Section 0720-37-.06 - SERVICES PROVIDED(1) Medical Services. Each ACH shall provide twenty-four (24) hour nursing services furnished or supervised by the adult care home provider, resident manager or substitute caregiver. Licensed registered nurses and licensed practical nurses may provide all prescribed medical services that are within the scope of the nurse's professional license.(2) Medical services in an ACH shall be provided by: (a) Appropriately licensed staff of an ACH;(b) Appropriately licensed or qualified contractors of an ACH;(c) A licensed home care organization; or(d) Another appropriately licensed entity.(3) Standards for Medication Administration. An ACH shall: (a) Ensure that all drugs and biologicals shall be administered by a licensed professional operating within the scope of the professional license and according to the resident's plan of care; and(b) Ensure that all medications are kept in a locked, central location, separate from medications of the staff.(c) Self-administration of Medication. Residents must have a physician or nurse practitioner's written order of approval to self-medicate. Residents able to handle their own medical regimen may keep medications in their own room in a locked storage container.(d) Injections. Subcutaneous, intramuscular, and intravenous injections may be self-administered by the resident or by a licensed professional operating within the scope of the professional license.(4) An ACH shall dispose of medications as follows:(a) Upon discharge of a resident, unused prescription medication shall be released to the resident, the resident's family member, or the resident's legal representative, unless specifically prohibited by the attending physician.(b) Upon the death of a resident, unused prescription medication must be destroyed in the manner outlined and by the individuals designated in the facility's medication disposal policy, unless otherwise requested by the resident's family member or the resident's legal representative and accompanied by a written order by a physician. The ACH's medication disposal policy shall be written in accordance with current FDA or current DEA medication disposal guidelines.(c) The ACH shall properly dispose of prescription medication administered by the facility in accordance with the facility's medication disposal policy, which shall be written in accordance with current FDA or current DEA medication disposal guidelines.(d) The ACH may dispose of prescription medication that is self-administered by the resident according to the facility's medication disposal policy, which shall be written in accordance with current FDA or current DEA medication disposal guidelines, or the facility may provide information to the resident's family member or the resident's legal representative regarding the proper method to dispose of the medication.(e) If the resident is a hospice patient, hospice shall be responsible for disposing of the prescription medication upon death of the resident.(f) The ACH's medication disposal policy shall also address the disposal of scheduled drugs, non-scheduled drugs, and devices that are misbranded, expired, deteriorated, not kept under proper conditions, and kept in containers with illegible or missing labels.(5) An ACH shall provide personal services as follows:(a) Each ACH shall provide each resident with at least the following personal services: 2. Safety when in the ACH;3. Daily awareness of the individual's whereabouts;4. The ability and readiness to intervene if crises arise;6. Non-medical living assistance with activities of daily living.(b) Recreational Services. An ACH shall provide to residents a daily regime of activities commensurate with the resident's needs, as identified through the assessment developed by the facility and specified in the resident's plan of care.(c) Laundry services. An ACH shall: 1. Provide arrangements for laundry of ACH linens and residents' clothing;2. Provide appropriate separate storage areas for soiled linens and residents' clothing; and3. Maintain clean linens in sufficient quantity to provide for the needs of the residents. Linens shall be changed whenever necessary.(d) Dietary services. 1. An adult care home provider shall provide three (3) nutritionally balanced meals per day or shall make arrangements for meals on an as needed basis. The food must be adapted to the habits, preferences and physical abilities of the residents. Additional nourishment and/or snacks shall be provided to residents with special dietary needs or upon request.2. There shall be no more than fourteen (14) hours between the evening and morning meals.3. All food served to the residents shall be of good quality and variety, sufficient quantity, attractive and at safe temperatures. Prepared foods shall be kept hot (140ºF or above) or cold (41ºF or less) as appropriate.4. Meal planning and preparation shall take into consideration any special dietary needs of the resident, as prescribed by the resident's physician.5. An ACH shall designate a person responsible for the food service, including the purchasing of adequate food supplies and the maintenance of sanitary practices in food storage, preparation and distribution. Sufficient arrangements or employees shall be maintained to cook and serve the food.6. An ACH may contract with an outside food management company if the company has a dietitian who serves the ACH on a full-time, part-time, or consultant basis, and if the company maintains at least the minimum standards specified in this section while providing for constant liaison with the ACH for recommendations on dietetic policies affecting resident treatment.7. An ACH shall have a current therapeutic diet manual approved by a dietitian readily available to all ACH personnel.8. Menus shall be planned one week in advance and posted in a location accessible to residents and families.9. An ACH shall: (i) Provide sufficient food provision capabilities and dining space;(ii) Maintain and properly store a forty-eight (48) hour food supply at all times;(iii) Provide appropriate, properly-repaired equipment and utensils for cooking and serving food to serve all residents;(iv) Maintain a clean and sanitary kitchen; and(v) Ensure employees shall wash and sanitize equipment, utensils and dishes after each use.Tenn. Comp. R. & Regs. 0720-37-.06
Emergency rule filed November 2, 2010; effective through May 1, 2011. New rule filed January 28, 2011; effective April 28, 2011. Amendment filed March 27, 2015; effective June 25, 2015. Transferred from chapter 1200-08-36 pursuant to Public Chapter 1119 of 2022 effective 7/1/2022.Authority: T.C.A. §§ 68-11-206, 68-11-209, and 68-11-270.