016.25.22 Ark. Code R. 004
Rules for Nursing Homes Office of Long
For the purpose of these standards the following definitions shall apply:
Administrator means a person licensed as a nursing home administrator by the Department who administers, manages, supervises, or is in general administrative charge of a nursing home.
Alteration means any work other than maintenance in an existing building and which does not increase the floor or roof area or the volume of enclosed space.
Consultant shall mean a qualified person who gives professional advice or service within his/her specialty, with or without re-numeration.
Consultant Dietitian a person who is eligible for registration by the Dietetic Association, has a baccalaureate degree with major studies in food and nutrition, dietetics, or food service management; has one year of supervisory experience in the dietetic service of a health care institution and participates annually in continuing dietetic education.
Consultant Pharmacist means a qualified licensed, registered pharmacist, who under arrangement with an institution, renders assistance in developing, implementing, evaluating, and revising where indicated, policies and procedures for providing the administrative and technical guidance of the pharmaceutical services relative to labeling, storing, handling, dispensing, and all other matters pertaining to the administration and control of drugs and medication. He/she provides such services and monitors activities within the institution with the express purpose of creating and maintaining the highest standards in medication distribution, control, and service.
Controlled Substances means a drug, substance or immediate precursor in Schedules I through V of Article 11 of the Controlled Substances Act.
Department shall mean the Arkansas Department of Human Services (DHS).
Director shall mean the Director of the Division of Provider Services and Quality Assurance
Disinfection shall mean the process employed to destroy harmful microorganisms, but ordinarily not viruses and bacterial spores.
Distinct Part shall mean an identifiable unit accommodating beds and related facilities including, but not limited to, a wing, floor, or building that is approved by the Division for a specific purpose.
Division shall mean the DHS/Division of Provider Services and Quality Assurance
Drug means
Drug Administration is an act restricted to nursing personnel as defined in Nurses Practice Act 432 or 1971, in which a single dose of a prescribed drug or biological is given to a patient. This activity includes the removal of the dose from a previously dispensed, properly labeled container, verifying it with the prescriber's orders, giving the individual dose to the proper patient, and recording the time and dose given.
Drug Dispensing is an act restricted to a pharmacist which involves the issuance of one or more doses of a medication in a container other than the original, with such new containers being properly labeled by the dispenser as to content and directions for use as directed by the prescriber. This activity also includes the compounding, counting, and transferring of medication from one labeled container to another.
Existing Facilities are those facilities which were in operation, or those proposed facilities which began construction or renovation of a building under final plans approved by the Division prior to adoption of these rules.
Fire Resistance Rating shall mean the time in hours or fractions thereof that materials or their assemblies will resist fire exposure as determined by fire test conducted in accordance with recognized standards.
Governing Body shall mean the individuals or group in whom the ultimate authority and legal responsibility is vested for conduct of the nursing home.
Institution is any facility requiring licensure under these rules.
Intermediate Care Facility (ICF) is a nursing home licensed by Arkansas Social Services as meeting the Intermediate Care Facility rules. It is a health facility, or a distinct part of a hospital or Skilled Nursing Facility that is staffed, organized, operated, and maintained to provide 24- hour long term inpatient care and other restorative services under nursing supervision.
Legend Drugs are drugs, which because of their toxicity or other potentiality for harmful effect, or the method of their use, or the collateral measures necessary to their use, are not safe for use except under the supervision of a practitioner licensed by law to administer such drugs, or shall be dispensed only on prescription by the pharmacist. Such drugs bear the label "Caution: Federal Law Prohibits Dispensing Without Prescription."
License shall mean the basic document issued by the Division permitting the operation of nursing homes. This document constitutes the authority to receive patients and to perform the services included within the scope of these rules.
Licensed Bed Capacity shall mean the exact number of beds for which license application has been made and granted.
Licensee shall mean any state, municipality, political subdivision, institution, public, or private corporation, association, individual, partnership or any other entity to whom a license is issued for the purpose of operating the nursing home, who shall assume primary responsibility for complying with approved standards for the institution.
Medication Assistant- Any medication assistive person who is qualified and certified under Ark. Code Ann. § 17-87-701 et. seq.
New Construction means those facilities which are constructed or renovated for the purpose of operating an institution according to architectural plans approved by the Division after adoption of these rules.
Nursing Home shall mean and be construed to include any buildings, structure, agency, institution, or other place for the reception, accommodation, board, care, or treatment of two (2) or more unrelated individuals, who, because of physical or mental infirmity are unable to sufficiently or properly care for themselves, and for which reception, accommodation, board, care, and treatment, a charge is made, provided the term "Nursing Home" shall not include the offices of private physicians and surgeons, boarding homes, hospitals, or institutions operated by the Federal Government. (Section 2, Act 141 of 1961 as amended)
Nursing Home Classification shall mean the level of care the nursing home is capable of rendering such as Skilled Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility for the Mentally Retarded.
O.T.C. Drugs are commonly referred to as "over-the-counter," or patient medication that may be provided without prescription.
Patient (interchangeable with resident) shall mean any individual who is being treated by a physician or whose health is being supervised by a physician while residing within the respective facility.
Patient Unit is an area designated to accommodate an individual patient bed, bedside cabinet, chair, reading light, and other necessary equipment placed at the bedside for the proper care and comfort of a patient.
Provisional Licensure is a temporary grant of authority to the purchaser to operate an existing longterm care facility upon application for licensure to the Department.
Restorative Nursing or Rehabilitative Nursing shall mean measures directed toward prevention of deterioration in normal body alignment, and muscle tone, restoration of the resident to full activity insofar as their health problems permit and maintaining a state in which their total need for care is minimal.
Restraint is any device or instrument used to limit, restrict, or hold patients under control, not including safety vests or other instruments such as bed rails used for the safety and positioning of patients. Personal safety devices and postural support devices that restrict movement are considered restraints.
Sanitation is the process of promoting hygiene and preventing disease by maintaining sanitary conditions.
Skilled Nursing Facility (SNF) is a nursing home, or a distinct part of another facility, licensed by the Department as meeting the skilled nursing facility licensure rules. A health facility which provides skilled nursing care and supportive care on a 24-hour basis to residents whose primary need is for availability of skilled nursing care on an extended basis.
Qualified Social Worker is a person who is registered by the State Board of Social Work and is a graduate of a school of social work accredited or approved by the council on Social Work Education.
State Health Officer shall mean the Director of the Arkansas Department of Health, Secretary of the State Board of Health.
Sterile the state of being free from all forms of micro-organisms.
Unit Dose Medication System shall mean a system in which single doses of drugs are prepackaged and pre-labeled in accordance with all applicable laws and rules governing these practices and made available separated by resident and by dosage time. The system includes all equipment and records deemed necessary and used in making the doses available to the resident in an accurate and safe manner. A pharmacist shall be in charge of and responsible for the system.
Guardian shall mean a court appointed person who by law is responsible for a patient's affairs.
Responsible Party shall mean the person who is accountable for the patient's affairs but who has not been appointed by the court.
Routine means the regular performance of a particular task.
Abbreviations | |
R.N. | Registered Nurse |
L.P.N. | Licensed Practical Nurse |
L.P.T.N. | Licensed Psychiatric Technician Nurse |
N.A. | Nurse's Aide |
P.T. | Part-time |
F.T. | Full-time 40 hours per week in these rules and should not be confused with (Fair Labor Standards Act) |
N.H. | Nursing Home |
LTC | Long Term Care |
O LTC | Office of Long Term Care |
O.T.C. | Over-the-counter drugs |
Nursing homes, or related institutions, shall be operated, conducted, or maintained in this State by obtaining a license pursuant to the provisions of these Licensing Standards. Separate institutions operated by the same management require separate licenses. Separate licenses are not required for separate buildings on the same grounds. The classification of license shall be Skilled Nursing Facility, Intermediate Care Facility, and Intermediate Care Facility for the Mentally Retarded.
Whenever ownership or controlling interest in the operation of a facility is sold, both the buyer and the seller must notify the Office of Long Term Care at least thirty (30) days prior to the completed sale. The thirty (30) day notice shall be the date the paperwork is stamped received by the Office of Long Term Care.
Applicants for license shall file a notarized application with the Division upon forms prescribed by the Division and shall pay an annual license fee of ten cents (10¢) per patient bed, or Ten Dollars ($10), whichever is greater. This fee shall be paid to the State Treasury. If the license is denied, the fee will be returned to the applicant. Facilities operated by any unit or division of state or local government shall be exempted from payment of a licensing fee. Application shall be signedby the owner if individually owned, by one partner if owned under partnership, by two (2) officers of the board if operated under corporation, church, or non-profit association, and in case of a governmental unit, by the head of the governmental entity having jurisdiction over it. Applicants shall set forth the full name and address of the institutions for which license is sought, the names of the persons in control, a signed statement by a registered nurse indicating responsibility for nursing services of the home, and such other information as the Division may require.
In these instances where a distinct part of a facility is to be licensed as a Skilled Nursing Facility and the remainder of the facility is to be licensed under some other category, separate applications must be filed for each license and separate licensure fees shall be required with each application.
* The identity of each person directly or indirectly having an ownership interest of five percent (5%) or more in such nursing home.
* In case such nursing home is organized as a corporation, the identify of each officer and director of the corporation.
* In case such nursing home is organized as a partnership, the identity of each partner.
* Identity of owners of building and equipment leased, including ownership breakdown of the leasing entity.
* Information on the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility.
* Information on the owner or owners of the building or other structures that will be used in the operation of the facility.
* Information on all other facilities owned, operated, or managed by the applicant or applicants.
* Information on all other facilities owned, operated, or managed by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility; and
* Affirmative evidence of ability to comply with standards, rules, and regulations as may be lawfully prescribed.
* The administrator, officers, directors, or management company, operator, or other management agent that the applicant will use to manage the facility has ever been convicted of a felony;
* A facility or facilities owned or operated by the applicant or applicants have been found, after final administrative decision, to have committed a Class A violation;
* A facility or facilities owned or operated by the administrator, directors, management company, operator, or other management agent (that the applicant or applicants will use to manage the facility) has been found, after final administrative decision, to have committed a Class A violation;
* The applicant or applicants have had a license revoked or suspended;
* The administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility have had a license revoked;
* The applicant or applicants have not demonstrated to the satisfaction of the department that any other facility owned, operated, or administered by the applicant or applicants, administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility, is and has been in substantial compliance with the standards as set by applicable state and federal law; or o The applicant or applicants have not demonstrated to the satisfaction of the Department that any other facility (owned, operated, or administered by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility) is and has been in substantial compliance with the standards as set by applicable state and federal law.
The Department may consider the mitigation of compliance issues by an applicant or applicants that would fall under the aforementioned section, including the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility.
Annual licensure fees shall be tendered with each application for a new long-term care facility license and annually thereafter by the anniversary of the date the department issued the long-term care facility license. A license or licensure renewal shall not be issued unless the initial annual licensure fee has been paid in full Any fee not paid when due shall be delinquent and shall be subject to assessment of a ten-percent penalty. If a long-term care facility fails to pay the annual licensure fee within sixty (60) calendar days of the anniversary of the date that the department issued the long-term care facility license, the department may suspend the license until the annual licensure fee is paid in full.
A license shall remain effective unless revoked, suspended, or terminated by the Department. A license shall be issued only for the premises and persons in the application and shall not be assignable or transferable.
The Division is empowered to deny, suspend, or revoke licenses on any of the following grounds:
If a long-term care facility intends to add, remove, or otherwise change the management company, owner, operator, or other management agent that manages the long-term care facility, the long-term care facility shall notify the department. The long-term care facility shall notify the department of the change and request approval at least thirty (30) days before the change occurs.
The long-term care facility shall complete the appropriate documents and provide the department with the information required to allow the department to evaluate whether the new management company, owner, operator, or other management agent that manages the long-term care facility meets the eligibility criteria set forth in the disqualifying criteria stated in the aforementioned section. The long-term care facility shall receive approval of the change from the department before the change occurs unless the change is required due to an emergency.
If a change occurs without prior approval from the department due to an emergency, the long-term care facility shall notify the Department within ten (10) days of the change. The Department may deny a requested change based on the criteria established in the above (second) paragraph of this section. If the Department denies a requested change, the long-term care facility may not employ or otherwise use the denied management company, owner, operator, or other management agent. A long-term care facility is not required to notify or receive approval from the Department for a change involving vendors that provide services to the long-term care facility but do not manage the facility.
Responsibilities of the seller and buyer:
* The seller shall remain responsible for the operation of the facility until such time as a license is issued to the buyer.
* The buyer shall be subject to any plan of correction submitted by the previous licensee and approved by the department.
* The seller shall remain liable for all penalties assessed against the facility that are imposed for violations or deficiencies occurring before the date the department issues the long-term care facility license to the buyer.
* The seller shall remain liable for all quality assurance fees and license fees that are assessed to the facility before the date that the department issues the long-term care facility license to the buyer.
Whenever the Division decides to deny, suspend, or revoke a license, it shall send to the applicant or licensee a notice stating the reasons for the action by certified mail. The applicant or licensee may appeal such notice to the Long Term Care Facility Advisory Board as permitted by Arkansas Statute Annotated §82-211. Procedures for appeal to the Long Term Care Facility Advisory Board are incorporated in these rules as Appendix A.
Any applicant or licensee who considers himself injured in his person, business, or property by final agency action shall be entitled to judicial review thereof. Proceedings for review shall be made by filing a petition in the Circuit Court, of any county in which the petitioner does business, or in the Circuit Court of Pulaski County, within thirty (30) days after service, upon the petitioner of the agency's final decision. All petitions for judicial review shall be in accordance with the Administrative Procedures Act Arkansas Statute Annotated §5-713.
Any person, partnership, association, or corporation, establishing, conducting, managing, or operating any institution within the meaning of this act (§§ 82-327 -- 82-354), without first obtaining a license therefor as herein provided, or who violates any provision of this act or rules lawfully promulgated hereunder shall be guilty of a misdemeanor, and upon conviction thereof shall be liable to a fine of not less than twenty five dollars ($25) nor more than one hundred dollars ($100) for the first offense and not less than one hundred dollars ($100) nor more than five hundred dollars ($500) for each subsequent offense, and each day such institution shall operate after a first conviction shall be considered a subsequent offense. (Section 27, Act 414 of 1961)
All institutions to which these rules apply shall be subject to inspection for reasonable cause at any time by the authorized representation of the Division.
An initial license will not be issued until the applicant has demonstrated to the satisfaction of the Division that the facility is in substantial compliance with the licensing standards set forth in these rules.
When noncompliance of the licensing standards is detected during surveys, licensees will be notified of the violations and will be requested to provide a plan of correction with a timetable for corrections. If an item of noncompliance is of a serious nature that affects the health and safety of patients and is not promptly corrected, action will be taken to suspend or revoke the facility's license.
Any nursing home, or related institution, that voluntarily closes must meet the rules for new construction to be eligible for re-licensure.
The Division reserves the right to make temporary exceptions to these standards where it is determined that the health and welfare of the community requires the services of the institution. Exceptions will be limited to unusual circumstances and the safety and well-being of the residents will be carefully evaluated prior to making such exceptions.
Overbeds will be authorized only in cases of emergency. An emergency exits when it can be demonstrated that the resident's health or safety would be placed in immediate jeopardy if relocation were not accomplished. A fire, natural disaster (such as a tornado or flood), or other catastrophic event that necessitates resident relocation, will be considered an emergency. The Department must be contacted for prior authorization of the overbed, and all authorizations must be in writing.
Subject to the requirements below, a provisional license shall be issued to the Applicant and new operator of the long-term care facility when the Department has received the Application for Licensure to Conduct a Long Term Care Facility. A provisional license shall remain in effect unless the provisional license is revoked, suspended, or terminated by the department. With the exception of Medicaid or Medicare provider status, a provisional license confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
A provisional license holder may operate the facility under a new name, whether fictitious or otherwise. For purposes of this section, the term new name means a name that is different than the name under which the facility was operated by the prior owner, and the term "operate" means that the provisional license holder may hold the facility out to the public using the new name.
Examples include, but are not limited to, signage, letterhead, brochures, or advertising (regardless of media) that bears the new name.
In the event that the provisional license holder operates the facility under a new name, the facility shall utilize the prior name in all communications with the Office of Long Term Care until such time as the license is issued. Such communications include, but are not limited to, incident reports, notices, Plans of Correction, and MDS submissions. Upon the issuance of the license, the facility shall utilize the new name in all communications with the Office of Long Term Care.
* Must provide information on the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility;
* Must provide information on the owner or owners of the building or other structures that will be used in the operation of the facility;
* Must provide information on all other facilities owned, operated, or managed by the applicant or applicants;
* Must provide information on all other facilities owned, operated, or managed by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility; and
* Must provide affirmative evidence of ability to comply with standards, and rules, as may be lawfully prescribed.
* The administrator, directors, or management company, operator, or other management agent that the applicant will use to manage the facility has ever been convicted of a felony;
* A facility or facilities owned or operated by the applicant or applicants have been found, after final administrative decision, to have committed a Class A violation;
* A facility or facilities owned or operated by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility have been found, after final administrative decision, to have committed a Class A violation;
* The applicant or applicants have had a license revoked or suspended;
* The administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility have had a license revoked;
* The applicant or applicants have not demonstrated to the satisfaction of the Department that any other facility owned, operated, or administered by the applicant or applicants is and has been in substantial compliance with the standards as set by applicable state and federal law; or
* The applicant or applicants have not demonstrated to the satisfaction of the department that any other facility owned, operated, or administered by the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility, is and has been in substantial compliance with the standards as set by applicable state and federal law.
The Department may consider the mitigation of compliance issues by whether an applicant or applicants that would fall under one (1) of the above denial criteria including the administrator, directors, management company, operator, or other management agent that the applicant or applicants will use to manage the facility. This includes any long-term care facility which was not licensed at the time of application or any additional bed capacity of a licensed facility.
If a long-term care facility intends to add, remove, or otherwise change the management company, operator, or other management agent that manages the longterm care facility, the long-term care facility shall notify the Department of the change and request approval at least thirty (30) days before the change occurs. The Department will timely process the application; however, additional requests for information may be necessary and extend this process
The long-term care facility shall provide the Department with the information required to allow the Department to evaluate whether the new management company, operator, or other management agent that manages the long-term care facility meets the eligibility criteria set forth in the disqualifying criteria stated in the aforementioned section. The long-term care facility shall receive approval of the change from the Department before the change occurs unless the change is required due to an emergency.
If a change occurs without prior approval from the Department due to an emergency, the long-term care facility shall notify the Department within ten (10) days of the change. The Department may deny a requested change based on the criteria established in below subdivision of this section. If the Department denies a requested change, the long-term care facility may not employ or otherwise use the denied management company, operator, or other management agent. A longterm care facility is not required to notify or receive approval from the Department for a change involving vendors that provide services to the long-term care facility but do not manage the facility. 405.1
Subject to the requirements below, a provisional license shall be issued to the Applicant and new operator of the long-term care facility when the Department has received the Application for Licensure to Conduct a Long Term Care Facility. A provisional license shall be effective from the date the Office of Long-Term Care provides notice to the Applicant and new operator, until the date the long-term care license is issued. With the exception of Medicaid or Medicare provider status, a provisional license confers upon the holder all the rights and duties of licensure.
Prior to the issuance of a provisional license:
A provisional license holder may operate the facility under a new name, whether fictitious or otherwise. For purposes of this section, the term new name means a name that is different than the name under which the facility was operated by the prior owner, and the term "operate" means that the provisional license holder may hold the facility out to the public using the new name. Examples include, but are not limited to, signage, letterhead, brochures, or advertising (regardless of media) that bears the new name.
In the event that the provisional license holder operates the facility under a new name, the facility shall utilize the prior name in all communications with the Department until such time as the license is issued. Such communications include, but are not limited to, incident reports, notices, Plans of Correction, and MDS submissions. Upon the issuance of the license, the facility shall utilize the new name in all communications with the Department.
016.25.22 Ark. Code R. 004