Chapter 3701-17 Nursing Homes

3701-17-01 Definitions.

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" has the same meaning as in section 5119.70 of the Revised Code.

(E) "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.

(F) "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.

(G) "Complex therapeutic diet" means a calculated nutritive regime including, but not limited to:

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

(2) Renal nutritive regimens;

(3) Dysphagia nutritive regimens excluding simple textural modifications; or

(4) Any other nutritive regimen requiring a daily minimum or maximum level of one or more specific nutrients or a specific distribution of one or more nutrients.

(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 the director's 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" has the same meaning as in division (A)(1) of section 3721.01 of the Revised Code.

(M) "Hospice care program" or "hospice" means an entity licensed under Chapter 3712. of the Revised Code.

(N) "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.

(O) "Licensed practical nurse" means a person licensed under Chapter 4723. of the Revised Code to practice nursing as a licensed practical nurse.

(P) "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.

(Q) "Mental impairment" does not mean mental illness as defined in section 5122.01 of the Revised Code or mental retardation as used in Chapter 5123. of the Revised Code.

(R) "Nurse" means a registered nurse or a licensed practical nurse.

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

(T) "Nursing home" has the same meaning as in section 3721.01 of the Revised Code.

(U) "Ohio building code" means the building requirements as adopted by the board of building standards pursuant to section 3781.10 of the Revised Code.

(V) "On duty" means being in the nursing home, awake, and immediately available.

(W) "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.

(X) "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 (GG) of this rule.

(Y) "Pharmacist" means an individual licensed under Chapter 4729. of the Revised Code to practice pharmacy.

(Z) "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 (B)(3) of rule 3701-17-15 of the Administrative Code.

(AA) "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.

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

(CC) "Resident" means an individual for whom the nursing home provides accommodations.

(DD) "Residential care facility" has the same meaning as in section 3721.01 of the Revised Code.

(EE) "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. 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.

(FF) "Registered nurse" means an individual licensed to practice nursing as a registered nurse under Chapter 4723. of the Revised Code.

(GG) "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.

(HH) "Special diet" means a diet that has been ordered for a resident by a physician or other licensed health professional acting within the applicable scope of practice, based upon the individual needs of that resident and adjusted to the needs of that resident. A special diet may include the following:

(1) Textural modifications, including chopped, ground, and pureed;

(2) Nutrient adjusted, including high protein, no added salt, and no concentrated sweets;

(3) Volume adjusted, including small, medium, and large portions;

(4) The use of finger foods or bite-sized pieces for a resident's physical needs; or

(5) Complex therapeutic diets.

(II) "Sponsor" means an adult relative, friend, or guardian of a resident who has an interest or responsibility in the resident's welfare.

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

(KK) "Toilet room" means a room or rooms conforming to the Ohio building code, and including a water closet and a lavatory which is located in or adjacent to the room in which the water closet is located.

(LL) "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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19 , 3721.21 , 3721.22 , 3721.23 , 3721.24 , 3721.25 , 3721.26 , 3721.28 , 3721.29 , 3721.30 , 3721.31 , 3721.32 , 3721.33
Prior Effective Dates: 5/2/1966, 7/1/73, 12/2/89, 12/21/92, 10/20/01

3701-17-02 Application of rules.

(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: 10/11/2011 and 10/01/2016
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, 2/21/92, 10/20/01

3701-17-03 License fee; application; issuance; revocation.

(A) The operator of a nursing home shall submit an initial application and pay the application fee specified in section 3721.02 of the Revised Code. The initial application and the application fee required under this paragraph shall be submitted to the director and the fee shall be made payable to the "treasurer, state of Ohio" in the form of a check or money order. The department shall deposit the fee in the state treasury to the credit of the general operations fund created by section 3701.83 of the Revised Code, and the fee 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 containing the following information:

(a) If the operator is an individual and owner of the business, the individual's name, address, and telephone number. If the operator of the business is owned by an association, corporation, or partnership, the business activity, address, and telephone number of the entity and the name of every person who has an ownership interest of five per cent or more in the entity;

(b) If the operator does not own the building or buildings or if the operator owns only part of the building or buildings in which the nursing home is housed, the name of each person who has an ownership interest of five per cent or more in the buildings;

(c) If the operator does not own the legal rights associated with the ownership and operation of the nursing homes beds, the name of each person who has an ownership interest of five per cent or more in the nursing home beds;

(d) 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;

(e) The name, business address and telephone number of the administrator of the nursing home, if different from the operator;

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

(g) The name, business address, and telephone number of the statutory agent of the operator; and

(h) The name, business address, and telephone number of the statutory agent of the owner of the legal rights associated with the ownership and operation of the nursing home beds.

(4) Copies of the certificate of use 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 operator of a nursing home shall truthfully and fully submit a license renewal application and pay the renewal fee specified in section 3721.02 of the Revised Code. The renewal application and the renewal fee required under this paragraph shall be submitted using an electronic system prescribed by the director. The department shall deposit the fee in the state treasury to the credit of the general operations fund created by section 3701.83 of the Revised Code, and the fee shall not be refunded.

(E) The renewal application shall:

(1) Include an update of the information required under paragraphs (C)(2) and (C)(3) of this rule; and

(2) Provide information the director may require to assess whether the operator has violated section 3721.07 of the Revised 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.

(F) 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 truthfully respond and submit any additional information requested by the director within sixty days of the director's request unless the director specifies otherwise.

(G) 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.

(H) 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.

(I) 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.

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

(K) The director may issue an order revoking a license in the event the director finds, upon hearing or opportunity afforded pursuant to Chapter 119. of the Revised Code, that any of the following apply to a person licensed under section 3721.07 of the Revised Code:

(1) Has violated any of the provisions of Chapter 3721. of the Revised Code or of rules 3701-17-01 to 3701-17-26 of the Administrative Code;

(2) Has violated any order issued by the director;

(3) Is not, or any of its principals are not suitable, morally or financially, to operate such an institution;

(4) Is not furnishing humane, kind, and adequate treatment and care; or

(5) Has had a long-standing pattern of violations of Chapter 3721. of the Revised Code, of rules 3701-17-01 to 3701-17-26 of the Administrative Code, of Chapter 3701-13 of the Administrative Code, or of Chapter 3701-60 of the Administrative Code that has caused physical, emotional, mental, or psychosocial harm to one or more residents.

(L) The director may issue an order denying a license in the event the director finds after investigation of the applicant and, if required by section 3721.02 of the Revised Code, inspection of the home, one or more of the following conditions exist:

(1) The applicant has been convicted of a felony or a crime involving moral turpitude;

(2) The applicant is violating any of the rules made by the public health council or any order issued by the director of health;

(3) The applicant has had a license to operate the home revoked pursuant to section 3721.03 of the Revised Code, other than division (B)(5) of section 3721.03 of the Revised Code, because of any act or omission that jeopardized a resident's health, welfare, or safety;

(4) The buildings in which the home is housed have not been approved by the state fire marshal or a township, municipal, or other legally constituted fire department approved by the marshal. In the approval of a home such agencies shall apply standards prescribed by the board of building standards, and by the state fire marshal, and by section 3721.071 of the Revised Code;

(5) The applicant, if it is an individual, or the principal participants, if it is an association or a corporation, is or are not suitable financially and morally to operate a home;

(6) The applicant is not equipped to furnish humane, kind, and adequate treatment and care;

(7) The home maintains or contains:

(a) Facilities for the performance of major surgical procedures;

(b) Facilities for providing therapeutic radiation;

(c) An emergency ward;

(d) A clinical laboratory unless it is under the supervision of a clinical pathologist who is a licensed physician in this state; or

(e) Facilities for radiological examinations unless such examinations are performed only by a person licensed to practice medicine, surgery, or dentistry in this state;

(8) The home accepts or treats outpatients, except upon the written orders of a physician licensed in this state, maternity cases, boarding children, or houses transient guests, other than participants in an adult day-care program, for twenty-four hours or less; or

(9) The home is not in compliance with sections 3721.28 and 3721.29 of the Revised Code.

(M) Upon the issuance of any order of revocation or denial, the person whose license is revoked or denied may appeal in accordance with Chapter 119. of the Revised Code.

(N) Once the director notifies a person licensed to operate a home that the license may be revoked or issues any order under section 3721.03 of the Revised Code or under this rule, the person shall not assign or transfer to another person or entity the right to operate that home. This prohibition shall remain in effect until proceedings under Chapter 119. of the Revised Code concerning the order or license revocation have been concluded or the director notifies the person that the prohibition has been lifted.

(1) If a license is revoked under this rule section, the former license holder shall not assign or transfer or consent to assignment or transfer of the right to operate the home. Any attempted assignment or transfer to another person or entity is void.

(2) On revocation of a license, the former license holder shall take all necessary steps to cease operation of the home.

(O) If, under division (B)(5) of section 3721.03 of the Revised Code, the license of a person has been revoked, the director of health shall not issue a license to the person or home at any time. 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.

(P) When closing a home, the operator shall provide the director written notification of closure at least ninety days prior to the proposed closing date. This notice shall include:

(1) An address where the operator may be reached after the closing of the home;

(2) A plan for the transfer and adequate relocation of all residents; and

(3) Assurances that the residents will be transferred to the most integrated and appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident.

(Q) While providing a written notification of closure under paragraph (O) of this rule, the operator shall, in accordance with Chapter 3701-61 of the Administrative Code, also provide written notice of the proposed date of closing of the home to its residents and their sponsors or legal representatives and the regional long-term care ombudsperson program, designated under section 173.16 of the Revised Code, serving the area where the home is located.

(R) 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.02 , 3721.03 , 3721.07 , 3721.08
Prior Effective Dates: 5/2/1966, 7/1/73, 12/21/92, 10/20/01

3701-17-04 Type and number of residents in home; beds.

(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 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;

(2) 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;

(3) 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011
Prior Effective Dates: 5/2/1966, 7/1/73, 12/21/92, 10/20/01

3701-17-05 Prohibitions.

(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.

(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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 11/15/1976, 9/30/88, 12/21/92, 10/20/01

3701-17-06 Responsibility of operator and nursing home administrator; quality assurance committee; notice to residents.

(A) The operator is responsible for:

(1) Operation of the nursing home;

(2) Payment of the annual license renewal fee to the director;

(3) Submission of such reports as may be required, using an electronic system prescribed by the director, including the immediate reporting of real, alleged, or suspected abuse, neglect, or misappropriation; and

(4) 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:

(1) Daily operation of the nursing home in accordance with rules 3701-17-01 to 3701-17-26 of the Administrative Code;

(2) Implementation of the provisions of section 3721.12 of the Revised Code, including the development of policies and procedure that ensure the rights of residents are not violated;

(3) 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; and

(4) If the nursing home is physically part of a hospital, 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.

(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:

(a) Monitor and evaluate the quality of care and quality of life provided in the home;

(b) 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;

(c) Identify problems and trends; and

(d) 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:

(a) The home has a quality assurance committee which addresses quality concerns;

(b) Staff know how to access that process; and

(c) 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.

Replaces: 3701-17-06

Effective: 04/01/2012
R.C. 119.032 review dates: 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19 , 3721.21 , 3721.22 , 3721.23 , 3721.24 , 3721.25 , 3721.26 , 3721.28 , 3721.29 , 3721.30 , 3721.31 , 3721.32 , 3721.33
Prior Effective Dates: 5/2/1966, 3/1/71, 12/21/92, 9/5/97, 10/20/01

3701-17-07 [Effective until 12/8/2014] Qualifications and health of personnel.

(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 that minimize the likelihood of transmission and follows infection control precautions and procedures.

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

(1) Under the influence of alcohol, intoxicants or 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 single blood assay for M. tuberculosis (BAMT) test, or the two-step Mantoux skin test using five tuberculin units of purified protein derivative or, if the individual has a documented history of a significant BAMT test, or Mantoux skin test, a chest x-ray.

(a) The individual shall not have any resident contact until after the results of the BAMT test, or first step of the Mantoux test have been obtained and recorded in millimeters of induration. Only a single Mantoux or BAMT test is required if the individual has documentation of either a single step Mantoux test or a two-step Mantoux, or a BAMT test within one year of commencing work;

(b) The first step of the Mantoux test should be read within forty-eight to seventy-two hours following application. If the first step in the Mantoux test is nonsignificant, a second step shall be performed at least seven, but not more than twenty-one days after the first step was performed.

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

(d) If the results of the BAMT test or either step of the Mantoux test are 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 BAMT or Mantoux test. Additional tuberculosis 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.

(e) If the chest x-ray does not indicate active pulmonary tuberculosis, but there is evidence of a significant BAMT or 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

(f) 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.

(g) Individuals who cease to work at a nursing home and who subsequently return to work at the nursing home from which they left are not required to have additional tuberculosis testing prior to the timeframe for annual testing in paragraph (D) of this rule, provided the nursing home:

(i) Has no reason to believe the individual has come into contact with or acquired tuberculosis; and

(ii) Assesses the individual for signs and symptoms of tuberculosis.

(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 tuberculosis 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. Training may also be provided by an out-of-state provider certified in the state in which the provider is located to offer technical or vocational programs or to offer degrees and college credits. For individuals hired after April 18, 2002, 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.

(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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011 , 3721.04
Prior Effective Dates: 5/2/1966, 7/1/73, 9/30/88, 12/21/92, 9/5/97, 10/20/01, 11/30/09

3701-17-07 [Effective 12/8/2014] Qualifications and health of personnel.

(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 that minimize the likelihood of transmission and follows infection control precautions and procedures.

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

(1) Under the influence of alcohol, intoxicants or 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) No individual shall work in a nursing home in any capacity for ten or more hours in any thirty-day period unless the individual 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. Operators shall retain documentation evidencing compliance with this paragraph and shall furnish such documentation to the director upon request. This paragraph does not apply to volunteers.

(E) Employees of temporary employment services or, to the extent applicable, paid consultants working in a nursing home, shall have medical examinations in accordance with paragraph (D) of this rule, except that a new medical certification is not required for each new assignment. Each nursing home in which such an individual works shall obtain verification of the medical certification 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 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. Training may also be provided by an out-of-state provider certified in the state in which the provider is located to offer technical or vocational programs or to offer degrees and college credits. For individuals hired after April 18, 2002, 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.

(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.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011 , 3721.04
Prior Effective Dates: 5/21/1966, 7/1/73, 9/30/88, 12/21/92, 9/5/97, 10/20/01, 11/30/09, 4/1/12

3701-17-07.1 Required training and competency evaluation for nurse aides working in long-term care facilities.

(A) For the purposes of this rule:

(1) "Competency evaluation program" means a program conducted by the director or the director's designee under division (C) of section 3721.31 of the Revised Code and rule 3701-18-22 of the Administrative Code.

(2) "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.

(3) "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.

(4) "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.

(5) "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.

(6) 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.

(7) "Training and competency evaluation program" means a program of nurse aide training and evaluation of competency to provide nursing and nursing-related services approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code.

(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 under 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 or has satisfied the requirements of paragraphs (B)(2)(a) and (B)(2)(b) of this rule and, in either case, also has completed successfully the competency evaluation program . An individual shall be considered to have satisfied the requirement of having successfully completed a training and competency evaluation program 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 under former rule 3701-18-07 of the Administrative Code in effect at the time of the determination and was otherwise comparable to approved training and competency evaluation programs ;

(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 ; 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 .

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 , 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 ; or

(3) A training and competency evaluation program and the competency evaluation program .

(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 ;

(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 .

(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 , 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 ; or

(3) A training and competency evaluation program and, in addition, a competency evaluation program .

(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 , 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 .

(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 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 assessed needs of residents as determined by their care plan. 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 assessed 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 ensure competency and 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
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, 10/20/01, 5/17/04

3701-17-07.2 Dining assistants.

(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) "Training and competency evaluation program" has the same meaning as in rule 3701-17-07.1 of the Administrative Code.

(6) "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 nine 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 (R) 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 a training and competency evaluation program 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.

Click to view Appendix

Click to view Appendix

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.31
Prior Effective Dates: 5/17/2004

3701-17-07.3 Nurse aide registry.

(A) The director shall maintain a nurse aide registry listing all individuals 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 shall 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 divisions (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 and hours 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.28 , 3721.32
Prior Effective Dates: 6/21/2004

3701-17-08 Personnel requirements.

(A) Each nursing home 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:

(1) Employ a registered nurse who shall serve as director of nursing:

(a) This requirement may be met by two registered nurses who share the position as co-directors of nursing.

(b) The director of nursing or co-directors 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.

(c) The name of the director of nursing shall be posted in a place easily accessible to residents, resident's families or sponsors, and staff.

(2) Designate another registered nurse in its employ to serve as acting director of nursing in the event the director of nursing or co-directors of nursing are absent from the nursing home due to illness, vacation or an emergency situation. The name of the acting director of nursing shall be posted in a place easily accessible to residents, residents' families or sponsors, and staff.

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

(1) Nurse aides;

(2) Registered nurses, including registered nurses who perform administrative and supervisory duties; and

(3) Licensed practical nurses, including licensed practical nurses who perform administrative and supervisory duties.

(D) Each nursing home shall have a registered nurse on call whenever one is not on duty in the home. The name of the registered nurse who is on call shall be posted in a place easily accessible to residents, residents' families or sponsors, and staff.

(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) Social services staff to assist the home in meeting the medically-related social service needs of the residents and the requirements of rule 3701-17-09 of the Administrative Code. Each nursing home with more than one hundred and twenty beds shall employ, on a full-time basis, one individual licensed as a social worker under Chapter 4757. of the Revised Code.

(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.

Effective: 06/13/2013
R.C. 119.032 review dates: 03/29/2013 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011 , 3721.04 , 3721.07 , 3721.12
Prior Effective Dates: 5/2/1966, 1/1/74, 12/21/92, 10/20/01, 4/1/12

3701-17-09 Activities; social services; chaplain services; visiting hours; telephone service; pets; mail.

(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 and shall provide or arrange for private space for visitation.

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

(F) No nursing home shall interfere with a resident's use of a cellular phone, computer, or other technological device owned by the resident unless the resident's use of that device is not medically advisable or is disruptive to other residents or the safe and orderly operation of the home.

(G) 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 licensed to practice veterinary medicine under Chapter 4741. of the Revised Code, and implement a written protocol regarding animals and pets that protects the health and safety and rights of residents. At minimum, the written protocol shall include:

(1) An annual physical examination, including an examination for internal and external parasites;

(2) Vaccinations for common infectious agents, including rabies;

(3) Any other preventive care necessary to protect the health, safety and rights of residents;

(4) Procedure to follow if an animal:

(a) Bites a person; or

(b) Becomes ill or injured;

(5) The name of the designated member or members of the staff responsible for the care of the animal and for maintaining the protocol, including medical records for the animal; and

(6) An evaluation of the medical needs of residents.

(H) 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/01

3701-17-10 [Effective until 12/8/2014] Resident assessments; tuberculosis testing.

(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) The comprehensive assessment shall be performed within fourteen days after the individual begins to reside in the facility.

(2) 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, sensory and physical impairments, and the risk of falls;

(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 resident's ability to perform activities of daily living;

(9) The resident's risk of falls;

(10) Vision, dental and hearing function; and

(11) 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) The resident's risk of falls;

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

(8) 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 blood assay for M. tuberculosis (BAMT) or Mantoux tests and who do not have a record of a BAMT or of a two-step or single step Mantoux testing within the twelve months preceding admission, shall have a single BAMT, or two-step Mantoux test using five tuberculin units of purified protein derivative. Only a single BAMT or Mantoux test is required if the resident has documentation of either a BAMT, a single Mantoux test, or a two-step Mantoux test within one year of admission. Each resident shall have a single BAMT or Mantoux test repeated annually within thirty days of the anniversary date of the most recent testing.

(1) The first step should be read within forty eight to seventy two hours following application. If the first step is nonsignificant for the Mantoux test, the second step shall be performed no less than seven or more than twenty-one days from the date of the first step.

(2) The nursing home shall assure that residents with significant BAMT or 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 BAMT or 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.

(3) Residents with nonsignificant BAMT or Mantoux tests shall receive a single BAMT or Mantoux test if they are exposed to a known case of tuberculosis and another BAMT or 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.

(4) Residents who have been transferred or discharged to a hospital or other health care facility and are again admitted to the nursing home from which they were transferred or discharged, are not required to have additional tuberculosis testing prior to the timeframe for annual testing in paragraph (G) of this rule, provided the nursing home:

(a) Has no reason to believe the resident has come into contact with or acquired tuberculosis; and

(b) Assesses the resident for signs and symptoms of tuberculosis.

(5) 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- 43.1 of the Administrative Code, shall be considered in compliance with paragraphs (D), (E) and (F) of this rule.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.04 , 3721.041
Prior Effective Dates: 5/2/66, 12/21/92, 10/20/2001, 11/20/09

3701-17-10 [Effective 12/8/2014] Resident assessments; advanced care planning.

(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) The comprehensive assessment shall be performed within fourteen days after the individual begins to reside in the facility.

(2) 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, sensory and physical impairments, and the risk of falls;

(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 resident's ability to perform activities of daily living;

(9) The resident's risk of falls;

(10) Vision, dental and hearing function; and

(11) 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) The resident's risk of falls;

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

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

(G) 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- 43.1 of the Administrative Code, shall be considered in compliance with paragraphs (D), (E) and (F) of this rule.

(H) Beginning July 1, 2015, each nursing home shall participate in advance care planning with each resident or the resident's sponsor if the resident is unable to participate. For each resident, the advance care planning shall be provided on admission to the nursing home or, in the case of an individual residing in a nursing home on July 1, 2015, as soon as practicable. Thereafter, for each resident, the advance care planning shall be provided quarterly each year. For purposes of this paragraph, "advance care planning" means providing an opportunity to discuss the goals that may be met through the care provided by a nursing home.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.04 , 3721.041
Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/01, 11/20/09, 4/1/12

3701-17-11 [Effective until 12/8/2014] Infection control.

(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 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 an alcohol-based product used according to manufacturer's directions or other alternative methods accepted by the United States centers for disease control and prevention, as being an effective alternative, but not as a substitute for regular hand-washing:

(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 United States 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 11/15/1976, 9/30/88, 12/21/92, 10/20/01

3701-17-11 [Effective 12/8/2014] Infection control; tuberculosis control plan.

(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 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) Each nursing home shall develop and follow a tuberculosis control plan that is based on the home's assessment of the facility. The control and assessment shall be consistent with the United States centers for disease control and prevention "Guidelines for Preventing the Transmission of My cobacterium tuberculosis in Health Care Settings, 2005," MMWR 2005, Volume 54, No. RR-17. The home shall retain documentation evidencing compliance with this paragraph and shall furnish such documentation to the director upon request.

(C) 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.

(D) 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 an alcohol-based product used according to manufacturer's directions or other alternative methods accepted by the United States centers for disease control and prevention, as being an effective alternative, but not as a substitute for regular hand-washing:

(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.

(E) 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 United States 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.

(F) 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.

(G) 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.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.04
Prior Effective Dates: 11/15/1976, 9/30/88, 12/21/92, 10/20/01; 4/1/12

3701-17-12 Notification and reporting of changes in health status, illness, injury and death of a resident.

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

(A) Immediately inform the resident, consult with resident's physician or other licensed health professional acting within the applicable scope of practice, or the medical director, if the attending physician or other licensed health professional acting within the applicable scope of practice is not available, and notify the resident's sponsor or authorized representative, with the resident's permission, 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 (H) 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.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 3/1/71, 12/21/92, 10/20/01

3701-17-13 Medical supervision.

(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 (I) of rule 3701-17-17 of the Administrative Code and the quality assurance activities required by paragraph (C) 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 administer any medication to any resident unless ordered by a physician or by other licensed health professionalsacting within the 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 accepted in accordance with United States drug enforcement administration and board of pharmacy of the state of Ohio requirements.

(C) The nursing home shall not administer any treatment to any resident unless ordered by a physician or by other licensed health professionals acting within the applicable scope of practice. If orders are given by telephone, they shall be recorded with the licensed health professional's name, the date, 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 treatment orders concerning that individual's 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 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, if allowed by law.

(D) 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 or other licensed health professionals acting within the applicable scope of practice, 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 or other licensed health professionals acting within the applicable scope of practice 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 in person. 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.

(E) Each nursing home shall, on an annual basis, offer to each resident a vaccination against influenza and a vaccination against pneumococcal pneumonia as required by section 3721.041 of the Revised Code.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.02 , 3701.03 , 3721.041 , 3721.05 , 3721.07
Prior Effective Dates: 5/2/1966, 11/15/76, 9/30/88, 5/20/91, 12/21/92, 10/20/01

3701-17-13.1 [Rescinded] Use of advanced practice nurses in nursing homes.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.02 , 3701.04 , 3721.13
Prior Effective Dates: 6/20/2005

3701-17-14 Plan of care; treatment and care: discharge planning, bathing.

(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 other licensed health professional acting within the applicable scope of practice, or both, a registered nurse with responsibility for the resident and other appropriate staff in disciplines as determined by the needs of the resident including, but not limited to dietary, recreation, and social work staff, 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) Each nursing home shall provide adequate supervision of residents who are assessed for risk of falls, or elopement, or both.

(E) 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.

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

(G) The nursing home shall transfer and discharge a resident in an orderly, dignified, and safe manner in accordance with Chapter 3701-61 of the Administrative Code. In anticipation of a discharge, the nursing home shall :

(1) 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;

(a) 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;

(b) 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;

(2) Provide for drugs to be sent with or arranged for the resident pursuant to paragraph (F)(2) of rule 3701-17-17 of the Administrative Code.

(3) With the consent of the resident, arrange and confirm the services, equipment and supplies in advance of discharge or transfer of the resident.

(H) 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. The nursing home shall allow the hospice care program to retain professional management responsibility for directing the implementation of the resident's plan of care related to the resident's terminal illness pursuant and related conditions to Chapter 3701-19 of the Administrative Code as long as the resident is receiving hospice care. The 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.

(I) The nursing shall ensure that the privacy and dignity of residents is protected when residents are transported to and from bathing facilities, when residents are preparing for bathing, and during resident bathing.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 3/8/93, 10/20/01

3701-17-15 Restraints.

(A) For purposes of this rule:

(1) "Prone restraint" means all items or measures used to limit or control the movement or normal functioning of any portion, or all, of an individual's body while the individual is in a face-down position for an extended period of time. Prone restraint includes physical or mechanical restraints.

(2) "Transitional hold" means a brief physical positioning of an individual face-down for the purpose of quickly and effectively gaining physical control of that individual in order to prevent harm to self and others, or prior to transport to enable the individual to be transported safely.

(B) 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) The use of prone restraints and transitional holds is prohibited in nursing homes.

(3) A nursing home's use of the following for the purposes stated in this paragraph shall not be construed as physically or chemically restraining a resident or subjecting a resident to prolonged isolation:

(a) Devices that assist a resident in the improvement of the resident's mental and physical functional status and that do not restrict freedom of movement or normal access to one's body;

(b) Medications that are standard treatment or a documented exception to standard treatment for the resident's medical or psychiatric condition which assist a resident in attaining or maintaining the resident's highest practicable physical, mental, and psycho-social well-being; and

(c) Placement of residents in a unit who are assessed to need specialized care 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 (C) 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 the resident to remain 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.

(C) 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 orders if such orders include restraint use or isolation authorization and the home complies with the provisions of this paragraph within twenty-four hours of the resident's admission or readmission to the home.

(D) If a physical restraint is ordered, the nursing home shall select the restraint appropriate for the physical build and characteristics of the resident and shall follow the manufacturer's instructions in applying the restraint. The nursing home shall ensure that correct application of the restraint is supervised by a nurse and that the restrained resident is monitored every thirty minutes. The visual monitoring of the restrained resident may be delegated as permitted under state law. Jackets, sheets, cuffs, belts, or mitts made with unprotected elements of materials such as heavy canvas, leather, or metal shall not be used as restraints.

(E) The attending physician or a staff physician may authorize continued use of physical or chemical restraints for a period not to exceed thirty days and, at the end of this period and any subsequent period, may extend the authorization for an additional period of not more than thirty days. The use of physical or chemical restraints shall not be continued without a personal examination of the resident and the written authorization of the attending physician stating the reasons for continuing the restraint.

(F) Physical or chemical restraints or isolation may be used in an emergency situation without authorization of, or personal examination by, the attending physician only to protect the resident from injury to self or others. Use of the physical or chemical restraint or isolation shall not be continued for more than twelve hours after the onset of the emergency without personal examination and authorization by the attending physician.

(G) When isolation or confinement is used, the nursing home shall ensure that:

(1) The resident is continually monitored and periodically reassessed for continued use and need of this method of intervention;

(2) The door is secured in such a way as to be readily opened in case of an emergency;

(3) The resident is isolated or confined for the least amount of time to achieve desired outcome.

(H) Members of the nursing home's quality assurance committee, required by rule 3701-17-06 of the Administrative Code, shall review monthly the use of restraints and isolation and any incidents that resulted from their use, as well as incidents which resulted in the use of restraints or isolation. The review shall identify any trends, increases, and problems, the need for additional training, consultations or corrective action which shall be discussed and reflected in the minutes of the next quality assurance committee meeting.

Replaces: 3701-17-15, 3701-17- 15.1

Effective: 04/01/2012
R.C. 119.032 review dates: 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09
Prior Effective Dates: 5/2/1966 10/20/01, 6/20/10

3701-17-15.1 [Rescinded] Prone restraint.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19 , 3721.21 , 3721.22 , 3721.23 , 3721.24 , 3721.25 , 3721.26 , 3721.28 , 3721.29 , 3721.30 , 3721.31 , 3721.32 , 3721.33
Prior Effective Dates: 6/20/2010

3701-17-16 Equipment and supplies.

(A) Each resident, if the resident so chooses, shall be provided with an individual bed not less than thirty-six inches wide, a clean comfortable flame-resistant mattress and clean pillows, sheets, and covering suitable for the resident's comfort. A nursing home shall arrange for the provision of at least a double size bed, upon request of a married couple or other consenting adult residents sharing a room in accordance with the nursing home's policy, unless there is an overriding documented medical reason that puts one of the consenting parties at risk of health and safety or there is a risk to other residents. Mattresses shall be protected with waterproof material unless otherwise ordered by a physician. Roll away beds,cots, double deck beds, stacked bunk beds, hide-a-bed couches, or studio couches shall not be used as beds. All mattresses purchased or obtained by the nursing home, or brought to the nursing home by residents, shall be in safe condition.

(B) Unless otherwise ordered by a physician or other licensed health professional acting with the applicable scope of practice, each resident shall be provided with a bedside table, a bedside light that is sufficient for reading and staff rendering of bedside care, a bureau or equivalent, a waste basket with liners, a comfortable chair, and adequate closet or wardrobe space for the storage of personal clothing in the resident's room. A nursing home may provide additional storage space for resident belongings elsewhere in the nursing home. Resident rooms shall be designed or equipped to assure full visual privacy for each resident . For the purposes of this paragraph, "full visual privacy" means that the resident has a means of completely withdrawing from public view while occupying their bed through such means as a curtain, moveable screens or private room.

(C) Each nursing home shall have a call signal system in good working order that, at minimum, provides for the transmission of calls from resident rooms and toilet and bathing facilities.

(D) Supplies such as hypodermic syringes, needles, and lancets shall be discarded after use in accordance with state and federal requirements. Reusable items shall be cleaned and disinfected according to manufacturer's directions and in accordance with applicable state and federal law and regulations.

(E) All nursing homes shall, at all times, have the supplies and equipment necessary to provide the services and nursing care needed by the type of residents admitted to or residing in the nursing home. Wheelchairs, gerichairs, quad canes, adaptive eating equipment and utensils, and other assistive devices shall be maintained in good and safe working condition and shall be equipped properly for the specific needs of each resident.

(1) All equipment and supplies in a nursing home shall be kept clean and usable and shall be satisfactorily stored when not in use.

(2) In selecting supplies and equipment, the home shall consider resident needs.

(F) Within areas generally accessible to residents, all disinfectants, pesticides, and poisons shall be kept in a locked area separate from medications and food.

(G) The nursing home shall provide a safe, clean, comfortable and homelike environment allowing each resident to use personal belongings to the extent possible. Residents may refuse furnishings, equipment and supplies provided by the nursing home. The nursing home shall allow residents to bring their own furnishings and other personal items into the home to personalize their individual environment if the furnishings and items do not create a health and safety risk, are not medically inadvisable, or infringe upon the rights of other residents. Upon request, the nursing home shall assist the resident in obtaining essential furnishings and supplies.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 3/1/1971, 12/21/92, 10/20/01

3701-17-17 Medicines and drugs.

(A) The nursing home shall provide or obtain routine and emergency medicines, drugs and biologicals for its resident except if prohibited by state or federal law. The nursing home shall permit residents to use and continue to obtain medicines, drugs and biologicals dispensed to them from a pharmacy of choice provided the medicines, drugs and biologicals meet the standards of this rule.

(1) Each nursing home shall provide pharmacy services by employing a pharmacist on either a full-time, part-time, or consultant basis or by contracting with a pharmacy service. The pharmacist or pharmacy service shall be responsible for maintaining supervision and control of the stocking and dispensing of drugs and biologicals in the home in accordance with state pharmacy rules.

(2) The nursing home, in conjunction with the pharmacist or pharmacy service, shall:

(a) Maintain an emergency and contingency drug supply for use in the absence of the pharmacist; and

(b) Ensure that the contingency drug supply is maintained in accordance with state pharmacy rules.

(B) Medicines and drugs shall be given only to the individual resident for whom they are prescribed, shall be given in accordance with the directions on the prescription or the physician's orders, and shall be recorded on the resident's medication administration record.

(C) Every container of medicine and drugs prescribed for a resident shall be properly and clearly labeled in accordance with applicable state regulations as to the following:

(1) Date dispensed.

(2) Name of resident.

(3) Directions for use.

(4) Name of the prescriber.

(5) Name of the drug, strength, and prescription number if there is one.

(D) Containers too small to bear a complete prescription label shall be labeled with at least the prescription number and the name of the resident, unless application of this label would impair the functioning of the product, and shall be dispensed in a container bearing a complete prescription label.

(E) The nursing home shall ensure that all medications and drugs are stored under proper temperature controls and secured against unauthorized access. All medicines and drugs, including those requiring refrigeration, shall be kept in locked storage areas and separate from materials that may contaminate the medicines and drugs such as poisonous substances. Where a pharmacist is not present twenty-four hours-a-day, keys to locked contingency drug supplies shall be made available to a health care professional licensed under Chapter 4723. or 4731. of the Revised Code and authorized by such chapters to administer drugs.

(F) Each nursing home shall ensure that the following requirements regarding individual resident's drugs are met:

(1) Appropriate drugs for an individual resident shall, upon order of a prescriber, be sent with or arranged for the resident upon temporary absence other than for hospital leave.

(2) At the order of a prescriber, a resident's drugs shall be sent with or arranged for the resident upon transfer and discharge. Drugs not so ordered by the prescriber upon transfer or discharge shall be returned to the pharmacy or disposed of in accordance with any applicable state or federal laws, rules and regulations.

(3) Upon death of a resident all drugs shall be returned to the pharmacy, or disposed of in accordance with any applicable state or federal laws, rules, and regulations.

(G) Paragraph (F) of this rule does not preclude a nursing home from charging a resident for medications and drugs provided to the resident upon discharge for which the resident has not already paid.

(H) Controlled substances shall be ordered, dispensed, administered, and disposed of in accordance with state and federal laws and regulations.

(I) The nursing home shall ensure that the pharmaceutical needs of each resident are met and that the drug regimen of each resident is reviewed and documented at least once a month by a pharmacist.

(J) The nursing home shall coordinate the ordering of medicines, drugs and biologicals for hospice patients with the appropriate hospice care program.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011 , 3721.04 , 3721.10 , 3721.14
Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/01

3701-17-18 Food and nutrition.

(A) Each nursing home shall have a kitchen and other food service facilities which are adequate for preparing and serving appetizing food for all residents. The nursing home shall develop and implement a policy addressing its method for accommodating religious, ethnic and cultural and personal preferences.

(B) Each nursing home shall provide at least three nourishing, palatable, and appetizing meals daily to all residents at regular hours. The meals shall provide the dietary referenced intake of the "Food and Nutrition Board" of the "National Academy of Science." For scheduled meal services, there shall be at least a four-hour interval of time between the mid-point of the breakfast and the mid-point of the noon meal and between the mid-point of the noon and mid-point of the evening meal. There shall be no more than sixteen hours between the evening meal and breakfast. Each nursing home shall offer a nourishing snack, consisting of a choice of beverages and a food item from a basic food group, after the evening meal. Food substitutes of similar nutritive value shall be offered to residents who refuse the food served and serving size may be adjusted according to resident preference. The nursing home shall accommodate a resident's preference or medical need to eat at different intervals.

(C) A nursing home may provide any alternate format of meal service that otherwise meets the requirements of this rule, if the residents agree to participate in the meal service and the home:

(1) Uses precautions to prevent contamination of food being served; and

(2) Assists residents when necessary .

(D) Each nursing home shall maintain at all times sufficient food supplies for residents. The home shall maintain at least two days' supply of perishable food items and at least one week's supply of staple food items. The amount of such supplies shall be based on the number of meals that the nursing home provides and the nursing home's census.

(E) Each nursing home shall have planned menus, which are approved by the dietitian required by paragraph (K) of this rule, for all meals, including complex therapeutic diets, at least one week in advance. Menus shall be varied and be based on a standard meal planning guide published, or approved by a licensed or registered dietitian in accordance with acceptable standards or practice, or both. The nursing home shall maintain records for all meals, including complex therapeutic diets, as served. The meal records shall be kept on file in the nursing home for at least one year after being served and made available to the director upon request. The records shall indicate the date that each meal was served along with any food substitutions from the menu.

(F) Food shall be prepared and served in a form that meets the resident's needs based on the assessment conducted pursuant to rule 3701-17-10 of the Administrative Code.

(G) Safe, fresh, and palatable drinking water shall be accessible for residents at all times.

(H) . Complex therapeutic diets shall be:

(1) Ordered by a physician or other licensed health professional acting within the applicable scope of practice;

(2) Prepared and provided in accordance with the instructions of a dietitian pursuant to the verified diet order; and

(3) Adjusted as ordered by a physician, dietitian or other licensed health professional acting within the applicable scope of practice.

(I) The nursing home shall monitor each resident's nutritional intake and make adjustments in accordance with the resident's needs. Notification of any significant unplanned or undesired weight change shall be made to the resident's attending physician and the dietitian required by paragraph (K) of this rule. "Significant unplanned or undesired weight change" means a five per cent weight gain or loss over a one month period, a seven and one-half per cent or more weight gain or loss over a three month period, or a ten per cent or more weight gain or loss over a six month period.

(J) The nursing home shall store, prepare, distribute and serve food under sanitary conditions and in a manner that protects it against contamination and spoilage in accordance with food service requirements of Chapter 3717-1 of the Administrative Code.

(K) Each nursing home shall employ a dietitian, who may be hired on a full-time, part-time or consultant basis, to plan, manage and implement dietary services that meet the residents' nutritional needs and comply with the requirements of this rule. If the home does not have the full-time equivalent of a dietitian, the nursing home shall designate a person who meets the qualifications specified in paragraph (H) of rule 3701-17-07 of the Administrative Code, to serve as the food service manager. The part-time or consultant dietitian, at a minimum, shall consult monthly with the food service manager. Each nursing home shall ensure that the dietitian performs the following functions:

(1) Assesses, plans, manages and implements nutritional services that meet the needs of the residents;

(2) Oversees the development and implementation of policies and procedures which assure that all meals are prepared and served as ordered and that food service personnel maintain sanitary conditions in procurement, storage, preparation, distribution and serving of food;

(3) Monitors at least quarterly, or more often as determined by the dietitian, food preparation staff, staff responsible for carrying out the duties specified in this rule, and residents on complex therapeutic diets;

(4) Evaluate residents' response to new complex therapeutic diets, and the home's compliance in the provision of such diet, within one month after the nursing home commences providing the diet. For the purposes of this provision, "new" means either a food regimen that the nursing home has never before supervised or a food regimen that has been prescribed for a resident for the first time; and

(5) Oversees, or arranges for, the training of staff in performing the duties specified in this rule and in the preparation of special diets. Trained unlicensed staff, including the dietary manager, may perform routine tasks that:

(a) May be assigned pursuant to Chapter 4759. of the Revised Code and this rule; and

(b) Do not require professional judgment or knowledge.

(L) Tube feedings and parenteral nutrition shall be administered by the appropriate licensed health professionals in accordance with acceptable standards of practice. Tube feedings shall not be used for convenience or when in conflict with treatment decisions, or a resident's advance directive, in accordance with applicable provisions of Chapters 1337. and 2133. of the Revised Code.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 10/8/86, 12/21/92, 10/20/01

3701-17-19 Records and reports.

(A) Nursing homes shall keep the following records and such other records as the director may require:

(1) An individual medical record shall be maintained for each resident. Such record shall be started immediately upon admission of a resident to the home and shall contain the following:

(a) Admission record. Name, residence, age, sex, race/ethnicity, religion, date of admission, name and address of nearest relative or guardian, admission diagnoses from referral record and name of attending physician and, if applicable, other licensed health professional acting within the applicable scope of practice.

(b) Referral record. All records, reports, and orders which accompany the resident as required by rule 3701-17-10 of the Administrative Code.

(c) Nursing notes and care notes. A note of the condition of the resident on admission and subsequent notes as indicated to describe changes in condition, unusual events or accidents. Other individuals rendering services to the resident may enter notes regarding the services they render.

(d) Medication administration record. A doctor's order sheet upon which orders are recorded and signed by the physician or other licensed health professional acting within the applicable scope of practice, including telephone orders as required by rule 3701-17-13 of the Administrative Code; a nurse's treatment sheet upon which all treatments or medications are recorded as given, showing what was done or given, the date and hour, and signed by the nurse giving the treatment or medication; or other documentation authenticating who gave the medication or treatment.

(e) Resident progress notes. A sheet or sheets upon which the doctor, dentist, advanced practice nurse and other licensed health professionals may enter notes concerning changes in diagnosis or condition of the resident. Resident refusal of treatment and services shall also be documented in the progress notes.

(f) Resident assessment record. All assessments and information required by rule 3701-17-10 of the Administrative Code.

(g) Care plan. The plan of care required by rule 3701-17-14 of the Administrative Code.

(h) Photograph. A photograph is only necessary for residents who have been identified as being a elopement risk. The photograph of the resident shall be updated annually.

(2) The nursing home shall maintain all records required by state and federal laws and regulations, as to the purchase, delivery, dispensing, administering, and disposition of all controlled substances including unused portions.

(3) The nursing home shall maintain a record of all residents admitted to or discharged from the nursing home.

(B) A record shall be kept showing the name and hours of duty of all persons who work in the home. The nursing home shall maintain each employee's current home address in its personnel file.

(C) All records and reports required under rules 3701-17-01 to 3701-17-26 of the Administrative Code shall be prepared, maintained, filed, and transmitted when required, and shall be made available for inspection at all times when requested by the director or his authorized representative. The records may be maintained in electronic format, microfilm, or other method that assures a true and accurate copy of the records are available.

(1) The nursing home shall maintain the records and reports required by paragraph (A)(1) of this rule in the following manner:

(a) The home shall safeguard the records and reports against loss, destruction, or unauthorized use and store them in a manner that protects and ensures confidentiality.

(b) The home shall maintain the records and reports for seven years following the date of the resident's discharge, except if the resident is a minor, the records shall be maintained for three years past the age of majority but not less than seven years.

(c) Upon closure of the home, the operator shall provide and arrange for the retention of records and reports in a secured manner for not less than seven years. The operator shall notify the director of the location where the records will be stored.

(2) The nursing home shall maintain all other records and reports required by rules 3701-17-01 to 3701-17-26 of the Administrative Code for seven years.

(3) Upon the request of the resident, or legal representative, the nursing home shall provide:

(a) Access to medical and financial records and reports pertaining to the resident within twenty-four hours, excluding holidays and weekends; and

(b) Photocopies of any records and reports, or portions thereof, at a cost not to exceed the community standard for photocopying, unless otherwise specified by law, upon two working days advanced notice.

(D) All records and reports required by Chapter 3701-13 of the Administrative Code shall be maintained and made available in accordance with that chapter.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19 , 3721.21 , 3721.22 , 3721.23 , 3721.24 , 3721.25 , 3721.26 , 3721.28 , 3721.29 , 3721.30 , 3721.31 , 3721.32 , 3721.33
Prior Effective Dates: 5/2/1966, 3/1/71, 3/8/81, 12/21/92, 9/5/97, 10/20/01

3701-17-20 Smoking or use of flame producing devices; waste containers and ash trays.

(A) No employee, resident of a nursing home, visitors, or other persons in the nursing home shall be permitted to smoke, carry a lighted cigarette, cigar or pipe or use any spark or flame producing device in any room or area in a nursing home where oxygen is stored or in use. Approved terminals of a piped oxygen supply does not constitute storage.

(B) "No smoking" signs shall be posted in areas and on doors of rooms where oxygen is stored or in use.

(C) Except as provided for in paragraph (D) of this rule, indoor resident smoking shall only be permitted in separately enclosed and separately ventilated designated areas as allowed for in division (D) of section 3794.03 of the Revised Code that accommodate the needs of the smokers. Nursing homes that allow outdoor resident smoking shall make accommodations for residents during adverse weather conditions.

(1) The nursing home shall not designate as resident smoking areas the dining and recreation area or room, resident rooms, and areas or rooms where oxygen is stored, except smoking may be permitted in the dining and recreation areas or rooms when such areas or rooms meet the requirements of division (D) of section 3794.03 of the Revised Code and are not being used for their stated purpose.

(2) The nursing home shall post smoking signs at all designated resident smoking areas. The nursing home shall take reasonable precautions to ensure the safety of all residents when residents smoke.

(D) The nursing home may establish a smoke-free environment if all residents are notified of the policy prior to admission. If a nursing home establishes a policy of this nature, the nursing home shall continue to accommodate the needs of smokers living in the home on the effective date of the smoke-free policy by complying with the provisions of paragraph (C) of this rule.

(E) Ash trays, waste baskets or containers where burnable materials may be placed shall not be made of materials which are flammable, combustible or capable of generating quantities of smoke or toxic gases. Ash trays and waste baskets and containers where burnable materials may be placed shall be noncombustible or carry a fire resistant "UL" or "FM" rating.

(F) Ash trays shall be provided in all designated resident smoking areas. These ash trays shall be either self-closing or have a cigarette island in the middle and shall not have any cigarette holders located around the outside rim of the tray.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.03 , 3741.07 , 3721.071
Prior Effective Dates: 5/2/1966, 3/1/71, 12/21/92, 10/20/01

3701-17-21 Dining and recreation rooms; utility rooms; toilet rooms.

(A) Every building occupied as a nursing home on and in continuous operation since December 22, 1964 shall have not less than one room or suitable area which shall be used for no other purposes than dining and recreation by the residents. Such room or area shall be so located and of such size as to meet the needs of the residents and shall not be used for adult day care participants unless the home meets the square footage requirements of paragraph (B) of this rule. Any building occupied as a nursing home on December 22, 1964 that is discontinued for such use, shall, if such use is resumed, comply with paragraph (C) of this rule.

(B) Every building erected or converted to use as a nursing home after and in continuous operation since December 22, 1964, and before July 17, 2002, shall have a room or suitable area which shall be used for no other purposes than dining and recreation. The dining and recreation room or area shall have a minimum total area of:

(1) Twenty-five square feet per resident for seventy-five per cent of the total number of residents;

(2) If the nursing home provides an adult day care program on the same site as the home and shares the dining and recreation room or area with the day care participants, twenty-five square feet per participant for seventy-five per cent of the total number of participants ; and

(3) Any building licensed by the state as a nursing home on or after December 22, 1964 that is discontinued for such use, shall, if such use is resumed, comply with paragraph (C) of this rule.

(C) Every building erected or converted to use as a nursing home after July 17, 2002 shall have a room or suitable area which shall be used for dining purposes and a separate room or suitable area which shall be used for recreational purposes. A nursing home may use the dining room or area for recreational purposes when the room or area is not being used for dining. Each room or area shall have a minimum total area as follows:

(1) Dining room or area: Twenty-five square feet per resident for the total number of residents . If the nursing home provides an adult day care program on the same site as the home and shares the dining area with the day care participants, twenty-five square feet per participant for the total number of participants; and

(2) Recreational room or area: Twenty-five square feet per resident for seventy-five per cent of the total number of residents. If the nursing home provides an adult day care program on the same site as the home and shares the recreation room or area with the day care participants, twenty-five square feet per participant for seventy-five per cent of the total number of participants.

(D) Every nursing home shall employ methods and have adequate facilities and supplies for clean and soiled laundry in accordance with prevailing infection control practices.

(E) Bathrooms and toilet rooms shall conform to the Ohio building code.

(F) Bathrooms and all fixtures therein shall ensure resident privacy and dignity in accordance with paragraph (I) of rule 3701-17-14 of the Administrative Code.

(G) Bathrooms, toilet rooms and all the facilities therein shall, at all times, be kept in good repair, in a clean and sanitary condition, free from filth and accumulation of waste, and shall be provided with a supply of toilet tissue. Each hand washing basin shall be provided with a soap dispenser. Bathrooms and toilet rooms shall be designed or equipped to assure full visual privacy for each resident.

(H) Grab rails and other safety devices such as non-slip surfaces shall be provided and maintained in good repair.

(I) In every building or addition to a building constructed or converted to use as a nursing home on or after October 20, 2001, there shall be one room toilet room directly accessible from, and exclusively for, each resident sleeping room, except the hand washing basin may be located in either room containing the toilet or the sleeping room.

(J) For purposes of this rule, "bathroom" means a room or rooms conforming to the Ohio building code containing a group of fixtures consisting of a water closet, lavatory, bathtub or shower, including or excluding a bidet, an emergency floor drain, or both.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09
Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/01

3701-17-22 [Effective until 12/8/2014] General building and sanitation requirements.

(A) The building or buildings in which a nursing home is located shall be in compliance with the applicable provisions of the Ohio building code and shall have a certificate of use issued by the appropriate building authority.

(B) All plumbing shall be so installed and maintained as to be free of leakage and odors and as to reasonably insure adequate health and safety protection. Plumbing fixtures in nursing homes or additions to nursing homes constructed, erected, altered or relocated after September 10, 1984, and plumbing fixtures in buildings converted into nursing homes after September 10, 1984 shall conform to the applicable provisions of the Ohio building code.

(C) Lavatories, bathing facilities, and shower facilities shall be supplied with hot and cold running water and shall be regulated by approved devices for temperature control. The hot water temperature in areas used by residents shall be a minimum of one hundred five degrees Fahrenheit and not exceed one hundred and twenty degrees Fahrenheit.

(D) The nursing home's water supply shall be adequate in quantity and of suitable chemical and bacteriological quality for drinking, culinary, and cleaning purposes. The water supply for a nursing home shall be taken from a public supply, if available. If from a source of supply other than a public supply, the water supply shall comply with all applicable local and state regulations regarding the construction, development, installation, alteration, and use of private water systems.

(E) All liquid wastes from nursing homes shall be discharged into a public sanitary sewerage system, if available. Where not available, such wastes shall be discharged into a sewage disposal system that meets all applicable local and state regulations regarding the construction, development, installation, alteration, and use of private household sewage disposal systems. The nursing home shall properly maintain its sewage disposal system in good, safe working condition.

(F) Heating, cooling, electrical, and other building service equipment shall be maintained in good working and safe condition.

(G) The buildings and grounds shall be maintained in a clean and orderly manner.

(H) All garbage and other refuse shall be disposed of immediately after production, or shall be stored in leak-proof containers with tight fitting covers until time of disposal, and all wastes shall be disposed of in a satisfactory manner.

(I) Adequate measures shall be taken to prevent the entrance of insects, rodents, and pests into any building used for a nursing home or part thereof and to prevent their infestation of the premises.

(J) The extermination of insects, rodents, and pests shall be done in such a manner as not to create a fire or health hazard.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 7/1/73, 9/10/84, 12/21/92, 10/20/01

3701-17-22 [Effective 12/8/2014] General building and sanitation requirements; overhead paging.

(A) The building or buildings in which a nursing home is located shall be in compliance with the applicable provisions of the Ohio building code and shall have a certificate of use issued by the appropriate building authority.

(B) All plumbing shall be so installed and maintained as to be free of leakage and odors and as to reasonably insure adequate health and safety protection. Plumbing fixtures in nursing homes or additions to nursing homes constructed, erected, altered or relocated after September 10, 1984, and plumbing fixtures in buildings converted into nursing homes after September 10, 1984 shall conform to the applicable provisions of the Ohio building code.

(C) Lavatories, bathing facilities, and shower facilities shall be supplied with hot and cold running water and shall be regulated by approved devices for temperature control. The hot water temperature in areas used by residents shall be a minimum of one hundred five degrees Fahrenheit and not exceed one hundred and twenty degrees Fahrenheit.

(D) The nursing home's water supply shall be adequate in quantity and of suitable chemical and bacteriological quality for drinking, culinary, and cleaning purposes. The water supply for a nursing home shall be taken from a public supply, if available. If from a source of supply other than a public supply, the water supply shall comply with all applicable local and state regulations regarding the construction, development, installation, alteration, and use of private water systems.

(E) All liquid wastes from nursing homes shall be discharged into a public sanitary sewerage system, if available. Where not available, such wastes shall be discharged into a sewage disposal system that meets all applicable local and state regulations regarding the construction, development, installation, alteration, and use of private household sewage disposal systems. The nursing home shall properly maintain its sewage disposal system in good, safe working condition.

(F) Heating, cooling, electrical, and other building service equipment shall be maintained in good working and safe condition.

(G) The buildings and grounds shall be maintained in a clean and orderly manner.

(H) All garbage and other refuse shall be disposed of immediately after production, or shall be stored in leak-proof containers with tight fitting covers until time of disposal, and all wastes shall be disposed of in a satisfactory manner.

(I) Adequate measures shall be taken to prevent the entrance of insects, rodents, and pests into any building used for a nursing home or part thereof and to prevent their infestation of the premises.

(J) The extermination of insects, rodents, and pests shall be done in such a manner as not to create a fire or health hazard.

(K) Beginning July 1, 2015, each nursing home shall prohibit the use of overhead paging within the nursing home, except that the nursing home may permit the use of overhead paging for matters of urgent public safety or urgent clinical operations. The nursing home shall develop a written policy regarding its use of overhead paging and make the policy available to staff, residents, and residents' families.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.04
Prior Effective Dates: 5/2/1966, 7/1/73, 9/10/84, 12/21/92, 10/20/01, 4/1/12

3701-17-23 Space requirements; limitation of number in wards.

(A) In every building where there is a nursing home, the premises of which were initially licensed by the state as a nursing home prior to December 22, 1964 and have been in continuous operation since being initially licensed, every room occupied for sleeping purposes by one person shall have a habitable floor area of not less than eighty square feet and every room occupied for sleeping purposes by more than one person shall have a habitable floor area of not less than eighty square feet per person. Any building licensed by the state as a nursing home prior to December 22, 1964 that is discontinued for such use shall, if such use is resumed, comply with paragraph (B) of this rule.

(B) In every building or addition to a building, erected or converted to use or initially licensed as a home after December 22, 1964, every room occupied for sleeping purposes by one person shall have a habitable floor area of not less than one hundred square feet and every room occupied for sleeping purposes by more than one person shall have a habitable floor area of not less than eighty square feet per person. In every building occupied as a nursing home on December 22, 1964, every room added for sleeping purposes shall comply with this paragraph.

(C) Except as provided for in paragraph (D) of this rule, no room, ward, section, or similar division used for sleeping purposes by residents shall be occupied by more than four residents. Any building licensed by the state as a nursing home on or after December 22, 1964 that is discontinued for such use, shall, if such use is resumed, comply with paragraph (D) of this rule.

(D) In every building or addition to a building, erected or converted to use or initially licensed as a home on or after July 17, 2002, every room occupied for sleeping purposes by residents shall be occupied by no more than two residents and shall be designed to assure full visual privacy, as defined in paragraph (B) of rule 3701-17-16 of the Administrative Code, for each resident.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 5/2/1966, 12/21/92, 10/20/01

3701-17-24 Temperature regulation in homes.

(A) For the purposes of this rule:

(1) "Resident area" means any area within a nursing home that is occupied at any time by a resident except for an area, such as a greenhouse, that is specifically designed to be kept a higher temperature.

(2) "Temperature range" means between seventy-one degrees fahrenheit and eighty-one degrees fahrenheit.

(B) Each nursing home shall maintain the temperature within the temperature range and the humidity in resident areas at a safe and comfortable level.

(C) Residents in rooms containing separate heating and cooling systems who are capable of controlling them may maintain the temperature of their rooms at any level they desire except the nursing home shall take appropriate intervention if a resident's desired temperature level adversely affects or has potential for adversely affecting the health and safety of the resident or the health, safety and comfort of any other resident sharing the resident room.

(D) Each nursing home in consultation with its medical director, shall develop written policies and procedures for responding to temperatures in resident areas that are outside the temperature range as defined in paragraph (A) of this rule. The policies and procedures shall be signed by the medical director and shall include at least the following:

(1) An identification of available sites within or outside the nursing home to which residents can be relocated temporarily and of other suitable health care facilities that will be available to receive transfers of residents if the temperature level adversely affects or has potential for adversely affecting the health and safety of residents;

(2) Measures to be taken to assure the health, safety and comfort of residents who remain in the nursing home when temperatures are outside the temperature range as defined in paragraph (A)(2) of this rule; and

(3) Identification of the circumstances that require notification of the medical director or a resident's attending physician or that require medical examinations or other medical intervention and appropriate time frames for these actions.

(E) Whenever the temperature in any resident area is outside the temperature range as defined in paragraph (A)(2) of this rule, the nursing home shall immediately evaluate the situation and monitor residents at risk and take appropriate action to ensure the health, safety and comfort of its residents, including but not limited to implementation of the policies and procedures developed under paragraph (D) of this rule. The nursing home shall document all action taken under this paragraph and shall maintain, on site, documentation of action taken during the current calendar year and during the preceding calendar year.

(F) Each nursing home shall maintain appropriate arrangements with qualified persons that provide for emergency service in the event of an electrical, heating, ventilation or air conditioning failure or malfunction and shall maintain documentation of the arrangements such as employment or other written agreements. The nursing home shall ensure that all necessary repairs are completed within forty-eight hours or less. If, for reasons beyond the nursing home's control, repairs cannot be completed timely, the nursing home shall take any necessary action, as specified in paragraph (E) of this rule, and shall provide for the repairs to be completed as soon as possible.

R.C. 119.032 review dates: 10/11/2011 and 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3701.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 10/20/2001

3701-17-25 Disaster preparedness and fire safety.

(A) Each operator shall provide, maintain, and keep current a written disaster preparedness plan to be followed in case of emergency or disaster. A copy of the plan shall be readily available at all times within the nursing home. The nursing home shall ensure that each staff member, consultant and volunteer is trained and periodically updated about the home's disaster preparedness plan and understands their role in the event of fire or other disaster or emergency. The plan shall include the following:

(1) Procedures for evacuating all individuals in the nursing home, including:

(a) Provisions for evacuating residents with physical or cognitive impairments;

(b) Provisions for transporting all of the residents of the nursing home to a predetermined appropriate facility or facilities that will accommodate all the residents in the event a disaster requires long-term evacuation of the nursing home; and

(c) A written transfer agreement, renewed biannually, with the appropriate facility or facilities for accommodating all of the residents of the nursing home in case of a disaster requiring evacuation of the nursing home;

(2) A plan for protection of all persons in the event of fire and when the fire alarm or sprinkler system is undergoing maintenance or inoperative, and procedures for fire control and evacuation, including a fire watch in accordance with rule 1301:7-7-09 of the Administrative Code.

(3) Procedures for locating missing residents, including notification of local law enforcement;

(4) Procedures for ensuring the health and safety of residents during severe weather situations, such as tornadoes and floods, and designation of tornado shelter areas in the home; and

(5) Procedures, as appropriate, for ensuring the health and safety of residents in nursing homes located in close proximity to areas known to have specific disaster potential, such as airports, chemical processing plants, and railroad tracks.

(B) Each operator shall conduct the following drills, unless the state fire marshal allows a home to vary from this requirement and the nursing home has written documentation to this effect from the state fire marshal:

(1) Twelve fire exit drills every year, approximately every three months on each shift to familiarize nursing home personnel with signals and emergency action required under varied times and conditions. Fire exit drills shall include the transmission of a fire alarm signal to the appropriate fire department or monitoring station, verification of receipt of that signal, and simulation of emergency fire conditions except that the movement of infirm and bedridden residents to safe areas or to the exterior of the structure is not required. Drills conducted between nine p.m. and six a.m. may use a coded announcement instead of an audible alarm. The nursing home shall reset the alarms after each drill; and

(2) At least two disaster preparedness drills per year, one of which shall be a tornado drill which shall occur during the months of March through July.

(C) Each operator shall keep a written record and evaluation of each conducted drill and practice which shall include the date, time, employee attendance, effectiveness of the plan, and training format used. This record shall be on file in the nursing home for three years.

(D) Each operator shall provide and post in a conspicuous place in each section and on each floor of the nursing home a correctly-oriented, wall-specific floor plan designating room use, locations of alarm sending stations, fire extinguishers, fire hoses, exits and flow of resident evacuation.

(E) Each operator shall provide for annual training in fire prevention for regularly scheduled staff members on all shifts, to be conducted by the state fire marshal or township, municipal, or local legally constituted fire department. The operator shall require all staff members to be periodically instructed in the home's fire control and evacuation and disaster procedures and kept informed of their duties under the evacuation plan.

(F) Each operator shall conduct at least monthly a fire safety inspection which shall be recorded on forms provided by the department and kept on file in the nursing home for three years.

Effective: 04/01/2012
R.C. 119.032 review dates: 10/27/2011 and 12/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3721.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19
Prior Effective Dates: 7/1/73, 12/21/91, 10/20/2001

3701-17-26 Variances.

(A) The director may grant a variance from the requirements of rules 3701-17-01 to 3701-17-26 of the Administrative Code as will not be contrary to the public interest, where the operator shows that because of practical difficulties or other special conditions, their strict application will cause unusual and unnecessary hardship. However, no variance shall be granted:

(1) That will defeat the spirit and general intent of these rules, adversely affect the health or safety of the residents, or otherwise not be in the public interest; or

(2) For a requirement that is mandated by statute.

(B) A request for a variance from the requirements of rules 3701-17-01 to 3701-17-26 of the Administrative Code shall be made in writing to the director, specifying the following:

(1) The rule requirement for which the variance is requested;

(2) The time period for which the variance is requested;

(3) The specific alternative action which the nursing home proposes;

(4) The reason for the request; and

(5) An explanation of the anticipated effect granting of the variance will have on residents.

(C) The director shall notify the operator, in writing, of the director's determination regarding a variance request and of a revocation of a granted variance. The director may establish conditions that the nursing home shall meet for a variance to be operative and a time frame for which the variance will be effective. The director shall provide the nursing home with an opportunity for an informal hearing concerning the denial of a variance request or a revocation of a granted variance, if requested by the operator within thirty days of the mailing of the notice of denial or revocation, but the nursing home shall not be entitled to a hearing under Chapter 119. of the Revised Code. The informal hearing shall be held within thirty days of the request unless both parties agree otherwise. If the director proposes to deny or revoke a license because the nursing home is in violation of a rule for which a variance was denied or revoked, the director shall afford the nursing home a hearing in accordance with Chapter 119. of the Revised Code.

(D) The director may revoke a variance if the director determines that:

(1) The variance is adversely affecting the health and safety of the residents;

(2) The nursing home has failed to comply with the variance as granted;

(3) The operator or administrator notified the department that the owner or administrator wishes to relinquish the variance; or

(4) The variance conflicts with a statutory change thus rendering the variance invalid.

R.C. 119.032 review dates: 10/11/2011 and 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.02 , 3721.021 , 3721.022 , 3721.023 , 3721.024 , 3721.026 , 3701.027 , 3721.03 , 3721.031 , 3721.032 , 3721.04 , 3721.041 , 3721.05 , 3721.051 , 3721.06 , 3721.07 , 3721.071 , 3721.08 , 3721.09 , 3721.10 , 3721.11 , 3721.12 , 3721.121 , 3721.13 , 3721.14 , 3721.15 , 3721.16 , 3721.161 , 3721.162 , 3721.17 , 3721.18 , 3721.19 , 3721.21 , 3721.22 , 3721.23 , 3721.24 , 3721.25 , 3721.26 , 3721.28 , 3721.29 , 3721.30 , 3721.31 , 3721.32 , 3721.33
Prior Effective Dates: 10/20/2001

3701-17-50 Definitions.

As used in rules 3701-17-50 to 3701-17-68 of the Administrative Code:

(A) "Accommodations" means housing, meals, laundry, housekeeping transportation, social or recreational activities, maintenance, security, or similar services that are not personal care services or skilled nursing care.

(B) "Activities of daily living" means walking and moving, bathing, grooming, toileting, oral hygiene, hair care, dressing, eating, and nail care.

(C) "Administrator" means the person responsible for the daily operation of the residential care facility. The administrator and the operator may be the same person.

(D) "Bedroom" means a room used by a resident or residents for sleeping purposes that is either a resident unit or a portion of a resident unit.

(E) "Call signal system" means a set of devices that are connected electrically, electronically, by radio frequency transmission, or in a like manner, are resident activated, and effectively can alert the staff member or members on duty of emergencies or resident needs.

(F) "Complex therapeutic diets" means calculated nutritive regimens that have been ordered by a physician or other licensed health practitioner acting within their applicable scope of practice, based upon the individual needs of the resident and adjusted to the needs of that resident. A complex therapeutic diet includes, but is not limited to:

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

(2) Renal nutritive regimens;

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

(4) 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.

(G) "County home" and "district home" mean an entity operated under Chapter 5155. of the Revised Code.

(H) "Department" means the department of health.

(I) "Developmental delay" means that a child has not reached developmental milestones expected for his or her chronological age as measured by qualified professionals using appropriate diagnostic instruments and/or procedures.

(1) Delay shall be demonstrated in one or more of the following developmental areas: adaptive behavior, physical developmental or maturation (fine and gross motor skills; growth) cognition; social or emotional development; and sensory development; or

(2) An established risk involving early aberrant development related to diagnosed medical disorders, such as infants and toddlers who are on a ventilator, are adversely affected by drug exposure, or have a diagnosed medical disorder or physical or mental condition known to result in developmental delay such as Down syndrome.

(J) "Developmental diagnosis" means a severe, chronic disability that is characterized by the following:

(1) It is attributable to a mental or physical impairment or a combination of mental and physical impairments, other than a mental impairment solely caused by mental illness as defined in division (A) of section 5122.01 of the Revised Code.

(2) It is manifested before age twenty-two.

(3) It is likely to continue indefinitely.

(4) It results in one of the following:

(a) In the case of a person under three years of age, at least one developmental delay or an established risk;

(b) In the case of a person at least three years of age but under six years of age, at least two developmental delays or an established risk.

(c) In the case of a person six years of age or older, a substantial functional limitation in at least three of the following areas of major life activity, as appropriate for the person's age; self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and if the person is at least sixteen years of age, capacity for economic self-sufficiency.

(5) It causes the person to need a combination and sequence of special, interdisciplinary, or other type of care, treatment, or provision of services for an extended period of time that is individually planned and coordinated for the person.

(K) "Director" means the director of health or any division, bureau, agency, official or employee of the department to which the director has delegated his authority or duties.

(L) "Dietitian" means an individual licensed under Chapter 4759. of the Revised Code to practice dietetics.

(M)

(1) "Home" means both of the following:

(a) Any institution, residence, or facility that provides, for a period of more than twenty-four hours, whether for a consideration or not, accommodations to three or more unrelated individuals who are dependent upon the services of others, including a nursing home, residential care facility, and the Ohio veterans' home;

(b) A county home or district home that is or has been licensed as a residential care facility.

(2) "Home" also means any facility that a person, as defined in section 3702.51 of the Revised Code, proposes for certification as a skilled nursing facility or nursing facility under Title XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended (1981), and for which a certificate of need, other than a certificate to recategorize hospital beds as described in section 3702.522 of the Revised Code or under division (R)(7)(d) of the version of section 3702.51 of the Revised Code in effect immediately prior to April 20, 1995, has been granted to the person under sections 3702.51 to 3702.62 of the Revised Code after August 5, 1989.

(3) "Home" does not mean any of the following:

(a) Except as provided in division (A)(1)(b) of section 3721.01 of the Revised Code, a public hospital or hospital as defined in section 3701.01 or 5122.01 of the Revised Code;

(b) A residential facility for mentally ill persons as defined under section 5119.22 of the Revised Code;

(c) A residential facility as defined in section 5123.19 of the Revised Code;

(d) An alcohol or drug addiction program as defined in section 3793.01 of the Revised Code;

(e) A facility licensed to provide methadone treatment under section 3793.11 of the Revised Code;

(f) A facility providing services under contract with the department of mental retardation and developmental disabilities under section 5123.18 of the Revised Code;

(g) A facility operated by a hospice care program licensed under section 3712.04 of the Revised Code that is used exclusively for care of hospice patients;

(h) A facility, infirmary, or other entity that is operated by a religious order, provides care exclusively to members of religious orders who take vows of celibacy and live by virtue of their vows within the orders as if related, and does not participate in the medicare program established under Title XVIII of the "Social Security Act" or the medical assistance program established under Chapter 5111. of the Revised Code and Title XIX of the "Social Security Act," if on January 1, 1994, the facility, infirmary, or entity was providing care exclusively to members of the religious order;

(i) A county home or district home that has never been licensed as a residential care facility.

(N) "Home health agency" means an agency certified as a provider of home health services under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended (1981).

(O) "Licensed practical nurse" means a person licensed under Chapter 4723. of the Revised Code to practice nursing as a licensed practical nurse.

(P) "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.

(Q) "Maximum licensed capacity" means the authorized type and number of residents in a home as determined in paragraph (O) of rule 3701-17-52 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) "Nonambulatory" means not able to walk or not physically able to leave the premises without assistance from another individual.

(T) "Nurse" means a registered nurse or licensed practical nurse.

(U) "Nursing home" means a home used for the reception and care of individuals who by reason of illness or physical or mental impairment require skilled nursing care and of individuals who require personal care services but not skilled nursing care. A nursing home is licensed to provide personal care services and skilled nursing care.

(V) "Ohio building code" means the building requirements, as adopted by the board of building standards pursuant to section 3781.10 of the Revised Code.

(W) "On call" means the person can be contacted at all times and is immediately available to go on duty in the home upon short notice.

(X) "On duty" means being in the home, awake, and immediately available.

(Y) "Operator" means the person, firm, partnership, association, or corporation which is required by section 3721.05 of the Revised Code to obtain a license in order to open, maintain or operate a home and the superintendent or administrator of a county home or district home licensed or seeking to be licensed as a residential care facility.

(Z) "Personal care services" means services including, but not limited to, the following:

(1) Assisting residents with activities of daily living:

(2) Assisting residents with self-administration of medication, in accordance with rule 3701-17-59 of the Administrative Code;

(3) Preparing food for special diets, other than complex therapeutic diets, for residents pursuant to the instructions of a physician, a licensed health care professional acting within their applicable scope of practice, or a licensed dietitian, in accordance with rule 3701-17-60 of the Administrative Code.

"Personal care services" does not include "skilled nursing care". A facility need not provide more than one of the services listed in this paragraph to be considered to be providing personal care services.

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

(BB) "Registered nurse" means an individual licensed to practice nursing as a registered nurse under Chapter 4723. of the Revised Code.

(CC) "Resident" means an unrelated individual to whom a residential care facility provides accommodations.

(DD) "Resident unit" means the private room or rooms occupied by a resident or residents.

(EE) "Residents' rights" means the rights enumerated in sections 3721.10 to 3721.17 of the Revised Code.

(FF) "Residential care facility" means a home that provides either of the following:

(1) Accommodations for seventeen or more unrelated individuals and supervision and personal care services for three or more of those individuals who are dependent on the services of others by reason of age or physical or mental impairment;

(2) Accommodations for three or more unrelated individuals, supervision and personal care services for at least three of those individuals who are dependent on the services of others by reason of age or physical or mental impairment, and to at least one of those individuals, any of the skilled nursing care authorized by section 3721.011 of the Revised Code.

(GG) "Serious mental illness" means an illness classified in the "Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-IIIR)," that meets at least two of the three following criteria of diagnosis, duration and disability:

(1) Diagnosis: The current primary diagnosis is:

(a) Delusional disorders (DSM-IIIR 297.10 );

(b) Dissociative disorders (DSM-IIIR 300.14 );

(c) Eating disorders (DSM-IIIR 307.10 , 307.51 , 307.52 );

(d) Mood disorders (DSM-IIIR 296.3 x, 296.4 x, 296.5 x, 296.6 x, 296.70, 300.40, 301.13 , 311.00 );

(e) Organic mental disorders (DSM-IIIR 290.0, 290.10, 290.1 x, 290.4 x, 294.10, 294.80 );

(f) Personality disorders (DSM-IIIR 301.00, 301.20 , 301.22 , 301.40, 301.50, 301.60, 301.70, 301.81, 301.82, 301.83, 301.84, 301.90 );

(g) Psychotic disorders (DSM-IIIR 395.40, 295.40, 295.70, 298.90 );

(h) Schizophrenia (DSM-IIIR 295.1 x, 295.2 x, 295.3 x, 295.6 x, 295.9 x);

(i) Somatoform disorder (DSM-IIIR 307.80 );

(j) Other disorders (DSM-IIIR 313.23 , 313.81, 313.82 ); or

(k) Other specified.

(2) Duration: the length of the problem can be assessed by either inpatient or outpatient use of service history, reported length of time of impairment, or some combination, including at least two prior hospitalizations of more than twenty-one days or any number of hospitalizations (more than one) totaling at least forty-two days prior to the assessment, or ninety to three hundred sixty-five days in a hospital or nursing home within three prior years, or major functional impairment lasting more than two years, resulting in utilization of outpatient mental health services on an intermittent basis, a continuous basis, or both.

(3) Disability/functional impairment: severity of disability can be established by disruption in two or more life activities, including but not limited to:

(a) Employment;

(b) Contributing substantially to one's own financial support (not to be entitlements);

(c) Independent residence;

(d) Self-care;

(e) Perception and cognition;

(f) Stress management or coping skills; or

(g) Interpersonal and social relations.

(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 or other licensed health care professional acting within their applicable scope of practice, such as hypodermically, rectally, or orally, including observation of the resident after receipt of the medication;

(5) Carrying out other treatments prescribed by the physician or other licensed health care professional acting within their applicable scope of practice, that involve a similar level of complexity and skill in administration.

(II) "Special care unit" means a residential care facility, or part thereof, that is dedicated to providing care to residents with diagnoses, that include, but are not limited to, late-stage cognitive impairment with significant ongoing daily living assistance needs, cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both; or, serious mental illness.

(JJ) "Special diets" means a diet that has been ordered for a resident by a physician or other licensed health care professional acting within their applicable scope of practice, based upon the individual needs of that resident and adjusted to the needs of that resident. A special diet may include the following:

(1) Texture modifications, including chopped, ground and pureed;

(2) Nutrient adjusted, including high protein, no added salt, and no concentrated sweets;

(3) Volume adjusted, including small, medium and large portions;

(4) Physical needs, including the use of finger foods or bite-sized pieces; or

(5) Complex therapeutic diets.

(KK) "Staff member" or "staff" means an individual working in a residential care facility including the owner; the administrator; a full-time, part-time or temporary paid employee; or an individual working on contract for the facility.

(LL) "Supervision" means:

(1) Watching over a resident, when necessary, while the resident engages in activities of daily living or other activities to ensure the resident's health, safety, and welfare;

(2) Reminding a resident to do or complete such an activity, as by reminding him or her to engage in personal hygiene or other self-care activity; or

(3) Helping a resident to schedule or keep an appointment, or both, including the arranging for transportation.

"Supervision" does not include reminding a resident to take medication and watching the resident to ensure that the resident follows the directions on the container or supervision of special diets as described in paragraph (J) of rule 3701-17-60 of the Administrative Code.

(MM) "Supervision of complex therapeutic diets" means services, including, but not limited to, the following:

(1) Monitoring a resident's access to appropriate foods as required by a complex therapeutic diet;

(2) Monitoring a resident's weight and acceptance of a complex therapeutic diet;

(3) Providing assistance to residents on complex therapeutic diets as needed or requested: and

(4) Providing or preparing complex therapeutic diets.

(NN) "Unrelated individual" means one who is not related to the owner or operator of the residential care facility or to his or her spouse as a parent, grandparent, child, grandchild, brother, sister, niece, nephew, aunt, uncle, or as the child of an aunt or uncle.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.12
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-51 General provisions and prohibitions.

(A) Nothing contained in rules 3701-17-50 to 3701-17-68 of the Administrative Code shall be construed as authorizing the supervision, regulation, or control of the spiritual care or treatment of residents who rely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any recognized church or religious denomination.

(B) For the purposes of rules 3701-17-50 to 3701-17-68 of the Administrative Code:

(1) Any residence, institution, hotel, assisted living facility, congregate housing project, or similar facility that meets the definition of a residential care facility or a home for the aging under section 3721.01 of the Revised Code is such a home regardless of how the facility holds itself out to the public;

(2) Any residence, institution, hotel, assisted living facility, congregate housing project, or similar facility that provides personal care services to fewer than three residents or that provides for any number of residents, only housing, housekeeping, laundry, meals, social or recreational activities, maintenance, security, transportation, and similar services that are not personal care services or skilled nursing care is not a home required to be licensed under Chapter 3721. of the Revised Code or rules 3701-17-50 to 3701-17-68 of the Administrative Code; and

(3) Personal care services or skilled nursing care shall be considered to be provided by a residential care facility if they are provided by a person employed by or associated with the facility or by another person pursuant to an agreement to which neither the resident who receives the services nor his sponsor is a party.

(C) Nothing in paragraph (AA) of rule 3701-17-50 of the Administrative Code shall be construed to permit personal care services to be imposed upon a resident who is capable of performing the activity in question without assistance. Nothing in paragraph (II) of rule 3701-17-50 of the Administrative Code shall be construed to permit skilled nursing care to be imposed upon an individual who does not require skilled nursing care.

(D) In addition to providing accommodations, supervision, and personal care services to its residents, a residential care facility is licensed to provide skilled nursing care to its residents as follows:

(1) Supervision of special diets;

(2) Application of dressings pursuant to division (A)(2) of section 3721.011 of the Revised Code and paragraph (J) of rule 3701-17-59 of the Administrative Code;

(3) Subject to division (B)(1) of section 3721.011 of the Revised Code, administration of medication;

(4) Subject to division (C) of section 3721.011 of the Revised Code, other skilled nursing care provided on a part-time, intermittent basis for not more than a total of one hundred twenty days in any twelve-month period;

(5) Subject to division (D) of section 3721.011 of the Revised Code, skilled nursing care provided for more than one hundred twenty days in any twelve-month period to a resident whose physician has determined the skilled nursing care needed is routine, or to a hospice patient as defined in section 3712.01 of the Revised Code.

(E) A residential care facility may not admit or retain individuals requiring skilled nursing care or provide skilled nursing care beyond the limits established under section 3721.011 of the Revised Code and rule 3701-17-59.1 of the Administrative Code.

(F) Each residential care facility shall provide services as outlined in the resident agreement in accordance with acceptable practices and the facility's policies and procedures.

(G) Each residential care facility shall comply with all the residents' rights provisions under Chapter 3721. of the Revised Code.

(H) A residential care facility shall not use the word "hospital" in its name, letterhead or advertising.

(I) A residential care facility shall not admit residents in excess of the maximum licensed bed capacity.

(J) Notwithstanding section 3721.011 of the Revised Code, a residential care facility in which residents receive skilled nursing care as described in section 3721.011 of the Revised Code is not a nursing home.

(K) An applicant for a license to operate a residential care facility shall not accept more than two residents who need personal care services, medication administration, supervision of special diets, application of dressings or skilled nursing care before receiving a license.

(L) In addition to the above provisions, no person, firm, partnership, association, or corporation shall:

(1) Operate a residential care facility as defined in section 3721.01 of the Revised Code and paragraph (GG) of rule 3701-17-50 of the Administrative Code without obtaining a license from the director;

(2) Violate any of the conditions or requirements necessary for licensing after the license has been issued;

(3) Operate a residential care facility after the license for such has been revoked by the director;

(4) Interfere with the inspection of a licensed residential care facility by any state or local official when he or she is performing duties required of him or her by Chapter 3721. of the Revised Code. All licensed residential care facilities shall be open for inspection.

(5) Violate any applicable provision of Chapter 3721. of the Revised Code or rules 3701-17-50 to 3701-17-68 of the Administrative Code.

(M) No county home or district home licensed under section 3721.07 of the Revised Code shall do any of the following:

(1) Violate any of the conditions or requirements necessary for licensing after the licensed has been issued;

(2) Continue operation after its license has been revoked by the director of health;

(3) Fail to be open for an inspection, or interfere with an inspection, by a state or local official performing inspection duties under Chapter 3721. of the Revised Code.

(4) Violate any of the provisions of this chapter or any rules adopted thereunder.

(N) Nothing contained in rules 3701-17-50 to 3701-17-68 of the Administrative Code shall be construed to permit any individual to engage in the practice of nursing as a registered nurse or the practice of nursing as a licensed practical nurse if the individual does not hold a valid license issued under Chapter 4723. of the Revised Code.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.012 , 3721.05 , 3721.06 , 3721.13
Prior Effective Dates: 12/21/1992, 9/29/96, 6/21/97, 12/01/01, 4/01/07

3701-17-52 Residential care facility licensure application and renewal procedures; revocation.

(A) Every applicant for a license to operate a residential care facility shall truthfully and fully complete and submit an initial application on a form prescribed and furnished by the director and pay the nonrefundable application fee, specified in section 3721.02 of the Revised Code,to the director not less than sixty days before the proposed opening of the facility. The application fee required by this rule shall be submitted to the director and the fee shall be made payable to the "treasurer, state of Ohio" in the form of a check or money order. The department shall deposit the fee in the state treasury to the credit of the general operations fund created by section 3701.83 of the Revised Code.

(B) The initial application for a license to operate a residential care facility shall be accompanied by:

(1) A statement of financial solvency at the time of the initial application and updated as requested by the director, on a form prescribed and furnished by the director, showing that the applicant has the financial ability to staff, equip, and operate the residential care facility in accordance with Chapter 3721. of the Revised Code, and rules 3701-17-50 to 3701-17-68 of the Administrative Code, and that the applicant has sufficient capital or financial reserve to cover not less than three months' operation;

(2) A statement containing the following information:

(a) If the operator is an individual and owner of the business, or superintendent or administrator of a county home or district home, the individual's name, address, and telephone number. If the operator is a business owned by an association, corporation, or partnership, the business activity, address, and telephone number of the entity and the name of every person who has an ownership interest of five per cent or more in the entity; and

(b) If the operator does not own the building or buildings or if the operator owns only part of the building or buildings in which the residential care facility is housed, the name of each person who has an ownership interest of five per cent or more in the buildings.

(c) The name and address of any residential care facility and any facility described in paragraphs (M)(1) and (M)(3) of rule 3701-17-50 of the Administrative Code in which the operator or administrator, or both, have an ownership interest of five per cent or more or with which the operator or administrator have been affiliated with through ownership or employment in the five years prior to the date of the application;

(d) The name, business address and telephone number of the administrator of the residential care facility, if different from the operator;

(e) The name, business address and telephone number of any management firm or business employed to manage the residential care facility; and

(f) The name, business address, and telephone number of the statutory agent of the operator.

(3) Copies of the:

(a) Floor plan for the building or area of a building to be licensed as a residential care facility, including beds;

(b) Certificate of occupancy required by paragraph (A) of rule 3701-17-63 of the Administrative Code;

(c) Inspection report of the state fire marshal or a township, municipal, or other legally constituted fire department approved by the marshal required by paragraph (A) of rule 3701-17-63 of the Administrative Code; and

(d) Heating inspection report required by paragraph (A) of rule 3701-17-65 of the Administrative Code.

The operator or administrator shall notify the director in writing of any changes in the information contained in this paragraph. The operator or administrator shall provide this notification no later than ten days after the change occurs.

(C) The operator of a residential care facility shall truthfully and fully submit a license renewal application and pay the nonrefundable application fee specified in section 3721.02 of the Revised Code specified in section 3721.02 of the Revised Code using an electronic system prescribed by the director. Any residential care facility that does not pay its renewal fee in January shall pay, beginning the first day of February, a late fee of one hundred dollars for each week or part thereof that the renewal fee is not paid. If either the renewal fee or the late fee is not paid by the fifteenth day of February, the director may, in accordance with Chapter 119. of the Revised Code, revoke the facility's license.

(D) The license renewal application requred by paragraph (C) of this rule shall:

(1) Include an update of the information required under paragraphs (B)(2) and (B)(3) of this rule;

(2) A copy of the most recent inspection report by the state fire marshal or a township, municipal, or other legally constituted fire department approved by the marshal required by paragraph (A) of rule 3701-17-63 of the Administrative Code;

(3) Provide information the director may require to assess whether the operator has violated section 3721.07 of the Revised Code; and

(4) Be updated no less than ten days after any changes in the information contained in this paragraph occurs.

(E) If the residential care facility alters its physical facilities in a manner that affects bed capacity or proposes to relocate existing beds to a unlicensed portion of the facility, the facility shall notify the director, in writing, at least sixty days prior to the date the facility wants to commence filling the new beds or relocating existing beds. The residential care facility shall not use the altered or unlicensed area until the department notifies the facility, in writing, that the alteration or move complies with the applicable provisions of Chapter 3721. of the Revised Code and rules 3701-17-50 to 3701-17-68 of the Administrative Code. The written notice from the facility shall include:

(1) A floor plan of the area, including beds;

(2) The results of the inspection by the state fire marshal or a township, municipal, or other legally constituted fire department approved by the marshal for the area; and

(3) A certificate of occupancy for the area.

(F) The director may request any additional information the director determines to be necessary to assess compliance with the applicable criteria, standards, and requirements established by Chapter 3721. of the Revised Code and rules 3701-17-50 to 3701-17-68 of the Administrative Code. The applicant shall truthfully respond and submit any additional information requested by the director within sixty days of the director's request.

(G) The director shall issue a license to operate a residential care facility if, after completion of the inspection required by paragraph (A) of rule 3701-17-53 of the Administrative Code and review of the license application, the director determines that the facility meets the requirements of section 3721.07 of the Revised Code. The license shall remain in effect until revoked by the director or voided at the request of the applicant if the annual renewal fee is paid during the month of January of each year.

(H) A license to operate a residential care facility is valid only for the premises named in the application. If ownership of a facility is assigned or transferred to a different person, the new owner is responsible and liable for compliance with any notice of proposed action or order issued under section 3721.08 of the Revised Code prior to the effective date of the assignment or transfer.

(I) An operator who operates one or more residential care facilities in more than one building shall obtain a separate license for each building except if such buildings are on the same lot and constitute a single residential care facility, such facility may be operated under a single license. On or after the effective date of this rule, an operator who operates one or more residential care facilities in more than one building, where the buildings are intersected by a public roadway, shall not be granted a license to operate the buildings as a single residential care facility, unless before the effective date of this rule the buildings were so licensed.

(J) The operator shall post the license in a conspicuous place in the residential care facility.

(K) The director may issue an order revoking a license in the event the director finds, upon hearing or opportunity afforded pursuant to Chapter 119. of the Revised Code, that any of the following apply to a person, county home, or district home licensed under section 3721.07 of the Revised Code:

(1) Has violated any of the provisions of Chapter 3721. of the Revised Code or of rules 3701-17-50 to 3701- 17-68 of the Administrative Code;

(2) Has violated any order issued by the director;

(3) Is not, or any of its principals are not suitable, morally or financially, to operate such an institution;

(4) Is not furnishing humane, kind, and adequate treatment and care; or

(5) Has had a long-standing pattern of violations of Chapter 3721. of the Revised Code or of rules 3701-17-50 to 3701-17-68 of the Administrative Code that has caused physical, emotional, mental, or psychosocial harm to one or more residents.

(L) The director may issue an order denying a license in the event the director finds after investigation of the applicant and, if required by section 3721.02 of the Revised Code, inspection of the home, one or more of the following conditions exist:

(1) The applicant has been convicted of a felony or a crime involving moral turpitude;

(2) The applicant is violating any of the rules made by the public health council or any order issued by the director of health;

(3) The applicant has had a license to operate the home revoked pursuant to section 3721.03 of the Revised Code, other than division (B)(5) of section 3721.03 of the Revised Code, because of any act or omission that jeopardized a resident's health, welfare, or safety;

(4) The buildings in which the home is housed have not been approved by the state fire marshal or a township, municipal, or other legally constituted fire department approved by the marshal. In the approval of a home such agencies shall apply standards prescribed by the board of building standards, and by the state fire marshal, and by section 3721.071 of the Revised Code;

(5) The applicant, if it is an individual, or the principal participants, if it is an association or a corporation, is or are not suitable financially and morally to operate a home;

(6) The applicant is not equipped to furnish humane, kind, and adequate treatment and care;

(7) The home maintains or contains:

(a) Facilities for the performance of major surgical procedures;

(b) Facilities for providing therapeutic radiation;

(c) An emergency ward;

(d) A clinical laboratory unless it is under the supervision of a clinical pathologist who is a licensed physician in this state; or

(e) Facilities for radiological examinations unless such examinations are performed only by a person licensed to practice medicine, surgery, or dentistry in this state;

(8) The home accepts or treats outpatients, except upon the written orders of a physician licensed in this state, maternity cases, boarding children, or houses transient guests, other than participants in an adult day-care program, for twenty-four hours or less; or

(9) The home is not in compliance with sections 3721.28 and 3721.29 of the Revised Code.

(M) Upon the issuance of any order of revocation or denial, the person whose license is revoked or denied, or county home or district home that has its license revoked or denied, may appeal in accordance with Chapter 119. of the Revised Code.

(N) Once the director notifies a person, county home, or district home licensed to operate a home that the license may be revoked or issues any order under section 3721.03 of the Revised Code or under this rule, the person, county home, or district home shall not assign or transfer to another person or entity the right to operate that home. This prohibition shall remain in effect until proceedings under Chapter 119. of the Revised Code concerning the order or license revocation have been concluded or the director notifies the person, county home, or district home that the prohibition has been lifted.

(1) If a license is revoked under this section, the former license holder shall not assign or transfer or consent to assignment or transfer of the right to operate the home. Any attempted assignment or transfer to another person or entity is void.

(2) On revocation of a license, the former license holder shall take all necessary steps to cease operation of the home.

(O) If, under division (B)(5) of section 3721.03 of the Revised Code, the license of a person, county home, or district home has been revoked, the director of health shall not issue a license to the person or home at any time. A person, county home, or district home whose license is revoked for any reason other than nonpayment of the license renewal fee or late fees may not apply for a new license under Chapter 3721. of the Revised Code until a period of one year following the date of revocation has elapsed.

(P) An operator shall give the director written notification of a closing at least sixty days prior to a planned closing date and within twenty four hours of an unplanned closing. This notice shall include:

(1) An address where the operator may be reached after the closing of the home;

(2) A plan for the transfer and adequate relocation of all residents; and

(3) Assurances that the residents will be transferred to the most integrated and appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident.

(Q) While providing a written notification of closure under paragraph (P) of this rule, the operator shall, in accordance with Chapter 3701-61 of the Administrative Code, also provide written notice of the proposed date of closing of the home to its residents and their sponsors or legal representatives and the regional longterm care ombudsperson program, designated under section 173.16 of the Revised Code, serving the area where the home is located.

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

(1) The facility maintains, in addition to a residential care facility, a separate and discrete part or unit that provides accommodations to individuals who do not require or receive skilled nursing care and do not receive personal care services from the residential care facility, in which case the individuals in the separate and discrete part or unit shall not be considered in determining the number of residents in the residential care facility if the separate and discrete part or unit is in compliance with the Ohio basic building code established by the board of building standards under Chapters 3781. and 3791. of the Revised Code and the facility permits the director, on request, to inspect the separate and discrete part or unit and speak with the individuals residing there, if they consent, to determine whether the separate and discrete part or unit meets the requirements of section 3721.02 of the Revised Code and this paragraph.

(2) The facility provides an adult day care program on the same site as the facility that is separate and distinct from the facility except as otherwise permitted in rules 3701-17-50 to 3701-17-68 of the Administrative Code, in which case the participants of the adult day care program shall not be considered in determining the number of residents in the facility.

(S) The director shall determine the type and number of residents a residential care facility can accommodate which shall be the authorized maximum licensed capacity of the facility. Such determination shall be made on the basis of the physical facilities, personnel of the facility and the services and care needed by the residents to be admitted or retained in the residential care facility, and the permitted occupancy approved by the department of commerce. No operator, administrator, staff member or any other person shall set up beds for resident use in a residential care facility which exceed the authorized maximum licensed capacity.

Replaces: parts of 3701-17-51, 3701-17-52

Effective: 01/01/2013
R.C. 119.032 review dates: 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.03 , 3721.05 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 6/21/97, 12/01/01, 4/01/07

3701-17-53 Inspections and investigations; correction.

(A) The director shall inspect each residential care facility at least once prior to the issuance of a license, at least once every fifteen months and as the director considers necessary. The inspections may be announced or unannounced except that one unannounced inspection shall be conducted at least every fifteen months. The state fire marshal or a township, municipal, or other legally constituted fire department approved by the fire marshal shall also inspect a residential care facility prior to issuance of a license, at least once every fifteen months thereafter, and at any other time requested by the director. A residential care facility does not have to be inspected prior to issuance of a license by the director, state fire marshal, or a fire department if ownership of the facility is assigned or transferred to a different person and the facility was licensed under Chapter 3721. of the Revised Code as a residential care facility immediately prior to the assignment or transfer.

(B) The director may investigate any complaint concerning a facility in accordance with sections 3721.031 and 3721.17 of the Revised Code.

(C) An operator, administrator, staff member or any other person shall not:

(1) Refuse to permit the director for the purpose of inspecting or investigating the operation of a residential care facility, to enter and inspect at any time a building or premise where a residential care facility is located, or to enter and inspect records, including resident medical records, which are kept concerning the operation of the residential care facility for information pertinent to the legitimate interest of the department.

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

(D) When inspecting or investigating a residential care facility, the director shall respect the residents' privacy and dignity, cooperate with the residents, behave in a congenial manner toward the residents, protect the residents' rights, and behave in a cooperative and professional manner toward individuals working in the facility. The director or the director's designee shall:

(1) Refrain from using language or behavior that is derogatory, insulting, intimidating, or threatening;

(2) Not harass or coerce residents or otherwise attempt to influence residents' responses to inquiries;

(3) Not make remarks or comparison, positive or negative, about another residential care facility or other residents;

(4) Not solicit, accept, or agree to accept from the residential care facility or a resident of the facility compensation, gratuities, gifts, or any other thing of value that is of such character as to manifest a substantial and improper influence upon the director or the director's designee with respect to their duties;

(5) Obtain the resident's consent prior to conducting an evaluation of a resident unless a court has issued a search warrant or other order authorizing such an evaluation. When requesting the resident's consent to evaluate the resident, the director or the director's designee shall explain that:

(a) The resident has the option to consent or not to consent to the evaluation;

(b) The resident will not be evaluated without the resident's consent;

(c) The resident may have another individual of the resident's choice present during the evaluation. If a resident requests that another individual be present during the evaluation and that individual is not available, the resident has not consented to the evaluation; and

(d) The resident will not suffer any adverse consequences if the resident refuses to consent.

(E) The director may enter at any time, for the purposes of investigation, any institution, residence, facility, or other structure which has been reported to the director or that the director has reasonable cause to believe is operating as a residential care facility without a valid license or in the case of a county or district home, is operating despite the revocation of its residential care facility license.

(F) If an inspection reveals a violation or violations of Chapter 3721. of the Revised Code or of rules 3701-17-50 to 3701-17-68 of the Administrative Code, the director may provide the facility with the opportunity to correct the violation or violations.

R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.02 , 3721.031 , 3721.05 , 3721.06 , 3721.08 , 3721.13 , 3721.14 , 3721.17
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-54 Personnel requirements.

(A) Each residential care facility shall arrange for the services of an administrator who shall:

(1) Meet the applicable requirements of rule 3701-17-55 of the Administrative Code;

(2) Be responsible for the daily operation of the residential care facility including, but not limited to, assuring that residents' ongoing or changing service needs, as identified in the resident assessments, and services ordered by a licensed health care professional are acted upon by the appropriate staff member. If the facility does not provide for the needed service, it shall be discussed with the resident as required by paragraph (H) of rule 3701-17-58 of the Administrative Code;

(3) Provide not less than twenty hours of service in the facility during each calendar week during the hours of eight a.m. and six p.m. If the administrator is unable to provide at least twenty hours of service in the residential care facility in a given calendar week because of a vacation, illness, or other temporary situation, the administrator shall designate a staff member, who shall not be less than twenty-one years of age and who meets the requirements of paragraphs (D) and (K) of rule 3701-17-55 of the Administrative Code, to serve as acting administrator;

The administrator or acting administrator shall be accessible at all other times when not present at the residential care facility. A residential care facility located in the same building as a nursing home, or on the same lot as a nursing home, both of which are owned and operated by the same entity, shall be considered to have met this requirement if the nursing home has a full-time administrator licensed under Chapter 4751. of the Revised Code who is responsible for both the residential care facility and nursing home. For the purposes of this paragraph, "full-time" means no less than thirty-two hours per calendar week.

(B) The residential care facility administrator may provide services to residents if the administrator meets the applicable qualifications of rule 3701-17-55 of the Administrative Code. An administrator, providing personal care services, of a facility with:

(1) Sixteen or less beds may be counted toward meeting the staffing requirements of paragraph (C)(1) of this rule;

(2) Seventeen to thirty-five beds shall not be counted toward meeting the staffing requirements of paragraph (C)(1) until he or she has met the requirements of paragraph (A)(3) of this rule;

(3) More than thirty-five beds shall not be counted toward meeting the staffing requirements of paragraph (C)(1) of this rule.

(C) Each residential care facility shall have the following staff members who are competent to perform the duties they are assigned:

(1) At least one staff member on duty at all times who shall meet the qualifications of rule 3701-17-55 of the Administrative Code for staff members providing personal care services. During the night, the staff member who is physically present in the facility may be on call if the facility meets the call signal system requirements of paragraph (B)(5) of rule 3701-17-64 of the Administrative Code. When only one staff person is on duty in the facility, the residential care facility shall designate another staff member who meets the same qualifications to be on call; and

(2) Sufficient additional staff members who meet the applicable qualifications of rule 3701-17-55 of the Administrative Code for the services they perform and appropriate scheduling of sufficient staff time to adequately do all of the following:

(a) Meet, in a timely manner, the residents' total care, supervisory and emotional needs as determined by the resident assessment required under rule 3701-17-58 of the Administrative Code and consistent with the resident agreement required under rule 3701-17-57 of the Administrative Code and reasonable and appropriate requests for services, including monitoring in excess of supervision of residents with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both;

(b) Properly provide dietary, housekeeping, laundry, and facility maintenance services and recreational activities for the residents in accordance with the rules of this chapter; and

(c) Assist, when necessary, with prompt evacuation of nonambulatory residents. The additional staff members needed to implement the facility's evacuation plan required by paragraph (J) of rule 3701-17-63 of the Administrative Code shall be present in the facility at all times.

(d) Provide or arrange for resident activities required under rule 3701-17-61 of the Administrative Code.

(3) Each residential care facility shall have at least one staff member capable of giving personal care services who has successfully completed the first aid training required by paragraph (E) of rule 3701-17-55 of the Administrative Code, if applicable, present in the facility at all times.

(4) In determining the staffing level for the facility, the facility is not required to consider resident needs:

(a) That are being served through a contractual arrangement between the resident and a third party provider;

(b) That the resident chooses not to have met as documented in the resident's record; or

(c) That the resident has not contracted with the facility to meet if the facility has complied with paragraph (H) of rule 3701-17-58 of the Administrative Code.

(5) Unless the resident's needs are being met by a private psychologist or physician, each residential care facility that admits or retains residents with a diagnosis of late-stage cognitive impairment with significant ongoing daily living assistance needs, cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, or serious mental illness, shall have a psychologist or physician with experience in the diagnosis and treatment of the applicable condition or conditions, either on staff or as a consultant.

(D) In addition to the requirements set forth in this rule, each residential care facility that elects to admit or retain residents for whom the facility provides skilled nursing care beyond the supervision of special diets, application of dressings, or administration of medication shall do all of the following:

(1) Employ or contract with a registered nurse who shall provide onsite supervision of skilled nursing care provided to residents. For purposes of this rule, "onsite supervision" means that the registered nurse shall spend sufficient time each week in the facility to manage the provision of skilled nursing care in accordance with accepted standards of practice.

(2) Have a licensed nurse on call when one is not present in the facility; and

(3) Have sufficient additional nursing staff to meet residents' needs.

(E) The operator or administrator shall establish a schedule for staff coverage that includes coverage during vacations, emergency situations, and long-term absences due to illness. The residential care facility shall not require, coerce or persuade a resident to supervise other residents, provide personal care services, supervise special diets, administer medications or manage the facility. Residents who voluntarily help or receive assistance from one another shall not be counted in determining whether the residential care facility meets the staffing requirements of this rule.

(F) Each residential care facility which elects to administer medication shall have one of the following individuals on duty who shall administer medications in accordance with paragraphs (G) and (H) of rule 3701-17-59 of the Administrative Code and remain on duty for a sufficient amount of time to observe medication acceptance and reaction:

(1) A registered nurse;

(2) A licensed practical nurse holding proof of successful completion of a course in medication administration approved by the Ohio board of nursing pursuant to Chapter 4723. of the Revised Code who shall administer medication only at the direction of a registered nurse or physician;

(3) A physician; or

(4) A person authorized by law to administer medication.

(G) Each residential care facility which elects to supervise complex therapeutic diets shall provide or arrange for a dietitian and comply with the requirements of rule 3701-17-60 of the Administrative Code.

(H) Each residential care facility which elects to provide for the application of dressings in accordance with division (A)(2) of section 3721.011 of the Revised Code shall have sufficient nursing staff to provide the service and shall comply with the requirements of paragraph (J) of rule 3701-17-59 of the Administrative Code.

(I) Each residential care facility that elects to provide skilled nursing care using staff members, in accordance with division (C) of section 3721.011 of the Revised Code and paragraph (B)(3) of rule 3701-17-59.1 of the Administrative Code, shall have sufficient nursing staff to provide the skilled nursing care. If the residential care facility elects to provide enteral tube feedings on a part-time intermittent basis the facility shall provide or arrange for a dietitian and provide sufficient nursing staff with appropriate experience and training in enteral tube feedings. Skilled nursing care may be delegated in accordance with Chapter 4723-13 of the Administrative Code.

(J) A residential care facility that is physically located in the same building or on the same lot as a nursing home, or that provides an adult day care program, or both,which are owned and operated by the same entity may use staff from the residential care facility to provide services in the nursing home or adult day care program, or use appropriate and qualified staff from the nursing home or the adult day care program to meet part or all of the staffing requirements of this rule, if all of the following criteria are met:

(1) The residential care facility at all times meets the minimal staffing levels required by paragraph (C)(1) of this rule. The staff members, assigned to and responsible for meeting the residential care facility residents' needs, may provide services to nursing home residents if they meet the nurse aide qualifications of rule 3701-17-07.1 of the Administrative Code, but shall not be counted towards meeting the nursing home staffing levels of rule 3701-17-08 of the Administrative Code;

(2) The nursing home at all times meets the staffing level requirements of rule 3701-17-08 of the Administrative Code;

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

(4) The residential care facility has the call signal systems required by paragraph (B)(5) of rule 3701-17-64 of the Administrative Code, for residents to use in obtaining unscheduled care or services, as needed, when unexpected care needs arise and the monitoring of call signal systems in the residential care facility and nursing home is not disrupted. The residential care facility shall not limit the use of the call signal systems to emergencies only;

(5) Utilization of the nurses or aides, or both, does not adversely affect the quality and timeliness of meeting the care needs of the nursing home and residential care facility residents; and

(6) For a residential care facility on the same lot as a nursing home, the homes are located within two minutes or less response time from each other.

No staff member simultaneously assigned to the staffing schedule of the residential care facility and the nursing home shall be counted in determining whether the residential care facility meets the staffing requirements of paragraph (C) of this rule, unless over fifty per cent of the staff member's assigned daily working hours are in the residential care facility.

(K) The operator or the administrator of each residential care facility shall maintain records, on forms provided by the director, documenting compliance with the personnel requirements of this rule.

Replaces: part of 3701-17-52

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011 , 3721.07 , 3721.12 , 3721.14
Prior Effective Dates: 12/21/1992, 9/29/96, 6/21/97, 12/01/01, 4/01/07

3701-17-55 [Effective until 12/8/2014] Qualifications and health of personnel.

(A) No person with a disease which may be transmitted in the performance of the person's job responsibilities shall work in a residential care facility during the stage of communicability unless the person is given duties that minimize the likelihood of transmission and follows infection control precautions and procedures.

(B) No person shall work in a residential care facility who uses alcohol or drugs to the extent that it adversely affects the performance of the person's duties or the health or safety of any resident.

(C) No person shall work in a residential care facility in any capacity as a full-time, part-time or temporary paid employee of the facility unless the person has been examined by a physician or other health care professional acting within their applicable scope of practice within thirty days before commencing work or on the first day of work. No person shall commence work in a residential care facility in any capacity unless the person is medically capable of performing the person's prescribed duties. A person who provides ten or more hours of service at the facility in any thirty-day period shall meet the tuberculosis testing requirements of this paragraph. Operators shall retain copies of the examinations and tests required by this paragraph and shall furnish them to the director upon request.

(1) The required tuberculosis test shall include a single blood assay for M. tuberculosis (BAMT) test, or the two-step Mantoux test for tuberculosis using five tuberculin units of purified protein derivative or, if the individual has a documented history of a significant BAMT test, or Mantoux test, a chest x-ray.

(a) The individual shall not commence work until after the results of the BAMT test, or first step of the Mantoux test have been obtained and recorded in millimeters of induration unless the individual has documentation of either a single step or two-step Mantoux or BAMT test having been performed within one year of commencing work and there is no reason to believe the individual has come into contact with or acquired tuberculosis.

(b) The first step of the Mantoux test should be read within forty eight to seventy two hours following application. If the first step in the Mantoux test is nonsignificant, a second step shall be performed at least seven but not more than twenty-one days after the first step was performed.

(c) If the tuberculosis testing performed pursuant to paragraphs (C)(1)(a) and (C)(1)(b) of this rule is nonsignificant, a single Mantoux or BAMT test shall be performed annually within thirty days of the anniversary date of the most recent testing.

(d) If the results of the BAMT test or either step of the Mantoux are significant, the individual shall have a chest x-ray and shall not enter the facility until after the results of the chest x-ray have been obtained and the individual is determined not to have active pulmonary tuberculosis. Whenever a chest x-ray is required by paragraph (C) 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 BAMT or Mantoux test. Additional tuberculosis 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.

(e) If the chest x-ray does not indicate active pulmonary tuberculosis, but there is evidence of a significant BAMT or Mantoux test, the facility shall require that the individual be evaluated and considered for preventive therapy. Thereafter, the facility shall require the individual to report promptly any symptoms suggesting tuberculosis. The facility 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

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

(2) The residential care facility may allow volunteers to work in the facility for less than ten days within one thirty day period without being tested for tuberculosis pursuant to paragraph (C)(1) of this rule, if the facility:

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

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

(c) Requires a volunteer who continues to work in the facility for more than ten hours during any thirty day period to meet the tuberculosis testing requirements of paragraph (C)(1) of this rule.

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

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

(D) Each residential care facility staff member and volunteer:

(1) Who provides personal care services shall be at least sixteen years of age. Staff members or volunteers who provide personal care services who are under the age of eighteen shall have on-site supervision by a staff member over the age of eighteen. The administrator shall be at least twenty-one years of age;

(2) Who assists residents with self-administration of medications shall demonstrate an ability to read, write and understand information and directions in English. All other staff members and volunteers shall demonstrate an ability to understand and communicate job-related information and directions in English.

(3) Who plan activities for residents with late-stage cognitive impairment with significant ongoing daily living assistance needs, cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both; or, serious mental illness shall have training in appropriate activities for such residents.

(E) Staff members who provide personal care services in a residential care facility, except licensed health professionals whose scope of practice include the provision of personal care services, shall meet the following training requirements:

(1) Within sixty days of hire, have first-aid training evidenced by one of the following:

(a) Currently valid documentation of successful completion of the "American Red Cross Standard First-Aid Course", the "American Red Cross First-Aid Basics", or any other American Red Cross course covering the training topics described in paragraph (E)(1)(c) of this rule;

(b) Currently valid documentation of successful completion of the "American Heart Association Heartsaver First-Aid" course, or any other "American Heart Association" course covering the training topics described in paragraph (E)(1)(c) of this rule; or

(c) Documentation of successful completion, within the past three years, of first-aid training by a physician or registered nurse, an emergency medical technician, or an instructor certified by the "American Red Cross" or the "American Heart Association." This training shall include recognition and emergency management of bleeding, burns, poisoning, respiratory distress including choking, musculoskeletal injury, wounds including animal and insect bites, sudden illness, shock, hypothermia, heat stroke and exhaustion, and frost bite;

(2) Have documentation that, prior to providing personal care services without supervision in the facility, the staff member met one of the following requirements:

(a) Successfully completed training or continuing education that shall cover, as is necessary to meet the needs of residents in the facility, the following:

(i) The correct techniques of providing personal care services as required by the staff member's job responsibilities;

(ii) Observational skills such as recognizing changes in residents' normal status and the facility's procedures for reporting changes; and

(iii) Communication and interpersonal skills.

The training or continuing education shall be provided by a registered nurse or a licensed practical nurse under the direction of a registered nurse and be sufficient to ensure that the staff member receiving the training can demonstrate an ability to provide the personal care services. The facility may utilize other health care professionals acting within the scope of the professional's practice as part of the training or continuing education; or

(b) Successfully completed the training and competency evaluation program and competency evaluation program approved or conducted by the director under section 3721.31 of the Revised Code; or

(c) Successfully completed the training or testing requirements in accordance with the medicare condition of participation of home health aide services, 42 C.F.R. 484.4 (January 15, 2008) and 42 C.F.R.484.36(June 18, 2001);

(3) If the residential care facility provides accommodations to individuals with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, each staff member shall have documentation that the staff member successfully completed training or continuing education in the appropriate interventions for meeting these needs and for handling and minimizing such problems. The documentation required by this paragraph shall be signed and dated by the provider of the training.

(4) Successfully complete at least eight hours of continuing education annually.

The continuing education hours referenced in paragraphs (G), (H), and (I) of this rule may count towards this annual requirement.

(F) Staff members whose job responsibilities will include providing complex therapeutic diets shall be trained by a dietitian prior to performing this responsibility.

(G) Except as provided in paragraph (I) of this rule, staff members employed by a residential care facility, or part thereof, that admits or retains residents with late-stage cognitive impairment with significant ongoing daily living assistance needs, or cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, shall have:

(1) Within fourteen days of the first day of work, two hours of training in the care of such residents. This initial training may be counted toward the training requirement of paragraph (E)(3) of this rule;

(2) Four hours of continuing education in the care of such residents annually. These four hours of continuing education may be counted toward the continuing education requirements of paragraph (E)(4) of this rule.

(H) Except as provided in paragraph (I) of this rule, staff members employed by a residential care facility, or part thereof, that admits or retains residents with diagnoses of serious mental illness shall have:

(1) Within fourteen days of the first day of work, two hours of training in the care of such residents. This initial training may be counted toward the training requirements of paragraph (E)(3) of this rule;

(2) Four hours of continuing education in the care of such residents annually. These four hours of continuing education may be counted toward the continuing education requirements of paragraph (E)(4) of this rule.

(I) Staff members employed by a residential care facility, or part thereof, that admits or retains residents with late-stage cognitive impairment with significant ongoing daily living assistance needs, or cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, and that admits or retains residents with diagnoses of serious mental illness, shall have both the initial training and the continuing education required by paragraphs (G) and (H) of this rule. The four hours of continuing education shall be provided in equal proportions between cognitive impairments and serious mental illness.

(1) The initial training required by this rule may be counted toward the training requirements of paragraph (E)(3) of this rule;

(2) The four hours of continuing education required by this rule may be counted toward the continuing education requirements of paragraph (E)(4) of this rule.

(J) The initial training required by paragraphs (G), (H) and (I) of this rule must be conducted by a qualified instructor for the topic covered. The annual continuing education requirements of paragraphs (G), (H) and (I) in this rule may be completed online or by other media provided there is a qualified instructor present to answer questions and to facilitate discussion about the topic at the end of the lesson.

(K) The administrator shall meet either of the following qualifications:

(1) The individual is licensed as a nursing home administrator under Chapter 4751. of the Revised Code; or

(2) The individual meets one of the following criteria at the time of employment:

(a) Has three thousand hours of direct operational responsibility for a senior housing facility, health care facility, residential care facility, adult care facility or any other group home licensed or approved by the state;

(b) Has successfully completed one hundred credit hours of post high school education in the field of gerontology or health care;

(c) Holds a baccalaureate degree; or

(d) Is a licensed health professional as that term is defined in rule 3701-17-07.1 of the Administrative Code.

(3) The administrator shall receive annually at least nine hours of continuing education in the fields of gerontology, health care, business administration, or residential care facility operation. Successful completion of course work at an accredited college or university, or of courses approved by the following entities, may be used to demonstrate compliance with this paragraph:

(a) The Ohio state bar association;

(b) The Ohio state board of nursing;

(c) The Ohio state board of pharmacy;

(d) The Ohio state board of psychology;

(e) The Ohio state board of nursing home administrators;

(f) The Ohio state medical board; or

(g) Any other health-related state board organized pursuant to Title 47 of the Revised Code.

(L) The operator or administrator shall ensure that each staff member, other than a volunteer who does not provide personal care services, receives and completes orientation and training applicable to the staff member's job responsibilities within three working days after beginning employment with the residential care facility. The orientation and training required by this paragraph shall include at least orientation to the physical layout of the residential care facility, the staff member's job responsibilities, the residential care facility's policies and procedures, training in how to secure emergency assistance, and residents' rights. A staff member shall not stay alone in the residential care facility with residents until the staff member has received the orientation and training required under this paragraph and the general staff training in fire control and evacuation procedures required under paragraph (P) of rule 3701-17-63 of the Administrative Code.

(M) Each residential care facility shall provide appropriate staff training to implement each resident right under division (A) of section 3721.13 of the Revised Code on an annual basis and additionally as needed. The training required by this rule shall include, but not be limited to, an explanation of:

(1) The residents' rights and the staff's responsibility in implementation of the rights;

(2) The staff's obligation to provide all residents who have similar needs with comparable service.

(N) Except as provided in Chapter 3701-13 of the Administrative Code no residential care facility 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)(2) of section 3721.121 of the Revised Code.

(O) All individuals used by the residential care facility who function in a professional capacity shall meet the standards applicable to that profession, including but not limited to, possessing a current Ohio license, registration, or certification, if required by law.

(P) For purposes of this rule, "annual" means a calendar year. The training hours required by this rule may be pro-rated from the employee's date of hire.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04 , 3721.121
Rule Amplifies: 3721.011 , 3721.07 , 3721.12 , 3721.14 , 3721.121
Prior Effective Dates: 12/21/1992, 9/29/96, 9/05/97, 12/01/01, 4/01/07

3701-17-55 [Effective 12/8/2014] Qualifications and health of personnel.

(A) No person with a disease which may be transmitted in the performance of the person's job responsibilities shall work in a residential care facility during the stage of communicability unless the person is given duties that minimize the likelihood of transmission and follows infection control precautions and procedures.

(B) No person shall work in a residential care facility who uses alcohol or drugs to the extent that it adversely affects the performance of the person's duties or the health or safety of any resident.

(C) No person shall work in a residential care facility in any capacity as a full-time, part-time or temporary paid employee of the facility unless the person has been examined by a physician or other health care professional acting within their applicable scope of practice within thirty days before commencing work or on the first day of work. No person shall commence work in a residential care facility in any capacity unless the person is medically capable of performing the person's prescribed duties. Operators shall retain copies of the examinations and tests required by this paragraph and shall furnish them to the director upon request.

(1) Employees of temporary employment services or, to the extent applicable, paid consultants working in a facility shall have medical examinations in accordance with paragraph (C) of this rule, except that a new physical examination is not required for each new assignment. Each facility in which such an individual works shall obtain verification of the physical examination , as applicable, from the employment agency or consultant before the individual begins work and shall maintain this documentation on file.

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

(D) Each residential care facility staff member and volunteer:

(1) Who provides personal care services shall be at least sixteen years of age. Staff members or volunteers who provide personal care services who are under the age of eighteen shall have on-site supervision by a staff member over the age of eighteen. The administrator shall be at least twenty-one years of age;

(2) Who assists residents with self-administration of medications shall demonstrate an ability to read, write and understand information and directions in English. All other staff members and volunteers shall demonstrate an ability to understand and communicate job-related information and directions in English.

(3) Who plan activities for residents with late-stage cognitive impairment with significant ongoing daily living assistance needs, cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both; or, serious mental illness shall have training in appropriate activities for such residents.

(E) Staff members who provide personal care services in a residential care facility, except licensed health professionals whose scope of practice include the provision of personal care services, shall meet the following training requirements:

(1) Within sixty days of hire, have first-aid training evidenced by one of the following:

(a) Currently valid documentation of successful completion of the "American Red Cross Standard First-Aid Course", the "American Red Cross First-Aid Basics", or any other American Red Cross course covering the training topics described in paragraph (E)(1)(c) of this rule;

(b) Currently valid documentation of successful completion of the "American Heart Association Heartsaver First-Aid" course, or any other "American Heart Association" course covering the training topics described in paragraph (E)(1)(c) of this rule; or

(c) Documentation of successful completion, within the past three years, of first-aid training by a physician or registered nurse, an emergency medical technician, or an instructor certified by the "American Red Cross" or the "American Heart Association." This training shall include recognition and emergency management of bleeding, burns, poisoning, respiratory distress including choking, musculoskeletal injury, wounds including animal and insect bites, sudden illness, shock, hypothermia, heat stroke and exhaustion, and frost bite;

(2) Have documentation that, prior to providing personal care services without supervision in the facility, the staff member met one of the following requirements:

(a) Successfully completed training or continuing education that shall cover, as is necessary to meet the needs of residents in the facility, the following:

(i) The correct techniques of providing personal care services as required by the staff member's job responsibilities;

(ii) Observational skills such as recognizing changes in residents' normal status and the facility's procedures for reporting changes; and

(iii) Communication and interpersonal skills.

The training or continuing education shall be provided by a registered nurse or a licensed practical nurse under the direction of a registered nurse and be sufficient to ensure that the staff member receiving the training can demonstrate an ability to provide the personal care services. The facility may utilize other health care professionals acting within the scope of the professional's practice as part of the training or continuing education; or

(b) Successfully completed the training and competency evaluation program and competency evaluation program approved or conducted by the director under section 3721.31 of the Revised Code; or

(c) Successfully completed the training or testing requirements in accordance with the medicare condition of participation of home health aide services, 42 C.F.R. 484.4 (January 15, 2008) and 42 C.F.R. 484.36 (June 18, 2001);

(3) If the residential care facility provides accommodations to individuals with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, each staff member shall have documentation that the staff member successfully completed training or continuing education in the appropriate interventions for meeting these needs and for handling and minimizing such problems. The documentation required by this paragraph shall be signed and dated by the provider of the training.

(4) Successfully complete at least eight hours of continuing education annually.

The continuing education hours referenced in paragraphs (G), (H), and (I) of this rule may count towards this annual requirement.

(F) Staff members whose job responsibilities will include providing complex therapeutic diets shall be trained by a dietitian prior to performing this responsibility.

(G) Except as provided in paragraph (I) of this rule, staff members employed by a residential care facility, or part thereof, that admits or retains residents with late-stage cognitive impairment with significant ongoing daily living assistance needs, or cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, shall have:

(1) Within fourteen days of the first day of work, two hours of training in the care of such residents. This initial training may be counted toward the training requirement of paragraph (E)(3) of this rule;

(2) Four hours of continuing education in the care of such residents annually. These four hours of continuing education may be counted toward the continuing education requirements of paragraph (E)(4) of this rule.

(H) Except as provided in paragraph (I) of this rule, staff members employed by a residential care facility, or part thereof, that admits or retains residents with diagnoses of serious mental illness shall have:

(1) Within fourteen days of the first day of work, two hours of training in the care of such residents. This initial training may be counted toward the training requirements of paragraph (E)(3) of this rule;

(2) Four hours of continuing education in the care of such residents annually. These four hours of continuing education may be counted toward the continuing education requirements of paragraph (E)(4) of this rule.

(I) Staff members employed by a residential care facility, or part thereof, that admits or retains residents with late-stage cognitive impairment with significant ongoing daily living assistance needs, or cognitive impairments with increased emotional needs or presenting behaviors that cause problems for the resident or other residents, or both, and that admits or retains residents with diagnoses of serious mental illness, shall have both the initial training and the continuing education required by paragraphs (G) and (H) of this rule. The four hours of continuing education shall be provided in equal proportions between cognitive impairments and serious mental illness.

(1) The initial training required by this rule may be counted toward the training requirements of paragraph (E)(3) of this rule;

(2) The four hours of continuing education required by this rule may be counted toward the continuing education requirements of paragraph (E)(4) of this rule.

(J) The initial training required by paragraphs (G), (H) and (I) of this rule must be conducted by a qualified instructor for the topic covered. The annual continuing education requirements of paragraphs (G), (H) and (I) in this rule may be completed online or by other media provided there is a qualified instructor present to answer questions and to facilitate discussion about the topic at the end of the lesson.

(K) The administrator shall meet either of the following qualifications:

(1) The individual is licensed as a nursing home administrator under Chapter 4751.of the Revised Code; or

(2) The individual meets one of the following criteria at the time of employment:

(a) Has three thousand hours of direct operational responsibility for a senior housing facility, health care facility, residential care facility, adult care facility or any other group home licensed or approved by the state;

(b) Has successfully completed one hundred credit hours of post high school education in the field of gerontology or health care;

(c) Holds a baccalaureate degree; or

(d) Is a licensed health professional as that term is defined in rule 3701-17- 07.1 of the Administrative Code.

(3) The administrator shall receive annually at least nine hours of continuing education in the fields of gerontology, health care, business administration, or residential care facility operation. Successful completion of course work at an accredited college or university, or of courses approved by the following entities, may be used to demonstrate compliance with this paragraph:

(a) The Ohio state bar association;

(b) The Ohio state board of nursing;

(c) The Ohio state board of pharmacy;

(d) The Ohio state board of psychology;

(e) The Ohio state board of nursing home administrators;

(f) The Ohio state medical board; or

(g) Any other health-related state board organized pursuant to Title 47 of the Revised Code.

(L) The operator or administrator shall ensure that each staff member, other than a volunteer who does not provide personal care services, receives and completes orientation and training applicable to the staff member's job responsibilities within three working days after beginning employment with the residential care facility. The orientation and training required by this paragraph shall include at least orientation to the physical layout of the residential care facility, the staff member's job responsibilities, the residential care facility's policies and procedures, training in how to secure emergency assistance, and residents' rights. A staff member shall not stay alone in the residential care facility with residents until the staff member has received the orientation and training required under this paragraph and the general staff training in fire control and evacuation procedures required under paragraph (P) of rule 3701-17-63 of the Administrative Code.

(M) Each residential care facility shall provide appropriate staff training to implement each resident right under division (A) of section 3721.13 of the Revised Code on an annual basis and additionally as needed. The training required by this rule shall include, but not be limited to, an explanation of:

(1) The residents' rights and the staff's responsibility in implementation of the rights;

(2) The staff's obligation to provide all residents who have similar needs with comparable service.

(N) Except as provided in Chapter 3701-13 of the Administrative Code no residential care facility 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)(2) of section 3721.121 of the Revised Code.

(O) All individuals used by the residential care facility who function in a professional capacity shall meet the standards applicable to that profession, including but not limited to, possessing a current Ohio license, registration, or certification, if required by law.

(P) For purposes of this rule, "annual" means a calendar year. The training hours required by this rule may be pro-rated from the employee's date of hire.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04 , 3721.121
Rule Amplifies: 3721.011 , 3721.07 , 3721.12 , 3721.14 , 3721.121
Prior Effective Dates: 12/21/1992, 9/29/96, 9/5/97, 12/1/01, 4/1/07, 1/1/13

3701-17-57 Resident agreement: other information to be provided upon admission; risk agreements.

(A) A residential care facility shall not admit an individual who requires services or accommodations beyond that which a residential care facility is authorized to provide under paragraph (D) of rule 3701-17-51 of the Administrative Code or beyond that which the specific facility provides.

(B) Except for residents receiving hospice care, no residential care facility shall admit or retain an individual who:

(1) Requires skilled nursing care that is not authorized by section 3721.011 of the Revised Code or is beyond that which the specific facility can provide;

(2) Requires medical or skilled nursing care at least eight hours per day or forty hours per week;

(3) Requires chemical or physical restraints as defined in paragraph (L) of rule 3701-17-59 of the Administrative Code;

(4) Is bedridden with limited potential for improvement;

(5) Has stage III or IV pressure ulcers. For purposes of this rule, "pressure ulcers" means any lesion caused by unrelieved pressure, or pressure in combination with shear and/or friction, which results in damage to the underlying tissue. Pressure ulcers must be staged in accordance with the "Updated Staging System" issued by the "National Pressure Ulcer Advisory Panel" (2007); or

(6) Has a medical condition that is so medically complex or changes so rapidly that it requires constant monitoring and adjustment of treatment regimen on an ongoing basis.

(C) A residential care facility shall enter into a written resident agreement with each prospective resident prior to beginning residency in the residential care facility. The agreement shall be signed and dated by the operator or administrator and the prospective resident or, if the prospective resident is physically or cognitively unable to sign and consents, another individual designated by the prospective resident. The facility shall provide both the prospective resident and any other individual signing on the resident's behalf with a copy of the agreement and shall explain the agreement to them.

(D) The agreement required by paragraph (C) of this rule shall include at least the following items:

(1) An explanation of all charges to the resident including security deposits, if any are required;

(2) A statement that all charges, fines, or penalties that shall be assessed against the resident are included in the resident agreement;

(3) A statement that the basic rate shall not be changed unless thirty days written notice is given to the resident or, if the resident is unable to understand this information, to his or her sponsor;

(4) An explanation of the residential care facility's policy for refunding charges in the event of the resident's absence, discharge, or transfer from the facility and the facility's policy for refunding security deposits;

(5) An explanation of the services offered by the facility, the types of skilled nursing care that the facility provides or allows residents to receive in the facility, the providers that are authorized to render that care, and the limitations of the type and duration of skilled nursing care that is offered;

(6) An explanation of the extent and types of services the facility will provide to the resident and who is responsible for payment;

(7) A statement that the facility must discharge or transfer a resident when a resident needs skilled nursing care beyond the limitations identified in paragraph (D)(5) of this rule.

(E) Prior to admission or upon the request of a prospective resident or prospective resident's sponsor, the residential care facility shall provide the resident or resident's sponsor with a copy and explain the contents of the following policies:

(1) The facility's residents' rights policy and procedures required by section 3721.12 of the Revised Code;

(2) The facility's smoking policy required by paragraph (T) of rule 3701-17-63 of the Administrative Code;

(3) The facility's policy regarding advance directives and an explanation of the rights of the resident under state law concerning advance directives. A residential care facility may not require an execution of an advance directive as a condition for admission;

(4) The definition of skilled nursing care as defined in rule 3701-17-50 of the Administrative Code;

(5) For individuals seeking residency on a special care unit, the facility's policy on care for residents in the special care unit. The policy shall include:

(a) A statement of mission or philosophy that reflects the needs of the special population;

(b) Admission criteria to the special care unit, including screening criteria, if applicable;

(c) Transfer and discharge criteria and procedures;

(d) A weekly staffing plan for the special care unit, if applicable, including:

(i) A statement of how this plan differs from the staffing plan for the remainder of the facility; and

(ii) The necessary increase in supervision, due to decreased safety awareness or other assessed condition, of residents with cognitive impairments or serious mental illness in the special care unit;

(e) A description of activities offered, including frequency and type, and how the activities meet the needs of the type of residents in that special care unit, including how these activities differ from those offered in the remainder of the facility, if applicable;

(f) A listing of the costs of the services provided by the facility to the resident;

(g) Specialized staff training and continuing education practices;

(h) The process used for assessment and the provision of services, including the method for altering services based on changes in condition;

(i) If necessary, how the facility addresses the behavioral healthcare needs of residents;

(j) The physical environment and design features to support the functioning of residents;

(k) The involvement of families and the availability of family support programs for residents; and

(l) Any services or other procedures that are over and above those provided in the remainder of the facility, if applicable.

(6) An explanation of the facility's ability to accommodate disabled residents or potentially disabled residents and the facility's policy regarding transferring residents to units that accomodate residents with disabilities; and

(7) Any other facility policies that residents must follow.

(F) A residential care facility may enter into a risk agreement with a resident or the resident's sponsor with the consent of the resident. Under a risk agreement, the resident or sponsor and the facility agree to share responsibility for making and implementing decisions affecting the scope and quantity of services provided by the facility to the resident. The facility shall identify the risks inherent in a decision made by a resident or sponsor not to receive a service provided by the facility. A risk agreement is valid only if it is made in writing. The residential care facility shall maintain a copy of any risk agreement in the resident's record.

(G) Each residential care facility that has a policy of entering into risk agreements shall provide each prospective resident, or the prospective resident's sponsor with the consent of the resident, a written explanation of the policy and the provisions that may be contained in a risk agreement. At the time the information is provided, the facility shall obtain a statement signed by the individual receiving the information acknowledging that the individual received the information. The facility shall maintain the signed statement on file. Any waiver of the resident's rights under section 3721.13 of the Revised Code contained in the risk agreement is void.

Replaces: part of 3701-17-52

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.011 , 3721.012 , 3721.13
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-58 [Effective until 12/8/2014] Resident health assessments.

(A) The residential care facility, in accordance with this rule shall require written initial and periodic health assessments of prospective and current residents. The different components of the health assessment may be performed by different licensed health professionals, consistent with the type of information required and the professional's scope of practice, as defined by applicable law. In conducting the assessment, the licensed health professional may use resident information obtained by or from unlicensed staff as long as the licensed health professional evaluates such information in accordance with their applicable scope of practice. The residential care facility shall ensure that all components of the assessments required by this rule are completed and that residents do not require accommodations or services beyond those that the residential care facility provides. Each residential care facility shall, on an annual basis, offer to each resident a vaccination against influenza and a vaccination against pneumococcal pneumonia as required by section 3721.041 of the Revised Code.

(B) Each resident shall be initially assessed within forty-eight hours of admission, except that paragraphs (C)(11) and (C)(12) of this rule shall be performed within fourteen days after admission. If the resident had an assessment meeting the requirements of paragraph (C) of this rule performed no more than ninety days before beginning to reside in the residential care facility, the resident is not required to obtain another initial assessment.

(C) The initial health assessment shall include documentation of the following:

(1) Medical diagnoses, if applicable;

(2) Psychological history, if applicable;

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

(4) Developmental diagnosis, if applicable;

(5) Prescription medications, over-the-counter medications, and dietary supplements;

(6) Dietary requirements, including any food allergies;

(7) Height and weight;

(8) A functional assessment which evaluates how the resident performs activities of daily living and instrumental activities of daily living. For the purposes of this paragraph, "instrumental activities of daily living" means using the telephone, acquiring and using public and private transportation, shopping, preparing own meals, performing housework, laundering, , and managing financial affairs;

(9) Type of care or services, including the amount, frequency, and duration of skilled nursing care the resident needs as determined by a licensed health professional in accordance with the resident's assessment under paragraph (C) of this rule;

(10) A determination by a physician or other licensed healthcare professional working within their scope of practice, as to whether or not the resident is capable of self-administering medications. The documentation also shall specify what assistance with self-administration, as authorized by paragraph (F) of rule 3701-17-59 of the Administrative Code, if any, is needed or if the resident needs to have medications administered in accordance with paragraphs (G) and (H) of rule 3701-17-59 of the Administrative Code;

(11) If skilled care is provided to the resident by staff members, a determination by a physician or other licensed healthcare professional working within their scope of practice of:

(a) Whether the resident's personal care needs have been affected by the skilled nursing care needs, other than the administration of medication or supervision of special diets; and

(b) Whether any changes are required in the manner personal care services are provided. The individual conducting the assessment shall establish the extent, if any, of the changes required.

(12) If skilled nursing care is provided to the resident by staff members, the resident's attending physician or other licensed healthcare professional working within their scope of practice, shall sign orders documenting the need for skilled nursing care, including the specific procedures and modalities to be used and the amount, frequency, and duration. This care shall be provided and reviewed pursuant to paragraph (B) of rule 3701-17-59.1 of the Administrative Code.

(13) If the resident has been determined to have medical, psychological, or developmental or intellectual impairment, the assessment must include:

(a) A plan for addressing the assessed needs of the resident;

(b) The need for physical environment and design features to support the functioning of residents with assessed needs; and

(c) The need for increased supervision, due to decreased safety awareness or other assessed condition.

(D) Subsequent to the initial health assessment, the residential care facility shall require each resident's health to be assessed at least annually unless medically indicated sooner. The annual health assessment shall be performed within thirty days of the anniversary date of the resident's last health assessment. This health assessment shall include documentation of at least the following:

(1) Changes in medical diagnoses, if any;

(2) Updated dietary requirements, including any food allergies;

(3) Height and weight;

(4) Prescription medications, over-the-counter medications, and dietary supplements;

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

(6) If the resident has been determined to have medical, psychological, or developmental or intellectual impairment, an assessment as described in paragraph (C)(13) of this rule;

(7) Type of care or services, including the amount, frequency, and duration of skilled nursing care, the resident needs as determined by a licensed health professional in accordance with paragraph (D) of this rule;

(8) A determination by a physician or other licensed healthcare professional working within their scope of practice, as to whether or not the resident is capable of self-administering medications. The documentation also shall specify what assistance with self-administration, as authorized by paragraph (F) of rule 3701-17-59 of the Administrative Code, if any, is needed or if the resident needs to have medications administered in accordance with paragraphs (G) and (H) of rule 3701-17-59 of the Administrative Code; and

(9) If skilled care is provided to the resident by staff members, a determination by a physician or other licensed healthcare professional working within their scope of practice, of:

(a) Whether the resident's personal care needs have been affected by the skilled nursing care needs, other than the administration of medication or supervision of special diets; and

(b) Whether any changes are required in the manner personal care services are provided. The individual conducting the assessment shall establish the extent, if any, of the changes required.

(E) The residential care facility shall require each resident's health to be assessed if a change in condition or functional abilities warrants a change in services or equipment. The assessment shall include, as applicable, documentation of paragraphs (D)(1) to (D)(9) of this rule. The facility shall make a good faith effort to obtain information from residents about assessments independently obtained outside the facility.

(F) Prior to admitting or transferring a resident to a special care unit that restricts the resident's freedom of movement, the residential care facility shall ensure that a physician or other licensed healthcare professional working within their scope of practice, has made a determination that the admission or transfer to the special care unit is needed. This determination shall be updated, to include both improvement and decline, during the periodic reassessment required by paragraph (D) of this rule. Prior to admission to the special care unit, the residential care facility shall provide the resident with an updated resident agreement required by rule 3701- 17-57 of the Administrative Code and with the facility's policy on care of residents by means of a special care unit required by paragraph (E)(5) of that rule. No resident shall be admitted to a secured special care unit based solely on his or her diagnosis.

(G) In addition to the requirements of paragraphs (C), (D), and (E) of this rule, prior to or within forty-eight hours after admission, residents who have not had previous known significant blood assay for M. tuberculosis (BAMT) or Mantoux tests and who do not have a record of a BAMT or of a two-step or single step Mantoux testing within the twelve months preceding admission shall have a single BAMT, or two-step Mantoux test using five tuberculin units of purified protein derivative. If a resident has had a BAMT, a two-step Mantoux test, or a single Mantoux test within one year of admission the resident need only obtain a single BAMT or Mantoux test.

(1) The first step should be read within forty eight to seventy two hours following application. If the first step is nonsignificant for the Mantoux test, the second step shall be performed no less than seven or more than twenty-one days from the date of the first step.

(2) The residential care facility shall assure that residents with significant BAMT or 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 BAMT or Mantoux testing is not required after one medically documented significant test. The residential care facility 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.

(3) Residents with nonsignificant BAMT or Mantoux tests shall receive a single BAMT or Mantoux test if they are exposed to a known case of tuberculosis and another BAMT or single Mantoux performed no less than 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 the significant BAMT or Mantoux test and the physician or other licensed health professional determines another x-ray is not needed.

(a) If the chest x-ray does not reveal active pulmonary tuberculosis, the residential care facility shall document that the resident has been evaluated and considered for preventive treatment. The facility 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 residential care facility shall manage the resident in accordance with guidelines issued by the U.S. centers for disease control and prevention for respiratory precaution

(4) Residents who have been transferred or discharged to a hospital or other health care facility and are again admitted to the residential care facility from which they were transferred or discharged, are not required to have additional tuberculosis testing prior to the timeframe for annual testing in paragraph (G) of this rule, provided the residential care facility:

(a) Has no reason to believe the resident has come into contact with or acquired tuberculosis; and

(b) Assesses the resident for signs and symptoms of tuberculosis.

(5) The residential care facility shall require participants of an adult day care program provided by and on the same site as the residential care facility 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 residential care facility, day care participants and residents of the facility intermingle, or if there is a sharing of staff between the program and the facility. If an adult day care participant is assessed as having active pulmonary tuberculosis, the residential care facility shall not permit the participant to enter the facility until the appropriate local public health authority determines the participant is no longer infectious.

(6) Within thirty days of the anniversary date of the previous testing, each resident shall have a single BAMT or Mantoux test repeated annually unless the resident previously had a significant BAMT or Mantoux test.

(7) Residents admitted to the residential care facility for stays of less than ten days are exempted from the testing required by paragraph (G) of this rule if the facility:

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

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

(H) If a resident needs services or accommodations beyond that which a residential care facility is authorized to provide or beyond that which the specific facility provides, refuses needed services, or fails to obtain needed services for which the resident agreed to be responsible under the resident agreement required by rule 3701-17-57 of the Administrative Code, the residential care facility shall take the following action:

(1) Except in emergency situations, the residential care facility shall meet with the resident, and, if applicable, the resident's sponsor and discuss the resident's condition, the options available to the resident including whether the needed services may be provided through a medicaid waiver program, and the consequences of each option;

(2) If the lack of needed services has resulted in a significant adverse change in the resident, the residential care facility shall seek appropriate intervention in accordance with paragraph (A) of rule 3701-17-62 of the Administrative Code. If an emergency does not exist the facility shall provide or arrange for the provision of any needed services that the resident has not refused until the resident is discharged or transferred or the resident and the facility have mutually resolved the issue in a manner that does not jeopardize the resident's health or the health, safety or welfare of the other residents. This paragraph does not authorize a facility to provide skilled nursing care beyond the limits established in section 3721.011 of the Revised Code; and

(3) The residential care facility shall transfer or discharge the resident in accordance with section 3721.16 of the Revised Code and Chapter 3701-61 of the Administrative Code if the resident needs skilled nursing care or services beyond what the facility provides and the residential care facility, based on the meeting with the resident required by paragraph (H)(1) of this rule, determines that such action is necessary to assure the health, safety and welfare of the resident or the other residents of the facility. The residential care facility may retain a resident who refuses available services if doing so does not endanger the health, safety, and welfare of other residents and the resident does not require services beyond that which a facility is authorized to provide under Chapter 3721. of the Revised Code and rules 3701-17-50 to 3701-17-68 of the Administrative Code.

Replaces: part of 3701-17-52

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-58 [Effective 12/8/2014] Resident health assessments.

(A) The residential care facility, in accordance with this rule shall require written initial and periodic health assessments of prospective and current residents. The different components of the health assessment may be performed by different licensed health professionals, consistent with the type of information required and the professional's scope of practice, as defined by applicable law. In conducting the assessment, the licensed health professional may use resident information obtained by or from unlicensed staff as long as the licensed health professional evaluates such information in accordance with their applicable scope of practice. The residential care facility shall ensure that all components of the assessments required by this rule are completed and that residents do not require accommodations or services beyond those that the residential care facility provides. Each residential care facility shall, on an annual basis, offer to each resident a vaccination against influenza and a vaccination against pneumococcal pneumonia as required by section 3721.041 of the Revised Code.

(B) Each resident shall be initially assessed within forty-eight hours of admission, except that paragraphs (C)(11) and (C)(12) of this rule shall be performed within fourteen days after admission. If the resident had an assessment meeting the requirements of paragraph (C) of this rule performed no more than ninety days before beginning to reside in the residential care facility, the resident is not required to obtain another initial assessment.

(C) The initial health assessment shall include documentation of the following:

(1) Medical diagnoses, if applicable;

(2) Psychological history, if applicable;

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

(4) Developmental diagnosis, if applicable;

(5) Prescription medications, over-the-counter medications, and dietary supplements;

(6) Dietary requirements, including any food allergies;

(7) Height and weight;

(8) A functional assessment which evaluates how the resident performs activities of daily living and instrumental activities of daily living. For the purposes of this paragraph, "instrumental activities of daily living" means using the telephone, acquiring and using public and private transportation, shopping, preparing own meals, performing housework, laundering, , and managing financial affairs;

(9) Type of care or services, including the amount, frequency, and duration of skilled nursing care the resident needs as determined by a licensed health professional in accordance with the resident's assessment under paragraph (C) of this rule;

(10) A determination by a physician or other licensed healthcare professional working within their scope of practice, as to whether or not the resident is capable of self-administering medications. The documentation also shall specify what assistance with self-administration, as authorized by paragraph (F) of rule 3701-17-59 of the Administrative Code, if any, is needed or if the resident needs to have medications administered in accordance with paragraphs (G) and (H) of rule 3701-17-59 of the Administrative Code;

(11) If skilled care is provided to the resident by staff members, a determination by a physician or other licensed healthcare professional working within their scope of practice of:

(a) Whether the resident's personal care needs have been affected by the skilled nursing care needs, other than the administration of medication or supervision of special diets; and

(b) Whether any changes are required in the manner personal care services are provided. The individual conducting the assessment shall establish the extent, if any, of the changes required.

(12) If skilled nursing care is provided to the resident by staff members, the resident's attending physician or other licensed healthcare professional working within their scope of practice, shall sign orders documenting the need for skilled nursing care, including the specific procedures and modalities to be used and the amount, frequency, and duration. This care shall be provided and reviewed pursuant to paragraph (B) of rule 3701-17- 59.1 of the Administrative Code.

(13) If the resident has been determined to have medical, psychological, or developmental or intellectual impairment, the assessment must include:

(a) A plan for addressing the assessed needs of the resident;

(b) The need for physical environment and design features to support the functioning of residents with assessed needs; and

(c) The need for increased supervision, due to decreased safety awareness or other assessed condition.

(D) Subsequent to the initial health assessment, the residential care facility shall require each resident's health to be assessed at least annually unless medically indicated sooner. The annual health assessment shall be performed within thirty days of the anniversary date of the resident's last health assessment. This health assessment shall include documentation of at least the following:

(1) Changes in medical diagnoses, if any;

(2) Updated dietary requirements, including any food allergies;

(3) Height and weight;

(4) Prescription medications, over-the-counter medications, and dietary supplements;

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

(6) If the resident has been determined to have medical, psychological, or developmental or intellectual impairment, an assessment as described in paragraph (C)(13) of this rule;

(7) Type of care or services, including the amount, frequency, and duration of skilled nursing care, the resident needs as determined by a licensed health professional in accordance with paragraph (D) of this rule;

(8) A determination by a physician or other licensed healthcare professional working within their scope of practice, as to whether or not the resident is capable of self-administering medications. The documentation also shall specify what assistance with self-administration, as authorized by paragraph (F) of rule 3701-17-59 of the Administrative Code, if any, is needed or if the resident needs to have medications administered in accordance with paragraphs (G) and (H) of rule 3701-17-59 of the Administrative Code; and

(9) If skilled care is provided to the resident by staff members, a determination by a physician or other licensed healthcare professional working within their scope of practice, of:

(a) Whether the resident's personal care needs have been affected by the skilled nursing care needs, other than the administration of medication or supervision of special diets; and

(b) Whether any changes are required in the manner personal care services are provided. The individual conducting the assessment shall establish the extent, if any, of the changes required.

(E) The residential care facility shall require each resident's health to be assessed if a change in condition or functional abilities warrants a change in services or equipment. The assessment shall include, as applicable, documentation of paragraphs (D)(1) to (D)(9) of this rule. The facility shall make a good faith effort to obtain information from residents about assessments independently obtained outside the facility.

(F) Prior to admitting or transferring a resident to a special care unit that restricts the resident's freedom of movement, the residential care facility shall ensure that a physician or other licensed healthcare professional working within their scope of practice, has made a determination that the admission or transfer to the special care unit is needed. This determination shall be updated, to include both improvement and decline, during the periodic reassessment required by paragraph (D) of this rule. Prior to admission to the special care unit, the residential care facility shall provide the resident with an updated resident agreement required by rule 3701-17-57 of the Administrative Code and with the facility's policy on care of residents by means of a special care unit required by paragraph (E)(5) of that rule. No resident shall be admitted to a secured special care unit based solely on his or her diagnosis.

(G) If a resident needs services or accommodations beyond that which a residential care facility is authorized to provide or beyond that which the specific facility provides, refuses needed services, or fails to obtain needed services for which the resident agreed to be responsible under the resident agreement required by rule 3701-17-57 of the Administrative Code, the residential care facility shall take the following action:

(1) Except in emergency situations, the residential care facility shall meet with the resident, and, if applicable, the resident's sponsor and discuss the resident's condition, the options available to the resident including whether the needed services may be provided through a medicaid waiver program, and the consequences of each option;

(2) If the lack of needed services has resulted in a significant adverse change in the resident, the residential care facility shall seek appropriate intervention in accordance with paragraph (A) of rule 3701-17-62 of the Administrative Code. If an emergency does not exist the facility shall provide or arrange for the provision of any needed services that the resident has not refused until the resident is discharged or transferred or the resident and the facility have mutually resolved the issue in a manner that does not jeopardize the resident's health or the health, safety or welfare of the other residents. This paragraph does not authorize a facility to provide skilled nursing care beyond the limits established in section 3721.011 of the Revised Code; and

(3) The residential care facility shall transfer or discharge the resident in accordance with section 3721.16 of the Revised Code and Chapter 3701-61 of the Administrative Code if the resident needs skilled nursing care or services beyond what the facility provides and the residential care facility, based on the meeting with the resident required by paragraph (G)(1) of this rule, determines that such action is necessary to assure the health, safety and welfare of the resident or the other residents of the facility. The residential care facility may retain a resident who refuses available services if doing so does not endanger the health, safety, and welfare of other residents and the resident does not require services beyond that which a facility is authorized to provide under Chapter 3721. of the Revised Code and rules 3701-17-50 to 3701-17-68 of the Administrative Code.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 12/1/01, 4/1/07, 1/1/13

3701-17-59 Personal care services; medication administration; resident medications; application of dressings; supervision of special diets.

(A) For the purposes of this rule;

(1) Personal care services or skilled nursing care shall be considered to be provided by a residential care facility if they are provided by a person employed by or associated with the facility or by another person pursuant to an agreement to which neither the resident who receives the services nor his or her sponsor is a party.

(2) A residential care facility may provide the skilled nursing care authorized by paragraphs (J) and (K) of this rule through the following arrangements as long as the residential care facility complies with the applicable provisions of this rule:

(a) Qualified staff members of the residential care facility;

(b) Through agreements or contractual arrangements, including but not limited to, contracts with a home health agency certified under Title XVIII of "the Social Security Act", 42 U.S.C. 301 , as amended (1981), or a licensed hospice care program, licensed under Chapter 3712. of the Revised Code.

(B) Each residential care facility shall:

(1) Specify in its policies and the resident agreements, required by rule 3701-17-57 of the Administrative Code, the extent and types of personal care services it provides; and

(2) Provide personal care services to its residents who require those services, unless the resident and the facility have entered into a risk agreement under rule 3701-17-57 of the Administrative Code or the resident has refused services, and may provide personal care services to other residents upon request.

Nothing in this paragraph shall be construed to permit personal care services to be imposed upon a resident who is capable of performing the activity in question without assistance unless requested.

(C) If a resident requires certain personal care services that the residential care facility does not offer:

(1) The facility shall comply with paragraph (H) of rule 3701-17-58 of the Administrative Code; and

(a) The facility or the resident shall arrange for the services to be provided; or

(b) The facility shall transfer the resident to an appropriate setting or discharge the resident in accordance with section 3721.16 of the Revised Code and Chapter 3701-61 of the Administrative Code; or

(2) The facility and the resident may enter into a risk agreement in accordance with paragraphs (F) and (G) of rule 3701-17-57 of the Administrative Code, if the facility has a policy of entering into such agreements.

(D) Each residential care facility shall ensure that personal care services are provided to residents:

(1) In accordance with acceptable standards of care;

(2) By staff members meeting the training requirements of rule 3701-17-55 of the Administrative Code; and

(3) That meet the needs of residents as determined in the resident assessments required under rule 3701-17-58 of the Administrative Code and consistent with the resident agreements under rule 3701-17-57 of the Administrative Code.

(E) A residential care facility may provide for the administration of medication to residents in accordance with division (B) of section 3721.011 of the Revised Code and this rule.

(1) All medication taken by residents of residential care facilities shall be self-administered, and members of the staff of a residential care facility shall not administer medication to residents, except that medication may be administered in accordance with division (B) of section 3721.011 of the Revised Code and paragraphs (G) and (H) of this rule.

(2) A residential care facility may admit or retain an individual requiring medication only if the individual is capable of taking his or her own medication and biologicals, as determined in writing by the person's attending physician or other licensed healthcare professional working within their scope of practice, or if the facility provides for the administration of medication by:

(a) A home health agency certified under Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended (1981);

(b) A hospice care program licensed under Chapter 3712. of the Revised Code; or

(c) A member of the staff of the residential care facility who is qualified to perform medication administration.

(F) Staff members may assist with self-administration of medication by doing any of the following once they have received training in providing the services, as required by paragraph (E) of rule 3701-17-55 of the Administrative Code:

(1) Remind a resident when to take medication, and watch to ensure that the resident follows the directions on the container;

(2) Assist a resident in self-administration of medication by taking the medication from the locked area, where it is stored and handing it to the resident. The staff member shall check the name on the prescription label and verify that the resident's name on the prescription label corresponds to the resident requesting the medication before handing it to the resident. The staff member may read the label and directions on the medication container to the resident upon request. The staff member also may remind the resident and any other individual designated by the resident when prescribed medication needs to be refilled. Staff members shall not assist a resident with self-administration of a prescription medication that belongs to another resident. If the resident is physically unable to open a container, a staff member may open the container for the resident; and

(3) Assist a physically impaired but mentally alert resident such as, but not limited to, a resident with arthritis, cerebral palsy, or Parkinson's disease, upon that resident's request, in removing oral or topical medication from containers and in consuming or applying the medication upon request by or with the consent of the resident. If the resident is physically unable to place a dose of medicine to his or her mouth without spilling it, a staff member may place the dose in a container and place the container to the mouth of the resident. As used in this paragraph, "topical medication" means:

(a) Eye, nose, or ear drops excluding irrigations; and

(b) Medication used in the treatment of a skin condition or minor abrasion, excluding debriding agents.

(4) Assist a resident with organizing the resident's medications in a weekly pill organizer if the resident is able to differentiate between pills and actively participates in the organization. Nothing in this rule shall be construed to allow staff members to fill a weekly pill organizer for a resident.

(G) Medication shall be administered in accordance with accepted standards of practice to a resident in a residential care facility only by the following persons authorized by law to administer medication:

(1) A registered nurse;

(2) A licensed practical nurse holding proof of successful completion of a course in medication administration approved by the Ohio board of nursing pursuant to Chapter 4723. of the Revised Code who shall administer medication only at the direction of a registered nurse or physician;

(3) A physician; or

(4) A person authorized by law to administer medication.

(H) Residential care facilities that administer medication shall comply with all of the following:

(1) No medication shall be given to any resident unless ordered by a physician or individual authorized under state law to prescribe medications. Ordered medications shall be administered unless the resident refuses or the resident exhibits symptoms that contraindicate medication administration. If a medication is not administered, the staff member responsible for administering the medication shall document in the resident's record why the medication was not administered. Telephone orders shall not be accepted by a person other than a licensed nurse, another physician or a pharmacist except that a licensed health professional may receive, document and date medication orders concerning his or her specific discipline, to the extent permitted by applicable licensing laws. If orders are given by telephone, they shall be recorded with the prescriber's name and the date, and the order signed by the person who accepted the order. All telephone orders shall be signed by the physician who gave the order or other licensed health professional with prescriptive authority working under the supervision of or in collaboration with the physician within fourteen days after the order was given. The residential care facility may accept facsimile and electronic documentation of orders in accordance with paragraph (B)(4) of rule 3701-17-59.1 of the Administrative Code;

(2) All medications shall be given only to the individual resident for whom they are prescribed, given in accordance with the directions on the prescription or the physician's or other authorized prescriber's orders, and recorded on the resident's medication record required by paragraph (I)(7) of this rule;

(3) The person who administers the medication shall observe the resident for adverse effects, contraindications, and medication effectiveness. Such person shall notify the resident's attending physician or other licensed healthcare professional working within their scope of practice, of any undesirable effects and document these effects and the date and time of such notification in the resident's medication record;

(4) The residential care facility may administer drugs bearing the American hospital formulary service therapeutic class 4:00, 28:16:08, 28:24:08, or 28:24:92 only when necessary to treat a resident's medical condition and to assist the resident to attain his or her highest practicable physical, mental, and psychosocial well-being. Drugs used for this purpose are not considered chemical restraints as defined in paragraph (L) of this rule. Drugs in these classifications shall be administered only with the authorization of the attending physician, after personal examination of the resident and documentation of the medical condition being treated and reasons for use of the drug and

(5) Ohio board of pharmacy and United States drug enforcement administration regulations.

(I) Residential care facilities shall handle residents' medication in accordance with the following requirements:

(1) The residential care facility shall not stock or dispense medicines or drugs which may be sold only by prescription unless the facility has in its employ, on either a full-time or part-time supervisory and consulting basis, a pharmacist registered under Chapter 4729. of the Revised Code, who will be in complete control of such stock and the dispensing thereof.

(2) The residential care facility shall keep all prescription medications in locked storage areas, including drugs requiring refrigeration, except medications of residents living in individual units who self-administer their own medications may be stored in the resident's unit if the resident and residential care facility take reasonable precautions to prohibit access to the medications by other residents.

(3) The residential care facility shall assure that the labeling of prescription medicine and drugs meet the following criteria:

(a) Every container of medicine and drugs prescribed for a resident for self-administration or assistance by non-licensed health care personnel, shall be clearly labeled with the resident's name, the proprietary or generic name of the medication dispensed and its strength, the name and address of the dispensing pharmacy, the name or initials of the dispensing pharmacist, the prescription number, the date dispensed, the name of the prescribing physician or individual authorized under state law to prescribe medications, and the instructions for use including any cautions which may be required by federal or state law. Containers too small to bear a complete prescription label shall be labeled with at least the prescription number and the dispensing date and shall be dispensed in a container bearing a complete prescription label.

(b) Medicines and drugs dispensed by a health care facility pharmacy for administration by a licensed nurse or physician to residents whereby the medicines and drugs are not in the possession of the resident prior to administration shall be clearly labeled in accordance with rule 4729-17-10 of the Administrative Code.

(c) The residential care facility shall not repackage or relabel resident medications.

(d) Over-the-counter medications kept by residents capable of self-administration do not need to meet the requirements of this rule.

(e) Over-the-counter medications that are either administered by an individual acting within their scope of practice and based on a prescriber's order, or given to residents capable of self-administration of medication, shall contain a United States food and drug administration label indicating, in part, the medications:

(i) Name;

(ii) Strength;

(iii) Quantity;

(iv) Accessory instructions;

(v) Lot number; and

(vi) Expiration date.

(4) The residential care facility shall send a resident's medication with him or her upon permanent transfer or discharge or destroy or dispose them with the consent of the resident in accordance with any applicable state or federal laws and regulations.

(5) If controlled substances are used, controlled substances shall be ordered, dispensed, administered, and disposed of in accordance with state and federal laws and regulations.

(6) Each residential care facility shall keep a written list of all medications prescribed for each resident and shall make a good-faith effort to keep the list current.

(7) Each residential care facility shall maintain an individual medication record for each resident to whom the residential care facility administers medications in which:

(a) Medication orders, including telephone, electronic, and fascimile orders, are recorded and signed by the prescriber; and

(b) All medications are recorded as given, documenting the name of the medication, date and time given, route of administration, and signed by the individual administering the medication.

(J) Each residential care facility that provides for the application of dressings in accordance with division (A) of section 3721.011 of the Revised Code shall:

(1) Establish in writing the services pertaining to the application of dressings that are routinely managed by the facility. The determination of the type of applications of dressings that are managed by the facility shall be based on staff education, staff competence, the amount of staff experience with the listed types of applications of dressings, and support services available in the facility;

(2) Develop and follow policies and procedures which assure that the application of dressings are provided in accordance with acceptable standards of practice;

(3) Ensure that the application of dressings are provided only by individuals authorized under state law to provide the application of the dressing. Skilled nursing care may be delegated in accordance with Chapter 4723-13 of the Administrative Code;

(4) Evaluate each resident at least once every seven days to determine whether the resident should be transferred to a nursing home or other appropriate health care setting. The evaluation and determination shall be performed by the appropriate health care professional and documented in the resident's record;

(5) Document all applications of dressings that are provided by the residential care facility in the resident's record. Such documentation shall include, but not be limited to, treatment and medication orders issued by appropriate licensed health care professionals when needed to authorize provision of a service and nurse's notes indicating the nature of the service provided and the resident's status. The residential care facility may accept facsimile and electronic orders in accordance with paragraph (B)(4) of rule 3701-17-59.1 of the Administrative Code; and

(6) Ensure that a nurse coordinates the overall nursing care of each resident who receives applications of dressings.

(K) Each residential care facility that provides supervision of special diets shall comply with the applicable provisions of rule 3701-17-60 of the Administrative Code. The residential care facility may accept facsimile and electronic documentation of special diet orders in accordance with paragraph (B)(4) of rule 3701-17-59.1 of the Administrative Code;

(L) The residential care facility shall not physically, chemically or through isolation restrain residents.

(1) For the purposes of this paragraph:

(a) "Physical restraint" means, but is not limited to, any article, device, or garment that interferes with the free movement of the resident and that the resident is unable to remove easily, a geriatric chair, or a locked room door;

(b) "Chemical restraint" means any medication bearing the American hospital formulary service therapeutic class 4:00, 28:16:08, 28:24:08, or 28:24:92 that alters the functioning of the central nervous system in a manner that limits physical and cognitive functioning to the degree that the resident cannot attain his or her highest practicable physical, mental, and psychosocial well-being; and

(c) "Freedom of movement" means the ability of the resident to move around within the context of the resident's functional capacity as assessed by the facility.

(2) A residential care facility's use of the following items for the purposes stated in this paragraph shall not be construed as physically or chemically restraining a resident or subjecting a resident to prolonged isolation:

(a) Devices that assist a resident in the improvement of the resident's mental and physical functional status and that do not restrict freedom of movement or normal access to one's body;

(b) Medications that are standard treatment or a documented exception to standard treatment for the resident's medical or psychiatric condition which assist a resident in attaining or maintaining the resident's highest practicable physical, mental, and psycho-social well-being;

(c) Residency in a secured special care unit that restricts a resident's freedom of movement throughout the facility if;

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

(ii) The need for continued residency in the secured special care unit is reviewed during each periodic assessment required by rule 3701-17-58 of the Administrative Code;

(iii) The secured special care unit meets the requirements of the state building and fire codes; and

(iv) Residency on the secured special care unit is not based solely on the resident's diagnosis.

(d) Not withstanding paragraph (L)(2)(c) of this rule, a resident may choose to reside in the secured special care unit based upon his or her specific circumstances, such as if his or her spouse is a resident of the secured special care unit, or if the only room available in the facility is on the secured special care unit. A resident who chooses to reside in the secured special care unit must be able to enter and exit the unit without assistance.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011
Prior Effective Dates: 12/21/1992, 9/29/96, 6/21/97, 12/01/01, 4/01/07

3701-17-59.1 Skilled nursing care.

(A) Except as provided for in division (D) of section 3721.011 of the Revised Code, a residential care facility may admit or retain individuals who require skilled nursing care beyond the supervision of special diets, application of dressings, or administration of medication only if the skilled nursing care will be provided on a part-time, intermittent basis for not more than a total of one hundred twenty days in any twelve-month period regardless of any transfer or discharge and readmission to the facility. A part-time, intermittent basis means that skilled nursing care is rendered for less than eight hours a day or less than forty hours a week. For the purposes of this provision:

(1) The residential care facility shall use the following criteria in tracking the one hundred and twenty days of part-time, intermittent skilled nursing care permitted under this paragraph:

(a) Self-care shall not be counted toward the allowable one hundred twenty days;

(b) Services provided by physical and occupational therapists and assistants licensed under Chapter 4755. of the Revised Code and speech-language pathologists licensed under Chapter 4753. of the Revised Code do not constitute skilled nursing care and shall not be counted;

(c) Only days on which skilled nursing care is performed shall be counted toward the allowable one hundred and twenty days;

(d) Medication administration, supervision of special diets and or application of dressings shall be counted toward the allowable one hundred and twenty days, if the residential care facility does not provide for these services, pursuant to rule 3701-17-59 of the Administrative Code.

(2) Skilled nursing care may be provided by one or more of the following:

(a) A home health agency certified under Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended (1981);

(b) A hospice care program licensed under Chapter 3712. of the Revised Code;

(c) A member of the staff who is authorized under state law to provide skilled nursing care.

If a resident's condition requires more skilled nursing care than permitted under this paragraph, the residential care facility shall transfer or discharge the resident in accordance with section 3721.16 of the Revised Code and Chapter 3701-61 of the Administrative Code.

(B) Each residential care facility that provides skilled nursing care using staff members shall:

(1) Develop and follow policies and procedures which assure that the skilled nursing care is provided in accordance with acceptable standards of practice;

(2) Ensure that the skilled nursing care is provided in accordance with accepted standards of practice only by individuals authorized under state law to provide skilled nursing care. Skilled nursing care may be delegated in accordance with Chapter 4723-13 of the Administrative Code;

(3) Except for residents receiving medication administration, supervision of special diets, the application of dressings, or skilled nursing care permitted by paragraph (D) of this rule, evaluate each resident receiving the skilled nursing care at least once every seven days to determine whether the resident should be transferred to a nursing home or other appropriate health care setting. The evaluation and determination shall be performed by the appropriate licensed health care professional and documented in the resident's record;

(4) Document all skilled nursing care provided by the residential care facility in the resident's record. Such documentation shall include, but not be limited to, medication and treatment orders when needed to authorize provision of a service and nurse's notes indicating the nature of the service provided and the resident's status. All orders shall be signed and dated by the licensed health professional who gave the order within fourteen days after the order was given;

(a) Telephone orders shall not be accepted by a person other than a licensed nurse on duty, another physician or a pharmacist, except that a licensed health professional may receive, document and date medication and treatment orders concerning his or her specific discipline for residents under their care, to the extent permitted by applicable licensing laws.

(b) The residential care facility may accept signed treatment and medication orders issued by a licensed health professional by facsimile transmission if the facility has instituted procedural safeguards for authentication and maintaining confidentiality of the facsimile order, and for handling the order in an expedient and priority manner.

(c) An entry that is an electronic record as defined in section 3701.75 of the Revised Code may be authenticated by an electronic signature in accordance with section 3701.75 of the Revised Code.

(5) Meet the skilled nursing care needs of each resident receiving care as determined by the assessment required under rule 3701-17-58 of the Administrative Code and consistent with the resident agreement required under rule 3701-17-57 of the Administrative Code; and

(6) Ensure that a nurse coordinates the overall nursing care of each resident who receives skilled nursing care from facility staff.

(C) In addition to the requirements of paragraphs (A) and (B) of this rule, each residential care facility that provides enteral tube feedings on a part-time intermittent basis shall:

(1) Establish in writing the types of enteral tube feedings that are routinely managed by the facility. The determination of the types of enteral tube feedings that are provided by the facility shall be based on staff education, staff competence, the amount of staff experience with the listed types of enteral tube feedings, and support services available in the facility;

(2) Develop and follow policies and procedures which assure that enteral tube feedings are prepared and offered as ordered and that sanitary conditions are maintained in procurement, storage, preparation, and the administration of the enteral tube feedings;

(3) Document the weight of the resident and the resident's acceptance and tolerance of the enteral tube feedings in accordance with policies and procedures developed by the dietitian and the nurse responsible for the overall nursing care of the resident; and

(4) Provide or arrange for a dietitian.

(D) A residential care facility may admit or retain an individual who requires skilled nursing care for more than one hundred twenty days in any twelve-month period only if:

(1) The facility has entered into a written agreement with each of the following:

(a) The individual, the individual's sponsor, or both;

(b) The individuals' personal physician or other licensed health professional acting within their applicable scope of practice, unless either of the following apply:

(i) If the provision of the skilled nursing care is not overseen by the individuals' personal physician, the provider of the skilled nursing care may enter into the agreement; or

(ii) If the individual is a hospice patient as defined in section 3712.01 of the Revised Code, a hospice care program licensed under Chapter 3712. of the Revised Code may enter into the agreement.

(2) The written agreement required by this paragraph includes a statement signed by all parties acknowledging that they understand the agreement and that the individual's needs can be met at the facility. The agreement shall not be complete without this signed statement. Additionally, the agreement shall include all of the following provisions:

(a) That the individual will be provided skilled nursing care in the facility only if a determination has been made that the individual's needs can be met at the facility. This determination shall be made by the residential care facility, the individual's attending physician, and, if applicable, the provider of the skilled nursing care;

(b) That the individual will be retained in the facility only if periodic re-determinations are made that the individual's needs can be met at the facility;

(c) That the re-determinations will be made according to a schedule specified in the agreement and as the resident's condition requires, but no less frequently than every thirty days, except for hospice patients whose re-determinations shall be no less frequently than every fifteen days;

(d) Unless the individual is a hospice patient, the individual's personal physician has determined that the skilled nursing care the resident or prospective resident needs is routine. For purposes of this rule, "routine" does not include those conditions listed in paragraph (B) of rule 3701-17-57 of the Administrative Code; and

(e) If the individual is a hospice patient, that the individual has been given an opportunity to choose the hospice care program that best meets the individual's needs.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011
Prior Effective Dates: 6/21/1997, 12/01/01, 4/01/07

3701-17-60 Dietary services; supervision of special diets.

(A) Each residential care facility shall specify in its residential care facility policies and the resident agreements, required by rule 3701-17-57 of the Administrative Code, the amount and types of dietary services it provides. The facility shall elect to provide any of the following:

(1) No meals;

(2) One, two, or three daily meals;

(3) Preparation of regular and special diets other than complex therapeutic diets; one, two, or three daily meals; or

(4) Preparation and supervision of special diets. Each facility that elects to supervise special diets shall provide three daily meals and meet the requirements of this chapter of the Administrative Code for the supervision of special diets;

(5) Each residential care facility that provides meals shall include a variety of food accommodating religious restrictions and ethnic and cultural preferences of residents in accordance with the residential care facility's policy.

(B) Each residential care facility that agrees to provide three daily meals for a resident shall make available at least three nourishing, palatable, attractive and appetizing meals at regular hours. The meals shall provide the dietary referenced intake of the "Food and Nutrition Board" of the "National Academy of Science", be based on a standard meal planning guide from a diet manual published by a dietitian, approved by a dietitian, or both. There shall be at least a four-hour scheduled interval available between the mid-point of the breakfast meal and the mid-point of the noon meal and between the mid-point of the noon meal and the mid-point of the evening meal. The hours of meal service shall take into consideration residents' preferences. The facility shall make evening snacks available .

(C) Each residential care facility that agrees to provide one or two meals a day shall provide meals based on a standard meal planning guide from a diet manual published by a dietitian, approved by a dietitian, or both. Meals shall provide the dietary referenced intake of the "Food and Nutrition Board" of the "National Academy of Science," and shall follow the patterns set forth in this paragraph:

(1) The breakfast meal shall include at least:

(a) One and one-half ounce cooked, edible portion of lean meat, eggs, legumes, or other protein;

(b) One and one-half cups of fruit or vegetables;

(c) Two servings of enriched or whole grain bread or cereals;

(d) Two teaspoons of butter or margarine as appropriate; and

(e) One cup of milk or milk product.

(2) The lunch or dinner meals shall include at least:

(a) Two ounces cooked, edible portion of lean meat, eggs, legumes, or other protein;

(b) One and one-half cups of fruit or vegetables;

(c) Two servings of enriched or whole grain bread or alternate;

(d) Two teaspoons of butter or margarine as appropriate; and

(e) One cup of milk or milk product.

(3) Each meal shall include the choice of appropriate condiments, sauces and dressings.

(D) Each residential care facility that prepares special diets other than complex therapeutic diets shall:

(1) Prepare and provide the special diets in accordance with the orders of a physician or other licensed health professional acting within their scope of practice, or a dietitian; and

(2) Adjust special diet menus as ordered by the resident's attending physician or other licensed health professional acting within their scope of practice or a dietitian.

(E) Each residential care facility that provides one or more meals and that does not permit residents to have food in their resident units shall make snacks available twenty-four hours a day.

(F) Each residential care facility that does not provide any meals shall ensure that each resident unit is appropriately and safely equipped with food storage and preparation appliances which the facility maintains in safe operating condition or that each resident has access to an appropriately and safely equipped food storage and preparation area. Each residential care facility that does not provide any meals shall permit residents to store and prepare food in a safe manner in their resident units or in a resident food storage and preparation area.

(G) Each residential care facility shall have a kitchen and other food service facilities that are adequate for preparing and serving the amount and types of meals the facility agrees to provide.

(H) If applicable, the residential care facility shall have a food service operation license issued under Chapter 3701-21 of the Administrative Code.

(I) Each residential care facility that provides meals shall procure, store, prepare, distribute, and serve all food in a manner that protects it against contamination and spoilage.

(1) Each residential care facility shall assure that the kitchen and dining areas are cleaned after each meal and shall:

(a) Transport meals in a sanitary manner to prevent contamination;

(b) Provide handwashing facilities, including hot and cold water, soap and individual towels in the food preparation and service area.

(c) Provide and maintain clean and sanitary kitchen and dining areas and a clean, sanitary and adequate supply of eating and drinking utensils, pots, and pans for use in preparing, serving, and eating appetizing meals and snacks;

(d) Place food scraps and trash in garbage cans with tightfitting lids and bag liners and shall empty garbage cans daily, or more often if needed. Nondisposable containers shall be cleaned frequently enough to maintain sanitary conditions. Disposable bags of garbage may be stored outside only in a non-absorbent container with a close-fitting cover. Liquid wastes resulting from compacting shall be disposed of as sewage.

(2) Residential care facilities may provide any format of meal service, which otherwise meet the requirements of this rule, with input from residents.

(3) Residential care facilities may provide a dining environment as natural and independent as possible, comparable with eating at home, with choices from a wide variety of food items tailored to the residents' wants and needs, which otherwise meet the requirements of this rule.

(J) Each residential care facility that supervises special diets shall, at minimum:

(1) Provide dietary services in accordance with paragraph (B) of this rule;

(2) Assure that special diets are prepared and offered as ordered;

(3) Monitor and document resident acceptance of special diets;

(4) Monthly weigh and record the weights of residents on special diets:

(a) For residents on special diets other than complex therapeutic diets, notify either the dietitian or the resident's attending physician or other licensed health professional acting within their scope of practice, or both, of any unplanned significant weight changes in accordance with facility policies;

(b) For residents on complex therapeutic diets, notify the resident's attending physician or other licensed health professional acting within their scope of practice and the dietitian required by paragraph (K) of this rule of any unplanned significant weight changes in accordance with policies and procedures developed by the dietitian.

(5) Adjust special diet menus as ordered by the resident's attending physician or other licensed health professional acting within their scope of practice, or a dietitian.

(K) Each residential care facility which supervises complex therapeutic diets shall provide or arrange for a dietitian to plan, oversee, and assist in implementing dietary services that meet the residents' needs and comply with the requirements of this rule. The dietitian shall, at a minimum, consult quarterly with the food service staff. Each residential care facility shall ensure the dietitian performs the following functions for residents on complex therapeutic diets:

(1) Plan, oversee, and assist in the implementation of nutrition services that meet the needs of the residents;

(2) Evaluate the residents' acceptance of meal service and response to nutrition related interventions at least quarterly;

(3) Within one month after the facility begins supervising a new complex therapeutic diet, monitor staff that prepares or serves a new complex therapeutic diet and monitor the resident receiving a new complex therapeutic diet. The facility shall notify the dietitian upon receipt of a physician's order for a new complex therapeutic diet. For the purposes of this provision, "new complex therapeutic diet" means either a complex therapeutic diet that the residential care facility has never before supervised or a complex therapeutic diet that has been prescribed for a resident for the first time; and

(4) Oversees and assists in the training of food service staff in the preparation and serving of foods including any special dietary interventions.

(L) Each residential care facility that provides meals shall maintain at all times for residents a one-week supply of staple foods and a two-day supply of perishable foods. The amount of such supplies shall be based on the number of meals the facility, through its admission policies and resident agreements, has decided to provide daily.

(M) Each residential care facility that provides meals shall plan all menus for meals at least one week in advance. Food shall vary in texture, color and include seasonal foods. Residential care facilities shall maintain records of dated menus, including complex therapeutic diets, as served for a period of at least one year. The records shall be made available to the director upon request. The records shall indicate any substitutions made to the menus except that alternate items offered to individual residents because of food intolerances or preferences do not need to be recorded unless the resident is on a complex therapeutic diet. All foods substituted shall be of similar nutritive value.

(N) Each residential care facility that provides meals shall observe, supervise, and assist a resident in consuming meals if the resident needs observation, supervision, or assistance. The residential care facility shall ensure that food texture is appropriate to the individual needs of each resident, except that residential care facility staff shall not perform syringe feedings.

(O) Residential care facilities shall not administer parenteral nutrition. A residential care facility may administer enteral tube feedings on a part-time intermittent basis in accordance with rule 3701-17-59.1 of the Administrative Code.

(P) All residential care facilities shall provide safe drinking water which shall be accessible to residents at all times.

(Q) A hospice patient's diet shall be planned by a dietitian, the hospice program, or both, as appropriate for that individual.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 6/21/97, 12/01/01, 4/01/07

3701-17-61 Laundry services; activities; resident finances; pets.

(A) The residential care facility shall specify in the resident agreements required by rule 3701-17-57 of the Administrative Code what laundry services it provides. The residential care facility shall launder or assist in arranging for the laundering of all clothing and bed and bath linen for residents who require laundry services as described in the resident agreement. The facility may provide a washer and dryer in the home for residents' use or may provide residents with transportation to and from a laundromat.

(B) Each residential care facility shall encourage residents to participate in social, recreational, and leisure activities. The residential care facility shall, with consideration given to resident preferences, provide or arrange for varied activities of sufficient quantity so that residents' lives may be more meaningful, to stimulate physical and mental capabilities and to assist residents in attaining their optimal social, physical, and emotional well-being, including self-care and maintenance. The residential care facility shall provide, at minimum, all of the following:

(1) One local daily newspaper or current community activity brochures and advertisements;

(2) Information about the availability of transportation to community activities; and

(3) An opportunity for residents to engage in a variety of activities which may include, but shall not be limited to, television, crafts, reading, or games.

(C) A residential care facility shall not coerce, induce, or prompt a resident to assign, transfer, give, or sign over to the facility money, valuables, insurance benefits, property, or anything of value other than payment for services rendered by the facility. A residential care facility shall not manage a resident's financial affairs unless authorized by the resident or a sponsor with power of attorney. Such authorization shall be in writing and shall be attested to by a witness who is not connected in any manner whatsoever with the residential care facility or its administrator. A facility that manages a resident's financial affairs shall do all of the following:

(1) The residential care facility shall maintain accounts pursuant to division (A)(27)(b) of section 3721.13 of the Revised Code of resident funds and personal property or possessions deposited for safekeeping with the facility for use by the resident or resident's sponsor. The resident has the right to receive, upon written or oral request, an accounting statement of financial transactions made on the resident's behalf. This statement shall include:

(a) A complete record of all funds, personal property, or possessions from any source whatsoever, that have been deposited for safekeeping with the facility for use by the resident or resident's sponsor;

(b) A listing of all deposits and withdrawals transacted, which shall be substantiated by receipts that shall be available for inspection and copying by the resident or sponsor.

(2) The residential care facility shall deposit the resident's funds in excess of one hundred dollars, and may deposit the resident's funds that are one hundred dollars or less, in an interest-bearing account separate from any of the facility's operating accounts. Interest earned on the resident's funds shall be credited to the resident's account. A resident's funds that are one hundred dollars or less and have not been deposited in an interest-bearing account may be deposited in a noninterest-bearing account or petty cash fund.

(3) Each residential care facility that manages the financial affairs of residents shall purchase a surety bond or otherwise provide assurance satisfactory to the director to assure the security of all residents' funds managed by the facility.

(4) Upon the resident's transfer, discharge, or death, all resident accounts shall be closed and a final accounting made. The residential care facility shall make provision for the conveyance of any remaining funds to the resident or the resident's estate.

(5) The residential care facility shall allow the resident access to his or her funds during normal bank business hours within the community.

(6) No residential care facility shall require a resident to allow the facility to manage the resident's financial affairs as a condition of admission to the facility.

(D) Each residential care facility that allows animals or pets to visit or to reside in the facility shall, in consultation with a veterinarian licensed to practice veterinary medicine under Chapter 4741. of the Revised Code, establish and implement a written protocol regarding animals and pets that protects the health and safety of residents and staff members. At minimum, the written protocol shall include:

(1) An annual physical examination, including an examination for internal and external parasites;

(2) Vaccinations for common infectious agents, including rabies;

(3) Any other preventive care necessary to protect the health, safety and rights of residents;

(4) Procedure to follow if an animal:

(a) Bites a person; or

(b) Becomes ill or injured;

(5) If an animal is owned by the facility, the name of the designated member or members of the staff responsible for the care of the animal and for maintaining the protocol, including medical records for the animal;

(6) If an animal is owned by a resident, the responsibilities of the resident as they relate to the animal; and

(7) An evaluation of the medical needs of residents.

(E) Neither the administrator of a residential care facility nor facility staff may serve as the guardian or attorney-in-fact of a resident unless related by blood, marriage, or adoption to that resident.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.07 , 3721.13 , 3721.15
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-62 [Effective until 12/8/2014] Changes in residents' health status; incidents; infection control.

(A) In the event of a significant adverse change in residents' health status, the residential care facility shall do all of the following:

(1) Take immediate and proper steps to see that the resident receives necessary intervention including, if needed, medical attention or transfer to an appropriate medical facility;

(2) Make a notation of the change in health status and any intervention taken in the resident's record;

(3) Provide pertinent resident information to the person providing the intervention as soon as possible; and

(4) Notify the sponsor unless the resident refuses or requests otherwise.

(B) As used in this paragraph, "incident" means any accident or episode involving a resident, staff member, or other individual in a residential care facility which presents a risk to the health, safety, or well-being of a resident. In the event of an incident, the facility shall do both of the following:

(1) Take immediate and proper steps to see that the resident or residents involved receive necessary intervention including, if needed, medical attention or transfer to an appropriate medical facility; and

(2) Investigate the incident and document the incident and the investigation. The facility shall maintain an incident log separate from the resident record which shall be accessible to the director and shall contain the time, place, and date of the occurrence; a general description of the incident; and the care provided or action taken. The facility shall maintain a notation about the incident in the resident's record.

(C) Each residential care facility shall establish and implement appropriate written policies and procedures to control the development and transmission of infections and diseases which, at minimum, shall provide for the following:

(1) Individuals working in the facility shall wash their hands vigorously for ten to fifteen seconds before beginning work and upon completing work, before and after eating, after using the bathroom, after covering their mouth when sneezing and coughing, before and after providing personal care services or skilled nursing care, when there has been contact with body substances, after contact with contaminated materials, before handling food, and at other appropriate times;

(2) If the residential care facility provides any laundering services, the facility shall keep clean and soiled linen separate. Soiled laundry shall be handled as little as possible. Laundry that is wet or soiled with body substances shall be placed in moisture-resistant bags which are secured or tied to prevent spillage. Laundry staff shall wear moisture-resistant gloves, suitable for sorting and handling soiled laundry, and a moisture-resistant gown or sleeved plastic apron if soiling of staff members' clothing is likely. The facility shall use laundry cycles according to the washer and detergent manufacturers' recommendations. Protective clothing shall be removed before handling clean laundry;

(3) Individuals providing personal care services or skilled nursing care that may result in exposure to body substances, shall wear disposable vinyl or latex gloves as a protective barrier and shall remove and dispose of the used gloves and wash hands before contact with another resident. If exposed to body substances, the individual who has been exposed shall wash his or her hands and other exposed skin surfaces immediately and thoroughly with soap and water. The facility shall provide follow-up consistent with the guidelines issued by the U.S. centers for disease control and prevention for the prevention of transmission of human immunodefiency virus and hepatitis B virus to health-care and public-safety workers in effect at the time. Individuals providing personal care services or skilled nursing care shall wash their hands before and after providing the services or care even if they used gloves;

(4) Place disposable articles,other than sharp items , contaminated with body substances in a container impervious to moisture and manage them in a fashion consistent with Chapter 3734. of the Revised Code. Reusable items contaminated with body substances shall be bagged, then sent for decontamination;

(5) Wear a moisture-resistant gown or other appropriate protective clothing if soiling of clothing with body substances is likely;

(6) Wear a mask and protective eye wear if splashing of body substances is likely or if a procedure that may create an aerosol is being performed;

(7) Ensure that all hypodermic needles, syringes, lancets, razor blades and similar sharp wastes are disposed of by placing them in rigid, tightly closed puncture-resistant containers before they are transported off the premises of the facility, in a manner consistent with Chapter 3734. of the Revised Code. The residential care facility shall provide instructions to residents who use sharps on the proper techniques for disposing of them.

For the purposes of this paragraph, "body substance" means blood, semen, vaginal secretions, feces, urine, wound drainage, emesis, and any other body fluids that have visible blood in them.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01

3701-17-62 [Effective 12/8/2014] Changes in residents' health status; incidents; infection control; tuberculosis control plan.

(A) In the event of a significant adverse change in residents' health status, the residential care facility shall do all of the following:

(1) Take immediate and proper steps to see that the resident receives necessary intervention including, if needed, medical attention or transfer to an appropriate medical facility;

(2) Make a notation of the change in health status and any intervention taken in the resident's record;

(3) Provide pertinent resident information to the person providing the intervention as soon as possible; and

(4) Notify the sponsor unless the resident refuses or requests otherwise.

(B) As used in this paragraph, "incident" means any accident or episode involving a resident, staff member, or other individual in a residential care facility which presents a risk to the health, safety, or well-being of a resident. In the event of an incident, the facility shall do both of the following:

(1) Take immediate and proper steps to see that the resident or residents involved receive necessary intervention including, if needed, medical attention or transfer to an appropriate medical facility; and

(2) Investigate the incident and document the incident and the investigation. The facility shall maintain an incident log separate from the resident record which shall be accessible to the director and shall contain the time, place, and date of the occurrence; a general description of the incident; and the care provided or action taken. The facility shall maintain a notation about the incident in the resident's record.

(C) Each residential care facility shall establish and implement appropriate written policies and procedures to control the development and transmission of infections and diseases which, at minimum, shall provide for the following:

(1) Individuals working in the facility shall wash their hands vigorously for ten to fifteen seconds before beginning work and upon completing work, before and after eating, after using the bathroom, after covering their mouth when sneezing and coughing, before and after providing personal care services or skilled nursing care, when there has been contact with body substances, after contact with contaminated materials, before handling food, and at other appropriate times;

(2) If the residential care facility provides any laundering services, the facility shall keep clean and soiled linen separate. Soiled laundry shall be handled as little as possible. Laundry that is wet or soiled with body substances shall be placed in moisture-resistant bags which are secured or tied to prevent spillage. Laundry staff shall wear moisture-resistant gloves, suitable for sorting and handling soiled laundry, and a moisture-resistant gown or sleeved plastic apron if soiling of staff members' clothing is likely. The facility shall use laundry cycles according to the washer and detergent manufacturers' recommendations. Protective clothing shall be removed before handling clean laundry;

(3) Individuals providing personal care services or skilled nursing care that may result in exposure to body substances, shall wear disposable vinyl or latex gloves as a protective barrier and shall remove and dispose of the used gloves and wash hands before contact with another resident. If exposed to body substances, the individual who has been exposed shall wash his or her hands and other exposed skin surfaces immediately and thoroughly with soap and water. The facility shall provide follow-up consistent with the guidelines issued by the U.S. centers for disease control and prevention for the prevention of transmission of human immunodefiency virus and hepatitis B virus to health-care and public-safety workers in effect at the time. Individuals providing personal care services or skilled nursing care shall wash their hands before and after providing the services or care even if they used gloves;

(4) Place disposable articles, other than sharp items, contaminated with body substances in a container impervious to moisture and manage them in a fashion consistent with Chapter 3734. of the Revised Code. Reusable items contaminated with body substances shall be bagged, then sent for decontamination;

(5) Wear a moisture-resistant gown or other appropriate protective clothing if soiling of clothing with body substances is likely;

(6) Wear a mask and protective eye wear if splashing of body substances is likely or if a procedure that may create an aerosol is being performed;

(7) Ensure that all hypodermic needles, syringes, lancets, razor blades and similar sharp wastes are disposed of by placing them in rigid, tightly closed puncture-resistant containers before they are transported off the premises of the facility, in a manner consistent with Chapter 3734. of the Revised Code. The residential care facility shall provide instructions to residents who use sharps on the proper techniques for disposing of them.

For the purposes of this paragraph, "body substance" means blood, semen, vaginal secretions, feces, urine, wound drainage, emesis, and any other body fluids that have visible blood in them.

(D) Each residential care facility shall develop and follow a tuberculosis control plan that is based on the home's assessment of the facility. The control and assessment shall be consistent with the United States centers for disease control and prevention "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005," MMWR 2005, Volume 54, No. RR-17. The home shall retain documentation evidencing compliance with this paragraph and shall furnish such documentation to the director upon request.

Effective: 12/8/2014
Five Year Review (FYR) Dates: 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 1/1/13

3701-17-63 Building, plumbing, and fire safety requirements.

(A) The building or buildings in which a residential care facility is located shall be approved by and have a certificate of occupancy for the appropriate use group designation issued by the local certified building department with jurisdiction over the area in which the building or buildings are located or by the department of commerce if there is no local certified building department. In the case of a license renewal, if any alterations to the buildings have been made since the original license was issued or the license was last renewed, whichever is later, the residential care facility shall have a certificate of occupancy for the residential care facility issued by the department of commerce or a local certified building department.

(B) The plumbing fixtures in a residential care facility shall conform to the applicable provisions of the Ohio plumbing code.

(C) All plumbing shall be installed in accordance with the Ohio plumbing code and maintained free of leakage and odors and have adequate water pressure to reasonably ensure resident health and safety protection. This includes, but is not limited to, plumbing in:

(1) Water closets;

(2) Service sinks;

(3) Kitchens;

(4) Utility closets;

(5) Public and resident bathrooms;

(6) Shower and bathing areas; and

(7) Drinking fountains.

(D) Lavatories, bathing facilities, and shower facilities shall be provided with pressure balancing thermostatic mixing devices in accordance with the Ohio plumbing code to prevent unanticipated changes in hot water temperatures.

(E) The water supply for a residential care facility shall be taken from a public supply, if available. Each residential care facility using a water source other than a public water system shall comply with all applicable local and state regulations regarding the construction, development, installation, alteration, and use of private water systems.

(F) Each residential care facility not using a public sewage disposal system shall comply with all applicable local and state regulations regarding the construction, development, installation, alteration, and use of household sewage disposal systems.

(G) Each residential care facility shall comply with all the applicable state fire code standards of Chapter 1301:7-7 of the Administrative Code.

(H) Each residential care facility shall be inspected for fire safety in accordance with paragraph (A) of rule 3701-17-53 of the Administrative Code.

(I) Each residential care facility shall provide paths of clear and unobstructed access to egress exits. Additionally, the propping open of a door through the use of door stops, wedges or other devices shall be prohibited.

(J) Each residential care facility shall develop and maintain a written disaster preparedness plan to be followed in case of emergency or disaster. A copy of the plan shall be readily available at all times within the residential care facility. Such plan shall include the following:

(1) Procedures for evacuating all individuals in the residential care facility, which shall include the following:

(a) Provisions for evacuating residents with impaired mobility; and

(b) Provisions for transporting all of the residents of the residential care facility to a predetermined appropriate facility or facilities that will accommodate all the residents of the residential care facility in case of a disaster requiring evacuation of the residential care facility.

(2) A plan for protection of all persons in the event of fire and procedures for fire control and evacuation, including a fire watch and the prompt notification of the local fire authority and state fire marshal's office when a fire detection, fire alarm, or sprinkler system is impaired or inoperable. For purposes of this rule, "fire watch" means the process required in the Ohio fire code for detecting and immediately alerting residents, staff, and the responding fire department of a fire or other emergency while the building's fire alarm or sprinkler system is impaired, inoperable or undergoing testing;

(3) Procedures for locating missing residents, including notification of local law enforcement;

(4) Procedures for ensuring the health and safety of residents during severe weather situations, such as tornadoes and floods, and designation of tornado shelter areas in the facility; and

(5) Procedures, as appropriate, for ensuring the health and safety of residents in residential care facilities located in close proximity to areas known to have specific disaster potential, such as airports, chemical processing plants, and railroad tracks.

(K) Each residential care facility shall conduct the following drills unless the state fire marshal allows a home to vary from this requirement and the residential care facility has written documentation to this effect from the state fire marshal:

(1) Twelve fire exit drills, one conducted on each shift at least every three months to familiarize staff members and residents with signals, evacuation procedures and emergency action required under varied times and conditions. Fire exit drills shall include the transmission of a fire alarm signal to the appropriate fire department or monitoring station, verification of receipt of that signal, and simulation of emergency fire conditions except that the movement of infirm and bedridden residents to safe areas or to the exterior of the structure is not required. Drills conducted between nine p.m. and six a.m. may use a coded announcement instead of an audible alarm. Residential care facilities that have an alarm system that is not capable of sending a fire alarm signal if an audible alarm is not used shall transmit a fire alarm signal and verify receipt of that signal no more than twelve hours after the coded announcement. Fire drills shall meet the following requirements.

(a) Each staff member shall participate in at least one fire drill annually.

(b) One staff member with knowledge of the disaster preparedness plan and the fire evacuation routes shall be designated to observe and evaluate each drill and shall not participate in that drill.

(c) Residents capable of self-evacuation shall be actually evacuated to safe areas or to the exterior of the residential care facility in at least two fire drills a year on each shift. Movement of non-ambulatory residents to safe areas or to the exterior of the facility is not required.

(2) At least two disaster preparedness drills per year, one of which shall be a tornado drill which shall occur during the months of March through July.

(3) The residential care facility shall reset the alarms after each drill.

(L) Each residential care facility shall investigate all problems encountered in the drills required under paragraph (K) of this rule and take corrective action.

(M) Each residential care facility shall keep a written record and evaluation of each fire drill which shall include the date, time, staff member attendance, method of activation, effectiveness of the drill procedures, number of individuals evacuated, total time for evacuation, and the weather conditions during the evacuation, and of each tornado drill. The records shall also describe any problems encountered and the corrective actions taken. This record shall be on file in the facility for three years.

(N) Each residential care facility shall post in a conspicuous place in each section or floor of the residential care facility a correctly oriented wall-specific floor plan designating room use, locations of alarm sending stations, evacuation routes and exits, fire alarms and fire extinguishers and flow of resident evacuation.

(O) The buildings in which a residential care facility is housed shall be equipped with both an automatic fire extinguishing system and fire alarm system. Such systems shall conform to standards set forth in rules 4101:1-1 to 4101:1-35 and rules 1301:7-7-01 to 1301:1-7-47 of the Administrative Code. Records of the installation, testing and maintenance of both systems shall be kept at the facility and produced for inspection upon request.

(P) All staff members in each residential care facility shall be trained in fire control and evacuation procedures within three working days of beginning employment. A staff member shall not stay alone in the residential care facility with residents until the staff member has received the training in fire control and evacuation procedures required by this rule.

(Q) Each residential care facility shall provide for annual training in fire prevention for regularly scheduled staff members on all shifts to be conducted by the state fire marshal or township, municipal or local legally constituted fire department. Records of this training shall be kept at the facility.

(R) Each residential care facility shall train all residents in the proper actions to take in the event of fire, tornado, disaster, or other emergency.

(S) Each residential care facility shall conduct at least monthly a fire safety inspection which shall be recorded on forms provided by the department and kept on file in the facility for three years.

(T) Smoking shall be permitted only in properly designated areas which may include resident units with the approval of the administrator. No staff member, resident of a residential care facility or other persons in the facility shall be permitted to smoke, carry a lighted cigarette, cigar, or pipe or use any spark or flame producing device in any room or area in the facility where oxygen is stored or in use. Approved terminals of a piped oxygen supply does not constitute storage. "No smoking" signs shall be posted in areas and on doors of rooms where oxygen is stored or in use. Each residential care facility shall take reasonable precautions to ensure the safety of all residents when permitting residents to smoke. Ash trays, wastebaskets or containers into which burnable materials are placed shall not be made of materials which are flammable, combustible, or capable of generating quantities of smoke or toxic gases and shall be used solely for that purpose. Such containers shall be readily available in all areas where smoking is permitted. Residential care facilities that allow outdoor resident smoking shall make accommodations for residents during adverse weather conditions.

(U) Each residential care facility shall maintain all electrical systems including, but not limited to, cords, switches, lighting fixtures, and lamps in good, safe operating condition and ensure that appliances are in good, safe operating condition;

(V) Each residential care facility shall report any incident of fire, damage due to fire and any incidence of illness, injury or death due to fire or smoke inhalation of a resident within twenty-four hours to the office of the state fire marshal and the department on forms provided by these entities.

(W) Each residential care facility shall maintain written transfer agreements with other facilities that can meet the needs of residents who require transfer because their health and safety is or potentially is adversely affected by conditions in the facility.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.02 , 3721.03 , 3721.07 , 3721.071
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-64 Space requirements.

(A) For purposes of this rule, "habitable floor area" means the clear floor area of a bedroom or resident unit and the floor area occupied by the usual room furniture, such as beds, chairs, sofas, dressers, and tables and does not include areas partitioned off in the bedroom or resident unit such as closets and toilet rooms.

(B) Each residential care facility shall provide resident unit space for each resident which meets the following criteria:

(1) Except as provided for in paragraphs (B)(1)(a) and (B)(1)(b) of this rule, in facilities which were licensed prior to December 22, 1964, and in continuous operation since that date, every single-occupancy bedroom shall have a habitable floor area of not less than eighty square feet and every multi-occupancy bedroom shall have a habitable floor area of not less than seventy square feet per person.

(a) Resident units added after December 22, 1964, shall comply with paragraph (B)(2) of this rule; and

(b) Any building licensed as a facility on or before December 22, 1964, that discontinued operating as a facility and later resumed facility operation shall comply with paragraph (B)(2) of this rule.

(2) For every building or addition to a building erected or converted to use or initially licensed as a facility after December 22, 1964, every single-occupancy resident unit shall have a habitable floor area of not less than one hundred square feet and every multi-occupancy resident unit shall have a habitable floor area of not less than eighty square feet per person.

(3) No resident unit, bedroom, or similar division used for sleeping purposes by residents shall be occupied by more than four residents.

(4) A resident unit shall not be used as a passageway to other areas of the residential care facility.

(5) Each resident shall have a resident-activated call signal system in good working order that, at minimum, provides for the transmission of calls from resident rooms and toilet and bathing facilities and cannot be deactivated from any location except from where the resident initiated the call, unless the staff is able to communicate with the resident.

(6) Resident units shall be separated from halls, corridors, and other rooms by permanent floor-to-ceiling walls. Temporary partitions shall not be used to separate resident units;

(7) Each resident bedroom shall have a minimum of one window with a curtain, shade, or other appropriate covering to assure privacy and a screen if the window is operable;

(8) Each residential care facility shall ensure that each resident unit is equipped with the furnishings and supplies specified in paragraph (C) of rule 3701-17-65 of the Administrative Code.

(9) Each residential care facility shall assign non-ambulatory residents to resident units on a floor that exits to ground level unless there is an elevator to accommodate movement of such residents to other floors of the facility.

(C) Each residential care facility that provides meals shall have at least one room or suitable area to be used by residents for dining purposes that comfortably accommodates the number of residents to whom the residential care facility provides meals. All furniture shall be comfortable, safe, and functional.

(D) As used in this paragraph, "bathroom" means a room or rooms including at least one toilet, one shower or bathtub, and one sink. Each residential care facility shall provide at least one toilet, one shower or bathtub, and one sink for every eight residents living in the residential care facility. Each residential care facility shall meet the following requirements regarding bathroom facilities:

(1) The bathrooms and all the facilities therein shall be in good repair, in a clean and sanitary condition, free from filth and accumulation of waste.

(2) Bathrooms and all fixtures therein shall ensure resident privacy and dignity. Where there are more than one toilet or more than one bathtub or shower in a bathroom, each toilet and each bathtub or shower shall be enclosed in such a way as to maintain the privacy of each resident.

(3) Bathrooms shall conform to the Ohio building code.

(4) Bathrooms and all the facilities therein shall, at all times, be kept in good repair, in a clean and sanitary condition, and free from filth and accumulated waste, and shall be provided with a supply of toilet tissue, unless provided by the resident as specified in the resident agreement. Each hand washing basin shall be provided soap and a self-draining device or other appropriate dispenser unless provided by the resident as specified in the resident agreement. At a minimum, the residential care facility shall provide toilet tissue and soap in a self-draining device or other appropriate dispenser.

(5) There shall be nonskid surfacing and handrails or grab bars in each bathtub and shower. Each residential care facility shall also provide handrails or grab bars near each toilet in resident units occupied by individuals who need assistance with activities of daily living or, if resident units do not have toilets, near a sufficient number of toilets on each floor of the facility to accommodate such individuals.

(6) Each bathtub, shower, and sink shall have hot and cold running water. If the residential care facility is in control of the hot water temperature, the hot water shall be at least one hundred five degrees Fahrenheit and no more than one hundred twenty degrees Fahrenheit at the point of use. If a resident is in control of the hot water temperature in his or her resident unit, the residential care facility shall ensure that the hot water is at a safe temperature sufficient to meet the preferences of the resident.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721, 04
Rule Amplifies: 3721.02 , 3721.03 , 3721.07 , 3721.071
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-65 Building maintenance, equipment and supplies.

(A) Each residential care facility shall maintain heating, electrical, and other building service equipment in good working and safe condition. Each residential care facility shall have its central heating system checked every two years by a heating contractor.

(B) Each residential care facility shall maintain a clean, healthy environment by doing at least the following:

(1) Establishing and implementing housekeeping and maintenance procedures to assure a clean, safe, sanitary environment;

(2) Providing durable garbage and refuse receptacles to accommodate wastes. The residential care facility shall store all garbage and other refuse in leakproof containers with tight fitting covers until time of disposal, and dispose all wastes in a satisfactory manner;

(3) Eliminating any existing insects and rodents and taking effective measures to prevent the presence of insects and rodents in or around any building used for a residential care facility or part thereof. The extermination of insects and rodents shall be done in such a manner as not to create a fire or health hazard.

(C) Unless the resident chooses to bring his or her own or as specified in the resident agreement, the residential care facility shall provide each resident with the following bedroom furnishings and supplies:

(1) An individual bed equipped with springs and a clean comfortable flame resistant mattress or a clean comfortable mattress with a flame resistant mattress cover. The bed shall be sturdy, safe, and in good condition. Rollaway beds and cots, double deck beds, stacked bunk beds, hide-a-bed couches, or studio couches do not meet the requirements of this rule.

(2) Bed linen which shall include at least two sheets, a pillow and pillow case, a bedspread, and one blanket that fit properly and are free of tears, holes, and excessive fraying or wear.

(a) The residential care facility shall ensure that the mattresses of incontinent residents are protected with an intact waterproof material unless contraindicated or otherwise ordered by a physician or other licensed healthcare professional working within their scope of practice.

(b) The residential care facility shall provide each resident with additional blankets and pillows upon request and ensure that two sets of bed linen are available for each bed at all times. Residential care facilities shall ensure that bed linen is changed weekly and more often if soiled or requested by the resident.

(3) Closet or wardrobe space with a minimum width of twenty-two inches of hanging space sufficient in height and equipped for hanging full length garments and at least one shelf of adequate size within reach of the resident.

(4) A bedside table, personal reading lamp, adequate bureau, dresser or equivalent space, a mirror appropriate for grooming, a waste basket with liners, and a chair with a padded back and seat, with arms for lateral support. If a resident has a wheelchair, the wheelchair may meet this requirement unless the resident indicates he or she wants a comfortable chair in addition to the wheelchair.

(5) Bath linen that includes at least two full towels, two face towels, and two washcloths.

(6) A shower curtain and appropriate hanging devices.

(7) Basic toiletry items and paper products.

(D) In meeting the requirements of paragraph (C) of this rule, residential care facilities may allow residents to provide all or part of the bedroom furnishings and supplies listed under paragraphs (C)(1) to (C)(7) of this rule if the bedroom furnishings and supplies meet the requirements of paragraphs (C)(1) to (C)(7) of this rule and there is sufficient space in the residential care facility. Residents who smoke shall provide documentation that the mattress they bring to the residential care facility is flame resistant. Residents shall be permitted to bring personal furnishings and items in addition to the bedroom furnishings and supplies listed under paragraphs (C)(1) to (C)(7) of this rule if the personal furnishings and items do not create a safety hazard or infringe upon the rights of other residents.

(E) A residential care facility shall arrange for the provision of at least a double size bed, upon request of a married couple or other consenting adult residents sharing a room in accordance with the residential care facility's policy, unless there is an overriding documented medical reason that puts one of the consenting parties at risk of health and safety or there is a risk to other residents.

(F) All residential care facilities shall have the supplies and equipment necessary to provide the services needed by the residents admitted to or retained in the facility.

The residential care facility shall keep all equipment and supplies in the facility clean and usable and shall store it satisfactorily and safely when not in use.

(G) Waste baskets or containers in common areas where burnable materials may be placed shall not be made of materials which are flammable, combustible or capable of generating quantities of smoke or toxic gases.

(H) Each residential care facility shall provide at least one non-pay telephone to which residents shall have reasonable access at all times for making local calls. The telephone shall be provided in a location or manner which affords privacy. The residential care facility shall arrange for a method by which residents can make long-distance calls from the residential care facility at the residents' expense.

(I) Each residential care facility also shall meet the following safety and maintenance requirements:

(1) The residential care facility shall keep floors in good repair. Any rugs used in the facility shall be secured in a manner that does not create a safety hazard;

(2) The residential care facility shall keep corridors, entrances, exits, fire escape routes and outside pathways in good repair, free of obstacles, and ice and snow. Buildings that are constructed or converted for use as residential care facilities after the effective date of this rule must have accessible means of egress that open to a hard surface leading to a public way;

(3) Common areas and exits shall be well-lighted;

(4) The residential care facility shall store poisonous and hazardous materials in clearly labeled containers, away from foodstuffs and medication. Poisonous and hazardous materials shall be stored in accordance with the manufacturer's instructions and the applicable provisions of the Ohio fire code;

(5) If resident units have locks, the residential care facility shall have duplicate keys or a master key available and readily accessible at all times to the staff members on duty or present in the facility for use in case of emergency;

(6) The residential care facility shall maintain first-aid supplies in a closed but unlocked container which is easily accessible to the administrator and staff;

(7) The residential care facility shall maintain its buildings and grounds in a clean and orderly manner; and

(8) Residential care facilities shall not require residents or staff members to obtain approval from the operator, administrator or staff member prior to telephoning for assistance in the event of an emergency. Each residential care facility shall prominently display emergency telephone numbers, such as the fire and police department numbers, at each telephone provided by the residential care facility.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.07 , 3721.13
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/01/07

3701-17-66 Temperature regulation in residential care facilities.

(A) For the purposes of this rule:

(1) "Resident area" means any area within a residential care facility that is occupied at any time by a resident.

(2) "Temperature range" means between seventy-one degrees Fahrenheit and eighty-one degrees Fahrenheit.

(B) Each residential care facility shall maintain the temperature and humidity in resident areas at a safe and comfortable level.

(C) Residents in rooms containing separate heating and cooling systems who are capable of controlling them may maintain the temperature of their rooms at any level they desire except the residential care facility shall take appropriate intervention if a resident's desired temperature level adversely affects or has potential for adversely affecting the health and safety of the resident or the health, safety and comfort of any other resident sharing the resident room.

(D) Each residential care facility, in consultation with a physician or an appropriate health care professional acting within the professional's scope of practice, shall develop written policies and procedures for responding to temperatures in resident areas that are outside the temperature range as defined in paragraph (A) of this rule. The policies and procedures shall include at least the following items:

(1) An identification of available sites within or outside the residential care facility to which residents can be relocated temporarily and of other suitable health care facilities or facilities that provide personal care services that will be available to receive transfers of residents if the temperature level adversely affects or has potential for adversely affecting the health and safety of residents;

(2) Measures to be taken to assure the health, safety and comfort of residents who remain in the facility when temperatures are outside the temperature range as defined in paragraph (A) of this rule; and

(3) Identification of the circumstances that require notification of the resident's attending physician or other licensed healthcare professional working within their scope of practice, or that require medical examinations or other medical intervention and appropriate time frames for these actions.

(E) Whenever the temperature in any resident area is outside the temperature range as defined in paragraph (A) of this rule, the residential care facility immediately shall evaluate the situation, monitor residents, and take appropriate action to ensure the health, safety and comfort of its residents, including but not limited to implementation of the policies and procedures developed under paragraph (D) of this rule. The residential care facility shall document all action taken under this paragraph and shall maintain, on site, documentation of action taken during the current calendar year and during the preceding calendar year.

(F) Each residential care facility shall maintain appropriate arrangements with qualified persons that provide for emergency service in the event of an electrical, heating, ventilation or air conditioning failure or malfunction and shall maintain documentation of the arrangements such as employment or other written agreements. The residential care facility shall ensure that all necessary repairs are completed within forty-eight hours or less. If, for reasons beyond the facility's control, repairs cannot be completed timely, the residential care facility shall take any necessary action, as specified in this paragraph, and shall provide for the repairs to be completed as soon as possible.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.13
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01

3701-17-67 Records and reports.

Each residential care facility shall maintain the following records which shall be made available for inspection at all times when requested by the director:

(A) An individual record for each resident which shall be stored in a manner that protects and ensures confidentiality, except that information shall be immediately accessible for an emergency.

(1) Each resident record shall be started immediately upon admission to the residential care facility and shall include the following:

(a) The resident's name, previous address, date of birth, sex, race, religion; the date the resident began living at the residential care facility; the names, addresses, and telephone numbers of the resident's attending physician, nearest relative, guardian, if any, and any other individuals the resident designates to be contacted, including individuals to be notified in the event of an emergency. The residential care facility shall not coerce a resident to provide any of this information;

(b) Copies of the health assessments required by rule 3701-17-58 of the Administrative Code;

(c) Notations about incidents and adverse changes in health status required by rule 3701-17-62 of the Administrative Code;

(d) The medication record required by paragraph (I)(7) of rule 3701-17-59 of the Administrative Code as well as any medicare-D plan, if any, in which the resident is enrolled and receives prescription medication;

(e) The documentation required by paragraph (J) of rule 3701-17-60forresidentsonspecial diets; and

(f) The written resident agreement required by rule 3701-17-57 of the Administrative Code;

(g) The documentation required by paragraphs (J)(5) of rule 3701-17-59 and (B)(4) and (C)(3) of rule 3701-17-59.1 of the Administrative Code for residents receiving skilled nursing care provided by the residential care facility;

(h) A copy of risk agreements entered into under paragraph (G) of rule 3701-17-57 of the Administrative Code and the signed statement required under paragraph (H) of rule 3701-17-57 of the Administrative Code, if applicable.

(B) The incident log required by paragraph (B)(2) of rule 3701-17-62 of the Administrative Code;

(C) Copies of all current licenses, approvals and inspections required by rules 3701-17-50 to 3701-17-68 of the Administrative Code;

(D) A record of the name, address, working hours, medical statements, and training for staff members;

(E) Documentation of compliance with rule 3701-17-66 of the Administrative Code;

(F) Fire and evacuation procedures and records of fire drills required by rule 3701-17-63 of the Administrative Code;

(G) Records of heating system checks required by paragraph (A) of rule 3701-17-65 of the Administrative Code and fire extinguishing system checks;

(H) All records required by state and federal laws and regulations as to the purchase, dispensing, administering, and disposition of prescription medications including unused portions.

(I) The residents' rights policies, procedures and records.

(J) All other records required by Chapter 3721. of the Revised Code and rules 3701-17-50 to 3701-17-68 of the Administrative Code.

(K) All records and reports required by Chapter 3701-13 of the Administrative Code shall be maintained and made available in accordance with that chapter.

The residential care facility shall maintain the records required by paragraphs (A) and (B) of this rule for seven years following the date of the resident's discharge except if the resident is a minor, such records shall be maintained for three years past the age of majority but not less than seven years.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 12/01/01, 4/1/07

3701-17-68 Variances.

(A) The director may grant a variance from the requirements of rules 3701-17-50 through 3701-17-68 of the Administrative Code unless required by statute if the operator or administrator shows that granting the variance will not jeopardize the health or safety of any resident and that:

(1) Because of practical difficulties or other special conditions, strict application of the licensure requirement will cause unusual and unnecessary hardship; or

(2) An alternative to the licensure requirement, including new concepts, methods, procedures, techniques, or the conducting of pilot projects is in the interest of better health care or management.

No variance shall be granted that will defeat the spirit and general intent of these rules or otherwise not be in the public interest.

(B) A request for a variance from the requirements of the residential care facility licensure rules shall be made in writing to the director, specifying the following:

(1) The rule requirement for which the variance is requested;

(2) The time period for which the variance is requested;

(3) The specific alternative action which the residential care facility proposes;

(4) The reasons for the request;

(5) An explanation of the anticipated affect granting of the variance will have on residents;

The director may request additional information from the residential care facility prior to making a determination regarding the request.

(C) The director may revoke a variance if the director determines that:

(1) The variance is adversely affecting the health and safety of the residents;

(2) The residential care facility has failed to comply with the variance as granted;

(3) The operator or administrator notifies the department in writing that the owner or administrator wishes to relinquish the variance; or

(4) The variance conflicts with a statutory change thus rendering the variance invalid.

(D) The director shall notify the operator, in writing, of the director's determination regarding a variance request and of a revocation of a granted variance. The director may establish conditions that the residential care facility must meet for a variance to be operative. The director shall provide the residential care facility with an opportunity for an informal hearing concerning the denial of a variance request or a revocation of a granted variance, if requested by the operator within thirty days of the mailing of the notice of denial or revocation, but the residential care facility shall not be entitled to a hearing under Chapter 119. of the Revised Code. If the director proposes to deny or revoke a license because the residential care facility is in violation of a rule for which a variance was denied or revoked, the director shall afford the residential care facility a hearing in accordance with Chapter 119. of the Revised Code.

R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 12/1/01