CHAPTER 62
RESIDENTIAL CARE FACILITIES
FOR PERSONS WITH MENTAL ILLNESS (RCF/PMI)
481—62.1(135C) Definitions. For the purposes of these rules, the following terms shall have the meaning indicated in this chapter. The definitions set out in Iowa Code section 135C.1 shall be considered incorporated verbatim in the rules. The use of the words “shall” and “must” indicate these standards are mandatory.
“Abuse” means any of the following as a result of the willful or negligent acts or omissions of a caretaker:
	1.	Physical abuse
	2.	Physical injury to or unreasonable confinement or cruel punishment of a resident
	3.	Sexual abuse
	4.	Mental abuse
	5.	Verbal abuse
	6.	Exploitation of a resident
	7.	The deprivation of the minimum food, shelter, clothing, supervision, physical and mental health care, and other care necessary to maintain a resident’s life or health as a result of the acts or omissions of the resident.
“Academic services” means those activities provided to assist a person to acquire general information and skills which establish the basis for subsequent acquisition and application of knowledge.
“Age appropriate” means those activities, settings, and personal appearance and possessions commensurate with the person’s chronological age.
“Chronic mental illness” means a persistent mental or emotional disorder that seriously impairs an adult’s functioning relative to such primary aspects of daily living as personal relations, living arrangements, or employment.
“Commission” means the mental health and mental retardation commission.
“Community living training services” are those activities provided to assist a person to acquire or sustain the knowledge and skills essential to independent functioning to the person’s maximum potential in the physical and social environment. These services may focus on the following areas:
	1.	Independent living skills means those skills necessary to sustain oneself in the physical environment and are essential to the management of one’s personal property and business. This includes self-advocacy skills.
	2.	Socialization skills which include self-awareness and self-control, social responsiveness, group participation, social amenities, and interpersonal skills.
	3.	Communication skills which include expressive and receptive skills in verbal and nonverbal language including reading and writing.
	4.	Leisure time and recreational skills which include the skills necessary for a person to use leisure time in a manner which is satisfying and constructive to the person.
	5.	Parenting skills which include those skills necessary to meet the needs of the person’s child. This service is designed to assist the person with mental illness to acquire or sustain the skills necessary for parenting.
“Department” means the Iowa department of inspections and appeals.
“Diagnosis” means the investigation and analysis of the cause or nature of a person’s condition, situation, or problem.
“Direct care staff” means those staff persons who provide a homelike environment for the residents and assist or supervise the resident in meeting the goals in the resident’s program plan.
“Evaluation services” means those activities designed to identify a person’s current functioning level and those factors which are barriers to maintaining the current level or achieving a higher level of functioning.
“Exploitation” means the act or process of taking unfair advantage of a resident, or the resident’s physical or financial resources, for one’s own personal or pecuniary profit by the use of undue influence, harassment, duress, deception, false representation, or false pretenses.
“Goals” means general statements of attainable expected accomplishments to be achieved in meeting identified needs.
“Incident” means all accidental, purposeful, or other occurrences within the facility or on the premises affecting residents, visitors, or employees whether there is apparent injury or where hidden injury may have occurred.
“Individual program plan (IPP)” means a written plan for the provision of services to the resident that is developed and implemented using an interdisciplinary process, that is based on the resident’s functional status, strengths and needs, and that identifies service activities designed to enable a person to maintain or move toward independent functioning. The plan identifies a continuum of development and outlines progressive steps and anticipated outcomes of services.
“Informed consent” means an agreement by a person, or by the person’s legally authorized representative, based upon an understanding of:
	1.	A full explanation of the procedures to be followed including an identification of those that are and are not experimental,
	2.	A description of the attendant discomforts, risks, and benefits to be expected,
	3.	A disclosure of appropriate alternative procedures that would be advantageous for the person.
“Interdisciplinary process” means an approach to assessment, individual program planning, and service implementation in which planning participants function as a team. Each participant utilizing the skills, competencies, insights and perspectives provided by the participant’s training and experience focuses on identifying the service needs of the resident and the resident’s family. The purpose of the process is for participants to review and discuss, face-to-face, all information and recommendations and to reach decisions as a team. Participants share all information and recommendations, and develop as a team a single, integrated, individual program plan to meet the resident’s and, when appropriate, the resident’s family’s needs.
“Interdisciplinary team” means the group of persons who develop a single, integrated, individual program plan to meet a resident’s needs for services. The interdisciplinary team consists of, at a minimum, the resident, the resident’s legal guardian, if applicable, the resident’s advocate if desired by the resident, a referral agency representative, other appropriate staff members, other providers of services, and other persons relevant to resident’s needs.
“Least restrictive environment” means the environment in which the interventions in the lives of people with mental illness can be carried out with a minimum of limitation, intrusion, disruption, and departure from commonly accepted patterns of living.
It is the environment which allows residents to participate, to the maximum extent possible, in everyday life and to have control over the decisions that affect them. It is an environment that provides needed supports which do not interfere with personal liberty and do not unduly interfere with a person’s access to the normal events of life.
“Legal services” means those activities designed to assist the person in exercising constitutional and legislatively enacted rights.
“Level of functioning” means a person’s current physiological and psychological status and current academic, community living, self-care, and vocational skills.
“Long-term residential care facility for persons with mental illness (RCF/PMI)” means a residential setting to maintain or improve community living skills to reach maximum potential for independent living and to prevent movement to a more restrictive setting.
“Mechanical restraint” means a device applied to a person’s limbs, head, or body which restricts a person’s movement and includes but is not limited to leather straps, leather cuffs, camisoles, or handcuffs.
“Mental abuse” means, but is not limited to, humiliation, harassment, and threats of punishment or deprivation.
“Mental illness” means a substantial disorder of thought or mood which significantly impairs judgment, behavior, or the capacity to recognize reality or the ability to cope with the ordinary demands of life. Mental disorders include the organic and functional psychoses, neuroses, personality disorders, alcoholism and drug dependence, behavioral disorders and other disorders as defined by the current edition of American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
“Normalization” means helping persons, in accordance with their needs and preference, to achieve a lifestyle that is consistent with the norms and patterns of general society and in ways which incorporate the age-appropriate and least restrictive principles.
“Objectives” means specific, time-limited, and measurable statements showing outcomes or accomplishments necessary to progress toward the goal.
“Physical abuse” means, but is not limited to, corporal punishment and the use of restraints as punishment.
“Physical injury” means damage to any bodily tissue to the extent the tissue must undergo a healing process in order to be restored to a sound and healthy condition. It may also mean damage to the extent the bodily tissue cannot be restored to a sound and healthy condition, or results in the death of the resident whose bodily tissue sustained the damage.
“Physical or physiological treatment” means those activities designed to prevent, halt, control, relieve, or reverse symptoms or conditions which interfere with the physical or physiological functioning of the human body.
“Physical restraint” means a technique involving the use of one or more of a staff person’s arms, legs, hands or other body areas to restrict or control the movements of a resident. This does not include the use of mechanical restraint.
“Physician” means a person licensed to practice medicine and surgery, osteopathy and surgery, osteopathy, or chiropractic under the laws of this state; but a physician licensed as a physician and surgeon shall be designated as a “physician” or “surgeon”; a person licensed as an osteopath and surgeon shall be designated as an “osteopathic physician” or “osteopathic surgeon”; a person designated as an osteopath shall be designated as an “osteopathic physician”; and a person licensed as a chiropractor shall be designated as a “chiropractor.”
“Program” means a set of related resources and services directed to the accomplishment of a fixed set of goals and objectives for any of the following:
	1.	Special target populations,
	2.	The population of a specified geographic area(s),
	3.	A specified purpose, and
	4.	A person.
“Psychotherapeutic treatment” means those activities designed to assist a person in the identification or modification of beliefs, emotions, attitudes, or behaviors in order to maintain or improve the person’s functioning in response to the physical, emotional and social environment.
“Qualified mental health professional (QMHP)” means a person who:
Is a psychiatrist, psychologist, social worker, psychiatric nurse or mental health counselor; or
Is a doctor of medicine or osteopathic medicine or has at least a master’s degree or its equivalent with coursework focusing on diagnosis and evaluation and psychotherapeutic treatment of mental health problems and mental illness.
Equivalent means at least 32 semester hours of graduate level study in the following areas:
	1.	Psychology (normal and abnormal)
	2.	Assessment (psychological and physiological)
	3.	Growth, development, and personality
	4.	Learning theory
	5.	Counseling theory and technique (group dynamics)
	6.	Human behavior
	7.	Sociology
	8.	Interpersonal relations
	9.	Change
	10.	Systems theory
	11.	Interdisciplinary team process
	12.	Organizational theory
	13.	Planning
These persons must have two years of documented supervised experience in providing mental health services; or
Is employed by a community mental health center or mental health service provider accredited by the commission and has less than a master’s degree but at least a bachelor’s degree and sufficient education and experience as determined by the chief administrative officer of the community mental health center, with the approval of the commission with coursework and experience focusing on diagnosis and evaluation and treatment of persons with mental health problems and mental illness.
All persons must hold a current license when required by Iowa law.
	1.	“Psychiatrist” means a doctor of medicine or osteopathic medicine and surgery who is certified by the American Board of Psychiatry and Neurology or who is eligible for certification.
	2.	“Psychologist” means a person who is licensed to practice psychology in the state of Iowa, or is certified by the Iowa department of education as a school psychologist, or is eligible for certification, or meets the requirements for eligibility for a license to practice psychology in the state of Iowa that were effective prior to July 1, 1985.
	3.	“Social worker” means a person who is licensed to practice social work in the state of Iowa, or who is eligible for licensure.
	4.	“Psychiatric nurse” means a person who meets the requirements of certified psychiatric-mental health nurse practitioner pursuant to 655—Chapter 7, Iowa Administrative Code, or is eligible for certification.
	5.	“Mental health counselor” means a person who is certified or eligible for certification as a mental health counselor by the National Academy of Certified Clinical Mental Health Counselors.
“Resident” means a person who has been admitted to the facility to receive care and services.
“Seclusion” means the isolation of the resident in a locked room which cannot be opened by the resident.
“Self-care training services” means those activities provided to assist a person to acquire or sustain the knowledge, habits, and skills essential to the daily needs of the person. The activities focus on personal hygiene, general health maintenance, mobility skills, and other activities of daily living.
“Service” means a set of interrelated activities provided to a resident pursuant to the IPP.
“Sexual abuse” means, but is not limited to, the exposing of pubes to a resident, the exposure of a resident’s genitals, pubes, breasts or buttocks for sexual satisfaction, fondling or touching the inner thigh, groin, buttocks, anus or breast of a resident or the clothing covering these areas, sexually suggestive comments or remarks made to a resident, a genital to genital or oral to genital contact or the commission of a sexual offense under Iowa Code chapter 709 or Iowa Code section 726.2.
“Short-term transitional residential care facility for persons with mental illness” means a transitional setting to move the person toward independent living by helping the person gain mastery of independent living skills.
“Support services” means those activities provided to or on behalf of a person in the areas of personal care and assistance and property maintenance in order to allow a person to live in the least restrictive environment.
“Transportation services” means those activities designed to assist a person to travel from one place to another to obtain services or carry out life’s activities.
“Verbal abuse” means, but is not limited to, the use of derogatory terms or names, undue voice volume and rude comments, orders, or responses to residents.
“Vocational training services” means those activities designed to familiarize a person with production or employment requirements and to maintain or develop the person’s ability to function in a work setting. This service includes programming which allows or promotes the development of skills, attitudes, and personal attributes appropriate to the work setting.
“Work” means any activity during which a resident provides goods or services for wages.
“Written, in writing or recorded” means that an account or entry is made in a permanent form.
481—62.2(135C) Application for license.
	62.2(1)  Initial application and licensing. In order to obtain an initial license for a residential care facility for persons with mental illness, the applicant must meet all of the rules, regulations, and standards contained in Iowa Code chapter 135C, and Iowa Administrative Code 481—Chapters 60 and 62, and submit an application to the department which states the type and category of license for which the facility is applying.
	a. 	Submit a résumé of care with a narrative which includes the following information:
	(1)	The purpose of the facility.
	(2)	A description of the target population and limitations on resident eligibility.
	(3)	An identification and description of the services the facility will provide which shall minimally include specific and measurable goals and objectives for each of the services to be made available by the facility and a description of the resources needed to provide each of the services including staff, physical facilities and funds.
	(4)	A description of the human services system available in the area, including, but not limited to, social, public health, visiting nurse, vocational training, employment services, sheltered living arrangements, and services of private agencies.
	(5)	A description of working relationships with the human services agencies when applicable, which shall include at a minimum:
	1.	A description of how the facility will coordinate with the human services to facilitate continuity of care and coordination of services to residents; and
	2.	A description of how the facility will coordinate with those agencies to identify unnecessary duplication of services and plan for development and coordination of needed services.
	b. 	Submit a floor plan of each floor of the facility drawn on 8½- x 11-inch paper showing room areas in proportion, room dimensions, room numbers for all rooms, including bathroom; and designation of the use to which room will be put and window and door location;
	c. 	Submit a photograph of the front and side elevation of the facility;
	d. 	Submit the statutory fee for a residential care facility license;
	e. 	Show evidence of a certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules.
	62.2(2) Renewal application or change of ownership. In order to obtain a renewal or change of ownership license of the residential care facility to serve persons with mental illness the applicant must:
	a. 	Submit to the department the completed application form 30 days prior to annual license renewal or change of ownership date of the residential care facility license.
	b. 	Submit the statutory license fee for a residential care facility for persons with mental illness with the application for renewal or change of ownership.
	c. 	Have an approved current certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules.
	d. 	Submit documentation of review of résumé of care pursuant to 62.2(1)“a” and a copy of any revisions to the plan.
This rule is intended to implement Iowa Code sections 135C.7 and 135C.9.
481—62.3(135C) Licenses for distinct parts.
	62.3(1) Separate licenses may be issued for distinct parts which are clearly identifiable parts of a health care facility, containing contiguous rooms in a separate wing or building or on a separate floor of the facility and which provide care and services of separate categories.
	62.3(2) The following requirements shall be met for a separate licensing of a distinct part:
	a. 	The distinct part shall serve only residents who require the category of care and services immediately available to them within that part. (III)
	b. 	The distinct part shall meet all the standards, rules, and regulations pertaining to the category for which a license is being sought.
	c. 	The distinct part must be operationally and financially feasible.
	d. 	A separate personal care staff with qualifications appropriate to the care and services being rendered must be regularly assigned and working in the distinct part under responsible management. (III)
	e. 	Separately licensed distinct parts may have certain services such as management, building maintenance, laundry and dietary in common with each other.
	62.3(3) Licenses are issued to the person or governmental unit which has responsibility for the operation of the facility and authority to comply with all applicable statutes, rules or regulations.
The person or governmental unit must be the owner of the facility or, if the facility is leased, the lessee.
This rule is intended to implement Iowa Code sections 135C.6(1) and 135C.6(2).
481—62.4(135C) Variances. Variances from these rules may be granted by the director of the department:
	1.	When the need for a variance has been established consistent with the résumé of care or the resident’s individual program plan.
	2.	When there is no danger to the health, safety, welfare, or rights of any resident.
	3.	The variance will apply only to a specific residential care facility for the mentally ill.
	4.	Variances shall be reviewed at the time of each licensure survey by the department to see if the need for the variance is still acceptable.
	62.4(1) To request a variance, the licensee must:
	a. 	Apply in writing on a form provided by the department;
	b. 	Cite the rule or rules from which a variance is desired;
	c. 	State why compliance with the rule or rules cannot be accomplished;
	d. 	Explain how the variance is consistent with the résumé of care or the individual program plan;
	e. 	Demonstrate that the requested variance will not endanger the health, safety, welfare, or rights of any resident.
	62.4(2) Upon receipt of a request for variance, the director shall:
	a. 	Examine the rule from which the variance is requested;
	b. 	Evaluate the requested variance against the requirement of the rule to determine whether the request is necessary to meet the needs of the residents;
	c. 	Examine the effect of the requested variance on the health, safety, or welfare of the residents;
	d. 	Consult with the applicant to obtain additional written information if required.
	62.4(3) Based upon this information, approval of the variance will be either granted or denied within 120 days of receipt.
481—62.5(135C) General requirements.
	62.5(1) The license shall be valid and be posted in each facility so the public can see it easily. (III)
	62.5(2) The license shall be valid only for the premises and person named on the license and is not transferable.
	62.5(3) The posted license shall accurately reflect the current status of the residential care facility for persons with mental illness. (III)
	62.5(4) Licenses expire one year after the date of issuance or as indicated on the license.
	62.5(5) There shall be no more beds erected than are stipulated on the license. (II, III)
	62.5(6) Each citation or a copy of each citation issued by the department for a class I or class II violation shall be prominently posted by the facility in plain view of the residents, visitors, and persons inquiring about placement in the facility. The citation or copy of the citation shall remain posted until the violation is corrected to the satisfaction of the department. (III)
This rule is intended to implement Iowa Code section 135C.8.
481—62.6(135C) Notification required by the department. The department shall be notified:
Within 48 hours, by letter, of any reduction or loss of personal care or dietary staff lasting more than seven days which places the staff ratio below that required for licensing. No additional residents shall be admitted until the minimum staff requirements are achieved. (II, III)
Within 30 days of any proposed change in the résumé of care for the RCF/PMI. (II, III)
Thirty days before addition, alteration, or new construction is begun in the residential care facility or on the premises; (III)
Thirty days in advance of closure of the residential care facility for persons with mental illness; (III)
Within two weeks of any change of administrator; (II, III)
Within 30 days when any change in the category of license is sought. (III)
Prior to the purchase, transfer, assignment, or lease of a residential care facility the licensee shall:
	1.	Inform the department in writing of pending sale, transfer, assignment, or lease of the facility; (III)
	2.	Inform the department in writing of the name and address of the prospective purchaser, transferee, assignee, or lessee at least 30 days before the sale, transfer, assignment, or lease is completed; (III)
	3.	Submit a written authorization to the department permitting the department to release information of whatever kind from the department’s files concerning the licensee’s residential care facility to the named prospective purchaser, transferee, assignee, or lessee. (III)
After the authorization has been submitted to the department, the department shall upon request send or give copies of all recent licensure surveys and any other pertinent information relating to the facility’s licensure status to the prospective purchaser, transferee, assignee or lessee. Costs for copies requested shall be paid by the prospective purchaser, transferee, assignee or lessee. No information personally identifying any resident shall be provided to prospective purchaser, transferee, assignee or lessee. (II, III)
This rule is intended to implement Iowa Code sections 135C.6(3) and 135C.16(2).
481—62.7(135C) Administrator. Each residential care facility for persons with mental illness shall have one person in charge, duly approved by the department or acting in a provisional capacity in accordance with these rules. (II, III)
	62.7(1) The administrator shall be at least 21 years of age and shall meet at least one of the following conditions:
	a. 	Be a licensed nursing home administrator, or a certified residential care administrator in Iowa. These individuals must have at least two years’ experience in direct care or supervision of persons with mental illness, (II, III) or
	b. 	Be a qualified mental health professional (QMHP) with at least one year of experience in an administrative capacity in a health care facility, (II, III) or
	c. 	Have completed a one-year educational training program approved by the department with emphasis on serving the needs of persons with mental illness, and two years’ experience in direct care or supervision of persons with mental illness. (II, III)
	d. 	Those individuals currently employed as administrators on the effective date of these rules (March 30, 1988) shall not be required to meet the above criteria during their employment in the current facility.
	62.7(2) The administrator shall be responsible for no more than 150 beds in total if the administrator is an administrator of more than one facility. (II, III)
	a. 	The distance between the two farthest facilities shall be no greater than 50 miles. (II, III)
	b. 	An administrator of more than one facility must designate an administrative staff person in each facility who shall be responsible for directing programs in the facility during the administrator’s absence. (II, III)
	62.7(3) The administrative staff person shall be designated in writing and immediately available to the facility on a 24-hour basis when the administrator is absent and residents are in the facility. (II, III)
The person(s) designated shall:
	a. 	Have at least two years’ experience or training in a supervisory or direct care position in a mental health setting; (II, III)
	b. 	Be knowledgeable of the operation of the facility; (II, III)
	c. 	Have access to records concerned with the operation of the facility; (II, III)
	d. 	Be capable of carrying out administrative duties and of assuming administrative responsibilities; (II, III)
	e. 	Be at least 21 years of age; (III)
	f. 	Be empowered to act on behalf of the licensee during the administrator’s absence concerning the health, safety, and welfare of the residents; (II, III)
	g. 	Have training to carry out assignments and take care of emergencies and sudden illnesses of residents. (II, III)
	62.7(4) If an administrator serves more than one facility, a written plan shall be developed and available for review and approval by the department designating regular and specific times the administrator will be available to meet with the staff and residents to provide direction and supervision of resident care and services. (II, III)
	62.7(5) The licensee may be the approved administrator providing the requirements set forth in these rules are met. (III)
	62.7(6) When a facility has been unable to replace the administrator, through no fault of its own, a provisional administrator meeting the qualifications of the administrative staff person may be appointed on a temporary basis by the licensee to assume the administrative responsibilities for the facility. This person shall not serve more than three months. The department must be notified before the appointment of the provisional administrator. (III)
A facility applying for initial licensing shall not have a provisional administrator. (III)
This rule is intended to implement Iowa Code section 135C.14(2).
481—62.8(135C) Administration.
	62.8(1) The licensee shall:
	a. 	Be responsible for the overall operation of the RCF/PMI. (III)
	b. 	Be responsible for compliance with all applicable laws and with the rules of the department. (II, III)
	c. 	Establish written policies, which shall be available for review by the department or other agencies designated by Iowa Code section 135C.16(3), for the operation of the RCF/PMI including but not limited to: (III)
	1.	Personnel (III)
	2.	Admission (III)
	3.	Evaluation services (II, III)
	4.	Programming and individual program plan (II, III)
	5.	Crisis intervention (II, III)
	6.	Discharge or transfer (III)
	7.	Medication management (II)
	8.	Resident property (II, III)
	9.	Financial affairs (II, III)
	10.	Records (III)
	11.	Health and safety (II, III)
	12.	Nutrition (III)
	13.	Physical facilities and maintenance (III)
	14.	Care review (III)
	15.	Resident rights (II, III)
	d. 	Furnish statistical information concerning the operation of the facility to the department within 30 days of request. (III)
	62.8(2) The administrator shall be responsible for the implementation of procedures to support the policies established by the licensee. (III)
This rule is intended to implement Iowa Code section 135C.14.
481—62.9(135C) Personnel.
	62.9(1) The personnel policies and procedures shall include the following requirements: (III)
	a. 	Written job descriptions for all employees or agreements for all consultants, which include duties and responsibilities; education, experience, or other requirements, and supervisory relationships. (III)
	b. 	Annual performance evaluation of all employees and consultants which is dated and signed by the employee or consultant and the supervisor. (III)
	c. 	Personnel records which are current, accurate, complete, and confidential to the extent allowed by law. The record shall contain documentation of how the employee’s or consultant’s education and experience are relevant to the position for which hired. (III)
	d. 	Roles, responsibilities, and limitation of student interns and volunteers. (III)
	e. 	An orientation program for all newly hired employees and consultants which includes an introduction to the facility’s personnel policies and procedures, and a discussion of the facility’s safety plan. (II, III)
	f. 	A plan for a continuing education program with a minimum of eight in-service programs per year for all employees which shall include a written, individualized staff development plan for each employee. This includes, but is not limited to, the administrator, department heads, and direct care staff. The plan shall take into consideration the needs of the facility as identified in the résumé of care. The plan shall ensure that each employee has the opportunity to develop and enhance skills and to broaden and increase knowledge contributing to effective resident care, including but not limited to: (II, III)
	(1)	First aid. (II, III)
	(2)	Human needs and behavior. (II, III)
	(3)	Problems and needs of persons with mental illness. (II, III)
	(4)	Medication. (II, III)
	(5)	Crisis intervention. (II)
	(6)	Delivery of services in accordance with the principles of normalization. (III)
	(7)	Wellness. (III)
	(8)	Fire safety, disaster, and tornado preparation. (II, III)
	g. 	Equal opportunity and affirmative action employment practices. (III)
	h. 	Procedures to be used when disciplining an employee. (III)
	i. 	Appropriate dress and personal hygiene for staff and residents. (III)
	62.9(2) The facility shall require regular health examinations for all personnel, and examinations shall be required at the commencement of employment and thereafter at least every four years. The examination shall include, at a minimum, the health and tuberculosis status of the employee. (III)
	a. 	No person shall be allowed to provide services in a facility if the person has a disease:
	(1)	Which is transmissible through required workplace contact, (I, II, III)
	(2)	Which presents a significant risk of infecting others, (I, II, III)
	(3)	Which presents a substantial possibility of harming others, and (I, II, III)
	(4)	For which no reasonable accommodation can eliminate the risk. (I, II, III)
Refer to Guidelines for Infection Control in Hospital Personnel, Centers for Disease Control, U.S. Department of Health and Human Services, PB85-923402 to determine (1), (2), (3) and (4).
	b. 	There shall be written policies for emergency medical care for employees in case of sudden illness or accident. These policies shall include the administrative individuals to be contacted. (III)
	c. 	Health certificates for all employees shall be available for review by the department. (III)
	62.9(3) Staffing. The facility shall establish, subject to approval of the department, the numbers and qualifications of the staff required in an RCF/PMI using as its criteria the services being offered as indicated on the résumé of care and as required for implementation of individual program plans. (II, III)
	a. 	Personnel in an RCF/PMI shall provide 24-hour coverage for residential care services. Personnel shall be up and dressed at all times in facilities over 15 beds. In facilities with 15 or less beds, personnel shall be up and dressed when residents are awake. (II, III)
	b. 	The policies and procedures shall provide for staff accessibility during normal sleeping hours in facilities with 15 beds or less. (I)
	c. 	Direct care staff shall be present in the facility unless all residents are involved in activities away from the facility. The policies and procedures shall provide for an on-call staff person to be available when residents and staff are absent from the facility. (II, III)
	(1)	The on-call staff person shall be designated in writing.
	(2)	Residents shall be informed of how to call the on-call person.
	d. 	The staffing plan shall ensure that at least one qualified direct care staff is on duty to carry out and implement the individual program plans. (II, III)
	e. 	The RCF/PMI shall provide for services of a qualified mental health professional by direct employment or contract and whose responsibilities shall include, but not be limited to: (II, III)
	(1)	Approval of each resident’s individual program plan; (II, III)
	(2)	Monitoring the implementation of each resident’s individual program plan; (II, III)
	(3)	Recording each resident’s progress; (II, III)
	(4)	Participation in a periodic review of each individual program plan pursuant to 62.12(4)“a” and “b.” (II, III)
	f. 	Each residential care facility with over 15 beds shall employ a person to direct the activity program both inside and outside the facility in accordance with each resident’s individual program plan. (III)
	g. 	Staff for the activity program shall be provided on a minimum basis of 45 minutes per licensed bed per week:
	(1)	The activity coordinator shall have completed the activity coordinator’s orientation course approved by the department within six months of beginning employment or have comparable training and experience as approved by the department. (III)
	(2)	The activity coordinator shall attend workshops or educational programs which relate to activity programming. These shall total a minimum of ten contact hours per year. (III)
	(3)	There shall be a written plan for personnel coverage when the activity coordinator is absent during scheduled working hours. (III)
	h. 	The activity coordinator shall have access to all residents’ records excluding financial records; (III)
	i. 	Responsibilities of the activity coordinator shall include:
	(1)	Coordinating all activities, including volunteer or auxiliary activities and religious services. (III)
	(2)	Keeping all necessary records including attendance, individual resident progress notes at least quarterly, and monthly calendars prepared one month in advance. (III)
	(3)	Coordinating the activity program with all other services in the facility. (III)
	(4)	Participating in the in-service training program in the facility. This shall include attending as well as presenting sessions. (III)
	62.9(4) Personnel record. A personnel record shall be kept for each employee. (III)
	a. 	The record shall include the employee’s:
	1.	Name and address, (III)
	2.	Social security number, (III)
	3.	Date of birth, (III)
	4.	Date of employment, (III)
	5.	References, (III)
	6.	Position in the facility, (III)
	7.	Job description, (III)
	8.	Documentation of experience and education, (III)
	9.	Staff development plan, (III)
	10.	Annual performance evaluation, (II, III)
	11.	Documentation of disciplinary action, (II, III)
	12.	Date and reason for discharge or resignation, (III)
	13.	Current physical examination. (III)
	b. 	The personnel records shall be made available to the long-term care resident’s advocate/ombudsman of the department of elder affairs in response to a complaint being investigated.
	62.9(5) Personnel histories.
	a. 	Each health care facility shall submit a form specified by the department of public safety to the department of public safety, and receive the results of a criminal history check and dependent adult abuse record check before any person is employed in a health care facility. The health care facility may submit a form specified by the department of human services to the department of human services to request a child abuse history check. For the purposes of this subrule, “employed in a facility” shall be defined as any individual who is paid, either by the health care facility or any other entity (i.e., temporary agency, private duty, Medicare/Medicaid or independent contractors), to provide direct or indirect treatment or services to residents in a health care facility. Direct treatment or services include those provided through person-to-person contact. Indirect treatment or services include those provided without person-to-person contact such as those provided by administration, dietary, laundry, and maintenance. Specifically excluded from the requirements of this subrule are individuals such as building contractors, repair workers or others who are in a facility for a very limited purpose, are not in the facility on a regular basis, and who do not provide any treatment or services to the residents of the health care facility. (I, II, III)
	b. 	A person who has a criminal record or founded dependent adult abuse report cannot be employed in a health care facility unless the department of human services has evaluated the crime or founded abuse report and concluded that the crime or founded abuse report does not merit prohibition from employment. (I, II, III)
	c. 	Each health care facility shall ask each person seeking employment in a facility “Do you have a record of founded child or dependent adult abuse or have you ever been convicted of crime in this state or any other state?” The person shall also be informed that a criminal history and dependent adult abuse record check will be conducted. The person shall indicate, by signature, that the person has been informed that the record checks will be conducted. (I, II, III)
	d. 	If a person has a record of founded child abuse in Iowa or any other state, the person shall not be employed in a health care facility unless the department of human services has evaluated the crime or founded report and concluded that the report does not merit prohibition of employment. (I, II, III)
	e. 	Proof of dependent adult abuse and criminal history checks may be kept in files maintained by the temporary employee agencies and contractors. Facilities may require temporary agencies and contractors to provide a copy of the results of the dependent adult abuse and criminal history checks. (I, II, III)
This rule is intended to implement Iowa Code sections 135C.14(2) and 135C.14(6).
481—62.10(135C) General admission policies. There shall be admission policies which address the following:
	1.	No resident shall be admitted or retained who is in need of greater services than the facility can provide. (II, III)
	2.	Residents shall be admitted only on a written order signed by a physician certifying that the individual requires no more than personal care and supervision and does not require nursing care. (II, III)
	3.	A preplacement visit shall be completed prior to admission, except in case of an emergency admission or readmission, to familiarize the applicant with the facility and services offered. The policies and procedures may allow for waiving the requirement at the request of a person seeking admission when the completion of the visit would create a hardship for the person seeking admission. If the distance to be traveled makes it impossible to complete the visit in an eight-hour day, this may be considered to create a hardship. (III)
	4.	Prior to admission of an applicant, the facility shall obtain sufficient information to determine if its program is appropriate and adequate to meet the person’s needs. (III)
	5.	Admission criteria shall include but not be limited to age, sex, diagnosis, from the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, substance abuse, dual diagnosis and criteria that are consistent with the résumé of care. (III)
	6.	Each facility shall maintain a waiting list with selection priorities identified. (III)
	7.	No RCF/PMI may admit more residents than the number of beds for which it is licensed. (II, III)
	8.	There shall be a written, organized orientation program for all residents which shall be planned and implemented to resolve or reduce personal, family, business, and emotional problems that may interfere with the health care, recovery, and rehabilitation of the individual and which shall be available for review by the department. (III)
	9.	Infants and children under the age of 18 shall not be admitted to an RCF/PMI for adults unless given prior written approval by the department. A distinct part of an RCF/PMI, segregated from the adult section, may be established based on a résumé of care submitted by the licensee or applicant which is commensurate with the needs of the residents of the health care facility and has received the department’s review and approval. (III)
This rule is intended to implement Iowa Code sections 135C.3 and 135C.23.
481—62.11(135C) Evaluation services.
	62.11(1) Each resident admitted shall have had a physical examination prior to admission and annually thereafter. If the resident is admitted directly from a hospital, a copy of the hospital admission physical and discharge summary may be part of the record in lieu of an additional physical examination. (II, III)
The record of the admission physical examination shall portray the current medical status of the resident and shall include the resident’s name, sex, age, medical history, tuberculosis status, diagnosis, statement of chief complaints, and results of any diagnostic procedure. (II, III)
	62.11(2) Evaluation services shall be provided to each resident. An annual evaluation of each resident shall be completed no later than 12 months from the date of the last available evaluation. For residents who are on leave from a state mental health institution, the institution shall be responsible for the completion of the evaluation. The facility shall ensure the completion of the evaluation of all other residents. The annual evaluation shall identify physical health and current level of functioning and need for services. (II, III)
	62.11(3) The portion of the evaluation to identify the resident’s physical health shall:
	a. 	Result in identification of current illness and disabilities and recommendations for physical and physiological treatment and services. (II, III)
	b. 	Include an evaluation of the resident’s ability for health maintenance. (III)
	c. 	Be performed by a medical doctor or doctor of osteopathic medicine who holds a current license to practice medicine in the state of Iowa. If the evaluation is completed out of Iowa, it must be by a physician who holds a current license in the state in which the evaluation is performed. (II, III)
	62.11(4) The portion of the evaluation to identify the resident’s current functioning level and need for services shall:
	a. 	Identify the resident’s level of functioning and need for services in each of the following areas: self-care, community living skills, psychotherapeutic treatment, vocational skills, academic skills. (II, III)
	b. 	Be of sufficient detail to determine the appropriateness of placement according to the skills and needs of the resident. (II, III)
	c. 	Be made without regard to the availability of services. (III)
	d. 	Be performed by a QMHP, in consultation with the interdisciplinary team. (II, III)
	e. 	If an evaluation is available from the referral source, the evaluation shall be secured by the facility prior to the admission of the applicant. (III)
	f. 	If an evaluation is not available, or does not contain all the required information, the facility shall ensure an evaluation to the extent necessary to determine if the applicant meets the criteria for admission. For those admitted, the remainder of the evaluation shall be performed prior to the development of an individual program plan. (III)
	g. 	Results of all evaluations shall be in writing and maintained in the resident’s record. Evaluations subsequent to the initial evaluation shall be performed in sufficient detail to determine changes in the resident’s physical health, skills and need for services. (II, III)
	62.11(5) A narrative social history shall be completed for each resident within 30 days of admission and approved by the qualified mental health professional prior to the development of the IPP. (III)
	a. 	When the social history was secured from another provider, the information contained shall be reviewed within 30 days of admission. The date of the review, signature of the staff reviewing the history and a summary of significant changes in the information shall be entered in the resident’s record. (III)
	b. 	An annual review of the information contained within the social history shall be incorporated into the individual program plan progress note. (III)
	c. 	The social history shall minimally address the following areas:
	1.	Referral source and reason for admission, (II, III)
	2.	Legal status, (II, III)
	3.	A description of previous living arrangements, (III)
	4.	A description of previous services received and summary of current service involvements, (II, III)
	5.	A summary of significant medical conditions including, but not limited to, illnesses, hospitalizations, past and current drug therapies, and special diets, (II, III)
	6.	Substance abuse history, (II, III)
	7.	Work history, (III)
	8.	Educational history, (III)
	9.	Relationship with family, significant others, and other support systems, (III)
	10.	Cultural and ethnic background and religious affiliation, (II, III)
	11.	Hobbies and leisure time activities, (III)
	12.	Likes, dislikes, habits, and patterns of behavior, (II, III)
	13.	Impressions and recommendations.
This rule is intended to implement Iowa Code section 135C.14(7).
481—62.12(135C) Programming.
	62.12(1) Individual program plan. An individual program plan (IPP) for each resident shall be developed by an interdisciplinary team. Services to the resident shall be appropriate to address the short-term transitional or long-term residential needs of the resident. The resident or the resident’s legal guardian has the ultimate authority to accept or reject the plan unless otherwise determined by the court. The IPP shall be approved and implementation monitored by the QMHP. (II, III)
	a. 	The IPP shall be based on the individual service plan of the referring agency, if available, the information contained in the social history, the need for services identified in the evaluation, and any other pertinent information. (III)
	b. 	The facility shall assist the resident in obtaining access to academic, community living skills training, legal, self-care training, support, transportation, treatment, and vocational training services to the resident as needed. These services may be provided by the facility or obtained from other providers. (III)
	c. 	Services to the resident shall be provided in the least restrictive environment and shall incorporate the principle of normalization. (III)
	d. 	If needed services are not available and accessible, the facility shall document the actions which were taken to locate and access or deliver those services. The documentation shall include the identification of the type of needs which will not be met due to the lack of available services. (III)
	e. 	The IPP shall be developed within 30 days following admission to the facility and renewed at least annually. (II, III)
	f. 	The IPP shall be in writing, dated, signed by the interdisciplinary team members, and maintained in the resident’s record. (III)
	g. 	Written notice of the meeting to develop an IPP shall be sent to all persons to be included in the interdisciplinary team conference in advance of the scheduled meeting. (III)
	62.12(2) The IPP shall include the following:
	1.	Goals, (III)
	2.	Objectives, (III)
	3.	The specific service(s), including medication counseling, to be provided to achieve the objectives, the person(s) or agency(ies) responsible for providing the service(s), and the date of initiation and anticipated duration of service(s). (III)
	62.12(3) The IPP shall state the evaluation procedure for determining if objectives are achieved which shall include the incorporation of a continuous process for review and revision. (III)
	62.12(4) There shall be a review of the IPP by relevant staff, the resident, and appropriate others at least semiannually. (II, III)
	a. 	The review shall include the development of a written report which addresses the following: summary of the resident’s progress toward objectives; the need for continued services and any recommendation concerning alternative services or living arrangements; and any recommended change in guardianship or conservatorship status. The report shall reflect those involved in the review and the date of the review, and shall be maintained in the resident’s record. (II, III)
	b. 	The review shall be approved by the qualified mental health professional. (III)
	62.12(5) There shall be procedures for recording the activities of each service provider toward assisting the resident in achieving the objectives in the IPP and the resident’s response which shall include a mechanism for coordination with all service providers. (III)
	a. 	An entry into the resident’s record shall be made by staff whenever possible at the time of service provision but no later than seven days from service provision. (III)
	b. 	Entries shall be dated and signed by the person providing the service. (III)
	c. 	When the service includes ongoing activities occurring more than once a week, a summarized entry may be made weekly by staff in the resident’s record. (III)
	d. 	Entries shall be written in terms of behavioral observations and specific activities. Entries that involve subjective interpretations of a resident’s behavior or progress shall be clearly identified and shall be supplemented with the behavioral observations which served as the basis of the interpretation. (III)
This rule is intended to implement Iowa Code section 135C.14.
481—62.13(135C) Crisis intervention.
	62.13(1) There shall be written policies and procedures concerning crisis intervention. (II) These policies and procedures shall be:
	a. 	Directed to maximizing the growth and development of the individual by incorporating a hierarchy of available alternative methods that emphasize positive approaches; (II, III)
	b. 	Available in each program area and living unit; (II, III)
	c. 	Available to individuals and their families; and (II, III)
	d. 	Developed with the participation, as appropriate, of individuals served. (II, III)
	62.13(2) Corporal punishment and verbal abuse (shouting, screaming, swearing, name- calling, or any other activity that would be damaging to an individual’s self-respect) are prohibited by written policy. (II)
	62.13(3) Medication shall not be used as punishment, for the convenience of staff, or as a substitute for a program. Direct care staff shall monitor residents on medication and notify the physician if a resident is too sedated to participate in IPP. (I, II)
	62.13(4) Residents shall not be subjected to mechanical restraint. (I, II)
	62.13(5) There shall be written policies that define the uses of seclusion and physical restraints, designate the staff member(s) who may authorize its use, and establish a mechanism for monitoring and controlling its use. (I, II) Temporary physical restraint and temporary seclusion of residents shall be used only under the following conditions: (I, II)
	a. 	An emergency to prevent injury to the resident or to others; or (I, II)
	b. 	For crisis intervention but shall not be used for punishment, for the convenience of staff or as a substitution for supervision or program; (I, II) and
	c. 	Seclusion may only be used in an RCF/PMI if a variance is granted. When a seclusion room is used, it shall meet the standards set out in 481—subrule 61.5(12). (I, II)
	62.13(6) The physician and QMHP shall be notified immediately of the resident’s need for placement in seclusion and a time-limited order for seclusion obtained from the physician. The order shall be for no more than one hour at a time. If the resident is placed in seclusion longer than one hour, the resident shall be visited and evaluated by the physician or qualified mental health professional before a continuation of the seclusion order can be obtained. If the evaluation is conducted by a QMHP, the physician shall be notified of the resident’s condition and the physician shall see the resident within 24 hours of each incident of seclusion and sign the seclusion order. (I, II)
	62.13(7) If orders for seclusion remain in force for more than a total of 3 hours in a 24-hour period, the facility shall make arrangements for immediate transfer of the resident to a higher level of care. (I, II)
	62.13(8) Standing or PRN orders for seclusion are prohibited. (I, II)
	62.13(9) Written documentation of the above information shall be kept as a part of each resident’s record and the administrator shall be responsible for maintaining a daily record of seclusion usage which shall be kept available for review by the department. (II, III)
	62.13(10) Written documentation shall be kept of each incident of seclusion to minimally include: (II)
	a. 	Explanation of less restrictive measures implemented prior to use of seclusion, (I, II)
	b. 	Record of visual observation of the resident every ten minutes or more frequently if needed, (I)
	c. 	Description of the resident’s activity at the time of observation to include verbal exchange and behavior, (I, II)
	d. 	Description of safety procedures taken (removal of dangerous objects, etc.), (I)
	e. 	Record of vital signs including blood pressure, pulse and respiration unless contraindicated by resident behavior and reasons documented, (I, II)
	f. 	Record of intake of food and fluid, (II, III)
	g. 	Record of rest room use, (II, III)
	h. 	Record of numbers of hours and minutes in seclusion. (II)
	62.13(11) The facility shall provide training by qualified professionals to the staff on physical restraint and seclusion theory and techniques. (I)
	a. 	The facility shall keep a record of above training for review by the department and shall include attendance. (II, III)
	b. 	Only staff who have documented training in physical restraint and seclusion theory and techniques shall be authorized to assist with seclusion or physical restraint of a resident. (I)
	c. 	Under no circumstances shall a resident be allowed to actively or passively assist in the restraint of another resident. (I)
This rule is intended to implement Iowa Code section 135C.14.
481—62.14(135C) Discharge or transfer. Procedures for the discharge or transfer of the resident shall be established and followed: (II, III)
	62.14(1) The decision to discharge a person and the plan for doing so shall be established through the participation of the resident, members of the interdisciplinary team and other resource personnel as appropriate for the welfare of the individual. (II, III)
	a. 	Discharge planning shall begin within 30 days of admission and be carried out in accordance with the IPP. (II, III)
	b. 	As changes occur in a resident’s physical or mental condition, necessitating services or care which cannot be adequately provided by the facility, the resident shall be transferred promptly to another appropriate facility pursuant to 62.10(1)“a.”  (I, II)
	c. 	Notification shall be made to the next of kin, legal representative, attending physician, and sponsoring agency, if any, prior to transfer or discharge of any resident. (III)
	d. 	Proper arrangements shall be made for the welfare of the resident prior to the transfer or discharge in the event of an emergency or inability to reach the next of kin or legal representative. (III)
	e. 	The licensee shall not refuse to discharge or transfer a resident when directed by the physician, resident, legal representative, or court. (II, III)
	f. 	Advance notification by telephone shall be made to the receiving facility prior to the transfer of any resident. (III)
	g. 	When a resident is transferred or discharged, the current evaluation and treatment plan and progress notes for the last 30 days, as set forth in these rules, shall accompany the resident. (II, III)
	h. 	Prior to the transfer or discharge of a resident to another health care facility, arrangements to provide for continuity of care shall be made with the facility to which the resident is being sent. (II, III)
	i. 	A discharge or transfer authorization and summary shall be prepared for each resident who has been discharged or transferred from the facility and shall be disseminated to appropriate persons to ensure continuity of care and in accordance with the requirements to ensure confidentiality. (II, III)
	j. 	A transfer to a part of a facility that has a different license must be handled the same way as a transfer to another facility, and not as an intrafacility transfer.
	62.14(2) Intrafacility transfer. Residents shall not be moved from room to room within a health care facility arbitrarily. (I, II)
	a. 	Involuntary relocation may occur only to implement goals and objectives in the IPP and in the following situations:
	(1)	Incompatibility with or behavior disturbing to roommates, as documented in the residents’ records; (I, II)
	(2)	To allow a new admission to the facility which would otherwise not be possible due to separation of roommates by sex; (II, III)
	(3)	Reasonable and necessary administrative decisions regarding the use and functioning of the building. (II, III)
	b. 	Unreasonable and unjustified reasons for changing a resident’s room without the concurrence of the resident or legal guardian include:
	(1)	Punishment or behavior modification. (II)
	(2)	Discrimination on the basis of race or religion. (II)
	c. 	If intrafacility relocation is necessary for reasons outlined in paragraph “a,” the resident shall be notified at least 48 hours prior to the transfer and the reason shall be explained. The legal guardian shall be notified as soon as possible. The notification shall be documented in the resident’s record and signed by the resident or legal guardian. (II)
	d. 	If emergency relocation is required to protect the safety or health of the resident or other residents, the notification requirements may be waived. The conditions of the emergency shall be documented. The family and legal guardian shall be notified immediately, or as soon as possible, of the condition requiring emergency relocation and the notification shall be documented. (II)
	62.14(3) Involuntary discharge or transfer. Residents shall be transferred or discharged from the facility in accordance with contract arrangements and requirements of Iowa Code chapter 135C which states that a resident shall be transferred or discharged only for the following:
	a. 	Medical reasons which include:
	(1)	Acute stage of alcoholism, mental illness, or an active state of a communicable disease, (I, II) or
	(2)	Need for medical procedures as determined by a physician, or services which cannot be or are not being carried out in the facility. (I, II)
	b. 	Resident’s welfare or welfare of other residents which includes a resident who is dangerous to the resident or other residents (I), or
	c. 	Nonpayment except as prohibited by Medicaid. (II)
	62.14(4) Involuntary transfer or discharge of a resident from a facility shall be preceded by a written notice to the resident or responsible party at least 30 days in advance of the proposed transfer or discharge. (II) The 30-day requirement shall not apply in any of the following instances:
	a. 	If an emergency transfer or discharge is mandated by the resident’s health care needs and is in accord with the written orders and written medical justification of the attending physician. Emergency transfers or discharges may also be mandated to protect the health, safety, or well-being of other residents and staff. (I, II)
	b. 	If the transfer or discharge is subsequently agreed to by the resident or by the resident’s legal guardian, and notification is given to the legal guardian, physician, and the person or agency responsible for the resident’s placement, maintenance, and care in the facility. (II)
	(1)	The notice required by 62.14(4) shall contain all of the following information:
	1.	The stated reason for the proposed transfer or discharge. (II)
	2.	The effective date of the proposed transfer or discharge. (II)
	3.	The following statement must be included:
“You have a right to appeal the facility’s decision to transfer or discharge you. If you think you should not have to leave this facility, you may request a hearing in writing or verbally with the Iowa state department of inspections and appeals (hereinafter referred to as department) within seven days after receiving this notice. You have a right to be represented at the hearing by an attorney or any other individual of your choice. If you request a hearing, it will be held no later than 14 days after receipt of your request by the department and you will not be transferred prior to a final decision. Provision may be made for extension of the 14-day requirement upon request to the department designee in emergency circumstances. If you lose the hearing, you will not be transferred before the expiration date of 30 days following receipt of the original notice of the discharge or transfer, or no sooner than 5 days following final decision of such hearing. To request a hearing or receive further information, call the department at (515)281-4115 or you may write to the department to the attention of: Administrator, Division of Health Facilities, Iowa Department of Inspections and Appeals, Lucas State Office Building, Des Moines, Iowa 50319.” (II)
	(2)	A request for a hearing made under 62.14(4)“b”(1) shall stay a transfer or discharge pending a hearing or appeal decision. (II)
	(3)	The type of hearing shall be determined by a representative of the department. Notice of the date, time, and place of the hearing shall be sent by certified mail or delivered in person to the licensee, resident, legal guardian, and Iowa department of elder affairs long-term care resident’s advocate/ombudsman of record, not later than five full business days after receipt of the request. This notice shall also inform the licensee, resident, or legal guardian that they have a right to appear at the hearing in person or be represented by their attorneys or other individual. The hearing shall be dismissed if neither party is present or represented at the hearing. If only one party appears or is represented, the hearing shall proceed with one party present. The Iowa department of elder affairs’ long-term care resident’s advocate/ombudsman shall have the right to appear at the hearing. (II)
	(4)	The hearing shall be heard by a department of inspections and appeals hearing officer pursuant to department rules. The licensee or designee shall have the opportunity to present oral testimony or written materials to show by a preponderance of the evidence just cause why a transfer or discharge may be made. The resident and legal guardian shall also have an opportunity to present oral testimony or written material to show just cause why a transfer or discharge should not be made; the burden of proof rests on the party requesting the transfer or discharge. (II)
	(5)	Based upon all testimony and material submitted to the representative of the department, the representative shall issue, in accordance with Iowa Code chapter 17A, written findings of fact and conclusions of law and issue a decision and order in respect to the adverse action. This decision shall be mailed by regular mail to the licensee, resident, responsible party, and department of elder affairs long-term care ombudsman within 10 working days after the hearing has been concluded. The representative shall have the power to issue fines and citations against the facility in appropriate circumstances.
A request for review of a proposed decision in which the department is the final decision maker shall be made within 15 days of issuance of the proposed decision, unless otherwise provided by statute. Requests shall be mailed or delivered by either party to the Director, Department of Inspections and Appeals, Lucas State Office Building, Des Moines, Iowa 50319-0083. Failure to request review will preclude judicial review unless the department reviews a proposed decision upon its own motion within 15 days of the issuance of the decision. (II)
	(6)	A copy of the notice required by 62.14(4) shall be personally delivered to the resident and a copy placed in the resident’s record. A copy shall also be transmitted to the department, the resident’s legal guardian, physician, the person or agency responsible for the resident’s placement, maintenance, and care in the facility, and the department of elder affairs’ long-term care resident’s advocate/ombudsman. (II)
	(7)	If nonpayment is the basis for involuntary transfer or discharge, the resident shall have the right to make full payment up to the date that the discharge or transfer is to be made and then shall have the right to remain in the facility. (II)
	(8)	The involuntary transfer or discharge shall be discussed with the resident, legal guardian, and the person or agency responsible for the resident’s placement, maintenance, and care in the facility within 48 hours after notice of discharge has been received. The explanation and discussion of the reasons for involuntary transfer or discharge shall be given by the facility administrator or other appropriate facility representative as the administrator’s designee. The content of the discussion and explanation shall be summarized in writing and shall include the names of the individuals involved in the discussions and shall be made a part of the resident’s record. (II)
	(9)	The resident shall receive counseling services before (by sending facility) and after (by receiving facility) the involuntary transfer to minimize the possible adverse effects of the involuntary transfer. Counseling shall be documented in the resident’s record. Counseling shall be provided by a qualified individual who meets one of the following criteria: (II)
	1.	Has a bachelor’s or master’s degree in social work from an accredited college. (II)
	2.	Is a graduate of an accredited four-year college and has had at least one year of full-time paid employment in a social work capacity with a public or private agency. (II)
	3.	Has been employed in a social work capacity for a minimum of four years in a public or private agency. (II)
	4.	Is a licensed psychologist or psychiatrist. (II)
	(10)	The facility shall develop a plan to provide for the orderly and safe transfer or discharge of each resident to be discharged or transferred. (II)
	(11)	The receiving health care facility of a resident involuntarily discharged or transferred shall immediately formulate and implement a plan of care which takes into account possible adverse effects the transfer may cause. (II)
	(12)	In the case of an emergency transfer or discharge as outlined in 62.14(4)“a,” the resident must still be given a written notice prior to or within 48 hours following transfer or discharge. A copy of this notice must be placed in the resident’s file and it must contain all the information required by 62.14(4)“b”(1)“1” and “2.” In addition, the notice must contain a statement in not less than 12-point type, which reads:
“You have a right to appeal the facility’s decision to transfer or discharge you on an emergency basis. If you think you should not have to leave this facility, you may request a hearing in writing or verbally with the Iowa department of inspections and appeals within seven days after receiving this notice. You have the right to be represented at the hearing by an attorney or any other individual of your choice. If you request a hearing, it will be held no later than 14 days after receipt of your request by the department. You may be transferred or discharged before the hearing is held or before a final decision is rendered. If you win the hearing, you have the right to be transferred back into the facility. To request a hearing or receive further information, call the department at (515)281-4115 or you may write to the department to the attention of: Administrator, Division of Health Facilities, Department of Inspections and Appeals, Lucas State Office Building, Des Moines, Iowa 50319-0083.”
A hearing requested pursuant to this subrule shall be held in accordance with 62.14(4)“b”(3), (4) and (5). (II)
	(13)	Residents shall not have the right to a hearing to contest an involuntary discharge or transfer resulting from the revocation of the facility’s license by the department. In the case of a facility voluntarily closing, a period of 30 days must be allowed for an orderly transfer of residents to other facilities. (II)
This rule is intended to implement Iowa Code sections 135C.14(8), 135C.31, 135C.43, and 135C.46.
481—62.15(135C) Medication management.
	62.15(1) Medications shall be prescribed on an individual basis by one who is authorized by Iowa law to prescribe. (I, II)
	a. 	Medication orders shall be correctly implemented by qualified personnel. (II)
	b. 	Qualified staff shall ensure that residents are able to take their own medication. (I, II)
	c. 	Each physician order allowing a resident to take their own medications shall specify whether this self-medication shall be without supervision or under the supervision of qualified staff as defined in 62.15(2). (I, II)
	62.15(2) Drug administration.
	a. 	A properly trained person shall be charged with the responsibility of administering nonparenteral medications.
	b. 	The individual shall have knowledge of the purpose of the drugs, their dangers, and contraindications.
	c. 	This person shall be a licensed nurse or physician or shall have successfully completed a department-approved medication aide course or passed a department-approved medication aide challenge examination administered by an area community college.
	d. 	Prior to taking a department-approved medication aide course, the individual shall:
	(1)	Successfully complete an approved residential aide course, nurse aide course, nurse aide training and testing program or nurse aide competency examination;
	(2)	Be employed in the same facility for at least six consecutive months prior to the start of the medication aide course. This requirement is not subject to waiver.
	(3)	Have a letter of recommendation for admission to the medication aide course from the employing facility.
	e. 	A person who is a nursing student or a graduate nurse may take the challenge examination in place of taking a medication aide course. This individual shall do all of the following before taking the medication aide challenge examination:
	(1)	Complete a clinical or nursing theory course within six months before taking the challenge examination;
	(2)	Successfully complete a nursing program pharmacology course within one year before taking the challenge examination;
	(3)	Provide to the community college a written statement from the nursing program’s pharmacology or clinical instructor indicating the individual is competent in medication administration.
	f. 	A person who has written documentation of certification as a medication aide in another state may become a medication aide in Iowa by successfully completing a department-approved nurse aide competency examination and a medication aide challenge examination.
The requirements of paragraph “d” of this subrule do not apply to this individual.
	g. 	Unit dose medication shall remain in the identifiable unit dose package until given to the resident. (II)
	h. 	Medications that are not contained in unit dose packaging shall be set up and administered by the same person and must be administered within one hour of preparation. (II)
	i. 	The person administering medications must observe and check to make sure the resident swallows oral medications and must record the date, time, amount and name of each medication given. (II)
	j. 	Injectable medications shall be administered by a qualified nurse or physician.
	k. 	Residents certified by their physician as capable of injecting their own insulin may do so. Insulin may be administered pursuant to “j” above or as otherwise authorized by the resident’s physician. Authorization by the physician shall:
	(1)	Be in writing,
	(2)	Be maintained in the resident’s record,
	(3)	Be renewed quarterly,
	(4)	Include the name of the individual authorized to administer the insulin,
	(5)	Include documentation by the physician that the authorized person is qualified to administer insulin to that resident.
	l. 	Current and accurate records must be kept on the receipt and disposition of all Schedule II drugs. (II, III)
	62.15(3) For each resident who is taking medication with or without supervision there shall be documentation on the individual’s record to include:
	a. 	Name of resident, (II, III)
	b. 	Name of drug, dose, and schedule, (II, III)
	c. 	Method of administration, (II, III)
	d. 	Drug allergies and adverse reactions, (I, II)
	e. 	Special precautions, (I, II)
	f. 	Documentation of resident’s continuing ability to administer own medication. (I, II)
	62.15(4) Medication counseling shall be provided for all residents in accordance with the IPP on an ongoing basis and as part of discharge planning unless contraindicated in writing by the physician with reasons and pursuant to 62.12(2)“c.” (II, III)
Each resident shall be given verbal and written information about all medications the resident is currently using, including over-the-counter medications. A suggested reference is “USPDI, Advice for the Patient.” (II, III)
The information shall include:
	a. 	Name, reason for, and amount of medication to be taken; (II)
	b. 	Time medication is to be taken and the reason that schedule was established; (II)
	c. 	Possible benefits, risks and side effects of each medication including over-the-counter medications; (II)
	d. 	The names of people in the community qualified to answer questions about medications. (II, III)
	e. 	A list of available resources or agencies which may assist the resident to obtain medication after discharge. (III)
	62.15(5) Drug storage.
	a. 	Residents who have been certified in writing by the physician as capable of taking their own medications may retain these medications in their bedrooms. Individual locked storage shall be utilized. (II, III)
	b. 	Drug storage for residents who are unable to take their own medications and require supervision shall meet the following requirements:
	(1)	Adequate size cabinet with lock which can be used for storage of drugs, solutions, and prescriptions. A locked drug cart may be used. (II, III)
	(2)	A bathroom shall not be used for drug storage. (II, III)
	(3)	The drug storage cabinet shall be kept locked when not in use. (II, III)
	(4)	The drug storage cabinet key shall be in the possession of the employee charged with the responsibility of administering medication. (III)
	(5)	Medications requiring refrigeration which are stored in a common refrigerator shall be kept in a locked box properly labeled, and separated from food and other items. (III)
	(6)	Drugs for external use shall be stored separately from drugs for internal use. External medications are those to be applied to the outside of the body and include but are not limited to salves, ointments, gels, pastes, soaps, baths, and lotions. Internal medications are those to be applied inside the body or ingested and include but are not limited to oral and injectable medications, eye drops, ear drops and suppositories. Also, eye drops and ear drops shall be separated from each other as well as from other internal and external medications. (II, III)
	(7)	All potent, poisonous, or caustic materials shall be stored in a separate room from the medications. (II, III)
	(8)	Inspection of the condition of stored drugs shall be made by the administrator and a licensed pharmacist not less than once every three months. The inspection shall be verified by a report signed by the administrator and the pharmacist and filed with the administrator. The report shall include, but need not be limited to, certifying absence of the following: expired drugs, deteriorated drugs, improper labeling, drugs for which there is no current order, and drugs improperly stored. (III)
	(9)	Double-locked storage of Schedule II drugs shall not be required under single unit package drug distribution systems in which the quantity stored does not exceed a seven-day supply and a missing dose can be readily detected but must be kept in a locked medication cabinet. Quantities in excess of a seven-day supply must be double-locked. (II)
	c. 	Bulk supplies of prescription drugs shall not be kept. (III)
	62.15(6) Drug safeguards.
	a. 	All labels on medications must be legible. If labels are not legible, the medication shall be sent back to the dispenser as defined in Iowa Code section 147.107 for relabeling. (II, III)
	b. 	The medication for each resident shall be kept or stored in the original dispensed containers. (II, III)
	c. 	The facility shall adopt policies and procedures for the destruction of unused prescription drugs for residents who have died. The policies and procedures shall include, but not be limited to, the following: (III)
	(1)	Drugs shall be destroyed by the person in charge in the presence of the administrator or the administrator’s designee;
	(2)	Notation of the destruction shall be made in the resident’s chart, with signatures of the persons involved in the destruction;
	(3)	The manner in which the drugs are disposed of shall be identified (i.e., incinerator, sewer, landfill). (II, III)
	d. 	The facility shall also adopt policies and procedures for the disposal of controlled substances dispensed to residents whose administration has been discontinued by the prescriber. These policies and procedures shall include, but not be limited to, the following:
	(1)	Procedures for obtaining a release from the resident;
	(2)	The manner in which the drugs were destroyed and by whom, including witnesses to the destruction;
	(3)	Mechanisms for recording the destruction;
	(4)	Procedures to be used when the resident or the conservator or guardian refuses to grant permission for destruction. (II, III)
	e. 	The facility shall adopt policies and procedures for the disposal of unused discontinued medication. The procedures shall include but not be limited to:
	(1)	A specified time after which medication must be destroyed, sent back to the dispenser or placed in long-term storage;
	(2)	Procedures for obtaining permission of the resident, or the conservator or guardian;
	(3)	Procedures to be used when the resident or conservator or guardian refuses to grant permission for disposal;
	(4)	Unused discontinued medication shall be locked and shall be separate from current medication. (II, III)
	f. 	All medication orders which do not specifically indicate the number of doses to be administered or the length of time the drug is to be administered shall be stopped automatically after a given time period. The automatic stop order may vary for different types of drugs. The facility, in consultation with a physician or pharmacist serving the home, shall institute policies and provide procedures. These shall be provided to all prescribers and pharmacists serving the facility and conveniently located for personnel administering medications. (III)
	g. 	Residents shall not keep any prescription medication in their possession unless the attending physician has certified in writing on the resident’s medical record that the resident is mentally and physically capable of doing so. Over-the-counter medications may be maintained provided they are in a locked container and pursuant to subrule 62.16(5). (I, II)
	h. 	No prescription drugs shall be administered to a resident without a written order signed by a person qualified to prescribe the medication and renewed quarterly. (II)
	i. 	Prescription drugs shall be reordered only with the permission of the attending prescriber. (II, III)
	j. 	No medications prescribed for one resident may be administered to or allowed in the possession of another. (II)
	k. 	Residents on prescribed medication may maintain over-the-counter medication pursuant to 62.15(6)“g” unless contraindicated by the physician. The facility shall request this information from the physician and document in the resident’s record. (II)
	62.15(7) Each facility shall have policies and procedures established to govern the administration of prescribed medications to residents on leave from the facility. (III)
	a. 	Medication may be issued to residents who will be on leave from a facility for less than 24 hours. Non-child-resistant containers may be used. Each container may hold only one medication. A label on each container shall indicate the date, the resident’s name, the facility, the medication, its strength, dose, and time of administration.
	b. 	Medication for residents on leave from a facility longer than 24 hours shall be obtained in accordance with requirements established by the Iowa board of pharmacy examiners.
	c. 	Medication distributed as above may be issued only by facility personnel responsible for administering medication.
	62.15(8) Each RCF/PMI that administers controlled substances shall obtain annually a registration issued by the board of pharmacy pursuant to Iowa Code section 124.302(1). (III)
This rule is intended to implement Iowa Code section 135C.14.
481—62.16(135C) Resident property.
	62.16(1) The admission of a resident does not give the facility or any employee of the facility the right to manage, use, or dispose of any property of the resident except with the written authorization of the resident or the resident’s legal guardian. (II, III)
	62.16(2) The admission of a resident shall not grant the RCF/PMI the authority or responsibility to manage the personal affairs of the resident except as may be necessary for the resident’s safety and for safe and orderly management of the residential care facility as required by these rules and in accordance with the IPP. (III)
	62.16(3) An RCF/PMI shall provide for the safekeeping of personal effects, funds, and other property of its residents. The facility may require that items of exceptional value or which would convey unreasonable responsibilities to the licensee be removed from the premises of the facility for safekeeping. (III)
	62.16(4) Resident’s funds held by the RCF/PMI shall be in a trust account and kept separate from funds of the facility. (III)
	62.16(5) No administrator, employee or representative thereof shall act as guardian, trustee, or conservator for any resident or the resident’s property, unless the resident is related to the person acting as guardian within the third degree of consanguinity. (III)
	62.16(6) If a facility is a county care facility and upon the verified petition of the county board of supervisors, the district court may appoint the administrator of a county care facility as conservator or guardian or both of a resident of that county care facility without fee. The administrator may establish either separate or common bank accounts for cash funds of these residents. (III)
This rule is intended to implement Iowa Code section 135C.24.
481—62.17(135C) Financial affairs. Each resident who has not been assigned a guardian or conservator by the court may manage the resident’s personal financial affairs, and to the extent, under written authorization by the resident that the facility assists in management, the management shall be carried out in accordance with Iowa Code section 135C.24. (II)
	62.17(1) The facility shall maintain a written account of all the resident’s funds received by or deposited with the facility. (II)
	a. 	An employee shall be designated in writing to be responsible for resident accounts. (II)
	b. 	The facility shall keep on deposit personal funds over which the resident has control.
	c. 	If the resident requests these funds, they shall be given to the resident with a receipt maintained by the facility and a copy to the resident. If a conservator or guardian has been appointed for the resident, the conservator or guardian shall designate the method of disbursing the resident’s funds. (II)
	d. 	If the facility makes a financial transaction on a resident’s behalf, the resident or the resident’s legal guardian or conservator must receive or acknowledge having seen an itemized accounting of disbursements and current balances at least quarterly. A copy of this statement shall be maintained in the resident’s financial or business record. (II)
	e. 	A resident’s personal funds shall not be used without the written consent of the resident or the resident’s guardian. (II)
	f. 	A resident’s personal funds shall be returned to the resident when the funds have been used without the written consent of the resident or the resident’s guardian. The department may report findings that resident funds have been used without written consent to the audits division or the local law enforcement agency, as appropriate. (II)
	62.17(2) Contracts. There shall be a written contract between the facility and each resident which meets the following requirements:
	a. 	State the base rate or scale per day or per month, the services included, and the method of payment; (III)
	b. 	Contain a complete schedule of all offered services for which a fee may be charged in addition to the base rate; (III)
	c. 	Stipulate that no further additional fees shall be charged for items not contained in complete schedule of services as set forth in subrule 62.17(2); (III)
	d. 	State the method of payment of additional charges; (III)
	e. 	Contain an explanation of the method of assessment of additional charges and an explanation of the method of periodic reassessment, if any, resulting in charging the additional charges; (III)
	f. 	State that additional fees may be charged to the resident for nonprescription drugs, other personal supplies, and services by a barber, beautician, etc.	(III)
	g. 	Contain an itemized list of those services, with the specific fee the resident will be charged and method of payment, as related to the resident’s current condition, based on the program assessment at the time of admission, which is determined in consultation with the administrator. (III)
	h. 	Include the total fee to be charged initially to the specific resident. (III)
	i. 	State the conditions whereby the facility may make adjustments to its overall fees for residential care as a result of changing costs. (III) Furthermore, the contract shall provide that the facility shall give:
	(1)	Written notification to the resident and responsible party, when appropriate, of changes in the overall rates of both base and additional charges at least 30 days prior to the effective date of changes; (III)
	(2)	Notification to the resident and payor when appropriate, of changes in additional charges based on a change in the resident’s condition. Notification must occur prior to the date the revised additional charges begin. If notification is given orally, subsequent written notification must also be given within a reasonable time, not to exceed one week, listing specifically the adjustments made; (III)
	(3)	State the terms of agreement in regard to refund of all advance payments, in the event of transfer, death, or voluntary or involuntary discharge. (III)
	j. 	State the terms of agreement concerning the holding and charging for a bed when a resident is hospitalized or leaves the facility temporarily for recreational or therapeutic reasons. The terms shall contain a provision that the bed will be held at the request of the resident or the resident’s legal representative.
	(1)	The facility shall ask the resident or legal representative if they want the bed held. This request shall be made before the resident leaves or within 48 hours after the resident leaves. The inquiry and the response shall be documented. (II)
	(2)	The facility shall reserve the bed when requested for as long as payments are made in accordance with the contract. (II)
	k. 	State the conditions under which the involuntary discharge or transfer of a resident would be effected; (III)
	l. 	State the conditions of voluntary discharge or transfer; (III)
	m. 	Set forth any other matters deemed appropriate by the parties to the contract. No contract or any provision shall be drawn or construed so as to relieve any health care facility of any requirement or obligation imposed upon it by this chapter or any standards or rules in force pursuant to this chapter; (III)
	62.17(3) Each party shall receive a copy of the signed contract. (III)
This rule is intended to implement Iowa Code sections 135C.24 and 135C.23(1).
481—62.18(135C) Records.
	62.18(1) Resident record. The licensee shall keep a permanent record about each resident with all entries current, dated, and signed. (II) The record shall include:
	a. 	Name and previous address of resident; (III)
	b. 	Birth date, sex, and marital status of resident; (III)
	c. 	Church affiliation; (III)
	d. 	Physician’s name, telephone number, and address; (III)
	e. 	Dentist’s name, telephone number, and address; (III)
	f. 	Name, address and telephone number of next of kin or legal representative; (III)
	g. 	Name, address and telephone number of the person to be notified in case of emergency; (III)
	h. 	Funeral director, telephone number, and address; (III)
	i. 	Pharmacy name, telephone number, and address; (III)
	j. 	Results of evaluation pursuant to 62.11(135C); (III)
	k. 	Certification by the physician that the resident requires no more than personal care and supervision, but does not require nursing care; (III)
	l. 	Physician’s orders for medication and treatments shall be in writing and signed by the physician quarterly; diet orders shall be renewed yearly; (III)
	m. 	A notation of yearly or other visits to physician or other professionals, all consultation reports and progress notes; (III)
	n. 	Any change in the resident’s condition; (II, III)
	o. 	A notation describing the resident’s condition on admission, transfer, and discharge; (III)
	p. 	In the event of a resident’s death, notations in the resident’s record shall include the date and time of the resident’s death, the circumstances of the resident’s death, the disposition of the resident’s body, and the date and time that the resident’s family and physician were notified of the resident’s death; (III)
	q. 	A copy of instructions given to the resident, legal representative, or facility in the event of discharge or transfer; (III)
	r. 	Disposition of personal property; (III)
	s. 	Copy of IPP pursuant to 62.12(1); (III)
	t. 	Progress notes pursuant to 62.12(4) and 62.12(5). (III)
	62.18(2) Confidentiality of resident records. The facility shall have policies and procedures providing that each resident shall be ensured confidential treatment of all information, including information contained in an automatic data bank. The resident’s or the resident’s legal guardian’s written informed consent shall be required for the release of information to persons not otherwise authorized under law to receive it. (II)
A release of information form shall be used which includes to whom the information shall be released, the reason for the information being released, how the information is to be used, and the period of time for which the release is in effect. A third party, not requesting the release, shall witness the release of information form. (II)
	a. 	The facility shall limit access to any resident records to staff and consultants providing professional service to the resident. Information shall be made available to staff only to the extent that the information is relevant to the staff person’s responsibilities and duties. (II)
Only those personnel concerned with financial affairs of the residents may have access to the financial information. This is not meant to preclude access by representatives of state or federal regulatory agencies. (II)
	b. 	The resident, or the resident’s legal guardian, shall be entitled to examine all information and shall have the right to secure full copies of the record at reasonable cost upon request, unless the physician or QMHP determines the disclosure of the record or section is contraindicated in which case this information will be deleted prior to making the record available to the resident. This determination and the reasons for it must be documented in the resident’s record by the physician or qualified mental health professional in collaboration with the resident’s interdisciplinary team. (II)
	62.18(3) Incident records.
	a. 	Each RCF/PMI shall maintain an incident record report and shall have available incident report forms. (II, III)
	b. 	The report of every incident shall be in detail on a printed incident report form. (II, III)
	c. 	The person in charge at the time of the incident shall oversee the preparation and sign the report. (III)
	d. 	A copy of the incident report shall be kept on file in the facility available for review and a part of administrative records. (III)
	62.18(4) Retention of records.
	a. 	Records shall be retained in the facility for five years following termination of services to the resident even when there is a change of ownership. (III)
	b. 	When the facility ceases to operate, the resident’s record shall be released to the facility to which the resident is transferred. If no transfer occurs, the record shall be released to the individual’s physician. (III)
This rule is intended to implement Iowa Code section 135C.24.
481—62.19(135C) Health and safety.
	62.19(1) Physician. Each resident shall have a designated licensed physician who may be called when needed. (III)
	62.19(2) Emergency care. The facility shall have written policies and procedures for emergency medical or psychiatric care to include:
	a. 	A written agreement with a hospital or psychiatric facility or documentation of attempt to obtain a written agreement for the timely admission of a resident who, in the opinion of the attending physician, requires inpatient services; (II, III)
	b. 	Provisions consistent with Iowa Code chapter 229; (II, III)
	c. 	Immediate notification by the person in charge to the physician or QMHP, as appropriate, of any accident, injury or adverse change in the resident’s condition. (I, II)
	62.19(3) First-aid kit. A first-aid emergency kit shall be available on each floor in every facility. (II, III)
	62.19(4) Infection control. Each facility shall have a written and implemented infection control program addressing the following:
	a. 	Techniques for hand washing consistent with Guidelines for Handwashing and Hospital Control, 1985, Centers for Disease Control, U.S. Department of Health and Human Services, PB85-923404; (I, II, III)
	b. 	Techniques for handling of blood, body fluids, and body wastes consistent with Guideline for Isolation Precautions in Hospitals, Centers for Disease Control, U.S. Department of Health and Human Services, PB96-138102; (I, II, III)
	c. 	Dressings, soaks, or packs; (I, II, III)
	d. 	Infection identification; (I, II, III)
	e. 	Resident care procedures to be used when there is an infection present consistent with Guideline for Isolation Precautions in Hospitals, Centers for Disease Control, U.S. Department of Health and Human Services, PB96-138102; (I, II, III)
	f. 	Sanitation techniques for resident care equipment; (I, II, III)
	g. 	Techniques for sanitary use and reuse of feeding syringes and single-resident use and reuse of urine collection bags; (I, II, III)
	h. 	Techniques for use and disposal of needles, syringes, and other sharp instruments consistent with Guideline for Isolation Precautions in Hospitals, Centers for Disease Control, U.S. Department of Health and Human Services, PB96-138102; (I, II, III)
CDC Guidelines may be obtained from the U.S. Department of Commerce, Technology Administration, National Technical Information Service, 5285 Port Royal Rd., Springfield, Virginia 22161 (1-800-553-6847).
	62.19(5) Aseptic techniques. If a resident needs any of the treatment or devices on the list below, written and implemented procedures regarding aseptic techniques shall be followed.
	a. 	Intravenous or central line catheter consistent with Guideline for Prevention of Intravascular Device Related Infections, Centers for Disease Control, U.S. Department of Health and Human Services, PB97-130074, (I, II, III)
	b. 	Urinary catheter, (I, II, III)
	c. 	Respiratory suction, oxygen or humidification, (I, II, III)
	d. 	Decubitus care, (I, II, III)
	e. 	Tracheostomy, (I, II, III)
	f. 	Nasogastric or gastrostomy tubes, (I, II, III)
	g. 	Sanitary use and reuse of feeding syringes and single-resident use and reuse of urine collection bags. (I, II, III)
	62.19(6) Dental services. Personnel shall assist residents to obtain regular and emergency dental services and provide necessary transportation. Dental services shall be performed only on the request of the resident or legal guardian. The resident’s physician shall be advised of the resident’s dental problems. (III)
	62.19(7) Safe environment. The licensee of an RCF/PMI is responsible for the provision and maintenance of a safe environment for residents and personnel. (I, II) The RCF/PMI shall meet the fire and safety rules and regulations as promulgated by the state fire marshal. (I, II)
	62.19(8) Disaster. The licensee shall have a written emergency plan to be followed in the event of fire, tornado, explosion, or other emergency. (II, III)
	a. 	The plan shall be posted. (II, III)
	b. 	Training shall be provided to ensure that all employees and residents are knowledgeable of the emergency plan. The training shall be documented. (II, III)
	c. 	Residents shall be permitted to smoke only in posted areas where proper facilities are provided. Smoking by residents considered to be careless shall be prohibited except under direct supervision and in accordance with the IPP. (II, III)
	62.19(9) Safety precautions. The facility shall take reasonable measures to ensure the safety of residents and shall involve the residents in learning the safe handling of household supplies and equipment in accordance with the policies and procedures established by the facility. (II)
	a. 	All potent, poisonous, or caustic materials shall be plainly labeled and stored in a specific locked, well-illuminated cabinet, closet, or storeroom and made accessible only to authorized persons. (I, II)
	b. 	Residents shall have access to storage areas for cleaning and laundry supplies as appropriate to the activities being performed unless contraindicated in their IPP. (I, II)
	62.19(10) Hazards. Entrances, exits, steps, and outside steps and walkways shall be kept free from ice, snow, and other hazards. (II, III)
	62.19(11) Laundry. All soiled linens shall be collected in and transported to the laundry room in closed, leakproof laundry bags or covered, impermeable containers. (III)
	a. 	Except for related activities, the laundry room shall not be used for other purposes. (III)
	b. 	Resident’s personal laundry shall be marked with an identification unless the resident is responsible for doing the resident’s own laundry as indicated in the individual program plan. (III)
	c. 	There shall be an adequate supply of clean, stain-free linens so that each resident shall have at least three washcloths, hand towels, and bath towels. (III)
	d. 	Each bed shall be provided with clean, stain-free, washable bedspreads and sufficient lightweight serviceable blankets. A complete change of bed linens shall be available for each bed. (III)
	62.19(12) Supplies, equipment, and storage.
	a. 	Each facility shall provide a variety of supplies and equipment of a nature calculated to fit the needs and interests of the residents. These may include: books (standard and large print), magazines, newspapers, radio, television, bulletin boards, board game, game equipment, songbooks, cards, craft supplies, record player, movie projector, piano, and outdoor equipment. Supplies and equipment shall be appropriate to the chronological age of the residents. (III)
	b. 	Storage shall be provided for recreational equipment and supplies. (III)
This rule is intended to implement Iowa Code section 135C.14(1).
481—62.20(135C) Nutrition.
	62.20(1) There shall be policies and procedures written and implemented for dietary staffing.
	a. 	The person responsible for planning menus and monitoring the kitchens in each facility shall have completed training, approved by the department, in sanitation and food preparation. (III)
	b. 	In facilities licensed for over 15 beds, food service personnel shall be on duty during a 12-hour span extending from the preparation of breakfast through supper. (III)
	c. 	There shall be written work schedules and time schedules covering each type of job in the food service department for facilities over 15 beds. These work and time schedules shall be posted or kept in a notebook which is available for use in the food service area. (III)
	62.20(2) Nutrition and menu planning.
	a. 	Residents shall be encouraged to the maximum extent possible to participate in meal planning, shopping, and in preparing and serving the meal and cleaning up. The facility shall be responsible for helping residents become knowledgeable of what constitutes a nutritionally adequate diet. (III)
	b. 	Menus shall be planned and served to meet nutritional needs of residents in accordance with the physician’s diet orders which shall be renewed yearly. Menus shall be planned and served to include foods and amounts necessary to meet the recommended daily dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences. (II) Other foods shall be included to meet energy requirements (calories) to add to the total nutrients and variety of meals. (III)
	c. 	At least three meals or their equivalent shall be made available to each resident daily, consistent with those times normally existing in the community. (II, III)
	(1)	There shall be no more than a 14-hour span between the substantial evening meal and breakfast. (III)
	(2)	To the extent medically possible, bedtime nourishments, containing a protein source, shall be offered routinely to all residents. Special nourishments shall be available when ordered by the physician. (II, III)
	d. 	Menus shall include a variety of foods prepared in various ways. The same menus shall not be repeated on the same day of the following week. (III)
	e. 	If modified diets are ordered by the physician, the person responsible for writing the menus shall have completed department-approved training in simple therapeutic diets and a copy of a modified diet manual approved by the department and written within the past five years shall be available in the facility. (II, III)
	f. 	Therapeutic diets shall be served accurately. (II)
	g. 	Menus shall be written at least one week in advance. The current menu shall be located in an accessible place in the dietetic service department for easy use by persons purchasing, preparing, and serving food. (III)
	h. 	Records of menus as served shall be filed and maintained for 30 days and shall be available for review by departmental personnel. When substitutions are necessary, they shall be of similar nutritive value and recorded on the menu or in a notebook. (III)
	i. 	A file of tested recipes adjusted to the number of people to be fed in the facility shall be maintained. (III)
	62.20(3) Dietary storage, food preparation, service.
	a. 	The use of foods from salvaged, damaged, or unlabeled containers is prohibited. (II, III)
	b. 	No perishable food shall be allowed to stand at room temperature any longer than is required to prepare and serve. (II, III)
	c. 	Canning of food is prohibited. The facility may freeze fruits, vegetables, and meats provided strict sanitary procedures are followed and in accordance with recommendations in the “Food Service Manual” revised 1976, U.S. Department of Health, Education, and Welfare, Public Health Service, U.S. Government Printing Office, Washington, D.C. (II)
	d. 	Supplies of staple foods for a minimum of a one-week period and of perishable foods for a minimum of a three-day period shall be maintained on the premises. (III)
	e. 	If family-style service is used, all leftover prepared food that has been on the table shall be safely handled. (III)
	f. 	Poisonous compounds shall not be kept in food storage or preparation areas except for a sanitizing agent which shall be kept in a locked cabinet. (II, III)
	62.20(4) Sanitation in food preparation area.
	a. 	The facility shall develop and implement policies and procedures to address sanitation, meal preparation and service in accordance with recommendations in the food service sanitation manual pursuant to 62.20(2)“c,” and which shall be used as the established, nationally recognized reference for establishing and determining satisfactory compliance with the department’s food service and sanitation rules. (III)
	b. 	Residents shall be allowed in the food preparation area in accordance with their IPP. (III)
	c. 	In facilities licensed for over 15 beds, the kitchen shall not be used for serving meals to residents, food service personnel, or other staff. (III)
	d. 	All appliances and work areas shall be kept clean and sanitized. (III)
	e. 	There shall be written procedures established for cleaning all work and serving areas in facilities over 15 beds and a schedule of duties to be performed daily shall be posted in each food area. (III)
	f. 	The food service area shall be located so it will not be used as a passageway by residents, guests, or nonfood service staff in facilities over 15 beds. (III)
	g. 	Dirty linen shall not be carried through the food service area unless it is in sealed, leakproof containers. (III)
	h. 	Mops, scrub pails, and other cleaning equipment used in the resident areas shall not be stored or used in the dietary area. (III)
	62.20(5) Hygiene of food service personnel.
	a. 	In the event food service employees are assigned duties outside the dietetic service, these duties shall not interfere with sanitation, safety, or time required for dietetic work assignments. (II, III)
	b. 	Employees shall wear clean, washable uniforms that are not used for duties outside the food service area in facilities over 15 beds. (III)
	c. 	Hairnets shall be worn by all food service personnel in facilities over 15 beds and effective hair restraints in facilities less than 15 beds. (III)
	d. 	Persons handling food shall use correct hand-washing and food-handling techniques as identified in the food service sanitation manual. (III)
	e. 	Persons handling dirty dishes shall not handle clean dishes without washing their hands. (III)
This rule is intended to implement Iowa Code section 135C.14.
481—62.21(135C) Physical facilities and maintenance.
	62.21(1) Housekeeping. The facility shall have written procedures for daily and weekly cleaning (III) to include but need not be limited to:
	a. 	All rooms including furnishings, all corridors, storage areas, linen closets, attics, and basements shall be kept in a clean, orderly condition, free of unserviceable furniture and equipment or accumulations of refuse. (III)
	b. 	All resident bedrooms, including furnishings, shall be cleaned and sanitized before use by another resident. (III)
	c. 	Polishes used on floors shall provide a slip-resistant finish. (III)
	62.21(2) Equipment. Housekeeping and maintenance personnel shall be provided with well-constructed and properly maintained equipment appropriate to the function for which it is to be used. (III)
	a. 	All facilities shall be provided with clean and sanitary storage for cleaning equipment, supplies, and utensils. In facilities over 15 beds a janitor’s closet shall be provided. It shall be equipped with water for filling scrub pails and a janitor’s sink for emptying scrub pails. A hallway or corridor shall not be used for storage of equipment. (III)
	b. 	Sufficient numbers of noncombustible trash containers, which have covers, shall be available. (III)
	c. 	All containers for trash shall be watertight, rodent-proof, and have tight-fitting covers and shall be thoroughly cleaned each time a container is emptied. (III)
	d. 	All wastes shall be properly disposed of in compliance with the local ordinances and state codes. (III)
	62.21(3) Bedrooms.
	a. 	Each resident shall be provided with a bed, substantially constructed and in good repair. Roll-away beds, metal cots, or folding beds are not acceptable. (III)
	b. 	Each bed shall be equipped with the following: casters or glides; clean springs in good repair; a clean, comfortable, well-constructed mattress approximately 5 inches thick and standard in size for the bed; and clean, comfortable pillows of average bed size. (III)
	c. 	There shall be a comfortable chair, either a rocking chair or arm chair, per resident bed. The resident’s personal wishes shall be considered and documented. (III)
	d. 	There shall be drawer space for each resident’s clothing. In a multiple bedroom, drawer space shall be assigned each resident. (III)
	e. 	There shall be a bedside table with a drawer and a reading lamp for each resident.
	f. 	All furnishings and equipment shall be durable, cleanable, and appropriate to their function. (III)
	g. 	All resident areas shall be decorated, painted, and furnished to provide a homelike atmosphere and in a manner which is age and culture appropriate. (III)
	h. 	Upholstery materials shall be moisture- and soil-resistant, except on furniture which is provided by the resident and is the property of the resident. (III)
	i. 	Beds and other furnishings shall not obstruct free passage to and through doorways. (III)
	j. 	Beds shall not be placed with the side of the bed against a radiator or in close proximity to it unless the radiator is covered to protect the resident from contact with it or from excessive heat. (III)
	62.21(4) Bath and toilet facilities. All lavatories shall have nonreusable towels and an available supply of soap. (III)
	62.21(5) Dining and living rooms.
	a. 	Every facility shall have a dining room and a living room easily accessible to all residents. (III)
	b. 	Dining rooms and living rooms shall at no time be used as bedrooms. (III)
	c. 	Dining rooms and living rooms shall be available for use by residents at appropriate times to allow social, diversional, individual, and group activities. (III)
	d. 	A combination dining room and living room may be permitted if the space requirements of a multipurpose room as provided in 481—subrule 60.6(2) are met. (III)
	e. 	Living rooms shall be suitably furnished and maintained for the use of residents and their visitors and may be used for recreational activities. (III)
	f. 	Dining rooms shall be furnished with dining tables and chairs appropriate to the size and function of the facility. These rooms and furnishings shall be kept clean and sanitary. (III)
	62.21(6) Family and employee accommodations.
	a. 	The residents’ bedrooms shall not be occupied by employees, family members of employees, or family members of the licensee. (III)
	b. 	In facilities where the total occupancy of family, employees, and residents is five or less, one toilet and one tub or shower is the minimum requirement. (III)
	c. 	In all health care facilities, if the family or employees live within the facility, living quarters shall be required for the family or employees separate from areas provided for residents. (III)
	62.21(7) Animals. Animals shall be allowed within the facility with written approval of the department and under controlled conditions. (III)
	62.21(8) Maintenance. Each facility shall establish a maintenance program to ensure continued maintenance of the facility, to promote good housekeeping procedures, and to ensure sanitary practices throughout the facility. In facilities over 15 beds, this program shall be in writing and be available for review by the department. (III)
	a. 	The buildings, furnishing, and grounds shall be maintained in a clean, orderly condition and be in good repair. (III)
	b. 	The buildings and grounds shall be kept free of flies, other insects, rodents, and their breeding areas. (III)
	62.21(9) Buildings, furnishings, and equipment.
	a. 	Battery-operated, portable emergency lights in good working condition shall be available at all times, at a ratio of one light per employee on duty from 6 p.m.	to 6 a.m.	(III)
	b. 	All windows shall be supplied with curtains and shades or drapes which are kept in good repair. (III)
	c. 	Wherever glass sliding doors or transparent panels are used, they shall be marked conspicuously and decoratively. (III)
	62.21(10) Water supply. Every facility shall have an adequate water supply from an approved source. A municipal source of water shall be considered as meeting this requirement. (III) Private sources of water to a facility shall be tested annually and the report submitted with the annual application for license. (III)
	a. 	A bacterially unsafe source of water shall be grounds for denial, suspension, or revocation of license. (III)
	b. 	The department may require testing of private sources of water to a facility at its discretion in addition to the annual test. The facility shall supply reports of tests as directed by the department. (III)
This rule is intended to implement Iowa Code section 135C.14.
481—62.22(135C) Care review committee. Each facility shall have a care review committee in accordance with Iowa Code section 135C.25, which shall operate within the scope of the rules for care review committees promulgated by the department of elder affairs. (II)
	62.22(1) Role of committee in complaint investigations.
	a. 	The department shall notify the facility’s care review committee of a complaint from the public. The department shall not disclose the name of a complainant.
	b. 	The department may refer complaints to the care review committee for initial evaluation or investigation by the committee pursuant to rules promulgated by the department of elder affairs. Within ten days of completion of the investigation, the committee shall report to the department in writing the results of the evaluation of the investigation.
	c. 	When the department investigates a complaint, upon conclusion of its investigation, it shall notify the care review committee and the department of elder affairs of its findings, including any citations and fines issued.
	d. 	Results of all complaint investigations addressed by the care review committee shall be forwarded to the department within ten days of completion of the investigation.
	62.22(2) The care review committee shall, upon department request, be responsible for monitoring correction of substantiated complaints.
	62.22(3) When requested, names, addresses and telephone numbers of family members shall be given to the care review committee, unless the family refuses. The facility shall provide a form on which a family member may refuse to have the member’s name, address or telephone number given to the care review committee.
This rule is intended to implement Iowa Code section 135C.25.
481—62.23(135C) Residents’ rights in general.
	62.23(1) Each facility shall ensure that policies and procedures are written and implemented which include, at a minimum, all of the following provisions (subrules 62.23(2) to 62.23(22)) and which govern all areas of service provided to staff, residents, their families or legal representatives and shall be available to the public and shall be reviewed annually. (II)
	62.23(2) Grievances. Written policies and procedures shall include a method for submitting grievances and recommendations by residents or their responsible party and for ensuring a response and disposition by the facility. The written procedure shall ensure protection of the resident from any form of reprisal or intimidation and shall include:
	a. 	An employee or an alternate designated to be responsible for handling grievances and recommendations; (II) and
	b. 	Methods to investigate and assess the validity of a grievance or recommendation, resolve grievances, and take action. (II)
	62.23(3) Informed of rights. Policies and procedures shall include a provision that each resident shall be fully informed of the resident’s rights and responsibilities as a resident and of all rules governing resident conduct and responsibilities. This information must be provided upon admission, or in the case of residents already in the facility, upon the facility’s adoption or amendment of residents’ rights policies and be posted in locations accessible to all residents. (II)
	a. 	The facility shall make known to residents what they may expect from the facility and its staff, and what is expected from residents. The facility shall communicate these expectations during the period of not more than two weeks before or five days after admission. The communication shall be in writing, e.g., in a separate handout or brochure describing the facility, and interpreted verbally, e.g., as part of a preadmission interview, resident counseling, or in individual or group orientation sessions following admission. (II)
	b. 	Resident’s rights and responsibilities shall be presented in language understandable to the resident. If the facility serves residents who are not English-speaking or are deaf, steps shall be taken to translate the information into a foreign or sign language. In the case of blind residents, either Braille or a recording shall be provided. Residents shall be encouraged to ask questions about their rights and responsibilities and these questions shall be answered. (II)
	c. 	A statement shall be signed by the resident and legal guardian, if applicable, indicating an understanding of these rights and responsibilities, and the statement shall be maintained in the record. The statement shall be signed no later than five days after admission, and a copy of the signed statement shall be given to the resident or legal guardian. (II)
	d. 	All residents, next of kin, or legal guardian shall be advised within 30 days following changes made in the statement of residents’ rights and responsibilities. Appropriate means shall be used to inform non-English-speaking, deaf or blind residents of changes. (II)
	62.23(4) Informed of health condition. Each resident or legal guardian shall be fully informed by a physician of the resident’s health and medical condition unless medically contraindicated as documented by a physician in the resident’s record. (II)
	62.23(5) Research. The resident or legal guardian shall make the decision as whether to participate in experimental research and then only upon written informed consent. (II, III)
Any clinical investigation involving residents must be under the sponsorship of an institution with a human subjects review board functioning in accordance with the requirement of Public Law 93-348, as implemented by Part 46 of Title 45 of the Code of Federal Regulations, as amended to December 1, 1981 (45 CFR 46). (III)
	62.23(6) Resident work. Services performed by the resident for the facility shall be in accordance with the IPP. (II)
	a. 	Residents shall not be used to provide a source of labor for the facility against the resident’s will. Physician’s approval is required for all work programs and must be renewed yearly. (II, III)
	b. 	If the individual program plan requires activities for therapeutic or training reasons, the plan for these activities must be professionally developed and implemented. Therapeutic or training goals must be clearly stated and measurable and the plan shall be time-limited and reviewed at least quarterly. (II)
	c. 	A resident engaged in work programs in the RCF/PMI shall be paid wages commensurate with wage and hour regulations for comparable work and productivity. (II)
	d. 	The resident shall have the right to employment options commensurate with training and skills. (II)
	62.23(7) Residents performing work shall not be used to replace paid employees in fulfilling staffing requirements. (II)
	62.23(8) Encouragement to exercise rights. Each resident shall be encouraged and assisted throughout the resident’s period of stay, to exercise resident and citizen rights and may voice grievances and recommend changes in policies and services to administrative staff or to outside representatives of the resident’s choice, free from interference, coercion, discrimination, or reprisal. (II)
	62.23(9) Posting of names. The facility shall post in a prominent area the name, telephone number, and address of the long-term care resident’s advocate/ombudsman, survey agency, local law enforcement agency, care review committee members, Iowa Protection and Advocacy Services, Inc., and text of Iowa Code section 135C.46, to provide to residents another course of redress. (II)
	62.23(10) Dignity preserved. Each resident shall be treated with consideration, respect, and full recognition of the resident’s dignity and individuality, including privacy in treatment and in care of personal needs. (II)
	a. 	Staff shall display respect for residents when speaking with, caring for, or talking about them, as constant affirmation of the individuality and dignity of human beings. (II)
	b. 	Schedules of daily activities shall allow maximum flexibility for residents to exercise choice about what they will do and when they will do it. Residents’ individual preferences regarding such things as menus, clothing, religious activities, friendships, activity programs, entertainment, sleeping, eating, and times to retire at night and arise in the morning shall be elicited and considered by the facility. The facility shall make every effort to match nonsmokers with other nonsmokers. (II)
	c. 	Residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door shall shield the resident from passersby. People not involved in the care of the residents shall not be present without the resident’s consent while the resident is being examined or treated. (II)
	d. 	Privacy for each person shall be maintained when residents are being taken to the toilet or being bathed and while they are being helped with other types of personal hygiene, except as needed for resident safety or assistance. (II)
	e. 	Staff shall knock and be acknowledged before entering a resident’s room unless the resident is not capable of a response. This does not apply under emergency conditions. (II)
	62.23(11) Communications. Each resident may communicate, associate, and meet privately with persons of the resident’s choice, unless to do so would infringe upon the rights of other residents. Each resident may send and receive personal mail unopened unless prohibited in the IPP which has explicit approval of the resident or legal guardian. (II)
	62.23(12) Visiting hours. Subject to reasonable scheduling restrictions, visiting policies and procedures shall permit residents to receive visits from anyone they wish. Visiting hours shall be posted. (II)
	a. 	Reasonable, regular visiting hours shall not be less than 12 hours per day and shall take into consideration the special circumstances of each visitor. A particular visitor(s) may be restricted by the facility for one of the following reasons:
	(1)	The resident refuses to see the visitor(s). (II)
	(2)	The visit would not be in accordance with the IPP. (II)
	(3)	The visitor’s behavior is unreasonably disruptive to the functioning of the facility.
Reasons for denial of visitation shall be documented in the resident’s records. (II)
	b. 	Decisions to restrict a visitor are reevaluated at least quarterly by the QMHP or at the resident’s request. (II)
	62.23(13) Privacy. Space shall be provided for residents to receive visitors in comfort and privacy. (II)
	62.23(14) Telephone calls. Telephones consistent with ANSI standards 42 CFR 405.1134(c) (10-1-86) shall be available and accessible for residents to make and receive calls with privacy. Residents who need help shall be assisted in using the telephone. (II)
	62.23(15) Arrangements shall be made to provide assistance to residents who require help in reading or sending mail. (II)
	62.23(16) Residents shall be permitted to leave the facility and environs at reasonable times unless there are justifiable reasons established in writing by the attending physician, QMHP, or facility administrator for refusing permission. (II)
	62.23(17) Residents shall not have their personal lives regulated beyond reasonable adherence to meal schedules, bedtime hours, and other written policies which may be necessary for the orderly management of the facility and as required by these rules; however, residents shall be encouraged to participate in recreational programs. (II)
	62.23(18) Resident activities. Each resident may participate in activities of social, religious, and community groups as desired unless contraindicated for reasons documented by the attending physician or qualified mental health professional, as appropriate, in the resident’s record. (II)
Residents who wish to meet with or participate in activities of social, religious or community groups in or outside the facility shall be informed, encouraged, and assisted to do so. (II)
	62.23(19) Resident property. Each resident may retain and use personal clothing and possessions as space permits and provided use is not otherwise prohibited in these rules. (II)
	a. 	Residents shall be permitted to keep reasonable amounts of personal clothing and possessions for their use while in the facility. The personal property shall be kept in a secure location which is convenient to the resident. (II)
	b. 	Residents shall be advised, prior to or at the time of admission, of the kinds and amounts of clothing and possessions permitted for personal use, and whether the facility will accept responsibility for maintaining these items, e.g., cleaning and laundry. (II)
	c. 	Any personal clothing or possessions retained by the facility for the resident shall be identified and recorded on admission and the record placed on the resident’s chart. The facility shall be responsible for secure storage of items, and they shall be returned to the resident promptly upon request or upon discharge from the facility. (II)
	d. 	A resident’s personal property shall not be used without the written consent of the resident or the resident’s guardian. (II)
	e. 	A resident’s personal property shall be returned to the resident when it has been used without the written consent of the resident or the resident’s guardian. The department may report findings that a resident’s property has been used without written consent to the local law enforcement agency, as appropriate. (II)
	62.23(20) Sharing rooms. Residents, including spouses staying in the same facility, shall be permitted to share a room, if available, if requested by both parties, unless contraindicated in the IPP and when the reasons for denial are documented in the resident’s record. (II)
	62.23(21) Choice of physician and pharmacy. Each resident shall be permitted free choice of a physician and a pharmacy. The facility may require the pharmacy selected to use a drug distribution system compatible with the system currently used by the facility. (II)
	62.23(22) Incompetent residents.
	a. 	Each facility shall provide that all rights and responsibilities of the resident devolve to the resident’s legal guardian when a resident is adjudicated incompetent in accordance with state law or, in the case of a resident who has not been adjudicated incompetent under the laws of the state, in accordance with 42 CFR 483.10. This paragraph is not intended to limit the authority of any individual acting pursuant to Iowa Code chapter 144A. (II)
	b. 	The fact that a resident has been adjudicated incompetent does not absolve the facility from advising the resident of these rights to the extent the resident is able to understand them. The facility shall also advise the legal guardian, if any, and acquire a statement indicating an understanding of resident’s rights. (II)
	62.23(23) Resident abuse prohibited. Each resident shall receive kind and considerate care at all times and shall be free from physical, sexual, mental and verbal abuse, exploitation, and physical injury. (I, II)
	62.23(24) Upon a claim of dependent adult abuse of a resident being reported, the administrator of the facility shall separate the victim and accused abuser immediately and maintain the separation until the abuse investigation is completed. (I, II)
	62.23(25) Pursuant to Iowa Code chapter 235B, a mandatory reporter of dependent adult abuse is any person who, in the course of employment, examines, attends, counsels, or treats a dependent adult and reasonably believes the dependent adult has suffered abuse. This includes a member of the staff or employee of a health care facility. (II, III)
If a staff member or employee is required to report pursuant to this subrule, the staff member or employee shall immediately notify the person in charge of the facility or the person’s designated agent, and the person in charge or the designated agent shall make the report to the department of human services. (II, III)
This rule is intended to implement Iowa Code sections 135C.14(8) and 135C.24.
481—62.24(135C) County care facilities. In addition to Chapter 62 licensing rules, county care facilities licensed as residential care facilities for persons with mental illness must also comply with department of human services rules, 441—Chapter 37. Violation of any standard established by the department of human services is a class II violation pursuant to 481—56.2(135C).
This rule is intended to implement Iowa Code section 227.4.
481—62.25(135C) Another business or activity in a facility. A facility is allowed to have another business or activity in a health care facility or in the same physical structure of the facility, if the other business or activity is under the control of and is directly related to and incidental to the operation of the health care facility, or the business or activity is approved by the department and the state fire marshal.
To obtain the approval of the department and the state fire marshal, the facility must submit to the department a written request for approval which identifies the service(s) to be offered by the business and addresses the factors outlined in paragraphs “a” through “j” of this rule. (I, II, III)
	62.25(1) The following factors will be considered by the department in determining whether a business or activity will interfere with the use of the facility by residents, interfere with services provided to residents, or be disturbing to residents:
	a. 	Health and safety risks for residents;
	b. 	Compatibility of the proposed business or activity with the facility program;
	c. 	Noise created by the proposed business or activity;
	d. 	Odors created by the proposed business or activity;
	e. 	Use of entrances and exits for the business or activity in regard to safety and disturbance of residents and interference with delivery of services;
	f. 	Use of the facility’s corridors or rooms as thoroughfares to the business or activity in regard to safety and disturbance of residents and interference with delivery of services;
	g. 	Proposed staffing for the business or activity;
	h. 	Sharing of services and staff between the proposed business or activity and the facility;
	i. 	Facility layout and design; and
	j. 	Parking area utilized by the business or activity.
	62.25(2) Approval of the state fire marshal shall be obtained before approval of the department will be considered.
	62.25(3) A business or activity conducted in a health care facility or in the same physical structure as a health care facility shall not reduce space, services or staff available to residents below minimums required in these rules and 481—Chapter 60. (I, II, III)
This rule will become effective July 1, 1992.
481—62.26(135C) Respite care services. Respite care services means an organized program of temporary supportive care provided for 24 hours or more to a person in order to relieve the usual caregiver of the person from providing continual care to the person. A facility which chooses to provide respite care services must meet the following requirements related to respite care services and must be licensed as a health care facility.
	62.26(1) A facility which chooses to provide respite care services is not required to obtain a separate license or pay a license fee.
	62.26(2) Rules regarding involuntary discharge or transfer rights do not apply to residents who are being cared for under a respite care contract.
	62.26(3) The facility shall have a contract with each resident in the facility. When the resident is there for respite care services, the contract shall specify the time period during which the resident will be considered to be receiving respite care services. At the end of that period, the contract may be amended to extend that period of time. The contract shall specifically state the resident may be involuntarily discharged while being considered as a respite care resident. The contract shall meet other requirements for contracts between a health care facility and resident, except the requirements concerning the holding and charging for a bed when a resident is hospitalized or leaves the facility temporarily for recreational or therapeutic reasons.
	62.26(4) Respite care services shall not be provided by a facility to persons requiring a level of care which is higher than the level of care the facility is licensed to provide.
These rules are intended to implement Iowa Code sections 135C.2(6), 135C.4, 135C.6(1) to 135C.6(3), 135C.7, 135C.8, 135C.14, 135C.16(2), 135C.23 to 135C.25, 135C.31, 135C.36, and 227.4.
[Filed 2/5/88, Notice 10/7/87—published 2/24/88, effective 3/30/88]
[Filed 5/26/88, Notice 4/20/88—published 6/15/88, effective 7/20/88]
[Filed 9/30/88, Notice 8/24/88—published 10/19/88, effective 11/23/88]
[Filed 12/9/88, Notices 8/24/88, 10/5/88—published 12/28/88, effective 2/1/89]
[Filed 4/14/89, Notice 2/8/89—published 5/3/89, effective 6/7/89]
[Filed 6/23/89, Notice 5/17/89—published 7/12/89, effective 8/16/89]
[Filed 7/20/89, Notice 6/14/89—published 8/9/89, effective 9/13/89]
[Filed 8/16/89, Notices 4/19/89, 7/12/89—published 9/6/89, effective 10/11/89]
[Filed 3/14/91, Notice 9/19/90—published 4/3/91, effective 5/8/91]
[Filed 1/31/92, Notice 11/13/91—published 2/19/92, effective 7/1/92]
[Filed 3/12/92, Notice 12/11/91—published 4/1/92, effective 5/6/92]
[Filed 1/15/93, Notice 11/25/92—published 2/3/93, effective 3/10/93]
[Filed 5/16/95, Notice 3/15/95—published 6/7/95, effective 7/12/95]
[Filed 11/30/95, Notice 9/13/95—published 12/20/95, effective 1/24/96]
[Filed 7/11/97, Notice 4/23/97—published 7/30/97, effective 9/3/97]
[Filed emergency 7/25/97—published 8/13/97, effective 7/25/97]
[Filed emergency 11/14/97—published 12/3/97, effective 11/14/97]
[Filed 11/14/97, Notice 8/13/97—published 12/3/97, effective 1/7/98]
[Filed 3/31/98, Notice 12/3/97—published 4/22/98, effective 5/27/98]
[Filed 7/9/98, Notice 4/22/98—published 7/29/98, effective 9/2/98]
[Filed 1/15/04, Notice 10/1/03—published 2/4/04, effective 3/10/04]
[Filed 1/15/04, Notice 12/10/03—published 2/4/04, effective 3/10/04]
[Filed 9/20/06, Notice 8/2/06—published 10/11/06, effective 11/15/06]