This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and
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| Rule |
Rule 3701-17-01 | Definitions.
Effective:
January 1, 2018
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) "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. (F) "Complex therapeutic diet" has the same
meaning as "therapeutic diet" as that term is defined in paragraph
(LL) of this rule.: (G) "Department" means the department of health
of the state of Ohio. (H) "Dietitian" means an individual licensed
under Chapter 4759. of the Revised Code to practice dietetics. (I) "Director" means the director of the
department of health of the state of Ohio or the director's duly
authorized representative. (J) "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. (K) "Home" has the same meaning as in division
(A)(1) of section 3721.01 of the Revised Code. (L) "Hospice care program" or "hospice"
means an entity licensed under Chapter 3712. of the Revised Code. (M) "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. (N) "Licensed practical nurse" means a person
licensed under Chapter 4723. of the Revised Code to practice nursing as a
licensed practical nurse. (O) "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. (P) "Mechanically altered food"
means that the texture of food is altered altered by chopping, grinding,
mashing, or pureeing so that it can be successfully chewed and safely
swallowed. (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 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 (HH) 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.A. 1, as amended (2015),
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) "Resident call
system" means a set of devices that are connected electrically,
electronically, by radio frequency transmission, or in a like manner that can
effectively 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. (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
and therapeutic diets; (2) Objective observation
of changes in the resident's condition as a means of analyzing and
determining the nursing care required and the need for further medical
diagnosis and treatment; (3) Special procedures
contributing to rehabilitation; (4) Administration of
medication by any method ordered by a physician, such as hypodermically,
rectally, or orally, including observation of the resident after receipt of the
medication; (5) Carrying out other
treatments prescribed by the physician that involve a similar level of
complexity and skill in administration. (II) "Special diet" means a therapeutic diet
limited to: (1) Nutrient adjusted diets, including
high protein, no added salt, and no concentrated sweets; (2) Volume adjusted diets, including
small, medium, and large portions; (3) The use of finger foods or bite-sized
pieces for a resident's physical needs; or (4) Mechanically altered
food. (JJ) "Sponsor" means an adult relative, friend, or
guardian of a resident who has an interest or responsibility in the
resident's welfare. (KK) "Supervision" means the monitoring of a
resident to ensure that the health, safety, and welfare of the resident is
protected. (LL) "Therapeutic diet" means a diet ordered by a
health care practitioner: (1) As part of the
treatment for a disease or clinical condition; (2) To modify, eliminate,
decrease, or increase certain substances in the diet; or (3) To provide
mechanically altered food when indicated. (MM) "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. (NN) "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.
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Rule 3701-17-02 | Application of rules.
Effective:
October 20, 2001
Promulgated Under:
Ch 119.
(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.
Supplemental Information
Authorized By:
–
Amplifies:
–
Five Year Review Date:
Prior Effective Dates:
3/1/1971, 2/21/1992
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Rule 3701-17-03 | License fee; application; issuance; revocation.
Effective:
January 1, 2018
(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. However, no nursing home
shall be licensed in the same building as another nursing home. (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 director 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.
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Rule 3701-17-03.1 | Expedited inspections.
(A) For purposes of this rule,
"inspection" may be conducted either in-person or on-line using
remote conferencing technology. (B) An applicant for licensure as a
nursing home may request an expedited initial licensure inspection by providing
the department of health with the following: (1) A complete initial
nursing home application and fee required by paragraph (A) of rule 3701-17-03
of the Administrative Code; (a) An application will be deemed complete when the
department verifies all information contained therein is complete and accurate
and meets the requirements of paragraph (C) of rule 3701-17-03 of the
Administrative Code; (b) An applicant may elect an expedited initial licensure
inspection on the initial nursing home application and, if electing such an
inspection, provide a fee in addition to that required by paragraph (A) of rule
3701-17-03 of the Administrative Code, in the amount of two thousand two
hundred fifty dollars; (2) Certificate of need confirmation that all certificate
of need requirements are met, as applicable; and (3) Notice of readiness for
inspection. (C) The operator of an existing nursing home that is
seeking approval to increase or decrease the nursing home's licensed
capacity or to make any other change for which the director requires a
licensing inspection to be conducted may request an expedited licensure
inspection by providing the department of health with the
following: (1) A written notice that
includes, if applicable: (a) A floor plan of the area, including beds; (b) The results of the inspection by the state fire marshal
or a township, municipal, or other legally constituted fire department approved
by the marshal for the area; and (c) A certificate of occupancy for the area; (2) A fee in the amount
of two thousand two hundred fifty dollars; (3) Certificate of need confirmation that all certificate
of need requirements are met; and (4) Notice of readiness. (D) A fee collected by the department pursuant to this rule
shall be deposited in the state treasury to the credit of the general
operations fund created by section 3701.83 of the Revised Code, and the fee
shall not be refunded. (E) Upon receipt of a completed request for expedited
inspection made pursuant to this paragraph (B) or (C) of this rule, the
department will commence an inspection of the nursing home not later than ten
business days. Inspections under this rule will be scheduled in the order in
which the request for expedited inspection is determined to be
complete. (F) If the nursing home does not meet the requirements for
licensure upon the initial inspection requested under paragraph (B) of this
rule, the department of health may deny the license. (G) If an existing nursing home does not meet the
requirements for licensure upon the expedited inspection requested under
paragraph (C) of this rule, the department of health may refuse to approve the
increase or decrease in capacity, or refuse to license the previously
unlicensed space.
Last updated May 16, 2022 at 8:21 AM
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Rule 3701-17-04 | 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.
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Rule 3701-17-05 | Prohibitions.
Effective:
January 1, 2018
(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) Exceed the nursing
home's authorized maximum licensed capacity. (4) Knowingly falsify
records, or misrepresent information to the director. (5) Allow transient
guests to remain in a licensed part of a home for more than thirty-six hours in
any seventy-two hour period. Accommodations for transient guests may be
provided in an area or areas outside the licensed part of a home. (D) For purposes of this rule,
"transient guest" means an individual, whether related to a resident
or not, who stays in a home. "Transient guest" does not include an
individual who stays in a home for a period of time not exceeding fourteen days
and is: (1) Admitted to the home for short term respite
care; (2) Staying with a resident upon admission to the home;
or (3) Staying with a resident receiving end-of-life
care.
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Rule 3701-17-06 | Responsibility of operator and nursing home administrator; quality assurance and performance improvement.
Effective:
January 1, 2018
(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 an
ongoing quality assurance and performance improvement (QAPI) program to address
all systems of care and management practices, including clinical care, quality
of life, and resident choice. As part of the QAPI program, each home shall, at
minimum: (1) Establish a quality assurance committee that shall meet
on an ongoing basis, but at least quarterly to systematically: (a) Monitor and evaluate
the quality of care and quality of life provided in the home; (b) Track, investigate,
and monitor incidents, accidents, and events that have occurred in the
home; (c) Track and monitor the
effectiveness of the infection control program; (d) Identify problems and
trends; and (e) Develop and implement
appropriate action plans to correct identified problems; and (2) Participate in at least one quality improvement project
every two years from those approved by the department of aging through the
nursing home quality initiative established under section 173.60 of the Revised
Code. (D) The records of meetings of the
quality assurance committee by this rule are not required to be disclosed to
the director. The nursing home shall document, and the director shall verify
through interviews with committee members and, as necessary, direct care staff,
that: (1) The home has a
quality assurance committee which addresses quality concerns; (2) Staff know how to
access that process; and (3) 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. (E) Good faith attempts by the committee
to identify and correct quality deficiencies will not be used as a basis for
sanctions.
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Rule 3701-17-07 | Qualifications and health of personnel.
Effective:
January 1, 2018
(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 who has
supervisory and management responsibility and the authority to direct and
control food preparation and service shall obtain the level two certification
in food protection according to 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, person-centered care, 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) No nursing home shall employ a person
who applies for a position that involves the provision of direct care to an
older adult, if the person: (1) Has been convicted of
or pleaded guilty to an offense listed in division (C)(1) of section 3721.121
of the Revised Code, unless the individual is hired under the personal
character standards set forth in rule 3701-13-06 of the Administrative
Code; (2) Fails to complete the
form(s) or provide fingerprint impressions as required by division (B)(3) of
section 3721.121 of the Revised Code; (3) Is the subject of a
finding of abuse or neglect of a resident or misappropriation of the property
of a resident on the nurse aide registry, established pursuant to section
3721.32 of the Revised Code; (4) Is the subject of a
finding of abuse or neglect of a resident or misappropriation of the property
of a resident on the nurse aide registry established by another state where the
home believes or has reason to believe the person resides or resided;
or (5) Has had a
disciplinary action taken against a professional license by a state licensure
body as a result of a finding of abuse, neglect, mistreatment of residents or
misappropriation of resident property.
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Rule 3701-17-07.1 | Required training and competency evaluation for nurse aides working in long-term care facilities.
Effective:
January 1, 2018
(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,
principles of person-centered 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 be
conducted by the aide's immediate supervisor or a nurse designated by the
facility to conduct the performance evaluations and consist, at minimum, of an
evaluation of the nurse aide's working knowledge, application of the
principles of person-centered care, and clinical performance. 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, or 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. 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. (4) In addition to the
requirements of this paragraph, a nursing home that holds itself out as
providing specialty care to residents shall ensure each nurse aide who provides
specialty care receives sufficient additional hours of training each year to
ensure competency and to meet the individual needs of the residents. For
purposes of this paragraph, a nursing home or part thereof is considered to
"hold itself out as providing specialty care" when it advertises the
home provides specialty care, represents to the department or the public that
it provides specialty care, or admits ten or more individuals with common
specialized care needs. "Specialty care" includes, but is not limited
to, dementia care, behavioral care, mental health care, or hospice
care.
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Rule 3701-17-07.2 | Dining assistants.
Effective:
January 1, 2018
(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 and
therapeutic 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
5165.77 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.
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Rule 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.
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Rule 3701-17-08 | Personnel requirements.
Effective:
January 1, 2018
(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 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 conduct an assessment of the
residents admitted to the facility, based on the residents' plans of care,
to determine the staffing level needed 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 3701-17-07.1
of the Administrative Code and provide services in accordance with applicable
scopes of practice. (G) With input from the medical director
and the director of nursing, the nursing home may 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. (H) 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. (I) A nursing home that is physically
located in the same building or on the same lot as a licensed residential care
facility, or a home certified as a intermediate care facility for individuals
with intellectual disabilities that 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 licensed residential care
facility, certified intermediate care facility for individuals with
intellectual disabilities, or adult day care program or use appropriate and
qualified staff from the licensed residential care facility, certified
intermediate care facility for individuals with intellectual disabilities, 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 the
residential care facility, certified intermediate care facility for individuals
with intellectual disabilities, or adult day program shall be counted towards
meeting the staffing requirements of this rule; (2) The other licensed
residential care facility or certified intermediate care facility for
individuals with intellectual disabilities, 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
residential care facility; (3) Separate staffing
schedules are maintained for the nursing home, residential care facility,
certified intermediate care facility for individuals with intellectual
disabilities, 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, residential care facility, or intermediate care facility
for individuals with intellectual disabilities residents and the participants
of the adult day care program; (5) The nursing home,
residential care facility, intermediate care facility for individuals with
intellectual disabilities 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.
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Rule 3701-17-09 | Resident life enrichment.
Effective:
January 1, 2018
(A) All nursing homes shall provide a
comprehensive activity program designed to meet the physical, mental,
emotional, psycho-social well-being and personal interests of each resident.
Activities shall be provided based on the needs and preferences of each
resident as identified on their comprehensive assessment and care plan required
by rules 3701-17-10 and 3701-17-14 of the Administrative Code, respectively,
and needs and preferences identified during resident's time in the home.
Activities shall be implemented and adjusted based on resident input and
residents' changes in abilities, physical and mental status. Activities
shall be scheduled for day time, week end, evening, and include the community
to the extent possible. (B) All nursing homes shall provide
social services to: (1) Meet the
medically-related social service needs of each resident; (2) Meet the physical,
mental, and psycho-social well-being of each resident; and (3) Assist each resident
in attaining or maintaining the highest practicable level of
functioning. (C) Residents may receive visitors of
their choice at any time. 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. (D) Residents may keep pets if allowed by
facility policy. If a nursing home allows residents to keep animals or pets, or
has facility pets, the nursing home shall, in consultation with the medical
director and a veterinarian licensed to practice veterinary medicine under
Chapter 4741. of the Revised Code, develop 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) For resident pets, if
the resident is transfered, discharged or otherwise unable to care for the pet,
responsibilities for care of the pet until a family member or sponsor can
retrieve the pet; (6) In the case of a
facility pet, the name of the designated member or members of the staff
responsible for the care of the animal and for maintaining the protocol,
including medical records for the animal; and (7) An evaluation of the
medical needs of residents. (E) Residents shall have reasonable
access to various methods of communication. The administrator shall ensure
that: (1) Each resident
receives all mail, telegrams, or other communications addressed to the resident
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) Each 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; (3) Each resident has
access to telephone services that meets the needs of the resident in an area
where calls can be made without being overheard; and (4) Each resident can use
his or her cellular phone, computer, or other technological device unless the
use of that device is not medically advisable or is disruptive to other
residents or the safe and orderly operation of the home.
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Rule 3701-17-10 | Resident assessments; advanced care planning.
Effective:
January 1, 2018
(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, including allergies and intolerances; 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) Preferences of the
resident including hobbies, usual activities, bathing, sleeping patterns,
socialization and religious; (2) Medical
diagnoses; (3) Psychological, and intellectual
disabilities and developmental diagnoses and history, if
applicable; (4) Health history and physical,
including cognitive functioning, sensory and physical impairments, and the risk
of falls; (5) Psycho-social history; (6) Prescription and over-the-counter
medications; (7) Nutritional and dietary requirements,
food preferences, and need for any adaptive equipment, and needs for assistance
and supervision of meals; (8) Height, weight and history of weight
changes; (9) A functional assessment which
evaluates the resident's ability to perform activities of daily
living; (10) The resident's risk of
falls; (11) Vision, dental and hearing function,
including the need for eyeglasses or other visual aids; (12) Dental function; including the need
for dentures or partial dentures; (13) Hearing function, including the need
for hearing aids or other hearing devices; and (14) 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, weight and
history of weight changes; (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) Each nursing home shall participate
in advance care planning with each resident or the resident's sponsor if
the resident is unable to participate. The advance care planning shall be
provided on admission to the nursing home. 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.
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Rule 3701-17-11 | Infection control; tuberculosis control plan.
Effective:
December 8, 2014
(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 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. (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.
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Rule 3701-17-12 | Notification and reporting of changes in health status, illness, injury and death of a resident.
Effective:
January 1, 2018
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
resident's 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.
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Rule 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 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 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.
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Rule 3701-17-14 | Plan of care; treatment and care: discharge planning, bathing.
Effective:
January 1, 2018
(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 resident-focused and goal driven, and 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. The home shall offer
opportunities for the resident, the resident's sponsor, and those of the
resident's choice to participate in the care planning process and will
provide necessary information, support, and options for engaging in the process
to ensure that the resident/sponsor directs the process to the maximum extent
possible and is enabled to make informed choices and decisions. (1) The plan of care
shall be consistent with the comprehensive assessment with recognition of the
capabilities, preferences and goals 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,
needs, or preferences that warrant 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 those persons
of the resident's choice, that indicates where the individual plans to
reside, and any arrangements that have been made for the resident's follow
up care and any post-discharge medical and non-medical services. 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. (J) Upon a resident's transfer,
discharge, or death, the nursing home shall make an accounting of all that
resident's monies held by the facility. The nursing home shall convey any
remaining funds immediately to the resident or within thirty days to the
resident's estate unless otherwise directed by law.
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Rule 3701-17-15 | Restraints.
Effective:
January 1, 2018
(A) For purposes of this
rule: (1) "Attending
physician" means the physician with the most significant role in the
determination and delivery of medical care to the individual at the time of a
restraint order, which may include, the resident's physician, the medical
director of the home, or another physician on the staff of the
home. (2) "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 restraint. (3) "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 an attending 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.
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Rule 3701-17-16 | Equipment and supplies.
Effective:
January 1, 2018
(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.
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Rule 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.
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Rule 3701-17-18 | Food and nutrition.
Effective:
January 1, 2018
(A) Each nursing home shall have a
kitchen and other food service facilities which are adequate for preparing and
serving 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) 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. (C) Each nursing home shall provide at least three
nourishing, palatable, and appetizing meals daily to all residents at regular
hours comparable to normal mealtimes in the community. The meals shall be
varied and meet the nutritional needs of the residents and be capable of
providing the dietary referenced intake of the "Food and Nutrition
Board" of the "National Academy of Science." Food shall be
prepared and served in a form that meets the resident's individual needs
based on the assessment conducted pursuant to rule 3701-17-10 of the
Administrative Code, the plan of care required by rule 3701-17-14 of the
Administrative Code, allow for resident choice, and accommodate religious,
ethnic, cultural and personal preferences. 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. (D) 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) Ensures safe food
handling practices to prevent contamination of food being served;
and (2) Assists residents
when necessary. (E) 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. (F) Each nursing home shall have planned menus for all
meals that are approved by the dietitian required by paragraph (K) of this
rule, for all meals at least one week in advance. The nursing home shall
maintain records for all meals, including therapeutic diets, as served. The
meal records shall be kept on file in the nursing home for at least three
months 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. (G) Safe, fresh, and palatable drinking
water shall be accessible for residents at all times. (H) All diets shall be: (1) Ordered by a
physician or other licensed health professional acting within their scope of
practice; (2) Prepared and provided
in accordance with the instructions of a dietitian pursuant to the diet order;
and (3) Adjusted as ordered by a physician,
dietitian or other licensed health professional acting within their 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) Each nursing home shall employ a dietitian, who may be
hired on a full-time, part-time or consultant basis, to plan, direct 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, or sooner, if
needed, with the food service manager. Each nursing home shall ensure that the
dietitian performs the following functions: (1) Assesses, plans,
monitors and evaluates 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 safe and sanitary conditions in procurement, storage, preparation,
distribution and serving of food; (3) Monitors food
preparation staff and staff responsible for carrying out the duties specified
in this rule; (4) For each resident
receiving a therapeutic diet, on an on-going basis: (a) Determine that the diet ordered is appropriate
according to the resident's individual nutritional care plan; (b) Monitor the resident's nutritional intake and
acceptance of the diet; (c) Evaluate the home's compliance in the provision of
the diet; and (d) Adjust nutritional care plans and diets as
needed. (5) Oversees, or arranges
for, the training of staff in performing the duties specified in this rule and
in the preparation of foods for all 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. (K) Tube feedings and parenteral nutrition shall be ordered
by a physician or other licensed health professional acting within their scope
of practice and 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.
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Rule 3701-17-19 | Records and reports.
Effective:
January 1, 2018
(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 the resident's
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 former resident, or the resident's or former
resident's 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. (E) Upon the change of operator of a
nursing home, the records required to be kept pursuant to this rule shall be
transferred to the new operator of the home.
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Rule 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.
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Rule 3701-17-21 | Dining and recreation rooms; utility rooms; toilet rooms.
Effective:
January 1, 2018
(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 or residential care facility residents 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 twenty-five square
feet per resident for seventy-five per cent of the nursing home's licensed
capacity. 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. Each nursing home that shares the dining and
recreation room or area with participants of an adult day-care program,
residents of a residential care facility, or both, shall provide an additional
twenty-five square feet per participant, resident, or both, for seventy-five
per cent of the total number of adult day-care program participants, the
licensed capacity of the residential care facility, or both. (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. (1) Dining room or area:
Twenty-five square feet per resident for the nursing home's licensed
capacity. Each nursing home that shares the dining room
or area with participants of an adult day-care program, residents of a
residential care facility, or both, shall provide an additional twenty-five
square feet per participant, resident, or both, for the total number of adult
day-care program participants, the licensed capacity of the residential care
facility, or both. (2) Recreational room or
area: Twenty-five square feet per resident for seventy-five per cent of the
nursing home's licensed capacity. Each nursing home that shares the recreation
room or area with participants of an adult day-care program, residents of a
residential care facility, or both, shall provide an additional twenty-five
square feet per participant, resident, or both, for seventy-five per cent of
the total number of adult day-care program participants, the licensed capacity
of the residential care facility, or both. (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 each resident sleeping room,
except the hand washing basin may be located in either the room containing the
toilet or the sleeping room. No more than two residents may share a toilet
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.
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Rule 3701-17-22 | General building and sanitation requirements; overhead paging.
Effective:
December 8, 2014
(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.
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Rule 3701-17-23 | Space requirements; limitation of number in wards.
Effective:
January 1, 2018
(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.
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Rule 3701-17-24 | Temperature regulation in homes.
Effective:
January 1, 2018
(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.
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Rule 3701-17-25 | Disaster preparedness, fire and carbon monoxide safety.
Effective:
January 1, 2018
(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. (G) Each nursing home shall install and
maintain carbon monoxide alarms or carbon monoxide detectors in accordance with
manufacturer's directions. Carbon monoxide alarms shall be installed in
the following locations: (1) On the ceiling of
each room containing a permanently installed fuel-burning appliance;
and (2) Centrally located on
every habitable level and in every heating/ventilation/air conditioning zone of
the building. (H) Nursing homes licensed as such prior
to the effective date of this rule have twelve months to come into compliance
with paragraph (G) of this rule. (I) For purposes of this
rule: (1) "Carbon monoxide alarm" means a single- or
multiple-station alarm tested to underwriters laboratory standard 2034, that is
intended for the purpose of detecting carbon monoxide gas and alerting
occupants by a distinct audible signal comprising an assembly that incorporates
a sensor, control components, and an alarm notification appliance in a single
unit operated from a power source either located in the unit or obtained at the
point of installation; (2) "Carbon monoxide detector" means a device
tested to underwriters laboratory standard 2075 that is intended to be
connected to a carbon monoxide detection system for the purpose of detecting
carbon monoxide gas and alerting occupants by a distinct and audible signal;
and (3) "Carbon monoxide detection system means" a
system of devices that consists of a control panel and circuits arranged to
monitor and annunciate the status of carbon monoxide detectors and to initiate
the appropriate response to those signal.
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Rule 3701-17-26 | Variances.
Effective:
January 1, 2018
(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. The director may establish conditions that the nursing home shall meet
for a variance to be operative, a time frame for which the variance will be
effective, or both. (D) The director shall notify the
operator, in writing, of the director's determination to revoke a granted
variance. The director may revoke a variance if the director determines
that: (1) The variance is
adversely affecting the health and safety of the residents; (2) The 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. (E) The refusal of the director to grant
or revoke a variance or waiver, in whole or in part, shall be final and shall
not be construed as creating any rights to a hearing under Chapter 119. of the
Revised Code.
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