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CODE OF RHODE ISLAND RULES
AGENCY 14. DEPARTMENT OF HEALTH
SUB-AGENCY 090. HEALTH FACILITIES, LICENSURE, CONSTRUCTION
CHAPTER 023. LICENSING OF NURSING FACILITIES
Date:
08/31/2009
Document:
14 090 023 LICENSING OF NURSING FACILITIES
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Section 9.0 Denial, Suspension, Revocation of License or Curtailment of Activities & Sanctions.
9.1 The licensing agency is authorized to deny, suspend, revoke the license, or curtail the activities of any nursing facility which: (1) has failed to comply with the rules and regulations pertaining to licensing of nursing facilities; (2) has aided, abetted or permitted any illegal act or conduct adverse to the health, welfare and safety of residents or of the general public; or (3) has failed to comply with municipal, state or federal law.
a) Lists of deficiencies noted in inspections conducted in accordance with section 8.0 herein shall be maintained on file in the licensing agency, and shall be considered by the licensing agency in rendering determinations to deny, suspend or revoke the license of a nursing facility or to curtail its activities.
9.2 In those instances wherein the licensing agency determines that a nursing facility licensed in accordance with reference 1 is not being operated in conformity with all of the requirements established thereby, the licensing agency may (in lieu of suspension or revocation) curtail activities of the facility, order the licensee to be placed on probationary status and set conditions with which the licensee must comply within a set period of time, order the licensee to admit no additional persons to the facility, to provide health services to no additional persons through the facility, to transfer all or some of the persons occupying the facility to other suitable accommodations, or to take any other corrective action necessary to secure compliance with the requirements established under the Act. Notice of the order and any subsequent hearing that may be scheduled shall comply with the requirements of procedural due process stipulated in section 23-17-8 of the Rhode Island General Laws, as amended. Such action may be taken only when the licensing agency determines that operation of the home shall not result in undue hardship to residents.
a) Notice of an order to curtail any or all activities of a nursing facility in accordance with section 9.2 herein shall be made in writing by certified mail and shall state the reason thereof, the action to be taken by the licensee and the time within which said action shall be taken.
9.3 When the licensing agency deems that operation of a nursing facility results in undue hardship to residents as a result of deficiencies enumerated in the notice of deficiencies, the licensing agency is authorized to deny licensure to facilities not previously licensed, or to suspend the license for a stipulated period of time or to revoke the license of a facility already licensed.
9.4 Whenever an action shall be proposed to deny, suspend or revoke the license or curtail activities of a licensee, the licensing agency shall notify the nursing facility by certified mail (or may be hand delivered), setting forth reasons for the proposed action, and the applicant or licensee shall be given an opportunity for a prompt and fair hearing in accordance with reference 20.
a) However, if the licensing agency finds that public health, safety, or welfare, including the health and safety of residents, imperatively requires emergency action and incorporates a finding to that effect in its order, the licensing agency may order summary suspension of license pending proceedings for revocation or other action.
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19.18 Before transferring a resident to another facility or level of care within a facility, the resident shall be informed of the need for such a transfer and of any alternatives to such a transfer.
a) A resident shall be transferred or discharged only for medical reasons, or for his welfare or that of other residents or for nonpayment of his stay.
b) Reasonable advance notice for transfers to health care facilities other than hospitals shall be given to ensure orderly transfer or discharge and such actions shall be documented in the medical record.
19.18.1 Bed-Hold and Readmission: A nursing facility must provide written information pertaining to bed-hold and readmission for residents transferred for hospitalization or therapeutic leave as follows:
a) Notice before transfer: Before a resident of a nursing facility is transferred for hospitalization or therapeutic leave, a nursing facility must provide written information to the resident and a family member or legal representative concerning:
i) the provisions of the medical assistance program state plan regarding the period (if any) during which the resident will be permitted under the state plan to return and resume residence in the facility; and
ii) the policies of the facility regarding such a period, which policies must be consistent with section b) hereunder;
b) Notice upon transfer: At the time of the transfer of a resident to a hospital or for therapeutic leave, a nursing facility must provide written notice to the resident and a family member or legal representative of the duration of any period described in section c) hereunder; except in an emergency, said notice must be given within 24 hours of the transfer.
c) Permitting resident to return: A nursing facility must establish and follow a written policy under which a resident:
i) who is transferred from the facility for hospitalization or therapeutic leave; and
ii) whose hospitalization or therapeutic leave exceeds a period paid for under the state plan for the holding of a bed in the facility for the resident, will be readmitted to the facility immediately upon the first availability of a bed of appropriate level of care in a semi-private room in the facility if at time of readmission, the resident requires the services provided by the facility;
iii) Any nursing facility that accepts private payment for purposes of reserving a bed in the facility for a resident who is transferred from the facility for hospitalization or other institutional therapeutic leave, and that resident's medical and health care is being paid for by the state Medical Assistance Program, shall not charge an amount per day for reserving a bed in the facility that exceeds the facility's current Medicaid daily rate; for a minimum of the first five (5) days of said hospitalization or the institutional therapeutic leave.
iv) the departments of human services and of health shall receive, on a monthly basis, the names from each nursing home of those persons awaiting readmission under these provisions.
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22.4 Reporting of Communicable Diseases
a) Each facility shall report promptly to the Rhode Island Department of Health, Division of Disease Prevention & Control, cases of communicable diseases designated as "reportable diseases" when such cases are diagnosed in the facility in accordance with reference 11.
b) When infectious diseases present a potential hazard to residents or personnel, these shall be reported to the Rhode Island Department of Health, Division of Disease Prevention & Control even if not designated as "reportable diseases."
c) When outbreaks of food-borne illness are suspected, such occurrences shall be reported immediately to the Rhode Island Department of Health, Division of Disease Prevention & Control or to the Office of Food Protection and Sanitation.
d) Facilities must comply with the provisions of section 23-28.36-3, which requires notification of fire fighters, police officers and emergency medical technicians after exposure to infectious diseases.
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27.5 Policies and procedures shall be established for the dietetic service, pertaining to but not limited to the following:
a) responsibilities and functions of personnel;
b) standards for nutritional care in accordance with reference 12;
c) alterations or modifications to diet orders or schedules;
d) food purchasing storage, preparation and service;
e) safety and sanitation relative to personnel and equipment in accordance with reference 10; and
f) ancillary dietary services, including food storage and preparation in satellite kitchens and vending operations in accordance with reference 10; and
g) a plan to include alternate methods and procedures for food preparation and service, including provisions for potable water, to be used in emergencies.
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Section 37.0 Disaster Preparedness.
37.1 Each facility shall develop and maintain a written disaster preparedness plan that shall include plans and procedures to be followed in case of fire or other emergencies. The plan shall include provisions for evacuation of the facility in the event of a natural disaster. The plan and procedures shall be developed with the assistance of qualified safety, emergency management, and/or other appropriate experts and shall be coordinated with the local emergency management agency.
37.2 The plan shall include procedures to be followed pertaining to no less than the following:
a) fire, explosion, severe weather, loss of power and/or water, flooding, failure of internal systems and/or equipment, and other calamities;
b) transfer of casualties;
c) transfer of records;
d) location and use of alarm systems, signals and fire fighting equipment;
e) containment of fire;
f) notification of appropriate persons;
g) relocations of residents and evacuation routes;
h) feeding of residents;
i) handling of drugs and biologicals;
j) missing residents;
k) back-up or contingency plans to address possible internal systems (e.g., food, power, water, sewage disposal) and/or equipment failures; and
l) any other essentials as required by the local emergency management agency.
37.3 A copy of the plan shall be available at every nursing unit.
37.4 Emergency steps of action shall be clearly outlined and posted in conspicuous locations throughout the facility.
37.5 Simulated drills testing the effectiveness of the plan shall be conducted for all shifts at least quarterly. Written reports and evaluation of all drills shall be maintained by the facility.
37.6 All personnel shall receive training in disaster preparedness as part of their employment orientation.
37.7 The administrator of the facility shall notify the licensing agency (Office of Facilities Regulation) immediately by telephone of any unscheduled implementation of any part of the facility's disaster preparedness plan and shall provide a follow-up report in writing within three (3) business days using the form supplied in Appendix "E" herein.
37.8 Each nursing facility shall agree to enter into a memorandum of agreement with the licensing agency and the local municipality in which the nursing facility is geographically located to participate in a statewide distribution plan for medications and/or vaccines in the event of a public health emergency or disease outbreak.
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**Note: Only the section analyzed by the PHASYS team is included here as the entire regulation exceeded ~100 pages.
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