Chapter 3701-17 Nursing Homes

As used in rules 3701-17-01 to 3701-17-26 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 bed mobility, locomotion and transfer, bathing, grooming, toileting, dressing, and eating.

(C) “Administrator” means the individual, licensed as a nursing home administrator under Chapter 4751. of the Revised Code, who is responsible for planning, organizing, directing and managing the operation of the nursing home.

(D) “Adult care facility” means an entity as defined in section 3722.01 of the Revised Code.

(E) “Advanced practice nurse” means a registered nurse approved by the board of nursing as an advance practice nurse under section 4723.55 of the Revised Code, or authorized to practice as a certified nurse specialist, certified registered nurse anesthetist, certified nurse midwife or certified nurse practitioner under section 4723.41 of the Revised Code.

(F) “Call signal system” means a set of devices that are connected electrically, electronically, by radio frequency transmission, or in a like manner that effectively can alert the staff member or members on duty, at the nurses’ station or at another point in the nursing unit, of emergencies or resident needs and that can not be deactivated from any location except from where the resident initiated the call.

(G) “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 highest practicable physical, mental, and psycho-social well-being.

(H) “Department” means the department of health of the state of Ohio.

(I) “Dietitian” means an individual licensed under Chapter 4759. of the Revised Code to practice dietetics.

(J) “Director” means the director of the department of health of the state of Ohio or his duly authorized representative.

(K) “Habitable floor area” means the clear floor area of a room and the floor area occupied by the usual bedroom furniture, such as beds, chairs, dressers, and tables and does not include the floor area occupied by wardrobes unless the wardrobe is of the resident’s own choice and it is in addition to the individual closet space in the resident’s room, and areas partitioned off in the room such as closets and toilet rooms.

(L) “Home” means a home as defined by division (A)(1) of section 3721.01 of the Revised Code.

(M) “Home for the aging” means a home as defined by division (A)(8) of section 3721.01 of the Revised Code.

(N) “Hospice care program” or “hospice” means an entity licensed under Chapter 3712. of the Revised Code.

(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) “Licensed practical nurse” or “LPN” means a person licensed under Chapter 4723. of the Revised Code to practice nursing as a licensed practical nurse.

(Q) “Maximum licensed capacity” means the authorized type and number of residents in a nursing home as determined in rule 3701-17-04 of the Administrative Code.

(R) “Mental impairment” does not mean mental illness as defined in section 5122.01 of the Revised Code or mental retardation as defined in section 5123.01 of the Revised Code.

(S) “Nurse” means a registered nurse or a licensed practical nurse.

(T) “Nurse aide” means an individual as defined in paragraph (A)(3) of rule 3701-17-07.1 of the Administrative Code.

(U) “Nursing home” means a home as defined by division (A)(6) of section 3721.01 of the Revised Code.

(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 duty” means being in the nursing home, awake, and immediately available.

(X) “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.

(Y) “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 rules adopted under section 3721.04 of the Revised Code;

(3) Preparing special diets, other than complex therapeutic diets, for residents pursuant to the instructions of a physician or a licensed dietitian, in accordance with rules adopted under section 3721.04 of the Revised Code.

“Personal care services” does not include “skilled nursing care” as defined in paragraph (II) of this rule.

(Z) “Pharmacist” means an individual licensed under Chapter 4729. of the Revised Code to practice pharmacy.

(AA) “Physically restrained” means that residents are confined or in the home in such a manner that the freedom for normal egress from the home is dependent upon the unlocking or unbolting by others of one or more doors or barriers, or the removal of physical restraints, except as permitted under paragraph (A)(2) of rule 3701-17-15 of the Administrative Code.

(BB) “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.

(CC) “Physician” means an individual licensed under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(DD) “Resident” means an individual for whom the nursing home provides accommodations.

(EE) “Residential care facility” means a home as defined by division (A)(7) of section 3721.01 of the Revised Code.

(FF) “Residents’ rights advocate” means:

(1) An employee or representative of any state or local government entity that has a responsibility regarding residents and that has registered with the department of health under division (B) of section 3701.07 of the Revised Code;

(2) An employee or representative of any private nonprofit corporation or association that qualifies for tax-exempt status under section 501(A) of the “Internal Revenue Code of 1986,” 100 Stat. 2085, 26 U.S.C.A. 1, as amended, and that has registered with the department of health under division (B) of section 3701.07 of the Revised Code and whose purposes include educating and counseling residents, assisting residents in resolving problems and complaints concerning their care and treatment, and assisting them in securing adequate services to meet their needs;

(3) A member of the general assembly.

(GG) “RN” or “registered nurse” means an individual licensed to practice nursing as a registered nurse under Chapter 4723. of the Revised Code.

(HH) “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, such as hypodermically, rectally, or orally, including observation of the resident after receipt of the medication;

(5) Carrying out other treatments prescribed by the physician that involve a similar level of complexity and skill in administration.

(II) “Special diets” means simple diets and calculated diets which have been ordered by a physician.

(1) “Simple diets” means non-complex food regimens including, but not limited to:

(a) No added salt food regimens;

(b) Reduced fat, reduced cholesterol food regimens;

(c) Reduced or no simple sugars food regimens;

(d) Small frequent meals;

(e) Full liquid or clear liquid food regimens for no more than seventy-two hours; and

(f) Simple textural modifications.

(2) “Calculated diets” means complex food regimens which require computation of nutritive values, including, but not limited to:

(a) Diabetic and other nutritive regimens requiring a daily specific kilocalorie level;

(b) Renal nutritive regimens;

(c) Dysphagia nutritive regimens excluding simple textural modifications; and

(d) Any other nutritive regimens requiring a daily maximum or minimum level of one or more specific nutrients, or a specific distribution of one or more nutrients.

(JJ) “Sponsor” means an adult relative, friend, or guardian of a resident who has an interest or responsibility in the resident’s welfare.

(KK) “Supervision” means the monitoring of a resident to ensure that the health, safety, and welfare of the resident is protected.

(LL) “Toilet room” means a room or rooms conforming to the Ohio building code, and including not less than one of each of the following plumbing fixtures: water closet, shower or bathtub and a lavatory which is located in or adjacent to the room in which the water closet is located.

(MM) “Volunteer” means an individual working in or used by a home who does not receive or expect to receive any form of compensation for services the individual performs other than reimbursement for actual expenses.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3701.01 to 3721.33

Prior Effective Dates: 7/1/1973, 12/2/89, 12/21/92, 10/20/2001

(A) All nursing homes shall comply with rules 3701-17-01 to 3701-17-26 of the Administrative Code and the applicable provisions of Chapter 3721. of the Revised Code.

(B) Nothing contained in rules 3701-17-01 to 3701-17-26 of the Administrative Code shall be construed as authorizing the supervision, regulation, or control of the spiritual care or treatment of residents in any nursing home who rely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any recognized church or religious denomination; provided, however, each nursing home shall otherwise comply with rules 3701-17-01 to 3701-17-26 of the Administrative Code, and each resident shall otherwise be provided with the services and care required by such rules.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01, 3721.02, 3721.03, 3721.05, 3721.07

Prior Effective Dates: 3/1/1971, 12/21/92, 10/20/2001

(A) The operator of a nursing home shall pay the fees specified in section 3721.02 of the Revised Code. The application and the fees required under this paragraph shall be submitted to the director and the fees shall be made payable to the “treasurer, state of Ohio” in the form of a check or money order. The department shall deposit the fees in the state treasury to the credit of the general operations fund created by section 3701.83 of the Revised Code, and the fees shall not be refunded.

(B) Every applicant for a license to operate a nursing home shall truthfully and fully complete and submit an application to the director not less than sixty days before the proposed opening of the nursing home. Such application shall be made on a form prescribed and furnished by the director.

(C) The initial application for a license to operate a nursing home shall be accompanied by:

(1) A statement by the applicant of the status of the proposed nursing home under any applicable zoning ordinances or rules, or a statement by the applicant that there is no zoning authority where the proposed home is to be located.

(2) A statement of financial solvency at the time of initial application, on a form prescribed and furnished by the director, showing that the applicant has the financial ability to staff, equip, and operate the nursing home in accordance with Chapter 3721. of the Revised Code, and rules 3701-17-01 to 3701-17-26 of the Administrative Code, and that the applicant has sufficient capital or financial reserve to cover not less than four months’ operation.

(3) A statement of ownership containing the following information:

(a) If the operator is an individual, the individual’s name, address, and telephone number. If the operator is 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 nursing home 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 nursing home and any facility described in divisions (A)(1)(a) and (A)(1)(c) of section 3721.01 of the Revised 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 nursing home, if different from the operator; and

(e) The name, business address and telephone number of any management firm or business employed to manage the nursing home.

(4) Copies of the certificate of occupancy required by paragraph (A) of rule 3701-17-22 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.

(D) The director may request additional information at any time which 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 3701-17-01 to 3701-17-26 of the Administrative Code. The applicant shall submit any additional information requested by the director within sixty days of the director’s request unless the director specifies otherwise.

(E) The license to operate a nursing home shall be issued by the director in accordance with Chapter 3721. of the Revised Code, and shall remain in effect until revoked by the director or voided at the request of the applicant; provided, the annual renewal fee is paid during the month of January of each year. Any nursing home 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 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 nursing home’s license.

(F) A license to operate a nursing home is not assignable or transferable and is valid only for the operator and premises named in the application except as otherwise permitted under section 3721.023 of the Revised Code. If ownership of a home 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.

(G) An operator who operates one or more nursing homes 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 nursing home, such nursing home may be operated under a single license.

(H) The license shall be posted in a conspicuous place in the nursing home.

(I) The director may deny or revoke a license in accordance with Chapter 119. of the Revised Code for violating any of the requirements of Chapter 3721. of the Revised Code or rules 3701-17-01 to 3701-17-26 of the Administrative Code.

(J) A person 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.

(K) When closing a home, the operator shall provide the director written notification of closure at least ninety days prior to the proposed closing date. At the same time, 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 long-term care ombudsperson program, designated under section 173.16 of the Revised Code, serving the area where the home is located.

(L) The nursing home shall include in all official correspondence with the department pertaining to the home, its name, address and license number as it appears on the nursing home license.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.02, 3721.08

Prior Effective Dates: 7/1/1973, 12/21/92, 10/20/2001

(A) The director shall determine the type and number of residents a nursing home can accommodate which shall be the authorized maximum licensed capacity of a nursing home. Such determination shall be made on the basis of the physical facilities, personnel of the nursing home and the services and care needed by the residents to be admitted or retained in the nursing home, and the permitted occupancy approved by the department of commerce.

(B) In determining the number of residents in a nursing home for the purpose of licensing, the director shall consider all the individuals for whom the home provides accommodations as one group unless one of the following is the case:

(1) The home is seeking licensure as a home for the aging, in which case all the individuals in the part or unit licensed as a residential care facility shall be considered as one group and all the individuals in the part or unit licensed as a nursing home shall be considered as another group;

(2) The home is both a nursing home and an adult care facility. In that case, all individuals in the part or unit licensed as a nursing home shall be considered as one group and all the individuals in the part or unit licensed as an adult care facility shall be considered as another group;

(3) The home maintains, in addition to a nursing home, 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 home, 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 home if the separate and discrete part or unit is in compliance with the Ohio building code established by the board of building standards under Chapters 3781. and 3791. of the Revised Code and the home 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 this division;

(4) The home provides an adult day care program on the same site as the home, in which case the participants shall not be considered in determining the number of residents in the home if, except as otherwise permitted in rules 3701-17-01 to 3701-17-26 of the Administrative Code, the program is operated in a separate area which is not part of the licensed home.

(C) If the nursing home alters its physical facilities in a manner that proposes to move existing beds to an area of the home not previously used for this purpose or proposes to add new beds, the home shall notify the director, in writing, at least sixty days prior to the date the home wants to commence filling the new beds or moving existing beds. The home shall not commence filling the new beds or moving existing beds until the director notifies the home, in writing, that the alteration or move complies with the applicable provisions of Chapter 3721. of the Revised Code and rules 3701-17-01 to 3701-17-26 of the Administrative Code.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.011

Prior Effective Dates: 7/1/1973, 12/21/92, 10/20/2001

(A) No nursing home, except a nursing home that is owned and operated by, and physically part of, a hospital registered under section 3701.07 of the Revised Code, may use the word “hospital” in its name or letterhead. Any nursing home that is physically part of a hospital shall inform a prospective resident, prior to admission, that the home is licensed as a nursing home and is not part of the acute care service of the hospital.

(B) No applicant for a license to operate a nursing home shall accept more than two residents, who require skilled nursing care or personal care services, before receiving a license.

(C) No operator, administrator, employee, or other person shall:

(1) Interfere with the inspection of a licensed nursing home by any state or local official who is performing duties required by Chapter 3721. of the Revised Code. All licensed nursing homes shall be open for inspection. As used in this paragraph, “interfere” means to obstruct directly or indirectly any individual conducting an authorized inspection from carrying out his or her prescribed duties. Interference includes, but is not limited to, harassment, intimidation, delay of access to premises or records, and refusal to permit the director or his authorized representative upon presentation of official department identification, for the purpose of inspecting or investigating the operation of a nursing home, to enter and inspect at any time a building or premise where a home is located, or to enter and inspect records which are kept concerning the operation of the home for information pertinent to the legitimate interest of the department including, but not limited to, the records and reports required by rule 3701-17-19 of the Administrative Code.

(2) Use profane or abusive language directed at or in the presence of residents or the director or his authorized representatives.

(3) Set up beds for resident use in a nursing home which exceeds the authorized maximum licensed capacity.

(4) Knowingly falsify records, or misrepresent information to the director.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.19

Prior Effective Dates: 11/15/1976, 9/30/88, 12/21/92, 10/20/2001

(A) The operator is responsible for the operation of the nursing home, for payment of the annual license renewal fee to the director, for such reports as may be required, and for compliance with Chapter 3721. of the Revised Code, Chapters 3701-13 and 3701-61, and rules 3701-17-01 to 3701-17-26 of the Administrative Code, and all federal, state, and local laws applicable to the operation of a nursing home.

(B) Each operator shall appoint an administrator. The administrator is responsible for the day-to-day operation of the nursing home in accordance with rules 3701-17-01 to 3701-17-26 of the Administrative Code, for implementing the provisions of section 3721.12 of the Revised Code, and for ensuring that individuals used by the home are competent to perform their job responsibilities and that services are provided in accordance with acceptable standards of practice.

(C) Each nursing home shall establish and maintain a quality assurance committee consisting of the director of nursing, the medical director or physician designee and at least three other members of the home’s staff.

(1) The quality assurance committee shall meet at least quarterly to systematically monitor and evaluate the quality of care and quality of life provided in the home, review and investigate incidents and accidents that have occurred in the home, including, but not limited to, those related to the use of restraints as required by rule paragraph (H) of rule 3701-17-15 of the Administrative Code, identify problems and trends, and develop and implement appropriate plans of action to correct identified problems.

(2) The records of the quality committee meetings are not required to be disclosed to the director. The director shall verify through interviews with committee members and, as necessary, direct care staff that the home has a quality assurance committee which addresses quality concerns, that staff know how to access that process, and that the committee has established a protocol or method for addressing specific quality problems in the nursing home that the home believes to have now been resolved.

(3) Good faith attempts by the committee to identify and correct quality deficiencies will not be used as a basis for sanctions.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.33

Prior Effective Dates: 3/1/1971, 12/21/92, 9/5/97, 10/20/2001

(A) Every nursing home administrator shall be licensed pursuant to Chapter 4751. of the Revised Code, unless specifically exempted from licensing under that chapter.

(B) No person with a disease which may be transmitted in the performance of the person’s job responsibilities shall work in a nursing home during the stage of communicability unless the person is given duties which minimize the likelihood of transmission.

(C) No person shall work in a nursing home under either of the following circumstances:

(1) Under the influence of alcohol, intoxicants illegal drugs; or

(2) When the person is using medications to the extent that the use adversely affects the performance of his or her duties or the health or safety of any resident of the home.

(D) Except as provided in paragraph (D)(3) of this rule, no individual shall work in a nursing home in any capacity for ten or more hours in any thirty-day period unless the individual:

(1) Has been tested for tuberculosis in accordance with this paragraph.

The required tuberculosis test shall include a two-step mantoux skin test using five tuberculin units of purified protein derivative or, if the individual has a documented history of a significant mantoux skin test, a chest x-ray.

(a) The individual shall not have any resident contact until after the results of the first skin test have been obtained and recorded in millimeters of induration. If the first step is nonsignificant, a second step shall be performed at least seven but not more than twenty-one days after the first step was performed. Only a single Mantoux is required if the individual has documentation of either a single step Mantoux test or a two-step Mantoux test within one year of commencing work;

(b) If the Mantoux testing performed pursuant to paragraph (D)(1)(a) of this rule is nonsignificant, a single Mantoux test shall be repeated annually within thirty days of the anniversary date of the most recent testing.

(c) If either step of the Mantoux test is significant, the individual shall have a chest x-ray and shall not enter the home until after the results of the chest x-ray have been obtained and the individual is determined to not have active pulmonary tuberculosis. Whenever a chest x-ray is required by paragraph (D) of this rule, a new chest x-ray need not be performed if the individual has had a chest x-ray no more than thirty days before the date of the significant Mantoux test. Additional Mantoux testing is not required after one medically documented significant test. A subsequent chest x-ray is not required unless the individual develops symptoms consistent with active tuberculosis.

(d) If the chest x-ray does not indicate active pulmonary tuberculosis, but there is evidence of a significant Mantoux test, the nursing home shall require that the individual be evaluated and considered for preventive therapy. Thereafter, the nursing home shall require the individual to report promptly any symptoms suggesting tuberculosis The nursing home shall maintain a listing of individuals with evidence or a history of conversion and annually document the presence or absence of symptoms in such an individual and maintain this documentation on file; and

(e) If the chest x-ray reveals active pulmonary tuberculosis, the nursing home shall not permit the individual to enter the home until the appropriate local public health authority determines the individual is no longer infectious.

(2) Has been examined within thirty days before commencing work, or on the first day of work, by a physician or other licensed health professional acting within their applicable scope of practice and certified as medically capable of performing his or her prescribed duties. This paragraph does not apply to volunteers.

(3) The nursing home may allow volunteers to work in the home for less than ten days within one thirty day period without being tested for tuberculosis pursuant to paragraph (D)(1) of this rule, if the nursing home:

(a) Assesses the volunteer for signs and symptoms of tuberculosis; and

(b) Ensures that a volunteer assessed as having signs and symptoms is not permitted to enter the home until the volunteer meets the requirements of paragraph (D)(1) of this rule.

The nursing home shall require a volunteer who continues to work in the home for ten or more days within one thirty day period or for more than ten hours during any subsequent thirty day period to meet the tuberculosis testing requirements of paragraph (D)(1) of this rule.

(4) Operators shall retain documentation evidencing compliance with this paragraph and shall furnish such documentation to the director upon request.

(E) Employees of temporary employment services or, to the extent applicable, paid consultants working in a nursing home, shall have medical examinations and tuberculosis tests in accordance with paragraph (D) of this rule, except that a new tuberculosis test and medical certification are not required for each new assignment. Each nursing home in which such an individual works shall obtain verification of the medical certification and the Mantoux test result, as applicable, from the employment agency or consultant before the individual begins work and shall maintain this documentation on file.

(F) Individuals used by an adult day care program provided by and on the same site as the nursing home shall have medical examinations and tuberculosis tests in accordance with paragraph (D) of this rule if the adult day care program is located or shares space within the same building as the nursing home or if there is a sharing of staff between the nursing home and adult day care program.

(G) The individual required by paragraph (A) of rule 3701-17-09 of the Administrative Code to direct the activities program shall meet one of the following qualifications:

(1) Has two years of experience in a social or recreational program within five years preceding the date of hire, one year of which was full-time in a resident activities program in a health care setting;

(2) Is licensed as an occupational therapist under Chapter 4755. of the Revised Code;

(3) Is licensed as an occupational therapy assistant under Chapter 4755. of the Revised Code;

(4) Is certified by a nationally recognized accrediting body as a therapeutic recreation specialist or activities professional; or

(5) Has successfully completed training covering activities programming from a technical or vocational school, college, university, or other educational institution, and has one year of experience in recreational or activities services. Commencing one hundred and eighty days after the effective date of this rule, the minimum amount of training needed to meet this requirement shall be ninety hours.

(H) A food service manager designated pursuant to paragraph (K) of rule 3701-17-18 of the Administrative Code shall have successfully completed a certification in food service course approved by the director in accordance with rule 3701-21-25 of the Administrative Code. Individuals serving as food service managers on the effective date of this rule have one year from the rule effective date to comply with this provision.

(I) All individuals used by the nursing home 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.

(J) The operator or administrator shall ensure that each staff member, consultant and volunteer used by the nursing home receives orientation and training to the extent necessary to perform their job responsibilities prior to commencing such job responsibilities independently. The orientation and training shall include appropriate orientation and training about residents rights, the physical layout of the nursing home, the applicable job responsibilities, the home’s policies and procedures applicable to assuring safe and appropriate resident care, emergency assistance procedures, and the disaster preparedness plan.

(K) Except as provided in Chapter 3701-13 of the Administrative Code, no nursing home shall employ a person who applies on or after January 27, 1997, 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; or

(2) Fails to complete the form(s) or provide fingerprint impressions as required by division (B)(3) of section 3721.121 of the Revised Code.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.33

Prior Effective Dates: 3/1/1971, 12/21/92, 9/5/97, 10/20/2001

(A) For the purposes of this rule:

(1) “Licensed health professional” means all of the following:

(a) An occupational therapist or occupational therapy assistant licensed under Chapter 4755. of the Revised Code;

(b) A physical therapist or physical therapy assistant licensed under Chapter 4755. of the Revised Code;

(c) A physician as defined in section 4730.01 of the Revised Code;

(d) A physician’s assistant for whom a physician holds a valid certificate of registration issued under section 4730.04 of the Revised Code;

(e) A registered nurse, including those authorized to practice in an advance practice role, or a licensed practical nurse licensed under Chapter 4723.

of the Revised Code;

(f) A social worker or independent social worker licensed, or social work assistant certified under Chapter 4757. of the Revised Code;

(g) A speech pathologist or audiologist licensed under Chapter 4753. of the Revised Code;

(h) A dentist or a dental hygienist licensed under Chapter 4715. of the Revised Code;

(i) An optometrist licensed under Chapter 4725. of the Revised Code;

(j) A pharmacist licensed under Chapter 4729. of the Revised Code;

(k) A psychologist licensed under Chapter 4732. of the Revised Code;

(l) A chiropractor licensed under Chapter 4734. of the Revised Code;

(m) A nursing home administrator licensed or temporarily licensed under Chapter 4751. of the Revised Code;

(n) A dietitian licensed under Chapter 4759. of the Revised Code;

(o) A respiratory care professional licensed under Chapter 4761. of the Revised Code; and

(p) A massage therapist licensed under section 4731.17 of the Revised Code.

(2) “Long-term care facility” or “facility” means either of the following:

(a) A nursing home as defined in section 3721.01 of the Revised Code, other than a nursing home or part of a nursing home certified as an intermediate care facility for the mentally retarded under Title XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended; or

(b) A facility or part of a facility that is certified as a skilled nursing facility or a nursing facility under Title XVIII or XIX of the Social Security Act.

(3) “Nurse aide” means an individual who provides nursing and nursing-related services to residents in a long-term care facility, other than a licensed health professional practicing within the scope of his or her license or an individual who provides nursing or nursing-related services as a volunteer without monetary compensation.

(4) “Nursing and nursing-related services” when performed by a nurse aide in a long term care facility, means activities including attending to the personal care needs of residents, and providing personal care services and activities delegated by a nurse which may include implementation of portions of the nursing regimen, as defined in section 4723.01 of the Revised Code, for residents whose care does not require nursing assessment or the judgment of a nurse during the performance of the delegated activity. Nursing and nursing-related services does not include activities that are part of the nursing regimen which require the specialized knowledge, judgment, and skill of a registered nurse or the application of the basic knowledge and skill required of a licensed practical nurse licensed under Chapter 4723. of the Revised Code or any other activities that are required to be performed by a licensed nurse under Chapter 4723. of the Revised Code. [“]Nursing and nursing-related services” does not include assisting residents with feeding when performed by a dining assistant pursuant to rule 3701-17-07.2 of the Administrative Code.

(5) To “use an individual as a nurse aide” means to engage the individual to perform nursing and nursing-related services in and on behalf of a long-term care facility.

(B) No long-term care facility shall use an individual as a nurse aide for more than four months unless the individual is competent to provide the services he or she is to provide; the facility has received from the nurse aide registry, established under section 3721.32 of the Revised Code, the information concerning the individual provided through the registry; and one of the following is the case:

(1) The individual was used by a facility as a nurse aide on a full-time, temporary, per diem, or other basis at any time during the period commencing July 1, 1989, and ending January 1, 1990, and successfully completed, not later than October 1, 1990, a competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code, and former rule 3701-18-07 of the Administrative Code, in effect prior to October 1, 1990;

(2) The individual either has successfully completed a training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code or has satisfied the requirements of paragraph (B)(2)(a) and (B)(2)(b) of this rule and, in either case, also has completed successfully the competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code. An individual shall be considered to have satisfied the requirement of having successfully completed a training and competency evaluation program approved by the director if the individual meets both of the following:

(a) The individual, as of July 1, 1989, completed at least sixty hours divided between skills training and classroom instruction in the topic areas described in divisions (B)(1) to (B)(8) of section 3721.30 of the Revised Code; and

(b) The individual received, as of that date, at least the difference between seventy-five hours and the number of hours actually spent in training and competency evaluation in supervised practical nurse aide training or regular in-service nurse aide education. For an individual to satisfy the requirements of this paragraph, the combination of skills training, classroom instruction, supervised practical nurse aide training and in-service nurse aide education shall have addressed the topic areas and subject matter components prescribed by former rule 3701-18-07 of the Administrative Code and its appendix in effect at the time of the determination.

(3) Prior to July 1, 1989, if the long-term care facility is certified as a skilled nursing facility or a nursing facility under Title XVIII or XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended, or prior to January 1, 1990, if the facility is not so certified, the individual completed a program that the director determines included a competency evaluation component no less stringent than the competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code and former rule 3701-18-07 of the Administrative Code in effect at the time of the determination and was otherwise comparable to the training and competency evaluation programs being approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code;

(4) The individual is listed in a nurse aide registry maintained by another state and that state certifies that its program for training and evaluation of competency of nurse aides complies with Titles XVIII and XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended, and regulations adopted thereunder;

(5) Prior to July 1, 1989, the individual was found competent to serve as a nurse aide after the completion of a course of nurse aide training of at least one hundred hours’ duration. The determination of competency shall have been made by the director or by an instructor of the course of nurse aide training;

(6) The individual is enrolled in a prelicensure program of nursing education approved by the board of nursing or by an agency of another state that regulates nursing education, has provided the long-term care facility with a certificate from the program indicating that the individual has successfully completed the courses that teach basic nursing skills including infection control, safety and emergency procedures and personal care, and has successfully completed the competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code; or

(7) The individual has the equivalent of twelve months or more of full-time employment in the preceding five years as a hospital aide or orderly and has successfully completed a competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code.

Before allowing an individual to serve as a nurse aide for more than four months in accordance with this paragraph, a facility shall receive registry verification that the individual has met the competency requirements under this paragraph unless the individual can prove that he or she has recently met the requirements and has not yet been listed on the registry. In the event that an individual has not yet been listed on the registry, facilities shall follow up by contacting the nurse aide registry to ensure that such an individual actually becomes listed on the registry. Once the facility receives written registry verification, it shall maintain such verification on file.

(C) During the four month period provided for in paragraph (B) of this rule, during which a long-term care facility may, subject to paragraph (H) of this rule, use as a nurse aide an individual who does not have the qualifications specified in paragraphs (B)(1) to (B)(7) of this rule, a facility shall require the individual to participate in one of the following:

(1) If the individual has successfully completed a training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code, a competency evaluation program conducted by the director;

(2) If the individual is enrolled in a prelicensure program of nursing education described in paragraph (B)(6) of this rule, and has completed or is working toward completion of the courses described in that paragraph, or the individual has the experience described in paragraph (B)(7) of this rule, a competency evaluation program conducted by the director; or

(3) A training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and, in addition, the competency evaluation program conducted by the director under division (D) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code.

(D) No long-term care facility shall continue for longer than four months to use as a nurse aide an individual who previously met the requirements of paragraph (B) of this rule but since most recently doing so has not performed nursing and nursing-related services for monetary compensation for twenty-four consecutive months, unless the individual successfully completes additional training and competency evaluation by complying with paragraphs (D)(1) and (D)(2) of this rule:

(1) Doing one of the following:

(a) Successfully completing a training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code;

(b) Successfully completing a training and competency evaluation program described in paragraph (B)(4) of this rule; or

(c) Meeting the requirements specified in paragraph (B)(6) or (B)(7) of this rule; and (2) In the case of an individual who is described in paragraph (D)(1)(a) or (D)(1)(c) of this rule, successfully completing the competency evaluation program conducted by the director under division (D) of section 3721.31 of the Revised Code and the applicable rules under Chapter 3701-18 of the Administrative Code.

(E) During the four-month period provided for in paragraph (D) of this rule during which a long-term care facility may, subject to paragraph (H) of this rule, use as a nurse aide an individual who does not have the qualifications specified in paragraphs (D)(1) and (D)(2) of this rule, a facility shall require the individual to participate in one of the following:

(1) If the individual has successfully completed a training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code, a competency evaluation program conducted by the director;

(2) If the individual is enrolled in a prelicensure program of nursing education described in paragraph (B)(6) of this rule and has completed or is working toward completion of the courses described in that paragraph or the individual has the experience described in paragraph (B)(7) of this rule, a competency evaluation program conducted by the director; or

(3) A training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code and, in addition, the competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code.

(F) For the purposes of paragraphs (C) and (E) of this rule, an individual shall be considered to be participating in a training and competency evaluation program or a competency evaluation program, as applicable, if, at minimum, the individual has a document signed by a representative of the program attesting that the individual is scheduled to attend the program.

(G) The four month periods provided for in paragraphs (B) and (D) of this rule include any time, on or after June 1, 1990, that an individual is used as a nurse aide on a full time, temporary, per diem or other basis by the facility or any other long-term care facility.

(H) A long-term care facility shall not permit an individual used by the facility as a nurse aide while participating in a training and competency evaluation program to provide nursing and nursing-related services unless both of the following are the case:

(1) The individual has completed the number of hours of training that he or she must complete prior to providing services to residents as prescribed by paragraph (A)(4) of rule 3701-18-05 of the Administrative Code through the program in which the individual is enrolled; and

(2) The individual is under the personal supervision of a registered or licensed practical nurse licensed under Chapter 4723. of the Revised Code.

An individual used by a long-term care facility as a nurse aide while participating in a training and competency evaluation program shall wear a name pin at all times that clearly indicates that the individual is a trainee. As used in this paragraph, “personal supervision” means being present physically on the floor where the individual is providing services, being available at all times to respond to requests for assistance from the individual, and being within a distance which allows the nurse periodically to observe the individual providing services.

(I) No long-term care facility shall impose on a nurse aide any charge for participation in any competency evaluation program or training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code or conducted by the director under division (C) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code, including any charge for textbooks, other required course materials or a competency evaluation.

(J) No long-term care facility shall require that an individual used by the facility as a nurse aide or seeking employment as a nurse aide pay or repay, either before or while the individual is employed by the facility or when the individual leaves the facility’s employ, any costs associated with the individual’s participation in a competency evaluation program or training and competency evaluation program approved or conducted by the director.

(K) In addition to competency evaluation programs and training and competency evaluation programs required by this rule, each long-term care facility shall provide all of the following to each nurse aide it uses:

(1) An orientation program that includes at least an explanation of the organizational structure of the facility, its policies and procedures, its philosophy of care, a description of its resident population, and an enumeration of its employee rules. The orientation program shall be of sufficient duration to cover the topics enumerated in this paragraph adequately in light of the size and nature of the facility, its resident population, and the anticipated length of employment of the nurse aide. The orientation program for nurse aides permanently employed by the long-term care facility shall be at least three hundred and sixty minutes in length to occur during the first forty hours worked, with one hundred and eighty minutes occurring before the nurse aide has any resident contact;

(2) Regular performance review to assure that individuals working in the facility as nurse aides are competent to perform the nursing and nursing-related services they perform. Performance reviews shall be conducted at least ninety days after the nurse aide completes successfully the competency evaluation program conducted by the director under division (C) of section 3721.31 of the Revised Code and the applicable rules of Chapter 3701-18 of the Administrative Code or commences work in the facility and annually thereafter. The performance review shall consist, at minimum, of an evaluation of the nurse aide’s working knowledge and clinical performance and shall be conducted by the aide’s immediate supervisor or a nurse designated by the facility to conduct the performance evaluations. The facility shall maintain a written record of each performance review; and

(3) Regular in-service education, both in groups and, as necessary in specific situations, on a one-to-one basis, based on the outcome of performance reviews required by paragraph (K)(2)(a) of this rule. For the purposes of this provision, “specialty unit” means a discrete part of the nursing home that houses residents who have common specialized care needs, including, but not limited to, dementia care, hospice care, and mental health care units.

(a) Formal in-service education shall include an instructional presentation and may include skills demonstration with return demonstration and in-service training. In-service training may be provided on the unit as long as it is directed toward skills improvement, is provided by trained individuals and is documented.

(b) In-service education shall be sufficient to ensure the continuing competence of nurse aides and address areas of weakness as determined in nurse aides’ performance reviews and shall address the special needs of residents as determined by the facility staff. It also shall include, but is not limited to, training for nurse aides providing nursing and nursing-related services to residents with cognitive impairment. The in-service education for nurse aides working in specialty units shall address the special needs of the residents in the unit.

(c) The facility shall assure that each nurse aide receives at least twelve hours of formal in-service education each year and that each nurse aide who works in a specialty unit receives sufficient additional hours of training each year to meet the special needs of the residents of that specialty unit. In-service education may be obtained through web-based training programs. For purposes of this paragraph, the year within which a nurse aide must receive continuing education is calculated based on the commencement of employment.

(d) The facility shall maintain a written record of each formal in-service session which shall include a description of the subject matter, the identity of the individual or individuals providing the in-service education, a list of the nurse aides and other individuals attending the session that is signed by each attendee and the duration of the session.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04, 3721.28, 3721.29

Rule Amplifies: 3721.21, 3721.28, 3721.29, 3721.31

Prior Effective Dates: 12/29/1989, 5/14/90, 12/26/92, 10/20/2001, 5/17/04

(A) For purposes of this rule:

(1) “Long term care facility” has the same meaning as in rule 3701-17-07.1 of the Administrative Code.

(2) “Dining assistant” means an individual who meets the requirements specified in this rule and who is paid to feed long term care facility residents by a long term care facility or who is used under an arrangement with another agency or organization.

(3) “Supervision” means that the nurse is in the unit where the feeding assistance is furnished and is immediately available to provide help in an emergency.

(4) “Suspension of approval” means that a dining assistant training course is prohibited from providing training to individuals under this rule until the suspension is lifted pursuant to paragraph (K) of this rule.

(5) “Withdrawal of approval” means that a dining assistant training course is no longer eligible to provide training under this rule, but does not prohibit the submission of a new application for approval.

(B) A long term care facility may use dining assistants to feed residents who, based on the charge nurse’s assessment of the resident and the most recent resident assessment performed pursuant to rule 3701-17-10 of the Administrative Code and plan of care developed pursuant to rule 3701-17-14 of the Administrative Code, meet the following conditions:

(1) Need assistance or encouragement with eating and drinking;

(2) Do not have a complicated feeding problem, such as the need for tube or parenteral feeding, recurrent lung aspirations or difficulty swallowing that requires assistance with eating and drinking by a registered nurse, licensed practical nurse, or nurse aide.

(C) If a facility uses a dining assistant the facility must ensure that the dining assistant meets the following requirements:

(1) Except as provided in paragraph (D) of this rule, has successfully completed a dining assistant training course approved by the director as specified in paragraph (G) of this rule;

(2) Is not 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; and

(3) Performs duties only for residents who do not have a complicated feeding problem, and under the supervision of a registered nurse or licensed practical nurse.

(D) A person who has successfully completed a training course for dining assistants and has not worked in a long term care facility as a dining assistant for a period of twelve consecutive months shall not be used as a dining assistant in a long term care facility until the person successfully retakes the training course. The facility must maintain a record of all individuals, used by the facility as dining assistants.

(E) The training course for dining assistants shall provide a combined total of at least ten hours of instruction, including a one hour clinical portion. The clinical portion shall be provided for no more than eight participants at one time. The training course shall follow the curriculum specified in the appendix attached to this rule and address the following topics:

(1) Feeding techniques;

(2) Assistance with feeding and hydration, including the use of assistive devices;

(3) Communication and interpersonal skills;

(4) Appropriate responses to resident behavior;

(5) Safety and emergency procedures, including the Heimlich maneuver;

(6) Infection control;

(7) Residents rights;

(8) Recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse;

(9) Special diets;

(10) Documentation of type and amount of food intake; and

(11) Meal observation and actual feeding assistance to a resident.

(F) The instructor or instructors for a dining assistant course shall have appropriate experience and one of the following qualifications:

(1) A current valid license to practice as a nurse, as defined in paragraph (S) of rule 3701-17-01 of the Administrative Code;

(2) A current valid license issued under Chapter 4759. of the Revised Code to practice as a dietitian.

(3) A current valid license issued under Chapter 4753. of the Revised Code to practice as a speech-language pathologist; or

(4) A current valid license issued under Chapter 4755. of the Revised Code to practice as an occupational therapist.

(G) A long term care facility, employee organization, person, governmental entity, or an approved TCEP seeking approval of a dining assistant training course shall make an application to the director on a form prescribed by the director and shall provide any documentation or additional information requested by the director. The application shall include:

(1) An attestation that the information contained in the curriculum attached as appendix A of this rule is understood and will be adhered to; and

(2) The name and documentation of the qualifications of the instructor or instructors, as specified in paragraph (F) of this rule.

(H) The director shall approve an application of a dining assistant training course that demonstrates compliance with the requirements of this rule and, if the course is operated by or in a long term care facility, the facility is not the subject of an action listed in paragraph (I)(2) of this rule. An approved dining assistant training course is not required to renew an approval provided that the director is notified of any changes to the information provided in the original application.

(I) The director may suspend or withdraw approval of a dining assistant training course if at least one of the following applies:

(1) The course is not operated in compliance with this rule; or

(2) The course is operated by or in a long term care facility and one the following applies;

(a) The director has notified the facility of a real and present danger under section 3721.08 of the Revised code;

(b) An action has been taken against the facility under section 5111.51 of the Revised Code; or

(c) The license of the facility is revoked under section 3721.03 of the Revised Code.

(J) Suspension or withdrawal of approval is not subject to appeal. If the director determines that one of the criteria listed in paragraph (I) of this rule applies to a dining assistant training course the director may, upon written notice, immediately suspend the approval of the training course. The written notice to the dining assistant training course shall provide the following:

(1) The criteria listed in paragraph (I) of this rule giving rise to the suspension or proposed withdrawal of approval;

(2) An opportunity to submit documentation demonstrating that the matter giving rise to the suspension has been corrected;

(3) An opportunity to request an informal review;

(4) An indication of whether the director proposes to withdraw the approval.

(K) If the director determines that the training course has satisfactorily demonstrated that the matter which gave rise to the suspension has been satisfactorily corrected or otherwise does not apply to the training course, the director shall lift the suspension and, if applicable, rescind the proposal to withdraw.

(L) If the director determines that the training course has not satisfactorily demonstrated that the matter which gave rise to the suspension has been corrected the director shall withdraw the training course approval.

Appendix – Dining Assistant Program Standards and Guidelines

See Appendix at http://www.registerofohio.state.oh.us/pdfs/3701/0/17/3701-17-07$2_PH_FYR_C_APP1_20060519_0835.pdf

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.31

Prior Effective Dates: 5/17/2004

(A) The director shall maintain a nurse aide registry listing all indiiduals who have met the competency requirements of division (A) of section 3721.32 of the Revised Code. The registry also shall include both of the following:

(1) The statement required by section 3721.23 of the Revised Code detailing findings by the director under that section regarding alleged abuse or neglect of a resident or misappropriation of resident property;

(2) Any statement provided by an individual under section 3721.23 of the Revised Code disputing the director’s findings.

(B) The department may not continue to list an individual on the registry as eligible to work in a long-term care facility unless the department has received verification in accordance with paragraph (C) of this rule that the individual provided at least seven and one-half consecutive hours or eight hours in a forty-eight-hour period of nursing and nursing-related services for compensation during the twenty-four month period immediately following either the date that the individual was placed on the registry or the most recent date of verified work. As used in this rule, “nursing and nursing-related services” means:

(1) Attending to the personal care needs of individuals;

(2) Providing personal care services as defined at division (A)(5)(a)(i) to (A)(5)(a)(iii) of section 3721.01 of the Revised Code; and

(3) Performing activities delegated by a nurse which may include implementation of portions of the nursing regimen, as defined by section 4723.01 of the Revised Code, for individuals whose care does not require nursing assessment or the judgment of a nurse during the performance of the delegated activity, but does not include activities that are part of the nursing regimen which require the specialized knowledge, judgment, and skill of a registered nurse or the application of the basic knowledge and skill required of a licensed practical nurse licensed under Chapter 4723. of the Revised Code or any other activities that are required to be performed by a licensed nurse under Chapter 4723.of the Revised Code.

(C) If an individual desires to remain on the registry as eligible to work as a nurse aide but is not eligible because more than twenty-four consecutive months have passed since the last date of verified work, the individual must do one of the following:

(1) Submit documentation showing that he or she has provided at least seven and one-half consecutive hours or eight hours in a forty-eight-hour period of nursing and nursing-related services for compensation during that twenty-four month period; or

(2) Successfully complete additional training and competency evaluation by complying with paragraphs (D)(1) and (D)(2) of rule 3701-17-07.1 of the Administrative Code.

(D) The documentation required in paragraph (C)(1) of this rule shall include either of the following:

(1) In the case of a facility, agency, or any other health care provider that is authorized under applicable law to provide services that include implementation of portions of a nursing regimen, as defined by section 4723.01 of the Revised Code, a statement verifying the dates that the individual performed nursing and nursing-related services for compensation; or

(2) A statement by a physician or nurse verifying that he or she has personal knowledge that the individual provided nursing and nursing-related services to a patient under the physician’s or nurse’s care. The statement shall further verify:

(a) The name of the individual that provided nursing and nursing-related services for such patient;

(b) The nature of the nursing and nursing-related services and the date or dates the individual last provided seven and one-half consecutive hours or eight hours in a forty-eight-hour period of nursing and nursing-related services;

(c) That the individual received compensation for the services specified in paragraph (D)(2)(b) of this rule. If the physician or nurse is unable to verify that the individual was compensated for those services, the individual must provide further proof that he or she received compensation for the specified services.

(E) No long-term care facility shall continue for longer than four months to use as a nurse aide an individual who previously met the requirements of paragraph (B) of rule 3701-17-07.1 of the Administrative Code but is not able to verify in accordance with this rule that he or she is currently eligible to work in a long-term care facility, unless the individual successfully completes additional training and competency evaluation by complying with paragraphs (D)(1) and (D)(2) of rule 3701-17-07.1 of the Administrative Code.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.28, 3721.32

Prior Effective Dates: 6/21/2004

(A) Each nursing home and home for the aging shall arrange for the services of an administrator who shall be present in the home to the extent necessary for effectively managing the home and assuring that needs of the residents are being met, but not less than sixteen hours during each calendar week.

(B) Each nursing home shall employ a registered nurse who shall serve as director of nursing. The director of nursing shall be on duty five days per week, eight hours per day predominantly between the hours of six A.M. and six P.M. to direct the provision of nursing services. In the event the director of nursing is absent from the nursing home due to illness, vacation or an emergency situation, the home shall designate another registered nurse in its employ to serve as acting director of nursing. The director of nursing shall not be counted toward meeting the other nurse staffing requirements of this rule unless the home’s licensed capacity is no greater than sixty beds.

(C) Each nursing home shall have staff sufficient in number on each shift to provide care and services to meet the needs of the residents in an appropriate and timely manner and to provide a minimum daily average of two and three-fourths hours of direct care and services per resident per day as follows:

(1) A minimum daily average of two hours per resident per day to be provided by nurse aides with the ratio of nurse aides to residents not exceeding one nurse aide for every fifteen residents or major part thereof at any time. Licensed nurses may be counted toward meeting this requirement if the nurses are performing the same types of services as nurse aides and are not counted toward meeting the other nursing requirements of this paragraph;

(2) A minimum daily average of two-tenths of an hour per resident per day to be provided by registered nurses. A home may request a variance to use a licensed practical nurse to meet part or all of this requirement in accordance with paragraph (D) of this rule; and

(3) The remainder of the hours may be provided by nurses, nurse aides, activities aides, occupational therapists, physical therapists, dietitians, and social service workers who provide direct care and services to the residents. Each nursing home shall have a registered nurse on call whenever one is not on duty in the home.

(D) The director may grant a variance from the registered nurse requirement of paragraph (C)(2) of this rule, if the director determines that the strict application of the requirement would cause an undue hardship to the home and that granting of the variance will not defeat the spirit and general intent of this rule, adversely affect the health or safety of the residents, or otherwise not be in the public interest. A home seeking a variance under this paragraph, shall submit a request, in writing, to the director that demonstrates to the satisfaction of the director that:

(1) The home has made, and is continuing to make, diligent effort to recruit the required registered nurses personnel through advertising and the use of other techniques available in the area of the state in which the home is located, such as the use of public or private employment agencies;

(2) The home is offering the prevailing wage for registered nurses in the area of the state in which the home is located;

(3) That the facilities and personnel policies of the home are such as to offer satisfactory working conditions for prospective employees; and

(4) That the registered nurse requirement is an undue hardship for the home to meet and that the variance will not jeopardize the health and safety of the residents.

In accordance with paragraph (D) of rule 3701-17-26 of the Administrative Code, the director shall notify the operator of the director’s determination concerning the request for this variance and provide the operator with an opportunity for an informal review. The director shall also provide notice to the state long term care ombudsman and the protection and advocacy system in the state for the mentally ill and mentally retarded of a variance granted under this paragraph. The director may establish conditions that the nursing home shall meet for the variance to be operative and shall not grant the variance for a period to exceed one year.

(E) Each nursing home shall also have the following staff who are competent to perform the duties they are assigned:

(1) Activities program staff as required by paragraph (A) of rule 3701-17-09 of the Administrative Code;

(2) Dietary staff as required by paragraph (K) of rule 3701-17-18 of the Administrative Code;

(3) Pharmacy services staff as required by paragraph (A)(1) of rule 3701-17-17 of the Administrative Code; and

(4) A social worker to assist the home in meeting the social service needs of the residents and the requirements of rule 3701-17-09 of the Administrative Code. For nursing homes with one hundred and twenty beds or less, this individual may be hired on a part-time or consultant basis.

(F) In addition to complying with the requirements in this rule, each nursing home shall maintain sufficient additional staff to provide, in a timely manner, adequate services and care to meet the needs of the residents admitted to or retained in the nursing home and to properly operate the dietary, housekeeping, laundry, and nursing home maintenance facilities.

(1) The nursing home shall determine the number and type of additional staff required based on the services needing to be performed as identified in the plans of care required by rule 3701-17-14 of the Administrative Code, and authorized scopes of practice.

(2) The additional staff shall meet the applicable qualifications of rules 3701-17-07 and 3701-17-071 of the Administrative Code and provide services in accordance with applicable scopes of practice.

(G) The nursing home shall establish a protocol for staff coverage that includes coverage during vacations, emergency situations, and long-term absences due to illness and unexpected absences and a contingency plan for back-up coverage.

(H) With input from the medical director and the director of nursing, the nursing home shall adjust the staffing levels based on the needs and acuity levels of the residents, but in no event shall the staffing fail to meet the requirements of this rule.

(I) A nursing home that is physically located in the same building or on the same lot as other licensed homes and facilities which are owned and operated by the same entity, or that provides an adult day care program in the nursing home, may use staff from the nursing home to provide services in the other licensed homes, facilities, or adult day care program or use appropriate and qualified staff from the other homes, facilities or 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 nursing home at all times meets the minimal staffing levels required by this rule. No staff simultaneously assigned to the staffing schedules of the nursing home and another home, facility or an adult day program shall be counted towards meeting the staffing requirements of this rule;

(2) The other licensed homes and facilities at all times meet their applicable staffing level requirements. Shared nursing home staff shall not be counted towards meeting the minimum staffing requirements for the other licensed homes and facilities;

(3) Separate staffing schedules are maintained for the nursing home, residential care facility and adult day care program;

(4) The sharing of staff does not adversely affect the quality and timeliness of meeting the care needs of the nursing home and residential care facility residents and the participants of the adult day care program;

(5) The nursing home, residential care facility and adult day care program are within two minutes or less response time from each other; and

(6) The monitoring of the call signal systems in the nursing home and residential care facility are not disrupted and the use of call signal systems is not limited to emergency use only.

(J) Each nursing home shall maintain records necessary for the director to ascertain compliance with the requirements of this rule.

(K) Nothing in this rule shall be construed as authorizing an unlicensed individual to provide services that require the individual to be licensed under Title 47 of the Revised Code or a health care professional to provide services outside the professional’s licensed scope of practice.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.011, 3721.04, 3721.07, 3721.12

Prior Effective Dates: 1/1/1974, 12/21/92, 10/20/2001

(A) Each nursing home shall employ a full-time or full-time equivalent individual who meets the qualifications specified in paragraph (G) of rule 3701-17-07 of the Administrative Code to direct the activities program, and sufficient assistants to meet residents’ activity needs. All nursing homes shall provide an ongoing activity program which shall be designed to meet the physical, mental, emotional, psycho-social well-being and personal interests of each resident. The program shall reflect an activities schedule that involves day time, week end, evening, and community involvement programs to meet the identified needs of each resident based on their comprehensive assessment and care plan required by rules 3701-17-10 and 3701-17-14 of the Administrative Code, respectively. Based on the residents’ changes in abilities, physical and mental status, timely adjustments in programming shall be made to meet the residents’ needs at all times.

(B) All nursing homes shall provide social services to meet the physical, mental, and psycho-social well being of each resident and to assist each resident in attaining or maintaining the highest practicable level of functioning. The nursing home shall ensure that the social services needs related to admission and discharge planning are adequately addressed to ensure a safe and appropriate transfer of a resident to the nursing home or another facility or living arrangement.

(C) All nursing homes shall provide, facilitate or arrange for services to meet the spiritual preferences of their residents.

(D) Members of a resident’s immediate family, guardian, physician, friends, sponsors, or spiritual advisor may visit the resident at any time unless the resident objects. The nursing home may establish reasonable policies to ensure that visits will not unduly disturb other residents or interfere with the operation of the home.

(E) All nursing homes shall provide residents with reasonable access to telephone services. The telephone shall be located in an area where calls can be made without being overheard and, if necessary, shall be adapted to accommodate disabilities.

(F) Each nursing home that allows animals or pets to reside in the nursing home shall establish, in consultation with the medical director and a veterinarian, and implement a written protocol regarding animals and pets that protects the health and safety and rights of residents. For the purposes of this paragraph, “veterinarian” means an individual licensed to practice veterinary medicine under Chapter 4741. of the Revised Code.

(G) The administrator shall ensure that:

(1) All mail, telegrams, or other communications addressed to residents is delivered to the addressee unopened and unread immediately upon receipt at the nursing home, and opened and read to the resident after delivery if the resident so requests.

(2) The resident’s outgoing mail shall be delivered unopened and unread to the regular postal channels promptly upon its receipt from the resident except when there is no regularly scheduled postal delivery or pick-up service in which case it shall be placed into the next regularly scheduled delivery or pick-up. The nursing home shall assist a resident in writing a letter or have a letter written for him or her if the resident so requests.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.19

Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/2001

(A) Each nursing home, in accordance with this rule, shall require written initial and periodic assessments of all residents. The different components of the assessment may be performed by different licensed health care professionals, consistent with the type of information required and the professional’s scope of practice, as defined by applicable law, and shall be based on personal observation and judgment. This paragraph does not prohibit the licensed health professional from including in the assessment resident information obtained by or from unlicensed staff provided the evaluation of such information is performed by that licensed health professional in accordance with the applicable scope of practice.

(B) Prior to admission, the nursing home shall obtain from the prospective resident’s physician, other appropriate licensed health professionals acting within their applicable scope of practice, or the transferring entity, the current medical history and physical of the prospective resident, including the discharge diagnosis, admission orders for immediate care, the physical and mental functional status of the prospective resident, and sufficient additional information to assure care needs of and preparation for the prospective resident can be met. This information shall have been updated no more than five days prior to admission.

(C) Upon admission, the nursing home shall assess each resident in the following areas:

(1) Cardiovascular, pulmonary, neurological status including auscultation of heart and lung sounds, pulses and vital signs; and

(2) Hydration and nutritional status; and

(3) Presenting physical, psycho-social and mental status.

The nursing home shall also review each resident’s admission orders to determine if the orders are consistent with the resident’s status upon admission as assessed by the nursing home and shall reconfirm, as applicable, the orders with the attending physician or other licensed health care professional acting within the applicable scope of practice. The nursing home shall obtain any special equipment, furniture or staffing that is needed to address the presenting needs of the resident. The nursing home shall provide services to meet the specific needs of each resident identified through this admission assessment until such time as the care plan required by rule 3701-17-14 of the Administrative Code is developed and implemented.

(D) The nursing home shall perform a comprehensive assessment meeting the requirements of paragraph (E) of this rule on each resident as follows:

(1) For an individual beginning residence in the nursing home after the effective date of this rule, the comprehensive assessment shall be performed within fourteen days after the individual begins to reside in the facility.

(2) For a resident living in the nursing home on the effective date of this rule, a comprehensive assessment shall be performed within ninety days of the effective date of this rule. If the resident had a comprehensive assessment meeting the requirements of paragraph (E) of this rule no more than three months before the effective date of this rule, the nursing home is not required to perform another comprehensive assessment;

(3) Subsequent to the initial comprehensive assessment, a comprehensive assessment shall be performed at least annually thereafter. The annual comprehensive assessment shall be performed within thirty days of the anniversary date of the completion of the resident’s last comprehensive assessment.

(E) The comprehensive assessment shall include documentation of the following:

(1) Medical diagnoses;

(2) Psychological, and mental retardation and developmental diagnoses and history, if applicable;

(3) Health history and physical, including cognitive functioning, and sensory and physical impairments;

(4) Psycho-social history and the preferences of the resident including hobbies, usual activities, food preferences, bathing preferences, sleeping patterns, and socialization and religious preferences;

(5) Prescription and over-the-counter medications;

(6) Nutritional requirements and need for assistance and supervision of meals;

(7) Height and weight;

(8) A functional assessment which evaluates the residents ability to perform activities of daily living;

(9) Vision, dental and hearing function; and

(10) Any other alternative remedies and treatments the resident is taking or receiving.

The documentation required by this paragraph shall include the name and signature of the individual performing the assessment, or component of the assessment, and the date the assessment was completed.

(F) Subsequent to the initial comprehensive assessment, the nursing home shall periodically reassess each resident, at minimum, every three months, unless a change in the resident’s physical or mental health or cognitive abilities requires an assessment sooner. The nursing home shall update and revise the assessment to reflect the resident’s current status. This periodic assessment shall include documentation of at least the following:

(1) Changes in medical diagnoses;

(2) Updated nutritional requirements and needs for assistance and supervision of meals;

(3) Height and weight;

(4) Prescription and over-the counter medications;

(5) A functional assessment as described in paragraph (E)(8) of this rule;

(6) Any changes in the resident’s psycho-social status or preferences as described in paragraph (E)(4) of this rule; and

(7) Any changes in cognitive, communicative or hearing abilities or mood and behavior patterns.

(G) In addition to the requirements of this rule, except as permitted under paragraph (H) of this rule, prior to or within forty-eight hours after admission, residents who have not had previous known significant Mantoux tests and who do not have a record of two-step or single step Mantoux testing within the twelve months preceding admission, shall have a two-step Mantoux test using five tuberculin units of purified protein derivative. If the first step is nonsignificant, the second step shall be performed no less than seven or more than twenty-one days from the date of the first step. Only a single Mantoux is required if the resident has documentation of either a single Mantoux test or a two-step Mantoux test within one year of admission. Each resident shall have a single Mantoux test repeated annually within thirty days of the anniversary date of the most recent testing.

(1) The nursing home shall assure that residents with significant Mantoux tests are reviewed for history and symptoms by a physician, or other appropriate licensed health care professionals acting within their applicable scope of practice, and that they have had a chest x-ray within thirty days before, or within forty-eight hours after notification of significant test results. If appropriate, the physician or applicable health care professional shall order a repeat x-ray. Additional Mantoux testing is not required after one medically documented significant test. The nursing home shall assure that a resident who exhibits signs and symptoms of tuberculosis is reassessed. A subsequent chest x-ray is not required unless the individual develops symptoms consistent with active tuberculosis.

(2) Residents with nonsignificant Mantoux tests shall receive a single Mantoux test if they are exposed to a known case of tuberculosis and another single Mantoux test performed ninety days after break of exposure. If the test reveals evidence of conversion, the resident shall have a chest x-ray unless the resident has had a chest x-ray no more than thirty days before the date of conversion and the physician or other appropriate licensed health professional determines another x-ray is not needed.

(a) If the chest x-ray does not reveal active pulmonary tuberculosis, the nursing home shall document that the resident has been evaluated and considered for preventive treatment. The nursing home shall assess the resident for signs and symptoms suggesting tuberculosis and shall annually document the presence or absence of symptoms in the resident’s record.

(b) If the chest x-ray reveals active pulmonary tuberculosis, the nursing home shall manage the resident in accordance with the tuberculosis plan, required by paragraph (D) of rule 3701-17-11 of the Administrative Code, until the appropriate local public health authority determines the resident is no longer infectious.

(3) The nursing home shall require participants of an adult day care program provided by and on the same site as the nursing home to comply with the requirements of paragraph (G) of this rule if the program is located or shares space within the same building as the nursing home, day care participants and residents of the home intermingle, or if there is a sharing of staff between the program and the home. If an adult day care participant is assessed as having active pulmonary tuberculosis, the nursing home shall not permit the participant to enter the nursing home until the appropriate local public health authority determines the participant is no longer infectious.

(H) Residents admitted to the nursing home for stays of less than ten days are exempted from the testing required by paragraph (G) of this rule if the nursing home:

(1) Assesses the resident upon admission for signs and symptoms of tuberculosis; and

(2) Ensures that a resident assessed as having signs and symptoms of tuberculosis has the chest x-ray and follow-up required by paragraph (G) of this rule.

(I) Nursing homes that conduct resident assessments in accordance with 42 C.F.R. 483.20, using the resident assessment instrument specified by rule 5101:3-3-40 of the Administrative Code, shall be considered in compliance with paragraphs (D), (E) and (F) of this rule.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.09

Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/2001

(A) Each nursing home shall establish and implement appropriate written policies and procedures to assure a safe, sanitary and comfortable environment for residents and to control the development and transmission of infections and diseases. Each nursing home shall establish an infection control program to monitor compliance with the home’s infection control policies and procedures, to investigate, control and prevent infections in the home, and to institute appropriate interventions. The home shall designate an appropriate licensed health professional with competency in infection control to serve as the infection control coordinator.

(B) If any resident, or individual used by the nursing home, exhibits signs and symptoms of a disease listed in rule 3701-3-02 of the Administrative Code, the nursing home shall ensure that appropriate interventions and follow-up are implemented and shall make reports to the appropriate local public health authority as required by law.

(C) Each nursing home shall use appropriate infection control precautions in caring for all residents. At minimum, individuals working in a nursing home shall:

(1) Wash their hands vigorously with soap and water for at least ten to fifteen seconds or, if hand-washing facilities are not readily available, with a water-less alcohol-based product used according to manufacturer’s directions or other alternative methods accepted by the centers for disease control and prevention, or another recognized infectious disease organization, as being an effective alternative:

(a) After using the toilet;

(b) Before direct contact with a resident, dispensing medication, or handling food;

(c) Immediately after touching body substances;

(d) After handling potentially contaminated objects;

(e) Between direct contact with different residents; and

(f) After removing gloves.

(2) Place disposable articles contaminated with body substances (other than sharp items) 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 contained until cleaning and decontamination occurs using products that are approved by the United States food and drug administration;

(3) Wear disposable gloves for contact with any resident’s body substances, non-intact skin or mucous membranes. The gloves shall be changed before and after contact with another resident and disposed of in accordance with state law;

(4) Wear an impervious cover gown or other appropriate protective clothing if soiling of clothing with body substances is likely to occur;

(5) Wear a mask and protective goggles or a face shield if splashing of body substances is likely or if a procedure that may create an aerosol is being performed;

(6) Dispose of all hypodermic needles, syringes, scalpel blades and similar sharp wastes by placing them in rigid, tightly closed puncture-resistant containers before they are transported off the premises of the home, in a manner consistent with Chapter 3734. of the Revised Code. The nursing home shall provide instructions to all individuals who use sharps in the home on the proper techniques for disposal; and

(7) Disposable equipment and supplies shall not be re-used.

For the purposes of paragraph (C) of this rule, “body substance” means blood, semen, saliva, vaginal secretions, feces, urine, wound drainage, emesis and any other secretion or excretion of the human body except tears and perspiration.

(D) In addition to following the standard precautions required by paragraph (C) of this rule, nursing homes shall follow the current guidelines for isolation requirements issued by the centers for disease control and prevention when caring for a resident known or suspected to be infected with a disease listed in paragraph (A) of rule 3701-3-02 of the Administrative Code. The nursing home shall develop and follow a tuberculosis control plan, based on a facility assessment, which is consistent with current guidelines issued by the centers for disease control and prevention.

(E) The nursing home shall keep clean and soiled laundry separate. Soiled laundry shall be handled as little as possible. Laundry that is wet or soiled with body substances, as defined in paragraph (C) of this rule, shall be placed in impervious bags which are secured to prevent spillage. Individuals performing laundry services shall wear impervious gloves and an impervious gown. Individuals handling soiled or wet laundry on the unit shall wear gloves and, if appropriate, other personal protective equipment. The home shall use laundry cycles according to the washer and detergent manufacturers’ recommendations. Protective clothing shall be removed before handling clean laundry.

(F) If the nursing home provides an adult day care program which is located, or shares space, within the same building as the nursing home, shares staff between the program and the home, or where the day care participants at any time intermingle with residents of the home, the requirements of this rule are also applicable to participants of the adult day care program.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.19

Prior Effective Dates: 11/15/1976, 9/30/88, 12/21/92, 10/20/2001

The nursing home administrator or the administrator’s designee shall:

(A) Immediately inform the resident, consult with the resident’s physician or the medical director, if the attending physician is not available, and notify the resident’s sponsor or authorized representative, unless the resident objects, and other proper authority, in accordance with state and local laws and regulations when there is:

(1) An accident involving the resident which results in injury and has the potential for requiring physician intervention;

(2) A significant change in the resident’s physical, mental, or psycho-social status such as a deterioration in health, mental, or psycho-social status in either life-threatening conditions or clinical complications;

(3) A need to alter treatment significantly such as a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment.

The notification shall include a description of the circumstances and cause, if known, of the illness, injury or death. A notation of the change in health status and any intervention taken shall be documented in the medical record. If the resident is a patient of a hospice care program, the notifications required by this paragraph shall be the responsibility of the hospice care program unless otherwise indicated in the coordinated plan of care required under paragraph (G) of rule 3701-17-14 of the Administrative Code.

(B) Report the death of a resident within twenty-four hours to the appropriate third-party payer; or, if the office is closed, as soon thereafter as it is open.

(C) 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 to the director.

(D) Report the diseases required to be reported under Chapter 3701-3 of the Administrative Code in the manner specified by that chapter.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.19

Prior Effective Dates: 3/1/1971, 12/21/92, 10/20/2001

(A) Each nursing home operator shall arrange for the services of a physician to serve as the home’s medical director, the medical director shall:

(1) In collaboration with the administrator, the nursing director, and other health professionals, develop formal resident care policies for the nursing home that:

(a) Provide for the total medical and psycho-social needs of the resident, including admissions, transfer, discharge planning, range of services available to the resident, emergency procedures and frequency of physician visits in accordance with resident needs and the applicable requirements of Chapter 3721. of the Revised Code and of rules 3701-17-01 to 3701-17-26 of the Administrative Code.

(b) Promote resident rights as enumerated in section 3721.13 of the Revised Code.

(2) Make available medical care for residents not under the care of their own physicians and to make available emergency medical care to all residents, provided their personal physicians are not readily available.

(3) Meet periodically with nursing and other professional staff to discuss clinical and administrative issues, including the need for additional staff, specific resident care problems and professional staff needs for education or consultants to assist in meeting special needs such as dentistry, podiatry, dermatology, and orthopedics, offer solutions to problems, and identify areas where policy should be developed. In carrying out this function, the medical director shall:

(a) Observe residents and facilities at least quarterly or more frequently as needed; and

(b) Review pharmacy reports, at least quarterly, including summaries of drug regimen reviews required by paragraph (H) of rule 3701-17-17 of the Administrative Code and the quality assurance activities required by paragraph (D) of rule 3701-17-06 of the Administrative Code, and take appropriate and timely action as needed to implement recommendations.

(4) Monitor the clinical practices of, and discuss identified problems with, attending physicians; act as a liaison between the attending physicians and other health professionals caring for residents and the residents’ families; and intervene as needed on behalf of residents or the home’s administration.

(5) Maintain surveillance of the health of the nursing home’s staff.

(6) Assist the administrator and professional staff in ensuring a safe and sanitary environment for residents and staff by reviewing incidents and accidents, identifying hazards to health and safety, and advising about possible correction or improvement of the environment.

(B) The nursing home shall not give any medication or treatment to any resident unless ordered by a physician or by other licensed health professionals, acting within their applicable scope of practice. If orders are given by telephone, they shall be recorded with the licensed health professional’s name and the date, and the order and signed by the person who accepted the order. All orders, including facsimile, telephone, or verbal orders, shall be signed and dated by the physician or other licensed health professional working in collaboration with the physician who gave the order within fourteen days after the order was given.

(1) 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 physical, occupational or respiratory therapist, audiologist, speech pathologist, dietitian, or other 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.

(2) The nursing home may accept signed orders issued by a licensed health professional having prescriptive authority by facsimile transmission if the home has instituted procedural safeguards for authenticating and maintaining confidentiality of the facsimile order, and for handling it in an expedient and priority manner.

(3) 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.

(C) Each resident of a nursing home shall be under the supervision of a physician. Each resident of a nursing home shall be evaluated by a physician at least once every thirty days for the first ninety days after admission or three evaluations. After this period, each resident of a nursing home shall be evaluated by a physician at least every sixty days, except that if the attending physician documents in the medical record why it is appropriate, the resident may be evaluated no less frequently than once every one hundred twenty days.

(1) The evaluations required by this rule shall be made by the physician personally except after the initial thirty day evaluation, at the option of the physician, evaluations may alternate between personal evaluations by the physician and personal evaluations performed by a licensed health professional, acting within their applicable scope of practice, who is working in collaboration with the physician. In conducting the evaluation, the physician or licensed health professional shall solicit resident input to the extent of the resident’s capabilities.

(2) The physician or licensed health professional shall write a progress note after each evaluation depicting the current condition of the resident based upon consideration of the physical, mental and emotional status of the resident.

(3) A physician or licensed health professional visit is considered timely if it occurs no later than ten calendar days after the date the visit was required.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.02, 3721.03, 3721.05, 3721.07

Prior Effective Dates: 11/15/1976, 9/30/88, 5/20/91, 12/21/92, 10/20/2001

(A) An advanced practice nurse, as defined in paragraph (E) of rule 3701-17-01 of the Administrative Code, who is acting within his or her scope of practice and is working in collaboration with an attending physician if authorized by a written standard care arrangement required by rule 4723-8-04 of the Administrative Code, may undertake the following:

(1) Receive notice and participate in consultations under paragraph (A) of rule 3701-17-12 of the Administrative Code in addition to or in lieu of the attending physician;

(2) Notwithstanding paragraph (C) of rule 3701-17-13 of the Administrative Code, perform all resident evaluations required to be performed under that rule;

(3) Issue orders relating to resident appropriate room furnishings under paragraph (B) of rule 3701-17-16 of the Administrative Code.

(B) The nursing home medical director may discuss identified problems of a resident with the resident’s advanced practice nurse who is acting within his or her scope of practice, and who is working in collaboration with the attending physician pursuant to a written standard arrangement required by rule 4723-8-04 of the Administrative Code.

(C) The name of a resident’s advanced practice nurse shall be listed in addition to the attending physician on the resident admission record as required by paragraph (A)(1)(a) of rule 3701-17-19 of the Administrative Code.

(D) The name of the advanced practice nurse shall be listed in addition to the attending physician on the medication administration record referenced in paragraph (A)(1)(d) of rule 3701-17-19 of the Administrative Code. An advanced practice nurse may sign orders on the doctors order sheet under paragraph (A)(1)(d) of rule 3701-17-19 of the Administrative Code when acting within his or her scope of practice, and when working in collaboration with the attending physician pursuant to a written standard arrangement required by rule 4723-8-04 of the Administrativ Code.

(E) Nothing in this rule shall be construed to allow the use of an advanced practice nurse to perform the physician requirements specified in rule 3701-17-15 of the Administrative Code.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.02, 3721.04, 3721.13

Prior Effective Dates: 6/20/2005

(A) The nursing home shall assure that development of a plan of care is initiated upon admission and completed and implemented for each resident within seven days of completion of the initial comprehensive assessment, required by rule 3701-17-10 of the Administrative Code. The plan shall be prepared by an interdisciplinary team that includes the attending physician or the attending advance practice nurse, or both, a registered nurse with responsibility for the resident and other appropriate staff in disciplines as determined by the needs of the resident and, to the extent practicable, the resident and the family or sponsor of the resident unless the resident does not wish them to be involved.

(1) The plan of care shall be consistent with the comprehensive assessment with recognition of the capabilities and preferences of the resident, and shall contain a written description of what services, supplies and equipment, are needed, when, how often, and by whom services, supplies and equipment will be provided and the measurable goals or outcomes.

(2) The plan of care shall be reviewed whenever there is a change in the resident’s condition and the needs of the resident warrants a change in the services, supplies or equipment to be provided, and at least quarterly, by the nursing home and the resident, or sponsor, or both, and shall be updated, as appropriate.

(3) Each resident shall have access to his or her assessment and plan of care at any time upon request.

(B) All skilled nursing care shall be provided by a nurse except a nurse may delegate certain tasks as authorized by Chapter 4723. of the Revised Code in accordance with the applicable rules adopted under that chapter.

(C) The nursing home shall provide all residents who cannot give themselves adequate personal care with such care as is necessary to keep them clean and comfortable.

(D) All services, supplies and equipment provided or arranged for by the nursing home shall be provided, in accordance with acceptable standards of practice and the written plans of care, by individuals who meet the applicable qualifications of this chapter.

(E) The nursing home shall assure that all residents receive adequate, kind, and considerate care and treatment at all times.

(F) The nursing home shall transfer and discharge a resident in an orderly and safe manner in accordance with Chapter 3701-61 of the Administrative Code. In anticipation of a discharge, the nursing home shall prepare the following information to be shared with appropriate persons and agencies upon consent of the resident, except the resident’s right to refuse release of such information does not apply in the case of transfer to another home, hospital, or health care system, if the release is required by law or rule or by a third-party payment contract:

(1) An updated assessment that addresses the criteria outlined in paragraph (E) of rule 3701-17-10 of the Administrative Code and accurately identifies the resident’s condition and continuing care need at the time of transfer and discharge;

(2) A plan that is developed with the resident and family members, with the consent of the resident, that describes what services, supplies and equipment are needed, how needed services, supplies and equipment can be accessed, and how to coordinate care if multiple care givers are involved. The plan shall also identify need for the resident and care givers’ education, including resident and care giver instruction on the proper use of grab rails and other safety devices, and any accommodations to the physical environment to meet the needs of the resident; and

(3) The nursing home shall, with the consent of the resident, arrange or confirm the services, equipment and supplies in advance of discharge or transfer of the resident.

(G) If the nursing home resident is also a patient of a hospice care program, the nursing home shall communicate and work with the hospice in development and implementation of a coordinated plan of care between the nursing home and hospice. This coordinated plan of care shall:

(1) Reflect the hospice philosophy;

(2) Be based on the assessment of the resident and the unique living situation in the nursing home; and

(3) Identify the services, supplies, and equipment to be provided by the nursing home and those to be provided by the hospice care program.

The nursing home shall allow the hospice care program to retain professional management of the resident’s plan of care related to the resident’s terminal illness pursuant to Chapter 3701-19 of the Administrative Code as long as the resident is receiving hospice care. The nursing home shall take directions from the hospice regarding implementation of the coordinated plan of care related to the resident’s terminal illness.

R.C. 119.032 review dates: 05/19/2006 and 05/01/2011

Promulgated Under: 119.03

Statutory Authority: 3721.04

Rule Amplifies: 3721.01 to 3721.19

Prior Effective Dates: 5/2/1966, 3/8/93, 10/20/2001

(A) Except as provided in paragraph (F) of this rule for emergency situations, the nursing home shall not physically or chemically restrain a resident or subject a resident to prolonged isolation except on written order of a physician which shall include the date, means of restraint to be used, medical reason for restraint, and duration of restraint. Such written orders shall be made a part of the resident’s record.

(1) The nursing home shall not use a physical or chemical restraint or isolation for punishment, incentive, or convenience.

(2) A nursing home’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; and

(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) Placement of residents who are cognitively impaired in a specialized care unit that restricts their freedom of movement throughout the home if:

(i) The home has made the determination to place each resident in such unit in accordance with paragraph (B) of this rule;

(ii) Care and services are provided in accordance with each resident’s individual needs and preferences, not for staff convenience;

(iii) The need for continuation of placement of a resident in the locked unit is reviewed during each periodic assessment required by paragraph (F) of rule 3701-17-10 of the Administrative Code and during the continuing care planning required by rule 3701-17-14 of the Administrative Code;

(iv) The locked unit meets the requirements of the state building and fire codes; and

(v) Residents who are not cognitively impaired are able to enter and exit the unit without assistance.

(B) Except as provided in this paragraph, and paragraph (F) of this rule for emergency situations, prior to authorizing the use of a physical or chemical restraint on any resident, the nursing home shall ensure that the attending physician:

(1) Makes a personal examination of the resident and an individualized determination of the need to use the restraint on that resident; and

(2) In conjunction with an interdisciplinary team of health professionals and other care givers, conducts an individualized comprehensive assessment of the resident. This assessment shall:

(a) Identify specific medical symptoms that warrant the use of the restraint;

(b) Determine the underlying cause of the medical symptom and whether that underlying cause can be mitigated;

(c) Investigate and determine if possible alternative interventions have been attempted and found unsuccessful. Determine the least restrictive device that is most appropriate to meet the needs of the resident, taking into consideration any contraindications;

(d) Discuss with the resident or authorized representative, and any other individual designated or authorized by the resident, the risks and benefits of the restraint; and

(e) Obtain written consent from the resident or the resident’s authorized representative.

A nursing home may restrain or isolate a resident transferred from another health care facility based on the resident’s transfer