CHAPTER 63RESIDENTIAL CARE FACILITY—THREE- TO FIVE-BED SPECIALIZED LICENSE[Prior to 7/15/87, Health Department[470] Ch 63]48163.1(135C) Definitions. For the purpose of these rules, the following terms shall have the meanings indicated in this chapter. The definitions set out in Iowa Code section 135C.1 shall be considered to be incorporated verbatim in the rules.
"Accommodation" means the provision of lodging, including sleeping, dining, and living areas.
"Administrator" means a person approved by the department who administers, manages, supervises, and is in general administrative charge of a three- to five-bed 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.
"Ambulatory" means the condition of a person who immediately and without aid of another person is physically and mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.
"Basement" means that part of a building where the finish floor is more than 30 inches below the finish grade of the building.
"Board" means the regular provision of meals.
"Change of ownership" means the purchase, transfer, assignment or lease of a licensed three- to five-bed residential care facility.
"Communicable disease" means a disease caused by the presence within a person’s body of a virus or microbial agents which may be transmitted either directly or indirectly to other persons.
"Department" means the state department of inspections and appeals.
"Interdisciplinary team" means the group of persons who develop a single, integrated, individual program plan to meet a resident’s needs for services. The interdisciplinary team consists of, at a minimum, the resident, the resident’s legal guardian if applicable, the resident’s advocate if desired by the resident, a referral agency representative, other appropriate staff members, other providers of services, and other persons relevant to the resident’s needs.
"Legal representative" means the resident’s guardian or conservator if one has been appointed or the resident’s power of attorney.
"Mechanical restraint" means restriction by the use of a mechanical device of a resident’s mobility or ability to use the hands, arms or legs.
"Medication" means any drug, including over-the-counter substances.
"Nonambulatory" means the condition of a person who immediately and without the aid of another person is not physically or mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.
"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 eating, and supervision over medications which can be self-administered.
"Physical restraint" means direct physical contact on the part of a staff person to control a resident’s physical activity for the resident’s own protection or for the protection of others.
"Primary care provider" means any of the following who provide primary care and meet licensure standards:
- A physician who is a family or general practitioner or an internist.
- An advanced registered nurse practitioner.
- A physician assistant.
"Program of care" means all services being provided for a resident in a health care facility.
"Prone restraint" means a restraint in which a resident is in a face-down position against the floor or another surface.
"Rate" means that daily fee charged for all residents equally and shall include the cost of all minimum services required in these rules.
"Records" includes electronic records.
"Responsible party" means the person who signs or cosigns the residency agreement required by rule 481—63.12(135C) or the resident’s legal representative. In the event that a resident has neither a legal representative nor a person who signed or cosigned the resident’s residency agreement, the term “responsible party” shall include the resident’s sponsoring agency, e.g., the department of human services, the U.S. Department of Veterans Affairs, a religious group, fraternal organization, or foundation that assumes responsibility and advocates for its client patients and pays for their health care.
"Restraints" means the measures taken to control a resident’s physical activity for the resident’s own protection or for the protection of others.
"Specialized residential care facility license" means a license for three- to five-bed residential care facilities serving persons with an intellectual disability, chronic mental illness, a developmental disability or brain injury.
Related ARC(s): 3740C48163.2(135C, 17A) Waiver. A waiver from these rules may be granted by the director of the department in accordance with 481—Chapter 6. A request for waiver will be granted or denied by the director within 120 calendar days of receipt.Related ARC(s): 3740C, 5719C48163.3(135C) Application for licensure. 63.3(1) Application and licensing—new facility or change of ownership. In order to obtain a specialized residential care facility license for a facility not currently licensed as a specialized residential care facility or for a specialized residential care facility when a change of ownership is contemplated, the applicant must: a. Make application at least 30 days prior to the proposed opening date of the facility. Application shall be made on forms provided by the department. b. Meet all of the rules, regulations, and standards contained in this chapter and in 481—Chapter 50. c. Submit a letter of intent and a written résumé of care. The résumé of care shall meet the requirements of subrule 63.3(2). d. Submit a floor plan of each floor of the residential care facility. The floor plan of each floor shall be drawn on 8½″ × 11″ paper, show room areas in proportion, room dimensions, window and door locations, designation of the use of each room, and the room numbers for all rooms, including bathrooms. e. Submit a photograph of the front and side of the residential care facility. f. Submit the fee for a specialized residential care facility license in accordance with 481—paragraph 50.3(2)“a.” g. Comply with all other local statutes and ordinances in existence at the time of licensure. h. Submit a certificate signed by the state or local fire inspection authority as to compliance with fire safety rules and regulations. 63.3(2) Résumé of care. The résumé of care shall describe the following: a. Purpose of the facility; b. Criteria for admission to the facility; c. Ownership of the facility; d. Composition and responsibilities of the governing board; e. Qualifications and responsibilities of the administrator; f. Medical services provided to residents, to include the availability of emergency medical services in the area and the designation of a primary care provider to be responsible for residents in an emergency; g. Dental services provided to residents and available in the area; h. Nursing services provided to residents, if applicable; i. Personal services provided to residents, including supervision of or assistance with activities of daily living; j. Activity program; k. Dietary services, including qualifications of the person in charge, consultation service (if applicable) and meal service; l. Other services available as applicable, including social services, physical therapy, occupational therapy, and recreational therapy; m. Housekeeping; n. Laundry; o. Physical plant; and p. Staffing provided to meet residents’ needs. 63.3(3) Renewal application. In order to obtain a renewal of the specialized residential care facility license, the applicant must submit the following: a. The completed application form 30 days prior to the annual license renewal date of the residential care facility license; b. The fee for a specialized residential care facility license in accordance with 481—paragraph 50.3(2)“a”; c. An approved current certificate signed by the state or local fire inspection authority as to compliance with fire safety rules and regulations; d. Changes to the résumé of care, if any; and e. Changes to the current residency agreement, if any.Related ARC(s): 3740C, 4577C48163.4(135C) Issuance of license. Licenses are issued to the person, entity or governmental unit with responsibility for the operation of the facility and for compliance with all applicable statutes, rules and regulations.Related ARC(s): 3740C48163.5(135C) General requirements. 63.5(1) The license shall be displayed in the facility in a conspicuous place which is accessible to the public. (III) 63.5(2) The license shall be valid only in the possession of the licensee to whom it is issued. 63.5(3) The posted license shall accurately reflect the current status of the facility. (III) 63.5(4) The license shall expire one year after the date of issuance or as indicated on the license. 63.5(5) The licensee shall: a. Assume the responsibility for the overall operation of the facility. (I, II, III) b. Be responsible for compliance with all applicable laws and with the rules of the department. (I, II, III) c. Provide an organized continuous 24-hour program of care commensurate with the needs of the residents. (I, II, III) 63.5(6) Each citation or a copy of each citation issued by the department for a class I or class II violation shall be prominently posted by the facility in plain view of the residents, visitors, and persons inquiring about placement in the facility. The citation or copy of the citation shall remain posted until the violation is corrected to the satisfaction of the department. (I, II, III)Related ARC(s): 3740C48163.6(135C) Required notifications to the department. The department shall be notified: 63.6(1) Thirty days before any proposed change in the residential care facility’s functional operation or addition or deletion of required services; (III) 63.6(2) Thirty days before the beginning of the renovation, addition, functional alteration, change of space utilization, or conversion in the residential care facility or on the premises; (III) 63.6(3) Thirty days before closure of the residential care facility; (III) 63.6(4) Within two weeks of any change in administrator; (III) 63.6(5) Ninety days before a change in the category of license; (III) 63.6(6) Thirty days before a change of ownership. The licensee shall: a. Inform the department of the pending change of ownership; (III) b. Inform the department of the name and address of the prospective purchaser, transferee, assignee, or lessee; (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)Related ARC(s): 3740C48163.7(135C) Administrator. Each facility shall have one person in charge, duly approved by the department or acting in a provisional capacity in accordance with these rules. (III) 63.7(1) Qualifications of an administrator. a. The administrator shall be at least 21 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: (1) Have a two-year degree in human services, psychology, sociology, nursing, health care administration, public administration, or a related field and have a minimum of two years’ experience in the field; or (III) (2) Have a four-year degree in human services, psychology, sociology, nursing, health care administration, public administration, or a related field and have a minimum of one year of experience in the field; or (III) (3) Have a master’s degree in human services, psychology, sociology, nursing, health care administration, public administration, or a related field and have a minimum of one year of experience in the field; or (III) (4) Be a licensed nursing home administrator; or (III) (5) Have completed a one-year educational training program approved by the department for residential care facility administrators; or (III) (6) Have passed the National Association of Long Term Care Administrator Boards (NAB) RC/AL administrator licensure examination; or (7) Have two years of direct care experience and at least six months of administrative experience in a residential care facility. (III) b. The administrator shall have at least one year of documented experience in a supervisory or direct care position working with persons with an intellectual disability, mental illness, a developmental disability, or brain injury. c. An individual employed as an administrator on May 16, 2018, will be deemed to meet the requirements of this subrule. 63.7(2) Duties of an administrator. The administrator shall: a. Select and direct competent personnel who provide services for the residential care program. (III) b. Provide in-service educational programming for all employees with direct resident contact and maintain records of programs and participants. (III) In-service educational programming offered during each calendar year shall include, at minimum, the following topics: (I, II, III) (1) Infection control. (2) Emergency preparedness (e.g., fire, tornado, flood, 911). (3) Meal time procedures/dietary. (4) Resident activities. (5) Mental illness, brain injury or intellectual disabilities, including behavioral intervention, de-escalation, and crisis intervention techniques. (6) Resident safety/supervision. (7) Resident rights. (8) Medication education, to include administration, storage and drug interactions. (9) Resident service plans/programming/goals. 63.7(3) Administrator serving at more than one residential care facility. 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) a. An administrator of more than one facility shall designate in writing an administrative staff person in each facility who shall be responsible for directing programs in the facility. b. The administrative staff person designated by the administrator shall: (1) Have at least one year of documented experience in a supervisory or direct care position working with persons with an intellectual disability, mental illness, a developmental disability, or brain injury; (II, III) (2) Be knowledgeable of the operation of the facility; (II, III) (3) Have access to records concerned with the operation of the facility; (II, III) (4) Be capable of carrying out administrative duties and of assuming administrative responsibilities; (II, III) (5) Be at least 21 years of age; (III) (6) Be empowered to act on behalf of the licensee concerning the health, safety and welfare of the residents; and (II, III) (7) Have training in emergency response, including how to respond to residents’ sudden illnesses. (II, III) c. If an administrator serves more than one facility, the administrator must designate in writing regular and specific times during which the administrator will be available to consult with staff and residents to provide direction and supervision of resident care and services. (II, III) 63.7(4) Provisional administrator. 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 one year when the facility has lost its administrator and has not been able to replace the administrator, provided that the department has been notified and has approved the provisional administrator prior to the date of the provisional administrator’s appointment. (III) The provisional administrator must meet the requirements of paragraph 63.7(3)“b.” 63.7(5) Temporary absence of administrator. a. In the temporary 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: (1) Be knowledgeable of the operation of the facility; (III) (2) Have access to records concerned with the operation of the facility; (III) (3) Be capable of carrying out administrative duties and of assuming administrative responsibilities; (III) (4) Be at least 21 years of age; (III) (5) Be empowered to act on behalf of the licensee during the administrator’s absence concerning the health, safety, and welfare of the residents; (III) (6) Have training in emergency response, including how to respond to residents’ sudden illnesses. (II, III) b. If the administrator is absent for more than six weeks, a provisional administrator must be appointed pursuant to subrule 63.7(4).Related ARC(s): 3740C48163.8(135C) Personnel. 63.8(1) Alcohol and drug use prohibited. No person under the influence of intoxicating drugs or alcoholic beverages shall be permitted to provide services in a residential care facility. (I, II) 63.8(2) Job description. There shall be a written job description developed for each category of worker. The job description shall include the job title, responsibilities and qualifications. (III) 63.8(3) Employee criminal record, child abuse and dependent adult abuse checks and employment of individuals who have committed a crime or have a founded abuse. The facility shall comply with the requirements found in Iowa Code section 135C.33 and rule 481—50.9(135C) related to completion of criminal record checks, child abuse checks, and dependent adult abuse checks and to employment of individuals who have committed a crime or have a founded abuse. (I, II, III) 63.8(4) Personnel record. A personnel record shall be kept for each employee and shall include but not be limited to the following information about the employee: name and address; social security number; date of birth; date of employment; position; job description; experience and education; results of criminal record checks, child abuse checks and dependent adult abuse checks; and date of discharge or resignation. (III) 63.8(5) Supervision and staffing. a. The facility shall provide sufficient staff to meet the needs of the residents served. (I, II, III) b. Personnel in a specialized residential care facility shall provide 24-hour coverage for residential care services. Personnel shall be available and responsive to residents’ needs at all times while on duty. (I, II, III) c. Direct care staff shall be present in the facility unless all residents are involved in activities away from the facility. (I, II, III) d. Staff shall be aware of and provide supervision levels based on the present needs of the residents in the staff’s care. The facility shall document the supervision of residents who require more than general supervision, as defined by facility policy. (I, II, III) e. The facility shall maintain an accurate record of actual hours worked by employees. (III) 63.8(6) Physical examination and screening. Employees shall have a physical examination within 12 months prior to beginning employment and every four years thereafter. Screening and testing for tuberculosis shall be conducted pursuant to 481—Chapter 59. (I, II, III)Related ARC(s): 3740C, 4577C48163.9(135C) General policies. The licensee shall establish and implement written policies and procedures as set forth in this rule. The policies and procedures shall be available for review by the department, other agencies designated by Iowa Code section 135C.16(3), staff, residents, residents’ families or legal representatives, and the public and shall be reviewed by the licensee annually. (II) 63.9(1) Facility operation. The licensee shall establish written policies for the operation of the facility, including but not limited to the following: (III) a. Personnel; (III) b. Admission; (III) c. Evaluation services; (II, III) d. Programming and individual program plans; (II, III) e. Registered sex offender management; (II, III) f. Crisis intervention; (II, III) g. Discharge or transfer; (III) h. Medication management, including self-administration of medications and chemical restraints; (III) i. Resident property; (II, III) j. Resident finances; (II, III) k. Records; (III) l. Health and safety; (II, III) m. Nutrition; (III) n. Physical facilities and maintenance; (III) o. Resident rights; (II, III) p. Investigation and reporting of alleged dependent adult abuse; (II, III) q. Investigation and reporting of accidents or incidents; (II, III) r. Transportation of residents; (II, III) s. Resident supervision; (II, III) t. Smoking; (III) u. Visitors; (III) v. Disaster/emergency planning; (III) and w. Infection control. (III) 63.9(2) Personnel policies. Written personnel policies shall include the hours of work and attendance at educational programs. (III) 63.9(3) Infection control. The facility shall have a written and implemented infection control program, which shall include policies and procedures based on guidelines issued by the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. The infection control program shall address the following: a. Techniques for hand washing; (I, II, III) b. Techniques for the handling of blood, body fluids, and body wastes; (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; (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) and h. Techniques for use and disposal of needles, syringes, and other sharp instruments. (I, II, III) 63.9(4) Resident care techniques. The facility shall have written and implemented procedures to be followed if a resident needs any of the following treatment or devices: a. Intravenous or central line catheter; (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) 63.9(5) Emergency care. The facility shall establish written policies for the provision of emergency medical care to residents and employees in case of sudden illness or accident. The policies shall include a list of those individuals to be contacted in case of an emergency. (I, II, III)Related ARC(s): 3740C48163.10(135C) Admission, transfer and discharge. 63.10(1) General admission policies. a. Residents shall be admitted to a specialized residential care facility only on a written order signed by a primary care provider or psychiatrist, specifying the level of care, and certifying that the individual being admitted requires no more than personal care and supervision and does not require routine nursing care. (II, III) b. No residential care facility shall admit or retain a resident who is in need of greater services than the facility can provide. (I, II, III) c. No residential care facility shall admit more residents than the number of beds for which the facility is licensed. (II, III) d. A residential care facility is not required to admit an individual through court order, referral or other means without the express prior approval of the administrator. (III) e. 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 the safe and orderly management of the residential care facility as required by these rules. (III) f. Individuals under the age of 18 shall not be admitted to a residential care facility without prior written approval by the department. A distinct part of a residential care facility, segregated from the adult section, may be established based on a résumé of care that is submitted by the licensee or applicant and is commensurate with the needs of the residents of the residential care facility and that has received the department’s review and approval. (III) g. 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 within the third degree of consanguinity to the person acting as guardian. (III) 63.10(2) Discharge or transfer. a. Notification shall be made to the legal representative, primary care provider, psychiatrist, if any, and sponsoring agency, if any, prior to the transfer or discharge of any resident. (III) b. The licensee shall not refuse to discharge or transfer a resident when the primary care provider, family, resident, or legal representative requests such transfer or discharge. (II, III) c. Advance notification will be made to the receiving facility prior to the transfer of any resident. (III) d. When a resident is transferred or discharged, the appropriate record will accompany the resident to ensure continuity of care. “Appropriate record” includes the resident’s face sheet, service plan, most recent orders of the primary care provider and any notifications of upcoming scheduled appointments. (II, III) e. When a resident is transferred or discharged, the resident’s unused prescriptions shall be sent with the resident or with a legal representative only upon the written order of a primary care provider. (II, III)Related ARC(s): 3740C48163.11(135C) Involuntary discharge or transfer. 63.11(1) Involuntary discharge or transfer permitted. A facility may involuntarily discharge or transfer a resident for only one of the following reasons: a. Medical reasons; b. The resident’s welfare or that of other residents; c. Repeated refusal by the resident to participate in the resident’s service plan; d. Due to action pursuant to Iowa Code chapter 229; or e. Nonpayment for the resident’s stay, as described in the residency agreement for the resident’s stay. 63.11(2) Medical reasons. Medical reasons for transfer or discharge shall be based on the resident’s needs and shall be determined and documented in the resident’s record by the primary care provider. Transfer or discharge may be required in order to provide a different level of care to the resident. (II) 63.11(3) Welfare of a resident. Welfare of a resident or that of other residents refers to a resident’s social, emotional, or physical well-being. A resident may 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). Written documentation 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 include specific information to support this determination. (II) 63.11(4) Notice. Involuntary transfer or discharge of a resident from a facility shall be preceded by a written notice to the resident and the responsible party. (II, III) a. The notice 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, that reads as follows: (II)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 department of inspections and appeals (hereinafter referred to as “department”) within 7 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. In emergency circumstances, extension of the 14-day requirement may be permitted upon request to the department’s designee. If you lose the hearing, you will not be transferred before the expiration of (1) 30 days following receipt of the original notice of the discharge or transfer, or (2) 5 days following final decision of such hearing, including exhaustion of all appeals, whichever occurs later. To request a hearing or receive further information, call the department at (515)281-4115, or 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. b. The notice 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; the resident’s primary care provider; and the person or agency responsible for the resident’s placement, maintenance, and care in the facility. The notice shall indicate that a copy has been transmitted to the required parties by using the abbreviation “cc:” and listing the names of all parties to whom copies were sent. (II) c. The notice required by paragraph 63.11(4)“a” shall be provided at least 30 days in advance of the proposed transfer or discharge unless one of the following occurs: (II) (1) An emergency transfer or discharge is mandated by the resident’s health care needs and is in accordance with the written orders and medical justification of the primary care provider. Emergency transfers or discharges may also be mandated in order to protect the health, safety, or well-being of other residents and staff from the resident being transferred. (II) (2) 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, the resident’s primary care provider, and the person or agency responsible for the resident’s placement, maintenance, and care in the facility. d. A hearing requested pursuant to this subrule shall be held in accordance with subrule 63.11(6). 63.11(5) Emergency transfer or discharge. In the case of an emergency transfer or discharge, the resident must be given a written notice prior to or within 48 hours following transfer or discharge. (II, III) a. A copy of this notice must be placed in the resident’s file. The notice must contain all of the following information: (1) The stated reason for the transfer or discharge. (II) (2) The effective date of the transfer or discharge. (II) (3) A statement, in not less than 12-point type, that reads: (II)You have a right to appeal the facility’s decision to transfer or discharge you on an emergency basis. If you think you should not have to leave this facility, you may request a hearing, in writing or verbally, with the Iowa department of inspections and appeals (hereinafter referred to as “department”) within 7 days after receiving this notice. You have the right to be represented at the hearing by an attorney or any other individual of your choice. If you request a hearing, it will be held no later than 14 days after receipt of your request by the department. You may be transferred or discharged before the hearing is held or before a final decision is rendered. If you win the hearing, you have the right to be transferred back into the facility. To request a hearing or receive further information, call the department at (515)281-4115, or 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. b. The notice 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; the resident’s primary care provider; and the person or agency responsible for the resident’s placement, maintenance, and care in the facility. The notice shall indicate that a copy has been transmitted to the required parties by using the abbreviation “cc:” and listing the names of all parties to whom copies were sent. (II) c. A hearing requested pursuant to this subrule shall be held in accordance with subrule 63.11(6). 63.11(6) Hearing. a. Request for hearing. (1) The resident must request a hearing within 7 days of receiving the written notice. (2) The request must be made to the department, either in writing or verbally. b. The hearing shall be held no later than 14 days after receipt of the request by the department unless the resident requests an extension due to emergency circumstances. c. Except in the case of an emergency discharge or transfer, a request for a hearing shall stay a transfer or discharge pending a final decision, including the exhaustion of all appeals. (II) d. The hearing shall be heard by a department of inspections and appeals administrative law judge pursuant to Iowa Code chapter 17A and 481—Chapter 10. The hearing shall be public unless the resident or the resident’s legal representative requests in writing that the hearing be closed. In a determination as to whether a transfer or discharge is authorized, the burden of proof by a preponderance of evidence rests on the party requesting the transfer or discharge. e. Notice of the date, time, and place of the hearing shall be sent by certified mail or delivered in person to the facility, the resident, the responsible party, and the office of the long-term care ombudsman not later than 5 full business days after receipt of the request. The notice shall also inform the facility and the resident or the responsible party that they have a right to appear at the hearing in person or be represented by an attorney or other individual. The appeal 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. A representative of the office of the long-term care ombudsman shall have the right to appear at the hearing. f. The administrative law judge’s written decision shall be mailed by certified mail to the licensee, resident, responsible party, and the office of the long-term care ombudsman within 10 working days after the hearing has been concluded. 63.11(7) Nonpayment. 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) 63.11(8) Discussion of involuntary transfer or discharge. Within 48 hours after notice of involuntary transfer or discharge has been received by the resident, the facility shall discuss the involuntary transfer or discharge 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. (II) a. The facility administrator or other appropriate facility representative serving as the administrator’s designee shall provide an explanation and discussion of the reasons for the resident’s involuntary transfer or discharge. (II) b. The content of the explanation and discussion shall be summarized in writing, shall include the names of the individuals involved in the discussion, and shall be made part of the resident’s record. (II) c. The provisions of this subrule do not apply if the involuntary transfer or discharge has already occurred pursuant to subrule 63.11(5) and emergency notice is provided within 48 hours. 63.11(9) Transfer or discharge planning. a. The facility shall develop a plan to provide for the orderly and safe transfer or discharge of each resident to be transferred or discharged. (II) b. To minimize the possible adverse effects of the involuntary transfer, the resident shall be offered counseling services by the sending facility before the involuntary transfer and by the receiving facility after the involuntary transfer. Counseling, if accepted, shall be provided by a licensed mental health professional as defined in Iowa Code section 228.1(6). Counseling shall be documented in the resident’s record. (II) c. The counseling requirement in paragraph 63.11(9)“b” does not apply if the discharge has already occurred pursuant to subrule 63.11(5) and emergency notice is provided within 48 hours. d. The receiving health care facility of a resident involuntarily transferred shall immediately formulate and implement a plan of care which takes into account possible adverse effects the transfer may cause. (II) 63.11(10) Transfer upon revocation of license or voluntary closure. 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 the voluntary closure of a facility, a period of 30 days must be allowed for an orderly transfer of residents to other facilities. 63.11(11) Intrafacility transfer. a. Residents shall not be arbitrarily relocated from room to room within a licensed health care facility. (I, II) Involuntary relocation may occur only in the following situations, which shall be documented in the resident’s record: (II) (1) Incompatibility with or disturbing to other roommates. (2) For the welfare of the resident or other residents of the facility. (3) To allow a new admission to the facility that would otherwise not be possible due to separation of roommates by sex. (4) In the case of a resident whose source of payment was previously private, but who now is eligible for Title XIX (Medicaid) assistance, the resident may be transferred from a private room to a semiprivate room or from one semiprivate room to another. (5) 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 subparagraph 63.11(11)“a”(4). (II) (2) As punishment or behavior modification, except as specified in subparagraph 63.11(11)“a”(1). (II) (3) Discrimination on the basis of race or religion. (II) c. If intrafacility relocation is necessary for reasons outlined in paragraph 63.11(11)“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, III) d. If emergency relocation is required in order 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 that necessitates emergency relocation, and such notification shall be documented. (II, III) e. A transfer to a part of a facility that has a different license must be handled the same way as a transfer to another facility, and not as an intrafacility transfer. (II, III)Related ARC(s): 3740C48163.12(135C) Residency agreement. 63.12(1) Each residency agreement shall: a. State the base rate or scale per day or per month, the services included, and the method of payment. (III) b. Contain a complete schedule of all offered services for which a fee may be charged in addition to the base rate. (III) Furthermore, the agreement shall: (1) Stipulate that no further additional fees shall be charged for items not contained in the complete schedule of services; (III) (2) State the method of payment for additional charges; (III) (3) 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) (4) State that additional fees may be charged to the resident for nonprescription drugs, other personal supplies, and services provided by a barber, beautician, and such. (III) c. Contain an itemized list of services to be provided to the resident based on an assessment at the time of the resident’s admission and in consultation with the administrator and including the specific fee the resident will be charged for each service and the method of payment. (III) d. Include the total fee to be charged initially to the resident. (III) e. State the conditions whereby the facility may make adjustments to its overall fees for resident care as a result of changing costs. (II, III) Furthermore, the agreement shall provide that the facility shall give: (1) 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; (II, III) (2) Notification to the resident, or the 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 also be given within a reasonable time, not to exceed one week, listing specifically the adjustments made. (II, III) f. State the terms of agreement in regard to a refund of all advance payments in the event of the transfer, death, or voluntary or involuntary discharge of the resident. (II, III) g. State the terms of agreement concerning the holding of 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. (II, III) (1) The facility shall ask the resident or responsible party whether the resident’s bed should be 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, III) (2) The facility shall inform the resident or responsible party that, when requested, the bed may be held beyond the number of days designated by the funding source, as long as payments are made in accordance with the agreement. (II, III) h. State the conditions under which the involuntary discharge or transfer of a resident would be effected. (II, III) i. Set forth any other matters deemed appropriate by the parties to the agreement. No agreement 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. (II, III) 63.12(2) Each party to the residency agreement shall be provided a copy of the signed agreement. (II, III)Related ARC(s): 3740C48163.13(135C) Medical examinations. 63.13(1) Each resident in a residential care facility shall have a designated primary care provider who may be contacted when needed. (II, III) 63.13(2) Each resident admitted to a residential care facility shall have 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 primary care provider, 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 medical concerns, 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) 63.13(3) The person in charge shall immediately notify the primary care provider of any accident, injury or adverse change in the resident’s condition that has the potential for requiring further medical treatment. (I, II, III) 63.13(4) Each resident shall be visited by or shall visit the resident’s primary care provider at least once each year. The one-year period shall be measured from the date of admission and does not include the resident’s preadmission physical. (III)Related ARC(s): 3740C48163.14(135C) Records. 63.14(1) Resident record. The licensee shall keep a permanent record on all residents admitted to a specialized 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. Primary care provider’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. Mortuary’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 primary care provider that the resident requires no more than personal care and supervision, but does not require nursing care; (III) l. Primary care provider’s orders for medication, treatment, and diet in writing and signed by the primary care provider; (III) m. A notation of yearly or other visits to primary care provider or other professional services; (III) n. Any change in the resident’s condition; (II, III) o. If the primary care provider 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 medication, treatments, and diet prescribed by the primary care provider for each resident; (III) p. If the primary care provider 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, including a medication manager or certified medication aide; (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 the resident’s 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 primary care provider 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) v. Current individual program plans. (II, III) 63.14(2) Confidentiality of resident records. a. Each resident shall be ensured confidential treatment of all information contained in the resident’s records. The resident’s written consent shall be required for the release of information to persons not otherwise authorized under law to receive it. (II) b. 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) c. 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) d. 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 primary care provider determines the disclosure of the record or section thereof is contraindicated in which case this information will be deleted before the record is made available to the resident or responsible party. This determination and the reasons for it must be documented in the resident’s record. (II) 63.14(3) Incident record. a. Each residential care facility shall maintain an incident record report and shall have available incident report forms. (II, III) b. Report of incidents shall be in detail on an incident report form. (III) c. The person in charge at the time of the incident shall oversee the preparation of and sign the incident report. The administrator or designee shall review, sign and date the incident report within 72 hours of the accident, incident or unusual occurrence. (II, III) d. An incident report shall be completed for every accident or incident where there is apparent injury or where an injury of unknown origin may have occurred. (II) e. An incident report shall be completed for every accident, incident or unusual occurrence within the facility or on the premises that affects a resident, visitor, or employee. (II, III) f. A copy of the incident report shall be kept on file in the facility. (II, III) 63.14(4) Retention of records. a. Records shall be retained in the facility for five years following the termination of services to a resident. (III) b. Records shall be retained within the facility upon change of ownership. (III) c. When the facility ceases to operate, a copy of the resident’s record shall be released to the facility to which the resident is transferred. (III) d. When the facility ceases to operate, records shall be maintained for five years in a clean, dry secured storage area. (III) 63.14(5) Electronic records. In addition to the access provided in 481—subrule 50.10(2), an authorized representative of the department shall be provided unrestricted access to electronic records pertaining to the care provided to the residents of the facility. (II, III) a. If access to an electronic record is requested by the authorized representative of the department, the facility may provide a tutorial on how to use its particular electronic system or may designate an individual who will, when requested, access the system, respond to any questions or assist the authorized representative as needed in accessing electronic information in a timely fashion. (II, III) b. The facility shall provide a terminal where the authorized representative may access records. (II, III) c. If the facility is unable to provide direct print capability to the authorized representative, the facility shall make available a printout of any record or part of a record on request in a time frame that does not intentionally prevent or interfere with the department’s survey or investigation. (II, III) 63.14(6) Reports to the department. The licensee shall furnish statistical information concerning the operation of the facility to the department on request. (III) 63.14(7) Personnel record. a. Personnel records for each employee shall be kept in accordance with subrule 63.8(4). (III) b. The personnel records shall be made available for review upon request by the department. (III)Related ARC(s): 3740C48163.15(135C) Resident care and personal services. 63.15(1) A complete change of bed linens shall be provided at least once a week and more often if necessary. (III) 63.15(2) Residents shall receive sufficient supervision to promote personal cleanliness. (II, III) 63.15(3) Residents shall have clean clothing as needed. Clothing shall be appropriate to residents’ activities and to the weather. (III) 63.15(4) Residents shall be encouraged to bathe at least twice a week. (II, III) 63.15(5) All nonambulatory residents shall be housed on the grade level floor unless the facility has a suitably sized elevator. (II)Related ARC(s): 3740C48163.16(135C) Drugs. 63.16(1) Drug storage. a. Residents who have been certified in writing by their primary care provider as capable of taking their own medications may retain these medications in their bedroom, but locked storage must be provided, with staff and the resident having access, and the drug storage shall be kept locked when not in use. Monitoring of the storage, administration, and documentation by the resident shall be carried out by a person who meets the requirements of subrule 63.16(3) and is responsible for administering medications. (II, III) b. Drug storage for residents who are unable to take their own medications and require supervision shall meet the following requirements: (1) Locked storage for drugs, solutions, and prescriptions shall be provided. (III) (2) A bathroom shall not be used for drug storage. (III) (3) The drug storage shall be kept locked when not in use. (III) (4) The drug storage key shall be secured and available only to those employees charged with the responsibility of administering medications. (II, III) (5) Schedule II drugs, as defined by Iowa Code chapter 124, shall be kept in a locked box within the locked drug storage. (II, III) (6) Medications requiring refrigeration shall be kept locked in a refrigerator and separated from food and other items. (II, III) (7) Drugs for external use shall be stored separately from drugs for internal use. (II, III) (8) All potent, poisonous, or caustic materials shall be stored separately from drugs, shall be plainly labeled and stored in a specific, well-illuminated cabinet, closet, or storeroom, and shall be made accessible only to authorized persons. (I, II) (9) Inspection of drug storage shall be made by the administrator or designee 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, certification of the absence of the following: expired drugs, deteriorated drugs, improper labeling, drugs for which there is no current primary care provider’s order, and drugs improperly stored. (III) (10) Bulk supplies of prescription drugs for multiresident use shall not be kept in a residential care facility. (III) 63.16(2) Drug safeguards. a. All prescribed medications shall be clearly labeled indicating the resident’s full name, primary care provider’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 primary care provider issuing the drug. Where unit dose is used, prescribed medications shall, at a minimum, indicate the resident’s full name, primary care provider’s name, name and strength of drug, and directions for use. Standard containers shall be utilized for dispensing drugs. (III) b. Sample medications provided by the resident’s primary care provider shall clearly identify to whom the medications belong. (III) c. Medication containers having soiled, damaged, illegible, or makeshift labels shall be returned to the issuing pharmacist, pharmacy, or primary care provider for relabeling or disposal. (III) d. The medication for each resident shall be kept or stored in the original containers unless the resident is participating in an individualized medication program. (II, III) e. Unused prescription drugs shall be destroyed by the person in charge, in the presence of a witness, and with a notation made on the resident’s record or shall be returned to the supplying pharmacist. (III) f. Prescriptions shall be refilled only with the permission of the resident’s primary care provider. (II, III) g. Medications prescribed for one resident shall not be administered to or allowed in the possession of another resident. (I, II) h. Instructions shall be requested from the Iowa board of pharmacy concerning disposal of unused Schedule II drugs prescribed for a resident who has died or for whom the Schedule II drug was discontinued. (III) i. Discontinued medications shall be destroyed within a specified time by a responsible person, in the presence of a witness, and with a notation made to that effect or shall be returned to the pharmacist for destruction. Drugs listed under the Schedule II drugs shall be destroyed in accordance with the requirements established by the Iowa board of pharmacy. (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 resident’s primary care provider, 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 possess any medications unless the primary care provider 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 primary care provider. (II) m. The facility shall establish a policy to govern the distribution of prescribed medications to residents who are on leave from the facility. (II, III) (1) Medications may be issued to residents who will be on leave from a facility for less than 24 hours. Only those medications needed for the time period that the resident will be on leave from the facility may be issued. Non-child-resistant containers may be used. Instructions shall be provided and include the date, the resident’s name, the name of the facility, and the name of the medication, its strength, dose and time of administration. (II, III) (2) Medication for residents on leave from a facility for longer than 24 hours shall be obtained in accordance with requirements established by the Iowa board of pharmacy. (II, III) (3) Medication for residents on leave from a facility may be issued only by facility personnel responsible for administering medication. (II, III) 63.16(3) Drug administration—authorized personnel. a. A properly trained person shall be charged with the responsibility of administering medications as ordered by a primary care provider. (II, III) b. The person shall have knowledge of the purpose of the drugs and their dangers and contraindications. (II, III) c. The person shall be a licensed nurse or primary care provider or an individual who has completed the state-approved training course in medication administration, including a medication manager or certified medication aide. (II, III) d. Prior to taking a department-approved medication aide course, the person shall have a letter of recommendation for admission to the medication aide course from the employing facility. (III) e. A person who is a nursing student or a graduate nurse may take the medication aide challenge examination in place of taking a course. The person shall do all of the following before taking the challenge examination: (1) Complete a clinical or nursing theory course within six months before taking the challenge examination; (III) (2) Successfully complete a nursing program pharmacology course within one year before taking the challenge examination; (III) (3) Provide to the community college a written statement from the nursing program’s pharmacology or clinical instructor indicating that the person is competent in medication administration. (III) 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 63.16(3)“d” do not apply to this person. (III) 63.16(4) Drug administration. a. 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. In facilities where the unit dose system is used, the person assigned the responsibility of medication administration must complete the procedure by observing the actual act of swallowing the oral medication and by charting the medication. Medications shall be prepared on the same shift of the same day that they are administered unless the unit dose system is used. (II) b. Injectable medications shall be administered as permitted by Iowa law by a registered nurse, licensed practical nurse, primary care provider or pharmacist. For purposes of this subrule, “injectable medications” does not include an epinephrine autoinjector, e.g., an EpiPen. (II, III) c. A resident certified by the resident’s primary care provider as capable of injecting the resident’s own insulin may do so. Insulin may be administered pursuant to paragraph 63.16(4)“b” or as otherwise authorized by the resident’s primary care provider. (II, III) Authorization shall: (1) Be in writing, (2) Be maintained in the resident’s record, (3) Be renewed quarterly, (4) Include the name of the person authorized to administer the insulin, (5) Include documentation by the primary care provider that the authorized person is qualified to administer insulin to that resident. (II, III) d. A resident may participate in the administration of the resident’s own medication if the primary care provider has certified in writing in the resident’s medical record that the resident is mentally and physically capable of participating and has explained in writing in the resident’s medical record what the resident’s participation may include. e. An individual inventory record shall be maintained for each Schedule II drug prescribed for each resident, with an accurate count and authorized signatures at every shift. (II) f. The facility may use a unit dose system. g. Medication aides and medication managers may administer PRN medications without contacting a licensed nurse or primary care provider if all of the following apply: (I, II, III) (1) A written order from the resident’s primary care provider specifies the purpose of the PRN medication and the frequency, dosage and strength of the PRN medication. (2) The resident’s primary care provider provides in writing specific criteria for administering PRN medications. (3) The pharmacist assesses the resident’s use of PRN medications when conducting the inspection of drug storage as required by subparagraph 63.16(1)“b”(9). h. The pharmacist shall assess the use of PRN medications when conducting the inspection of drug storage as required by subparagraph 63.16(1)“b”(9). (II, III) i. Medications administered by an employee of the facility shall be recorded on a medication record by the individual who administers the medication. (I, II, III)Related ARC(s): 3740C, 4577C48163.17(135C) Dental services. 63.17(1) The residential care facility personnel shall assist residents in obtaining annual and emergency dental services and shall arrange transportation for such services. (III) 63.17(2) Dental services shall be performed only on the request of the resident, responsible party, legal representative, or primary care provider. The resident’s primary care provider shall be advised of the resident’s dental problems. (III) 63.17(3) All dental reports or progress notes shall be included in the resident record as available. The facility shall make reasonable efforts to obtain the records following the provision of services. (III) 63.17(4) Personal care staff shall assist the resident in carrying out the dentist’s recommendations. (III)Related ARC(s): 3740C48163.18(135C) Dietary. 63.18(1) Dietary staffing. Personnel who are responsible for food preparation or service, or both food preparation and service, shall have an orientation on sanitation and safe food handling prior to handling food and shall have annual in-service training on food protection. (III) 63.18(2) Nutrition and menu planning. a. Menus shall be planned and followed to meet the nutritional needs of residents in accordance with the primary care provider’s orders. Diet orders should be reviewed as necessary, but at least quarterly, by the primary care provider. (II, III) b. In facilities where residents plan and prepare their own meals, education and support shall be provided to residents regarding proper food preparation, dietary guidelines, and food safety. c. In facilities where food is regularly prepared for residents, the following shall apply: (1) Menus shall be planned and served to include foods and amounts necessary to meet federal dietary guidelines. (II, III) (2) At least three meals or their equivalent shall be offered daily, at regular hours. (II, III)- There shall be no more than a 14-hour span between offering a substantial evening meal and breakfast. (II, III)
- Unless contraindicated, evening snacks shall be offered routinely to all residents. Special nourishments shall be available when ordered by the primary care provider. (II, III)