CHAPTER 57
RESIDENTIAL CARE FACILITIES
[Prior to 7/15/87, Health Department[470] Ch 57]
481—57.1(135C) Definitions. For the purpose 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 to be incorporated verbatim in the rules. The use of the words “shall” and “must” indicate those standards are mandatory. The use of the words “should” and “could” indicate those standards are recommended.
	57.1(1) “Accommodation” means the provision of lodging, including sleeping, dining, and living areas.
	57.1(2) “Administrator” means a person approved and certified by the department who administers, manages, supervises, and is in general administrative charge of a residential care facility, whether or not such individual has an ownership interest in such facility, and whether or not the functions and duties are shared with one or more individuals.
	57.1(3) “Alcoholic” means a person in a state of dependency resulting from excessive or prolonged consumption of alcoholic beverages as defined in Iowa Code section 125.2.
	57.1(4) “Ambulatory” means the condition of a person who immediately and without aid of another is physically and mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.
	57.1(5) “Basement” means that part of a building where the finish floor is more than 30 inches below the finish grade of the building.
	57.1(6) “Board” means the regular provision of meals.
	57.1(7) “Communicable disease” means a disease caused by the presence of viruses or microbial agents within a person’s body, which agents may be transmitted either directly or indirectly to other persons.
	57.1(8) “Department” means the state department of inspections and appeals.
	57.1(9) “Distinct part ” means a clearly identifiable area or section within a health care facility, consisting of at least a residential unit, wing, floor, or building containing contiguous rooms.
	57.1(10) “Drug addiction” means a state of dependency, as medically determined, resulting from excessive or prolonged use of drugs as defined in Iowa Code chapter 204.
	57.1(11) “Medication” means any drug including over-the-counter substances ordered and administered under the direction of the physician.
	57.1(12) “Nonambulatory” means the condition of a person who immediately and without aid of another is not physically and mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.
	57.1(13) “Personal care” means assistance with the activities of daily living which the recipient can perform only with difficulty. Examples are help in getting in and out of bed, assistance with personal hygiene and bathing, help with dressing and feeding, and supervision over medications which can be self-administered.
	57.1(14) “Program of care” means all services being provided for a resident in a health care facility.
	57.1(15) “Qualified mental retardation professional” means a psychologist, physician, registered nurse, educator, social worker, physical or occupational therapist, speech therapist or audiologist who meets the educational requirements for the profession, as required in the state of Iowa, and having one year’s experience working with the mentally retarded.
	57.1(16) “Rate” means that daily fee charged for all residents equally and shall include the cost of all minimum services required in these rules and regulations.
	57.1(17) “Responsible party” means the person who signs or cosigns the admission agreement required in 481—57.14(135C) or the resident’s guardian or conservator if one has been appointed. In the event that a resident has neither a guardian, conservator nor person who signed or cosigned the resident’s admission agreement, the term “responsible party” shall include the resident’s sponsoring agency, e.g., the department of social services, veteran’s administration, religious groups, fraternal organizations, or foundations that assume responsibility and advocate for their client patients and pay for their health care.
	57.1(18) “Restraints” means the measures taken to control a resident’s physical activity for the resident’s own protection or for the protection of others.
481—57.2(135C) Variances. Variances from these rules may be granted by the director of the department of inspections and appeals for good and sufficient reason when the need for variance has been established; no danger to the health, safety, or welfare of any resident results; alternate means are employed or compensating circumstances exist and the variance will apply only to an individual residential care facility. Variances will be reviewed at the discretion of the director of the department of inspections and appeals.
	57.2(1) To request a variance, the licensee must:
	a. 	Apply for variance in writing on a form provided by the department of inspections and appeals;
	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 alternate arrangements or compensating circumstances which justify the variance;
	e. 	Demonstrate that the requested variance will not endanger the health, safety, or welfare of any resident.
	57.2(2) Upon receipt of a request for variance, the director of the department of inspections and appeals will:
	a. 	Examine the rule from which variance is requested to determine that the request is necessary and reasonable;
	b. 	If the request meets the above criteria, evaluate the alternate arrangements of compensating circumstances against the requirement of the rules;
	c. 	Examine the effect of the requested variance on the health, safety, or welfare of the residents;
	d. 	Consult with the applicant if additional information is required.
	57.2(3) Based upon these studies, approval of the variance will be either granted or denied within 120 days of receipt.
481—57.3(135C) Application for licensure.
	57.3(1) Initial application and licensing. In order to obtain an initial residential care facility license for a residential care facility which is currently licensed the applicant must:
	a. 	Meet all of the rules, regulations, and standards contained in 481—Chapters 57 and 60;
	b. 	Submit a letter of intent and a written résumé of the resident care program and other services provided for departmental review and approval;
	c. 	Make application at least 30 days prior to the change of ownership of the facility on forms provided by the department;
	d. 	Submit a floor plan of each floor of the facility drawn on 8½- × 11-inch paper showing room areas in proportion, room dimensions, room numbers for all rooms, including bathrooms, and designation of the use to which room will be put and window and door location;
	e. 	Submit a photograph of the front and side elevation of the facility;
	f. 	Submit the statutory fee for a residential care facility license;
	g. 	Comply with all other local statutes and ordinances in existence at the time of licensure;
	h. 	Have a certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules and regulations.
	57.3(2) In order to obtain an initial residential care facility license for a facility not currently licensed as a residential care facility, the applicant must:
	a. 	Meet all of the rules, regulations, and standards contained in 481—Chapters 57 and 60. Exceptions noted in 481—subrule 60.3(2) shall not apply;
	b. 	Submit a letter of intent and a written résumé of the resident care program and other services provided for departmental review and approval;
	c. 	Make application at least 30 days prior to the proposed opening date of the facility on forms provided by the department;
	d. 	Submit a floor plan of each floor of the residential care facility, drawn on 8½- × 11-inch paper showing room areas in proportion, room dimensions, room numbers for all rooms, including bathrooms, and designation of the use to which room will be put and window and door locations;
	e. 	Submit a photograph of the front and side of the residential care facility;
	f. 	Submit the statutory fee for a residential care facility license;
	g. 	Comply with all other local statutes and ordinances in existence at the time of licensure;
	h. 	Have a certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules and regulations.
	57.3(3) Renewal application. In order to obtain a renewal of the residential care facility license, the applicant must:
	a. 	Submit the completed application form 30 days prior to annual license renewal date of residential care facility license;
	b. 	Submit the statutory license fee for a residential care facility with the application for renewal;
	c. 	Have an approved current certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules and regulations;
	d. 	Submit appropriate changes in the résumé to reflect any changes in the resident care program or other services.
	57.3(4) 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.
481—57.4(135C) Special categories. Special variations and considerations may be granted a residential care facility which is operated for people who have special problems such as retardation, physical disabilities, have a physical or mental disability or a condition in common which can best be treated in a specialized environment under an approved program of care commensurate with the needs of the residents of the facility. Criteria for these specialized programs shall be established by the department based on the résumé of programs and services furnished by the facility and the numbers and qualifications of the administrator and staff providing these services in the facility.
	57.4(1) Such a facility shall be provided with the kind of equipment, numbers of qualified staff, and operated in such fashion as to meet the requirements of the department.
	57.4(2) On approval of the department, the state fire marshal, the department of social services, or other appropriate agencies, other variations from the established rules and regulations and standards for a licensed health care facility of that category may be made as is necessary to successfully implement the specialized program, providing that it does not endanger the health, safety, or welfare of any resident and that alternate means to effect the same degree of protection shall be used when such variances are permitted.
481—57.5(135C) General requirements.
	57.5(1) The license shall be displayed in a conspicuous place in the facility which is viewed by the public. (III)
	57.5(2) The license shall be valid only in the possession of the licensee to whom it is issued.
	57.5(3) The posted license shall accurately reflect the current status of the residential care facility. (III)
	57.5(4) Licenses expire one year after the date of issuance or as indicated on the license.
	57.5(5) 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)
481—57.6(135C) Notifications required by the department. The department shall be notified:
	57.6(1) Within 48 hours, by letter, of any reduction or loss of personal care or dietary staff lasting more than seven days which places the staffing ratio below that required for licensing. No additional residents may be admitted until the minimum staffing requirements are achieved; (III)
	57.6(2) Of any proposed change in the residential care facility’s functional operation or addition or deletion of required services; (III)
	57.6(3) Thirty days before addition, alteration, or new construction is begun in the residential care facility or on the premises; (III)
	57.6(4) Thirty days in advance of closure of the residential care facility; (III)
	57.6(5) Within two weeks of any change in administrator; (III)
	57.6(6) When any change in the category of license is sought; (III)
	57.6(7) Prior to the purchase, transfer, assignment, or lease of a residential care facility, the licensee shall:
	a. 	Inform the department of the pending sale, transfer, assignment, or lease of the facility; (III)
	b. 	Inform the department of the name and address of the prospective purchaser, transferee, assignee, or lessee at least 30 days before the sale, transfer, assignment, or lease if completed; (III)
	c. 	Submit a written authorization to the department permitting the department to release all 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)
	57.6(8) Pursuant to the authorization submitted to the department by the licensee prior to the purchase, transfer, assignment, or lease of a residential care facility, the department shall upon request send or give copies of all recent licensure surveys and of any other pertinent information relating to the facility’s licensure status to the prospective purchaser, transferee, assignee, or lessee; costs for such copies shall be paid by the prospective purchaser.
481—57.7(135C) Witness fees. Rescinded IAB 3/30/94, effective 5/4/94. See 481—subrule 50.6(4).
481—57.8(135C) Licenses for distinct parts.
	57.8(1) Separate licenses may be issued for distinct parts of a health care facility which are clearly identifiable, 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.
	57.8(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.
481—57.9(135C) Administrator. Each residential care facility shall have one person in charge, duly approved by the department or acting in a provisional capacity in accordance with these regulations. (III)
	57.9(1) The administrator shall be at least 18 years of age and shall have a high school diploma or equivalent. (III) In addition, this person shall meet at least one of the following conditions:
	a. 	Be a licensed nursing home administrator; or (III)
	b. 	Have completed a one-year educational training program approved by the department for residential care facility administrators; or (III)
	c. 	Have two years of supervised experience in a residential care facility, at least six months of which was in an administrative capacity. (III)
	57.9(2) The administrator may act as an administrator for not more than two residential care facilities. (II)
	a. 	The distance between the two facilities shall be no greater than 50 miles. (II)
	b. 	The administrator shall spend the equivalent of three full eight-hour days per week in each facility. (II)
	c. 	The administrator may be responsible for no more than 150 beds in total if the administrator is an administrator of more than one facility. (II)
	57.9(3) The licensee may be the approved administrator providing the licensee meets the requirements set forth in these regulations and devotes the required time to administrative duties. Residency in the facility does not in itself meet the requirement. (III)
	57.9(4) A provisional administrator may be appointed on a temporary basis by the residential care facility licensee to assume the administrative responsibilities for a residential care facility for a period not to exceed six months when, through no fault of its own, the home has lost its administrator and has not been able to replace the administrator provided the department has been notified prior to the date of the administrator’s appointment. (III)
	57.9(5) In the absence of the administrator, a responsible person shall be designated in writing to the department to be in charge of the facility. (III) The person designated shall:
	a. 	Be knowledgeable of the operation of the facility; (III)
	b. 	Have access to records concerned with the operation of the facility; (III)
	c. 	Be capable of carrying out administrative duties and of assuming administrative responsibilities; (III)
	d. 	Be at least 18 years of age; (III)
	e. 	Be empowered to act on behalf of the licensee during the administrator’s absence concerning the health, safety, and welfare of the residents; (III)
	f. 	Have had training to carry out assignments and take care of emergencies and sudden illnesses of residents. (III)
	57.9(6) An administrator of only one facility shall be considered as a full-time employee. Full-time employment is defined as 40 hours per week. (III)
481—57.10(135C) Administration.
	57.10(1) The licensee shall:
	a. 	Assume the responsibility for the overall operation of the residential care facility; (III)
	b. 	Be responsible for compliance with all applicable laws and with the rules of the department; (III)
	c. 	Establish written policies, which shall be available for review, for the operation of the residential care facility. (III)
	57.10(2) The administrator shall:
	a. 	Be responsible for the selection and direction of competent personnel who provide services for the resident care program; (III)
	b. 	Be responsible for the arrangement for all department heads to annually attend a minimum of ten contact hours of educational programs to increase skills and knowledge needed for the position; (III)
	c. 	Be responsible for a monthly in-service educational program for all employees and to maintain records of programs and participants; (III)
	d. 	Make available the residential care facility payroll records for departmental review as needed. (III)
481—57.11(135C) General policies.
	57.11(1) There shall be written personnel policies in facilities of more than 15 beds to include hours of work and attendance at educational programs. (III)
	57.11(2) There shall be a written job description developed for each category of worker in facilities of more than 15 beds. The job description shall include title of job, job summary, age range, qualifications (formal education and experience), skills needed, physical requirements, and responsibilities. (III)
	57.11(3) There shall be written personnel policies for each facility. Personnel policies shall include the following requirements:
	a. 	Employees shall have a physical examination before employment. (I, II, III)
	b. 	Employees shall have a physical examination at least every four years. (I, II, III)
	c. 	Screening and testing for tuberculosis shall be conducted pursuant to 481—Chapter 59. (I, II, III)
	57.11(4) Health certificates for all employees shall be available for review. (III)
	57.11(5) Rescinded IAB 10/19/88, effective 11/23/88.
	57.11(6) There shall be written policies for emergency medical care for employees and residents in case of sudden illness or accident, which includes the individuals to be contacted in case of emergency. (III)
	57.11(7) The facility shall have a written agreement with a hospital for the timely admission of a resident who, in the opinion of the attending physician, requires hospitalization. (III)
	57.11(8) The residential care facility shall have established policies concerning the control, investigation, and prevention of infections within the facility. (III)
	57.11(9) Each facility licensed as a residential care facility shall provide an organized continuous 24-hour program of care commensurate with the needs of the residents of the home and under the direction of an administrator whose combined training and supervisory experience is such as to ensure adequate and competent care. (III)
	57.11(10) Prior to the removal of a deceased resident/patient from a facility, the funeral director or person responsible for transporting the body shall be notified by the facility staff of any special precautions that were followed by the facility having to do with the mode of transmission of a known or suspected communicable disease. (III)
	57.11(11) 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 Adminstration, National Technical Information Service, 5285 Port Royal Rd., Springfield, Virginia 22161 (1-800-553-6847).
	57.11(12) 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)
[ARC 0663C, IAB 4/3/13, effective 5/8/13]
481—57.12(135C) Personnel.
	57.12(1) General qualifications.
	a. 	No person with a current record of habitual alcohol intoxication or addiction to the use of drugs shall serve in a managerial role of a residential care facility. (II)
	b. 	No person under the influence of alcohol or intoxicating drugs shall be permitted to provide services in a residential care facility. (II)
	c. 	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).
	d. 	Reserved.
	e. 	Individuals with either physical or mental disabilities may be employed for specific duties, but only if that disability is unrelated to that individual’s ability to perform the duties of the job. (III)
	57.12(2) Supervision and staffing.
	a. 	Staffing.
	(1)	In a facility that is licensed for more than one level of care, where the facility consists of a single building or of contiguous buildings, the department shall establish on an individual facility basis the numbers and qualifications of the staff required in a residential care facility, based on the needs of the residents in that facility.
	(2)	In a facility licensed only for residential care the facility shall provide the following minimum staffing ratios of personal care staff:
Days—1:25 or less (II, III)
Evenings—1:35 or less (II, III)
Nights—1:45 or less (II, III)
Additional staffing above the minimum ratio may be required by the department commensurate with the needs of individual residents.
	b. 	Personnel in a residential care facility shall provide 24-hour coverage for residential care services. Personnel shall be up and dressed at all times in facilities over 15 beds. (II, III)
	c. 	Direct care staff shall be present in the facility unless all residents are involved in activities away from the facility. (II, III)
	d. 	Physician’s orders shall be implemented by qualified personnel. (II, III)
	57.12(3) 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)
481—57.13(135C) Admission, transfer, and discharge.
	57.13(1) General admission policies.
	a. 	No resident shall be admitted to or retained in a residential care facility who is in need of greater services than the facility can provide. (II, III)
	b. 	No residential care facility shall admit more residents than the number of beds for which it is licensed. (II, III)
	c. 	There shall be no more beds erected than is stipulated on the license. (II, III)
	d. 	There shall be no more beds erected in a room than its size and other characteristics will permit. (II, III)
	e. 	The admission of a resident to a residential care facility shall 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 representative. (III)
	f. 	The admission of a resident shall not grant the residential care facility the authority or responsibility to manage the personal affairs of the resident except as may be necessary for the safety of the resident and safe and orderly management of the residential care facility as required by these rules. (III)
	g. 	A residential care facility 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)
	h. 	Rescinded, effective 7/14/82.
	i. 	Funds or properties received by the residential care facility, belonging to or due a resident, expendable for the resident’s account, shall be trust funds. (III)
	j. 	Infants and children under the age of 16 shall not be admitted to health care facilities for adults unless given prior written approval by the department. A distinct part of a health care facility, segregated from the adult section, may be established based on a program 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)
	k. 	No health care facility, and no owner, administrator, employee or representative thereof shall act as guardian, trustee, or conservator for any resident’s property, unless such resident is related to the person acting as guardian within the third degree of consanguinity. (III)
	l. 	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 such county care facility. Such administrator shall serve as conservator or guardian or both without fee. The administrator may establish either separate or common bank accounts for cash funds of such resident wards. (III)
	57.13(2) Discharge or transfer.
	a. 	Prior 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)
	b. 	Proper arrangements shall be made by the residential care facility 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)
	c. 	The licensee shall not refuse to discharge or transfer a resident when the physician, family, resident, or legal representative requests such transfer or discharge. (II, III)
	d. 	Advance notification by telephone will be made to the receiving facility prior to the transfer of any resident. (III)
	e. 	When a resident is transferred or discharged, the appropriate record as set forth in 57.16(1) will accompany the resident. (II, III)
	f. 	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)
481—57.14(135C) Contracts. Each contract shall:
	57.14(1) State the base rate or scale per day or per month, the services included, and the method of payment; (III)
	57.14(2) Contain a complete schedule of all offered services for which a fee may be charged in addition to the base rate. (III) Furthermore, the contract shall:
	a. 	Stipulate that no further additional fees shall be charged for items not contained in complete schedule of services as set forth in subsection 2; (III)
	b. 	State the method of payment of additional charges; (III)
	c. 	Contain an explanation of the method of assessment of such additional charges and an explanation of the method of periodic reassessment, if any, resulting in changing such additional charges; (III)
	d. 	State that additional fees may be charged to the resident for nonprescription drugs, other personal supplies, and services by a barber, beautician, etc.	(III)
	57.14(3) 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)
	57.14(4) Include the total fee to be charged initially to the specific resident; (III)
	57.14(5) State the conditions whereby the facility may make adjustments to its overall fees for resident care as a result of changing costs. (III) Furthermore, the contract shall provide that the facility shall give:
	a. 	Written notification to the resident, or the 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 such changes; (III)
	b. 	Notification to the resident, or responsible party when appropriate, of changes in additional charges, based on a change in the resident’s condition. Notification must occur prior to the date such revised additional charges begin. If notification is given orally, subsequent written notification must be also given within a reasonable time, not to exceed one week, listing specifically the adjustments made. (III)
	57.14(6) State the terms of agreement in regard to refund of all advance payments, in the event of transfer, death, voluntary, or involuntary discharge; (III)
	57.14(7) 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 responsible party.
	a. 	The facility shall ask the resident or responsible party 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)
	b. 	The facility shall reserve the bed when requested for as long as payments are made in accordance with the contract. (II)
	57.14(8) State the conditions under which the involuntary discharge or transfer of a resident would be effected; (III)
	57.14(9) State the conditions of voluntary discharge or transfer; (III)
	57.14(10) Set forth any other matters deemed appropriate by the parties to the contract. No contract or any provision thereof 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)
	57.14(11) Each party shall receive a copy of the signed contract. (III)
481—57.15(135C) Physical examinations.
	57.15(1) Each resident in a residential care facility shall have a designated licensed physician, who may be called when needed. (III)
	57.15(2) Each resident admitted to a residential care facility shall have had a physical examination prior to admission. (II, III)
	a. 	If the resident is admitted directly from a hospital, a copy of the hospital admission physical and discharge summary may be a part of the record in lieu of an additional physical examination. A record of the examination, signed by the physician, shall be a part of the resident’s record. (II, III)
	b. 	The record of the admission physical examination and medical history shall portray the current medical status of the resident and shall include the resident’s name, sex, age, medical history, physical examination, diagnosis, statement of chief complaints, and results of any diagnostic procedures. (II, III)
	c. 	Screening and testing for tuberculosis shall be conducted pursuant to 481—Chapter 59. (I, II, III)
	57.15(3) Arrangements shall be made to have a physician available to furnish medical care in case of emergency. (II, III)
	57.15(4) Rescinded, effective 7/14/82.
	57.15(5) The person in charge shall immediately notify the physician of any accident, injury, or adverse change in the resident’s condition. (I, II, III)
	57.15(6) Each resident shall be visited by or shall visit the resident’s physician at least once each year. The year period shall be measured from the date of admission and is not to include preadmission physicals. Any required physician task or visit in a residential care facility may also be performed by an advanced registered nurse practitioner, clinical nurse specialist, or physician assistant who is working in collaboration with the physician. (III)
	57.15(7) Residents shall be admitted to a residential care facility only on a written order signed by a physician certifying that the individual being admitted requires no more than personal care and supervision but does not require nursing care. (III)
This rule is intended to implement Iowa Code section 135C.23(2).
[ARC 0663C, IAB 4/3/13, effective 5/8/13]
481—57.16(135C) Records.
	57.16(1) Resident record. The licensee shall keep a permanent record on all residents admitted to a residential care facility with all entries current, dated, and signed. (III) 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 person to be notified in case of emergency; (III)
	h. 	Mortician’s name, telephone number, and address; (III)
	i. 	Pharmacist’s name, telephone number, and address; (III)
	j. 	Physical examination and medical history; (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, treatments, and diet in writing and signed by the physician quarterly; (III)
	m. 	A notation of yearly or other visits to physician or other professional services; (III)
	n. 	Any change in the resident’s condition; (II, III)
	o. 	If the physician has certified that the resident is capable of taking prescribed medications, the resident shall be required to keep the administrator advised of current medications, treatments, and diet. The administrator shall keep a listing of medications, treatments, and diet prescribed by the physician for each resident; (III)
	p. 	If the physician has certified that the resident is not capable of taking prescribed medication, it must be administered by a qualified person of the facility. A qualified person shall be defined as either a registered or licensed practical nurse or an individual who has completed the state-approved training course in medication administration; (II)
	q. 	Medications administered by an employee of the facility shall be recorded on a medication record by the individual who administers the medication; (II, III)
	r. 	A notation describing condition on admission, transfer, and discharge; (III)
	s. 	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)
	t. 	A copy of instructions given to the resident, legal representative, or facility in the event of discharge or transfer; (III)
	u. 	Disposition of valuables. (III)
	57.16(2) Incident record.
	a. 	Each residential care facility shall maintain an incident record report and shall have available incident report forms. (III)
	b. 	Report of incidents shall be in detail on a printed incident report form. (III)
	c. 	The person in charge at the time of the incident shall oversee the preparation and sign the incident report. (III)
	d. 	The report shall cover all accidents whether there is apparent injury or where hidden injury may have occurred. (III)
	e. 	The report shall cover all accidents or unusual occurrences within the facility or on the premises affecting residents, visitors, or employees. (III)
	f. 	A copy of the incident report shall be kept on file in the facility. (III)
	57.16(3) Retention of records.
	a. 	Records shall be retained in the facility for five years following termination of services. (III)
	b. 	Records shall be retained within the facility upon change of ownership. (III)
	c. 	Rescinded, effective 7/14/82.
	d. 	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)
	57.16(4) Reports to the department. The licensee shall furnish statistical information concerning the operation of the facility to the department on request. (III)
	57.16(5) Personnel record.
	a. 	An employment record shall be kept for each employee consisting of the following information: Name and address of employee, social security number of employee, date of birth of employee, date of employment, experience and education, references, position in the home, date and reason for discharge or resignation. (III)
	b. 	The personnel records shall be made available for review upon request by the department. (III)
481—57.17(135C) Resident care and personal services.
	57.17(1) Beds shall be made daily and adjusted as necessary. A complete change of linen shall be made at least once a week and more often if necessary. (III)
	57.17(2) Residents shall receive sufficient supervision so that their personal cleanliness is maintained. (II, III)
	57.17(3) Residents shall have clean clothing as needed to present a neat appearance, be free of odors, and to be comfortable. Clothing shall be appropriate to their activities and to the weather. (III)
	57.17(4) Rescinded, effective 7/14/82.
	57.17(5) Residents shall be encouraged to leave their rooms and make use of the recreational room or living room of the facility. (III)
	57.17(6) Residents shall not be required to pass through another’s bedroom to reach a bathroom, living room, dining room, corridor, or other common areas of the facility. (III)
	57.17(7) Rescinded, effective 7/14/82.
	57.17(8) Uncontrollable residents shall be transferred or discharged from the facility in accordance with contract arrangements and requirements of Iowa Code chapter 135C. (II, III)
	57.17(9) Residents shall be required to bathe at least twice a week. (II, III)
	57.17(10) Nonambulatory residents.
	a. 	All nonambulatory residents shall be housed on the grade level floor. (II)
	b. 	These provisions in paragraph “a” above relating to nonambulatory residents are not applicable if the facility has a suitably sized elevator.
481—57.18 Rescinded, effective 7/14/82.
481—57.19(135C) Drugs.
	57.19(1) 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 bedroom but locked storage must be provided. (III)
	b. 	Drug storage for residents who are unable to take their own medications and require supervision shall meet the following requirements:
	(1)	A cabinet with a lock shall be provided which can be used for storage of drugs, solutions, and prescriptions; (III)
	(2)	A bathroom shall not be used for drug storage; (III)
	(3)	The drug storage cabinet shall be kept locked when not in use; (III)
	(4)	The drug storage cabinet key shall be in the possession of the employee charged with the responsibility of administering medications; (II)
	(5)	Schedule II drugs, as defined by Iowa Code chapter 204, shall be kept in a locked box within the locked medication cabinet; (II, III)
	(6)	Medications requiring refrigeration shall be kept in a refrigerator and separated from food and other items; (III)
	(7)	Drugs for external use shall be stored separately from drugs for internal use; (III)
	(8)	All potent, poisonous, or caustic materials shall be stored separately from drugs. They shall be plainly labeled and stored in a specific, well-illuminated cabinet, closet, or storeroom and made accessible only to authorized persons; (I, II)
	(9)	The drug cabinet shall have a work counter. Both the counter and cabinet shall be well-lighted; (III)
	(10)	Running water shall be available in the room in which the medicine cabinet is located or in an adjacent room; (III)
	(11)	Inspection of drug storage condition shall be made by the administrator and a registered 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 not be limited to, certifying absence of the following: expired drugs, deteriorated drugs, improper labeling, drugs for which there is no current physician’s order, and drugs improperly stored. (III)
	(12)	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 three-day supply and a missing dose can be readily detected. (II)
	c. 	Bulk supplies of prescription drugs shall not be kept in a residential care facility unless a licensed pharmacy is established in the facility under the direct supervision and control of a pharmacist. (III)
	57.19(2) Drug safeguards.
	a. 	All prescribed medications shall be clearly labeled indicating the resident’s full name, physician’s name, prescription number, name and strength of drug, dosage, directions for use, date of issue, and name and address and telephone number of pharmacy or physician issuing the drug. Where unit dose is used, prescribed medications shall, as a minimum, indicate the resident’s full name, physician’s name, name and strength of drug, and directions for use. Standard containers shall be utilized for dispensing drugs. Paper envelopes shall not be considered standard containers. (III)
	b. 	Medication containers having soiled, damaged, illegible, or makeshift labels shall be returned to the issuing pharmacist, pharmacy, or physician for relabeling or disposal. (III)
	c. 	The medication for each resident shall be kept or stored in the original containers. (II, III)
	d. 	When a resident is discharged or leaves the facility, the unused prescription shall be sent with the resident or with a legal representative only upon the written order of a physician. (III)
	e. 	Unused prescription drugs prescribed for residents who have died shall be destroyed by the person in charge with a witness and notation made on the resident’s record, or, if a unit dose system is used, such drugs shall be returned to the supplying pharmacist. (III)
	f. 	Prescriptions shall be refilled only with the permission of the attending physician. (II, III)
	g. 	No medications prescribed for one resident may be administered to or allowed in the possession of another resident. (II)
	h. 	Instructions shall be requested of the Iowa board of pharmacy examiners concerning disposal of unused Schedule II drugs prescribed for residents who have died or for whom the Schedule II drug was discontinued. (III)
	i. 	There shall be a formal routine for the proper disposal of discontinued medications within a reasonable but specified time. These medications shall not be retained with the resident’s current medications. Discontinued drugs shall be destroyed by a responsible person with a witness and notation made to that effect or returned to the pharmacist for destruction or resident credit. Drugs listed under the Schedule II drugs shall be disposed of in accordance with the provisions of the Iowa board of pharmacy examiners. (II, III)
	j. 	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 personal physician of the resident, in conjunction with the pharmacist, shall institute these policies and provide procedures for review and endorsement. (II, III)
	k. 	No resident shall be allowed to keep possession of any medications 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. (II)
	l. 	No medications or prescription drugs shall be administered to a resident without a written order signed by the attending physician. (II)
	m. 	Each facility shall establish a policy in conjunction with a licensed pharmacist to govern distributing prescribed medication to residents who are on leave from a facility. (III)
	(1)	Medication may be issued to residents who will be on leave from a facility for less than 24 hours. Notwithstanding the prohibition against paper envelopes in 57.19(2)“a,” 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.
	(2)	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.
	(3)	Medication distributed as above may be issued only by facility personnel responsible for administering medication.
	57.19(3) 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. 	Unless the unit dose system is used, the person assigned the responsibility of medication administration must complete the procedure by personally preparing the dose, observing the actual act of swallowing the oral medication, and charting the medication. (II) In facilities where the unit dose system is used, the person assigned the responsibility must complete the procedure by observing the actual act of swallowing the medication and charting the medication. Medications shall be prepared on the same shift of the same day that they are administered, (II) unless the unit dose system is used.
	h. 	Injectable medications shall be administered by a qualified nurse or physician.
	i. 	Residents certified by their physician as capable of injecting their own insulin may do so. Insulin may be administered pursuant to “h” 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.
	j. 	An individual inventory record shall be maintained for each Schedule II drug prescribed for each resident. (II)
	k. 	The unit dose system may be used by the facility.
	l. 	In a freestanding residential care facility licensed for 15 or fewer beds, a person who has successfully completed a state-approved medication manager course may administer medications.
481—57.20(135C) Dental services.
	57.20(1) The residential care facility personnel shall assist residents to obtain regular and emergency dental services. (III)
	57.20(2) Transportation arrangements shall be made when necessary for the resident to be transported to the dentist’s office. (III)
	57.20(3) Dental services shall be performed only on the request of the resident, responsible relative, or legal representative. The resident’s physician shall be advised of the resident’s dental problems. (III)
	57.20(4) All dental reports or progress notes shall be included in the clinical record. (III)
	57.20(5) Personal care staff shall assist the resident in carrying out dentist’s recommendations. (III)
	57.20(6) Dentists shall be asked to participate in the in-service program of the facility. (III)
481—57.21(135C) Dietary.
	57.21(1) Dietary staffing.
	a. 	In facilities licensed for over 15 beds, persons in charge of meal planning and food preparation shall complete the home study course on sanitation and food preparation offered by the department. (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. These work and time schedules shall be posted or kept in a notebook which is available for use in the food service area in facilities over 15 beds. (III)
	57.21(2) Nutrition and menu planning.
	a. 	Menus shall be planned and followed to meet nutritional needs of residents in accordance with the physician’s orders. (II)
	b. 	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) Recommended daily dietary allowances are:
	(1)	Milk - two or more cups served as beverage or used in cooking;
	(2)	Meat group - two or more servings of meat, fish, poultry, eggs, cheese or equivalent; at least four to five ounces edible portion per day;
	(3)	Vegetable and fruit group - four or more servings (two cups). This shall include a citrus fruit or other fruit and vegetable important for vitamin C daily, a dark green or deep yellow vegetable for vitamin A at least every other day, and other fruits and vegetables, including potatoes;
	(4)	Bread and cereal group - four or more servings of whole-grain, enriched or restored;
	(5)	Foods other than those listed will usually be included to meet daily energy requirements (calories) to add to the total nutrients and variety of meals.
	c. 	At least three meals or their equivalent shall be served daily, at regular hours. (II)
	(1)	There shall be no more than a 14-hour span between substantial evening meal and breakfast. (II, III)
	(2)	To the extent medically possible, bedtime nourishments shall be offered routinely to all residents. Special nourishments shall be available when ordered by physician. (II, III)
	d. 	Menus shall include a variety of foods prepared in various ways. The same menu shall not be repeated on the same day of the following week. (III)
	e. 	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)
	f. 	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)
	g. 	A file of tested recipes adjusted to the number of people to be fed in the facility shall be maintained. (III)
	57.21(3) Dietary storage, food preparation, and service.
	a. 	All food and drink shall be clean, wholesome, free from spoilage, and safe for human consumption. (II, III)
	b. 	The use of foods from salvaged, damaged, or unlabeled containers shall be prohibited. (III)
	c. 	All perishable or potentially hazardous food shall be stored at safe temperatures of 45°F (7°C) or below, or 140°F (60°C) or above. (III)
	d. 	No perishable food shall be allowed to stand at room temperature any longer than is required to prepare and serve. (III)
	e. 	Supplies of staple foods for a minimum of a one-week period and of perishable foods for a minimum of a two-day period shall be maintained on the premises. Minimum food portion requirements for a low-cost plan shall conform to information supplied by the nutrition section of the department of health. (II, III)
	f. 	Table service shall be attractive. Dishes shall be free of cracks, chips, and stains. (III)
	g. 	If family-style service is used, all leftover prepared food that has been on the table shall be properly handled. (III)
	h. 	Poisonous compounds shall not be kept in food storage or preparation areas. (II)
	57.21(4) Sanitation in food preparation area.
	a. 	“Food Service Sanitation Manual”, revised 1976, U.S. Department of Health, Education, and Welfare, Public Health Service, U.S. Government Printing Office, Washington, D.C., shall be used as the established, nationally recognized reference for establishing and determining satisfactory compliance with food service sanitation.
	b. 	Residents shall not be allowed in the food preparation area. (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 foods, while being stored, prepared, displayed, served, or transported shall be protected against contamination from dust, flies, rodents, and other vermin. (II, III)
	e. 	Food shall be protected from unclean utensils and worn surfaces, unnecessary handling, coughs and sneezes, flooding, drainage, and overhead leakage. (II, III)
	f. 	All appliances and work areas shall be kept clean. (III)
	g. 	There shall be written procedures established for cleaning all work and serving areas in facilities over 15 beds. (III)
	h. 	A schedule for duties to be performed daily shall be posted in each food area. (III)
	i. 	All cooking equipment in facilities of 15 or more beds shall be provided with a properly sized exhaust system and hood to eliminate excess heat, moisture, and odors from the kitchen. (III)
	j. 	Spillage and breakage shall be cleaned up immediately. (III)
	k. 	All garbage not mechanically disposed of shall be kept in nonabsorbent, cleanable containers pending disposal. All filled containers shall be covered and stored in a sanitary manner. (III)
	l. 	The food service area shall be located so it will not be used as a passageway by residents, guests, or nonfood service staff. (III)
	m. 	The walls, ceilings, and floors of all rooms in which food is prepared and served shall be in good repair, smooth, washable, and shall be kept clean. (III)
	n. 	There shall be no washing, ironing, sorting or folding of laundry in the food service area. Dirty linen shall not be carried through the food service area unless it is in sealed, leakproof containers. (III)
	o. 	Ice shall be stored and handled in such a manner as to prevent contamination. Ice scoops should be sanitized daily and kept in a clean container. (III)
	p. 	There shall be no animals or birds in the food preparation area. (III)
	q. 	No dishes or cooking utensils shall be towel dried. (III)
	r. 	In facilities over 15 beds, a mechanical dishwasher is required. (III)
	s. 	If there is a dishwashing machine, it must provide a wash temperature of 140°F (60°C) to 160°F (71°C) and a rinse temperature of 170°F (76°C) to 180°F (82°C). In a freestanding residential care facility licensed for 15 or fewer beds, a wash and rinse temperature of 140°F (60°C) to 160°F (71°C) shall be acceptable. (III)
	t. 	A three-compartment pot and pan sink with 110°F (43°C) to 115°F (46°C) water for washing, a compartment for rinsing with water at 170°F (76°C) to 180°F (82°C) for sanitizing with space for air drying, or a two-compartment sink with access to a mechanical dishwasher for sanitizing all utensils shall be provided. (III)
	u. 	All dishes, silverware, and cooking utensils shall be stored above the floor in a sanitary manner, in a clean, dry place protected from flies, splashes, dust, and other contaminants. (III)
	v. 	Procedures for washing and handling dishes shall be followed in order to protect the welfare of the residents and employees. Persons handling dirty dishes shall not handle clean dishes without washing their hands. (III)
	w. 	Dishes, silverware, and cooking utensils shall be properly cleaned by prerinsing or scraping, washing, sanitizing, and air-drying. (III)
	57.21(5) Hygiene of food service personnel.
	a. 	Food service personnel shall be free of communicable diseases and practice hygienic food-handling techniques. 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. Personnel recovering from a diagnosed intestinal infection shall submit a report from their physician showing freedom from infection before returning to work in the food service department. (II, III)
	b. 	Employees shall wear clean, washable uniforms that are not used for duties outside the food service area. (III)
	c. 	Hairnets shall be worn by all food service personnel. Individuals with beards shall provide for total enclosure of facial hair. (III)
	d. 	Clean aprons and hairnets shall be available for use by other personnel in emergency situations. (III)
	e. 	Persons handling food shall be knowledgeable of good hand-washing techniques. A hand-wash sink shall be provided in or adjacent to the food service area. Continuous on-the-job training on sanitation shall be encouraged. (III)
	f. 	The use of tobacco shall be prohibited in the kitchen. (III)
	57.21(6) Food and drink. All food and drink consumed within the facility shall be clean and wholesome and comply with local ordinances and applicable provisions of state and federal laws. (II, III)
481—57.22(135C) Service plan.
	57.22(1) Prior to admission of a resident, the administrator or the administrator’s designee shall develop a written and organized orientation plan. The plan shall be designed to assist the resident in adapting to the facility and to assist the facility staff in becoming knowledgeable of the resident and the resident’s needs. (III)
	57.22(2) Within 30 days of admission, the administrator or the administrator’s designee shall, in conjunction with the resident, other facility staff or any organization that works with or serves the resident, develop a written, individualized, and integrated program of ongoing services for the resident. (III)
	a. 	The program shall be planned and implemented to address the resident’s priorities and assessed needs, such as living, rehabilitation, activity, behavioral, emotional, mental health and social, and shall take into consideration the resident’s personal goals and preferences, including the resident’s preferred living situation. (III)
	b. 	The service plan shall include specific goals and objectives with regular documentation of each. (III)
	c. 	The service plan shall be reviewed at least quarterly, or more often as necessary. (III)
	57.22(3) Communications related to service plan changes or changes in the resident’s condition shall occur within five working days of the change, and shall be conveyed to all individuals inside and outside the residential care facility who work with the resident, as well as to the resident’s family members or responsible party. (III)
481—57.23(135C) Resident activities program.
	57.23(1) Each residential care facility shall provide an organized resident activity program for the group and for the individual resident which shall include suitable activities for evenings and weekends. (III)
	a. 	The activity program shall be designed to meet the needs and interests of each resident and to assist residents in continuing normal activities within limitations set by the resident’s physician. This shall include helping residents continue in their individual interests or hobbies. (III)
	b. 	The program shall include individual goals for each resident. (III)
	c. 	The activity program shall include both group and individual activities. (III)
	d. 	No resident shall be forced to participate in the activity program. (III)
	57.23(2) Coordination of activities program.
	a. 	Each residential care facility with over 15 beds shall employ a person to direct the activities program. (III)
	1b. 	2 Staffing for the activity program shall be provided on the minimum basis of 45 minutes per licensed bed per week. (II, III)
	c. 	The activity coordinator shall have completed the activity coordinators’ orientation course offered through the department within six months of employment or have comparable training and experience as approved by the department. (III)
	d. 	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. These programs shall be approved by the department. (III)
	e. 	There shall be a written plan for personnel coverage when the activity coordinator is absent during scheduled working hours. (III)
	57.23(3) Duties of activity coordinator. The activity coordinator shall:
	a. 	Have access to all residents’ records excluding financial records; (III)
	b. 	Coordinate all activities, including volunteer or auxiliary activities and religious services; (III)
	c. 	Keep all necessary records including:
	(1)	Attendance; (III)
	(2)	Record individual resident progress notes at least every three months; (III)
	(3)	Monthly calendars, prepared in advance. (III)
	d. 	Coordinate the activity program with all other services in the facility; (III)
	e. 	Participate in the in-service training program in the facility. This shall include attending as well as presenting sessions. (III)
	57.23(4) 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, and bulletin boards. Also appropriate would be box games, game equipment, songbooks, cards, craft supplies, record player, movie projector, piano, outdoor equipment, etc.	(III)
	b. 	Storage shall be provided for recreational equipment and supplies. (III)
	c. 	Locked storage should be available for potentially dangerous items such as scissors, knives, and toxic materials. (III)
1	Emergency, pursuant to Iowa Code section 17A.5(2)“b”(2).
2	Objection filed 2/14/79, see insert IAC 3/7/79.
481—57.24(135C) Resident advocate committee. Each facility shall have a resident advocate committee in accordance with Iowa Code section 135C.25, which shall operate within the scope of the rules for resident advocate committees promulgated by the department on aging. (II)
	57.24(1) Role of committee in complaint investigations.
	a. 	The department shall notify the facility’s resident advocate 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 resident advocate committee for initial evaluation or investigation by the committee pursuant to rules promulgated by the department on aging. Within ten days of completion of the investigation, the committee shall report to the department in writing the results of the evaluation or the investigation.
	c. 	When the department investigates a complaint, upon conclusion of its investigation, it shall notify the resident advocate committee and the department on aging of its findings, including any citations and fines issued.
	d. 	Results of all complaint investigations addressed by the resident advocate committee shall be forwarded to the department within ten days of completion of the investigation.
	57.24(2) The resident advocate committee shall, upon department request, be responsible for monitoring correction of substantiated complaints.
	57.24(3) When requested, names, addresses and telephone numbers of family members shall be given to the resident advocate committee, unless the family refuses. The facility shall provide a form on which a family member may refuse to have the family member’s name, address or telephone number given to the resident advocate committee.
This rule is intended to implement Iowa Code section 135C.25.
481—57.25(135C) Safety. The licensee of a residential care facility shall be responsible for the provision and maintenance of a safe environment for residents and personnel. (III)
	57.25(1) Fire safety.
	a. 	All residential care facilities shall meet the fire safety rules and regulations as promulgated by the state fire marshal. (I, II)
	b. 	The size of the facility and needs of the residents shall be taken into consideration in evaluating safety precautions and practices.
	57.25(2) Safety duties of administrator. The administrator shall have a written emergency plan to be followed in the event of fire, tornado, explosion, or other emergency. (III)
	a. 	The plan shall be posted. (III)
	b. 	In-service shall be provided to ensure that all employees are knowledgeable of the emergency plan. (III)
	57.25(3) Resident safety.
	a. 	Residents shall be permitted to smoke only where proper facilities are provided. Smoking shall not be permitted in bedrooms. Smoking by residents considered to be careless shall be prohibited except when under direct supervision. (II, III)
	b. 	Smoking is prohibited in all rooms where oxygen is being administered or in rooms where oxygen is stored. (II, III)
	c. 	Whenever full or empty tanks of oxygen are being used or stored, they shall be securely supported in an upright position. (II, III)
	d. 	Smoking shall be permitted only in posted areas. (II, III)
	e. 	Residents shall receive adequate supervision to ensure against hazard from themselves, others, or elements in the environment. (II, III)
	57.25(4) Restraints.
	a. 	Rescinded, effective 7/14/82.
	b. 	Residents shall not be kept behind locked doors;
	c. 	Temporary seclusion of residents shall be used only in an emergency to prevent injury to the resident or to others pending transfer to appropriate placement;
	d. 	A divided door equipped with a securing device that may be readily opened by personnel shall be considered an appropriate means of temporarily confining a resident in the resident’s room;
	e. 	Divided doors shall be of such type that when the upper half is closed the lower section shall close.
481—57.26(135C) Housekeeping.
	57.26(1) Written procedures shall be established and implemented for daily and weekly cleaning schedules. (III)
	57.26(2) Each resident unit shall be cleaned on a routine schedule. (III)
	57.26(3) All rooms, corridors, storage areas, linen closets, attics, and basements shall be kept in a clean, orderly condition, free of unserviceable furniture and equipment and accumulations of refuse. (III)
	57.26(4) A hallway or corridor shall not be used for storage of equipment. (III)
	57.26(5) All odors shall be kept under control by cleanliness and proper ventilation. (III)
	57.26(6) Clothing worn by personnel shall be clean and washable. (III)
	57.26(7) 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)
	57.26(8) All furniture, bedding, linens, and equipment shall be cleaned periodically and before use by another resident. (III)
	57.26(9) Polishes used on floors shall provide a nonslip finish. (III)
	57.26(10) Throw or scatter rugs shall not be permitted. (III)
	57.26(11) Entrances, exits, steps, and outside walkways shall be kept free from ice, snow, and other hazards. (II, III)
	57.26(12) Residents shall not have access to storage areas for all cleaning agents, bleaches, insecticides, or any other poisonous, dangerous, or flammable materials. (II, III)
	57.26(13) Sufficient numbers of noncombustible trash containers, which have covers, shall be available. (III)
	57.26(14) Personal possessions of residents which may constitute hazards to themselves or to others shall be removed and stored. (III)
481—57.27(135C) Maintenance.
	57.27(1) Each facility shall establish a maintenance program to ensure the continued maintenance of the facility, to promote good housekeeping procedures, and ensure sanitary practices throughout the facility. In facilities over 15 beds, this program shall be established in writing and available for review by the department. (III)
	57.27(2) The building, grounds, and other buildings shall be maintained in a clean, orderly condition and in good repair. (III)
	57.27(3) Draperies and furniture shall be clean and in good repair. (III)
	57.27(4) Cracks in plaster, peeling wallpaper or paint, and tears or splits in floor coverings shall be promptly repaired or replaced in a professional manner. (III)
	57.27(5) The electrical systems, including appliances, cords, and switches, shall be maintained to guarantee safe functioning and comply with the national electric code. (III)
	57.27(6) All plumbing fixtures shall function properly and comply with the state plumbing code. (III)
	57.27(7) Yearly inspections of the heating and cooling systems shall be made to guarantee safe operation. (III)
	57.27(8) The building, grounds, and other buildings shall be kept free of breeding areas for flies, other insects, and rodents. (III)
	57.27(9) The facility shall be kept free of flies, other insects, and rodents. (III)
	57.27(10) Janitor closet.
	a. 	Facilities shall be provided with storage for cleaning equipment, supplies, and utensils. (III)
	b. 	Mops, scrub pails, and other cleaning equipment used in the resident areas shall not be stored or used in the dietary area. (III)
	c. 	In facilities licensed for 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. (III)
481—57.28(135C) Laundry.
	57.28(1) All soiled linens shall be collected in and transported to the laundry room in closed, leakproof laundry bags or covered, impermeable containers. (III)
	57.28(2) Except for related activities, the laundry room shall not be used for other purposes. (III)
	57.28(3) Procedures shall be written for the proper handling of wet, soiled, and contaminated linens. (III)
	57.28(4) Residents’ personal laundry shall be marked with an identification. (III)
	57.28(5) Bed linens, towels, and washcloths shall be clean and stain-free. (III)
	57.28(6) If laundry is done in the facility, the following shall be provided:
	a. 	A clean, dry, well-lighted area to accommodate a washer and dryer of adequate size to serve the needs of the facility. (III)
	b. 	In facilities of over 15 beds, the laundry room shall be divided into separate areas, one for sorting soiled linen and one for sorting and folding clean linen. (III)
481—57.29(135C) Garbage and waste disposal.
	57.29(1) All garbage shall be gathered, stored, and disposed of in a manner that will not permit transmission of disease, create a nuisance, or provide a breeding or feeding place for vermin or insects. (III)
	57.29(2) All containers for refuse shall be watertight, rodent-proof, and have tight-fitting covers. (III)
	57.29(3) All containers shall be thoroughly cleaned each time the containers are emptied. (III)
	57.29(4) All wastes shall be properly disposed of in compliance with local ordinances and state codes. (III)
	57.29(5) Special provision shall be made for the disposal of soiled dressings and similar items in a safe, sanitary manner. (III)
481—57.30(135C) Buildings, furnishings, and equipment.
	57.30(1) Buildings—general requirements.
	a. 	For purposes of computation of usable floor space in bedrooms and other living areas of the facility, that part of the room having no less than seven feet of ceiling height shall be used. Usable floor space may include irregularities in the rooms such as alcoves and offsets with approval of the department. Usable floor space shall not include space needed for corridor door swings or wardrobes being used as a substitute for closet space. (III)
	b. 	Battery-operated, portable emergency lights in good working condition shall be available at all times, at a ratio of one light per one employee on duty from 6 p.m.	to 6 a.m.	(III)
	c. 	All windows shall be supplied with curtains and shades or drapes which are kept clean and in good repair. (III)
	d. 	Light fixtures shall be so equipped to prevent glare and to prevent hazards to the residents. (III)
	e. 	Exposed heating pipes, hot water pipes, or radiators in rooms and areas used by residents and within reach of residents shall be covered or protected to prevent injury or burns to residents. (II, III)
	f. 	All fans located within seven feet of the floor shall be protected by screen guards of not more than one-fourth inch mesh. (III)
	g. 	Whenever glass sliding doors or transparent panels are used, they shall be marked conspicuously. (III)
	h. 	The facility shall meet the equivalent requirements of the appropriate group occupancy of the state building code. (III)
	i. 	No part of any room shall be enclosed, subdivided, or partitioned unless such part is separately lighted and ventilated and meets such other requirements as its usage and occupancy dictates except closets used for the storage of residents’ clothing. (III)
	j. 	All stairways in resident-occupied areas shall have substantial handrails on both sides. (III)
	k. 	Each open stairway shall have protective barriers. (III)
	l. 	Screens of 16 mesh per square inch shall be provided at all openings. (III)
	m. 	Screen doors shall swing outward and be self-closing. At the discretion of the state fire marshal, screens for fire doors may swing in. (III)
	n. 	All resident rooms shall have a door. (III)
	o. 	All rooms in resident-occupied areas shall have general lighting switched at the entrance to each room. (III)
	57.30(2) Furnishings and equipment.
	a. 	All furnishings and equipment shall be durable, cleanable, and appropriate to its function and in accordance with the department’s approved program of care. (III)
	b. 	All resident areas shall be decorated, painted, and furnished to provide a home-like atmosphere. (III)
	c. 	Upholstery materials shall be moisture- and soil-resistant, except on furniture provided by the resident and the property of the resident. (III)
	d. 	Night lights shall be provided in corridors, at stairways, attendant’s stations and residents’ bedrooms, and hazardous areas with no less than one foot-candle throughout the area at all times. (III)
	57.30(3) 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 provide periods of social and 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 57.30(3)“e” are met. (III)
	e. 	Multipurpose rooms. When space is provided for multipurpose dining and activities and recreational purposes, the area shall total at least 30 square feet per licensed bed for the first 100 beds and 27 square feet per licensed bed for all beds in excess of 100. An open area of sufficient size shall be provided to permit group activities such as religious meetings or presentation of demonstrations or entertainment.
	f. 	Living rooms.
	(1)	Living rooms shall be maintained for the use of residents and their visitors and may be used for recreational activities. (III)
	(2)	Living rooms shall be suitably furnished. (III)
	(3)	When space is provided to be used only for activities and recreational purposes, the area shall be at least 15 square feet per licensed bed. At least 50 percent of the required area must be in one room. (III)
	g. 	Dining rooms.
	(1)	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)
	(2)	When space is provided to be used only for dining, the area shall total at least 15 square feet per licensed bed. (III)
	57.30(4) Bedrooms.
	a. 	Each resident shall be provided with a standard, single, or twin bed, substantially constructed and in good repair. Rollaway 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 five inches thick and standard in size for the bed; and clean, comfortable pillows of average bed size. (III)
	c. 	Each resident shall have a bedside table with a drawer to accommodate personal possessions. (III)
	d. 	There shall be a comfortable chair, either a rocking chair or arm chair, per resident bed. The resident’s personal wishes shall be considered. (III)
	e. 	There shall be drawer space for each resident’s clothing. In a multiple bedroom, drawer space shall be assigned each resident. (III)
	f. 	Walls, ceilings, and floors shall have easily cleanable surfaces and shall be kept clean and in good repair. (III)
	g. 	Beds and other furnishings shall not obstruct free passage to and through doorways. (III)
	h. 	There shall be a wardrobe or closet in each resident’s room. Minimum clear dimensions shall be 1′ 10″ deep by 1′ 8″ wide with full hanging space and provide a clothes rod and shelf. In a multiple bedroom, closet or wardrobe space shall be assigned each resident sufficient for the resident’s needs. (III)
	i. 	Beds shall not be placed with the head of the bed in front of a window or radiator. (III)
	j. 	Beds shall not be placed in such a manner that the side of the bed is against the radiator or in close proximity to it unless it is covered so as to protect the resident from contact with it or from excessive heat. (III)
	k. 	Reading lamps shall be provided each resident in the resident’s room. (III)
	l. 	Each room shall have sufficient accessible mirrors to serve residents’ needs. (III)
	m. 	Usable floor space of a room shall be no less than eight feet in any major dimension. (III)
	n. 	Bedrooms shall have a minimum of 80 square feet of usable floor space per bed. (III)
	o. 	There shall be no more than four residents per room. (III)
	p. 	Each resident room shall be provided with light and ventilation by means of a window or windows with an area equal to one-eighth of the total floor area. The windows shall be openable. (III)
	57.30(5) Bath and toilet facilities.
	a. 	Provision shall be made for bars to hold individual towels and washcloths. (III)
	b. 	All lavatories shall have paper towel dispensers and an available supply of soap. (III)
	c. 	Minimum numbers of toilet and bath facilities shall be one lavatory, one toilet for each 10 residents, and one tub or shower for each 15 residents or fraction thereof. (III)
	d. 	There shall be a minimum of one bathroom with tub or shower, toilet stool and lavatory on each floor in multistory buildings for facilities licensed for over 15 beds. Separate toilets for the sexes shall be provided. (III)
	e. 	Grab bars shall be provided at all toilet stools, tubs, and showers. Grab bars, accessories, and anchorage shall have sufficient strength to sustain a deadweight of 250 pounds for five minutes. (III)
	f. 	Each toilet room shall have a door. (III)
	g. 	All toilet, bath, and shower facilities shall be supplied with adequate safety devices appropriate to the needs of the individual residents. Raised toilet seats shall be available for residents who are aged or infirm. (III)
	h. 	Toilet and bath facilities shall have an aggregate outside window area of at least four square feet. Facilities having a system of mechanical ventilation are exempt from this regulation. (III)
	i. 	Every facility shall provide a toilet and lavatory with grab bars for the public and staff. (III)
	57.30(6) Heating. A centralized heating system capable of maintaining a minimum temperature of 78°F (26°C) shall be provided. Portable units or space heaters are prohibited from being used in the facility except in an emergency. (III)
	57.30(7) Water supply.
	a. 	Every facility shall have an adequate water supply from an approved source. A municipal source of supply shall be considered as meeting this requirement. (III)
	b. 	Private sources of supply shall be tested annually and the report submitted with the annual application for license. (III)
	c. 	A bacterially unsafe source of supply shall be grounds for denial, suspension, or revocation of license. (III)
	d. 	The department may require testing of private sources of supply at its discretion in addition to the annual test. The facility shall supply reports of such tests as directed by the department. (III)
	e. 	Hot and cold running water under pressure shall be available in the facility. (III)
	f. 	Prior to construction of a new facility or new water source, private sources of supply shall be surveyed and shall comply with the requirements of the department. (III)
	57.30(8) Sewage system.
	a. 	Sewage shall be collected and disposed of in a manner approved by the department. Disposal into a municipal system will be considered as meeting this requirement. (III)
	b. 	Private sewage systems shall conform to the rules and regulations of the department of environmental quality, state health department, and the natural resources council. (III)
	c. 	Every facility shall have an interior plumbing system complete with flushing device. (III)
	57.30(9) Attendant’s station. In facilities over 15 beds, an attendant’s station with a minimum of 40 square feet shall be provided which is centrally located in the resident area and shall have a well-lighted desk with the necessary equipment for the keeping of required records and supplies. (III)
481—57.31(135C) Family and employee accommodations.
	57.31(1) Children under 14 years of age shall not be allowed into the service areas. (III)
	57.31(2) The residents’ bedrooms shall not be occupied by employees, family members of employees, or family members of the licensee. (III)
	57.31(3) In facilities where the total occupancy of family, employees, and residents is five or less, one toilet and one tub or shower shall be the minimum requirement. (III)
	57.31(4) In facilities where the total occupancy of family, employees, and residents is more than five, separate bathing and toilet facilities shall be required for the family or employees distinct from such areas provided for residents. (III)
	57.31(5) In all health care facilities, if the family or employees live within the facility, separate living quarters and recreation facilities shall be required for the family or employees distinct from such areas provided for residents. (III)
481—57.32(135C) Animals. No animals shall be allowed within the facility except with written approval of the department and under controlled conditions. (III)
481—57.33(135C) Environment and grounds.
	57.33(1) A residential care facility shall be constructed in a neighborhood free from excessive noise, dirt, polluted, or odorous air, or similar disturbances. (III)
	57.33(2) There shall be an area available for outdoor activities calculated at 25 square feet per licensed bed. Open air porches may be included in meeting such requirements. (III)
481—57.34(135C) Supplies.
	57.34(1) Linen supplies.
	a. 	There shall be an adequate supply of linen so that each resident shall have at least three washcloths, hand towels, and bath towels per week. (III)
	b. 	A complete change of bed linens shall be available in the linen storage area for each bed. (III)
	c. 	Sufficient lightweight, clean, serviceable blankets shall be available. All blankets shall be laundered as often as necessary for cleanliness and freedom of odors. (III)
	d. 	Each bed shall be provided with clean, washable bedspreads. There shall be a supply available when changes are necessary. (III)
	e. 	Uncrowded and convenient storage shall be provided for linens, pillows, and bedding. (III)
	57.34(2) First aid kit. A first aid emergency kit shall be available on each floor in every facility. (II, III)
	57.34(3) General supplies.
	a. 	All equipment shall be properly cleaned and sanitized before use by another resident. (III)
	b. 	Clean and sanitary storage shall be provided for equipment and supplies. (III)
481—57.35(135C) Residents’ rights in general.
	57.35(1) Each facility shall ensure that policies and procedures are written and implemented which include, at a minimum, all of the following provisions (subrules 57.35(2) to 57.35(6)) and which govern all areas of service provided by the facility. These policies and procedures shall be available to staff, residents, their families or legal representatives and the public and shall be reviewed annually. (II)
	57.35(2) Policies and procedures regarding the admission, transfer, and discharge of residents shall ensure that:
	a. 	Only those persons are accepted whose needs can be met by the facility directly or in cooperation with community resources or other providers of care with which it is affiliated or has contracts. (II)
	b. 	As changes occur in residents’ physical or mental condition, necessitating services or care which cannot be adequately provided by the facility, they are transferred promptly to other appropriate facilities. (II)
	57.35(3) Policies and procedures regarding the use of chemical and physical restraints shall define the use of restraints and identify the individual who may authorize the application of physical restraints in emergencies, and describe the mechanism for monitoring and controlling their use. (II)
	57.35(4) Policies and procedures shall include a method for submitting complaints and recommendations by residents or their responsible party and for ensuring a response and disposition by the facility. (II)
	57.35(5) Policies and procedures shall include provisions governing access to, duplication of, and dissemination of information from the residents’ records. (II)
	57.35(6) 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. (II)
	a. 	The facility shall make known to residents what they may expect from the facility and its staff, and what is expected from them. 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. 	Residents’ rights and responsibilities shall be presented in language understandable to the resident. If the facility serves residents who are non-English speaking or 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, or the resident’s responsible party, if applicable, indicating an understanding of these rights and responsibilities, and 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 responsible party. In the case of a mentally retarded resident, the signature shall be witnessed by a person not associated with or employed by the facility. The witness may be a parent, guardian, Medicaid agency representative, etc.	(II)
	d. 	In order to ensure that residents continue to be aware of these rights and responsibilities during their stay, a written copy shall be prominently posted in a location that is available to all residents. (II)
	e. 	All residents shall be advised within 30 days following changes made in the statement of residents’ rights and responsibilities. Appropriate means shall be utilized to inform non-English speaking, deaf or blind residents of changes. (II)
	57.35(7) Each resident or responsible party shall be fully informed in a contract as required in rule 57.14(135C), prior to or at the time of admission and during the resident’s stay, of services available in the facility, and of related charges not covered by the facility’s basic per diem rate. (II)
	57.35(8) Each resident or responsible party 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). Each resident shall be afforded the opportunity to participate in the planning of the resident’s total care and medical treatment, which may include, but is not limited to, nursing care, nutritional care, rehabilitation, restorative therapies, activities, and social work services. Each resident only participates in experimental research conducted under the department of health and human services protection from research risks policy and then only upon the resident’s informed written consent. Each resident has the right to refuse treatment except as provided by Iowa Code chapter 229. In the case of a confused or mentally retarded individual, the responsible party shall be informed by the physician of the resident’s medical condition and be afforded the opportunity to participate in the planning of the resident’s total care and medical treatment, to be informed of the medical condition, and to refuse to participate in experimental research. (II)
	a. 	The requirement that residents shall be informed of their conditions, involved in the planning of their care, and advised of any significant changes in either, shall be communicated to every physician responsible for the medical care of residents in the facility. (II)
	b. 	The administrator or designee shall be responsible for working with attending physicians in the implementation of this requirement. (II)
	c. 	If the physician determines or in the case of a confused or mentally retarded resident the responsible party determines that informing the resident of the resident’s condition is contraindicated, this decision and reasons for it shall be documented in the resident’s record by the physician. (II)
	d. 	Any clinical investigation involving residents must be under the sponsorship of an institution with a human subjects review board functioning in accordance with the requirements 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). A resident being considered for participation in experimental research must be fully informed of the nature of the experiment, e.g., medication, treatment, and understand the possible consequences of participating or not participating. The resident’s (or responsible party’s) written informed consent must be received prior to participation. (II)
	57.35(9) In residential care facilities which are also county care facilities, policies and procedures shall address the admission and retention of persons with histories of dangerous and disturbing behavior. For the purpose of this subrule, persons with histories of dangerous or disturbing behavior are those persons who have been committed for evaluation and found to be seriously mentally impaired pursuant to Iowa Code section 229.13 or 812.1 within six months of the request for admission to the facility. In addition to establishing the criteria for admission and retention of persons so defined, the policies and procedures shall provide for:
	a. 	Reasonable precautions to prevent the resident from harming self, other residents, or employees of the facility.
	b. 	Treatment of persons with mental illness as defined in Iowa Code section 229.1(1) which is provided in accordance with the individualized health care plan.
	c. 	Ongoing and documented staff training on individualized health care planning for persons with mental illness.
481—57.36(135C) Involuntary discharge or transfer.
	57.36(1) A facility shall not involuntarily discharge or transfer a resident from a facility except: for medical reasons; for the resident’s welfare or that of other residents; for nonpayment for the resident’s stay (as contained in the contract for the resident’s stay), except as prohibited by Title XIX of the Social Security Act, 42 U.S.C. 1396 to 1396k and by reason of action pursuant to Iowa Code chapter 229. (I, II)
	a. 	“Medical reasons” for transfer or discharge are based on the resident’s needs and are determined and documented in the resident’s record by the attending physician. Transfer or discharge may be required to provide a different level of care. (II)
	b. 	“Welfare” of a resident or that of other residents refers to their social, emotional, or physical well-being. A resident might be transferred or discharged because the resident’s behavior poses a continuing threat to the resident (e.g., suicidal) or to the well-being of other residents or staff (e.g., the resident’s behavior is incompatible with other residents’ needs and rights). Evidence that the resident’s continued presence in the facility would adversely affect the resident’s own welfare or that of other residents shall be made by the administrator or designee and shall be in writing and shall include specific information to support this determination. (II)
	c. 	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. The 30-day requirement shall not apply in any of the following instances:
	(1)	If an emergency transfer or discharge is mandated by the resident’s health care needs and is in accord with the written orders and 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 from the resident being transferred. (II)
	(2)	If the transfer or discharge is subsequently agreed to by the resident or the resident’s responsible party, and notification is given to the responsible party, physician, and the person or agency responsible for the resident’s placement, maintenance, and care in the facility. (II)
	d. 	The notice required by paragraph “c” 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)	A statement in not less than 12-point type (elite), which reads: “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 of inspections and appeals designee in emergency circumstances. If you lose the hearing, you will not be transferred before the expiration 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, Department of Inspections and Appeals, Lucas State Office Building, Des Moines, Iowa 50319-0083.” (II)
	e. 	A request for a hearing made under 57.36(1)“d”(3) shall stay a transfer or discharge pending a hearing or appeal decision. (II)
	f. 	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, responsible party, and Iowa department on aging long-term care ombudsman of record, not later than five full business days after receipt of the request. This notice shall also inform the licensee, resident or responsible party 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 on aging long-term care ombudsman shall have the right to appear at the hearing.
	g. 	The hearing shall be heard by a department of inspections and appeals designee pursuant to Iowa Code chapter 17A. (The hearing shall be public unless the resident or representative requests in writing that it be closed.) The licensee or designee shall have the opportunity to present to the representative of the department any 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 responsible party shall also have an opportunity to present to the representative of the department any oral testimony or written material to show just cause why a transfer or discharge should not be made. In a determination as to whether a transfer or discharge is authorized, the burden of proof rests on the party requesting the transfer or discharge.
	h. 	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 certified mail to the licensee, resident, responsible party, and department on aging 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.
	i. 	A copy of the notice required by paragraph “c” 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 responsible party, physician, the person or agency responsible for the resident’s placement, maintenance, and care in the facility, and the department on aging long-term care ombudsman.
	j. 	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)
	k. 	The involuntary transfer or discharge shall be discussed with the resident, the resident’s responsible party, 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 made a part of the resident’s record. (II)
	l. 	The resident shall receive counseling services before (by the sending facility) and after (by the receiving facility) the involuntary transfer to minimize the possible adverse effects of the involuntary transfer. Counseling shall be documented in the resident’s record. (II)
	(1)	Counseling shall be provided by a qualified individual who meets one of the following criteria:
	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)
	5.	Is any other person of the resident’s choice. (II)
	(2)	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)
	(3)	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)
	m. 	In the case of an emergency transfer or discharge as outlined in 57.36(1)“c”(1), 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 subparagraphs (1) and (2) of 57.36(1)“d.” In addition, the notice must contain a statement in not less than 12-point type (elite), 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 state department of inspections and appeals within 7 days after receiving this notice. 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 paragraphs “f,” “g,” and “h.”  (II)
	n. 	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 of inspections and appeals. 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.
	57.36(2) Intrafacility transfer:
	a. 	Residents shall not be relocated from room to room within a licensed health care facility arbitrarily. (I, II) Involuntary relocation may occur only in the following situations, and the situation shall be documented in the resident’s record.
	(1)	Incompatibility with or disturbing to other roommates, as documented in the resident’s record.
	(2)	For the welfare of the resident or other residents of the facility.
	(3)	For medical, nursing or psychosocial reasons, as documented in the resident’s record, as judged by the attending physician, nurse or social worker in the case of a facility which groups residents by medical, nursing or psychosocial needs.
	(4)	To allow a new admission to the facility which would otherwise not be possible due to separation of roommates by sex.
	(5)	In the case of a resident whose source of payment was previously private, but who now is eligible for Title XIX assistance, the resident may be transferred from a private room to a semiprivate room or from one semiprivate room to another.
	(6)	Reasonable and necessary administrative decisions regarding the use and functioning of the building.
	b. 	Unreasonable and unjustified reasons for changing a resident’s room without the concurrence of the resident or responsible party include:
	(1)	Change from private pay status to Title XIX, except as outlined in 57.36(2)“a”(5). (II)
	(2)	As punishment or behavior modification (except as specified in 57.36(2)“a”(1)). (II)
	(3)	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 therefor shall be explained. The responsible party shall be notified as soon as possible. The notification shall be documented in the resident’s record and signed by the resident or responsible party. (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 or responsible party shall be notified immediately, or as soon as possible, of the condition requiring emergency relocation and the notification shall be documented. (II)
481—57.37(135C) Residents’ rights. Each resident shall be encouraged and assisted throughout the resident’s period of stay, to exercise the resident’s rights as a resident and as a citizen 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)
	57.37(1) The facility shall provide ongoing opportunities for residents to be aware of and to exercise their rights as residents. Residents shall be kept informed of issues or pending decisions of the facility that affect them and their views shall be solicited prior to action. (II)
	57.37(2) The facility shall implement a written procedure for registering and resolving grievances and recommendations by residents or their responsible party. The procedure shall ensure protection of the resident from any form of reprisal or intimidation. The written procedure shall include:
	a. 	Designation of an employee responsible for handling grievances and recommendations. (II)
	b. 	A method of investigating and assessing the validity of a grievance or recommendation. (II)
	c. 	Methods of resolving grievances. (II)
	d. 	Methods of recording grievances and actions taken. (II)
	57.37(3) The facility shall post in a prominent area the name, telephone number, and address of the ombudsman, survey agency, local law enforcement agency, and resident advocate committee members and the text of Iowa Code section 135C.46 to provide to residents a further course of redress. (II)
481—57.38(135C) Financial affairs—management. Each resident, who has not been assigned a guardian or conservator by the court, may manage the resident’s own 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)
	57.38(1) The facility shall maintain a written account of all residents’ funds received by or deposited with the facility. (II)
	57.38(2) An employee shall be designated in writing to be responsible for resident accounts. (II)
	57.38(3) The facility shall keep on deposit personal funds over which the resident has control in accordance with Iowa Code subsection 135C.24(2). Should the resident request these funds, they shall be given to the resident on request with receipts maintained by the facility and a copy to the resident. In the case of a confused or mentally retarded resident, the resident’s responsible party shall designate a method of disbursing the resident’s funds. (II)
	57.38(4) If the facility makes financial transactions on a resident’s behalf, the resident 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)
	57.38(5) A resident’s personal funds shall not be used without the written consent of the resident or the resident’s guardian. (II)
	57.38(6) 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)
481—57.39(135C) Resident abuse prohibited. Each resident shall receive kind and considerate care at all times and shall be free from mental and physical abuse. Each resident shall be free from chemical and physical restraints, except in an emergency for the shortest amount of time necessary to protect the resident from injury to the resident or to others, pending the immediate transfer to an appropriate facility. The decision to use restraints on an emergency basis shall be made by the designated charge person who shall promptly report the action taken to the physician and the reasons for using restraints shall be documented in the resident’s record. Mechanical supports used in normative situations to achieve proper body position and balance shall not be considered to be a restraint. (II)
	57.39(1) Mental abuse includes, but is not limited to, humiliation, harassment, and threats of punishment or deprivation. (II)
	57.39(2) Physical abuse includes, but is not limited to, corporal punishment and the use of restraints as punishment. (II)
	57.39(3) Drugs such as tranquilizers may not be used as chemical restraints to limit or control resident behavior for the convenience of staff. (II)
	57.39(4) 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 that separation until the abuse investigation is completed. (I, II)
	57.39(5) Suspected abuse reports. The department shall investigate all complaints of dependent adult abuse which are alleged to have happened in a health care facility. The department shall inform the department of human services of the results of all evaluations and dispositions of dependent adult abuse investigations.
	57.39(6) 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)
481—57.40(135C) Resident records. Each resident shall be ensured confidential treatment of all information contained in the resident’s records, including information contained in an automatic data bank. The resident’s written consent shall be required for the release of information to persons not otherwise authorized under law to receive it. (II)
	57.40(1) The facility shall limit access to any medical records to staff and consultants providing professional service to the resident. This is not meant to preclude access by representatives of state and federal regulatory agencies. (II)
	57.40(2) Similar procedures shall safeguard the confidentiality of residents’ personal records, e.g., financial records and social services records. Only those personnel concerned with the financial affairs of the residents may have access to the financial records. This is not meant to preclude access by representatives of state and federal regulatory agencies. (II)
	57.40(3) The resident, or the resident’s responsible party, shall be entitled to examine all information contained in the resident’s record and shall have the right to secure full copies of the record at reasonable cost upon request, unless the physician determines the disclosure of the record or section thereof is contraindicated in which case this information will be deleted prior to making the record available to the resident or responsible party. This determination and the reasons for it must be documented in the resident’s record. (II)
481—57.41(135C) Dignity preserved. The resident shall be treated with consideration, respect, and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs. (II)
	57.41(1) Staff shall display respect for residents when speaking with, caring for, or talking about them, as constant affirmation of their individuality and dignity as human beings. (II)
	57.41(2) 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 and eating, also times to retire at night and arise in the morning shall be elicited and considered by the facility. (II)
	57.41(3) Residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door or a drawn curtain 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)
	57.41(4) Privacy of a resident’s body also shall be maintained during toileting, bathing, and other activities of personal hygiene, except as needed for resident safety or assistance. (II)
	57.41(5) Staff shall knock and be acknowledged before entering a resident’s room unless the resident is not capable of a response. This shall not apply under emergency conditions. (II)
481—57.42(135C) Resident work. No resident may be required to perform services for the facility, except as provided by Iowa Code sections 35D.14 and 347B.5. (II)
	57.42(1) Residents may not be used to provide a source of labor for the facility against their will. Physician’s approval is required for all work programs. (I, II)
	57.42(2) Residents who perform work for the facility must receive remuneration unless the work is part of their approved training program. Persons on the resident census performing work shall not be used to replace paid employees in fulfilling staffing requirements. (II)
481—57.43(135C) 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, and may send and receive personal mail unopened. (II)
	57.43(1) 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)
	57.43(2) 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:
	a. 	The resident refuses to see the visitor(s). (II)
	b. 	The resident’s physician documents specific reasons why such a visit would be harmful to the resident’s health. (II)
	c. 	The visitor’s behavior is unreasonably disruptive to the functioning of the facility (this judgment must be made by the administrator and the reasons shall be documented and kept on file). (II)
	57.43(3) Decisions to restrict a visitor are reviewed and reevaluated: each time the medical orders are reviewed by the physician; at least quarterly by the facility’s staff; or at the resident’s request. (II)
	57.43(4) Space shall be provided for residents to receive visitors in reasonable comfort and privacy. (II)
	57.43(5) Telephones consistent with ANSI standards (405.1134(c)) 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)
	57.43(6) Arrangements shall be made to provide assistance to residents who require help in reading or sending mail. (II)
	57.43(7) 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, qualified mental retardation professional, or facility administrator for refusing permission. (II)
	57.43(8) 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)
481—57.44(135C) Resident activities. Each resident may participate in activities of social, religious, and community groups at the resident’s discretion unless contraindicated for reasons documented by the attending physician or qualified mental retardation professional as appropriate in the resident’s resident record. (II)
	57.44(1) Residents who wish to meet with or participate in activities of social, religious, or other community groups in or outside of the facility shall be informed, encouraged, and assisted to do so. (II)
	57.44(2) All residents shall have the freedom to refuse to participate in these activities. (II)
481—57.45(135C) Resident property. Each resident may retain and use personal clothing and possessions as space permits and provided such use is not otherwise prohibited by these rules. (II)
	57.45(1) 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 safe location which is convenient to the resident. (II)
	57.45(2) 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)
	57.45(3) Any personal clothing or possessions retained by the facility for the resident during the resident’s stay shall be identified and recorded on admission and a record placed on the resident’s chart. The facility shall be responsible for secure storage of the items, and they shall be returned to the resident promptly upon request or upon discharge from the facility. (II)
	57.45(4) A resident’s personal property shall not be used without the written consent of the resident or the resident’s guardian. (II)
	57.45(5) 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)
481—57.46(135C) Family visits. Each resident, if married, shall be ensured privacy for visits by the resident’s spouse; if both are residents in the facility, they shall be permitted to share a room, if available. (II)
	57.46(1) The facility shall provide for needed privacy in visits between spouses. (II)
	57.46(2) Spouses who are residents in the same facility shall be permitted to share a room, if available, unless one of their attending physicians documents in the medical record those specific reasons why such an arrangement would have an adverse effect on the health of the resident. (II)
	57.46(3) Family members shall be permitted to share a room, if available, if requested by both parties, unless one of their attending physicians documents in the medical record those specific reasons why such an agreement would have an adverse effect on the health of the resident. (II)
481—57.47(135C) Choice of physician. Each resident shall be permitted free choice of a physician and a pharmacy, if accessible. The facility may require the pharmacy selected to utilize a drug distribution system compatible with the system currently used by the facility. (II)
481—57.48(135C) Incompetent residents.
	57.48(1) Each facility shall provide that all rights and responsibilities of the resident devolve to the resident’s responsible party 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 subrule is not intended to limit the authority of any individual acting pursuant to Iowa Code chapter 144A. (II)
	57.48(2) 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 responsible party, if any, and acquire a statement indicating an understanding of residents’ rights. (II)
481—57.49(135C) County care facilities. In addition to Chapter 57 licensing rules, county care facilities licensed as residential care facilities must also comply with department of human services rules, 441—Chapter 37. Violations of any standard established by the department of human services is a Class II violation pursuant to 481—56.2(135C).
481—57.50(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)
	57.50(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.
	57.50(2) Approval of the state fire marshal shall be obtained before approval of the department will be considered.
	57.50(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)
481—57.51(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 residential care facility which chooses to provide respite care services must meet the following requirements related to respite services and must be licensed as a residential care facility.
	57.51(1) A residential care facility which chooses to provide respite care services is not required to obtain a separate license or pay a license fee.
	57.51(2) Rule 481—57.36(135C), regarding involuntary discharge or transfer rights, does not apply to residents who are being cared for under a respite care contract.
	57.51(3) Pursuant to rule 481—57.14(135C), 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 under 481—57.14(135C), except the requirements under subrule 57.14(7).
	57.51(4) Respite care services shall not be provided by a health care 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 10A.202, 10A.402, 135C.6(1), 135C.14, 135C.23(2), 135C.25, 135C.36, 227.4, 235B.1(6), and 235B.1(11).
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[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 7/13/05, Notice 6/8/05—published 8/3/05, effective 9/7/05]
[Filed 9/20/06, Notice 8/2/06—published 10/11/06, effective 11/15/06]
[Filed 11/14/07, Notice 10/10/07—published 12/5/07, effective 1/9/08]
[Filed 7/9/08, Notice 1/30/08—published 7/30/08, effective 9/3/08]
[Filed ARC 0663C (Notice ARC 0513C, IAB 12/12/12), IAB 4/3/13, effective 5/8/13]
◊	Two or more ARCs
1	Effective date of 470—57.15(2)“a” and “b” delayed until the expiration of 45 calendar days into the 1987 session of the General Assembly pursuant to Iowa Code section 17A.8(9), IAB 6/4/86.
2	See IAB, Inspections and Appeals Department.
3	Effective date of 481—57.12(2) “a,” last paragraph, delayed 70 days by the Administrative Rules Review Committee at its meeting held July 8, 1993.
OBJECTION
At its February 13 meeting the Administrative Rules Review Committee voted the following objection: [Subrules 57.23(2)“b,” 58.26(2)“b,” 59.31(2)“b,” 63.21(3)“b,” published IAB 12/13/78]
The committee objects to the amendments to 470* IAC 57.23(2)“b,” 58.26(2)“b,” 59.31(2)“b” and 63.21(3)“b,” which strike the phrase “Twenty-five percent of the staffing may be provided by qualified volunteers. The time shall be spent in working with the organized program activity.”, on the grounds these provisions are unreasonable. It is the understanding of the committee these deletions in effect require facilities to employ a person to coordinate recreation activities. It is the feeling of the committee this would result in higher per bed costs without demonstrably improving the services rendered to the patient. Volunteers have always played a major role in health care institutions, and no evidence has been submitted indicating a decline in that role or in public interest in donating time and energy.
These amendments appear in the 12-13-78 IAB, and have been filed under the emergency provisions of chapter 17A, 1979 Code.