the case of a person six years of age or older, a
substantial functional limitation in at least three of the following areas of
major life activity, as appropriate for the person's age; self-care,
receptive and expressive language, learning, mobility, self-direction, capacity
for independent living, and if the person is at least sixteen years of age,
capacity for economic self-sufficiency. (5) It causes the person
to need a combination and sequence of special, interdisciplinary, or other type
of care, treatment, or provision of services for an extended period of time
that is individually planned and coordinated for the person. (J) "Director" means the
director of health or any office, bureau, agency, official or employee of the
department to which the director has delegated his authority or
duties. (K) "Dietitian" means an
individual licensed under Chapter 4759. of the Revised Code to practice
dietetics. (L) (1) "Home"
means both of the following: (a) Any institution, residence, or facility that provides,
for a period of more than twenty-four hours, whether for a consideration or
not, accommodations to three or more unrelated individuals who are dependent
upon the services of others, including a nursing home, residential care
facility, and the Ohio veterans' home; (b) A county home or district home that is or has been
licensed as a residential care facility. (2) "Home" also
means any facility that a person, as defined in section 3702.51 of the Revised
Code, proposes for certification as a skilled nursing facility or nursing
facility under Title XVIII or XIX of the "Social Security Act," 49
Stat. 620 (1935), 42 U.S.C. 301, as amended (1981), and for which a certificate
of need, other than a certificate to recategorize hospital beds as described in
section 3702.522 of the Revised Code or under division (R)(7)(d) of the version
of section 3702.51 of the Revised Code in effect immediately prior to April 20,
1995, has been granted to the person under sections 3702.51 to 3702.62 of the
Revised Code after August 5, 1989. (3) "Home" does
not mean any of the following: (a) Except as provided in division (A)(1)(b) of section
3721.01 of the Revised Code, a public hospital or hospital as defined in
section 3701.01 or 5122.01 of the Revised Code; (b) A residential facility for mentally ill persons as
defined under section 5119.22 of the Revised Code; (c) A residential facility as defined in section 5123.19 of
the Revised Code; (d) An alcohol or drug addiction program as defined in
section 3793.01 of the Revised Code; (e) A facility licensed to provide methadone treatment
under section 3793.11 of the Revised Code; (f) A facility providing services under contract with the
department of mental retardation and developmental disabilities under section
5123.18 of the Revised Code; (g) A facility operated by a hospice care program licensed
under section 3712.04 of the Revised Code that is used exclusively for care of
hospice patients; (h) A facility operated by a pediatric respite care program
licensed under section 3712.041 of the Revised Code that is used exclusively
for care of pediatric respite care patients; (i) A facility, infirmary, or other entity that is operated
by a religious order, provides care exclusively to members of religious orders
who take vows of celibacy and live by virtue of their vows within the orders as
if related, and does not participate in the medicare program established under
Title XVIII of the "Social Security Act" or the medical assistance
program established under Chapter 5111. of the Revised Code and Title XIX of
the "Social Security Act," if on January 1, 1994, the facility,
infirmary, or entity was providing care exclusively to members of the religious
order; or (j) A county home or district home that has never been
licensed as a residential care facility. (M) "Home health agency" means an agency
certified as a provider of home health services under Title XVIII of the Social
Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended
(1981). (N) "Licensed practical nurse" means a person
licensed under Chapter 4723. of the Revised Code to practice nursing as a
licensed practical nurse. (O) "Lot" means a plot or parcel of land
considered as a unit, devoted to a certain use, or occupied by a building or
group of buildings that are united by a common interest and use, and the
customary accessories and open spaces belonging to the same. (P) "Maximum licensed capacity" means the
authorized type and number of residents in a home as determined in paragraph
(S) of rule 3701-16-03 of the Administrative Code. (Q) "Mechanically altered food" means that the
texture of food is altered altered by chopping, grinding, mashing, or pureeing
so that it can be successfully chewed and safely swallowed. (R) "Mental impairment" does not mean mental
illness as that term is defined in section 5122.01 of the Revised Code or
intellectual disability as that term is defined in section 5123.01 of the
Revised Code. (S) "Nonambulatory" means not able to walk or not
physically able to leave the premises without assistance from another
individual. (T) "Nurse" means a registered nurse or licensed
practical nurse. (U) "Nursing home" means a home used for the
reception and care of individuals who by reason of illness or physical or
mental impairment require skilled nursing care and of individuals who require
personal care services but not skilled nursing care. A nursing home is licensed
to provide personal care services and skilled nursing care. (V) "Ohio building code" means the building
requirements, as adopted by the board of building standards pursuant to section
3781.10 of the Revised Code. (W) "On call" means the person can be contacted
at all times and is immediately available to go on duty in the home upon short
notice. (X) "On duty" means being in the home, awake, and
immediately available. (Y) "Operator" means the person, firm,
partnership, association, or corporation which is required by section 3721.05
of the Revised Code to obtain a license in order to open, maintain or operate a
home and the superintendent or administrator of a county home or district home
licensed or seeking to be licensed as a residential care facility. (Z) "Personal care services" means services
including, but not limited to, the following: (1) Assisting residents
with activities of daily living: (2) Assisting residents
with self-administration of medication, in accordance with rule 3701-16-09 of
the Administrative Code; (3) Preparing food for
special diets, other than therapeutic diets, for residents pursuant to the
instructions of a physician, a licensed health care professional acting within
their applicable scope of practice, or a licensed dietitian, in accordance with
rule 3701-16-10 of the Administrative Code. "Personal care services" does not
include "skilled nursing care". A facility need not provide more than
one of the services listed in this paragraph to be considered to be providing
personal care services. (AA) "Physician" means an individual licensed
under Chapter 4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery. (BB) "Registered nurse" means an individual
licensed to practice nursing as a registered nurse under Chapter 4723. of the
Revised Code. (CC) "Resident" means an unrelated individual to
whom a residential care facility provides accommodations. (DD) "Resident call system" means a set of devices
that are connected electrically, electronically, by radio frequency
transmission, or in a like manner, are resident activated, and effectively can
alert the staff member or members on duty of emergencies or resident
needs. (EE) "Resident unit" means the private room or
rooms occupied by a resident or residents. (FF) "Residents' rights" means the rights
enumerated in sections 3721.10 to 3721.17 of the Revised Code. (GG) "Residential care facility" means a home that
provides either of the following: (1) Accommodations for
seventeen or more unrelated individuals and supervision and personal care
services for three or more of those individuals who are dependent on the
services of others by reason of age or physical or mental
impairment; (2) Accommodations for
three or more unrelated individuals, supervision and personal care services for
at least three of those individuals who are dependent on the services of others
by reason of age or physical or mental impairment, and to at least one of those
individuals, any of the skilled nursing care authorized by section 3721.011 of
the Revised Code. (HH) "Serious mental illness" means an illness
classified in the "Diagnostic and Statistical Manual of Mental Disorders,
Third Edition, Revised (DSM-IIIR)," that meets at least two of the three
following criteria of diagnosis, duration and disability: (1) Diagnosis: The
current primary diagnosis is: (a) Delusional disorders (DSM-IIIR 297.10); (b) Dissociative disorders (DSM-IIIR 300.14); (c) Eating disorders (DSM-IIIR 307.10, 307.51,
307.52); (d) Mood disorders (DSM-IIIR 296.3x, 296.4x, 296.5x,
296.6x, 296.70, 300.40, 301.13, 311.00); (e) Organic mental disorders (DSM-IIIR 290.0, 290.10,
290.1x, 290.4x, 294.10, 294.80); (f) Personality disorders (DSM-IIIR 301.00, 301.20, 301.22,
301.40, 301.50, 301.60, 301.70, 301.81, 301.82, 301.83, 301.84,
301.90); (g) Psychotic disorders (DSM-IIIR 395.40, 295.40, 295.70,
298.90); (h) Schizophrenia (DSM-IIIR 295.1x, 295.2x, 295.3x, 295.6x,
295.9x); (i) Somatoform disorder (DSM-IIIR 307.80); (j) Other disorders (DSM-IIIR 313.23, 313.81, 313.82);
or (k) Other specified. (2) Duration: the length
of the problem can be assessed by either inpatient or outpatient use of service
history, reported length of time of impairment, or some combination, including
at least two prior hospitalizations of more than twenty-one days or any number
of hospitalizations (more than one) totaling at least forty-two days prior to
the assessment, or ninety to three hundred sixty-five days in a hospital or
nursing home within three prior years, or major functional impairment lasting
more than two years, resulting in utilization of outpatient mental health
services on an intermittent basis, a continuous basis, or both. (3) Disability/functional
impairment: severity of disability can be established by disruption in two or
more life activities, including but not limited to: (a) Employment; (b) Contributing substantially to one's own financial
support (not to be entitlements); (c) Independent residence; (d) Self-care; (e) Perception and cognition; (f) Stress management or coping skills; or (g) Interpersonal and social relations. (II) "Skilled nursing care" means procedures that
require technical skills and knowledge beyond those the untrained person
possesses and that are commonly employed in providing for the physical, mental,
and emotional needs of the ill or otherwise incapacitated. "Skilled
nursing care" includes, but is not limited to, the following: (1) Irrigations,
catheterizations, application of dressings, and supervision of special
diets; (2) Objective observation
of changes in the resident's condition as a means of analyzing and
determining the nursing care required and the need for further medical
diagnosis and treatment; (3) Special procedures
contributing to rehabilitation; (4) Administration of
medication by any method ordered by a physician or other licensed health care
professional acting within their applicable scope of practice, such as
hypodermically, rectally, or orally, including observation of the resident
after receipt of the medication; or (5) Carrying out other
treatments prescribed by the physician or other licensed health care
professional acting within their applicable scope of practice, that involve a
similar level of complexity and skill in administration. (JJ) "Special care unit" means a residential care
facility, or part thereof, that is dedicated to providing care to residents
with diagnoses, that include, but are not limited to, late-stage cognitive
impairment with significant ongoing daily living assistance needs, cognitive
impairments with increased emotional needs or presenting behaviors that cause
problems for the resident or other residents, or both; or, serious mental
illness. (KK) "Special diets" means a therapeutic diet
limited to: (1) Nutrient adjusted
diets, including high protein, no added salt, and no concentrated
sweets (2) Volume adjusted
diets, including small, medium and large portions; (3) The use of finger
foods or bite-sized pieces for a resident's physical needs;
or (4) Mechanically altered
food. (LL) "Staff member" or "staff" means an
individual working in a residential care facility including the owner; the
administrator; a full-time, part-time or temporary paid employee; or an
individual working on contract for the facility. (MM) "Supervision" means: (1) Watching over a
resident, when necessary, while the resident engages in activities of daily
living or other activities to ensure the resident's health, safety, and
welfare; (2) Reminding a resident
to do or complete such an activity, as by reminding him or her to engage in
personal hygiene or other self-care activity; or (3) Helping a resident to
schedule or keep an appointment, or both, including the arranging for
transportation. "Supervision" does not include
reminding a resident to take medication and watching the resident to ensure
that the resident follows the directions on the container, or supervision of
therapeutic diets as described in paragraph (J) of rule 3701-16-10 of the
Administrative Code. (NN) "Supervision of therapeutic diets" means
services, including, but not limited to, the following: (1) Monitoring a
resident's access to appropriate foods as required by a therapeutic
diet; (2) Monitoring a
resident's weight and acceptance of a therapeutic diet; (3) Providing assistance
to residents on therapeutic diets as needed or requested: and (4) Providing or
preparing therapeutic diets. (OO) "Therapeutic diet" means a diet ordered by a
health care practitioner: (1) As part of the
treatment for a disease or clinical condition; (2) To eliminate,
decrease, or increase certain substances in the diet; or (3) To provide
mechanically altered food when indicated. (PP) "Unrelated individual" means one who is not
related to the owner or operator of the residential care facility or to his or
her spouse as a parent, grandparent, child, grandchild, brother, sister, niece,
nephew, aunt, uncle, or as the child of an aunt or uncle.
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Rule 3701-16-02 | General provisions and prohibitions.
(A) Nothing contained in rules 3701-16-01
to 3701-16-18 of the Administrative Code shall be construed as authorizing the
supervision, regulation, or control of the spiritual care or treatment of
residents who rely upon treatment by prayer or spiritual means in accordance
with the creed or tenets of any recognized church or religious
denomination. (B) For the purposes of rules 3701-16-01
to 3701-16-18 of the Administrative Code: (1) Any residence,
institution, hotel, assisted living facility, congregate housing project, or
similar facility that meets the definition of a residential care facility or a
home for the aging under section 3721.01 of the Revised Code is such a home
regardless of how the facility holds itself out to the public; (2) Any residence,
institution, hotel, assisted living facility, congregate housing project, or
similar facility that provides personal care services to fewer than three
residents or that provides for any number of residents, only housing,
housekeeping, laundry, meals, social or recreational activities, maintenance,
security, transportation, and similar services that are not personal care
services or skilled nursing care is not a home required to be licensed under
Chapter 3721. of the Revised Code or rules 3701-16-01 to 3701-16-18 of the
Administrative Code; and (3) Personal care
services or skilled nursing care shall be considered to be provided by a
residential care facility if they are provided by a person employed by or
associated with the facility or by another person pursuant to an agreement to
which neither the resident who receives the services nor his sponsor is a
party. (C) Nothing in paragraph (Z) of rule
3701-16-01 of the Administrative Code shall be construed to permit personal
care services to be imposed upon a resident who is capable of performing the
activity in question without assistance. Nothing in paragraph (II) of rule
3701-16-01 of the Administrative Code shall be construed to permit skilled
nursing care to be imposed upon an individual who does not require skilled
nursing care. (D) In addition to providing
accommodations, supervision, and personal care services to its residents, a
residential care facility is licensed to provide skilled nursing care to its
residents as follows: (1) Supervision of
therapeutic diets; (2) Application of
dressings pursuant to division (A)(2) of section 3721.011 of the Revised Code
and paragraph (J) of rule 3701-16-09 of the Administrative Code; (3) Subject to division (B)(1) of section
3721.011 of the Revised Code, administration of medication; (4) Subject to division
(C) of section 3721.011 of the Revised Code, other skilled nursing care
provided on a part-time, intermittent basis for not more than a total of one
hundred twenty days in any twelve-month period; and (5) Subject to division
(D) of section 3721.011 of the Revised Code, skilled nursing care provided for
more than one hundred twenty days in any twelve-month period to a resident
whose physician has determined the skilled nursing care needed is routine, or
to a hospice patient as defined in section 3712.01 of the Revised
Code. (E) A residential care facility may not
admit or retain individuals requiring skilled nursing care or provide skilled
nursing care beyond the limits established under section 3721.011 of the
Revised Code and rules 3701-16-07 and 3701-16-09.1 of the Administrative
Code. (F) Each residential care facility shall
provide services as outlined in the resident agreement in accordance with
acceptable practices and the facility's policies and
procedures. (G) Each residential care facility shall comply with all
the residents' rights provisions under Chapter 3721. of the Revised
Code. (H) A residential care facility shall not use the word
"hospital" in its name, letterhead or advertising. (I) A residential care facility shall not admit residents
in excess of the maximum licensed bed capacity. (J) Notwithstanding section 3721.011 of the Revised Code, a
residential care facility in which residents receive skilled nursing care as
described in section 3721.011 of the Revised Code is not a nursing
home. (K) An applicant for a license to operate a residential
care facility shall not accept more than two residents who need personal care
services, medication administration, supervision of therapeutic diets,
application of dressings or skilled nursing care before receiving a
license. (L) In addition to the provisions listed in this rule, no
person, firm, partnership, association, or corporation shall: (1) Operate a residential
care facility as defined in section 3721.01 of the Revised Code and paragraph
(GG) of rule 3701-16-01 of the Administrative Code without obtaining a license
from the director; (2) Violate any of the
conditions or requirements necessary for licensing after the license has been
issued; (3) Operate a residential
care facility after the license for such has been revoked by the
director; (4) Interfere with the
inspection of a licensed residential care facility by any state or local
official when he or she is performing duties required of him or her by Chapter
3721. of the Revised Code. All licensed residential care facilities shall be
open for inspection; or (5) Violate any
applicable provision of Chapter 3721. of the Revised Code or rules 3701-16-01
to 3701-16-18 of the Administrative Code. (M) No county home or district home licensed under section
3721.07 of the Revised Code shall do any of the following: (1) Violate any of the
conditions or requirements necessary for licensing after the licensed has been
issued; (2) Continue operation
after its license has been revoked by the director of health; (3) Fail to be open for
an inspection, or interfere with an inspection, by a state or local official
performing inspection duties under Chapter 3721. of the Revised Code;
or (4) Violate any of the
provisions of this chapter or any rules adopted thereunder. (N) Nothing contained in rules 3701-16-01 to 3701-16-18 of
the Administrative Code shall be construed to permit any individual to engage
in the practice of nursing as a registered nurse or the practice of nursing as
a licensed practical nurse if the individual does not hold a valid license
issued under Chapter 4723. of the Revised Code.
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Rule 3701-16-03 | Residential care facility licensure application and renewal procedures; revocation.
(A) Every applicant for a license to operate a residential care
facility shall truthfully and fully complete and submit an initial application
on a form prescribed and furnished by the director and pay the nonrefundable
application fee, specified in section 3721.02 of the Revised Code, to the
director not less than sixty days before the proposed opening of the facility.
The application fee required by this rule shall be submitted to the director
and the fee shall be made payable to the "treasurer, state of Ohio"
in the form of a check or money order. The department shall deposit the fee in
the state treasury to the credit of the general operations fund created by
section 3701.83 of the Revised Code. (B) The initial application for a license to operate a
residential care facility shall include: (1) An attestation of financial solvency at the time of the
initial application and updated as requested by the director, showing that the
applicant has the financial ability to staff, equip, and operate the
residential care facility in accordance with Chapter 3721. of the Revised Code,
and rules 3701-16-01 to 3701-16-18 of the Administrative Code, and that the
applicant has sufficient capital or financial reserve to cover not less than
three months' operation; (2) A statement containing the following
information: (a) If the operator is an
individual and owner of the business, or superintendent or administrator of a
county home or district home, the individual's name, address, and
telephone number. If the operator is a business owned by an association,
corporation, or partnership, the business activity, address, and telephone
number of the entity and the name of every person who has an ownership interest
of five per cent or more in the entity; (b) If the operator does
not own the building or buildings or if the operator owns only part of the
building or buildings in which the residential care facility is housed, the
name of each person who has an ownership interest of five per cent or more in
the buildings. (c) The name and address of
any residential care facility and any facility described in paragraphs (L)(1)
and (L)(3) of rule 3701-16-01 of the Administrative Code in which the operator
or administrator, or both, have an ownership interest of five per cent or more
or with which the operator or administrator have been affiliated with through
ownership or employment in the five years prior to the date of the
application; (d) The name, business
address and telephone number of the administrator of the residential care
facility, if different from the operator; (e) The name, business
address and telephone number of any management firm or business employed to
manage the residential care facility; and (f) The name, business
address, and telephone number of the statutory agent of the
operator. (3) Copies of the: (a) Floor plan for the
building or area of a building to be licensed as a residential care facility,
including beds; (b) Certificate of
occupancy required by paragraph (A) of rule 3701-16-13 of the Administrative
Code; (c) Inspection report of
the state fire marshal or a township, municipal, or other legally constituted
fire department approved by the marshal required by paragraph (A) of rule
3701-16-13 of the Administrative Code; and (d) Heating inspection
report required by paragraph (A) of rule 3701-16-15 of the Administrative
Code. The operator or administrator shall notify the
director in writing of any changes in the information contained in this
paragraph. The operator or administrator shall provide this notification no
later than ten days after the change occurs. (C) The operator of a
residential care facility shall truthfully and fully submit a license renewal
application and pay the nonrefundable application fee specified in section
3721.02 of the Revised Code specified in section 3721.02 of the Revised Code
using an electronic system prescribed by the director. Any residential care
facility that does not pay its renewal fee in January shall pay, beginning the
first day of February, a late fee of one hundred dollars for each week or part
thereof that the renewal fee is not paid. If either the renewal fee or the late
fee is not paid by the fifteenth day of February, the director may, in
accordance with Chapter 119. of the Revised Code, revoke the facility's
license. (D) The license renewal application required by paragraph (C) of
this rule shall: (1) Include an update of the information required
under paragraphs (B)(2) and (B)(3) of this rule; (2) A copy of the most recent inspection report
by the state fire marshal or a township, municipal, or other legally
constituted fire department approved by the marshal required by paragraph (A)
of rule 3701-16-13 of the Administrative Code; (3) Provide information the director may require to assess
whether the operator has violated section 3721.07 of the Revised Code;
and (4) Be updated no less than ten days after any changes in the
information contained in this paragraph occurs. (E) If the residential care facility alters its physical
facilities in a manner that affects bed capacity or proposes to relocate
existing beds to a unlicensed portion of the facility, the facility shall
notify the director, in writing, at least sixty days prior to the date the
facility wants to commence filling the new beds or relocating existing beds.
The residential care facility shall not use the altered or unlicensed area
until the department notifies the facility, in writing, that the alteration or
move complies with the applicable provisions of Chapter 3721. of the Revised
Code and rules 3701-16-01 to 3701-16-18 of the Administrative Code. The written
notice from the facility shall include: (1) A floor plan of the area, including
beds; (2) The results of the inspection by the state
fire marshal or a township, municipal, or other legally constituted fire
department approved by the marshal for the area; and (3) A certificate of occupancy for the
area. (F) The director may
request any additional information the director determines to be necessary to
assess compliance with the applicable criteria, standards, and requirements
established by Chapter 3721. of the Revised Code and rules 3701-16-01 to
3701-16-18 of the Administrative Code. The applicant shall truthfully respond
and submit any additional information requested by the director within sixty
days of the director's request. (G) The director shall
issue a license to operate a residential care facility if, after completion of
the inspection required by paragraph (A) of rule 3701-16-04 of the
Administrative Code and review of the license application, the director
determines that the facility meets the requirements of section 3721.07 of the
Revised Code. The license shall remain in effect until revoked by the director
or voided at the request of the applicant if the annual renewal fee is paid
during the month of January of each year. (H) A license to operate a
residential care facility is valid only for the premises named in the
application. If ownership of a facility is assigned or transferred to a
different person, the new owner is responsible and liable for compliance with
any notice of proposed action or order issued under section 3721.08 of the
Revised Code prior to the effective date of the assignment or
transfer. (I) An operator who
operates one or more residential care facilities in more than one building
shall obtain a separate license for each building except if such buildings are
on the same lot and constitute a single residential care facility, such
facility may be operated under a single license. On or after April 1, 2007, an
operator who operates one or more residential care facilities in more than one
building, where the buildings are intersected by a public roadway, shall not be
granted a license to operate the buildings as a single residential care
facility, unless before April 1, 2007 the buildings were so
licensed. (J) The operator shall post
the license in a conspicuous place in the residential care
facility. (K) The director may issue an order revoking a license in the
event the director finds, upon hearing or opportunity afforded pursuant to
Chapter 119. of the Revised Code, that any of the following apply to a person,
county home, or district home licensed under section 3721.07 of the Revised
Code: (1) Has violated any of the provisions of Chapter
3721. of the Revised Code or of rules 3701-16-01 to 3701-16-18 of the
Administrative Code; (2) Has violated any order issued by the
director; (3) Is not, or any of its principals are not
suitable, morally or financially, to operate such an institution; (4) Is not furnishing humane, kind, and adequate
treatment and care; or (5) Has had a long-standing pattern of violations
of Chapter 3721. of the Revised Code or of rules 3701-16-01 to 3701-16-18 of
the Administrative Code that has caused physical, emotional, mental, or
psychosocial harm to one or more residents. (L) The director may issue an order denying a license in the
event the director finds after investigation of the applicant and, if required
by section 3721.02 of the Revised Code, inspection of the home, one or more of
the following conditions exist: (1) The applicant has been convicted of a felony
or a crime involving moral turpitude; (2) The applicant is violating any of the rules
made, or any order issued, by the director of health; (3) The applicant has had a license to operate
the home revoked pursuant to section 3721.03 of the Revised Code, other than
division (B)(5) of section 3721.03 of the Revised Code, because of any act or
omission that jeopardized a resident's health, welfare, or
safety; (4) The buildings in which the home is housed
have not been approved by the state fire marshal or a township, municipal, or
other legally constituted fire department approved by the marshal. In the
approval of a home such agencies shall apply standards prescribed by the board
of building standards, and by the state fire marshal, and by section 3721.071
of the Revised Code; (5) The applicant, if it is an individual, or the
principal participants, if it is an association or a corporation, is or are not
suitable financially and morally to operate a home; (6) The applicant is not equipped to furnish
humane, kind, and adequate treatment and care; (7) The home maintains or contains: (a) Facilities for the
performance of major surgical procedures; (b) Facilities for
providing therapeutic radiation; (c) An emergency
ward; (d) A clinical laboratory
unless it is under the supervision of a clinical pathologist who is a licensed
physician in this state; or (e) Facilities for
radiological examinations unless such examinations are performed only by a
person licensed to practice medicine, surgery, or dentistry in this
state; (8) The home accepts or treats outpatients,
except upon the written orders of a physician licensed in this state, maternity
cases, boarding children, or houses transient guests, other than participants
in an adult day-care program, for twenty-four hours or less; or (9) The home is not in compliance with sections
3721.28 and 3721.29 of the Revised Code. (M) Upon the issuance of any order of revocation or denial, the
person whose license is revoked or denied, or county home or district home that
has its license revoked or denied, may appeal in accordance with Chapter 119.
of the Revised Code. (N) Once the director notifies a person, county home, or district
home licensed to operate a home that the license may be revoked or issues any
order under section 3721.03 of the Revised Code or under this rule, the person,
county home, or district home shall not assign or transfer to another person or
entity the right to operate that home. This prohibition shall remain in effect
until proceedings under Chapter 119. of the Revised Code concerning the order
or license revocation have been concluded or the director notifies the person,
county home, or district home that the prohibition has been
lifted. (1) If a license is revoked under this section,
the former license holder shall not assign or transfer or consent to assignment
or transfer of the right to operate the home. Any attempted assignment or
transfer to another person or entity is void. (2) On revocation of a license, the former
license holder shall take all necessary steps to cease operation of the
home. (O) If, under division (B)(5) of section 3721.03 of the Revised
Code, the license of a person, county home, or district home has been revoked,
the director of health shall not issue a license to the person or home at any
time. A person, county home, or district home whose license is revoked for any
reason other than nonpayment of the license renewal fee or late fees may not
apply for a new license under Chapter 3721. of the Revised Code until a period
of one year following the date of revocation has elapsed. (P) An operator shall give the director written notification of a
closing at least sixty days prior to a planned closing date and within twenty
four hours of an unplanned closing. This notice shall include: (1) An address where the operator may be reached
after the closing of the home; (2) A plan for the transfer and adequate
relocation of all residents; and (3) Assurances that the residents will be
transferred to the most integrated and appropriate facility or other setting in
terms of quality, services, and location, taking into consideration the needs,
choice, and best interests of each resident. (Q) While providing a written notification of closure under
paragraph (P) of this rule, the operator shall, in accordance with Chapter
3701-61 of the Administrative Code, also provide written notice of the proposed
date of closing of the home to its residents and their sponsors or legal
representatives and the regional longterm care ombudsman program, designated
under section 173.16 of the Revised Code, serving the area where the home is
located. (R) In determining the
number of residents in a residential care facility for the purpose of
licensing, the director shall consider all the individuals for whom the
facility provides accommodations as one group unless one of the following is
the case: (1) The facility maintains, in addition to a
residential care facility, a separate and discrete part or unit that provides
accommodations to individuals who do not require or receive skilled nursing
care and do not receive personal care services from the residential care
facility, in which case the individuals in the separate and discrete part or
unit shall not be considered in determining the number of residents in the
residential care facility if the separate and discrete part or unit is in
compliance with the Ohio basic building code established by the board of
building standards under Chapters 3781. and 3791. of the Revised Code and the
facility permits the director, on request, to inspect the separate and discrete
part or unit and speak with the individuals residing there, if they consent, to
determine whether the separate and discrete part or unit meets the requirements
of section 3721.02 of the Revised Code and this paragraph. (2) The facility provides an adult day care
program on the same site as the facility that is separate and distinct from the
facility except as otherwise permitted in rules 3701-16-01 to 3701-16-18 of the
Administrative Code, in which case the participants of the adult day care
program shall not be considered in determining the number of residents in the
facility. (S) The director shall
determine the type and number of residents a residential care facility can
accommodate which shall be the authorized maximum licensed capacity of the
facility. Such determination shall be made on the basis of the physical
facilities, personnel of the facility and the services and care needed by the
residents to be admitted or retained in the residential care facility, and the
permitted occupancy approved by the department of commerce. No operator,
administrator, staff member or any other person shall set up beds for resident
use in a residential care facility which exceed the authorized maximum licensed
capacity.
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Rule 3701-16-03.1 | Expedited inspections.
(A) For purposes of this rule,
"inspection" may be conducted either in-person or on-line using
remote conferencing technology. (B) An applicant for licensure as a
residential care facility may request an expedited initial licensure inspection
by providing the department of health with the following: (1) A complete initial
residential care facility application and fee required by paragraph (A) of rule
3701-16-03 of the Administrative Code; (a) An application will be deemed complete when the
department verifies all information contained therein is complete and accurate
and meets the requirements of paragraph (B) of rule 3701-16-03 of the
Administrative Code; (b) An applicant may elect an expedited initial licensure
inspection on the initial residential care facility application and, if
electing such an inspection, provide a fee in addition to that required by
paragraph (A) of rule 3701-16-03 of the Administrative Code, in the amount of
two thousand two hundred fifty dollars; and (2) Notice of readiness
for inspection. (C) The operator of an existing residential care facility
that is seeking approval to increase or decrease the residential care
facility's licensed capacity or to make any other change for which the
director requires a licensing inspection to be conducted may request an
expedited licensure inspection by providing the department of health with the
following: (1) A written notice in
accordance with paragraph (E) of of rule 3701-16-03 of the Administrative Code
that includes, if applicable: (a) A floor plan of the
area, including beds; (b) The results of the
inspection by the state fire marshal or a township, municipal, or other legally
constituted fire department approved by the marshal for the area;
and (c) A certificate of
occupancy for the area; (2) A fee in the amount
of two thousand two hundred fifty dollars; and (3) Notice of
readiness. (D) A fee collected by the department pursuant to this rule
shall be deposited in the state treasury to the credit of the general
operations fund created by section 3701.83 of the Revised Code, and the fee
shall not be refunded. (E) Upon receipt of a completed request for expedited
inspection made pursuant to this paragraph (B) or (C) of this rule, the
department will commence an inspection of the residential care facility not
later than ten business days. Inspections under this rule will be scheduled in
the order in which the request for expedited inspection is determined to be
complete. (F) If the residential care facility does not meet the
requirements for licensure upon the initial inspection requested under
paragraph (B) of this rule, the department of health may deny the
license. (G) If an existing residential care facility does not meet
the requirements for licensure upon the expedited inspection requested under
paragraph (C) of this rule, the department of health may refuse to approve the
increase or decrease in capacity, or refuse to license the previously
unlicensed space.
Last updated May 16, 2022 at 8:21 AM
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Rule 3701-16-04 | Inspections and investigations; correction.
(A) The director shall inspect each
residential care facility at least once prior to the issuance of a license, at
least once every fifteen months and as the director considers necessary. The
inspections may be announced or unannounced except that one unannounced
inspection shall be conducted at least every fifteen months. The state fire
marshal or a township, municipal, or other legally constituted fire department
approved by the fire marshal shall also inspect a residential care facility
prior to issuance of a license, at least once every fifteen months thereafter,
and at any other time requested by the director. A residential care facility
does not have to be inspected prior to issuance of a license by the director,
state fire marshal, or a fire department if ownership of the facility is
assigned or transferred to a different person and the facility was licensed
under Chapter 3721. of the Revised Code as a residential care facility
immediately prior to the assignment or transfer. (B) The director may investigate any
complaint concerning a facility in accordance with sections 3721.031 and
3721.17 of the Revised Code. (C) An operator, administrator, staff
member or any other person shall not: (1) Refuse to permit the
director for the purpose of inspecting or investigating the operation of a
residential care facility, to enter and inspect at any time a building or
premise where a residential care facility is located, or to enter and inspect
records, including resident medical records, which are kept concerning the
operation of the residential care facility for information pertinent to the
legitimate interest of the department. (2) Use profane or
abusive language directed at or in the presence of residents or the
director. (D) When inspecting or investigating a
residential care facility, the director shall respect the residents'
privacy and dignity, cooperate with the residents, behave in a congenial manner
toward the residents, protect the residents' rights, and behave in a
cooperative and professional manner toward individuals working in the facility.
The director or the director's designee shall: (1) Refrain from using
language or behavior that is derogatory, insulting, intimidating, or
threatening; (2) Not harass or coerce
residents or otherwise attempt to influence residents' responses to
inquiries; (3) Not make remarks or
comparison, positive or negative, about another residential care facility or
other residents; (4) Not solicit, accept,
or agree to accept from the residential care facility or a resident of the
facility compensation, gratuities, gifts, or any other thing of value that is
of such character as to manifest a substantial and improper influence upon the
director or the director's designee with respect to their
duties; (5) Obtain the
resident's consent prior to conducting an evaluation of a resident unless
a court has issued a search warrant or other order authorizing such an
evaluation. When requesting the resident's consent to evaluate the
resident, the director or the director's designee shall explain that the
resident: (a) Has the option to consent or not to consent to the
evaluation; (b) Will not be evaluated without the resident's
consent; (c) May have another individual of the resident's
choice present during the evaluation. If a resident requests that another
individual be present during the evaluation and that individual is not
available, the resident has not consented to the evaluation; and (d) Will not suffer any adverse consequences if the
resident refuses to consent. (E) The director may enter at any time,
for the purposes of investigation, any institution, residence, facility, or
other structure which has been reported to the director or that the director
has reasonable cause to believe is operating as a residential care facility
without a valid license or in the case of a county or district home, is
operating despite the revocation of its residential care facility
license. (F) If an inspection reveals a violation
or violations of Chapter 3721. of the Revised Code or of rules 3701-16-01 to
3701-16-18 of the Administrative Code, the director may provide the facility
with the opportunity to correct the violation or violations.
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Rule 3701-16-05 | Personnel requirements.
(A) Each residential care facility shall
arrange for the services of an administrator who shall: (1) Meet the applicable
requirements of rule 3701-16-06 of the Administrative Code; (2) Be responsible for
the daily operation of the residential care facility including, but not limited
to, assuring that residents' ongoing or changing service needs, as
identified in the resident assessments, and services ordered by a licensed
health care professional are acted upon by the appropriate staff member. If the
facility does not provide for the needed service, it shall be discussed with
the resident as required by paragraph (G) of rule 3701-16-08 of the
Administrative Code; (3) Provide not less than
twenty hours of service in the facility during each calendar week during the
hours of eight a.m. and six p.m. If the administrator is unable to provide at
least twenty hours of service in the residential care facility in a given
calendar week because of a vacation, illness, or other temporary situation, the
administrator shall designate a staff member, who shall not be less than
twenty-one years of age and who meets the requirements of paragraphs (D) and
(H) of rule 3701-16-06 of the Administrative Code, to serve as acting
administrator; The administrator or acting administrator shall
be accessible at all other times when not present at the residential care
facility. A residential care facility located in the same building as a nursing
home, or on the same lot as a nursing home, both of which are owned and
operated by the same entity, shall be considered to have met this requirement
if the nursing home has a full-time administrator licensed under Chapter 4751.
of the Revised Code who is responsible for both the residential care facility
and nursing home. For the purposes of this paragraph, "full-time"
means no less than thirty-two hours per calendar week. (B) The residential care facility
administrator may provide services to residents if the administrator meets the
applicable qualifications of rule 3701-16-06 of the Administrative Code. An
administrator, providing personal care services, of a facility
with: (1) Sixteen or less beds
may be counted toward meeting the staffing requirements of paragraph (C) of
this rule; (2) Seventeen to
thirty-five beds shall not be counted toward meeting the staffing requirements
of paragraph (C) of this rule until he or she has met the requirements of
paragraph (A)(3) of this rule; (3) More than thirty-five
beds shall not be counted toward meeting the staffing requirements of paragraph
(C) of this rule. (C) Each residential care facility shall
have the following staff members who are competent to perform the duties they
are assigned: (1) At least one staff
member on duty at all times who shall meet the qualifications of rule
3701-16-06 of the Administrative Code for staff members providing personal care
services. During the night, the staff member who is physically present in the
facility may be on call if the facility meets the resident call system
requirements of paragraph (B)(5) of rule 3701-16-14 of the Administrative Code.
When only one staff person is on duty in the facility, the residential care
facility shall designate another staff member who meets the same qualifications
to be on call; and (2) Sufficient additional
staff members who meet the applicable qualifications of rule 3701-16-06 of the
Administrative Code for the services they perform and appropriate scheduling of
sufficient staff time to adequately do all of the following: (a) Meet, in a timely manner, the residents' total
care, supervisory and emotional needs as determined by the resident assessment
required under rule 3701-16-08 of the Administrative Code and consistent with
the resident agreement required under rule 3701-16-07 of the Administrative
Code and reasonable and appropriate requests for services, including monitoring
in excess of supervision of residents with increased emotional needs or
presenting behaviors that cause problems for the resident or other residents,
or both; (b) Properly provide dietary, housekeeping, laundry, and
facility maintenance services and recreational activities for the residents in
accordance with the rules of this chapter; (c) Assist, when necessary, with prompt evacuation of
nonambulatory residents. The additional staff members needed to implement the
facility's evacuation plan required by paragraph (J) of rule 3701-16-13 of
the Administrative Code shall be present in the facility at all times;
and (d) Provide or arrange for resident activities required
under rule 3701-16-11 of the Administrative Code. (3) Each residential care
facility shall have at least one staff member capable of giving personal care
services who has successfully completed the first aid training required by
paragraph (E) of rule 3701-16-06 of the Administrative Code, if applicable,
present in the facility at all times. (4) In determining the staffing level for
the facility, the facility is not required to consider resident
needs: (a) That are being served through a contractual arrangement
between the resident and a third party provider; (b) That the resident chooses not to have met as documented
in the resident's record; or (c) That the resident has not contracted with the facility
to meet if the facility has complied with paragraph (G) of rule 3701-16-08 of
the Administrative Code. (5) Unless the
resident's needs are being met by a private psychologist or physician,
each residential care facility that admits or retains residents with a
diagnosis of late-stage cognitive impairment with significant ongoing daily
living assistance needs, cognitive impairments with increased emotional needs
or presenting behaviors that cause problems for the resident or other
residents, or both, or serious mental illness, shall have a psychologist or
physician with experience in the diagnosis and treatment of the applicable
condition or conditions, either on staff or as a consultant. (D) In addition to the requirements set
forth in this rule, each residential care facility that elects to admit or
retain residents for whom the facility provides skilled nursing care beyond the
supervision of special diets, application of dressings, or administration of
medication shall do all of the following: (1) Employ or contract
with a registered nurse who shall provide onsite supervision of skilled nursing
care provided to residents. For purposes of this rule, "onsite
supervision" means that the registered nurse shall spend sufficient time
each week in the facility to manage the provision of skilled nursing care in
accordance with accepted standards of practice; (2) Have a licensed nurse
on call when one is not present in the facility; and (3) Have sufficient
additional nursing staff to meet residents' needs. (E) The operator or administrator shall establish a
schedule for staff coverage that includes coverage during vacations, emergency
situations, and long-term absences due to illness. The residential care
facility shall not require, coerce or persuade a resident to supervise other
residents, provide personal care services, supervise special diets, administer
medications or manage the facility. Residents who voluntarily help or receive
assistance from one another shall not be counted in determining whether the
residential care facility meets the staffing requirements of this
rule. (F) Each residential care facility which elects to
administer medication shall have one of the following individuals on duty who
shall administer medications in accordance with paragraphs (G) and (H) of rule
3701-16-09 of the Administrative Code and remain on duty for a sufficient
amount of time to observe medication acceptance and reaction: (1) A registered
nurse; (2) A licensed practical
nurse holding proof of successful completion of a course in medication
administration approved by the Ohio board of nursing pursuant to Chapter 4723.
of the Revised Code who shall administer medication only at the direction of a
registered nurse or physician; (3) A physician;
or (4) A person authorized
by law to administer medication. (G) Each residential care facility which elects to
supervise therapeutic diets shall provide or arrange for a dietitian and comply
with the applicable requirements of rule 3701-16-10 of the Administrative
Code. (H) Each residential care facility which elects to provide
for the application of dressings in accordance with division (A)(2) of section
3721.011 of the Revised Code shall have sufficient nursing staff to provide the
service and shall comply with the requirements of paragraph (J) of rule
3701-16-09 of the Administrative Code. (I) Each residential care facility that elects to provide
skilled nursing care using staff members, in accordance with division (C) of
section 3721.011 of the Revised Code and paragraph (B) of rule 3701-16-09.1 of
the Administrative Code, shall have sufficient nursing staff to provide the
skilled nursing care. If the residential care facility elects to provide
enteral tube feedings on a part-time intermittent basis the facility shall
provide or arrange for a dietitian and provide sufficient nursing staff with
appropriate experience and training in enteral tube feedings. Skilled nursing
care may be delegated in accordance with Chapter 4723-13 of the Administrative
Code. (J) A residential care facility that is physically located
in the same building or on the same lot as a nursing home, or that provides an
adult day care program, or both, which are owned and operated by the same
entity may use staff from the residential care facility to provide services in
the nursing home or adult day care program, or use appropriate and qualified
staff from the nursing home or the adult day care program to meet part or all
of the staffing requirements of this rule, if all of the following criteria are
met: (1) The residential care
facility at all times meets the minimal staffing levels required by paragraph
(C) of this rule. The staff members, assigned to and responsible for meeting
the residential care facility residents' needs, may provide services to
nursing home residents if they meet the nurse aide qualifications of rule
3701-17-07.1 of the Administrative Code, but shall not be counted towards
meeting the nursing home staffing levels of rule 3701-17-08 of the
Administrative Code; (2) The nursing home at
all times meets the staffing level requirements of rule 3701-17-08 of the
Administrative Code; (3) Separate staffing
schedules for the residential care facility, nursing home, and adult day care
program are maintained; (4) The residential care
facility has the resident call systems required by paragraph (B)(5) of rule
3701-16-14 of the Administrative Code, for residents to use in obtaining
unscheduled care or services, as needed, when unexpected care needs arise and
the monitoring of resident call systems in the residential care facility and
nursing home is not disrupted. The residential care facility shall not limit
the use of the resident call systems to emergencies only; (5) Utilization of the
nurses or aides, or both, does not adversely affect the quality and timeliness
of meeting the care needs of the nursing home and residential care facility
residents; and (6) For a residential
care facility on the same lot as a nursing home, the homes are located within
two minutes or less response time from each other. No staff member simultaneously assigned to the
staffing schedule of the residential care facility and the nursing home shall
be counted in determining whether the residential care facility meets the
staffing requirements of paragraph (C) of this rule, unless over fifty per cent
of the staff member's assigned daily working hours are in the residential
care facility. (K) The operator or the administrator of each residential
care facility shall maintain records, on forms provided by the director,
documenting compliance with the personnel requirements of this
rule.
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Rule 3701-16-06 | Qualifications and health of personnel.
(A) No person with a disease which may be transmitted in the
performance of the person's job responsibilities shall work in a
residential care facility during the stage of communicability unless the person
is given duties that minimize the likelihood of transmission and follows
infection control precautions and procedures. (B) No person shall work in a residential care facility who uses
alcohol or drugs to the extent that it adversely affects the performance of the
person's duties or the health or safety of any resident. (C) No person shall work in a residential care facility in any
capacity as a full-time, part-time or temporary paid employee of the facility
unless the person has been examined by a physician or other health care
professional acting within their applicable scope of practice within thirty
days before commencing work or on the first day of work. No person shall
commence work in a residential care facility in any capacity unless the person
is medically capable of performing the person's prescribed duties.
Operators shall retain copies of the examinations required by this paragraph
and shall furnish them to the director upon request. (1) Employees of temporary employment services or, to the extent
applicable, paid consultants working in a facility shall have medical
examinations in accordance with paragraph (C) of this rule, except that a new
physical examination is not required for each new assignment. Each facility in
which such an individual works shall obtain verification of the physical
examination, as applicable, from the employment agency or consultant before the
individual begins work and shall maintain this documentation on
file. (2) Individuals used by an adult day care program provided by and
on the same site as the residential care facility shall have medical
examinations in accordance with paragraph (C) of this rule if the adult day
care program is located or shares space within the same building as the
residential care facility or if there is a sharing of staff between the
residential care facility and adult day care program. (D) Each residential care facility staff member and volunteer
who: (1) Provides personal care services shall be at
least sixteen years of age. Staff members or volunteers who provide personal
care services who are under the age of eighteen shall have on-site supervision
by a staff member over the age of eighteen. The administrator shall be at least
twenty-one years of age; (2) Assists residents with self-administration of
medications shall demonstrate an ability to read, write and understand
information and directions in English. All other staff members and volunteers
shall demonstrate an ability to understand and communicate job-related
information and directions in English; or (3) Plans activities for residents with
late-stage cognitive impairment with significant ongoing daily living
assistance needs, cognitive impairments with increased emotional needs or
presenting behaviors that cause problems for the resident or other residents,
or both; or, serious mental illness shall have training in appropriate
activities for such residents. (E) Staff members who provide personal care services in a
residential care facility, except licensed health professionals whose scope of
practice include the provision of personal care services, shall meet the
following training requirements: (1) Within sixty days of hire, have first-aid
training evidenced by one of the following: (a) Currently valid
documentation of successful completion of the "American Red Cross Standard
First-Aid Course", the "American Red Cross First-Aid Basics", or
any other American red cross course covering the training topics described in
paragraph (E)(1)(c) of this rule; (b) Currently valid
documentation of successful completion of the "American Heart Association
Heartsaver First-Aid" course, or any other "American Heart
Association" course covering the training topics described in paragraph
(E)(1)(c) of this rule; or (c) Documentation of
successful completion, within the past three years, of first-aid training by a
physician or registered nurse, an emergency medical technician, or an
instructor certified by the American red cross" or the American heart
association. This training shall include recognition and emergency management
of bleeding, burns, poisoning, respiratory distress including choking,
musculoskeletal injury, wounds including animal and insect bites, sudden
illness, shock, hypothermia, heat stroke and exhaustion, and frost
bite; (2) Have documentation that, prior to providing
personal care services without supervision in the facility, the staff member
met one of the following requirements: (a) Successfully completed
training or continuing education that shall cover, as is necessary to meet the
needs of residents in the facility, the following: (i) The correct techniques of providing personal
care services as required by the staff member's job
responsibilities; (ii) Observational skills such as recognizing
changes in residents' normal status and the facility's procedures for
reporting changes; and (iii) Communication and interpersonal
skills. The training or continuing education shall
be provided by a registered nurse or a licensed practical nurse under the
direction of a registered nurse and be sufficient to ensure that the staff
member receiving the training can demonstrate an ability to provide the
personal care services. The facility may utilize other health care
professionals acting within the scope of the professional's practice as
part of the training or continuing education; (b) Successfully completed
the training and competency evaluation program and competency evaluation
program approved or conducted by the director under section 3721.31 of the
Revised Code; or (c) Successfully completed
the training or testing requirements in accordance with the medicare condition
of participation of home health aide services, 42 C.F.R. 484.4 (November 6,
2014) and 42 C.F.R. 484.36 (June 18, 2001); (3) Except as provided in paragraph (E)(5) of
this rule, staff members employed by a residential care facility, or part
thereof, that admits or retains residents with late-stage cognitive impairment
with significant ongoing daily living assistance needs, or cognitive
impairments with increased emotional needs or presenting behaviors that cause
problems for the resident or other residents, or both, shall have: (a) Two hours of initial
training in the care of such residents within fourteen days of the first day of
work; and (b) Four hours of
continuing education in the care of such residents annually. The four hours of
continuing education may count towards the continuing education requirement of
paragraph (E)(7) of this rule. (4) Except as provided in paragraph (E)(5) of
this rule, staff members employed by a residential care facility, or part
thereof, that admits or retains residents with diagnoses of serious mental
illness shall have: (a) Two hours of initial
training in the care of such residents within fourteen days of the first day of
work; and (b) Four hours of
continuing education in the care of such residents annually. The four hours of
continuing education may count towards the of continuing education requirement
of paragraph (E)(7) of this rule. (5) Staff members employed by a residential care
facility, or part thereof, that admits or retains residents with late-stage
cognitive impairment with significant ongoing daily living assistance needs, or
cognitive impairments with increased emotional needs or presenting behaviors
that cause problems for the resident or other residents, or both, and that
admits or retains residents with diagnoses of serious mental illness, shall
have: (a) Four hours, divided in
equal proportions for each population, of initial training in the care of such
residents within fourteen days of the first day of work; and (b) Eight hours, divided in
equal proportions for each population, of continuing education in the care of
such residents annually. The eight hours of continuing education may count
towards continuing education requirement of paragraph (E)(7) of this
rule (6) Staff members serving special populations not
identified in paragraphs (E)(3) and (E)(4) of this rule shall have:
(a) Two hours of initial
training in the care of such residents within fourteen days of the first day of
work; and (b) Four hours of
continuing education in the care of such residents annually. The four hours of
continuing education may count towards the of continuing education requirement
of paragraph (E)(7) of this rule. (7) Successfully complete at least eight hours of
continuing education annually. (F) Staff members whose job responsibilities will include
providing therapeutic diets, other than special diets, shall be trained by a
dietitian prior to performing this responsibility. (G) The initial training required by paragraphs (E)(3) to (E)(6)
of this rule must be conducted by a qualified instructor for the topic covered.
The annual continuing education requirements of paragraphs (E)(3) to (E)(6) of
this rule may be completed online or by other media provided there is a
qualified instructor present to answer questions and to facilitate discussion
about the topic at the end of the lesson. (H) The administrator
shall: (1) Be licensed as a nursing home administrator
under Chapter 4751. of the Revised Code; or (2) Meet one of the following criteria at the
time of employment: (a) Has three thousand
hours of direct operational responsibility for a senior housing facility,
health care facility, residential care facility, adult care facility or any
other group home licensed or approved by the state; (b) Has successfully
completed one hundred credit hours of post high school education in the field
of gerontology or health care; (c) Holds a baccalaureate
degree; or (d) Is a licensed health
professional as that term is defined in rule 3701-17-07.1 of the Administrative
Code. (3) The administrator shall receive annually at
least nine hours of continuing education in the fields of gerontology, health
care, business administration, or residential care facility operation.
Successful completion of course work at an accredited college or university, or
of courses approved by the following entities, may be used to demonstrate
compliance with this paragraph: (a) The Ohio state bar
association; (b) The Ohio state board of
executives of long-term services and supports; (c) The Ohio state board of
nursing; (d) The Ohio state board of
pharmacy; (e) The Ohio state board of
psychology; (f) The Ohio state medical
board; or (g) Any other
health-related state board organized pursuant to Title 47 of the Revised
Code. (I) The operator or
administrator shall ensure that each staff member, other than a volunteer who
does not provide personal care services, receives and completes orientation and
training applicable to the staff member's job responsibilities within
three working days after beginning employment with the residential care
facility. A staff member shall not stay alone in the residential care facility
with residents until the staff member has received the orientation and training
required under this paragraph and the general staff training in fire control
and evacuation procedures required under paragraph (P) of rule 3701-16-13 of
the Administrative Code. The orientation and training required by this
paragraph shall include at least: (1) The physical layout of the residential care
facility; (2) The staff member's job
responsibilities; (3) The residential care facility's policies
and procedures; (4) How to secure emergency assistance;
and (5) Residents' rights. (J) All individuals used by the residential care facility who
function in a professional capacity shall meet the standards applicable to that
profession, including but not limited to, possessing a current Ohio license,
registration, or certification, if required by law. (K) Each residential care
facility shall provide appropriate staff training to implement each resident
right under division (A) of section 3721.13 of the Revised Code on an annual
basis and additionally as needed. The training required by this rule shall
include, but not be limited to, an explanation of: (1) The residents' rights and the
staff's responsibility in implementation of the rights; and (2) The staff's obligation to provide all
residents who have similar needs with comparable service. (L) No residential care
facility shall employ a person for a position that involves the provision of
direct care to an older adult, if the person: (1) Has been convicted of or pleaded guilty to an
offense listed in division (C)(1) of section 3721.121 of the Revised Code,
unless the individual is hired under the personal character standards set forth
in rule 3701-13-06 of the Administrative Code; (2) Fails to complete the form(s) or provide
fingerprint impressions as required by division (B)(2) of section 3721.121 of
the Revised Code; (3) Is the subject of a finding of abuse or
neglect of a resident or misappropriation of the property of a resident on the
nurse aide registry, established pursuant to section 3721.32 of the Revised
Code; (4) Is the subject of a finding of abuse or
neglect of a resident or misappropriation of the property of a resident on the
nurse aide registry established by another state where the home believes or has
reason to believe the person resides or resided; or (5) Have had a disciplinary action taken against
a professional license by a state licensure body as a result of a finding of
abuse, neglect, mistreatment of residents or misappropriation of resident
property. (M) For purposes of this rule, "annual" means a
calendar year. The training hours required by this rule may be pro-rated from
the employee's date of hire.
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Rule 3701-16-07 | Resident agreement; other information to be provided upon admission; risk agreements.
(A) A residential care facility shall not
admit an individual who requires services or accommodations beyond that which a
residential care facility is authorized to provide under paragraph (D) of rule
3701-16-02 of the Administrative Code or beyond that which the specific
facility provides. (B) A residential care facility shall not
admit a resident prior to searching for the individual on the Ohio sex offender
registry as required by section 3721.122 of the Revised Code. (C) Except for residents receiving
hospice care, no residential care facility shall admit or retain an individual
who: (1) Requires skilled
nursing care that is not authorized by section 3721.011 of the Revised Code or
is beyond that which the specific facility can provide; (2) Requires medical or
skilled nursing care at least eight hours per day or forty hours per
week; (3) Requires chemical or
physical restraints as defined in paragraph (L) of rule 3701-16-09 of the
Administrative Code; (4) Is bedridden with
limited potential for improvement; (5) Has stage III or IV
pressure ulcers. For purposes of this rule, "pressure ulcers" means
any lesion caused by unrelieved pressure, or pressure in combination with shear
and/or friction, which results in damage to the underlying tissue. Pressure
ulcers must be staged in accordance with the "Updated Staging System"
issued by the "National Pressure Ulcer Advisory Panel" (2007);
or (6) Has a medical
condition that is so medically complex or changes so rapidly that it requires
constant monitoring and adjustment of treatment regimen on an ongoing
basis. (D) A residential care facility shall enter into a written
resident agreement with each prospective resident prior to beginning residency
in the residential care facility. The agreement shall be signed and dated by
the operator, administrator, or acting administrator and the prospective
resident or, if the prospective resident is physically or cognitively unable to
sign and consents, another individual designated by the prospective resident.
The facility shall provide both the prospective resident and any other
individual signing on the resident's behalf with a copy of the agreement
and shall explain the agreement to them. (E) The agreement required by paragraph (D) of this rule
shall include at least the following items: (1) An explanation of all
charges to the resident including security deposits, if any are
required; (2) A statement that all
charges, fines, or penalties that shall be assessed against the resident are
included in the resident agreement; (3) A statement that the
basic rate shall not be changed unless thirty days written notice is given to
the resident or, if the resident is unable to understand this information, to
his or her sponsor; (4) An explanation of the
residential care facility's policy for refunding charges in the event of
the resident's absence, discharge, or transfer from the facility and the
facility's policy for refunding security deposits; (5) An explanation of the
services offered by the facility, the types of skilled nursing care that the
facility provides or allows residents to receive in the facility, the providers
that are authorized to render that care, and the limitations of the type and
duration of skilled nursing care that is offered; (6) An explanation of the
extent and types of services the facility will provide to the resident and who
is responsible for payment; and (7) A statement that the
facility must discharge or transfer a resident when a resident needs skilled
nursing care beyond the limitations identified in paragraph (E)(5) of this
rule. (F) Prior to admission or upon the request of a prospective
resident or prospective resident's sponsor, the residential care facility
shall provide the resident or resident's sponsor with a copy and explain
the contents of the following policies: (1) The facility's
residents' rights policy and procedures required by section 3721.12 of the
Revised Code; (2) The facility's
smoking policy required by paragraph (W) of rule 3701-16-13 of the
Administrative Code; (3) The facility's
policy regarding advance directives and an explanation of the rights of the
resident under state law concerning advance directives. A residential care
facility may not require an execution of an advance directive as a condition
for admission; (4) The definition of
skilled nursing care from rule 3701-16-01 of the Administrative
Code; (5) For individuals
seeking residency on a special care unit, the facility's policy on care
for residents in the special care unit. The policy shall include: (a) A statement of mission or philosophy that reflects the
needs of the special population; (b) Admission criteria to the special care unit, including
screening criteria, if applicable; (c) Transfer and discharge criteria and
procedures; (d) A weekly staffing plan for the special care unit, if
applicable, including: (i) A statement of how
this plan differs from the staffing plan for the remainder of the facility;
and (ii) The necessary
increase in supervision, due to decreased safety awareness or other assessed
condition, of residents with cognitive impairments or serious mental illness in
the special care unit; (e) A description of activities offered, including
frequency and type, and how the activities meet the needs of the type of
residents in that special care unit, including how these activities differ from
those offered in the remainder of the facility, if applicable; (f) A listing of the costs of the services provided by the
facility to the resident; (g) Specialized staff training and continuing education
practices; (h) The process used for assessment and the provision of
services, including the method for altering services based on changes in
condition; (i) If necessary, how the facility addresses the behavioral
healthcare needs of residents; (j) The physical environment and design features to support
the functioning of residents; (k) The involvement of families and the availability of
family support programs for residents; and (l) Any services or other procedures that are over and
above those provided in the remainder of the facility, if
applicable; (6) An explanation of the
facility's ability to accommodate disabled residents or potentially
disabled residents and the facility's policy regarding transferring
residents to units that accommodate residents with disabilities;
and (7) Any other facility
policies that residents must follow. (G) A residential care facility may enter into a risk
agreement with a resident or the resident's sponsor with the consent of
the resident. Under a risk agreement, the resident or sponsor and the facility
agree to share responsibility for making and implementing decisions affecting
the scope and quantity of services provided by the facility to the resident.
The facility shall identify the risks inherent in a decision made by a resident
or sponsor not to receive a service provided by the facility. A risk agreement
is valid only if it is made in writing. The residential care facility shall
maintain a copy of any risk agreement in the resident's
record. (H) Each residential care facility that has a policy of
entering into risk agreements shall provide each prospective resident, or the
prospective resident's sponsor with the consent of the resident, a written
explanation of the policy and the provisions that may be contained in a risk
agreement. At the time the information is provided, the facility shall obtain a
statement signed by the individual receiving the information acknowledging that
the individual received the information. The facility shall maintain the signed
statement on file. Any waiver of the resident's rights under section
3721.13 of the Revised Code contained in the risk agreement is
void.
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Rule 3701-16-08 | Resident health assessments.
(A) The residential care facility, in
accordance with this rule shall require written initial and periodic health
assessments of prospective and current residents. The different components of
the health assessment may be performed by different licensed health
professionals, consistent with the type of information required and the
professional's scope of practice, as defined by applicable law. In
conducting the assessment, the licensed health professional may use resident
information obtained by or from unlicensed staff as long as the licensed health
professional evaluates such information in accordance with their applicable
scope of practice. The residential care facility shall ensure that all
components of the assessments required by this rule are completed and that
residents do not require accommodations or services beyond those that the
residential care facility provides. Each residential care facility shall, on an
annual basis, offer to each resident a vaccination against influenza and a
vaccination against pneumococcal pneumonia as required by section 3721.041 of
the Revised Code. (B) Each resident shall be initially
assessed within forty-eight hours of admission, except that paragraphs (C)(11)
and (C)(12) of this rule shall be performed within fourteen days after
admission. If the resident had an assessment meeting the requirements of
paragraph (C) of this rule performed no more than ninety days before beginning
to reside in the residential care facility, the resident is not required to
obtain another initial assessment. (C) The initial health assessment shall
include documentation of the following: (1) Preferences of the
resident including hobbies, usual activities, bathing, sleeping patterns,
socialization and religious; (2) Medical diagnoses, if
applicable; (3) Psychological,
intellectual disabilities, and developmental diagnoses history, if
applicable; (4) Health history and
physical, including cognitive functioning and sensory and physical impairments,
and the risk of falls; (5) Prescription
medications, over-the-counter medications, and dietary
supplements; (6) Nutrition and dietary
requirements, including any food allergies and intolerances, food preferences,
and need for any adaptive equipment, and needs for assistance and supervision
of meals; (7) Height, weight, and
history of weight changes; (8) A functional
assessment which evaluates how the resident performs activities of daily living
and instrumental activities of daily living. For the purposes of this
paragraph, "instrumental activities of daily living" means using the
telephone, acquiring and using public and private transportation, shopping,
preparing meals, performing housework, laundering, and managing financial
affairs; (9) Type of care or
services, including the amount, frequency, and duration of skilled nursing care
the resident needs as determined by a licensed health professional in
accordance with the resident's assessment under paragraph (C) of this
rule; (10) A determination by a
physician or other licensed healthcare professional working within their scope
of practice, as to whether or not the resident is capable of self-administering
medications. The documentation also shall specify what assistance with
self-administration, as authorized by paragraph (F) of rule 3701-16-09 of the
Administrative Code, if any, is needed or if the resident needs to have
medications administered in accordance with paragraphs (G) and (H) of rule
3701-16-09 of the Administrative Code; (11) If skilled care is
provided to the resident by staff members, a determination by a physician or
other licensed healthcare professional working within their scope of practice
of: (a) Whether the resident's personal care needs have
been affected by the skilled nursing care needs, other than the administration
of medication or supervision of special diets; and (b) Whether any changes are required in the manner personal
care services are provided. The individual conducting the assessment shall
establish the extent, if any, of the changes required. (12) If skilled nursing
care is provided to the resident by staff members, the resident's
attending physician or other licensed healthcare professional working within
their scope of practice, shall sign orders documenting the need for skilled
nursing care, including the specific procedures and modalities to be used and
the amount, frequency, and duration. This care shall be provided and reviewed
pursuant to paragraph (B) of rule 3701-16-09.1 of the Administrative
Code. (13) If the resident has
been determined to have medical, psychological, or developmental or
intellectual impairment, the assessment must include: (a) A plan for addressing the resident's assessed
needs; (b) The need for physical environment and design features
to support the functioning of the resident; and (c) The need for increased supervision, due to decreased
safety awareness or other assessed condition. (D) Subsequent to the initial health
assessment, the residential care facility assess each resident's health at
least annually unless medically indicated sooner. The annual health assessment
shall be performed within thirty days of the anniversary date of the
resident's last health assessment. This health assessment shall include
documentation of at least the following: (1) Changes in medical
diagnoses, if any; (2) Updated nutritional
requirements, including any food allergies and intolerances; (3) Height, weight and
history of weight changes; (4) Prescription
medications, over-the-counter medications, and dietary
supplements; (5) A functional
assessment as described in paragraph (C)(8) of this rule; (6) If the resident has
been determined to have medical, psychological, or developmental or
intellectual impairment, an assessment as described in paragraph (C)(13) of
this rule; (7) Type of care or services, including
the amount, frequency, and duration of skilled nursing care, the resident needs
as determined by a licensed health professional in accordance with paragraph
(D) of this rule; (8) A determination by a physician or
other licensed healthcare professional working within their scope of practice,
as to whether or not the resident is capable of self-administering medications.
The documentation also shall specify what assistance with self-administration,
as authorized by paragraph (F) of rule 3701-16-09 of the Administrative Code,
if any, is needed or if the resident needs to have medications administered in
accordance with paragraphs (G) and (H) of rule 3701-16-09 of the Administrative
Code; and (9) If skilled care is provided to the
resident by staff members, a determination by a physician or other licensed
healthcare professional working within their scope of practice,
of: (a) Whether the resident's personal care needs have
been affected by the skilled nursing care needs, other than the administration
of medication or supervision of special diets; and (b) Whether any changes are required in the manner personal
care services are provided. The individual conducting the assessment shall
establish the extent, if any, of the changes required. (E) The residential care facility shall
require each resident's health to be assessed if a change in condition or
functional abilities warrants a change in services or equipment. The assessment
shall include, as applicable, documentation of paragraphs (D)(1) to (D)(9) of
this rule. The facility shall make a good faith effort to obtain information
from residents about assessments independently obtained outside the
facility. (F) Prior to admitting or transferring a
resident to a special care unit that restricts the resident's freedom of
movement, the residential care facility shall ensure that a physician or other
licensed healthcare professional working within their scope of practice, has
made a determination that the admission or transfer to the special care unit is
needed. This determination shall be updated, to include both improvement and
decline, during the periodic reassessment required by paragraph (D) of this
rule. Prior to admission to the special care unit, the residential care
facility shall provide the resident with an updated resident agreement required
by rule 3701-16-07 of the Administrative Code and with the facilitys
policy on care of residents by means of a special care unit required by
paragraph (E)(5) of that rule. No resident shall be admitted to a secured
special care unit based solely on his or her diagnosis. (G) If a resident needs services or accommodations beyond
that which a residential care facility is authorized to provide or beyond that
which the specific facility provides, refuses needed services, or fails to
obtain needed services for which the resident agreed to be responsible under
the resident agreement required by rule 3701-16-07 of the Administrative Code,
the residential care facility shall take the following action: (1) Except in emergency
situations, the residential care facility shall meet with the resident, and, if
applicable, the resident's sponsor and discuss the resident's
condition, the options available to the resident including whether the needed
services may be provided through a medicaid waiver program, and the
consequences of each option; (2) If the lack of needed
services has resulted in a significant adverse change in the resident, the
residential care facility shall seek appropriate intervention in accordance
with paragraph (A) of rule 3701-16-12 of the Administrative Code. If an
emergency does not exist the facility shall provide or arrange for the
provision of any needed services that the resident has not refused until the
resident is discharged or transferred or the resident and the facility have
mutually resolved the issue in a manner that does not jeopardize the
resident's health or the health, safety or welfare of the other residents.
This paragraph does not authorize a facility to provide skilled nursing care
beyond the limits established in section 3721.011 of the Revised Code;
and (3) The residential care
facility shall transfer or discharge the resident in accordance with section
3721.16 of the Revised Code and Chapter 3701-61 of the Administrative Code if
the resident needs skilled nursing care or services beyond what the facility
provides and the residential care facility, based on the meeting with the
resident required by paragraph (G)(1) of this rule, determines that such action
is necessary to assure the health, safety and welfare of the resident or the
other residents of the facility. The residential care facility may retain a
resident who refuses available services if doing so does not endanger the
health, safety, and welfare of other residents and the resident does not
require services beyond that which a facility is authorized to provide under
Chapter 3721. of the Revised Code and rules 3701-16-01 to 3701-16-18 of the
Administrative Code.
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Rule 3701-16-09 | Personal care services; medication administration; resident medications; application of dressings; supervision of therapeutic diets.
(A) For the purposes of this
rule; (1) Personal care
services or skilled nursing care shall be considered to be provided by a
residential care facility if they are provided by a person employed by or
associated with the facility or by another person pursuant to an agreement to
which neither the resident who receives the services nor his or her sponsor is
a party. (2) A residential care
facility may provide the skilled nursing care authorized by paragraphs (J) and
(K) of this rule through the following arrangements as long as the residential
care facility complies with the applicable provisions of this
rule: (a) Qualified staff members of the residential care
facility; or (b) Through agreements or contractual arrangements,
including but not limited to, contracts with a home health agency certified
under Title XVIII of "the Social Security Act", 42 U.S.C. 301, as
amended (1981), or a licensed hospice care program, licensed under Chapter
3712. of the Revised Code. (B) Each residential care facility
shall: (1) Specify in its
policies and the resident agreements, required by rule 3701-16-07 of the
Administrative Code, the extent and types of personal care services it
provides; and (2) Provide personal care
services to its residents who require those services, unless the resident and
the facility have entered into a risk agreement under rule 3701-16-07 of the
Administrative Code or the resident has refused services, and may provide
personal care services to other residents upon request. Nothing in this paragraph shall be construed to
permit personal care services to be imposed upon a resident who is capable of
performing the activity in question without assistance unless requested. (C) If a resident requires certain
personal care services that the residential care facility does not
offer: (1) The facility shall
comply with paragraph (G) of rule 3701-16-08 of the Administrative Code;
and (a) Arrange for or allow the resident to arrange for the
services to be provided; or (b) Transfer the resident to an appropriate setting or
discharge the resident in accordance with section 3721.16 of the Revised Code
and Chapter 3701-61 of the Administrative Code; or (2) The facility and the
resident may enter into a risk agreement in accordance with paragraphs (F) and
(G) of rule 3701-16-07 of the Administrative Code, if the facility has a policy
of entering into such agreements. (D) Each residential care facility shall
ensure that personal care services are provided to residents: (1) In accordance with
acceptable standards of care; (2) By staff members
meeting the training requirements of rule 3701-16-06 of the Administrative
Code; and (3) That meet the needs
of residents as determined in the resident assessments required under rule
3701-16-08 of the Administrative Code and consistent with the resident
agreements under rule 3701-16-07 of the Administrative Code. (E) A residential care facility may
provide for the administration of medication to residents in accordance with
division (B) of section 3721.011 of the Revised Code and this
rule. (1) All medication taken
by residents of residential care facilities shall be self-administered, and
members of the staff of a residential care facility shall not administer
medication to residents, except that medication may be administered in
accordance with division (B) of section 3721.011 of the Revised Code and
paragraphs (G) and (H) of this rule. (2) A residential care
facility may admit or retain an individual requiring medication only if the
individual is capable of taking his or her own medication and biologicals, as
determined in writing by the person's attending physician or other
licensed healthcare professional working within their scope of practice, or if
the facility provides for the administration of medication by: (a) A home health agency certified under Title XVIII of the
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, as amended
(1981); (b) A hospice care program licensed under Chapter 3712. of
the Revised Code; or (c) A member of the staff of the residential care facility
who is qualified to perform medication administration. (F) Staff members may assist with
self-administration of medication by doing any of the following once they have
received training in providing the services, as required by paragraph (E) of
rule 3701-16-06 of the Administrative Code: (1) Remind a resident
when to take medication, and watch to ensure that the resident follows the
directions on the container; (2) Assist a resident in
self-administration of medication by taking the medication from the locked area
where it is stored and handing it to the resident. If the resident is
physically unable to open a container, a staff member may open the container
for the resident. The staff member shall check the name on the prescription
label and verify that the resident's name on the prescription label
corresponds to the resident requesting the medication before handing it to the
resident. The staff member may read the label and directions on the medication
container to the resident upon request. The staff member also may remind the
resident and any other individual designated by the resident when prescribed
medication needs to be refilled. Staff members shall not assist a resident with
self-administration of a prescription medication that belongs to another
resident; (3) Assist a physically
impaired but mentally alert resident such as, but not limited to, a resident
with arthritis, cerebral palsy, or Parkinson's disease, upon that
resident's request, in removing oral or topical medication from containers
and in consuming or applying the medication upon request by or with the consent
of the resident. If the resident is physically unable to place a dose of
medicine to his or her mouth without spilling it, a staff member may place the
dose in a container and place the container to the mouth of the resident. As
used in this paragraph, "topical medication" means: (a) Eye, nose, or ear drops excluding irrigations;
and (b) Medication used in the treatment of a skin condition or
minor abrasion, excluding debriding agents; and (4) Assist a resident
with organizing the resident's medications in a weekly pill organizer if
the resident is able to differentiate between pills and actively participates
in the organization. Nothing in this rule shall be construed to allow staff
members to fill a weekly pill organizer for a resident. (G) Medication shall be administered in
accordance with accepted standards of practice to a resident in a residential
care facility only by the following persons authorized by law to administer
medication: (1) A registered
nurse; (2) A licensed practical
nurse holding proof of successful completion of a course in medication
administration approved by the Ohio board of nursing pursuant to Chapter 4723.
of the Revised Code who shall administer medication only at the direction of a
registered nurse or physician; (3) A physician;
or (4) A person authorized
by law to administer medication. (H) Residential care facilities that
administer medication shall comply with all of the following: (1) No medication shall
be given to any resident unless ordered by a physician or individual authorized
under state law to prescribe medications. Ordered medications shall be
administered unless the resident refuses or the resident exhibits symptoms that
contraindicate medication administration. If a medication is not administered,
the staff member responsible for administering the medication shall document in
the resident's record why the medication was not administered. Telephone
orders shall not be accepted by a person other than a licensed nurse, another
physician or a pharmacist except that a licensed health professional may
receive, document and date medication orders concerning his or her specific
discipline, to the extent permitted by applicable licensing laws. If orders are
given by telephone, they shall be recorded with the prescriber's name and
the date, and the order signed by the person who accepted the order. All
telephone orders shall be signed by the physician who gave the order or other
licensed health professional with prescriptive authority working under the
supervision of or in collaboration with the physician within fourteen days
after the order was given. The residential care facility may accept facsimile
and electronic documentation of orders in accordance with paragraph (B)(4) of
rule 3701-16-09.1 of the Administrative Code; (2) All medications shall
be given only to the individual resident for whom they are prescribed, given in
accordance with the directions on the prescription or the physician's or
other authorized prescriber's orders, and recorded on the resident's
medication record required by paragraph (I)(7) of this rule; (3) The person who
administers the medication shall observe the resident for adverse effects,
contraindications, and medication effectiveness. Such person shall notify the
resident's attending physician or other licensed healthcare professional
working within their scope of practice, of any undesirable effects and document
these effects and the date and time of such notification in the resident's
medication record; (4) Only administer drugs
bearing the American hospital formulary service therapeutic class 4:00,
28:16:08, 28:24:08, or 28:24:92 with the authorization of the attending
physician, after personal examination of the resident and documentation of the
medical condition being treated and reasons for use of the drug and when
necessary to treat a resident's medical condition and to assist the
resident to attain his or her highest practicable physical, mental, and
psychosocial well-being. Drugs used for this purpose are not considered
chemical restraints as defined in paragraph (L) of this rule; and (5) Ohio board of
pharmacy and United States drug enforcement administration
regulations. (I) Residential care facilities that
handle residents' medication shall: (1) Not stock or dispense
medicines or drugs which may be sold only by prescription unless the facility
has in its employ, on either a full-time or part-time supervisory and
consulting basis, a pharmacist registered under Chapter 4729. of the Revised
Code, who will be in complete control of such stock and the dispensing
thereof; (2) Keep all prescription
medications in locked storage areas, including drugs requiring refrigeration,
except medications of residents living in individual units who self-administer
their own medications may be stored in the resident's unit if the resident
and residential care facility take reasonable precautions to prohibit access to
the medications by other residents; (3) Assure that the
labeling of prescription medicine and drugs meet the following
criteria: (a) Every container of medicine and drugs prescribed for a
resident for self-administration or assistance by non-licensed health care
personnel, shall be clearly labeled with the resident's name, the
proprietary or generic name of the medication dispensed and its strength, the
name and address of the dispensing pharmacy, the name or initials of the
dispensing pharmacist, the prescription number, the date dispensed, the name of
the prescribing physician or individual authorized under state law to prescribe
medications, and the instructions for use including any cautions which may be
required by federal or state law. Containers too small to bear a complete
prescription label shall be labeled with at least the prescription number and
the dispensing date and shall be dispensed in a container bearing a complete
prescription label; (b) Medicines and drugs dispensed by a health care facility
pharmacy for administration by a licensed nurse or physician to residents
whereby the medicines and drugs are not in the possession of the resident prior
to administration shall be clearly labeled in accordance with rule 4729-17-10
of the Administrative Code; (c) Not repackage or relabel resident medications;
and (d) Ensure over-the-counter medications that are either
administered by an individual acting within their scope of practice and based
on a prescribers order, or given to residents capable of
self-administration of medication, shall contain a United States food and drug
administration label indicating, in part, the medication's: (i) Name; (ii) Strength; (iii) Quantity; (iv) Accessory
instructions; (v) Lot number;
and (vi) Expiration
date; Over-the-counter medications kept by
residents capable of self-administration do not need to meet the requirements
of this rule. (4) Send a
resident's medication with him or her upon permanent transfer or discharge
or destroy or dispose them with the consent of the resident in accordance with
any applicable state or federal laws and regulations; (5) If controlled
substances are used, order, dispense, administer, and dispose of controlled
substances in accordance with state and federal laws and
regulations; (6) Keep a written list
of all medications prescribed for each resident and shall make a good-faith
effort to keep the list current; and (7) Maintain an
individual medication record for each resident to whom the residential care
facility administers medications in which: (a) Medication orders, including telephone, electronic, and
facsimile orders, are recorded and signed by the prescriber; and (b) All medications are recorded as given, documenting the
name of the medication, date and time given, route of administration, and
signed by the individual administering the medication. (J) Each residential care facility that
provides for the application of dressings in accordance with division (A) of
section 3721.011 of the Revised Code shall: (1) Establish in writing
the services pertaining to the application of dressings that are routinely
managed by the facility. The determination of the type of applications of
dressings that are managed by the facility shall be based on staff education,
staff competence, the amount of staff experience with the listed types of
applications of dressings, and support services available in the
facility; (2) Develop and follow
policies and procedures which assure that the application of dressings are
provided in accordance with acceptable standards of practice; (3) Ensure that the
application of dressings are provided only by individuals authorized under
state law to provide the application of the dressing. Skilled nursing care may
be delegated in accordance with Chapter 4723-13 of the Administrative
Code; (4) Evaluate each
resident at least once every seven days to determine whether the resident
should be transferred to a nursing home or other appropriate health care
setting. The evaluation and determination shall be performed by the appropriate
health care professional and documented in the resident's
record; (5) Document all
applications of dressings that are provided by the residential care facility in
the resident's record. Such documentation shall include, but not be
limited to, treatment and medication orders issued by appropriate licensed
health care professionals when needed to authorize provision of a service and
nurse's notes indicating the nature of the service provided and the
resident's status. The residential care facility may accept facsimile and
electronic orders in accordance with paragraph (B)(4) of rule 3701-16-09.1 of
the Administrative Code; and (6) Ensure that a nurse
coordinates the overall nursing care of each resident who receives applications
of dressings. (K) Each residential care facility that
provides supervision of therapeutic diets shall comply with the applicable
provisions of rule 3701-16-10 of the Administrative Code. The residential care
facility may accept facsimile and electronic documentation of therapeutic diet
orders in accordance with paragraph (B)(4) of rule 3701-16-09.1 of the
Administrative Code; (L) The residential care facility shall
not physically, chemically or through isolation restrain
residents. (1) For the purposes of
this paragraph: (a) "Physical restraint" means, but is not
limited to, any article, device, or garment that interferes with the free
movement of the resident and that the resident is unable to remove easily, a
geriatric chair, or a locked room door; (b) "Chemical restraint" means any medication
bearing the American hospital formulary service therapeutic class 4:00,
28:16:08, 28:24:08, or 28:24:92 that alters the functioning of the central
nervous system in a manner that limits physical and cognitive functioning to
the degree that the resident cannot attain his or her highest practicable
physical, mental, and psychosocial well-being; and (c) "Freedom of movement" means the ability of
the resident to move around within the context of the resident's
functional capacity as assessed by the facility. (2) A residential care
facility's use of the following items for the purposes stated in this
paragraph shall not be construed as physically or chemically restraining a
resident or subjecting a resident to prolonged isolation: (a) Devices that assist a resident in the improvement of
the resident's mental and physical functional status and that do not
restrict freedom of movement or normal access to one's body; (b) Medications that are standard treatment or a documented
exception to standard treatment for the resident's medical or psychiatric
condition which assist a resident in attaining or maintaining the
resident's highest practicable physical, mental, and psycho-social
well-being; (c) Residency in a secured special care unit that restricts
a resident's freedom of movement throughout the facility if; (i) Care and services are
provided in accordance with each resident's individual needs and
preferences, not for staff convenience; (ii) The need for
continued residency in the secured special care unit is reviewed during each
periodic assessment required by rule 3701-16-08 of the Administrative
Code; (iii) The secured special
care unit meets the requirements of the state building and fire codes;
and (iv) Residency on the
secured special care unit is not based solely on the resident's
diagnosis. (d) Not withstanding paragraph (L)(2)(c) of this rule, a
resident may choose to reside in the secured special care unit based upon his
or her specific circumstances, such as if his or her spouse is a resident of
the secured special care unit, or if the only room available in the facility is
on the secured special care unit. A resident who chooses to reside in the
secured special care unit must be able to enter and exit the unit without
assistance.
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Rule 3701-16-09.1 | Skilled nursing care.
(A) Except as provided for in division
(D) of section 3721.011 of the Revised Code, a residential care facility may
admit or retain individuals who require skilled nursing care beyond the
supervision of special diets, application of dressings, or administration of
medication only if the skilled nursing care will be provided on a part-time,
intermittent basis for not more than a total of one hundred twenty days in any
twelve-month period regardless of any transfer or discharge and readmission to
the facility. A part-time, intermittent basis means that skilled nursing care
is rendered for less than eight hours a day or less than forty hours a week.
For the purposes of this provision: (1) The residential care
facility shall use the following criteria in tracking the one hundred and
twenty days of part-time, intermittent skilled nursing care permitted under
this paragraph: (a) Self-care shall not be counted toward the allowable one
hundred twenty days; (b) Services provided by physical and occupational
therapists and assistants licensed under Chapter 4755. of the Revised Code and
speech-language pathologists licensed under Chapter 4753. of the Revised Code
do not constitute skilled nursing care and shall not be counted; (c) Only days on which skilled nursing care is performed
shall be counted toward the allowable one hundred and twenty days;
and (d) Medication administration, supervision of therapeutic
diets or application of dressings shall be counted toward the allowable one
hundred and twenty days, if the residential care facility does not provide for
these services, pursuant to rule 3701-16-09 of the Administrative
Code. (2) Skilled nursing care
may be provided by one or more of the following: (a) A home health agency certified under Title XVIII of the
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as
amended (1981); (b) A hospice care program licensed under Chapter 3712. of
the Revised Code; (c) A member of the staff who is authorized under state law
to provide skilled nursing care. If a resident's condition requires more
skilled nursing care than permitted under this paragraph, the residential care
facility shall transfer or discharge the resident in accordance with section
3721.16 of the Revised Code and Chapter 3701-61 of the Administrative
Code. (B) Each residential care facility that
provides skilled nursing care using staff members shall: (1) Develop and follow
policies and procedures which assure that the skilled nursing care is provided
in accordance with acceptable standards of practice; (2) Ensure that the
skilled nursing care is provided in accordance with accepted standards of
practice only by individuals authorized under state law to provide skilled
nursing care. Skilled nursing care may be delegated in accordance with Chapter
4723-13 of the Administrative Code; (3) Except for residents
receiving medication administration, supervision of special diets, the
application of dressings, or skilled nursing care permitted by paragraph (D) of
this rule, evaluate each resident receiving skilled nursing care at least once
every seven days to determine whether the resident should be transferred to a
nursing home or other appropriate health care setting. The evaluation and
determination shall be performed by the appropriate licensed health care
professional and documented in the resident's record; (4) Document all skilled
nursing care provided by the residential care facility in the resident's
record. Such documentation shall include, but not be limited to, medication and
treatment orders when needed to authorize provision of a service and
nurse's notes indicating the nature of the service provided and the
resident's status. All orders shall be signed and dated by the licensed
health professional who gave the order within fourteen days after the order was
given; (a) Telephone orders shall not be accepted by a person
other than a licensed nurse on duty, another physician or a pharmacist, except
that a licensed health professional may receive, document and date medication
and treatment orders concerning his or her specific discipline for residents
under their care, to the extent permitted by applicable licensing
laws. (b) The residential care facility may accept signed
treatment and medication orders issued by a licensed health professional by
facsimile transmission if the facility has instituted procedural safeguards for
authentication and maintaining confidentiality of the facsimile order, and for
handling the order in an expedient and priority manner. (c) An entry that is an electronic record as defined in
section 3701.75 of the Revised Code may be authenticated by an electronic
signature in accordance with section 3701.75 of the Revised Code. (5) Meet the skilled
nursing care needs of each resident receiving care as determined by the
assessment required under rule 3701-16-08 of the Administrative Code and
consistent with the resident agreement required under rule 3701-16-07 of the
Administrative Code; and (6) Ensure that a nurse
coordinates the overall nursing care of each resident who receives skilled
nursing care from facility staff. (C) In addition to the requirements of
paragraphs (A) and (B) of this rule, each residential care facility that
provides enteral tube feedings on a part-time intermittent basis
shall: (1) Establish in writing
the types of enteral tube feedings that are routinely managed by the facility.
The determination of the types of enteral tube feedings that are provided by
the facility shall be based on staff education, staff competence, the amount of
staff experience with the listed types of enteral tube feedings, and support
services available in the facility; (2) Develop and follow
policies and procedures which assure that enteral tube feedings are prepared
and offered as ordered and that sanitary conditions are maintained in
procurement, storage, preparation, and the administration of the enteral tube
feedings; (3) Document the weight
of the resident and the resident's acceptance and tolerance of the enteral
tube feedings in accordance with policies and procedures developed by the
dietitian and the nurse responsible for the overall nursing care of the
resident; and (4) Provide or arrange
for a dietitian. (D) A residential care facility may admit
or retain an individual who requires skilled nursing care for more than one
hundred twenty days in any twelve-month period only if: (1) The facility has
entered into a written agreement with each of the following: (a) The individual, the individual's sponsor, or
both; (b) The individual's personal physician or other
licensed health professional acting within their applicable scope of practice,
unless either of the following apply: (i) If the provision of
the skilled nursing care is not overseen by the individual's personal
physician, the provider of the skilled nursing care may enter into the
agreement; or (ii) If the individual is
a hospice patient as defined in section 3712.01 of the Revised Code, a hospice
care program licensed under Chapter 3712. of the Revised Code may enter into
the agreement. (2) The written agreement
required by this paragraph includes a statement signed by all parties
acknowledging that they understand the agreement and that the individual's
needs can be met at the facility. The agreement shall not be complete without
this signed statement. Additionally, the agreement shall include all of the
following provisions: (a) That the individual will be provided skilled nursing
care in the facility only if a determination has been made that the
individuals needs can be met at the facility. This determination shall
be made by the residential care facility, the individual's attending
physician, and, if applicable, the provider of the skilled nursing
care; (b) That the individual will be retained in the facility
only if periodic re-determinations are made that the individual's needs
can be met at the facility; (c) That the re-determinations will be made according to a
schedule specified in the agreement and as the resident's condition
requires, but no less frequently than every thirty days, except for hospice
patients whose re-determinations shall be no less frequently than every fifteen
days; (d) Unless the individual is a hospice patient, the
individual's personal physician has determined that the skilled nursing
care the resident or prospective resident needs is routine. For purposes of
this rule, "routine" does not include those conditions listed in
paragraph (B) of rule 3701-16-07 of the Administrative Code; and (e) If the individual is a hospice patient, that the
individual has been given an opportunity to choose the hospice care program
that best meets the individuals needs.
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Rule 3701-16-10 | Dietary services; supervision of therapeutic diets.
(A) Each residential care facility shall
specify in its residential care facility policies and the resident agreements,
required by rule 3701-16-07 of the Administrative Code, the amount and types of
dietary services it provides. The facility shall elect to provide any of the
following: (1) No
meals; (2) One, two, or three
daily meals; (3) Preparation of
special diets other than therapeutic diets; one, two, or three daily meals;
or (4) Preparation and supervision of
therapeutic diets. Each facility that elects to supervise therapeutic diets
shall provide three daily meals and meet the requirements of this chapter of
the Administrative Code for the supervision of therapeutic diets; Each residential care facility that provides
meals shall include a variety of food accommodating religious restrictions and
ethnic and cultural preferences of residents in accordance with the residential
care facility's policy (B) Each residential care facility that
agrees to provide three daily meals for a resident shall make available at
least three nourishing, palatable, attractive and appetizing meals at regular
hours comparable to normal mealtimes in the community. The meals shall be
capable of providing the dietary referenced intake of the "Food and
Nutrition Board" of the "National Academy of Science", be based
on a standard meal planning guide from a diet manual published by a dietitian,
approved by a dietitian, or both. Food shall be prepared and served in a form
that meets the resident's individual needs based on the assessment
conducted pursuant to rule 3701-16-08 of the Administrative Code. There shall
be no more than sixteen hours between the evening meal and breakfast. Each
residential care facility that provides meals shall offer a nourishing snack,
consisting of a choice of beverages and a food item from a basic food group,
after the evening meal. Food substitutes of similar nutritive value shall be
offered to residents who refuse the food served and serving size may be
adjusted according to resident preference. The residential care facility shall
accommodate a resident's preference or medical need to eat at different
intervals. (C) All residential care facilities shall
provide safe drinking water which shall be accessible to residents at all
times. (D) Each residential care facility that
does not provide any meals shall ensure that each resident unit is
appropriately and safely equipped with food storage and preparation appliances
which the facility maintains in safe operating condition or that each resident
has access to an appropriately and safely equipped food storage and preparation
area. Each residential care facility that does not provide any meals shall
permit residents to store and prepare food in a safe manner in their resident
units or in a resident food storage and preparation area. (E) Each residential care facility that
provides one or more meals and that does not permit residents to have food in
their resident units shall make snacks available twenty-four hours a
day. (F) Each residential care facility shall
have a kitchen and other food service facilities that are adequate for
preparing and serving the amount and types of meals the facility agrees to
provide. (G) If applicable, the residential care
facility shall have a food service operation license issued under Chapter
3701-21 of the Administrative Code. (H) Each residential care facility that
provides meals: (1) Shall procure, store, prepare, distribute, and serve
all food in a manner that protects it against contamination and
spoilage; (2) Shall, at all times, maintain a one-week supply of
staple foods and a two-day supply of perishable foods for residents. The amount
of such supplies shall be based on the number of meals the facility provides
daily; (3) Shall plan all menus for meals at least one week in
advance. Food shall vary in texture, color and include seasonal foods.
Residential care facilities shall maintain records of dated menus, including
therapeutic diets, as served, for at least three months. The records shall be
made available to the director upon request and indicate any food substitutions
from the menu; (4) Shall observe, supervise, and assist a resident in
consuming meals if the resident needs observation, supervision, or assistance.
The residential care facility shall ensure that food texture is appropriate to
the individual needs of each resident, except that residential care facility
staff shall not perform syringe feedings; (5) Shall assure that the kitchen and
dining areas are cleaned after each meal and shall: (a) Transport meals in a sanitary manner to prevent
contamination; (b) Provide handwashing facilities, including hot and cold
water, soap and individual paper towels in the food preparation and service
area; (c) Provide and maintain clean and sanitary kitchen and
dining areas and a clean, sanitary and adequate supply of eating and drinking
utensils, pots, and pans for use in preparing, serving, and eating appetizing
meals and snacks; and (d) Place food scraps and trash in garbage cans with
tightfitting lids and bag liners and shall empty garbage cans daily, or more
often if needed. Nondisposable containers shall be cleaned frequently enough to
maintain sanitary conditions. Disposable bags of garbage may be stored outside
only in a non-absorbent container with a close-fitting cover. Liquid wastes
resulting from compacting shall be disposed of as sewage; (6) May provide any format of meal
service, which otherwise meet the requirements of this rule, with input from
residents; and (7) May provide a dining environment as
natural and independent as possible, comparable with eating at home, with
choices from a wide variety of food items tailored to the residents' wants
and needs, which otherwise meet the requirements of this rule. (I) Each residential care facility that elects to prepare
special diets other than therapeutic diets shall: (1) Prepare and provide
the special diets in accordance with the orders of a physician or other
licensed health professional acting within their scope of practice, or a
dietitian; and (2) Adjust special diet
menus as ordered by the resident's attending physician or other licensed
health professional acting within their scope of practice, or a
dietitian. (J) Each residential care facility which elects to
supervise therapeutic diets shall make available three daily meals in
accordance with paragraph (B) of this rule and provide or arrange for a
dietitian to plan, direct and implement dietary services that meet the
residents' nutritional needs and comply with the requirements of this rule
and for residents on therapeutic diets on an ongoing basis: (1) Determine that the
diet ordered is appropriate according to the resident's individual
nutritional assessment; (2) Monitor the
resident's nutritional intake and acceptance of the diet; (3) Evaluate the
home's compliance in the provision of the diet; and (4) Adjust nutritional
assessments and diets as needed. (K) If required by paragraph (J) of this rules, the
dietitian shall oversee, monitor and assist in the training of food service
staff in the preparation and serving of foods for therapeutic diets and consult
quarterly with the food service staff. Trained unlicensed staff, including the
dietary manager, may perform routine tasks that: (1) May be assigned
pursuant to Chapter 4759. of the Revised Code and this rule; and (2) Do not require
professional judgment or knowledge. (L) Residential care facilities shall not administer
parenteral nutrition. A residential care facility may administer enteral tube
feedings on a part-time intermittent basis in accordance with rule 3701-16-09.1
of the Administrative Code. (M) A hospice patient's diet shall be planned by a
dietitian, the hospice program, or both, as appropriate for that
individual.
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Rule 3701-16-11 | Resident life enrichment; finances; pets; laundry.
(A) Each residential care facility shall
encourage residents to participate in social, recreational, and leisure
activities. The residential care facility shall, with consideration given to
resident preferences, provide or arrange for varied activities of sufficient
quantity so that residents' lives may be more meaningful, to stimulate
physical and mental capabilities and to assist residents in attaining their
optimal social, physical, and emotional well-being. The residential care
facility shall provide, at minimum, all of the following: (1) One local daily
newspaper or current community activity brochures and
advertisements; (2) Information about
activities in the community and the availability of transportation to community
activities; and (3) An opportunity for
residents to engage in a variety of activities which may include, but shall not
be limited to, television, crafts, reading, or games. (B) A residential care facility shall not
coerce, induce, or prompt a resident to assign, transfer, give, or sign over to
the facility money, valuables, insurance benefits, property, or anything of
value other than payment for services rendered by the facility. A residential
care facility shall not manage a resident's financial affairs unless
authorized by the resident or a sponsor with power of attorney. Such
authorization shall be in writing and shall be attested to by a witness who is
not connected in any manner whatsoever with the residential care facility or
its administrator. A facility that manages a resident's financial affairs
shall: (1) Maintain accounts
pursuant to division (A)(27)(b) of section 3721.13 of the Revised Code of
resident funds and personal property or possessions deposited for safekeeping
with the facility for use by the resident or resident's sponsor. The
resident has the right to receive, upon written or oral request, an accounting
statement of financial transactions made on the resident's behalf. This
statement shall include a: (a) Complete record of all funds, personal property, or
possessions from any source whatsoever, that have been deposited for
safekeeping with the facility for use by the resident or resident's
sponsor; and (b) Listing of all deposits and withdrawals transacted,
which shall be substantiated by receipts that shall be available for inspection
and copying by the resident or sponsor. (2) Deposit the
resident's funds in excess of one thousand dollars, and may deposit the
resident's funds that are one thousand dollars or less, in an
interest-bearing account separate from any of the facility's operating
accounts. Interest earned on the resident's funds shall be credited to the
resident's account. A resident's funds that are one thousand dollars
or less and have not been deposited in an interest-bearing account may be
deposited in a noninterest-bearing account or petty cash fund. (3) Purchase a surety
bond or otherwise provide assurance satisfactory to the director to assure the
security of all residents' funds managed by the facility. (4) Upon the
resident's transfer, discharge, or death, close all resident accounts,
make a final accounting, and make provisions for the conveyance of any
remaining funds to the resident or the resident's estate. (5) Allow the resident
access to his or her funds during normal bank business hours within the
community. (6) Not require a
resident to allow the facility to manage the resident's financial affairs
as a condition of admission to the facility. (C) Neither the administrator of a
residential care facility nor facility staff may serve as the guardian or
attorney-in-fact of a resident unless related by blood, marriage, or adoption
to that resident. (D) Residents may keep pets if allowed
by facility policy. If a residential care facility allows residents to keep
animals or pets, or has facility pets, the facility shall, in consultation with
a veterinarian licensed to practice veterinary medicine under Chapter 4741. of
the Revised Code, establish and implement a written protocol regarding animals
and pets that protects the health and safety of residents and staff members. At
minimum, the written protocol shall include: (1) An annual physical
examination, including an examination for internal and external
parasites; (2) Vaccinations for
common infectious agents, including rabies; (3) Any other preventive
care necessary to protect the health, safety and rights of
residents; (4) Procedure to follow
if an animal: (a) Bites a person; or (b) Becomes ill or injured; (5) For resident pets, if
the resident is transfered, discharged or otherwise unable to care for the pet,
responsibilities for care of the pet until a family member or sponsor can
retrieve the pet; (6) In the case of a
facility pet, the name of the designated member or members of the staff
responsible for the care of the animal and for maintaining the protocol,
including medical records for the animal; and (7) An evaluation of the
medical needs of residents. (E) The residential care facility shall
specify in the resident agreements required by rule 3701-16-07 of the
Administrative Code what laundry services it provides. The residential care
facility shall launder or assist in arranging for the laundering of all
clothing and bed and bath linen for residents who require laundry services as
described in the resident agreement. The facility may provide a washer and
dryer in the home for residents' use or may provide residents with
transportation to and from a laundromat.
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Rule 3701-16-12 | Changes in residents' health status; incidents; infection control; tuberculosis control plan.
(A) In the event of a significant adverse
change in residents' health status, the residential care facility shall do
all of the following: (1) Take immediate and
proper steps to see that the resident receives necessary intervention
including, if needed, medical attention or transfer to an appropriate medical
facility; (2) Make a notation of
the change in health status and any intervention taken in the resident's
record; (3) Provide pertinent
resident information to the person providing the intervention as soon as
possible; and (4) Notify the sponsor
unless the resident refuses or requests otherwise. (B) As used in this paragraph,
"incident" means any accident or episode involving a resident, staff
member, or other individual in a residential care facility which presents a
risk to the health, safety, or well-being of a resident. In the event of an
incident, the facility shall do both of the following: (1) Take immediate and
proper steps to see that the resident or residents involved receive necessary
intervention including, if needed, medical attention or transfer to an
appropriate medical facility; and (2) Investigate the
incident and document the incident and the investigation. The facility shall
maintain an incident log separate from the resident record which shall be
accessible to the director and shall contain the time, place, and date of the
occurrence; a general description of the incident; and the care provided or
action taken. The facility shall maintain a notation about the incident in the
resident's record. (C) Each residential care facility shall
establish and implement appropriate written policies and procedures to control
the development and transmission of infections and diseases which, at minimum,
shall provide for the following: (1) Individuals working
in the facility shall wash their hands vigorously for ten to fifteen seconds
before beginning work and upon completing work, before and after eating, after
using the bathroom, after covering their mouth when sneezing and coughing,
before and after providing personal care services or skilled nursing care, when
there has been contact with body substances, after contact with contaminated
materials, before handling food, and at other appropriate times; (2) If the residential
care facility provides any laundering services, the facility shall keep clean
and soiled linen separate. Soiled laundry shall be handled as little as
possible. Laundry that is wet or soiled with body substances shall be placed in
moisture-resistant bags which are secured or tied to prevent spillage. Laundry
staff shall wear moisture-resistant gloves, suitable for sorting and handling
soiled laundry, and a moisture-resistant gown or sleeved plastic apron if
soiling of staff members' clothing is likely. The facility shall use
laundry cycles according to the washer and detergent manufacturers'
recommendations. Protective clothing shall be removed before handling clean
laundry; (3) Individuals providing
personal care services or skilled nursing care that may result in exposure to
body substances, shall wear disposable vinyl or latex gloves as a protective
barrier and shall remove and dispose of the used gloves and wash hands before
contact with another resident. If exposed to body substances, the individual
who has been exposed shall wash his or her hands and other exposed skin
surfaces immediately and thoroughly with soap and water. The facility shall
provide follow-up consistent with the guidelines issued by the United States
centers for disease control and prevention for the prevention of transmission
of human immunodefiency virus and hepatitis B virus to health-care and
public-safety workers in effect at the time. Individuals providing personal
care services or skilled nursing care shall wash their hands before and after
providing the services or care even if they used gloves; (4) Place disposable
articles, other than sharp items, contaminated with body substances in a
container impervious to moisture and manage them in a fashion consistent with
Chapter 3734. of the Revised Code. Reusable items contaminated with body
substances shall be bagged, then sent for decontamination; (5) Wear a
moisture-resistant gown or other appropriate protective clothing if soiling of
clothing with body substances is likely; (6) Wear a mask and
protective eye wear if splashing of body substances is likely or if a procedure
that may create an aerosol is being performed; and (7) Ensure that all
hypodermic needles, syringes, lancets, razor blades and similar sharp wastes
are disposed of by placing them in rigid, tightly closed puncture-resistant
containers before they are transported off the premises of the facility, in a
manner consistent with Chapter 3734. of the Revised Code. The residential care
facility shall provide instructions to residents who use sharps on the proper
techniques for disposing of them. For the purposes of this paragraph, "body
substance" means blood, semen, vaginal secretions, feces, urine, wound
drainage, emesis, and any other body fluids that have visible blood in
them. (D) Each residential care facility shall
appoint an individual with knowledge of the facility's infection control
plans to serve as a infection control designee and provide that individuals
name and contact information, including a electronic mail address, on an
electronic system prescribed by the director. (E) Each residential care facility shall
develop and follow a tuberculosis control plan that is based on the home's
assessment of the facility. The control and annual assessment shall be
consistent with the United States centers for disease control and prevention
"Guidelines for Preventing the Transmission of Mycobacterium tuberculosis
in Health Care Settings, 2005," MMWR 2005, Volume 54, No. RR-17. The home
shall retain documentation evidencing compliance with this paragraph and shall
furnish such documentation to the director upon request.
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Rule 3701-16-13 | Building, plumbing, fire and carbon monoxide safety requirements.
(A) The building or buildings in which a
residential care facility is located shall be approved by and have a
certificate of occupancy for the appropriate use group designation issued by
the local certified building department with jurisdiction over the area in
which the building or buildings are located, or by the department of commerce
if there is no local certified building department. In the case of a license
renewal, if any alterations to the buildings have been made since the original
license was issued or the license was last renewed, whichever is later, the
residential care facility shall have a certificate of occupancy for the
residential care facility issued by the department of commerce or a local
certified building department. (B) The plumbing fixtures in a
residential care facility shall conform to the applicable provisions of the
Ohio plumbing code. (C) All plumbing shall be installed in
accordance with the Ohio plumbing code and maintained free of leakage and odors
and have adequate water pressure to reasonably ensure resident health and
safety protection. This includes, but is not limited to, plumbing
in: (1) Water
closets; (2) Service
sinks; (3) Kitchens; (4) Utility
closets; (5) Public and resident
bathrooms; (6) Shower and bathing
areas; and (7) Drinking
fountains. (D) Lavatories, bathing facilities, and
shower facilities shall be provided with pressure balancing thermostatic mixing
devices in accordance with the Ohio plumbing code to prevent unanticipated
changes in hot water temperatures. (E) The water supply for a residential
care facility shall be taken from a public supply, if available. Each
residential care facility using a water source other than a public water system
shall comply with all applicable local and state regulations regarding the
construction, development, installation, alteration, and use of private water
systems. (F) Each residential care facility not
using a public sewage disposal system shall comply with all applicable local
and state regulations regarding the construction, development, installation,
alteration, and use of household sewage disposal systems. (G) Each residential care facility shall
comply with all the applicable state fire code standards of Chapter 1301:7-7 of
the Administrative Code. (H) Each residential care facility shall
be inspected for fire safety in accordance with paragraph (A) of rule
3701-16-04 of the Administrative Code. (I) Each residential care facility shall
provide paths of clear and unobstructed access to egress exits. Additionally,
the propping open of a door through the use of door stops, wedges, or other
devices shall be prohibited. (J) Each residential care facility shall develop and
maintain a written disaster preparedness plan to be followed in case of
emergency or disaster. A copy of the plan shall be readily available at all
times within the residential care facility. Such plan shall include the
following: (1) Procedures for
evacuating all individuals in the residential care facility, which shall
include the following: (a) Provisions for evacuating residents with impaired
mobility; and (b) Provisions for transporting all of the residents of the
residential care facility to a predetermined appropriate facility or facilities
that will accommodate all the residents of the residential care facility in
case of a disaster requiring evacuation of the residential care
facility. (2) A plan for protection
of all persons in the event of fire and procedures for fire control and
evacuation, including a fire watch and the prompt notification of the local
fire authority and state fire marshal's office when a fire detection, fire
alarm, or sprinkler system is impaired or inoperable. For purposes of this
rule, "fire watch" means the process required in the Ohio fire code
for detecting and immediately alerting residents, staff, and the responding
fire department of a fire or other emergency while the building's fire
alarm or sprinkler system is impaired, inoperable or undergoing
testing; (3) Procedures for
locating missing residents, including notification of local law
enforcement; (4) Procedures for
ensuring the health and safety of residents during severe weather situations,
such as tornadoes and floods, and designation of tornado shelter areas in the
facility; and (5) Procedures, as
appropriate, for ensuring the health and safety of residents in residential
care facilities located in close proximity to areas known to have specific
disaster potential, such as airports, chemical processing plants, and railroad
tracks. (K) Each residential care facility shall conduct the
following drills unless the state fire marshal allows a home to vary from this
requirement and the residential care facility has written documentation to this
effect from the state fire marshal: (1) Twelve fire exit
drills, one conducted on each shift at least every three months to familiarize
staff members and residents with signals, evacuation procedures and emergency
action required under varied times and conditions. Fire exit drills shall
include the transmission of a fire alarm signal to the appropriate fire
department or monitoring station, verification of receipt of that signal, and
simulation of emergency fire conditions except that the movement of infirm and
bedridden residents to safe areas or to the exterior of the structure is not
required. Drills conducted between nine p.m. and six a.m. may use a coded
announcement instead of an audible alarm. Residential care facilities that have
an alarm system that is not capable of sending a fire alarm signal if an
audible alarm is not used shall transmit a fire alarm signal and verify receipt
of that signal no more than twelve hours after the coded announcement. Fire
drills shall meet the following requirements. (a) Each staff member shall participate in at least one
fire drill annually. (b) One staff member with knowledge of the disaster
preparedness plan and the fire evacuation routes shall be designated to observe
and evaluate each drill and shall not participate in that drill. (c) Residents capable of self-evacuation shall be actually
evacuated to safe areas or to the exterior of the residential care facility in
at least two fire drills a year on each shift. Movement of non-ambulatory
residents to safe areas or to the exterior of the facility is not
required. (2) At least two disaster
preparedness drills per year, one of which shall be a tornado drill which shall
occur during the months of March through July. (3) The residential care
facility shall reset the alarms after each drill. (L) Each residential care facility shall investigate and
take corrective action for all problems encountered in the drills required
under paragraph (K) of this rule. (M) Each residential care facility shall keep a written
record and evaluation of each fire drill which shall include the date, time,
staff member attendance, method of activation, effectiveness of the drill
procedures, number of individuals evacuated, total time for evacuation, and the
weather conditions during the evacuation, and of each tornado drill. The
records shall also describe any problems encountered and the corrective actions
taken. This record shall be on file in the facility for three
years. (N) Each residential care facility shall post in a
conspicuous place in each section or floor of the residential care facility a
correctly oriented wall-specific floor plan designating room use, locations of
alarm sending stations, evacuation routes and exits, fire alarms and fire
extinguishers, and flow of resident evacuation. (O) The buildings in which a residential care facility is
housed shall be equipped with both an automatic fire extinguishing system and
fire alarm system. Such systems shall conform to standards set forth in rules
4101:1-1 to 4101:1-35 and rules 1301:7-7-01 to 1301:1-7-47 of the
Administrative Code. Records of the installation, testing and maintenance of
both systems shall be kept at the facility and produced for inspection upon
request. (P) All staff members in each residential
care facility shall be trained in fire control and evacuation procedures within
three working days of beginning employment. A staff member shall not stay alone
in the residential care facility with residents until the staff member has
received the training in fire control and evacuation procedures required by
this rule. (Q) Each residential care facility shall provide for annual
training in fire prevention for regularly scheduled staff members on all shifts
to be conducted by the state fire marshal or township, municipal or local
legally constituted fire department. Records of this training shall be kept at
the facility. (R) Each residential care facility shall train all
residents in the proper actions to take in the event of fire, tornado,
disaster, or other emergency. (S) Each residential care facility shall conduct at least
monthly a fire safety inspection which shall be recorded on forms provided by
the department and kept on file in the facility for three years. (T) Each residential care facility
licensed prior to the effective date of this rule with a permanently installed
fuel-burning appliance(s) shall, within twelve months of the effective date of
this rules, install and maintain carbon monoxide alarms or carbon monoxide
detectors in accordance with manufacturer's directions. Carbon monoxide
alarms or carbon monoxide detectors shall be installed in: (1) Each room containing
a permanently installed fuel-burning appliance; and (2) A central location on
every habitable level and in every heating/ventilation/air conditioning zone of
the building. (U) Each residential care facility
licensed on or after the effective date of this rule with a permanently
installed fuel-burning appliance(s) shall install and maintain carbon monoxide
detectors in accordance with manufacturer's directions. Carbon monoxide
detectors shall be installed in: (1) Each room containing
a permanently installed fuel-burning appliance; and (2) A central location on
every habitable level and in every heating/ventilation/air conditioning zone of
the building. (V) For purposes of this
rule: (1) "Carbon monoxide
alarm" means a single- or multiple-station alarm tested to underwriters
laboratory standard 2034, that is intended for the purpose of detecting carbon
monoxide gas and alerting occupants by a distinct audible signal comprising an
assembly that incorporates a sensor, control components, and an alarm
notification appliance in a single unit operated from a power source either
located in the unit or obtained at the point of installation; (2) "Carbon monoxide
detector" means a device tested to underwriters laboratory standard 2075
that is intended to be connected to a carbon monoxide detection system for the
purpose of detecting carbon monoxide gas and alerting occupants by a distinct
and audible signal; (3) "Carbon monoxide
detection system means" a system of devices that consists of a control
panel and circuits arranged to monitor and annunciate the status of carbon
monoxide detectors and to initiate the appropriate response to those signal;
and (4) "Fuel-burning
appliance" means an appliance that emits carbon monoxide as a by-product
of combustion of coal, kerosene, oil, wood, fuel gases or other petroleum or
hydrocarbon products. (W) Smoking shall be permitted only in properly designated
areas which may include resident units with the approval of the administrator.
No staff member, resident of a residential care facility or other persons in
the facility shall be permitted to smoke, carry a lighted cigarette, cigar, or
pipe or use any spark or flame producing device in any room or area in the
facility where oxygen is stored or in use. Approved terminals of a piped oxygen
supply does not constitute storage. "No smoking" signs shall be
posted in areas and on doors of rooms where oxygen is stored or in use. Each
residential care facility shall take reasonable precautions to ensure the
safety of all residents when permitting residents to smoke. Ash trays,
wastebaskets or containers into which burnable materials are placed shall not
be made of materials which are flammable, combustible, or capable of generating
quantities of smoke or toxic gases and shall be used solely for that purpose.
Such containers shall be readily available in all areas where smoking is
permitted. Residential care facilities that allow outdoor resident smoking
shall make accommodations for residents during adverse weather
conditions. (X) Each residential care facility shall maintain all
electrical systems including, but not limited to, cords, switches, lighting
fixtures, and lamps in good, safe operating condition and ensure that
appliances are in good, safe operating condition; (Y) Each residential care facility shall report any
incident of fire, damage due to fire and any incidence of illness, injury or
death due to fire or smoke inhalation of a resident within twenty-four hours to
the office of the state fire marshal and the department on forms provided by
these entities. (Z) Each residential care facility shall maintain written
transfer agreements with other facilities that can meet the needs of residents
who require transfer because their health and safety is or potentially is
adversely affected by conditions in the facility.
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Rule 3701-16-14 | Space requirements.
(A) For purposes of this rule,
"habitable floor area" means the clear floor area of a bedroom or
resident unit and the floor area occupied by the usual room furniture, such as
beds, chairs, sofas, dressers, and tables and does not include areas
partitioned off in the bedroom or resident unit such as closets and toilet
rooms. (B) Each residential care facility shall
provide resident unit space for each resident which meets the following
criteria: (1) Except as provided
for in paragraphs (B)(1)(a) and (B)(1)(b) of this rule, in facilities which
were licensed prior to December 22, 1964, and in continuous operation since
that date, every single-occupancy bedroom shall have a habitable floor area of
not less than eighty square feet and every multi-occupancy bedroom shall have a
habitable floor area of not less than seventy square feet per
person. (a) Resident units added after December 22, 1964, shall
comply with paragraph (B)(2) of this rule; and (b) Any building licensed as a facility on or before
December 22, 1964, that discontinued operating as a facility and later resumed
facility operation shall comply with paragraph (B)(2) of this
rule; (2) For every building or
addition to a building erected or converted to use or initially licensed as a
facility after December 22, 1964, every single-occupancy resident unit shall
have a habitable floor area of not less than one hundred square feet and every
multi-occupancy resident unit shall have a habitable floor area of not less
than eighty square feet per person; (3) No resident unit,
bedroom, or similar division used for sleeping purposes by residents shall be
occupied by more than four residents; (4) A resident unit shall
not be used as a passageway to other areas of the residential care
facility; (5) Each resident shall
have a resident-activated resident call system as defined by paragraph (DD) of
rule 3701-16-01 of the Administrative Code, in good working order that, at
minimum, provides for the transmission of calls from resident rooms and toilet
and bathing facilities and cannot be deactivated from any location except from
where the resident initiated the call, unless the staff is able to communicate
with the resident; (6) Resident units shall
be separated from halls, corridors, and other rooms by permanent
floor-to-ceiling walls. Temporary partitions shall not be used to separate
resident units; (7) Each resident bedroom
shall have a minimum of one window opening to the outside or to an atrium with
a curtain, shade, or other appropriate covering to assure privacy and a screen
if the window is operable; (8) Each residential care
facility shall ensure that each resident unit is equipped with the furnishings
and supplies specified in paragraph (C) of rule 3701-16-15 of the
Administrative Code; and (9) Each residential care
facility shall assign non-ambulatory residents to resident units on a floor
that exits to ground level unless there is an elevator to accommodate movement
of such residents to other floors of the facility. (C) Each residential care facility that
provides meals shall have at least one room or suitable area to be used by
residents for dining purposes that comfortably accommodates the number of
residents to whom the residential care facility provides meals. All furniture
shall be comfortable, safe, and functional. (D) As used in this rule,
"bathroom" means a room or rooms including at least one toilet, one
shower or bathtub, and one sink. Each residential care facility shall provide
at least one toilet, one shower or bathtub, and one sink for every eight
residents living in the residential care facility. Each residential care
facility shall meet the following requirements regarding bathroom
facilities: (1) The bathrooms and all
the facilities therein shall be in good repair, in a clean and sanitary
condition, free from filth and accumulation of waste; (2) Bathrooms and all
fixtures therein shall ensure resident privacy and dignity. Where there are
more than one toilet or more than one bathtub or shower in a bathroom, each
toilet and each bathtub or shower shall be enclosed in such a way as to
maintain the privacy of each resident; (3) Bathrooms shall conform to the Ohio
building code; (4) Bathrooms and all the facilities
therein shall, at all times, be kept in good repair, in a clean and sanitary
condition, and free from filth and accumulated waste, and shall be provided
with a supply of toilet tissue, unless provided by the resident as specified in
the resident agreement. Each hand washing basin shall be provided soap and a
self-draining device or other appropriate dispenser unless provided by the
resident as specified in the resident agreement; (5) Each bathtub and shower shall have
nonskid surfacing and handrails or grab bars. Each residential care facility
shall also provide handrails or grab bars near each toilet in resident units
occupied by individuals who need assistance with activities of daily living or,
if resident units do not have toilets, near a sufficient number of toilets on
each floor of the facility to accommodate such individuals; and (6) Each bathtub, shower, and sink shall
have hot and cold running water. If the residential care facility is in control
of the hot water temperature, the hot water shall be at least one hundred five
degrees fahrenheit and no more than one hundred twenty degrees fahrenheit at
the point of use. If a resident is in control of the hot water temperature in
his or her resident unit, the residential care facility shall ensure that the
hot water is at a safe temperature sufficient to meet the preferences of the
resident. (E) As used in this paragraph,
"toilet room" means a room or rooms conforming to the Ohio building
code, and including a water closet and a lavatory which is located in or
adjacent to the room in which the water closet is located. The residential care
facility shall provide toilet tissue, soap in a self-draining device or other
appropriate dispenser, and individual paper towels or a hand dryer for all
toilet rooms or bathrooms open to staff, visitors, or both.
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Rule 3701-16-15 | Building maintenance, equipment and supplies.
(A) Each residential care facility shall
maintain heating, electrical, and other building service equipment in good
working and safe condition. Each residential care facility shall have its
central heating system checked every two years by a heating
contractor. (B) Each residential care facility shall
maintain a clean, healthy environment by at minimum: (1) Establishing and
implementing housekeeping and maintenance procedures to assure a clean, safe,
sanitary environment; (2) Providing durable
garbage and refuse receptacles to accommodate waste. The residential care
facility shall store all garbage and other refuse in leakproof containers with
tight fitting covers until time of disposal, and dispose all waste in a
satisfactory manner; and (3) Eliminating any
existing insects and rodents and taking effective measures to prevent the
presence of insects and rodents in or around any building used for a
residential care facility or part thereof. The extermination of insects and
rodents shall be done in such a manner as not to create a fire or health
hazard. (C) Unless the resident chooses to bring
his or her own or as specified in the resident agreement, the residential care
facility shall provide each resident with the following bedroom furnishings and
supplies: (1) An individual bed
equipped with springs and a clean comfortable flame resistant mattress or a
clean comfortable mattress with a flame resistant mattress cover. The bed shall
be sturdy, safe, and in good condition. Rollaway beds and cots, double deck
beds, stacked bunk beds, hide-a-bed couches, or studio couches do not meet the
requirements of this rule; (2) Bed linen which shall
include at least two sheets, a pillow and pillow case, a bedspread, and one
blanket that fit properly and are free of tears, holes, and excessive fraying
or wear. The residential care facility shall: (a) Ensure that the mattresses of incontinent residents are
protected with an intact waterproof material unless contraindicated or
otherwise ordered by a physician or other licensed healthcare professional
working within their scope of practice; and (b) Provide each resident with additional blankets and
pillows upon request and ensure that two sets of bed linen are available for
each bed at all times. Residential care facilities shall ensure that bed linen
is changed weekly and more often if soiled or requested by the
resident; (3) Closet or wardrobe
space with a minimum width of twenty-two inches of hanging space sufficient in
height and equipped for hanging full length garments and at least one shelf of
adequate size within reach of the resident; (4) A bedside table,
personal reading lamp, adequate bureau, dresser or equivalent space, a mirror
appropriate for grooming, a waste basket with liners, and a chair with a padded
back and seat, with arms for lateral support. If a resident has a wheelchair,
the wheelchair may meet this requirement unless the resident indicates he or
she wants a comfortable chair in addition to the wheelchair; (5) Bath linen that
includes at least two full towels, two face towels, and two
washcloths; (6) A shower curtain and
appropriate hanging devices; and (7) Basic toiletry items
and paper products. (D) In meeting the requirements of
paragraph (C) of this rule, residential care facilities may allow residents to
provide all or part of the bedroom furnishings and supplies listed under
paragraphs (C)(1) to (C)(7) of this rule if the bedroom furnishings and
supplies meet the requirements of paragraphs (C)(1) to (C)(7) of this rule and
there is sufficient space in the residential care facility. Residents who smoke
shall provide documentation that the mattress they bring to the residential
care facility is flame resistant. Residents shall be permitted to bring
personal furnishings and items in addition to the bedroom furnishings and
supplies listed under paragraphs (C)(1) to (C)(7) of this rule if the personal
furnishings and items do not create a safety hazard or infringe upon the rights
of other residents. (E) A residential care facility shall arrange for the
provision of at least a double size bed, upon request of a married couple or
other consenting adult residents sharing a room in accordance with the
residential care facility's policy, unless there is an overriding
documented medical reason that puts one of the consenting parties at risk of
health and safety or there is a risk to other residents. (F) All residential care facilities shall have the supplies
and equipment necessary to provide the services needed by the residents
admitted to or retained in the facility. The residential care facility shall
keep all equipment and supplies in the facility clean and usable and shall
store it satisfactorily and safely when not in use. (G) Waste baskets or containers in common areas where
burnable materials may be placed shall not be made of materials which are
flammable, combustible or capable of generating quantities of smoke or toxic
gases. (H) Each residential care facility shall provide at least
one non-pay telephone to which residents shall have reasonable access at all
times for making local calls. The telephone shall be provided in a location or
manner which affords privacy. The residential care facility shall arrange for a
method by which residents can make long-distance calls from the residential
care facility at the residents' expense. (I) Each residential care facility also shall meet the
following safety and maintenance requirements: (1) The residential care
facility shall keep floors in good repair. Any rugs used in the facility shall
be secured in a manner that does not create a safety hazard; (2) The residential care
facility shall keep corridors, entrances, exits, fire escape routes and outside
pathways in good repair, free of obstacles, and ice and snow. Buildings that
are constructed or converted for use as residential care facilities after April
1, 2007, must have accessible means of egress that open to a hard surface
leading to a public way; (3) Common areas and
exits shall be well-lighted; (4) The residential care
facility shall store poisonous and hazardous materials in clearly labeled
containers, away from foodstuffs and medication. Poisonous and hazardous
materials shall be stored in accordance with the manufacturer's
instructions and the applicable provisions of the Ohio fire code; (5) If resident units
have locks, the residential care facility shall have duplicate keys or a master
key available and readily accessible at all times to the staff members on duty
or present in the facility for use in case of emergency; (6) The residential care
facility shall maintain first-aid supplies in a closed but unlocked container
which is easily accessible to the administrator and staff; (7) The residential care
facility shall maintain its buildings and grounds in a clean and orderly
manner; and (8) Residential care
facilities shall not require residents or staff members to obtain approval from
the operator, administrator or staff member prior to telephoning for assistance
in the event of an emergency. Each residential care facility shall prominently
display emergency telephone numbers, such as the fire and police department
numbers, at each telephone maintained by the residential care
facility.
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Rule 3701-16-16 | Temperature regulation in residential care facilities.
(A) For the purposes of this
rule: (1) "Resident
area" means any area within a residential care facility that is occupied
at any time by a resident. (2) "Temperature
range" means between seventy-one degrees Fahrenheit and eighty-one degrees
Fahrenheit. (B) Each residential care facility shall
maintain the temperature and humidity in resident areas at a safe and
comfortable level. (C) Residents in rooms containing
separate heating and cooling systems who are capable of controlling them may
maintain the temperature of their rooms at any level they desire except the
residential care facility shall take appropriate intervention if a
resident's desired temperature level adversely affects or has potential
for adversely affecting the health and safety of the resident or the health,
safety and comfort of any other resident sharing the resident
room. (D) Each residential care facility, in
consultation with a physician or an appropriate health care professional acting
within the professional's scope of practice, shall develop written
policies and procedures for responding to temperatures in resident areas that
are outside the temperature range as defined in paragraph (A) of this rule. The
policies and procedures shall include at least the following
items: (1) An identification of
available sites within or outside the residential care facility to which
residents can be relocated temporarily and of other suitable health care
facilities or facilities that provide personal care services that will be
available to receive transfers of residents if the temperature level adversely
affects or has potential for adversely affecting the health and safety of
residents; (2) Measures to be taken
to assure the health, safety and comfort of residents who remain in the
facility when temperatures are outside the temperature range as defined in
paragraph (A) of this rule; and (3) Identification of the
circumstances that require notification of the resident's attending
physician or other licensed healthcare professional working within their scope
of practice, or that require medical examinations or other medical intervention
and appropriate time frames for these actions. (E) Whenever the temperature in any
resident area is outside the temperature range as defined in paragraph (A) of
this rule, the residential care facility immediately shall evaluate the
situation, monitor residents, and take appropriate action to ensure the health,
safety and comfort of its residents, including but not limited to
implementation of the policies and procedures developed under paragraph (D) of
this rule. The residential care facility shall document all action taken under
this paragraph and shall maintain, on site, documentation of action taken
during the current calendar year and during the preceding calendar
year. (F) Each residential care facility shall
maintain appropriate arrangements with qualified persons that provide for
emergency service in the event of an electrical, heating, ventilation or air
conditioning failure or malfunction and shall maintain documentation of the
arrangements such as employment or other written agreements. The residential
care facility shall ensure that all necessary repairs are completed within
forty-eight hours or less. If, for reasons beyond the facility's control,
repairs cannot be completed timely, the residential care facility shall take
any necessary action, as specified in paragraph (E) of this rule, and shall
provide for the repairs to be completed as soon as possible.
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Rule 3701-16-17 | Records and reports.
(A) Each residential care facility shall
maintain records which shall be made available for inspection at all times when
requested by the director, including: (1) An individual record
for each resident which shall be stored in a manner that protects and ensures
confidentiality, except that information shall be immediately accessible for an
emergency; (a) Each resident record shall be started immediately upon
admission to the residential care facility and shall include the
following: (i) The resident's
name, previous address, date of birth, sex, race, religion; the date the
resident began living at the residential care facility; the names, addresses,
and telephone numbers of the resident's attending physician, nearest
relative, guardian, if any, and any other individuals the resident designates
to be contacted, including individuals to be notified in the event of an
emergency. The residential care facility shall not coerce a resident to provide
any of this information; (ii) Copies of the health
assessments required by rule 3701-16-08 of the Administrative
Code; (iii) Notations about
incidents and adverse changes in health status required by rule 3701-16-12 of
the Administrative Code; (iv) The medication
record required by paragraph (I)(7) of rule 3701-16-09 of the Administrative
Code as well as any medicare-D plan, if any, in which the resident is enrolled
and receives prescription medication; (v) Any documentation
required by paragraph (J) of rule 3701-16-10 of the Administrative Code for
residents on therapeutic diets; (vi) The written resident
agreement required by rule 3701-16-07 of the Administrative Code; (vii) The documentation
required by paragraphs (J)(5) of rule 3701-16-09 and (B)(4) and (C)(3) of rule
3701-16-09.1 of the Administrative Code for residents receiving skilled nursing
care provided by the residential care facility; and (viii) A copy of risk
agreements entered into under paragraph (G) of rule 3701-16-07 of the
Administrative Code and the signed statement required under paragraph (H) of
rule 3701-16-07 of the Administrative Code, if applicable; (2) The incident log
required by paragraph (B)(2) of rule 3701-16-12 of the Administrative
Code; (3) Copies of all current
licenses, approvals and inspections required by rules 3701-16-01 to 3701-16-18
of the Administrative Code; (4) A record of the name,
address, working hours, medical statements, and training for staff
members; (5) Documentation of
compliance with rule 3701-16-16 of the Administrative Code; (6) Fire and evacuation
procedures and records of fire drills required by rule 3701-16-13 of the
Administrative Code; (7) Records of heating
system checks required by paragraph (A) of rule 3701-16-15 of the
Administrative Code and fire extinguishing system checks; (8) All records required
by state and federal laws and regulations as to the purchase, dispensing,
administering, and disposition of prescription medications including unused
portions; (9) The residents'
rights policies, procedures and records; and (10) All other records
required by Chapter 3721. of the Revised Code and rules 3701-16-01 to
3701-16-18 of the Administrative Code. (B) All records and reports required by Chapter 3701-13 of
the Administrative Code shall be maintained and made available in accordance
with that chapter. (C) The residential care facility shall maintain those
records: (1) Required by
paragraphs (A)(1) and (A)(2) of this rule, for seven years following the date
of the resident's discharge except if the resident is a minor, such
records shall be maintained for three years past the age of majority but not
less than seven years; and (2) Required by
paragraphs (A)(3) to (A)(10) of this rule, for three years unless otherwise
required by law.
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Rule 3701-16-18 | Variances.
(A) The director may grant a variance
from the requirements of rules 3701-16-01 to 3701-16-18 of the Administrative
Code unless required by statute if the operator or administrator shows that
granting the variance will not jeopardize the health or safety of any resident
and that: (1) Because of practical
difficulties or other special conditions, strict application of the licensure
requirement will cause unusual and unnecessary hardship; or (2) An alternative to the
licensure requirement, including new concepts, methods, procedures, techniques,
or the conducting of pilot projects is in the interest of better health care or
management. No variance shall be granted that will defeat
the spirit and general intent of these rules or otherwise not be in the public
interest. (B) A request for a variance from the
requirements of the residential care facility licensure rules shall be made in
writing to the director, specifying the following: (1) The rule requirement
for which the variance is requested; (2) The time period for
which the variance is requested; (3) The specific
alternative action which the residential care facility proposes; (4) The reasons for the
request; and (5) An explanation of the
anticipated affect granting of the variance will have on
residents; The director may request additional information
from the residential care facility prior to making a determination regarding
the request. (C) The director shall notify the
operator, in writing, of the director's determination regarding a variance
request. The director may establish conditions that the residential care
facility must meet for a variance to be operative, a time frame for which the
variance will be effective, or both. (D) The director shall notify the
operator, in writing, of the director's determination to revoke a granted
variance. The director may revoke a variance if the director determines
that: (1) The variance is
adversely affecting the health and safety of the residents; (2) The residential care
facility has failed to comply with the variance as granted; (3) The operator or
administrator notified the department that the owner or administrator wishes to
relinquish the variance; or (4) The variance
conflicts with a statutory change thus rendering the variance
invalid. (E) The refusal of the director to grant
or revoke a variance or waiver, in whole or in part, shall be final and shall
not be construed as creating any rights to a hearing under Chapter 119. of the
Revised Code.
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