La. Admin. Code tit. 48 § I-8003

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-8003 - Licensing

A. An application packet shall be obtained from the Department of Health and Hospitals (department or DHH). A completed application packet for a CRCC facility shall be submitted to and approved by DHH prior to an applicant providing CRCC services.

B. It shall be unlawful to operate or maintain a CRCC without first obtaining a license from the department. The Department of Health and Hospitals is the only licensing agency for CRCC in the state of Louisiana.

C. A separately licensed CRCC shall not use a name which is substantially the same as the name of another CRCC licensed by the department unless the applicant is part of a corporation or is chain affiliated.

D. The licensing agency shall have authority to issue two licenses as described below.

1. Full license is issued only to those applicants that are in substantial compliance with all applicable federal, state, and local laws, regulations, and policies. The license shall be valid until the expiration date shown on the license.

2. Provisional license is issued to those existing licensed applicants which do not meet the criteria for full licensure. The license shall be valid for six months or until the termination date stated on such license.

a. An agency with a provisional license may be issued a full license if at the follow-up survey the applicant has corrected the violations. A full license will be issued for the remainder of the year until the CRCC's license anniversary date.

b. DHH may re-issue a provisional license or initiate licensing revocation of a provisional license when the CRCC fails to correct violations within 60 days of being cited, or at the time of the follow-up survey, whichever occurs first.

c. A provisional license may be issued by DHH for the following nonexclusive reasons:

i. the applicant has more than five violations of CRCC regulations during one survey;

ii. the applicant has more than three valid complaints in a one-year period;

iii. there is a documented incident that places a patient at risk;

iv. the applicant fails to correct violations within 60 days of being cited, or at the time of a follow-up survey, whichever occurs first;

v. the applicant has an inadequate referral base, other than at the time of the initial survey for licensure, has less than 10 new patients admitted since the last annual survey;

vi. the applicant fails to submit assessed fees after notification by DHH; or

vii. there is documented evidence that the applicant has bribed, or harassed any person to use the services of any particular CRCC agency.

E. The current license shall be displayed in a conspicuous place inside the CRCC program office at all times. A license shall be valid only in the possession of the CRCC to which it is issued and for only that particular physical address. A license shall not be subject to sale, assignment, or other transfer, voluntary or involuntary. A license shall not be valid for any CRCC other than the CRCC for which originally issued.

F. All requirements of the application process shall be completed by the applicant before the application will be processed by DHH. No application will be reviewed until payment of the application fee.

1. The applicant, with the exception of the demonstration model, must become fully operational and prepared for an initial survey within 90 days after payment of the application fee. If the agency is unable to do so, the application shall be considered closed and the agency shall be required to submit a new application packet, including fees.

2. An initial applicant shall, as a condition of licensure, submit:

a. a complete and accurate CRCC application packet. (This packet shall be purchased from DHH which contains the forms required for initial CRCC licensure. The fee for this packet shall be set by DHH.) The physical address provided on the application must be the physical address from which the applicant will be operating;

b. current licensing fee (as established by statute) by certified check, company check, or money order;

c. documentation of qualifications for the administrator and director of nursing. Any changes in the individuals designated or in their qualifications must be submitted to and approved by DHH prior to the initial survey;

d. disclosure of any financial and/or familial relationship with any other entity receiving third party payor funds, or any entity which has previously been licensed in Louisiana;

e. approval for occupancy from the Office of the State Fire Marshal;

f. approval of plan review from the DHH's Division of Engineering and Architectural Services; and

g. a recommendation for licensure from the Office of Public Health.

G. All CRCCs required to be licensed by the law shall comply with the rules, established fire protection standards, and enforcement policies as promulgated by the Office of State Fire Marshal. It shall be the primary responsibility of the Office of State Fire Marshal to determine if applicants are complying with those requirements. No license shall be issued or renewed without the applicant furnishing a certificate from the Office of State Fire Marshal stating that the applicant is complying with their provisions. A provisional license may be issued to the applicant if the Office of State Fire Marshal issues the applicant a conditional certificate.

H. All CRCCs required to be licensed by the law shall comply with the applicable rules and regulations contained in the Louisiana State Sanitary Code [Title 51 of the Louisiana Administrative Code (LAC 51)] as promulgated by the Office of Public Health. It shall be the primary responsibility of the Office of Public Health to determine if applicants are complying with those requirements. If a nursing facility published rule conflicts with this Chapter 80, the stricter of the two rules shall govern. No initial license shall be issued without the applicant furnishing a copy of the LHS-48 (Institution Report) form from the Office of Public Health stating that the applicant is complying with their provisions and is recommended for licensure. A provisional license may be issued to the applicant if the Office of Public Health issues the applicant a conditional certificate.

I. Construction documents (plans and specifications) are required to be submitted and approved by the Louisiana State Fire Marshal, the DHH's Division of Engineering and Architectural Services, and the Office of Public Health as a part of the licensing procedure and prior to obtaining a license.

1. Submission of Plans

a. The following documents shall be submitted for review and approval prior to construction:

i. one set of the final construction documents shall be submitted to the Louisiana State Fire Marshal for approval. The Fire Marshal's letter of approval and final inspection shall be sent to DHH's Division of Engineering and Architectural Services;

ii. one set of the final construction documents (plans and specifications) shall be submitted to the Louisiana Department of Health and Hospitals, Division of Engineering and Architectural Services, along with the appropriate review fee, and a plan review application form for approval; and

iii. one set of the final construction documents (plans and specifications) shall be submitted to the Office of Public Health for any ancillary facilities associated with the project including, but not limited to, plans and specifications for any food service facilities, swimming/treatment pools, water supply system (such as a facility's own water well/surface water treatment plant), or sewerage disposal system (such as the facility's own sewage treatment plant). Such plans and specifications shall be accompanied by a completed cover sheet which identifies the type of facility for which a license is to be applied for along with any of the proposed project's ancillary facilities. This Section shall not be interpreted to preclude the possibility of the necessity for the applicant to submit additional plans and specifications which may be required by the Office of Public Health.

b. Applicable Projects. Construction documents (plans and specifications) are required to be approved for the following type projects:

i. new construction;

ii. new CRCCs; or

iii. major alterations/substantial renovations.

c. The project shall be designed in accordance with the following criteria:

i. current Edition of Guidelines for Design and Construction of Hospital and Health Care Facilities, published by the American Institute of Architects, 1735 New York Ave., NW, Washington, D. C. 20006-5292 (Internet URL address: http://www.aia.org/);

ii. current edition of NFPA 101 C Life Safety Code, published by the National Fire Protection Association, 1 Batterymarch, Quincy, MA 02169-7471 (Internet URL address: http://www.nfpa.org/);

iii. Part XIV (Plumbing) of the Louisiana State Sanitary Code (LAC 51:XIV);

iv. current edition of the Americans with Disabilities Act C Accessibility Guidelines for Buildings and Facilities (ADAAG);

v. the current Louisiana Department of Health and Hospitals licensing standards for children's respite care centers (LAC 48:I.Chapter 80); and

vi. applicable provisions of the Louisiana State Sanitary Code (LAC 51).

d . Preparation of Construction Documents. Construction documents (plans and specifications) for submission to the Louisiana Department of Health and Hospitals shall be prepared only by a Louisiana licensed architect or qualified licensed engineer as governed by the licensing laws of the state of Louisiana for the type of work to be performed. Construction documents submitted shall be of an architectural or engineering nature, and thoroughly illustrate the project through accurately drawn, dimensioned, and noted plans, details, schedules, and specifications. At a minimum, the following shall be submitted:

i. site plan(s);

ii. floor plan(s). These shall include architectural, mechanical, plumbing, electrical, fire protection, and if required by code, sprinkler, and fire alarm plans;

iii. building elevations;

iv. room finish, door, and window schedules;

v. details pertaining to Americans with Disabilities Act (ADA) requirements;

vi. specifications for materials; and

vii. an additional set of basic preliminary type, legible site plan and floor plans in either 8-1/2" x 11"; 8-1/2" x 14"; or 11" x 17" format. (These are for use by DHH in doing the final inspection of the facility and should include legible room names).

2. Approval of Plans

a. Notice of satisfactory review from DHH's Division of Engineering and Architectural Services, the Office of State Fire Marshal, and the Office of Public Health constitutes compliance with this requirement if construction begins within 180 days of the date of such notice. This approval shall in no way permit and/or authorize any omission or deviation from the requirements of any restrictions, laws, ordinances, codes or rules of any responsible agency.

b. In the event that submitted materials do not appear to satisfactorily comply with all design criteria, the Department of Health and Hospitals, Division of Engineering and Architectural Services and/or the Office of Public Health shall furnish a letter to the party submitting the application for review, which lists the particular items in question and request further explanation and/or confirmation of necessary modifications.

3. Waivers

a. The secretary of the department may, within his sole discretion, grant waivers to building and construction guidelines which are not otherwise required under the provisions of the Louisiana State Sanitary Code. The facility must submit a waiver request in writing to the Division of Engineering and Architectural Services. The facility shall demonstrate how patient safety and the quality of care offered are not compromised by the waiver. The facility must demonstrate their ability to completely fulfill all other requirements of the waiver. The department will make a written determination of the request. Waivers are not transferable in an ownership change and are subject to review or revocation upon any change in circumstances related to the waiver.

b. The secretary, in exercising his discretion, must at a minimum, require the applicant to comply with the edition of the building and construction guidelines which immediately preceded the 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities.

c. The state health officer of the department may, within his sole discretion, grant waivers to building and construction guidelines which are required under the provisions of the Louisiana State Sanitary Code. The facility must submit a waiver request in writing to the state health officer. The facility shall demonstrate how public health and the quality of care offered are not compromised by the waiver. The facility must demonstrate their ability to completely fulfill all other requirements of the waiver. The state health officer will make a written determination of the request. Waivers are not transferable in an ownership change and are subject to review or revocation upon any change in circumstances related to the waiver.

J. An applicant may be denied a license for the following reasons:

1. failure to comply with applicable federal, state, and local laws;

2. failure to complete the application process;

3. conviction of a felony by the following, as shown by a certified copy of the record of the court of the conviction:

a. owner;

b. administrator;

c. director of nursing;

d. members or officers, or the person(s) designated to manage or supervise the CRCC if the applicant is a firm or corporation.

K. Physical Environment

1. Equipment and furnishings in a CRCC facility shall provide for the health care needs of the resident while providing a home-like atmosphere.

2. The CRCC facility shall design and equip areas for the comfort and privacy of patients and family members. The facility shall have:

a. physical space for private patient/family visiting;

b. accommodations for family members to remain with the patient throughout the night;

c. accommodations for family privacy after a patient's death; and

d. decor which is homelike in design and function.

3. Patient rooms shall be designed and equipped for adequate nursing care and the comfort and privacy of patients. Each patient's room shall:

a. be equipped with toilet and bathing facilities;

b. be equipped with a lavatory in each patient's room;

c. be at or above grade level;

d. contain room decor that is homelike and noninstitutional in design and function. Room furnishings for each patient shall include a bed with side rails, a bedside stand, an over-the-bed table, and individual reading light easily accessible to each patient, and a comfortable chair. The patient shall be permitted to bring personal items of furniture or furnishing into their rooms, unless medically inappropriate;

e. have closet space that provides security and privacy for clothing and personal belongings;

f. contain no more than two patient beds;

g. measure at least 100 square feet for a single patient room or 80 square feet for each patient for a multi patient room;

h. be equipped with a device for calling the staff member on duty. A call bell or other communication mechanism shall be placed within easy reach of the patient and shall be functioning properly. A call bell shall be provided in each patient's toilet, bath, and shower room; and

i. all patient rooms shall be outside rooms with a window of clear glass of not less than 12 square feet.

4. Water Temperature. The CRCC facility shall:

a. provide an adequate supply of hot water at all times for patient use;

b. have plumbing fixtures with a scald preventative valve of the pressure balancing, thermostatic, or combination mixing valve type that automatically regulates the temperature of the hot water used by patients to a maximum of 120°F; and

c. designate a staff member responsible for monitoring and logging water temperatures at least monthly. This person is responsible for reporting any problems to the administrator.

5. Linen Supply

a. The CRCC facility shall have available at all times a quantity of linen essential for proper care and comfort of patients. Linens shall be handled, stored, processed, and transported in such a manner as to prevent the spread of infection. The facility shall have a clean linen storage area.

b. The linen supply shall at all times be adequate to accommodate the number of beds and the number of incontinent patients.

c. Soiled linen and clothing shall be collected and enclosed in suitable bags or containers (covered carts or receptacles) and stored in a well ventilated area. Soiled linen shall not be permitted to accumulate in the facility.

d. The CRCC facility shall have policies and procedures that address:

i. frequency of linen changes;

ii. storage of clean linen; and

iii. storage of soiled linen.

6. The CRCC facility shall make provisions for isolating patients with infectious diseases. The CRCC should institute the most current recommendations of the Centers for Disease Control and Prevention (CDC) relative to the specific infection(s) and communicable disease(s). The CRCC facility shall isolate infected patients only to the degree needed to isolate the infecting organism. The method shall be the least restrictive possible while maintaining the integrity of the process and the dignity of the patient. The CRCC facility provisions for isolating patients with infectious diseases shall include:

a. definition of nosocomial infections and communicable diseases;

b. measures for assessing and identifying patients and health care workers at risk for infections and communicable diseases;

c. measures for prevention of infections, especially those associated with immunosupressed patients and other factors which compromise a patient's resistance to infection;

d. measures for prevention of communicable disease outbreaks;

e. provision of a safe environment consistent with the current CDC recommendations for identified infection and/or communicable disease;

f. isolation procedures and requirements for infected or immunosuppressed patients;

g. use and techniques for universal precautions;

h. methods for monitoring and evaluating practice of asepsis;

i. care of contaminated laundry, i.e., covered containers or receptacles, clearly marked bags and separate handling procedures;

j. care of dishes and utensils, i.e., clearly marked and handled separately;

k. use of any necessary gowns, gloves, or masks posted and observed by staff, visitors, and anyone else in contact with the patient;

l. techniques for hand washing, respiratory protection, asepsis sterilization, disinfection, needle disposal, solid waste disposal, as well as any other means for limiting the spread of contagion;

m. orientation of all CRCC personnel to the infection control program, and to communicable diseases; and

n. employee health policies regarding infectious diseases. When infected or ill, employees shall not render direct patient care.

7. The CRCC facility shall provide:

a. storage for administrative supplies;

b. hand washing facilities provided with hot and cold water, hand soap, and paper towels located convenient to each nurse's station and drug distribution station;

c. charting facilities for staff at each nurse's station;

d. a clean workroom which contains a work counter, sink with hot and cold water, storage facilities and covered waste receptacles;

e. a soiled workroom which contains a sink with hot and cold water and other facilities necessary for the receiving and cleanup of soiled equipment;

f. parking for stretchers and wheelchairs in an area out of the path of normal traffic and of adequate size for the facility;

g. a janitor's closet equipped with a floor drain and hot and cold water as well as mop hooks over the sink and storage space for housekeeping equipment and supplies;

h. a suitable multi-purpose lounge or lounges furnished for reception, recreation, dining, visitation, group social activities and worship. Such lounge or lounges shall be located convenient to the patient rooms designed to be served;

i. a conference and consultation room suitable and furnished for family privacy, clergy visitation, counseling, and viewing of a deceased patient's body during bereavement. The conference and consultation room shall be located convenient to the patient rooms it is designed to serve;

j. public telephone; and

k. public restrooms.

La. Admin. Code tit. 48, § I-8003

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:444 (February 2005).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2175.14(B).