R432.  Health, Family Health and Preparedness, Licensing.
R432-150.  Nursing Care Facility.
R432-150-1.  Legal Authority.
	This rule is adopted pursuant to Title 26, Chapter 21.

R432-150-2.  Purpose.
	The purpose of R432-150 is to establish health and safety standards to provide for the physical and psycho-social well being of individuals receiving services in nursing care facilities.

R432-150-3.  Construction Standard.
	Nursing Care Facilities shall be constructed and maintained in accordance with R432-5, Nursing Facility Construction.

R432-150-4.  Definitions.
	(1)  The definitions found in R432-1-3 apply to this rule.
	(2)  The following definitions apply to nursing care facilities.
	(a)  "Skilled Nursing Care" means a level of care that provides 24 hour inpatient care to residents who need licensed nursing supervision.  The complexity of the prescribed services must be performed by or under the close supervision of licensed health care personnel.
	(b)  "Intermediate Care" means a level of care that provides 24-hour inpatient care to residents who need licensed supervision and supportive care, but do not require continuous nursing care.
	(c)  "Medically-related Social Services" means assistance provided by the facility licensed social worker to maintain or improve each resident's ability to control everyday physical, mental and psycho-social needs.
	(d)  "Nurse's Aide" means any individual, other than an individual licensed in another category, providing nursing or nurse related services to residents in a facility.  This definition does not include an individual who volunteers to provide such services without pay.
	(e)  "Unnecessary Drug" means any drug when used in excessive dose, for excessive duration, without adequate monitoring, without adequate indications for its use, in the presence of adverse consequences which indicate the dose should be reduced or discontinued, or any combinations of these reasons.
	(f)  "Chemical Restraint" means any medication administered to a resident to control or restrict the resident's physical, emotional, or behavioral functioning for the convenience of staff, for punishment or discipline, or as a substitute for direct resident care.
	(g)  "Physical Restraint" means any physical method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the resident cannot remove easily which restricts the resident's freedom of movement or normal access to his own body.
	(h)  "Significant Change" means a major change in a resident's status that impacts on more than one area of the resident's health status.
	(i)  "Therapeutic Leave" means leave pertaining to medical treatment planned and implemented to attain an objective that is specified in the individual plan of care.
	(j)  "Licensed Practitioner" means a health care practitioner whose license allows assessment, treatment, or prescribing practices within the scope of the license and established protocols.
	(k)  "Governing Body" means the board of trustees, owner, person or persons designated by the owner with the legal authority and ultimate responsibility for the management, control, conduct and functioning of the health care facility or agency.
	(l)  "Nursing Staff" means nurses aides that are in the process of becoming certified, certified nurses aides, and those individuals that are licensed (e.g. licensed practical nurses and registered nurses) to provide nursing care in the State of Utah.
	(m)  "Licensed Practical Nurse" as defined in the Nurse Practice Act, Title 58, Chapter 31.
	(n)  "Registered Nurse" as defined in the Nurse Practice Act, Title 58, Chapter 31.
	(o)  "Palatable" means food that has a pleasant and agreeable taste and is acceptable to eat.
	(p)  "Dining Assistant" means an individual unrelated to a resident or patient who meets the training requirements defined in this rule to assist nursing care residents with eating and drinking.
	(q)  Certification in Cardiopulmonary Resuscitation (CPR) refers to certification issued after completion of a course that is consistent with the most current version of the American Heart Association Guidelines for Health Care Provider CPR.

R432-150-5.  Scope of Services.
	(1)  An intermediate level of care facility must provide 24-hour licensed nursing services.
	(a)  The facility shall ensure that nursing staff are present on the premises at all times to meet the needs of residents.
	(b)  The facility shall provide at least one registered nurse either by direct employ or by contract to provide direction to nursing services.
	(c)  The facility may employ a licensed practical nurse to act as the health services supervisor in lieu of a director of nursing provided that a registered nurse consultant meets regularly with the health services supervisor.
	(d)  The facility shall provide at least the following:
	(i)  medical supervision;
	(ii)  dietary services;
	(iii)  social services; and
	(iv)  recreational therapy.
	(e)  The following services shall be provided as required in the resident care plan:
	(i)  physical therapy;
	(ii)  occupational therapy;
	(iii)  speech therapy;
	(iv)  respiratory therapy; and
	(v)  other therapies.
	(2)  A skilled level of care facility must provide 24-hour licensed nursing services.
	(a)  The facility shall ensure that nursing staff are present on the premises at all times to meet the needs of residents.
	A licensed nurse shall serve as charge nurse on each shift.
	(b)  The facility shall employ a registered nurse for at least eight consecutive hours a day, seven days a week.
	(c)  The facility shall designate a registered nurse to serve as the director of nursing on a full-time basis.  A person may not concurrently serve as the director of nursing and as a charge nurse.
	(d)  A skilled level of care facility shall provide services to residents that preserve current capabilities and prevent further deterioration including the following:
	(i)  medical supervision;
	(ii)  dietary services;
	(iii)  physical therapy;
	(iv)  social services;
	(v)  recreation therapy;
	(vi)  dental services; and
	(vii)  pharmacy services;
	(e)  The facility shall provide the following services as required by the resident care plan:
	(i)  respiratory therapy,
	(ii)  occupational therapy, and
	(iii)  speech therapy.
	(3)  Respite services may be provided in nursing care facilities.
	(a)  The purpose of respite is to provide intermittent, time-limited care to give primary caretakers relief from the demands of caring for a person.
	(b)  Respite services may be provided at an hourly rate or daily rate, but shall not exceed 14-days for any single respite stay.  A respite stay which exceeds 14 days is a nursing facility admission subject to the requirements of this rule applicable to non-respite residents.
	(c)  The facility shall coordinate the delivery of respite services with the recipient of services, the case manager, if one exists, and the family member or primary caretaker.
	(d)  The facility shall document the person's response to the respite placement and coordinate with all provider agencies to ensure an uninterrupted service delivery program.
	(e)  The facility must complete the following:
	(i)  a Level 1 Preadmission Screening upon the persons admission for respite services; and
	(ii)  a service agreement to serve as the plan of care, which shall identify the prescribed medications, physician treatment orders, need for assistance with activities of daily living, and diet orders.
	(f)  The facility must have written respite care policies and procedures that are available to staff.  Respite care policies and procedures must address:
	(i)  medication administration;
	(ii)  notification of a responsible party in the case of an emergency;
	(iii)  service agreement and admission criteria;
	(iv)  behavior management interventions;
	(v)  philosophy of respite services;
	(vi)  post-service summary;
	(vii)  training and in-service requirement for employees; and
	(viii)  handling personal funds.
	(g)  Persons receiving respite services must receive a copy of the Resident Rights documents upon admission.
	(h)  The facility must maintain a record for each person receiving respite services.  The record shall contain the following:
	(i)  the service agreement;
	(ii)  resident demographic information;
	(iii)  nursing notes;
	(iv)  physician treatment orders;
	(v)  daily staff notes;
	(vi)  accident and injury reports;
	(vii)  a post service summary; and
	(viii)  an advanced directive, if available.
	(i)  Retention and storage of respite records shall comply with R432-150-25(3).
	(j)  Confidentiality and release of information shall comply with R432-150-25(4).
	(4)  Hospice care may only be arranged and provided by a licensed hospice agency in accordance with R432-750.  The facility shall be licensed as a hospice if it provides hospice care.
	(5)  A nursing care facility may provide terminal care.

R432-150-6.  Adult Day Care Services.
	(1)  Nursing Care Facilities may offer adult day care and are not required to obtain a license from Utah Department of Human Services.  If a facility provides adult day care, it shall submit policies and procedures for Department approval.
	(2)  In this section:
	(a)  "Adult Day Care" means nonresidential care and supervision for at least four but less than 24 hours per day, that meets the needs of functionally impaired adults through a comprehensive program that provides a variety of health, social, recreational, and related support services in a protective setting.
	(b)  "Consumer" means a functionally impaired adult admitted to or being evaluated for admission in a facility offering adult day care.
	(3)  The governing board shall designate a qualified Director to be responsible for the day-to-day program operation.
	(4)  The Director shall maintain written records on-site for each consumer and staff person, which shall include the following:
	(a)  demographic information;
	(b)  an emergency contact with name, address and telephone number;
	(c)  consumer health records, including the following:
	(i)  record of medication including dosage and administration;
	(ii)  a current health assessment, signed by a licensed practitioner; and
	(iii)  level of care assessment.
	(d)  signed consumer agreement and service plan.
	(e)  employment file for each staff person which includes:
	(i)  health history;
	(ii)  background clearance consent and release form;
	(iii)  orientation completion; and
	(iv)  in-service requirements.
	(5)  The facility shall have a written eligibility, admission, and discharge policy that includes the following:
	(a)  intake process;
	(b)  notification of responsible party;
	(c)  reasons for admission refusal, including the Director's written, signed statement;
	(d)  resident rights notification; and
	(e)  reason for discharge or dismissal.
	(6)  Before a facility admits a consumer, it must first assess, in writing, the consumer's current health and medical history, immunizations, legal status, and social psychological factors to determine whether the consumer may be placed in the program.
	(7)  The Director or designee, the responsible party, and the consumer if competent shall develop a written, signed consumer agreement.  The agreement shall include:
	(a)  rules of the program;
	(b)  services to be provided and cost of service, including refund policy; and
	(c)  arrangements regarding absenteeism, visits, vacations, mail, gifts and telephone calls.
	(8)  Within three days of admission to the program, the Director or designee, shall develop an individual consumer service plan that the facility shall implement for the consumer.  The service plan shall include the specification of daily activities and services. The Director or designees shall reevaluate, and modify if necessary, the consumer's service plan at least every six months.
	(9)  The facility shall make written incident and injury reports to document consumer death, injuries, elopement, fights or physical confrontations, situations which require the use of passive physical restraint, suspected abuse or neglect, and other situations or circumstances affecting the health, safety or well-being of a consumer while in care.  The facility shall document the actions taken, including actions taken to avoid future incident or injury, and keep the reports on file.  The Director shall notify and review the incident or injury report with the responsible party no later than when the consumer is picked up at the end of the day.
	(10)  The facility shall post and implement a daily activity schedule.
	(11)  Consumers shall receive direct supervision at all times and be encouraged to participate in activities.
	(12)  There shall be a minimum of 50 square feet of indoor floor space, excluding hallways, office, storage, kitchens, and bathrooms, per consumer designated for adult day care during program operational hours.
	(13)  All indoor and outdoor areas shall be maintained in a clean, secure and safe condition.
	(14)  There shall be at least one bathroom designated for consumers use during business hours.  For facilities serving more than 10 consumers, there shall be separate male and female bathrooms designated for consumer use.
	(15)  Staff supervision shall be provided continually when consumers are present.
	(a)  When eight or fewer consumers are present, one staff member shall provide continuous, direct supervision.
	(b)  For each eight additional consumers, or fraction thereof, the facility shall provide an additional staff member to provide continuous, direct supervision.  For example, ten consumers require two staff members.
	(c)  If one-half or more of the consumers is diagnosed by a physician's assessment with Alzheimer's or other dementia, the ratio shall be one staff for each six consumers, or fraction thereof.

R432-150-7.  Governing Body.
	The facility must have a governing body, or designated persons functioning as a governing body.
	(1)  The governing body must establish and implement policies regarding the management and operation of the facility.
	(2)  The governing body shall institute bylaws, policies and procedures relative to the general operation of all facility services including the health care of the residents and the protection of resident rights.
	(3)  The governing body must appoint the administrator in writing.

R432-150-8.  Administrator.
	(1)  The administrator must comply with the following requirements.
	(a)  The administrator must be licensed as a health facility administrator by the Utah Department of Commerce pursuant to Title 58, Chapter 15.
	(b)  The administrator's license shall be posted in a place readily visible to the public.
	(c)  The administrator may supervise no more than one nursing care facility.
	(d)  The administrator shall have sufficient freedom from other responsibilities to permit attention to the management and administration of the facility.
	(e)  The administrator shall designate, in writing, the name and title of the person who shall act as administrator in any temporary absence of the administrator.  This person shall have the authority and freedom to act in the best interests of resident safety and well-being.  It is not the intent of this paragraph to permit an unlicensed de facto administrator to supplant or replace the designated, licensed administrator.
	(2)  The administrator's responsibilities must be defined in a written job description on file in the facility.  The job description shall include at least the following responsibilities:
	(a)  complete, submit, and file all required reports, including a monthly census report to the Division of Medicaid and Health Financing as required by R414-401-4, by the end of the succeeding month;
	(i)  The Department may issue sanctions, including civil money penalties, in accordance with R432-3-7, for failure to report the required census information.
	(b)  act as a liaison between the licensee, medical and nursing staffs, and other supervisory staff of the facility;
	(c)  respond to recommendations made by the quality assurance committee;
	(d)  implement policies and procedures governing the operation of all functions of the facility; and
	(e)  review all incident and accident reports and document the action taken or reason for no action.
	(3)  The administrator shall ensure that facility policies and procedures reflect current facility practice, and are revised and updated as needed.
	(4)  The administrator shall secure and update contracts for required professional services not provided directly by the facility.
	(a)  Contracts shall document the following:
	(i)  the effective and expiration date of contract;
	(ii)  a description of goods or services provided by the contractor to the facility;
	(iii)  a statement that the contractor shall conform to the standards required by Utah law or rules;
	(iv)  a provision to terminate the contract with advance notice;
	(v)  the financial terms of the contract;
	(vi)  a copy of the business or professional license of the contractor; and
	(vii)  a provision to report findings, observations, and recommendations to the administrator on a regular basis.
	(b)  Contracts shall be signed, dated and maintained for review by the Department.
	(5)  The administrator shall maintain a written transfer agreement with one or more hospitals to facilitate the transfer of residents and essential resident information.  The transfer agreement must include:
	(a)  criteria for transfer;
	(b)  method of transfer;
	(c)  transfer of information needed for proper care and treatment of the resident transferred;
	(d)  security and accountability of personal property of the resident transferred;
	(e)  proper notification of hospital and responsible person before transfer;
	(f)  the facility responsible for resident care during the transfer; and
	(g)  resident confidentiality.

R432-150-9.  Medical Director.
	(1)  The administrator must retain by formal agreement a licensed physician to serve as medical director or advisory physician according to resident and facility needs.
	(2)  The medical director or advisory physician shall:
	(a)  be responsible for the development of resident care policies and procedures including the delineation of responsibilities of attending physicians;
	(b)  review current resident care policies and procedures with the administrator;
	(c)  serve as a liaison between resident physicians and the administrator;
	(d)  review incident and accident reports at the request of the administrator to identify health hazards to residents and employees; and
	(e)  act as consultant to the director of nursing or the health services supervisor in matters relating to resident care policies.

R432-150-10.  Staff and Personnel.
	(1)  The administrator shall employ personnel who are able and competent to perform their respective duties, services, and functions.
	(a)  The administrator, director of nursing or health services supervisor, and department supervisors shall develop job descriptions for each position including job title, job summary, responsibilities, qualifications, required skills and licenses, and physical requirements.
	(b)  All personnel must have access to facility policy and procedure manuals and other information necessary to effectively perform duties and carry out responsibilities.
	(c)  All personnel must be licensed, certified or registered as required by the Utah Department of Commerce.  A copy of the license, certification or registration shall be maintained for Department review.
	(2)  The facility shall maintain staffing records, including employee performance evaluations, for the preceding 12 months.
	(3)  The facility shall establish a personnel health program through written personnel health policies and procedures.
	(4)  The facility shall complete a health evaluation and inventory for each employee upon hire.
	(a)  The health inventory shall obtain at least the employee's history of the following:
	(i)  conditions that predispose the employee to acquiring or transmitting infectious diseases; and
	(ii)  conditions which may prevent the employee from performing certain assigned duties satisfactorily.
	(b)  The health inventory shall include health screening and immunization components of the employee's personnel health program.
	(c)  Infection control shall include staff immunization as necessary to prevent the spread of disease.
	(d)  Employee skin testing by the Mantoux method or other FDA approved in-vitro serologic test and follow up for tuberculosis shall be done in accordance with R388-804, Special Measures for the Control of Tuberculosis.
	(i)  The licensee shall ensure that all employees are skin-tested for tuberculosis within two weeks of:
	(A)  initial hiring;
	(B)  suspected exposure to a person with active tuberculosis; and
	(C)  development of symptoms of tuberculosis.
	(ii)  Skin testing shall be exempted for all employees with known positive reaction to skin tests.
	(e)  All infections and communicable diseases reportable by law shall be reported by the facility to the local health department in accordance with R386-702-3.
	(5)  The facility shall plan and document in-service training for all personnel.
	(a)  The following topics shall be addressed at least annually:
	(i)  fire prevention;
	(ii)  review and drill of emergency procedures and evacuation plan;
	(iii)  the reporting of resident abuse, neglect or exploitation to the proper authorities;
	(iv)  prevention and control of infections;
	(v)  accident prevention and safety procedures including instruction in body mechanics for all employees required to lift, turn, position, or ambulate residents; and proper safety precautions when floors are wet or waxed;
	(vi)  proper use and documentation of restraints;
	(vii)  resident rights;
	(viii)  A basic understanding of the various types of mental illness, including symptoms, expected behaviors and intervention approaches; and
	(ix)  confidentiality of resident information.
	(6)  Any person who provides nursing care, including nurse aides and orderlies, must work under the supervision of an RN or LPN and shall demonstrate competency and dependability in resident care.
	(a)  A facility may not have an employee working in the facility as a nurse aide for more than four months, on full-time, temporary, per diem, or other basis, unless that individual has successfully completed a State Department of Education-approved training and testing program.
	(b)  The facility shall verify through the nurse aide registry prior to employment that nurse aide applicants do not have a verified report of abuse, neglect, or exploitation.  If such a verified report exists, the facility may not hire the applicant.
	(c)  If an individual has not performed paid nursing or nursing related services for a continuous period of 24 consecutive months since the most recent completion of a training and competency evaluation program, the facility shall require the individual to complete a new training and competency evaluation program.
	(d)  The facility shall conduct regular performance reviews and regular in-service education to ensure that individuals used as nurse aides are competent to perform services as nurse aides.
	(7)  The facility shall ensure that on all shifts, staff are available who are CPR certified, trained in emergency procedures and basic first aid, including the Heimlich maneuver.
	(8)  The facility may utilize volunteers in the daily activities of the facility provided that volunteers are not included in the facility's staffing plan in lieu of facility employees.
	(a)  Volunteers shall be supervised and familiar with resident's rights and the facility's policies and procedures.
	(b)  Volunteers who provide personal care to residents shall be screened according to facility policy and under the direct supervision of a qualified employee.
	(9)  An employee who reports suspected abuse, neglect, or exploitation shall not be subject to retaliation, disciplinary action, or termination by the facility for making the report.

R432-150-11.  Quality Assurance.
	(1)  The administrator must implement a well-defined quality assurance plan designed to improve resident care.  The plan must:
	(a)  include a system for the collection of data indicators;
	(b)  include an incident reporting system to identify problems, concerns, and opportunities for improvement of resident care;
	(c)  implement a system to assess identified problems, concerns and opportunities for improvement; and
	(d)  implement actions that are designed to eliminate identified problems and improve resident care.
	(2)  The plan must include a quality assurance committee that functions as follows:
	(a)  documents committee meeting minutes including all corrective actions and results;
	(b)  conducts quarterly meetings and reports findings, concerns and actions to the administrator and governing body; and
	(c)  coordinates input of data indicators from all provided services and other departments as determined by the resident plan of care and facility scope of services.
	(3)  Incident and accident reports shall:
	(a)  be available for Department review;
	(b)  be numbered and logged in a manner to account for all filed reports; and
	(c)  have space for written comments by the administrator or medical director.
	(4)  Infection reporting must be integrated into the quality assurance plan and must be reported to the Department in accordance with R386-702, Communicable Disease Rule.

R432-150-12.  Resident Rights.
	(1)  The facility shall establish written residents' rights.
	(2)  The facility shall post resident rights in areas accessible to residents.  A copy of the residents' rights document shall be available to the residents, the residents' guardian or responsible person, and to the public and the Department upon request.
	(3)  The facility shall ensure that each resident admitted to the facility has the right to:
	(a)  be informed, prior to or at the time of admission and for the duration of stay, of resident rights and of all rules and regulations governing resident conduct.
	(b)  be informed, prior to or at the time of admission and for the duration of stay, of services available in the facility and of related charges, including any charges for services not covered by the facility's basic per diem rate or not covered under Titles XVIII or XIX of the Social Security Act.
	(c)  be informed by a licensed practitioner of current total health status, including current medical condition, unless medically contraindicated, the right to refuse treatment, and the right to formulate an advance directive in accordance with UCA Section 75-2-1101;
	(d)  be transferred or discharged only for medical reasons, for personal welfare or that of other residents, or for nonpayment for the stay, and to be given reasonable advance notice to ensure orderly transfer or discharge;
	(e)  be encouraged and assisted throughout the period of stay to exercise all rights as a resident and as a citizen, and to voice grievances and recommend changes in policies and services to facility staff and outside representatives of personal choice, free from restraint, interference, coercion, discrimination, or reprisal;
	(f)  manage personal financial affairs or to be given at least a quarterly accounting of financial transactions made on his behalf should the facility accept his written delegation of this responsibility;
	(g)  be free from mental and physical abuse, and from chemical and physical restraints;
	(h)  be assured confidential treatment of personal and medical records, including photographs, and to approve or refuse their release to any individual outside the facility, except in the case of transfer to another health facility, or as required by law or third party payment contract;
	(i)  be treated with consideration, respect, and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs;
	(j)  not be required to perform services for the facility that are not included for therapeutic purposes in the plan of care;
	(k)  associate and communicate privately with persons of the resident's choice, and to send and receive personal mail unopened;
	(l)  meet with social, religious, and community groups and participate in activities provided that the activities do not interfere with the rights of other residents in the facility;
	(m)  retain and use personal clothing and possessions as space permits, unless to do so would infringe upon rights of other residents;
	(n)  if married, to be assured privacy for visits by the spouse; and if both are residents in the facility, to be permitted to share a room;
	(o)  have members of the clergy admitted at the request of the resident or responsible person at any time;
	(p)  allow relatives or responsible persons to visit critically ill residents at any time;
	(q)  be allowed privacy for visits with family, friends, clergy, social workers or for professional or business purposes;
	(r)  have confidential access to telephones for both free local calls and for accommodation of long distance calls according to facility policy;
	(s)  have access to the State Long Term Care Ombudsman Program or representatives of the Long Term Care Ombudsman Program;
	(t)  choose activities, schedules, and health care consistent with individual interests, assessments and care plan;
	(u)  interact with members of the community both inside and outside the facility; and
	(v)  make choices about all aspects of life in the facility that are significant to the resident.
	(4)  A resident has the right to organize and participate in resident and family groups in the facility.
	(a)  A resident's family has the right to meet in the facility with the families of other residents in the facility.
	(b)  The facility shall provide a resident or family group, if one exists, with private space.
	(c)  Staff or visitors may attend meetings at the group's invitation.
	(d)  The facility shall designate a staff person responsible for providing assistance and responding to written requests that result from group meetings.
	(e)  If a resident or family group exists, the facility shall listen to the views and act upon the grievances and recommendations of residents and families concerning proposed policy and operational decisions affecting resident care and life in the facility.
	(5)  The facility must accommodate resident needs and preferences, except when the health and safety of the individual or other residents may be endangered.  A resident must be given at least a 24-hour notice before an involuntary room move is made in the facility.
	(a)  In an emergency when there is actual or threatened harm to others, property or self, the 24 hour notice requirement for an involuntary room move may be waived.  The circumstances requiring the emergency room change must be documented for Department review.
	(b)  The facility must make and document efforts to accommodate the resident's adjustment and choices regarding room and roommate changes.
	(6)  If a facility is entrusted with residents' monies or valuables, the facility shall comply with the following:
	(a)  The licensee or facility staff may not use residents' monies or valuables as his own or mingle them with his own.  Residents' monies and valuables shall be separate, intact and free from any liability that the licensee incurs in the use of his own or the institution's funds and valuables.
	(b)  The facility shall maintain adequate safeguards and accurate records of residents' monies and valuables entrusted to the licensee's care.
	(i)  Records of residents' monies which are maintained as a drawing account must include a control account for all receipts and expenditures, an account for each resident, and supporting vouchers filed in chronological order.
	(ii)  Each account shall be kept current with columns for debits, credits, and balance.
	(iii)  Records of residents' monies and other valuables entrusted to the licensee for safekeeping must include a copy of the receipt furnished to the resident or to the person responsible for the resident.
	(c)  The facility must deposit residents' monies not kept in the facility within five days of receipt of such funds in an interest-bearing account in a local bank or savings and loan association authorized to do business in Utah, the deposits of which shall be insured.
	(d)  A person, firm, partnership, association or corporation which is licensed to operate more than one health facility shall maintain a separate account for each such facility and shall not commingle resident funds from one facility with another.
	(e)  If the amount of residents' money entrusted to a licensee exceeds $100, the facility must deposit all money in excess of $100 in an interest-bearing account.
	(f)  Upon license renewal, the facility shall provide evidence of the purchase a surety bond or other equivalent assurance to secure all resident funds.
	(g)  When a resident is discharged, all money and valuables of that resident which have been entrusted to the licensee must be surrendered to the resident in exchange for a signed receipt.  Money and valuables kept within the facility shall be surrendered upon demand and those kept in an interest-bearing account shall be made available within three working days.
	(h)  Within 30 days following the death of a resident, except in a medical examiner case, the facility must surrender all money and valuables of that resident which have been entrusted to the licensee to the person responsible for the resident or to the executor or the administrator of the estate in exchange for a signed receipt. If a resident dies without a representative or known heirs, the facility must immediately notify in writing the local probate court and the Department.

R432-150-13.  Resident Assessment.
	(1)  The facility shall upon admission obtain physician orders for the resident's immediate care.
	(2)  The facility must complete a comprehensive assessment of each resident's needs including a description of the resident's capability to perform daily life functions and significant impairments in functional capacity.
	(a)  The comprehensive assessment must include at least the following information:
	(i)  medically defined conditions and prior medical history;
	(ii)  medical status measurement;
	(iii)  physical and mental functional status;
	(iv)  sensory and physical impairments;
	(v)  nutritional status and requirements;
	(vi)  special treatments or procedures;
	(vii)  mental and psycho social status;
	(viii)  discharge potential;
	(ix)  dental condition;
	(x)  activities potential;
	(xi)  rehabilitation potential;
	(xii)  cognitive status; and
	(xiii)  drug therapy.
	(b)  The facility must complete the initial assessment within 14 calendar days of admission and any revisions to the initial assessment within 21 calendar days of admission.
	(c)  A significant change in a resident's physical or mental condition requires an interdisciplinary team review and may require the facility to complete a new assessment within 14 calendar days of the condition change.
	(d)  At a minimum, the facility must complete three quarterly reviews and one full assessment in each 12 month period.
	(e)  The facility shall use the results of the assessment to develop, review, and revise the resident's comprehensive care plan.
	(3)  Each individual who completes a portion of the assessment must sign and certify the accuracy of that portion of the assessment.
	(4)  The facility must develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident's medical, nursing, and mental and psycho-social needs as identified in the comprehensive assessment.
	(a)  The comprehensive care plan shall be:
	(i)  developed within seven days after completion of the comprehensive assessment;
	(ii)  prepared with input from an interdisciplinary team that includes the attending physician, the registered nurse having responsibility for the resident, and other appropriate staff in disciplines determined by the resident's needs, and with the participation of the resident, and the resident's family or guardian, to the extent practicable; and
	(iii)  periodically reviewed and revised by a team of qualified persons at least after each assessment and as the resident's condition changes.
	(b)  The services provided or arranged by the facility shall meet professional standards of quality and be provided by qualified persons in accordance with the resident's written care plan.
	(5)  The facility must prepare at the time of discharge a final summary of the resident's status to include items in R432-150-13(2)(a).  The final summary shall be available for release to authorized persons and agencies, with the consent of the resident or representative.
	(a)  The final summary must include a post-discharge care plan developed with the participation of the resident and resident's family or guardian.
	(b)  If the discharge of the resident is based on the inability of the facility to meet the resident's needs, the final summary must contain a detailed explanation of why the resident's needs could not be met.

R432-150-14.  Restraint Policy.
	(1)  Each resident has the right to be free from physical restraints imposed for purposes of discipline or convenience, or not required to treat the resident's medical symptoms.
	(2)  The facility must have written policies and procedures regarding the proper use of restraints.
	(a)  Physical and chemical restraints may only be used to assist residents to attain and maintain optimum levels of physical and emotional functioning.
	(b)  Physical and chemical restraints must not be used as substitutes for direct resident care, activities, or other services.
	(c)  Restraints must not unduly hinder evacuation of the resident in the event of fire or other emergency.
	(d)  If use of a physical or a chemical restraint is implemented, the facility must inform the resident, next of kin, and the legally designated representative of the reasons for the restraint, the circumstances under which the restraint shall be discontinued, and the hazards of the restraint, including potential physical side effects.
	(3)  The facility must develop and implement policies and procedures that govern the use of physical and chemical restraints.  These policies shall promote optimal resident function in a safe, therapeutic manner and minimize adverse consequences of restraint use.
	(4)  Physical and chemical restraint policies must incorporate and address at least the following:
	(a)  resident assessment criteria which includes:
	(i)  appropriateness of use;
	(ii)  procedures for use;
	(iii)  purpose and nature of the restraint;
	(iv)  less restrictive alternatives prior to the use of more restrictive measures; and
	(v)  behavior management and modification protocols including possible alterations to the physical environment;
	(b)  examples of the types of restraints and safety devices that are acceptable for the use indicated and possible resident conditions for which the restraint may be used; and
	(c)  physical restraint guidelines for periodic release and position change or exercise, with instructions for documentation of this action.
	(5)  Emergency use of physical and chemical restraints must comply with the following:
	(a)  A physician, a licensed health practitioner, the director of nursing, or the health services supervisor must authorize the emergency use of restraints.
	(b)  The facility must notify the attending physician as soon as possible, but at least within 24 hours of the application of the restraints.
	(c)  The facility must notify the director of nursing or health services supervisor no later than the beginning of the next day shift of the application of the restraints.
	(d)  The facility must document in the resident's record the circumstances necessitating emergency use of the restraint and the resident's response.
	(6)  Physical restraints must be authorized in writing by a licensed practitioner and incorporated into the resident's plan of care.
	(a)  The interdisciplinary team must review and document the use of physical restraints, including simple safety devices, during each resident care conference, and upon receipt of renewal orders from the licensed practitioner.
	(b)  The resident care plan must indicate the type of physical restraint or safety device, the length of time to be used, the frequency of release, and the type of exercise or ambulation to be provided.
	(c)  Staff application of physical restraints must ensure minimal discomfort to the resident and allow sufficient body movement for proper circulation.
	(d)  Staff application of physical restraints must not cause injury or allow a potential for injury.
	(e)  Leather restraints, straight jackets, or locked restraints are prohibited.
	(7)  Chemical restraints must be authorized in writing by a licensed practitioner and incorporated into the resident's plan of care in conjunction with an individualized behavior management program.
	(a)  The interdisciplinary team must review and document the use of chemical restraints during each resident care conference and upon receipt of renewal orders from the licensed practitioner.
	(b)  The facility must monitor each resident receiving chemical restraints for adverse effects that significantly hinder verbal, emotional, or physical abilities.
	(c)  Any medication given to a resident must be administered according to the requirements of professional and ethical practice and according to the policies and procedures of the facility.
	(d)  The facility must initiate drug holidays in accordance with R432-150-15(13)(b).
	(8)  Facility policy must include criteria for admission and retention of residents who require behavior management programs.

R432-150-15.  Quality of Care.
	(1)  The facility must provide to each resident, the necessary care and services to attain or maintain the highest practicable physical, mental, and psycho-social well-being, in accordance with the comprehensive assessment and care plan.
	(a)  Necessary care and services include the resident's ability to:
	(i)  bathe, dress, and groom;
	(ii)  transfer and ambulate;
	(iii)  use the toilet;
	(iv)  eat; and
	(v)  use speech, language, or other functional communication systems.
	(b)  Based on the resident's comprehensive assessment, the facility must ensure that:
	(i)  each resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrates that diminution was unavoidable;
	(ii)  each resident is given the treatment and services to maintain or improve his abilities; and
	(iii)  a resident who is unable to carry out these functions receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene.
	(2)  The facility must assist residents in scheduling appointments and arranging transportation for vision and hearing care as needed.
	(3)  The facility's comprehensive assessment of a resident must include an assessment of pressure sores. The facility must ensure that:
	(a)  a resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and
	(b)  a resident having pressure sores receives the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing.
	(4)  The facility's comprehensive assessment of the resident must include an assessment of incontinence. The facility must ensure that:
	(a)  a resident who is incontinent of either bowel or bladder, or both, receives the treatment and services to restore as much normal functioning as possible;
	(b)  a resident who enters the facility without an indwelling catheter is not catheterized unless the resident's clinical condition demonstrates that catheterization is necessary;
	(c)  a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections; and
	(d)  a licensed nurse must complete a written assessment to determine the resident's ability to participate in a bowel and bladder management program.
	(5)  The facility must assess each resident to ensure that:
	(a)  a resident who enters the facility without a limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and
	(b)  a resident with a limited range of motion receives treatment and services to increase range of motion or to prevent further decrease in range of motion.
	(6)  The facility must ensure that the psycho-social function of the resident remains at or above the level at the time of admission, unless the individual's clinical condition demonstrates that a reduction in psycho-social function was unavoidable. The facility shall ensure that:
	(a)  a resident who displays psycho-social adjustment difficulty receives treatment and services to achieve as much re-motivation and reorientation as possible; and
	(b)  a resident whose assessment does not reveal a psycho-social adjustment difficulty does not display a pattern of decreased social interaction, increased withdrawn anger, or depressive behaviors, unless the resident's clinical condition demonstrates that such a pattern is unavoidable.
	(7)  The facility must assess alternative feeding methods to ensure that:
	(a)  a resident who has been able to eat enough alone or with assistance is not fed by naso-gastric tube unless the resident's clinical condition demonstrates that use of a naso-gastric tube is unavoidable; and
	(b)  a resident who is fed by a naso-gastric or gastrostomy tube receives the treatment and services to prevent aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers and to restore, if possible, normal feeding function.
	(8)  The facility must maintain the resident environment to be as free of accident hazards as is possible.
	(9)  The facility must provide each resident with adequate supervision and assistive devices to prevent accidents.
	(10)  Each resident's comprehensive assessment must include an assessment on nutritional status.  The facility must ensure that each resident:
	(a)  maintains acceptable nutritional status parameters, such as body weight and protein levels, unless the resident's clinical condition demonstrates that this is not possible; and
	(b)  receives a therapeutic diet when there is a nutritional problem.
	(11)  The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.
	(12)  The facility must ensure that residents receive proper treatment and care for the following special services:
	(a)  injections;
	(b)  parenteral and enteral fluids;
	(c)  colostomy, ureterostomy, or ileostomy care;
	(d)  tracheostomy care;
	(e)  tracheal suctioning;
	(f)  respiratory care;
	(g)  foot care; and
	(h)  prostheses care.
	(13)  Each resident's drug regimen must be free from unnecessary drugs and the facility shall ensure that:
	(a)  residents who have not used anti-psychotic drugs are not given these drugs unless anti-psychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record; and
	(b)  residents who use anti-psychotic drugs receive gradual dose reductions and behavioral interventions, unless clinically contraindicated in an effort to discontinue these drugs.
	(14)  The quality assurance committee must monitor medication errors to ensure that:
	(a)  the facility does not have medication error rates of five percent or greater;
	(b)  residents are free of any significant medication errors.

R432-150-16.  Physician Services.
	(1)  A physician must personally approve in writing a recommendation that an individual be admitted to a nursing care facility.
	(a)  Each resident must remain under the care of a physician licensed in Utah to deliver the scope of services required by the resident.
	(b)  Nurse practitioners or physician assistants, working under the direction of a licensed physician may initiate admission to a nursing care facility pending personal review by the physician.
	(2)  The facility must provide supervision to ensure that the medical care of each resident is supervised by a physician. When a resident's attending physician is unavailable, another qualified physician must supervise the medical care of the resident.
	(3)  The physician must:
	(a)  review the resident's total program of care, including medications and treatments, at each visit;
	(b)  write, sign, and date progress notes at each visit;
	(c)  indicate, in writing, direction and supervision of health care provided to residents by nurse practitioners or physician assistants; and
	(d)  sign all orders.
	(4)  Physician visits must conform to the following:
	(a)  The physician shall notify the facility of the name of the nurse practitioner or physician assistant who is providing care to the resident at the facility.
	(b)  Each resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least every 60 days thereafter.
	(c)  Physician visits must be completed within ten days of the date the visit is required.
	(d)  Except as required by R432-150-16(4)(e), all required physician visits must be made by the physician.
	(e)  At the option of the physician, required visits after the initial visit may alternate between personal visits by the physician and visits by a physician assistant or nurse practitioner.
	(5)  The facility must provide or arrange for the provision of physician services 24 hours a day in case of an emergency.

R432-150-17.  Social Services.
	Each nursing care facility must provide or arrange for medical social services sufficient to meet the needs of the residents.  Social services must be under the direction of a therapist licensed in accordance with Title 58 Chapter 60 of the Mental Health Practice Act.

R432-150-18.  Laboratory Services.
	(1)  The facility must provide laboratory services in accordance with the size and needs of the facility.
	(2)  Laboratory services must comply with the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA).  CLIA inspection reports shall be available for Department review.

R432-150-19.  Pharmacy Services.
	(1)  The facility must provide or obtain by contract routine and emergency drugs, biologicals, and pharmaceutical services to meet resident needs.
	(2)  The facility must employ or obtain the services of a licensed pharmacist who:
	(a)  provides consultation on all aspects of pharmacy services in the facility;
	(b)  establishes a system of records of receipt and disposition of all controlled substances which documents an accurate reconciliation; and
	(c)  determines that drug records are in order and that an account of all controlled substances is maintained and reconciled monthly.
	(3)  The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist.
	(a)  The pharmacist must report any irregularities to the attending physician and the director of nursing or health services supervisor.
	(b)  The physician and the director of Nursing or health services supervisor must indicate acceptance or rejection of the report and document any action taken.
	(4)  Pharmacy personnel must ensure that labels on drugs and biologicals are in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date.
	(5)  The facility must store all drugs and biologicals in locked compartments under proper temperature controls according to R432-150-19 (5)(e), and permit only authorized personnel to have access to the keys.
	(a)  The facility must provide separately locked, permanently affixed compartments for storage of controlled substances listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of 1976 and other drugs subject to abuse, except when the facility uses single unit dose package drug distribution systems in which the quantity stored is minimal and a missing dose can be readily detected.
	(b)  Non-medication materials that are poisonous or caustic may not be stored with medications.
	(c)  Containers must be clearly labeled.
	(d)  Medication intended for internal use shall be stored separately from medication intended for external use.
	(e)  Medications stored at room temperature shall be maintained within 59 and 80 degrees F.
	(f)  Refrigerated medications shall be maintained within 36 and 46 degrees F.
	(6)  The facility must maintain an emergency drug supply.
	(a)  Emergency drug containers shall be sealed to prevent unauthorized use.
	(b)  Contents of the emergency drug supply must be listed on the outside of the container and the use of contents shall be documented by the nursing staff.
	(c)  The emergency drug supply shall be stored and located for access by the nursing staff.
	(d)  The pharmacist must inventory the emergency drug supply monthly.
	(e)  Used or outdated items shall be replaced within 72 hours by the pharmacist.
	(7)  The pharmacy must dispense and the facility must ensure that necessary drugs and biologicals are provided on a timely basis.
	(8)  The facility must limit the duration of a drug order in the absence of the prescriber's specific instructions.
	(9)  Drug references must be available for all drugs used in the facility.  References shall include generic and brand names, available strength and dosage forms, indications and side effects, and other pharmacological data.
	(10)  Drugs may be sent with the resident upon discharge if so ordered by the discharging physician provided that a record of the drugs sent with the resident is documented in the resident's health record.
	(11)  Disposal of controlled substances must be in accordance with the Pharmacy Practice Act.

R432-150-20.  Recreation Therapy.
	(1)  The facility shall provide for an ongoing program of individual and group activities and therapeutic interventions designed to meet the interests, and attain or maintain the highest practicable physical, mental, and psycho-social well-being of each resident in accordance with the comprehensive assessment.
	(a)  Recreation therapy shall be provided in accordance with Title 58, Chapter 40, Recreational Therapy Practice Act.
	(b)  The recreation therapy staff must:
	(i)  develop monthly activity calendars for residents activities; and
	(ii)  post the calendar in a prominent location to be available to residents, staff, and visitors.
	(2)  Each facility must provide sufficient space and a variety of supplies and resource equipment to meet the recreational needs and interests of the residents.
	(3)  Storage must be provided for recreational equipment and supplies.  Locked storage must be provided for potentially dangerous items such as scissors, knives, and toxic materials.

R432-150-21.  Pet Policy.
	(1)  Each facility must develop a written policy regarding pets in accordance with local ordinances.
	(2)  The administrator or designee must determine which pets may be brought into the facility.  Family members may bring resident's pets to visit provided they have approval from the administrator and offer assurance that the pets are clean, disease free, and vaccinated.
	(3)  Pets are not permitted in food preparation or storage areas.  Pets are not permitted in any area where their presence would create a health or safety risk.

R432-150-22.  Admission, Transfer, and Discharge.
	(1)  Each facility must develop written admission, transfer and discharge policies and make these policies available to the public upon request.  The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless:
	(a)  The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;
	(b)  The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;
	(c)  The safety of individuals in the facility is endangered;
	(d)  The health of individuals in the facility is endangered;
	(e)  The resident has failed, after reasonable and appropriate notice, to pay for a stay at the facility; or
	(f)  The facility ceases to operate.
	(2)  The facility must document resident transfers or discharges under any of the circumstances specified in R432-150-22(1)(a) through (f), in the resident's medical record.  The transfer or discharge documentation must be made by:
	(a)  the resident's physician if transfer or discharge is necessary under R432-150-22(1)(a) and (b);
	(b)  a physician if transfer or discharge is necessary under R432-150-22(1)(c) and(d).
	(3)  Prior to the transfer or discharge of a resident, the facility must:
	(a)  provide written notification of the transfer or discharge and the reasons for the transfer or discharge to the resident, in a language and manner the resident understands, and, if known, to a family member or legal representative of the resident;
	(b)  record the reasons in the resident's clinical record; and
	(c)  include in the notice the items described in R432-150-22(6).
	(4)  Except when specified in R432-150-22(5)(a), the notice of transfer or discharge required under R432-150-22(3), must be made by the facility at least 30 days before the resident is transferred or discharged.
	(5)  Notice may be made as soon as practicable before transfer or discharge if:
	(a)  the safety or health of individuals in the facility would be endangered if the resident is not transferred or discharged sooner;
	(b)  the resident's health improves sufficiently to allow a more immediate transfer or discharge;
	(c)  an immediate transfer or discharge is required by the resident's urgent medical needs; or
	(d)  a resident has not resided in the facility for 30 days.
	(6)  The contents of the written transfer or discharge notice must include the following:
	(a)  the reason for transfer or discharge;
	(b)  the effective date of transfer or discharge;
	(c)  the location to which the resident is transferred or discharged; and
	(d)  the name, address, and telephone number of the State and local Long Term Care Ombudsman programs.
	(e)  For nursing facility residents with developmental disabilities, the notice must contain the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under part C of the Developmental Disabilities Assistance and Bill of Rights Act.
	(f)  For nursing facility residents who are mentally ill, the notice must contain the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the Protection and Advocacy for Mentally Ill Individuals Act.
	(7)  The facility must provide discharge planning to prepare and orient a resident to ensure safe and orderly transfer or discharge from the facility.
	(8)  Notice of resident bed-hold policy, transfer and re-admission must be documented in the resident file.
	(a)  Before a facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the facility must provide written notification and information to the resident and a family member or legal representative that specifies:
	(i)  the facility's policies regarding bed-hold periods permitting a resident to return; and
	(ii)  the duration of the bed-hold policy, if any, during which the resident is permitted to return and resume residence in the facility.
	(b)  At the time of transfer of a resident to a hospital or for therapeutic leave, the facility must provide written notice to the resident and a family member or legal representative, which specifies the duration of the bed-hold policy.
	(c)  If transfers necessitated by medical emergencies preclude notification at the time of transfer, notification shall take place as soon as possible after transfer.
	(d)  The facility must establish and follow a written policy under which a resident whose hospitalization or therapeutic leave exceeds the bed-hold period is readmitted to the facility.
	(9)  The facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services for all individuals regardless of pay source.
	(10)  The facility must have in effect a written transfer agreement with one or more hospitals to ensure that:
	(a)  residents are transferred from the facility to the hospital and ensured of timely admission to the hospital when transfer is medically necessary as determined by the attending physician;
	(b)  medical and other information needed for care and treatment of residents is exchanged between facilities including documentation of reasons for a less expensive setting; and
	(c)  security and accountability of personal property of the individual transferred is maintained.

R432-150-23.  Ancillary Health Services.
	(1)  If the nursing care facility provides its own radiology services, these facility must comply with R432-100-22, Radiology Services, in the General Acute Hospital Rule.
	(2)  A facility that provides specialized rehabilitative services may offer these services either directly or through agreements with outside agencies or qualified therapists.  If provided, these services must meet the needs of the residents.
	(a)  The facility must provide space and equipment for specialized rehabilitative services in accordance with the needs of the residents.
	(b)  Specialized rehabilitative services may only be provided by therapists licensed in accordance with Utah law.
	(c)  All therapy assistants must work under the direct supervision of the licensed therapist at all times.
	(d)  Speech pathologists must have a "Certificate of Clinical Compliance" from the American Speech and Hearing Association.
	(e)  Specialized rehabilitative services may be provided only if ordered by the attending physician.
	(i)  The plan of treatment must be initiated by an attending physician and developed by the therapist in consultation with the nursing staff.
	(ii)  An initial progress report must be submitted to the attending physician two weeks after treatment is begun or as specified by the physician.
	(iii)  The physician and therapist must review and evaluate the plan of treatment monthly unless the physician recommends an alternate schedule in writing.
	(f)  The facility must document the delivery of rehabilitative services in the resident record.
	(3)  The facility must provide or arrange for regular and emergency dental care for residents.
	(a)  Dental care provisions shall include:
	(b)  development of oral hygiene policies and procedures with input from dentists;
	(c)  presentation of oral hygiene in-service programs by knowledgeable persons;
	(d)  development of referral service for those residents who do not have a personal dentist; and
	(e)  arrangement for transportation to and from the dentist's office.

R432-150-24.  Food Services.
	(1)  The facility must provide each resident with a safe, palatable, well-balanced diet that meets the daily nutritional and special dietary needs of each resident.
	(2)  There must be adequate staff employed by the facility to meet the dietary needs of the residents.
	(a)  The facility must employ a dietitian either full-time, part-time, or on a consultant basis.
	(b)  The dietitian must be certified in accordance with Title 58, Chapter 49, Dietitian Certification Act.
	(c)  If a dietitian is not employed full-time, the administrator must designate a full-time person to serve as the dietetic supervisor.
	(d)  If the dietetic supervisor is not a certified dietitian, the facility must document at least monthly consulation by a certified dietitian according to the needs of the residents.
	(e)  The dietetic supervisor shall be available when the consulting dietitian visits the facility.
	(3)  The facility must develop menus that meet the nutritional needs of residents to the extent medically possible.
	(a)  Menus shall be:
	(i)  prepared in advance;
	(ii)  followed;
	(iii)  different each day;
	(iv)  posted for each day of the week;
	(v)  approved and signed by a certified dietician and;
	(vi)  cycled no less than every three weeks.
	(b)  The facility must retain documentation for at least three months of all served substitutions to the menu.
	(4)  The facility must make available for Department review all food sanitation inspection reports of State or local health department inspections.
	(5)  All therapeutic diets must be ordered in writing by the attending physician or by a qualified registered dietitian in consultation with the physician, if allowed by facility policy.
	(6)  There must be no more than a 14-hour interval between the evening meal and breakfast, unless a substantial snack is served in the evening.
	(7)  The facility must provide special eating equipment and assistive devices for residents who need them.
	(8)  The facility's food service must comply with the Utah Department of Health Food Service Sanitation Regulations R392-100.
	(9)  The facility must maintain a one-week supply of nonperishable staple foods and a three-day supply of perishable foods to complete the established menu for three meals per day, per resident.
	(10)  A nursing care facility may use trained dining assistants to aid residents in eating and drinking if:
	(a)  a licensed practical nurse-geriatric care manager, registered nurse , advance practice registered nurse, speech pathologist, occupational therapist, or dietitian has assessed that the resident does not have complicated feeding problems, such as recurrent lung aspirations, behaviors which interfere with eating, difficulty swallowing, or tube or parenteral feeding; and
	(b)  The service plan or plan of care documents that the resident needs assistance with eating and drinking and defines who is qualified to offer the assistance.
	(11)  If the nursing care facility uses a dining assistant, the facility must assure that the dining assistant:
	(a)  has completed a training course from a Department-approved training program;
	(b)  has completed a background screening pursuant to R432-35; and
	(c)  performs duties only for those residents who do not have complicated feeding problems.
	(12)  A long-term care facility, employee organization, person, governmental entity, or private organization must submit the following to the Department to become Department-approved training program:
	(a)  a copy of the curriculum to be implemented that meets the requirements of subsection (13); and
	(b)  the names and credentials of the trainers.
	(13)  The training course for the dining assistant shall provide eight hours of instruction and one hour of observation by the trainer to ensure competency.  The course shall include the following topics:
	(a)  feeding techniques;
	(b)  assistance with eating and drinking;
	(c)  communication and interpersonal skills;
	(d)  safety and emergency procedures including the Heimlich manuever;
	(e)  infection control;
	(f)  resident rights;
	(g)  recognizing resident changes inconsistent with their normal behavior and the importance in reporting those changes to the supervisory nurse;
	(h)  special diets;
	(i)  documentation of type and amount of food and hydration intake;
	(j)  appropriate response to resident behaviors, and
	(k)  use of adaptive equipment.
	(14)  The training program shall issue a certificate of completion and maintain a list of the dining assistants.  The certifcate shall include the training program provider and provider's telephone number at which a long-term care facility may verify the training, and the dining assistant's name and address.
	(15)  To provide dining assistant training in a Department-approved program, a trainer must hold a current valid license to practice as:
	(a)  a registered nurse, advanced practice registered nurse or licensed practical nurse-geriatric care manager pursuant to Title 58, Chapter 31b;
	(b)  a registered dietitian, pursuant to Title 58, Chapter 49;
	(c)  a speech-language pathologist, pursuant to Title 58, Chapter 41; or
	(d)  an occupational therapist, pursuant to Title 58, Chapter 42a.
	(16)  The Department may suspend a training program if the program's courses do not meet the requirements of this rule.
	(17)  The Department may suspend a training program operated by a nursing care facility if:
	(a)  a federal or state survey reveals failure to comply with federal regulations or state rules regarding feeding or dining assistant programs;
	(b)  the facility fails to provide sufficient, competent staff to respond to emergencies;
	(c)  the Department sanctions the facility for any reason; or
	(d)  the Department determines that the facility is in continuous or chronic non-compliance under state rule or that the facility has provided sub-standard quality of care under federal regulation.

R432-150-25.  Medical Records.
	(1)  The facility must implement a medical records system to ensure complete and accurate retrieval and compilation of information.
	(2)  The administrator must designate an employee to be responsible and accountable for the processing of medical records.
	(a)  The medical records department must be under the direction of a registered record administrator, RRA, or an accredited record technician, ART.
	(b)  If an RRA or ART is not employed at least part time, the facility must consult with an RRA or ART according to the needs of the facility, but not less than semi-annually.
	(3)  The resident medical record and its contents must be retained, stored and safeguarded from loss, defacement, tampering, and damage from fires and floods.
	(a)  Medical records must be protected against access by unauthorized individuals.
	(b)  Medical records must be retained for at least seven years.  Medical records of minors must be kept until the age of eighteen plus four years, but in no case less than seven years.
	(4)  The facility must maintain an individual medical record for each resident.  The medical record must contain written documentation of the following:
	(a)  records made by staff regarding daily care of the resident;
	(b)  informative progress notes by staff to record changes in the resident's condition and response to care and treatment in accordance with the care plan;
	(c)  a pre-admission screening;
	(d)  an admission record with demographic information and resident identification data;
	(e)  a history and physical examination up-to-date at the time of the resident's admission;
	(f)  written and signed informed consent;
	(g)  orders by clinical staff members;
	(h)  a record of assessments, including the comprehensive resident assessment, care plan, and services provided;
	(i)  nursing notes;
	(j)  monthly nursing summaries;
	(k)  quarterly resident assessments;
	(l)  a record of medications and treatments administered;
	(m)  laboratory and radiology reports;
	(n)  a discharge summary for the resident to include a note of condition, instructions given, and referral as appropriate;
	(o)  a service agreement if respite services are provided;
	(p)  physician treatment orders; and
	(q)  information pertaining to incidents, accidents and injuries.
	(r)  If a resident has an advanced directive, the resident's record must contain a copy of the advanced directive.
	(5)  All entries into the medical record must be authenticated including date, name or identifier initials, and title of the person making the entries.
	(6)  Resident respite records must be maintained within the facility.

R432-150-26.  Housekeeping Services.
	(1)  The facility must provide a safe, clean, comfortable environment, allowing the resident to use personal belongings to create a homelike environment.
	(a)  Cleaning agents, bleaches, insecticides, poisonous, dangerous, or flammable materials must be stored in a locked area to prevent unauthorized access.
	(b)  The facility must provide adequate housekeeping services and sufficient personnel to maintain a clean and sanitary environment.
	(i)  Personnel engaged in housekeeping or laundry services cannot be engaged concurrently in food service or resident care.
	(ii)  If housekeeping personnel also work in food services or direct patient care services, the facility must develop and implement employee hygiene and infection control measures to maintain a safe, sanitary environment.

R432-150-27.  Laundry Services.
	(1)  The administrator must designate a person to direct the facility's laundry service.  The designee must have experience, training , or knowledge of the following:
	(a)  proper use of chemicals in the laundry;
	(b)  proper laundry procedures;
	(c)  proper use of laundry equipment;
	(d)  facility policies and procedures; and
	(e)  federal, state and local rules and regulations.
	(2)  The facility must provide clean linens, towels and wash cloths for resident use.
	(3)  If the facility contracts for laundry services, there must be a signed, dated agreement that details all services provided.
	(4)  The facility must inform the resident and family of facility laundry policy for personal clothing.
	(5)  The facility must ensure that each resident's personal laundry is marked for identification.
	(6)  There must be enough clean linen, towels and washcloths for at least three complete changes of the facility's licensed bed capacity.
	(7)  There must be a bed spread for each resident bed.
	(8)  Clean linen must be handled and stored in a manner to minimize contamination from surface contact or airborne deposition.
	(9)  Soiled linen must be handled, stored, and processed in a manner to prevent contamination and the spread of infections.
	(10)  Soiled linen must be sorted in a separate room by methods affording protection from contamination.
	(11)  The laundry area must be separate from any room where food is stored, prepared, or served.

R432-150-28.  Maintenance Services.
	(1)  The facility must ensure that buildings, equipment and grounds are maintained in a clean and sanitary condition and in good repair at all times for the safety and well-being of residents, staff, and visitors.
	(a)  The administrator shall employ a person qualified by experience and training to be in charge of facility maintenance.
	(b)  If the facility contracts for maintenance services, there must be a signed, dated agreement that details all services provided.  The maintenance service must meet all requirements of this section.
	(c)  The facility must develop and implement a written maintenance program (including preventive maintenance) to ensure the continued operation of the facility and sanitary practices throughout the facility.
	(2)  The facility must ensure that the premises is free from vermin and rodents.
	(3)  Entrances, exits, steps, ramps, and outside walkways must be maintained in a safe condition with regard to snow, ice and other hazards.
	(4)  Facilities which provide care for residents who cannot be relocated in an emergency must make provision for emergency lighting and heat to meet the needs of residents.
	(5)  Functional flashlights shall be available for emergency use by staff.
	(6)  All facility equipment must be tested, calibrated and maintained in accordance with manufacturer specifications.
	(a)  Testing frequency and calibration documentation shall be available for Department review.
	(b)  Documentation of testing or calibration conducted by an outside agency must be available for Department review.
	(7)  All spaces within buildings which house people, machinery, equipment, approaches to buildings, and parking lots must have lighting.
	(8)  Heating, air conditioning, and ventilating systems must be maintained to provide comfortable temperatures.
	(9)  Back-flow prevention devices must be maintained in operating condition and tested according to manufacturer specifications.
	(10)  Hot water temperature controls must automatically regulate temperatures of hot water delivered to plumbing fixtures used by residents. Hot water must be delivered to public and resident care areas at temperatures between 105-115 degrees F.
	(11)  Disposable and single use items must be properly disposed of after use.
	(12)  Nursing equipment and supplies must be available as determined by facility policy in accordance with the needs of the residents.
	(13)  The facility must have at least one first aid kit and a first aid manual available at a specified location in the facility.  The first aid manual must be a current edition of a basic first aid manual approved by the American Red Cross or the American Medical Association.
	(14)  The facility must have at least one OSHA-approved spill or clean-up kit for blood-borne pathogens.
	(15)  Vehicles used to transport residents must be:
	(a)  licensed with a current vehicle registration and safety inspection;
	(b)  equipped with individual, size-appropriate safety restraints such as seat belts which are defined in the federal motor vehicle safety standards contained in the Code of Federal Regulations, Title 49, Section 571.213, and are installed and used in accordance with manufacturer specifications;
	(c)  equipped with a first aid kit as specified in R432-150-28(13); and
	(d)  equipped with a spill or clean-up kit as specified in R432-150-28(14).

R432-150-29.  Emergency Response and Preparedness Plan.
	(1)  The facility must ensure the safety and well-being of residents and make provisions for a safe environment in the event of an emergency or disaster.  An emergency or disaster may include utility interruption, explosion, fire, earthquake, bomb threat, flood, windstorm, epidemic, and injury.
	(2)  The facility must develop an emergency and disaster plan that is approved by the governing board.
	(a)  The facility's emergency plan shall delineate:
	(i)  the person or persons with decision-making authority for fiscal, medical, and personnel management;
	(ii)  on-hand personnel, equipment, and supplies and how to acquire additional help, supplies, and equipment after an emergency or disaster;
	(iii)  assignment of personnel to specific tasks during an emergency;
	(iv)  methods of communicating with local emergency agencies, authorities, and other appropriate individuals;
	(v)  individuals who shall be notified in an emergency in order of priority; and
	(vi)  methods of transporting and evacuating residents and staff to other locations.
	(b)  The facility must have available at each nursing station emergency telephone numbers including responsible staff persons in the order of priority.
	(c)  The facility must document resident emergencies and responses, emergency events and responses, and the location of residents and staff evacuated from the facility during an emergency.
	(d)  The facility must conduct and document simulated disaster drills semi-annually.
	(3)  The administrator must develop a written fire emergency and evacuation plan in consultation with qualified fire safety personnel.
	(a)  The evacuation plan must delineate evacuation routes, location of fire alarm boxes, fire extinguishers, and emergency telephone numbers of the local fire department.
	(b)  The facility must post the evacuation plan in prominent locations in exit access ways throughout the building.
	(c)  The written fire or emergency plan must include fire containment procedures and how to use the facility alarm systems and signals.
	(d)  Fire drills and fire drill documentation must be in accordance with the State of Utah Fire Prevention Board, R710-4.

R432-150-30.  Penalties.
	Any person who violates any provision of this rule may be subject to the penalties enumerated in Section 26-21-11 and R432-3-7 and be punished for violation of a class A misdemeanor as provided in Section 26-21-16.

KEY:  health care facilities
Date of Enactment or Last Substantive Amendment:  January 11, 2018
Notice of Continuation:  February 13, 2017
Authorizing, and Implemented or Interpreted Law:  26-21-5; 26-21-16