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•J^J/ : .AC '/•/- " __. - NORTH CAROLINA REGISTER VOLUME 10 • ISSUE 2 • Pages 54 -190 April 17, 1995 IN THIS ISSUE Executive Orders Acupuncture Licensing Board Environment, Health, and Natural Resources Human Resources Justice Labor List of Rules Codified Medical Examiners Real Estate Commission RRC Objections Contested Case Decisions PUBLISHED BY The Office ofAdministrative Hearings Rules Division PO Drawer 27447 Raleigh, NC 27611- 744 7 Telephone (919) 733-2678 Fax (919) 733-3462 Bag *! § fp" ~i \j B» £ 5 E a i; fu^' ^i: J vJ aoakj> APR 20 1995 KATHRINE R EYERETT LAW LIBRARY This publication is printed on permanent, acid-free paper in compliance with G.S. 125-11.13 INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE CODE NORTH CAROLINA REGISTER The North Carolina Register is published twice a month and contains information relating to agency, executive, legislative and ludicial actions required by or affecting Chapter 150B of the General Statutes. All proposed administrative rules and notices of public hearings filed under G.S. 150B-21.2 must be published in the Register. The Register will typically comprise approximately fifty pages per issue of legal text. State law requires that a copy of each issue be provided free of charge to each county in the state and to various state officials and institutions. The North Carolina Register is available by yearly subscription at a cost of one hundred and twenty dollars ($120.00) for 24 issues. Individual issues may be purchased for ten dollars ($10.00). Requests for subscription to the North Carolina Register should be directed to the Office of Administrative Hearings, PO Drawer 27447, Raleigh, NC 27611-7447. ADOPTION, AMENDMENT, AND REPEAL OF RULES The following is a generalized statement of the procedures to be followed for an agency to adopt, amend, or repeal a rule. For the specific statutory authority, please consult Article 2A of Chapter 150B of the General Statutes. Any agency intending to adopt, amend, or repeal a rule must first publish notice of the proposed action in the North Carolina Register. The notice must include the time and place of the public hearing (or instructions on how a member of the public may request a hearing); a statement of procedure for public comments; the text of the proposed rule or the statement of subject matter; the reason for the proposed action; a reference to the statutory authority for the action and the proposed effective date. Unless a specific statute provides otherwise, at least 15 days must elapse following publication of the notice in the North Carolina Register before the agency may conduct the public hearing and at least 30 days must elapse before the agency can take action on the proposed rule. An agency may not adopt a rule that differs substantially from the proposed form published as part of the public notice, until the adopted version has been published in the North Carolina Register for an additional 30 day comment period. When final action is taken, the promulgating agency must file the rule with the Rules Review Commission (RRC). After approval by RRC, the adopted rule is filed with the Office of Administrative Hearings (OAH). A rule or amended rule generally becomes effective 5 business days after the rule is filed with the Office of Administrative Hearings for publication in the North Carolina Administrative Code (NCAC). Proposed action on rules may be withdrawn by the promulgating agency at any time before final action is taken by the agency or before filing with OAH for publication in the NCAC. TEMPORARY RULES Under certain emergency conditions, agencies may issue temporary rules. Within 24 hours of submission to OAH, the Codifier of Rules must review the agency's written statement of findings of need for the temporary rule pursuant to the provisions in G.S. 150B-21.1. If the Codifier determines that the findings meet the criteria in G.S. 150B-21.1, the rule is entered into the NCAC. If the Codifier determines that the findings do not meet the criteria, the rule is returned to the agency. The agency may supplement its findings and resubmit the temporary rule for an additional review or the agency may respond that it will remain with its initial position. The Codifier, thereafter, will enter the rule into the NCAC. A temporary rule becomes effective either when the Codifier of Rules enters the rule in the Code or on the sixth business day after the agency resubmits the rule without change. The temporary rule is in effect for the period specified in the rule or 180 days, whichever is less. An agency adopting a temporary rule must begin rule-making procedures on the permanent rule at the same time the temporary rule is filed with the Codifier. NORTH CAROLINA ADMINISTRATIVE CODE The North Carolina Administrative Code (NCAC) is a compilation and index of the administrative rules of 25 state agencies and 40 occupational licensing boards. Compilation and publication of the NCAC is mandated by G.S. 150B-21.18. The Code is divided into Tides and Chapters. Each state agency is assigned a separate title which is further broken down by chapters. Title 21 is designated for occupational licensing boards. The NCAC is available in two formats. (1) Single pages may be obtained at a minimum cost of two dollars and 50 cents ($2.50) for 10 pages or less, plus fifteen cents ($0.15) per each additional page. Requests for pages of rules or volumes of the NCAC should be directed to the Office of Administrative Hearings. (2) The full publication and supplement service is printed and distributed by Barclays Law Publishers. It is available in hardcopy, CD-ROM and diskette format. For subscription information, call 1-800-888-3600. CITATION TO THE NORTH CAROLINA REGISTER The North Carolina Register is cited by volume, issue, page number and date. 10:01 NCR 1-67, April 3, 1995 refers to Volume 10, Issue 1, pages 1 through 67 of the North Carolina Register issued on April 3, 1995. t FOR INFORMATION CONTACT: Office of Administrative Hearings, ATTN: Rules Division, PO Drawer 27447, Raleigh, NC 27611-7447, (919) 733-2678, FAX (919) 733-3462. • NORTH CAROLINA IN THIS ISSUE I. EXECUTIVE ORDERS Executive Orders 73-74 . • Volume 1 O, Issue 2 Pages 54 - 190 April 17, 1995 This issue contains documents officially filed through March 31, 1995. n. IN ADDITION NPDES Permit Wildlife Resources Commission Proclamation 54- 55 56 57 Office of Administrative Hearings Rules Division 424 North Blount Street (27601) PO Drawer 27447 Raleigh, NC 27611-7447 (919) 733-2678 FAX (919) 733-3462 Julian Mann III, Director James R. Scarcella St., Deputy Director Molly Masich, Director of APA Services Ruby Creech, Publications Coordinator Teresa Kilpatrick, Editorial Assistant Jean Shirley, Editorial Assistant HI. PROPOSED RULES Environment, Health, and Natural Resources Sedimentation Control Commission 149 - 150 Human Resources Medical Assistance 118- 122 Medical Care Commission 58-118 Mental Health, Developmental Disabilities and Substance Abuse Services 118 Justice Departmental Rules 122 - 142 Labor Job Listing Services Act 149 Migrant Housing Act of NC 1 49 Retaliatory Employment Discrimination Act 149 Wage and Hour 142-149 Licensing Boards Acupuncture Licensing Board 150- 151 Medical Examiners 151 - 157 Real Estate Commission 157 - 166 IV. LIST OF RULES CODIFIED 167-169 V. RRC OBJECTIONS 170 VI. CONTESTED CASE DECISIONS Index to ALJ Decisions 171 - 175 Text of Selected Decisions 94 CPS 0237 176-178 94 EDC 0533 179-184 95 EHR 0140 185-186 VH. CUMULATIVE INDEX 188-190 NORTH CAROLINA REGISTER Publication Schedule (November 1994 - September 1995) Volume and Issue Number Issue Date Last Day for Filing Last Day for Elec-tronic Filing Earliest Date for Public Hearing 15 days from notice * End of Required Comment Period 30 days from notice Last Day to Submit toRRC ** Earliest Effective Date 9:15 11/01/94 10/11/94 10/18/94 11/16/94 12/01/94 12/20/94 02/01/95 9:16 11/15/94 10/24/94 10/31/94 11/30/94 12/15/94 12/20/94 02/01/95 9:17 12/01/94 11/07/94 11/15/94 12/16/94 01/03/95 01/20/95 03/01/95 9:18 12/15/94 11/22/94 12/01/94 12/30/94 01/17/95 01/20/95 03/01/95 9:19 01/03/95 12/08/94 12/15/94 01/18/95 02/02/95 02/20/95 04/01/95 9:20 01/17/95 12/21/94 12/30/94 02/01/95 02/16/95 02/20/95 04/01/95 9:21 02/01/95 01/10/95 01/18/95 02/16/95 03/03/95 03/20/95 05/01/95 9:22 02/15/95 01/25/95 02/01/95 03/02/95 03/17/95 03/20/95 05/01/95 9:23 03/01/95 02/08/95 02/15/95 03/16/95 03/31/95 04/20/95 06/01/95 9:24 03/15/95 02/22/95 03/01/95 03/30/95 04/17/95 04/20/95 06/01/95 10:1 04/03/95 03/13/95 03/20/95 04/18/95 05/03/95 05/22/95 07/01/95 10:2 04/17/95 03/24/95 03/31/95 05/02/95 05/17/95 05/22/95 07/01/95 10:3 05/01/95 04/07/95 04/17/95 05/16/95 05/31/95 06/20/95 08/01/95 10:4 05/15/95 04/24/95 05/01/95 05/30/95 06/14/95 06/20/95 08/01/95 10:5 06/01/95 05/10/95 05/17/95 06/16/95 07/03/95 07/20/95 09/01/95 10:6 06/15/95 05/24/95 06/01/95 06/30/95 07/17/95 07/20/95 09/01/95 10:7 07/03/95 06/12/95 06/19/95 07/18/95 08/02/95 08/21/95 10/01/95 10:8 07/14/95 06/22/95 06/29/95 07/31/95 08/14/95 08/21/95 10/01/95 10:9 08/01/95 07/11/95 07/18/95 08/16/95 08/31/95 09/20/95 11/01/95 10:10 08/15/95 07/25/95 08/01/95 08/30/95 09/14/95 09/20/95 11/01/95 10:11 09/01/95 08/11/95 08/18/95 09/18/95 10/02/95 10/20/95 12/01/95 10:12 09/15/95 08/24/95 08/31/95 10/02/95 10/16/95 10/20/95 12/01/95 This table is published as a public service, and the computation of time periods are not to be deemed binding or controlling. Time is computed according to 26 NCAC 2B . 0103 and the Rules of Civil Procedure, Rule 6. * An agency must accept comments for at least 30 days after the proposed text is published or until the date of any public hearing, whichever is longer. See G.S. 150B-21.2(f) for adoption procedures. ** The "Earliest Effective Date" is computed assuming that the agency follows the publication schedule above, that the Rules Review Commission approves the rule at the next calendar month meeting after submission, and that RRC delivers the rule to the Codifier of Rules five (5) business days before the 1st day of the next calendar month. Revised 10/94 EXECUTIVE ORDERS EXECUTIVE ORDER NO. 73 SUSPENSION OF RULES DURING LOCAL EMERGENCIES WHEREAS, electric service is one of the most essential services required by modern society, and the public welfare is immediately threatened by any occurrences, natural or manmade, which interrupt the delivery of electricity and electrical services; and WHEREAS, state and federal regulations prohibit electric supplier vehicles and commercial motor vehicle drivers from working extended hours to assist in the repair of damage and restoration of the delivery of electricity and electrical services; and WHEREAS, federal law, specifically 49 C.F.R. Section 390.23, allows a Governor to suspend these rules and regulations if the Governor determines that an emergency condition exists. NOW, THEREFORE, by the authority vested in me as Governor by the laws and Constitution of the State of North Carolina, IT IS ORDERED: Section 1. Electric supplier vehicles and commercial motor vehicle drivers are exempt from the rules and regulations restricting their participation in emergency relief efforts during a "local emergency." A "local emergency" shall be considered to be any power outage or interruption of electric service that occurs within the State of North Carolina, including a near term threat or occurrence of a meteorological condition or other condition reasonably likely to result in power outages or electric service interruption. A "local emergency" begins when the affected electric supplier receives notice of the power outage or interruption of electric service or receives notice of the existence of conditions reasonably likely to result in power outages or electric service interruption. The "local emergency" continues until the necessary maintenance or repair work is completed and personnel utilized to perform necessary maintenance or repair work have returned to their respective normal work routines. This Executive Order is effective immediately. Done in the City of Raleigh this the 15th day of March, 1995. EXECUTIVE ORDER NO. 74 DESIGNATING THE YEAR OF THE MOUNTAINS AND CREATING THE YEAR OF THE MOUNTAINS COMMISSION WHEREAS, North Carolina's mountains are among the state's most valuable and unique assets; and WHEREAS, North Carolina's mountains merit widespread appreciation and understanding; and WHEREAS, growth and change have brought new sets of opportunities and challenges to people of the mountains; and WHEREAS, regional efforts and partnerships with the State are needed to address challenges facing mountain communities today and in the future; and WHEREAS, new initiatives for Western North Carolina can honor and share the culture and history of the mountains and enhance respect for the natural beauty and environment of the region while fostering quality growth and develop-ment; and WHEREAS, the people of North Carolina's mountains are pursuing a new vision for the mountains that integrates the needs of young people, education, technology, industry, and recreation while protecting the region's resources and quality of life; and WHEREAS, the people of North Carolina's mountains seek to enhance Regional Identity and Recognition, to cultivate Sustainable Communities, and to promote and support Mountain Stewardship. NOW, THEREFORE, by the power vested in me as Governor by the Constitution and laws of North Carolina, IT IS ORDERED: Section 1. Year of the Mountains. The Year of the Mountains is hereby designated July 1 , 1995 through June 30, 1996. Section 2^ Establishment. The Year of the Mountains Commission is hereby estab-lished. Section 3. Membership and Terms. The Governor shall appoint 15 persons to serve on the Commission and shall designate one of its members to serve as Chair. The Commission shall meet regularly to carry out its duties at the call of the Chair. Section 4. Powers and Duties of the Commission. A. To develop a set of recommendations to effectuate the purposes of this Order through such activities as meetings, fact-finding tours, educational events, and reports. B. To focus statewide media and public attention on the mountains to enhance quality growth and development, protect the natural beauty, and preserve the culture of the region. C. To coordinate its efforts with local officials and to help promote mountain events. D. To perform and exercise such other duties and 10:2 NORTH CAROLINA REGISTER April 17, 1995 54 EXECUTIVE ORDERS powers as may be necessary to accomplish the purposes of this Executive Order. Section 5^. Administration. The Governor shall designate an Executive Coordinator to provide professional assistance and background information to the Commission, and coordinate its activities. The Executive Coordinator shall maintain the official minutes and other records of the Commission, and shall work in partnership with local and state governmental agencies, the community college and university system, and the private nonprofit sector to furnish additional staff assistance, educational and research materials, and any other adminis-trative support which the Commission may require. The Executive Coordinator shall report directly to the Commission and shall carry out its goals as set forth in the Commission's mission statement. Members of the Commis-sion shall receive necessary travel and subsistence expenses pursuant to N.C.G.S. 138-5. Funding for the Executive Coordinator and the Commission shall be provided by DEHNR, the Department of Commerce, the Department of Cultural Resources, and monies appropriated by the General Assembly. The Commission is authorized to accept donations of in-kind services and funds, subject to the Executive Budget Act. Western North Carolina Tomorrow (WNCT), a 501(c)(3) nonprofit, has agreed to administer the funds, including those previously appropriated to it by the General Assembly. The Commission shall be considered a "public body" and its meetings shall be open to the public pursuant to General Statutes Chapter 143, Article 33C. The Commission, for administrative purposes only, shall be located in the Governor's Office. This Executive Order shall be effective immediately and expire June 30, 1996. Done in the Capital City of Raleigh, North Carolina, this the 27th day of March, 1995. < I i 55 NORTH CAROLINA REGISTER April 17, 1995 10:2 IN ADDITION STATE OF NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION POST OFFICE BOX 29535 RALEIGH, NORTH CAROLINA 27626-0535 PUBLIC NOTICE OF INTENT TO ISSUE STATE GENERAL NPDES PERMITS Public notice of intent to modify State National Pollutant Discharge Elimination System (NPDES) General Permits for Point Source Discharges of Stormwater associated with the application requirements and clarifications of the visual monitoring requirements in : NPDES No. NCGO10000 governing the discharge of stormwater associated with construction activities including clearing, grading and excavation activities resulting in the disturbance land areas. On the basis of preliminary staff review and application of Article 21 of Chapter 143 of the General Statutes of North Carolina, Public Law 92-500 and other lawful standards and regulations, the North Carolina Environmental Management Commission proposes to modify State NPDES General Permits for the discharges as described above. INFORMATION: Copies of the draft NPDES General Permits and Fact Sheets concerning the draft Permits are available by writing or calling: Bill Mills Water Quality Section N.C. Division of Environmental Management P.O. Box 29535 Raleigh, North Carolina 27626-0535 Telephone (919) 733-5083 ext. 548 Persons wishing to comment upon or object to the proposed determinations are invited to submit their comments in writing to the above address no later than May 26. 1995 . All comments received prior to that date will be considered in the final determination regarding permit issuance. A public meeting may be held where the Director of the Division of Environmental Management finds a significant degree of public interest in any proposed permit issuance. The draft Permits, Fact Sheets and other information are on file at the Division of Environmental Management, 512 N. Salisbury Street, Room 925-C, Archdale Building, Raleigh, North Carolina. They may be inspected during normal office hours. Copies of the information of file are available upon request and payment of the costs of reproduction. All such comments and requests regarding these matters should make reference to the draft Permit Number, NCG010000. Date: March 29, 1995 A. Preston Howard, Jr., P.E., Director Division of Environmental Management 10:2 NORTH CAROLINA REGISTER April 17, 1995 56 IN ADDITION North Carolina Wildlife Resources Commission 512 N. Salisbury Street, Raleigh, North Carolina 27604-1188, 919-733-3391 Charles R. Fullwood, Executive Director PROCLAMATION Charles R. Fullwood, Executive Director, North Carolina Wildlife Resources Commission, acting pursuant to North Carolina General Statute §113-292 (cl) and authority duly delegated by the Wildlife Resources Commission, hereby declares that the season for harvesting striped bass by hook-and-line shall close in all waters of the Roanoke River Striped Bass Management Area downstream of the Edwards Ferry Boating Access Area at US 258 bridge on the Roanoke River in Halifax County at 12:00 midnight on Sunday April 9, 1995. In the Roanoke River and its tributaries upstream of the Edwards Ferry Boating Access Area at US 258 bridge striped bass may be harvested from 12:01 a.m. on Saturdays through 12:00 midnight on Sundays, and from 12:01 a.m. through 12:00 midnight on Wednesdays. On all other days all striped bass caught, regardless of condition, shall be immediately returned to the waters where taken and no striped bass may be possessed. The Roanoke River Striped Bass Management Area is defined as the inland and joint fishing waters of the Roanoke River and its tributaries, extending from its mouth to Roanoke Rapids Dam, including the Cashie, Middle, and Eastmost rivers and their tributaries. This proclamation shall be effective at 12:00 midnight on April 9, 1995 and shall remain in effect until a new proclamation closing described waters or portions thereof for striped bass fishing is issued. This proclamation supercedes and replaces all prior proclamations. NOTES: a) This Proclamation is issued under the authority of N.C.G.S. §§113-132; 113-134; 113-292; 113-304; and 113-305. b) All striped bass regardless of condition caught during the closed season shall be immediately returned to the waters where taken and no striped bass may be possessed. c) Any person who violates this Proclamation also violates applicable law and is subject to the sanctions provided by law. NORTH CAROLINA WILDLIFE RESOURCES COMMISSION By: Charles R. Fullwood Executive Director Date: 4/3/95 57 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES TITLE 10 - DEPARTMENT OF HUMAN RESOURCES Notice is hereby given in accordance with G.S. 150B-21.2 that the NC Medical Care Commission intends to repeal rules cited as 10 NCAC 3H .0108 - .0109, .0206 -.0220, .0306- .0318, .0407 - .0409, .0505 - .0507, .0510 - .0517, .0605 - .0609, .0705 - .0712, .0810 - .0812, .0903 - .0911, .1003 - .1008, .1105 - .1109, .1130 - .1136, .1150 -.1163, .1204- .1208, .1210, .1306- .1308, .1405 - .1406, .1408- .1410, .1501 - .1503, .1612 - .1613, .1703 - .1704, . 1804 - . 1807; and adopt rules cited as 10 NCAC 3H .2001, .2101 - .2110, .2201 - .2212, .2301 - .2308, .2401 - .2402, .2501 - .2506, .2601 - .2607, .2701, .2801 - .2802, .2901 - .2902, .3001 - .3005, .3011 - .3016, .3021 - .3032, .3101 - .3104, .3201 - .3202, .3301 - .3302, .3401 - .3404. Proposed Effective Date: September 1, 1995. A Public Hearing will be conducted at 9:30 a. m. on June 9, 1995 at the Council Building, Room 201, 701 Barbour Drive, Raleigh, NC. Reason for Proposed Action: To update state regulations for nursing homes to be compatible with federal regulations. Comment Procedures: In order to allow the Commission sufficient time to review and evaluate your written comments prior to the hearing, please submit your comments to Mr. Jackie Sheppard, APA Coordinator, DFS, P. O. Box 29530, Raleigh, NC 27626-0530, telephone (919) 733-2342 by May 31, 1995, but in no case later than the hearing on June 9, 1995. Fiscal Note: These Rules do not affect the expenditures or revenues of local government or state funds. CHAPTER 3 - DIVISION OF FACILITY SERVICES SUBCHAPTER 3H - RULES FOR THE LICENSING OF NURSING HOMES SECTION .0100 - GENERAL INFORMATION .0108 DEFINITIONS The following definitions will apply throughout this Subohaptor: ~m "Abuse" moans the willful infliction of physical pain, injury, mental anguish or unreasonable confinement whioh may oauoo or result in tempo rnry or permanent mental or physioal injury, pain, harm, or death.—Abuse includes, but is not limited to, the following! (ft) Verbal abuse—any use of oral, written or gos -&- -(e)- -(d)- -(e)- -O)- -m- -w- -&- -m- &- -(*>- -m-turod language whioh a reasonable person would view as disparaging and derogatory tormo to a patient rogardlooo of his or her ago, ability to comprehend or disability; Sexual abuse—sexual harassment, sexual coor oion or sexual assault of a patient; Physioal abuse — hitting, clapping, kicking or corporal punishment of a patient; Mental abuse language or treatment which would be viewed by a reasonable person as involving humiliation, harassment, threats of punishment or deprivation of a patient; —Unreasonable confinement—the separation of a patient from other persons, or from hio or her room, against the patient's will or the will of the patient's legal representative. Unreasonable confinement does not include emergency—e* short term monitored separation used as them poutio intervention to reduoe agitation until a plan of care is developed to moot the patient's needs. "Accident" moans an unplanned or unwanted event resulting in the injury or wounding, no matter how slight, of a patient or other individual. "Adequate"—moans,—when applied—to various servioos, that the sorvioos are at least satisfactory in mooting a referred to need when moaaured against contemporary professional standards of practice. "Administrator" means the person who has author ity for and is responsible for the overall operation of a facility. "Appropriate" moans right for the specified use or purpose, suitable or proper when used as an adj ective.—When used as a transitive verb it moans to sot aside for some specified exclusive use. "Brain injury long term care" is defined as an interdisc i plinary, intensive maintenance program for patients who have incurred brain damage caused by external physical trauma and who have completed—a primary—course of rehabilitative treatment and have reaohod a point of no gain or progress for more than three consecuti ve months. Services are provided through a medically super vised interdisciplinary process and are directed toward maintaining the individual at the optimal level of physioal, oognitive and behavioral funo tions . "Capacity" moans the maximum number of patient or resident beds for whioh the faoility is licensed to maintain at any given time.— "Combination facility" moans a combination home as defined in G.S. 13 IE 101. Convalescent care"—means oaro givon for the purpose of assisting the patient or resident to regain health or strength. -(40) "Department" means the North Carolina Depart 10:2 NORTH CAROLINA REGISTER April 17, 1995 58 PROPOSED RULES -W -tm- 4U>- <m- -m- -m-w- -(30)- -(3+)- -(33)- -(33)- mont of Human Resources. "Direotor of Nursing" rooano the nuroe who hao authority and direot reoponoibility for all nursing services and nursing oare. "Drug" moana subotanooo; -(a) recognized in tho offioiol United Statoo Pharma-oopoeia, offioial National Formulary, or any supplement to any of thorn; (te) intended for uoo in tho diagnosis, euro, mitiga-tion, treatment, or prevention of disease in man or other animalo; (e) intended to affect tho structure or any function of tho body of man or other animals, i.e., subotanooo other than food; and (d) intended for uoo as a oomponont of any artiole specified in (a), (b), or (c) of this Subparagraph. (13) "Duly licensed" moans holding a current and valid lioonoe as required under the General Statutes of North Carolina. "Existing facility"—moans a facility currently licensed or a proposed facility, proposed addition to a lioonood—faoility or proposed remodeled lioonood facility that—will be built aooording to plans and specifications which—have boon ap proved by tho Department through tho prolimi nary working drawings otato prior to the effeotive date of thio Rule. (15) "Exit oonforonoo" moans tho conference hold at tho end of a survey, or investigation between tho Department's—representatives—and the faoility administration representative . "Finding" moans a determination by tho Depart meet that an allegation of patient abuse or neglect, or misappropriation of patient property has boon substantiated. "HIV Unit" moans designated areas dedicated to pationts or residents known to have Human Imnw-nodefioionoy Virus dioeaoe. "Incident" means an unplanned or unwanted event which has not caused a wound or injury to any individual but whioh has tho potential for such should the event bo repeated. "Interdisciplinary" means an integrated process involving a roprosontativo from each discipline of tho health care team. "Lioenced praotioal nuroe " means a nurse who is duly licenced ao a praotioal nurse under G.S. 90, Article 9A. "Licensee" moans tho person, firm, partnership, aooooiation, corporation or organization to whom a license hao boon ioouod. "Medication" moans drug as defined in (11) of thio Rule. "Misappropriation of property" means the criminal taking, uoo, exploitation of, dootruotion of, or damage to, a patient' s bolongings or money.—The Department must prove tho misappropriation of prop erty by a preponderance of the evidence . Conviction of tho criminal act is not a prerequisite to placing a finding concerning the mioappropria tion of property on the North Carolina Nurse Aide Registry. (24) "Nogloot" moans a failure through a lack of attention, oareloooneoo, or omission, to provide timely and oonoiotont oervioeo, treatment or oare to a patient or patients whioh are nooooBary to obtain or maintain tho patient's of pationts' health, safety or oomfort. "New faoility" moans a proposed faoility, a pro posed addition to an existing facility or a proposed remodeled portion of an existing faoility that is oonotruoted aooording to plans and specifications approved by the Department subsequent to the effective date of this Rule.—If determined by tho Department that more than half of an existing faoility i s romodeled, the entire existing faoility shall be considered a new faoility. "Nuroo Aide" moans any individual providing -(35)- -(36)- nursing or nuroing related services to patients in a faoility who io not a lioonsed health professional, a qualified dietitian, or someone who volunteers—to provide such services without pay, and listed in a nurse aide regis try approved by the Department. -&¥ "Nuroe Aide Trainee" moans an individual who has not completed an approvod nurse aide training course and competency ovalua tion and is demonstrating knowledge, while performing tanks for whioh they have boon found proficient by an instructor.—Those tasks shall bo performed under tho direct supervision of a registered nurse.—The term doeo not apply to volunteers. (28) "Nursing Faoility" means that portion of a nursing homo certified under Title XIX of tho Social Seourity Aot (Medicaid) as in oompli anoo with federal program standardo for nuroing facilities. It io often used as synony rnous with tho term "nursing home" which i s the usual prerequisite lovol of state lioonsuro for nursing faoility (NF) oertifioation and Medicare—skilled—nursing—faoility—(SNF) certification. -(39) "Nurse in oharge " means the nurse to whom duties for a specified number of pati ents and staff for a spec i fied period of time have boon delegated, such as for Unit A on tho 7 3 or 3 11 shift. "On duty"—moans personnel—who are awaket -(30)- droooed,—responsive to patient needs and physi colly present in tho facility performing assigned duties. "Operator" means the owner of tho nursing home busineoo. "Patient" moans any person admitted for nursing -(34)- -(33)- -(334- "Pereon" means an individual, trust, estate, part 59 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES norahip of oorporation—including associations, joint steefc companies and inouranoo oompanieo. (34) "Propooal" means a Negative Aotion Proposal containing dooumontation of findings that may ultimately bo classified ao violations and penalized accordingly. (35) "ProviBional Lioenoo" moans an amonded lioonoe recognizing significantly looo than full oomplianoo with the lioonsuro rules. (36) "Phyoioian" meano a person licensed under G.S. Chapter 90, Artiole 1 to pmotioe medicine in North Carolina. (37) "Qualified Activities Director" moans a person who hao the authority and responsibility for the direotion of all thorapoutio aotivitioo in the nursing fac i lity and who meets the qualifications sot forth under 10 NCAC 3H .1204 . (38) "Qualified Dietitian" meano a person who meets the standards and qualification eotabliohed by the Commission on Dietetic Registration of the Amor icon Dietetic Association included in "Standards of Praotioe "—oeven dollars and twenty five oents ($7.25) or "Code of Ethioo for the Profession of Dietetics " two dollars and fifteen oenta ($2.15), -m- I -(«)- -m- I American Dietetic Association, 216 W. Jackson Blvd., Chioago, IL 60606 6995. "Qualifiod Pharmaci st" means a person who io licensed to practice pharmacy in North Carolina and who moots the qualifications sot forth under 10 NCAC 3H .0903. -(40) "Qualified Social Sorvioes Director"—means a person who has the authority and responsibility for the provision of social sorvioes in the nursing home and who moots the qualification set forth under 10 NCAC 3H .1306. (4 1) "Registered Nurse" moans a nurse who is duly licensed as a registered nurse under G.S. 90, Artiole 9A. "Resident" means any person admitted for oare to a domiciliary homo part of a combination homo as defined in G.S. 131E 101. "Sitter"means an individual employed—te provide companionship and sooial interaction to a particular pationt, usually on a private duty basis. (44) "Supervisor in Charge (domioiliary home)" means any employee to whom supervisory duties for the domiciliary homo portion of a combination homo have boon delegated by either the Administrator or Direotor of Nurs (45) Surveyor" moons an authorized representative of the Department who inspects nursing facilities and combination facilities to determine oomplianoe with rulos ao set forth in G.S. 13 IE 117 and applicable state and federal laws, rules and regula l ions . ( 46) "Ventilator dependence" is defined as phyoiologi oal dependency by a patient on the use of a venti lator for more than eight hours a day. (47) "Violation" moans a finding which directly relates to a patient' s health, safety or welfare or which oreatee a substantial risk that death or serious physical harm will occur and is determined to be an infraction of the regulations, standards and requirements sot forth in G.S. 13 IE 117 or appl i cable state and federal laws, rules and regulations. Authority G.S. 13IE-104; 42 U.S.C. 1396 r (a). .0109 EXEMPTIONS AND WAIVERS (a) Facilities exempt from rules for lioenoure contained in this Subchapter are: (4-) facilities operated by the federal government; (2) facilities lioonood as a part of a hospital subjeot to lioensure under G.S. 13 IE, Artiole 5, and G.S. 122C, Article 2, and (3) facilities operated by the State of North Caro (b) Waivers of rules in this Subchapter are not authorized by the Nursing Homo Lioonsuro Act. Statutory Authority G.S. 13IE- 104. SECTION .0200 - LICENSURE .0206 LICENSE REQUIRED No person defined in G.S. 13 IE 1(2) shall operate a nursing homo except as provided for in G.S. 13 IE 102. Those referenced statutes are adopted in accordance with G.S. 150B 14(o). Statutory Authority G.S. 131E-104; 150B- 14(c). .0207 APPLICATION REQUIRED (a) An application for lioenoure shall bo submitted to the Department prior to a license being issued. (b) The Department shall bo notified in writing prior to the ooourrenoe of any of the following oiroumstanoos: (4-) final site oeleotion, whioh must be approved by the Department prior to construction; (3) construction of a now facility or any renovation of an existing fac i l i ty; (3) inoreaoe or decrease in bed capacity for any level of caro; (4) the acquisition of a nursing homo or any change in ownership including any change in a partner ship; or (5) change of name or location. Statutory Authority G.S. 13IE-104. .0208 CONTENTS OF APPLICATION The application shall contain the following; 10:2 NORTH CAROLINA REGISTER April 17, 1995 60 PROPOSED RULES -(-!-) name and address of applicant; -(3) name and ourrent lioenoe number of tho Adminio trator; -(3) typo of facility to bo operated; -(4) location of tho facility; -(£) tho name and prinoipal buoinooo addreoo of eaoh partner, if applicant io a partnorohipt -(6) tho namo and prinoipal business addrooo of oaoh and all officers and diroctoro as well as tho name and prinoipal bucineoo addrooo of eaoh stockholder owning (dirootly or indirootly) Ten peroent or moro of tho stock; and -f?) such other documents or information as necessary to determine compliance with applicable ruleo and statutes as well as tho magnitude and oeope of services to bo offered. Statutory Authority G.S. 131E-104. .0209 ISSUANCE OF LICENSE Only one liconso shall bo issued to each facility.—The Department shall ioc.ua a lioonoo to tho operator of the nursing home buoinooo upon verification of compliance with applicable laws and rules. Statutory Authority G.S. 13IE-104. .0210 EXPIRATION Each license shall expire at midnight on tho expiration date of the lioense exoept ao otherwioo provided in G.S. 150B 3. Statutory Authority G.S. 131E-104. .0211 RENEWAL Eaoh licensee shall file an application for renewal of liconso with tho Department at least 30 days prior to tho date of expiration on forms furnished by tho Department. Failure to file a renewal application shall result in expiration of the lioense to operate . Statutory Authority G.S. 13IE-104. .0212 TYPES OF LICENSE A liconso shall bo issued for a 12 month period; however, a provisional liconso may bo issued for a period of loss than 12 months in eases where the facility has not fully complied with G.S. Chapter—13 IE, Artiole 6, Part A and rules contained in this Subchapter, and such noncompliance does not pose an immediate hazard to tho life or safety of tho persons oorvod. Statutory Authority G.S. 131E-104. .0213 POSTING OF LICENSE The lioenoo shall be posted in a prominent looation, accessible to public view, within tho licensed promises. Statutory Authority G.S. 13IE- 104. .0214 EXCEEDING LICENSED CAPACITY (a) A life oare oenter having an agroomonto to oare for all residents regardless of level of care needs may temporarily increase bod capaci ty by ten percent or ton bods, whichever io loco, over the licensed bed oapaoity for a period up to 30 days following notification of and approval by tho Depart mont, provided such increase is not aoeooiatod with a capital expenditure. —(b) A facility other than a life oare oenter shall aooopt no more pati ents than the number for which it io lioenood in each level of care oxoopt in an emergency situation ap proved in advance and confirmed in writing by tho Deport ment.—Emergency authorizations shall not oxoood seven calendar days and shall not oxoood tho total lioenoed bed capacity for tho facility. Statutory Authority G.S. 131E-104. .0215 TRANSFERABILITY licenses aro not transferable.—A licensee shall notify tho Department in writing of any propoood change in ownership at loast 30 days prior to the e ffective date of the change . Tho now owner shall be responsible for submitting an application for license at loast 30 days prior to assuming ownership. Statutory Authority G.S. 131E-104. .0216 DENIAL, AMENDMENT, OR REVOCATION OF LICENSE (a) Tho Department shall deny any licensure application upon becoming awaro that tho applicant is not in compliance with any applicable provision of the Certificate of Nood law located in Artiole 9 of Chapter 13 IE of the General Statutes and tho rules adopted under that law. (b) Tho Department may amend a liconso by reducing it from a full lioense to a provisional lioense whenever the Department finds that: (4-) tho licensee has substantially failed to comply with tho provisions of Part A of Article 6 of Chapter 13 IE of the General Statutes and the rules promulgated under that Part; and (3) there is a reasonable probability that tho licensee can remedy tho licensure deficiencies withia-ft reaoonable length of time; and (3-) there is a reasonable probability that tho lioonooo will bo able thereafter to remain in compliaflee with tho nursing homo licensure rules for tho forooooablo future. The Department shall give the licensee written notice of the amondmont of his license.—This notice shall be given by registered or certified mail or by personal service and shall oot forth the reasons for the action. —(o) The provisional licence shall be effective immediately-upon its receipt by tho licensee and must be posted in a prominent looation, accessible to public view, within tho licensed premises in lieu of the full license . The provisional I 61 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES license shall remain in offoct until; (i) the Department rootoroo the lioonooo—to full lioonaure otatuo; or (3) the Deportment revokes the liconfloo'a license; or (3) the end of the licensee's licensure year. If a lioonooo has a provisional lioenoe at the time that the lioonooo oubmito a renewal applioation,—the lioenoe ,—if fonowod, shall also bo a provisional license unless the Department determines that the licensee can bo returned to full lioenoure otatuo.—A dooioion to iooue a provisional lioonoo is stayed during the pendenoy of an administrative appeal and the licensee may continue to display ito full license during the appeal. —(d) The Department may revoke a lioenoe whenever: (4-) The Department findo that: (A) — the lioonooo has substantially failed to comply with the provisions of Parts A and B of Article 6 of Chapter 13 IE of the General Statutes and the ruloo promulgated under thooe parte; and (B) it is not reasonably probable that the licensee eon remedy the licensure deficiencies within a reasonable length of time; or (3) The Department findo that: (A) the licensee has substantially failed to comply with the provisions of Parts A and B of Article 6 of Chapter 13 IE of the General Statutee; and (B) although the l ioonooo may be able to romody the deficiencies within a reasonable time, it is not reasonably probable that the licensee will be able to remain in oomplianoe with nursing home lioenoure rules for the foreseeable future; er -(3) The Department finds that there has boon any (c)—The suspension will bo effective when the notice is served or on the date specified in the notioe of ouopenoion, whichever io later. The suspension will remain effective for the period specified in the notice or until the facility demonstrates to the Department that conditions are no longer detrimental to the health and safety of the patient. (d) The nursing home ohall not admit new patients during the effective period of the suspension. Statutory Authority G.S. 131E-104. .0218 PROCEDURE FOR APPEAL —A nursing homo may appeal any decision of the Depart ment to deny, revoke or alter a lioenoe or any decision to suspend admiooions by making ouoh an appeal in aooordanee with G.S. Chapter 150B and 10 NCAC IB .0200. Statutory Authority G.S. 13IE-104. .0219 INSPECTIONS (a) Any nursing homo licensed by the Department may bo inspected by any authorized representative of the Depart ment at any time. Generally, inspections will be conducted between the hours of 8 :00 a.m. and 6:00 p.m., Monday through Friday. However, complaint investigations shall be conducted at the most appropriate time for investigating allegations of the oomplamfcr (b) At the time of inspection, any authorized roprooonta tivo of the Department shall make his presence known to the Administrator or other person in oharge who ohall oooperate with the roprooontative(s) and faoilitate the inspection. (c) Inspections of medical records will be carried out in accordance with G.S. 13 IE 105. failure to oomply with the provisions of Parts A (d)—The faoility Administrator shall provide and moke and B of Article 6 of Chapter—13 IE of the General Statutes and the rules promulgated under those parts that endangers the health, safety or welfare of the patients in the facility. available to representatives of the Department finanoial and statistical records required to verify compliance with all rules contained in this Subchapter. —(e) — The Department ohall mail a written report of the The issuance of a provisional lioenoe is not a procedural lioenoure survey or complaint investigation whioh shall prerequisite to the revocation of a license pursuant to Subparagraphs (d)(1), (2) and (3) of this Rule. Statutory Authority G.S. 131E-104. .0217 SUSPENSION OF ADMISSIONS (a)—The Department may suspend the admission of any new patient to any nursing home when warranted under the provisions of G.S. 131E 109(c). (b)—The Department shall notify' the nursing home by oertifiod mail of the decision to suspend admissions.—Suoh Statutory Authority G.S. 13IE-104. notioe will include: -(£) the period of the suspension; include statements of any deficiencies cited to the facility within 10 working days from the date of the licensure survey or oomplaint investigation exit conference. (f) The faoility Administrator ohall prepare a written plan of correction and mail it to the Department within 10 working days following receipt of any statement of dofioion oioo. The plan of correction ohall be reviewed and accepted or rej ected with written notioe given to the Administrator within 10 working days of receipt by the Department. -(3) factual allegations; .0220 PUBLIC ACCESS TO DEPARTMENT LICENSURE RECORDS -(3) citation of statutes and rules alleged to be vio lated; and -(4) notice of the facility's right to contested case hearing on the suspension. (a) Exoept for documents containing the information listed in Paragraph (b) of this Rule, Department files pertaining to the licensure of any facility under this Subchapter shall bo open to inspection by any member of the public during 10:2 NORTH CAROLINA REGISTER April 17, 1995 62 PROPOSED RULES normal business hours, aftor the Department has had a roaoonablo opportunity to ensure that none of the informa tion identifiod in Paragraph (b) will bo disclosed during the inspection.—Except for information identifiod in Paragraph (b), any member of the publio may obtain copies of any information oontained in the Department licensure filoo, subject to the following conditions: (1) Appropriate foots for the copying may bo charged in advance; and (3) Delivery of the oopioo may be delayed for a roaoonable time if the Department otaff io en gaged in other duties at the time of the request, (b) Unless disclosure is ordorod by a court of competent jurisdiction, the following oloooeo of information shall not be disolooed to members of the publio: (4) infonnatiea — about—the — diagnosis,—prognosis, treatment,—or any other confidential medical information undor G.S. 8 53, regarding a named person, unless that person consents in writing to the disclosure; (3) the name of any person who provided informa-tion concerning a faoility lioensod under this Subohaptor, or registered a oomplaint about the treatment of a patient or resident, unless that person consents to the di sclosure; (3) information identifying any person as a recipient of publio asoistanoo or social servioos, unless that person consents to the disclosure; and (4) any confidential communioation between the attorney for the Department and the Department. (o) When documents in the file contain only confidential information of the typos identified in Paragraph (b), then they will bo removed from the file before inspection.—tf-a dooument contains both information of those types identifiod in Paragraph (b) and non confidential information, then the Department will provide for inspection a copy of the document—from which the confidential—information—is dolotod, in lieu of the original dooument. No ohargo will bo made for this copying if the person inspecting the files does not wish to retain the copies made. Statutory Authority G.S. 8-53; 108A-80; 13IE-104; 131E-124(c); 132-1.1. writton agroomont or in a facility's governing bylawsr —(e) The Administrator shall be responsible for the operation of a faoility and all servioes offered and for compliance with all applicable state and federal laws and regulations. Statutory Authority G.S. 90-284; 131E-104. .0307 VACANCY IN ADMINISTRATOR POSITION (a) If the position of Administrator booomoo vacant, the Department shall bo notified by the owner, licensee, or Chairman of the Board of the nursing homo on the first working day following suoh vaoanoy.—The notioe of a vaoanoy shall oontain the name and lioense number of the replacement or tho name of the person responsible for operation of the facility during the absonoo of a lioensod Administrator. —(b) — A vaoanoy in the Administrator's position shall bo reviewed by tho Department every 30 days for licensure action. Statutory Authority G.S. 131E-104. .0308 NUMBER OF FACILITIES SERVED If an Administrator servos two or more facilities located 51 or more miles apart or having a combined bed oapaoity of moro than 130 bods, each faoility must have on Assistant Administrator who is duly lioensod and has writton authority to aot in the Administrator's absence . The Assistant Administrator shall not servo as the Direotor of Nursing. Statutory Authority G.S. 131E-104. .0309 FISCAL MANAGEMENT Tho Administrator of a facility shall establish and maintain records relative to operating costs and statistical records of th e operation of the faoility whioh provide a viable audit trail.—Those rooords shall include , but not be limited to, detailed information indicating tho time worked by and salary paid to all employees, food invoices, and daily census information, including admissions and d i schargee. AH reoords shall be maintained for at least two years. SECTION .0300 - GENERAL STANDARDS OF ADMINISTRATION .0306 LICENSED ADMINISTRATOR —(a) — Each facility shall bo under tho direct management oontrol of one poroon who io ourrently licensed by the North Carolina State Board of Examiners for Nursing Home Administrators in accordance with G.S. 90, Article 20.—An Administrator so licensed shall not bo subject to domiciliary home or other faoility Administrator lioonsure requirements established by any othor agonoy.—The Administrator shall not sorvo simultaneously as tho Director of Nursing. (b) If an Administrator is not tho solo owner of a facility, hio authority and responsibility shall be oloarly defined in a Statutory Authority G.S. 131E-104. .0310 STATISTICAL DATA FOR STATE USE The Administrator of a facility shall maintain and make available to tho Department such statistical data as required by statute or rules oontained in this Subohaptor, for tho state's medical facilities plan and/or proper review for certificate of nood determination. Statutory Authority G.S. 13IE-104. .0311 ADMISSIONS (a) No patient shall bo admitted except under tho orders of a duly lioensod physioian. 63 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES (b) Tho Administrator ohall assure? tuberculosis and other oommunioable diooaoo ooreening on admiooion and tuborou The facility Adminiotrator shall assure written policies and procedures whioh aro available to and implemented by staff. looio ooreening annually thereafter until final dioohargo. Those polioieo and prooedureo ohall oover at least the Identification of a communicable disease does not, in all cases, in and of itself, preclude admission to the facility. The faoility ohall provide appropriate oare and treatment. —(e) — Tho faoility ohall aoquire prior to or at the time of admission ordors from the attending physician for the immediate care of tho patient or resident. —(d) — Within 4 8 houro of admission, the faoility shall aoquire modioal information whioh shall include ourrent medical—findings,—diagnosis,—rehabilitation—potential,— a summary of tho hospital stay if the patient is being trans ferred from a hospital, and ordero for the ongoing oare of the patient. (o) If a patient is admitted from somewhere other than a hospital, a physical examination shall be performed either within 5 days prior to admiooion or within 48 houro follow ing admiooion. —(f) Now facilities must prepare a plan of admission which, at a minimum, assures available staff time and plans for individual patient aooooomont, initiation of health oare or nuroing oare piano, and implementation of physioian and nursing treatment plans.—This plan must bo available for inspection during tho initial licensure survey prior to ioouanoo of a lioenoe. —(g) Only persons who are 1 8 years of age or older ohall bo admitted to tho domiciliary home portion of a combine tion faoility. Statutory Authority G.S. 13IE-104. .0312 PATIENTS AND RESIDENTS NOT TO BE ADMITTED Pationto or residents who require health, habilitative , or rehabilitative care or training beyond those for whioh tho facility is licensed and is capable of providing shall not bo admitted. Statutory Authority G.S. 131E-104. .0313 DISCHARGE OF PATENTS A record shall be maintained of all d ischarges of patients following areas: —(4) admissions; —(2) dietary; —(3) dischargee with physioian orders and/or patients or residents leaving against physician advice; —(4) gratuities and solicitation whioh at a minimum shall—provide that no owner, operator, agent or employee of a—faoility nor any member of his family shall accept a gratuity directly or indirectly from any patient or resident in tho facility or solioit for any type of contribution; houookooping; infection control which must include, but is not limited—to, requirements for sterile and aseptic toohniquoo; universal and isolation precautions and oommunioable diooaoo ooreening inoluding annual tuberculosis screening for all staff and inpatients of tho facility; -(7) maintenance of patient medioal or health oare rewords inoluding charting or reoord keeping; orientation of all facility personnel; patient or resident care plana, treatment and other health oare or nursing oare, inoluding but not limited to all polioieo and prooedureo required by rules contained in this Subchapter; im- pationto' or residents' rights; (11) physical evaluation for residents and pati ents at least annually; (12) physician services and utilization of tho individ uol'fl private physician; (13) procurement of suppl ies and equipmont to moot individual pati ent oare uoodo; (1 4) protection of pationto from abuse and neglect; -(45)- range of services provided; (16) recording and reporting to tho Department of accidents or incidents ooourring to pationto in any part of tho facility and maintenance of such ro ports or records; (17) rehabilitat i on services ; (1 8) release of medioal reoord informatiefit indicating tho reasons for discharge, the physician's order (19) screening and reporting oommunioable disease to for or other authorization for discharge, and tho condition of the patient at the time of discharge . A patient known to have Human Immunodeficiency Virus (20) disease may not bo discharged solely on tho basi s of tho diagnosis of Human Immunodeficiency Virus disease except ao authorized by the provisiono of N.C. General Statute 131E 117 (15) or other provioiono of the N.C. General Statutes or regulations promulgated thereunder or provisions of applicable federal laws and regulations. Statutory Authority G.S. 13IE-104. .0314 POLICES AND PROCEDURES tho Department (Division of Health Services) and local health Department; transfers. Statutory Authority G.S. 13IE- 104. .0315 NURSING HOME PATIENT RIGHTS (a)—Written policies and procedures shall bo developed and enforced to implement requirements in G.S. 13 IE 115 et ooq. (Nuroing Home Patients' Bill of Righto) concerning the righto of patients.—The Adminiotrator ohall make these policies and procedures known to staff, patients and families of patients and shall ensure their- availability to tho public by 10:2 NORTH CAROLINA REGISTER April 17, 1995 64 PROPOSED RULES placing thorn in a conspicuous plaoo, (b) In matters of patient abuoe, negleot or misappropria ^ tion the definitions oball have the moaning defined in Rul e .0108 of this Subchapter. Authority G.S. 131E-104; 131E-111; 131E-124; 131E-129; 42 U.S.C. 1396 r (e)(2)(B). .0316 SAFETY AND ENVIRONMENTAL CONTROL (a) A lioensed facility shall have polioies and prooedures for pationt safety and for environmental control which at a minimum shall include infection control. (b) A facility with a licensed oapaoity of 51 beds or more shall have a safety and environmental control committee which includes representation from administration; medical and nursing staff; pharmacy; maintenance, engineering or housekeeping; and di etary Borviooo, (o) A faoility with a lioensed oapaoity of 50 beds or less shall have a safety and environmental control committee which at a minimum includes the Administrator and Diroc tor of Nursing, (d) All oommittee members shall be designated in writing. (o) Responsibilities and duties of any safety and environ mental committee shall include, but not bo limited to, the following: (4-) moot at least quarterly, maintain minutes inouffi ciorjt detail to document committee proceedings and actions, and submit reports to the Adminis trator; (3} establish an inoident—and aooidont—reporting system in accordance with facility policies which includos a mechanism for reviewing, invoatigat ing and evaluating all incidents and accidents reported.—The oommittee shall dooument all reviews and action(s) taken; (£) conduct hazard surveillance program;- (4} oonduot fire proteotion program whioh inoludes: (A) development and adoption of a comprehensive fire and disaster plan; (£) — instruction and fire drills for all employees in th e following: (+) use of all alarms and signals; (») methods of fire containment; fiw) location and use of—fire fighting equip mont; (iv4 where , when and how to shut off oxygen and air conditioning*- fv) evacuation routes and procedures; and (vi} transmission of an alarm to the fire De partroent or other responsible emergenoy services; —assignment of specific responsibilities and tasks to all personnel in response to an alarm; and a fire drill for eaoh shift of omployooo at least quarterly; conduct water temperature surveillance program whioh assures oomplianoe with Rule .1 807(d) of this Subchapter; -(6) annually review polioieo and prooedurec for infection and communicable diooaoo oontrol; (A) handling food; -(€> -(B) processing laundry; -(G)- -0*- disposing of environmental or other waatoo and pationt or reoident ourgioal or wound dreoo ings, porsonal care pads or other wastes; (-B) — controlling poets and reporting infectiono and diseases; f£) monitor overall environmental/infeotion oontrol and implementation of safety policies and prooo (&) monitor—staff development—te — assure—active ongoing insorvioe — training at least annually which shall include universal precautions and other areas of safety and environmental/infection oontrol for all personnel; and (9) aoting on requirements from the Occupational Safety and Health Administratio&r Statutory Authority G.S. 13IE- 104. .0317 REPORTING AND INVESTIGATING ABUSE, NEGLECT OR MISAPPROPRIATION (a) The faoility shall take reasonable meaourec to prevent patient abuse , patient negleot, or misappropriation of patient property, including but not limited to orientation and instruction of facility staff on patients' righto, and the requesting of referenoeo for all prospootivo employees. (b) The Administrator shall aocuro that the Department is notified of all alleged incidents which appear to a reasonable person to bo related to pationt abuse, neglect or misappro-priation of patient property.— (o)—The inoident report shall be printed or typed and postmarked within 48 hours of the alleged inoident. The report shall be conducted as specified in 42 CFR subsection 4 8 3.13 and shall consist of a simple statement of the patient's full name ; room number; type of injury, date and time of the alleged incident of abuse, neglect or misappro priation of property; names of persons involved; and immediate aotion tak en by the faoility. (d) The faoility shall thoroughly investigate and dooument according to 42 CFR subsection 483.13, whioh is incorpo rated by reference, including subsequent amendments, all alleged incidents whioh appear to a reasonable person to be inoidents of pationt abuoe , pati ent negleot, or misappropria tion of pationt property and 3hall take whatever steps are necessary to prevent further incidents of abuse, neglect or misappropriation of property while the investigation io in progress. Authority G.S. 131E-104; 131E-111; 143B-165; 42 U.S.C. 1395; 42 U.S.C. 1396; 42 C.F.R. 483. .0318 PERSONNEL STANDARDS (a) The Administrator shall provide for the following; (4-) numbers and typeo of qualified personnel and 65 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES ancil lary—services as necessary—to assure the health, oafoty and proper oare of pationto and rooidento; (3) on duty personnel who for health or other rea sons present no throat to the health and safety of pationto and rooidento; and (3) an individual personnel rooord for eaoh em ployoo rogardlooo of job assignment Such rooord shall bo kept current and shall include oortifioate and licensure numbers, when applioa bio; the original application with verification of credentials; periodic performance ovaluationo; and a signed and dated certification that the employee hao road and understood the facility' s polioioo governing conditiono of employment, including but not limited to on duty dross, personal hygiene, sleeping on duty, ingestion of alcohol or other drugs, oonduot towards patients and rooidento, and the wearing of identification (b) Each employee shall bo assigned duties consistent with hio job description and with hio level of education and training, which includes documented on the job training and experience and in service education. Statutory Authority G.S. 131E-104. SECTION .0400 - PATIENT OR RESIDENT CARE ASSESSMENT AND PLANNING .0407 GENERAL The Administrator shall assure that policies and procedures are available and implemented for assessi ng each patient's or resident's health oare noedo and planning for meeting identified health oare needs. There shall be a oyotem for evaluating the effectiveness of the assessment, planning and implementation (delivery of care processes) for each patient or resident. Statutory Authority G.S. 131E-104. .0408 FREQUENCY, METHOD AND CONTENT OF ASSESSMENT AND PLANNING Each patient's and resident's condition must bo assessed on a regular, periodic basis, at least quarterly, with appro priato notation and updating of the health oare plan.—Heakb oare planning for eaoh pati ent and resident shall bo an on going process and must include but may not bo limited to the following! (1) data whioh is systematically and continuously oolleoted about health status;—The data shall be recorded so as to be accessible and communicated to all staff involved in the patient's or resident 8 -m- ourront problems and needs identified and priori tizod from a completed assessment relevant to the patient' s or resident's response to aging, illness and his/her general health status; and —(3) a ourrent plan of oare developed in conjunction with the patient or resident and/or legal guardian that includes measurable time related goals and approaches,—or measures—to bo employed -by various disciplines in order to aohieve the idonti fied goals. Statutory Authority G.S. 131E-104. .0409 IMPLEMENTATION OF HEALTH CARE PLAN All parts of the plan of care shall be assigned to specific disciplines or staff ao indicated in the plan of oare to assure that health oare and rehabilitative services are performed daily and documented for those patients and residents who required such services. Statutory Authority G.S. 13IE-104. SECTION .0500 - NURSING SERVICES .0505 NURSING/HEALTH CARE ADMINISTRATION AND SUPERVISION —(a) — A licensed facility shall have a Director of Nursing service who shall be responsible for the overall organization-and management of all nursing sorviooo and shall bo currently licensed to practice as a regi stered nurse by the North Carolina Board of Nursing in accordance with G.S. 90, Artiole 9A. (b) The Director of Nursing shall not serve ao Adminio trator or Assistant Administrator. (c) A licensed facility, with nursing facilities or combina tion facilities shall provide a full time Director of Nursing on duty at least eight hours per day, five dayo a week.— A registered nurse shall relievo the Director of Nursing (be in charge of nursing) during the Director's absence. (d) A l icensed facility shall employ and aooign registered nurse , licensed praotioal nurooo and nurse aideo for dutieo in accordance with G.S. 90, Article 9A. —(o) The Director of Nursing shall cause the following to be aooompliohed: (4-) establishment and implementation of nursing policies and procedures which shall include but not bo limited to the following; (A) — assessment of the planning for patiento' nuro ing oare or health oare needs, and implementa tion of nursing/health care plans; (B) daily charting of any unusual occurrences of aoute episodes related to patient oare, and progress notes written monthly reporting eaoh patient's—performance—in — accordance—wkh identified goals and objectives and each pa tient's progress toward rehabilitative nursing goals; (€) assurance of the delivery of nursing services in accordance with physicians' orders , nursing 10:2 NORTH CAROLINA REGISTER April 17, 1995 66 PROPOSED RULES oaro plans and the facility's poliotoo and prooo dures; -(D) notification of omergenoy phyoioiano or on oall physicians ! -(E) infection control to provont cross infection among pationto and staff shall be in oonfor monoo with 29 CFR 1910 (Oooupatioool Safety and Health Standards) which is incorporated by reference including subsequent amendments. Emphaoio ohall be placed on oomplianoe with 29 CFR 1910 1030 (Bloodbourne Pathogens). Copies of Title 29 Part 1910 may bo purchased from the Superintendent of Documento, U.S. Governmeat — Printing—Offioe ,—Washington, D.C. 20102 for $3 8 .00 or may bo purchased with a credit card by telephone to the Govern mont Printing Office at (202) 7 83 323 8 . Infection oontrol shall also be in oomplianoe with the Center of Dioeaoe Control Guidelines as published by the U.S. Department of Health and Human Services, Public Health Service whioh is incorporated by reference including subsequent amendments. Copies may be purohaoed from the National Tochnioal Infof motion Service, U.S. Department of Com meroe, 5285 Port Royal Road, Springfield, Virginia, 22161 for $15.95. -(F) — reporting of deaths ; -(G) oroorgoncy reporting of fire, patient or staff accidents or inoidento, or other omergenoy situations; -(H) use of protective devices or restraints to assure that each patient or resident is restrained 4b accordance—with phyoioian—orders and the faoility' s polioies,—and that the restrained patient or resident i s appropriately evaluated and released at a minimum of every 2 hours1 , —(f) special skin oare and deoubiti core; —(F) bowel and bladder training; -(K) maintenance of proper body alignment and restorative nursing care; -(t) supervision—of and assisting pationto with -W- -m-feeding; intake and output observation and reporting for thooe patients whoso condition warrants moni toring of their fluid balanoe.—This will include thooe patients on intravenouo fluids or tube feedings, and patients with kidney failure and temperatures elevated to 102 degrees F. or above ; -m- oatheter oare ; and -m- -(0) procedures used in caring for patients in the facility, d evelopment of written job descriptions for nursing peroonnol; periodic assessment of the nursing department with identification of personnel requirements as they relate to patient oare needs and reporting -£)- -&- -<&- same to the Administrates a planned orientation and continuing inoorvioe education program for nursing employeoo and documentation of staff attendance and subject matter covered during inooryioo education pro gramo; obtaining and provision of appropriate reference materials for the nuroing Department, which include a Physician's Desk Roforonoo or oompa rablo drug referenoe ,—policy and prooodure manual, and medical dictionary for each nursing station; and establishment of operational procedures to assure that appropriate supplies and equipment ore available to nursing staff as determined—by individual patient oaro needs. Authority G.S. 13IE-104; 42 U.S.C. 1396 r (a). .0506 VACANT DIRECTOR OF NURSING POSITION (a) The Administrator shall notify the Department within 72 hours when the Director of Nursing position becomes vacant and shall provide the name and license number of the individual who ie acting Director or the replacement for the Direotor of Nursing. (b) A faoility shall not operate without either a Direotor of Nursing or acting Director of Nursing. —(c) The Administrator shall employ a Director of Nursing within 30 days after a position beoomoo vaoant.—A vaoanoy whioh exceeds 30 days ohall bo reviewed by the Department for action relative to licensure status of the facility. Statutory Authority G.S. 13IE-104. .0507 NURSE STAFFING REQUIREMENTS —(a) — A licensed facility shall provide licensed nursing personnel sufficient to accomplioh the following: (+) patient needs aoooooment, patient oaro planning, and supervisory functions in accordance with the levels of patient or resident oaro advortiood or offered by the facility. The facility also shall provide other nursing porsonnol sufficient to assure that at least activities of daily living, pe rsonal grooming, restorative nuroing actions and other health oaro needs as identified in eaoh patient's or resident's plan of care are mot. —(b) A licensed multi storied facility (one having more than one story) shall provide at least one person on duty on eaoh pati ent oare floor at all times. —(e) — Daily direct patient care nursing staff, licensed and unlicensed, shall equal or exceed 2.1 nursing hours per patient. (This is sometimes referred to as nursing hours per pati ent day or NHPPD or NH/PD.) (4} Inclusive in those figures i s the requirement that at least one licensed nurse is on duty for direct pati ent oare at all times; and < 67 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES (3) Nursing cnro shall include tho services of a registered nurse for at least oight oonseoutive hours a day, seven days a week.—This ooverage can bo spread over moro than one shift if such a need exists.—The Director of Nursing may be oountod ao mooting tho requirement!) for both the Dirootor of Nursing and patient and resident staffing for facilities of a total census of 60 bods or loss. (5) Nursing—support—personnel—including—ward olorka, secretaries, nuroe eduoators and persons in primarily administrative managomont positions and not actively involved in direct patient care shall not be oounted toward oomplianoe with minimum daily requirements—for direot oare staffing. (d)—All exceptions to mooting the minimum staffing requirements shall be reported to tho Department at the end of eaoh month.—Staffing waivers granted by the federal government for Medicare and Medicaid oortifiod bods shall bo accepted for licensure purposes . (e)—The ratio of male to female nurse aides will be determined by tho seeds of the pati ents, particularly the numbers of male patients requiring assistance with personal Authority G.S. 131E-104; 42 U.S.C. 1396 r (b)(4)(c). .0510 DOMICILIARY HOME PERSONNEL REQUIREMENTS (a)—Tho Administrator shall designate a person to be in charge of tho domiciliary homo residents at all times.—The nurse in charge of tho nursing facility may also servo as supervisor in oharge of the domioiliary home or beds . (b)—If domioiliary home beds are located in a separate building or a separate lovol of the same building, there must bo a person on duty in tho domiciliary homo at all times. (o)—A licensed facility shall provide sufficient staff to assure that activities of daily living, personal grooming, and assistance with eating are provided to each resident. Medication administration as indicated by each resident's condition or phyoioian's orders shall be carried out as identified in eaoh resident's plan of oare. (d) Domiciliary homo facilities (Homo for tho Aged bods) licensed as a part of a combination facility' shall comply with the staffing requirements of 10 NCAC 42D .H07 as adopted by the Social Servioes Commisaion for freestanding domiciliary homos . Authority G.S. 131E-104; 42 U.S.C. 1396 r (a). .0511 REHABILITATIVE NURSING AND DECUBITUS CARE —Eaoh patient or resident shall bo given oare to prevent oontraotures, deformities, and dooubiti, including but not limited tet- —(+) changing positions of bedfast and chairfast patients or residents ovory two hours and administering simple preventive oare;—Documentation of such oare and outoome must be inoluded in routine summaries or progress notes ; —(¥) maintaining proper alignment and joint movement to prevent oontraotures and deformities, which must be documented in routine summaries or progress notes ; —(£) implementing an individualized bowel and bladder training program exoept for patients or residents whose reoordo are dooumented that ouch training is not effective;—a monthly summary for patients and quarterly summaries for domiciliary residents shall be written relative to eaoh pati ent's or resi dent's performance in the bowel and bladder training program. Authority G.S. 131E-104; 42 U.S.C. 1396. .0512 MEDICATION ADMINISTRATION (a) A licensed facility shall have policies and procedures governing the administration of medioations which shall be enforced and implemented by administration and staff. Policies and procedures shall include but not be limited to; (+) automatic stop orders for treatment and drugs; (3) accountability of controlled subotanoes as defined by the North Carolina Controlled Substances Act, G.S. 90, Article 5; (3) dispensing and administering behavior modifying drugs, such as hypnotios, sedatives, tmnquiliz ers, antidepressants and other psychotherapeutic agents; insulin; intravenous fluids and modioa tions;—cardiovascular—regulating—drugs;—aaA antibiotios. (b)—All medioations or drugs and treatments shall be administered and discontinued in accordance with signed physician' s orders which are recorded in tho patient's or resident's medical reoord. (44 Only physioions,—registered — nurses,—licensed practical nurses or physician assistants, if in accordance with tho assistant's approved prac tioe , shall administer medioations. (3) To ensure accountabil i ty, any medioation shall bo administered by tho same licensed personnel who proparod the dose for administrationr (3) Medioations shall be administered within a half-hour prior to or half hour after the prescribed time for administration unless precluded by emergency situations . (4) The — person—administering—medioations—shall id e ntify' eaoh pati ent or resident in accordance with tho facility's policies and procedures prior to administering any medication. ($) Medioation(s) administered to a patient or resi dent shall bo recorded in the patient's or resi ' dent's medioation administration reoord immedi atoly after administration in accordance with tho 10:2 NORTH CAROLINA REGISTER April 17, 1995 68 PROPOSED RULES facility's policies and proooduros. (4) Omiooion of medications and the reason for the omiooion ohall be indicated in the pationt'o or roaidont'o modioal record. (2} The person administering medications which ore ordered to be givon ao noodod (PRN) shall juotify the need for the same in the pationt'o or resident's modioal record. (8) Medication administration rooordo shall provide identification of the drug and strength of drug, quantity of drug administered, name of adminio toring employee, title of employee and time of administration. (o) Self administration of medications shall be permitted only if proooribod by a physician and directions are printed on the container. —-(d-) — The admini stration of one patient' s or resident' s medications to another patient or resident is prohibited except in the ease of an emergency. In the event of such an emergency, stops shall bo taken to assure that the borrowed medications shall bo replaced promptly and so documented. Statutory Authority G.S. 13IE- 104. .0513 ORIENTATION AND STAFF DEVELOPMENT —(a) A lioonsod facility ohall provide for all patient or resident oaro employees a planned orientation and continuing education program emphasizing patient or resident assess ment and planning, aotivitieo of daily living, personal grooming, rehabilitative nursing or reotorotive oare, other patient or resident care policies and procedures, patients' rights, and staff performance expectati ons.—Attendance and subject matter covered ohall be documented for eaoh session and available for lioonouro inspections. (b) The Administrator shall assure that each employee is oriontod within the first week of employment to the facility' s philosophy and goals. (o) Eaoh employee shall have speoifio on the job training ao necessary for the employee to properly perform hi s individual job assignment. Statutory Authority G.S. 131E-104. .0514 NURSE AIDE QUALD7ICATIONS (a) Effeotive Ootobor 1, 1 989 a faoility ohall not use as a nurse aide , any individual not qualifying under the provi sions of Rule .0515 unless the individual i s within the first four months aftor being hired. —(¥) — Nurse aides qualified under the provisions of Rul e .0515 who oxporienoe a period of 21 oonoeoutive montho or more of not being activoly employed in delivering nursing services shall bo considered unqualified.—Qualification may be — reestablished—by — ouooeoofully—passing an approved competency evaluation.—Any individual, nursing homo, or education facility may offer Department approved vocational education for nursing homo nurse aides. (o) An accurate record of nurse aide qualifications shall bo maintained for each nurse aide used by a faoility and shall be retained in the general personnel files of the faoility. Statutory Authority G.S. 131E-104; 143B-165; 42 U.S.C. 1395; 42 U.S.C. 1396. .0515 APPROVED NURSE AIDE EDUCATION —Effective Ootobor 1, 1989 the curriculum content required for nurse aide eduoation programs shall be subject to approval by the Division of Facility Servioeo and shall include, ao a minimum, basic nursing skills, personal care skills, cognitive, behavioral and social oaro, basic resto rative services, and patients' rights. Successful course completion shall be determined by passing a competency evaluation test. The minimum number of course hours shall bo 75 of which at least 20 hours shall bo classroom and at least 40 hours of supervised practical experi ence .—The initial orientation to the faoility ohall be exoluoive of the 75 hour training program. Competency evaluation shall be conducted in each of the following areas; —(+) Observation and documentation, —(3) Baoio nursing skills, —(3} Personal oare skills, —{A) Mental health and social service needs, —{$) Basic restorative servioeo, —f4) Residents' Righto. Statutory Authority G.S. 131E-104; 143B-165; 42 U.S.C. 1395; 42 U.S.C. 1396. .0516 COMPETENCY EVALUATION (a)—Suooossful course completion and skill oompotoncy shall bo determined by oompotenoy evaluation approved by the Department. —(h)—Commencing July 1, 1989, nurse aides who had formerly boon fully qualified under nurse aide training requirements—H*ay — re establish—their—qualifications—by ouooeoofully passing a oompotenoy evaluation test. Statutory Authority G.S. 131E-104; 143B-165; 42 U.S.C. 1395; 42 U.S.C. 1396. .0517 NORTH CAROLINA NURSE AIDE REGISTRY The function of the North Carolina Nuroe Aide Registry io to maintain a oentral listing of registered nurse aides. Effeotive January 1, 1990 t a faoility ohall not permit-aa individual to work as a nurse aide for a period longer than four months without verifying the person's registry or ouooeooful completion of an approved training program^ Statutory Authority G.S. 131E-104; 143B-165; 42 U.S.C. 1395; 42 U.S.C. 1396. SECTION .0600 - MEDICAL RECORDS .0605 POLICES AND PROCEDURES Eaoh lioenoed faoility ohall have policies and procedures 69 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES which shall bo implemented to provide for at loaot the following: -&h maintenance of oompleto and aoourate medioal -&- records for each patient admitted to the facility; filing of medical records to ensure aooossibility for oompiling or retrieving informationf ouporvioion of medioal reoordo; Statutory Authority G.S. 13IE-104. .0608 PATIENT INDEX The Administrator shall assure that a master patient index is maintained—listing patients alphabetically—by name, identifying information, dates of admiooion and disoharge and oase number. -(4) confidentiality of records; -(5) accessibility or non accessibility of medical record Statutory Authority G.S. 131E-104. information to the pati ent or logal guardian, faoility staff and non employees of the faoility; retention of records; —(7) disposition of records; and —(8) oharting and indexing of records. Statutory Authority G.S. 13IE-104. .0606 SUPERVISION AND SPACE —(a) An employee who works fulltime in the faoility shall bo designated to bo responsible for the modical record services.—If that employee i s not qualified by training-ef expe ri enoe in modioal rooord soionoe,—he shall reoeive oonoultation from a registered record administrator or an accredited record technic ian as determined by noods of the facility and to assure compliance with wiles contained in this Subchapter. (b)—Medioal record work space shall be so located to assure that records are protected from unauthorized disclo sure. All modical records shall bo stored in a protected or supervised environment. Statutory Authority G.S. 131E-104. .0607 CONTROL AND RETENTION (a) Medioal reoords shall not be removed from the faoility except by oourt order. (b) The facility's policy relative to retention of modical reoords shall assure that either the original or a copy of eaoh patient's or resident' s medioal record is retained in the faoility regardless of change of ownership or Administrator in accordance with North Carolina statutes of limitations for both adults and minors (G.S.I IS, 1 17). (o)—A plan for destruction of medioal reoords shall identify information to be retained and the manner of destruction to ensure confidentiality of all material. (d) Provisions shall bo made for a patient or resident or hio l egal guardian to have aooess to the information oon tainod in his modical record unless ordered otherwise by the patient's or resident's physician. (e)—Signed authorization forms oonoorning approval or disapproval of release of medioal information for lioenoure inspections shall be a part of each patient's and resident's modical record. Representatives of the Department shall bo notified at the time of inspeotion of the name and record number of any patient or resident who has deni ed medioal record access to the Department. .0609 CONTENT OF MEDICAL RECORD (*) — All entries in the rooord shall bo dated, legible and signed by the individual making the entry with signature and titles If initials are used the rooord must oarry a rooord of eaoh employee 's full official signature and signature initials used in lieu of full signature, (b)—The patient's or resident's name and case number must be reoorded on eaoh page of the record, (o) The medioal record shall contain at least the following information when applicable! (4) identification data [name, address, ago, box, marital status, (name, address, and telephone number of next of kin, legal guardian or both)]; (3) admission data, including modical history and physical examination ; hospital discharge sum mary (if the patient or resident io admitted from the hospital); admission diagnosis; and rehabili tation potential, all of which must be signed by a physician; (5) transfer form; (4) diagnostic reports; ($) consultation reports; (6) physician' s orders which are signed by the physician; physician's progress notes; modioal and treatment records , which include laboratory, x ray, dental examination, physical therapy reports, etc.; -m- graphio sheet; medication administration sheet; —(44-) diabetic shoots; —(4-3) patient assessment and progress notes by various disci plines; —(45) miscellaneous such as consent and release forrasr copy of transfer forms to tho receiving institu tion, disoharge order or release of liability for th e faoility if the patient or resident leaves against doctor's orders; and —(44) discharge summary including admitting and final diagnosis and/or prognosis or oause of death. Statutory Authority G.S. 13IE-104. SECTION .0700 - PHYSICIAN SERVICES .0705 POLICES AND PROCEDURES —(a) Each licensed facility shall have policies and proce 10:2 NORTH CAROLINA REGISTER April 17, 1995 70 PROPOSED RULES duroo which arc implemented to assure that the medical or health oaro of oaoh patient or rooidont io undor the oontinu ing supervision of a physioian.—Physioian sorvioes shall include at least those physician services roquirod in Section .0300 of this Subchapter. —(b) — Modioal ordors for all medications and treatments administered to any patient or rooident shall be signed and dated by the attending physician. All current orders shall be signed and dated by the physician at least every 60 days. —(o) A physioian's oral orders (including tel ephone orders) shall be given only to a licenced nurse or other licensed professionals who by law aro allowed to accept physician' s orders , except ordors for therapeutic diets which shall bo given either to a qualified dietitian or licensed nurse.—The record of oaoh tel ephone order shall include the name of physician giving the order, date and time of order , content of order and name of person receiving the order.—The physio ian who gives oral orders shall sign the orders within five days and in aooordanoe with the facility's written policies, (d) Standing ordors shall bo identified for oaoh patient and signed by the physioian. (e) All di scharge orders and instructions shall bo oigned by a phys ician. Statutory Authority G.S. 13IE-104. .0706 ADMITTING PHYSICIAN The admitting physician shall bo responsible for the patient' s medioal oare until ouch time as orders are received from the pati ent's attending physioian. Statutory Authority G.S. 13IE-104. .0707 EMERGENCY PHYSICIAN A facility shall designate a physician or physician group practice to provide emergency services to patients whenever th e regular physioian oannot be reached.—The name and te l ephone number of the designated emergenoy servioe physician or group shall be posted at each nursing station. Statutory Authority G.S. 13IE-104. .0708 PRIVATE PHYSICIAN Each patient or legal guardian shall bo allowed to select hie private physioian except in those facilities affiliated with medioal toaohing programs and having written policies requiring all patients to participate in the medical teaching program. Statutory Authority G.S. 131E-104. .0709 DOCUMENTATION —(a) — The phyoioion shall see the pati ent every 60 days in the nursing faoility.—A physioian visit io conside red timely if it occurs not later than 10 days after the date the visit was required, (b) Every physioian's visit shall be documented with an entry in the physician's notes. (o) Physioians shall review and sign all discharge summn ries oo required by Rule .0609 of this Subchapter. Authority G.S. 13IE-104; 42 U.S.C. 1396 r (a). .0710 USE OF PHYSICIAN EXTENDERS The Administrator shall have on file a current agreement between the Board of Medical Examiners and a sponsoring physioian concerning— e aoh physioian aooiotant or nuroe practitioner visiting patients.—The physioian assistant's or nurse practitioner's privileges in the nursing homo must bo clearly defined by the fac i lity's policies and procedures and must be limited to those privileges granted by the Board of Medioal ExaminefSr- Statutory Authority G.S. 131E-104. .0711 BRAIN INJURY LONG-TERM CARE PHYSICIAN SERVICES (a)—For nursing facility patients located in designated brain injury long term oaro units, there shall be an attending physioian who io responsible for the patient's specialized care program.—The intensity of the program requires that there shall bo direct patient contact by a physioian at least ono e pe r week and more often as the patient's condition warrants.—Eaoh pati ent's interdisciplinary, rehabilitation program shall bo developed and implemented undor the supervision of a physiatrist (a physician trained in Physical Medicine and Rehabilitation) or a physioian of equivalent training and experience. (b) If a physiatrist or physician of equivalent training or experience is not available on a weekly basis to the facility, the faoility shall provide for weekly medioal management of the patient by another physioian. In addi tion, oversight for the patient's interdisciplinary, long term care program shall bo provided by a qualified consultant physician who visits patients monthly, makes recommendations for and approves the interdisciplinary oare plan, and provides consultation as requested to the physician who is managing the patient on a weekly basis. —(e) — The attending physioian shall act i vely part i cipate in individual ease conferences or oare planning ooooions and shall review and sign discharge summaries and records within 15 days of a patient discharge.—When patients ore to be discharged to either another health oare faoility or a residential setting, the attending physioian shall assure that the pationt has boon provided with a discharge plan which incorporates optimum utilization of community resources and poet discharge oontinuity of oare and servioes. Statutory Authority G.S. 131E-104. .0712 PHYSICIAN SERVICES FOR VENTILATOR DEPENDENT PATENTS Nursing facilities with ventilator dependent oaro patients shall contract with a physician who is licensed to practice in North Carolina with Board Certification and who has t 71 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES facility. (o) Services shall inolude documented on site pharmaceu tiool reviews aooompliehed at leant every 31 oalondar days for all patients and residents. specialized training in pulmonary medicine.—This phyoioian shall be rooponoiblo for respiratory Qorvioos and ohall: —(4) establish, with the respiratory therupiot and nuro «g — staff,—appropriate—ventilator—policies—aad procoduroa, including omorgoncy procedures; —(3) assooo eaoh ventilator patient' o status at least Statutory Authority G.S. 13IE- 104. monthly with corresponding progress notes; —(3) bo available on a omorgoncy basis; and —(4) participate in individual patient care planningr Statutory Authority G.S. 13IE-104. SECTION .0800 - DENTAL SERVICES .0810 DENTAL EXAMINATION —A dental examination shall bo performed at the time of admission with the following information being placed in the patient's or resident's medioal or health oare record: —(4} typo of diet whioh the patient or resident oan boot manage (such as normal, soft or pureed); —(3) the presence of infection of gums, tooth, or jaws; (3) briof descri ptions of any removable dental appli onoes and a statement of their condition; and —(4) indications for dental treatment at the time of admission. Statutory Authority G.S. 13IE-104. .0811 EMERGENCY DENTAL CARE Names of dentists who have agreed to render emergency dental oare shall be maintained at eaoh nuroing station and at the supervisor's station in a domiciliary homo. Statutory Authority G.S. 13IE-104. .0812 GOOD PRACTICES OF ORAL HYGDZNE Staff of the facility shall ensure that! —(49 neoesoary doily dental oare is provided; .0904 PHARMACEUTICAL SERVICES PROVIDED THROUGH OTHER MEANS If pharmaoeutiool services are provided through means other than by an employee of the facility, there shall be a written agreement between the facility and the pharmacist which shall include the following! —(4) a statement of the responsibilities of eaoh part)'; —(3) a requirement for the pharmacist to submit to the Administrator and the patient's attending physician written reports of any discrepancies—in drug accountability or administration. Statutory Authority G.S. 131E-104. .0905 ADMINISTRATIVE RESPONSD3ILITDZS (a) The Administrator shall maintain reports of dioorepan cios in drug accountability or drug administration submitted by the pharmacist and shall make those reports available for the Director of Nursing and the Department's representative for lioensuro inspection. (b)—The Administrator shall provide documentation of action taken relative to di screpancies identified by the pharmacist whioh shall be available for lioensure inspeo Statutory Authority G.S. 131E-104. .0906 PHARMACEUTICAL SERVICES COMMITTEE (a)—The Administrator shall appoint a pharmaceutical oervioes oommittee whioh shall be oomposed of at least the -(3) eaoh patient or resident possesses appropriate pharmacist and designated representat i ves of administration, nursing and physician services . (b) A pharmaceutical services committee shall: (4) establish items and quantities for emergency toothbrushes and is encouraged and, when nccee sary, assisted in their use; and -&- eaoh—patient—or resident having a removable dentures is furnished a receptacl e in whioh to immerse the dentures in water overnight. Statutory Authority G.S. 131E-104. SECTION .0900 - PHARMACEUTICAL SERVICES .0903 AVAILABDLITY OF PHARMACEUTICAL SERVICES —(a) — A licensed—facility—shall provide pharmaceutical services under the supervision of a pharmacist currently licensed to practice pharmaoy in North Carolina. —(b) — A facil i ty shall be responsible for obtaining drugs, therapeutic nutrients and related products proscribed or ordered by a physician for patients or residents in the drug kit; -(3) moot at least annually and more often as change in conditions may dictate for reviewing pharma-ceutical servioes;—there shall be written doou mentation of these reviews including dates, attendance, business discussed, action taken, and other relevant matters;—those minutes shall bo available in the faoility for at least two years; -(£) develop and/or approve and annually revise pharmaceutical policies and procedures; -(4) approve staff insorvico training designed to improve staff skills and/or oorroot identified problems; and -(5) approve non legend drugs maintained in the faoility and a written formulary for same. 10:2 NORTH CAROLINA REGISTER April 17, 1995 72 PROPOSED RULES (c) Tho pharmacist ahnll bo a member of the pharmaoeMti-ool sorvioos oommittoo and shall part i c ipate in drug utilize tion review and report to the oommittoe at least annuaHy-en tho status of tho facility's pharmaceutical services and staff porformnnco. Statutory Authority G.S. 13IE- 104. .0907 DRUG PROCUREMENT —(a) — Nursing homoo shall not be permitted to possess a stock of proscription legend drugo for general or oommon use except as permitted by tho North Carolina Board of Pharmacy and as follows: fi) for all intravenous and irrigation solutions in single unit quantities exoooding—19 ml. Bad related equipment for tho use and administration of such; (3) diagnostic agonto; -(4)- vaooinec; drugs designated for inclusion in an approved emergency kit; {§} water for injection; and -&h normal saline for inject ion. (b) Patient Drugs . £±} Tho contents of all proscriptions shall bo kept in the original oontainor bearing tho original label as described in (b)(2) of thi s Rule. (3) Except in unit dose systems, each individual patient's or resident's proscription or legend drugs shall be label ed with tho following infor motion: (A) tho name of tho patient for whom tho drug i s intended; (B) the moot recent date of issue ; (€) tho name of the prosoriber; (©) tho name, concentration of the drug, quantity dispensed, and proscription sorial number; (E) a statement of generic equivalency which shall be indicated if a brand other than the brand proscribed is dispensed; (F) the expiration date and other auxiliary state mento as required of the drug; (G) — the name , address and telephone number of th e dispensing pharmacy; and (H) tho name of tho dispensing pharmacists Statutory Authority G.S. 13IE- 104. .0908 DRUG STORAGE (a) Except for emergency drug kit and properly secured modioation oarts, all proscription or legend drugs shall be stored in a locked room or locked wall cabinets except whon tho drugs are under tho immedi ate, direct physical supervi oion of a lioenoed nurse or pharmacist.—Non l egend or non preooription drugs shall be stored in an area whioh is locked whon not in use and aooossiblo only by authorized individuals . —(b) Emergenoy drug kit shall be stored in a reasonably secure area out of tho sight of patients and tho general public (o)—Drugo requiring rofrigoration shall be stored in a thermometer equipped refrigerator capable of maintaining a temperature range of 2!C. to 8 !C. (36!F. to 45!F.), Drugs shall not be stored in a refrigerator containing non drugs and non drug related items, exoept when stored in a separate looked container . (d)—Drugs intended for topical use shall bo stored in a designated area separate from drugs intended for oral and injectable use. (o) Tho pharmacist shall remove outdated and deteriorated drugs from tho facility within 30 days after their period of effectiveness has lapsed. Statutory Authority G.S. 131E-104. .0909 PHARMACEUTICAL RECORDS The pharmacist shall aooure that accurate records of the receipt, use and/or other disposition of drugs are maintained and readily available. Statutory Authority G.S. 13IE-104. .0910 EMERGENCY DRUGS (a)—The facility shall maintain a supply of emorgoooy drugs. —(b) — Emergenoy drugs shall bo stored in a portable oontainor sealed with an easily breakable closure which cannot be reooalod and shall be readily aoooosiblo for uoo. (o)—All emergenoy drugs and quantity to be maintained shall bo approved by tho pharmaceutical services oommittoo. (d) If emergency drag items require refrigerated storage, they shall be stored in a separate sealed container within the medi cation refrigerator.—The container shall be labeled to indicate tho emergency status of tho enclosed drug(s) and sealed as indicated in Paragraph (b) of this Rule. ( e )—An aoourate inventory of emergenoy drugs and supplies shall be maintained with oaoh emergenoy drug kit. (0 The pharmacist shall personally examine tho refrigor atod and non refrigerated emergency drug supply at least every 90 days and make any necessary ohonges at that time. (g) The faoility shall have written polioieo and procedures which are enforced to assure that in tho event tho sealed emergency drug container is opened and contents utilized, immediate steps are taken to replace the items used. —(4») The availability of a controlled substance in an omorgoncy drug kit shall bo in compliance with current state and federal laws. Statutory Authority G.S. 13IE- 104. .0911 DRUG DISPOSITION (a) Upon discharge of a patient or resident, tho remainder of his drug supply shall be disposed of promptly unless it is reasonably expected that tho patient or resident shall return to tho faoility and in such case, tho remaining drug supply may be held for not more than 30 oalendar days after the 73 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES dato of discharge. (b) The diopooition of drugo ohall be in aooordanoe with written polioi eo and prooedureo eotabliohod by the pharmn and served ao ordered.—The modioal record ohall oontain .1004 DIETS (a) All dieto ohall bo proooribod by the patient' o phyoioian nutritional assessments and progress notoo that include! (+) diet hiotory and observation of food intake; coutical sorvicos oommittoo. —(e) — Accurate rooordo of drug destruction shall bo main-tained and authenticated by tho pharmaoist and Direotor of Nursing. (d) Controlled substanoos shall bo dootroyod in accordance with provisions of tho North Carolina Controlled Substances Aot, G.S. 90, Artiole 5. Statutory Authority G.S. 131E-104. SECTION .1000 - DIETARY SERVICES .1003 ORGANIZATION (a)—Tho Administrator shall designate a person to bo known as the food sorvioo supervisor who shall be rosponsi bio for the nursing home 's dietary oervioe and dietary service personnel.—If this person is not a qualified dietitian, ho must have successfully completed a course which would evening meal containing a protein food and a morning meal —(3) aooooomont of body weight and form and dietary requirements; and —(3} notes of counseling of patients and family?- -fb) — Documentation of menus served shall reflect that! —(4-) regular di et piano moot nutritional Heeds of tho patients—in aooordanoe — with ourrent—reoom mended dietary allowances of tho Food and Nutrition Board, National Research Council and are adjusted to age, sex and acti vity; and (3) therapeutic diet plans moot nutritional standards as stated in (bXl) of this Rule to the extent that is medically possible, (o)—At least throe meats shall bo served daily to all pati ents and residents. —(d) No more than 1 4 hours shall elapse between an qualify' him for membership in the Dietary Managers Association.—If the oouroe has not boon oompleted, this person must bo enrolled in a course and making sati sfactory progress for completion within tho time limit specified by oouroe requirements. (b)—If the food oorvioo supervisor is not a qualified diotitian, tho Administrator shall provide for a minimum of eight hours per month consultation from a qualified dietitian or sufficient time to aooure that therapeutic diets are planned and served in aooordanoe with the physician's orders.—The consultant shall submit written reports to the Administrator and food sorvioo supervisor.—The reports will bo kept on file in the faci l ity for at least two years. —(e) Tho food oorvioo superv i sor shall be responsible for tho total operation of tho dietary Department.—This respon sibility shall include coordinating dietary services with other faoility sorvioos; developing written job descriptions; food purchasing; dietary staff orientation, training and suporvi sion of dietary employees; participation in patient caro conferences; implementing current policies and procedures ; and maintaining a ourrent record of diet order for each pati ent or resident who shall be identified by name, room and bod number and diet order. —(d) Dietary personnel shall bo employed and scheduled to meet tho nutritional needs of all pati ents and residents. (e) The kitchen ohall bo staffed by at least one person for twelve consecutive hours, breakfast through supper. (f) Duty assignments of dietary personnel shall bo posted and shall bo available to staff at all timeo. (g)—Dietary omployooo ohall participate in in servioo education which shall include but not bo limited to thorapou tic diets, food preparation requi rements, and principles of sanitation. Statutory Authority G.S. 13IE- 104. containing a protein food. —(e) Between meal nourishments ohall be availabl e and offered to all patients and residents. (f) If a therapeutic diet requires a specific between moal nourishment, documentation shall aooure the game was served or offered and refused by the patient or resident. (g)—An up to date manual approved by tho diotitian, medical staff, and tho Administrator shall bo used in tho planning of regular and therapoutio diets. (h) Menus ohall be dated and planned at least three weeks in advance for both regular and therapeutic diets.—They shall bo posted in tho kitchen and accessible to kitchen staff- All menus shall be corrected as served and kept on file in the faoility for a minimum of one year from the date served. (i) Food must bo prepared to conserve its nutritive value and appearance. —(j) — Unless medically contra indicated.—foods shall be served at the temperature or temperature range specified in tho diet manual, recipe, or package instructions, and in a consistency and texture to moot individual needs.—Hot food shall be served hot and oold foods served oold and in a consistency to meet individual needs? — If patients or resi dents require assistance in eating, food shall bo maintained at serving temperature until assistance is provided. (k)—Patients' and residents' food preferences must be considered. However, when food is substituted it must be of a similar nutritive value as that for which it i s substituted. Statutory Authority G.S. 13 IE- 104. .1005 FOOD SUPPLIES The following supplies must bo available in tho facility at all times and sufficient to moot nutritional needs of tho pati ents and residents: —(+) non perishable food sufficient for a 3 day period; 10:2 NORTH CAROLINA REGISTER April 17, 1995 74 PROPOSED RULES —(2) perishable food gufficiont for a 24 hour period. Statutory Authority G.S. 131E-104. .1006 RECORDS Tho Adminiotrator shall maintain the following records for at least one year: —(4-) a record of all food and supplies purchases show ing quantities and total cost of all items purchased; —(3) daily meal census (staff as well as pationto and resid ents); and —(3) labor costs for providing dietary services . Statutory Authority G.S. 131E-104. .1007 DINING FACILITIES Patients, including wheelchair patients, shall bo oncour aged to eat at the tables in the dining area and assisted when nooossary by non dietary staff.—An overbod table shall be provided for pationta who oat in bod.—A sturdy tray stand shall bo provided for those patients who oat out of bod but are unable to go to the dining area.—(An overbed table which oan be lowered to ohair height may substitute for the tray stand.) Statutory Authority G.S. 131E-104. .1008 SANITATION (a) Food services shall comply with tho most current rules for sanitation ao promulgated by the Commission for Health Sorvioos. —(b) — All facilities shall maintain a "Grade A" sanitation rating. If tho grade fall s below an "A", the Administrator shall notify' the Department within Ten days.—This notifioa tion shall include a oopy of the sanitation inspect i on report with a plan for corrective action which the facility shall accomplish within 90 days. —(«) — Reports of sanitation inspections and a record of corrective aotion for any defioienoies noted shall be on file in tho dietary Department and maintained for at least two years. (d)—Policies and prooedureo shall be developed and implemented to assure that dishes and utensils from patients with communicable diseases are isolated until sterilized or destroyed. —(e) Cleaning sohedulos and instructions for cleaning bH equipment and work and storage areas shall be posted in the dietary area and accessible to all dietary staff. —(f) Employees with infectious or communicable diseases shall not work in dietary services. (g)—A lioensod faoility must have a written plan for sanitizing dishes, such ao chomioal washing, in case of disasters, or malfunctioning of equipment. Statutory Authority G.S. 13IE- 104. SECTION .1100 - SPECIALLY DESIGNATED UNITS . 1 1 05 REQUIREMENTS FOR SERVICES —Specialized rehabilitative and habilitativ e sorvioos, suoh as physical therapy, occupational therapy and speech therapy, are not required as a condition of licensure.—However, patients requiring ouoh serviced shall not be admitted to nor retained in a faoility unless the faoility is capable of furnish ing tho Doodod sorvioo through faoility staff and equipment or through contractual arrangement.—If physical therapy, occupational therapy, or spoooh therapy are provided: —(4-) A physioian's order for sorvioos shall be recorded in tho patient' s or resident's rooord. —(2) The facility shall provide adequate space and appropriate equipment—for rendering physical therapy or oooupational therapy sorviooo required by patients or residents in tho facility. —(3} Tho sorvioos shall bo superv i sed by a therapist duly licensed or oortifiad to praotioe in the area supervised. —(4) Tho thorapist shall incorporate his notes pertaining to treatment in tho patient' s or resident's medical or health care record. —(£) The therapist's notes shall be available for physi cian review. Statutory Authority G.S. 13IE- 104. . 1 106 QUALITY OF SPECIALIZED REHABILITATION SERVICES (a) While the person supervising specialized rehabilitative and habilitative serv ices shall be a duly lioensed or oortifiod professional thorapist, all other support personnel shall bo trained in tho area of assignment and directly supervised by the therapist in the area of assignment. (b) Servioes provided through outside rosouroeo shall bo carried out through and in accordance with written agree monts. (o)—Sorvioos shall be designed to maintain and improve the patient's or resident's ability to funotion independently, prevent as much as possible tho advancement of progressive disabilities, and restore maximum function. —(d) If nuroing staff oany out selected therapy procedures, th ey shall do so under the supervision of the physical or occupational thorapi st and only after documented training and approval by tho thorapist.—This is not to prohibit simple restorativ e measures by the nursing staff. Statutory Authority G.S. 131E-104. .1107 VENTILATOR DEPENDENCE The general requirements in this Subchapter shall apply when applicable.—In addition, facilities having patients requiring tho use of ventilators for more than eight hours a day must moot the following requirements: —(44 The faoility must bo located within 30 minutes of an acute care facility. —(2) Respiratory therapy shall bo provided and super visod by a respiratory therapist ourrently regis I 75 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES torod by tho National Board for Respiratory Care. The respiratory therapist ohall: —(a) make, ao a minimum, wookly on site assess monta of each patient receiving ventilator sup port with corresponding progress notoo; —(b) be on oall 24 hours daily; and —(e) assist the pulmonologiot and nursing staff in establishing ventilator policies and procedures, including emergency policies and procedures. -(3) Di rect nursing oare staffing shall be in aooordanoe with 10 NCAC 3H . 1 109. Statutory Authority G.S. 131E-104. . 1 108 BRAIN INJURY LONG-TERM CARE —(a) — Tho general requirements in this Subchapter shall apply when applicable, but brain injury long term care units ohall meet the supplement requirements in Rules . 1 108 and .1109 of this Section.—Brain injury long term oare is an interdisciplinary, intensive maintenance program for patients who have incurred brain damage caused by external physical trauma and who have oompleted a primary oouroe of rehabilitative treatment and have rooohed a point of no gain or progress—for more than throe—consecutive—months. Services are provided through a medically—super. 1 i sod interdisciplinary prooooo as provided in Rule .07 1 1 of this subchapter and are direoted toward maintaining the individ ual at tho optimal level of physical, cognitive and behavioral functioning^ — Following are the minimum requirements for speoifio services that may be necessary to maintaining the individual at optimum level: (1) Overall—supervisory—responsibility—for brain injury long term care services shall bo assigned to a registered nurse with one year experience in oaring for brain injured patients. (3) Physical therapy shall bo provided by a physical therapist with a current valid North Carolina licence. Occupational therapy shall bo provided cal nutrition services shall include; -(A) — Assessing the appropriatenooo of the ordered diet for conformance with oaoh patient's phyoi ological and pharmacological condition. -(B) Evaluating oaoh patient's laboratory data-in relation to nutritional status and hydration. Applying—teohnioal—knowledge — -(G)- of feed i ng tubes, pumps and equipment to oaoh patient's specialized needs. -(4) Clinical social work shall be provided by a oooial workor mooting the requirements of Rule .1306 of this Subchapter. -&- Recreation therapy, when required, shall bo provided on either a full time or part time employment or oontract basis by a clinician eligible for certification as a therapeuti c rocro ation specialist by tho State of North Carolina Therapeutio Recreational Certification Board. The number of hours of therapoutio reoreation services shall bo adequate to moot tho needs of tho patients. In event that a qualified specialist is not looally available,—alternate treatment modalitioo ohall be developed by the oooupa t i onal therapist and reviewed by tho attending physician. Tho program dooignod must bo adequate to moot tho needs of this specialized population and must be administered in aooor dance with Section .1200 of this Subchapter. (6) Speech therapy, when required, shall bo pro vided by a clinician with a current valid license in opoooh pathology iooued by tho State Board of Audiology and Speech pathology. (2) Respiratory therapy, when required, shall bo provided by an individual mooting the oumo qualifications for providing respiratory thoropy under Rule . 1 107 of this Section, (b)—Each patient's program shall bo governed by an interdisciplinary treatment plan incorporating and expanding by an occupational therapist with a ourront valid upon tho health plan required under Section .0100 of this North Carolina license.—Tho services of a physical therapist and occupational therapist shall Subchapter.—The plan is to bo initiated on tho first day of admission. Upon completion of baseline data development be oombined to provide one full time equivalent and an integrated interdisciplinary assessment the initial position for oaoh 20 pati ents.—The assistanoe of a physical therapy aide and occupational therapy treatment plan is to be expanded and finalized within-44 days of admission. Through an interdisciplinary process tho aido, with appropriate supervision, shall bo treatment plan shall bo reviewed at least monthly and oombined to provide one full time equivalent position for oaoh 20 pati ents.—A proportionate number of hours shall bo provided for a census loss than 20 patients-revised as appropriate.—In executing tho treatment plan the interd i sciplinary team ohall be the major deoioion making body and shall determine tho goals, process, and time frames for accomplishment of each patient's program. -(3) Clinioal nutrition oorvioos shall bo provided by Diociplineo to be represented on the team ohall be medi cine, a qualified diotioian with two years elinieal-tmining and experience in nutrition.—Tho num bor of hours of clinical nutrition oorvioos on either a full time or part time employment or contract basis shall be adequate to moot tho needs of tho patients.—Each patient's nutrition needs shall bo reviewed at least monthly.—Clini nursing, clinioal pharmacy and all other disciplines d i rectly involved in tho patient's treatment or treatment plan. (c) Each patient's overall program shall be assigned to an individually designated oaoe manager.—The oase manager aoto ao the coordinator for assigned patients.—Any profos sional staff member involved in a patient's oare may bo assigned this responsibility for one or more patients. 10:2 NORTH CAROLINA REGISTER April 17, 1995 76 PROPOSED RULES Professional staff may divide this responsibility for all patients OB the unit in the boot manner to moot all pati ents' noods for a coordinated, interdisciplinary approach to oare. Tbo case managor shall bo responsible for; (4-) coordinating tho dovolopmont, implementation and periodio review of the patient's treatment (3) preparing a monthly summary of tho patient's progress; (3) cultivating—tho patient'o participation—in the program; (4) general supervision of tho pationt during tho course of treatment; (5) evaluating appropriatonooo of tho treatment plan in relation to tho attainment of otnted goals; and (6) assuring that discharge decisions and arrange roonto for post discharge follow up arc properly —-(d) — For eaoh 20 patiento or fraotion thereof, dedicated treatment facilities and equipmoDt shall bo provided as follows: (4) A combined therapy space oqual to or oxoooding 600 square foot, adequately equipped and ar ranged to support each of the therapies; (3) Access to ono full reclining wheelchair per patient. (3) Special phyGioal therapy and occupational thor apy equipment for use in fabricating positioning devices — for bods and wheelchairs—including splints, oastc, oushions, wodgoo, and bolsters. (4) There shall be roll in bath faoilitieo with a dressing area available to all patients which shall afford maximum privacy to tho pationt. Statutory Authority G.S. 13IE-104. . 1 109 SPECIAL NURSING REQUIREMENTS FOR BRAIN INJURY LONG-TERM CARE Direot oare nursing peroonnel staffing ratios established in Section .0500 of this Subchapter shall not bo applied to nursing services—for patients who require brain injury long term oare, due to their more intensive maintenance and nursing needs. The minimum direot oare nursing staff shall bo 5.5 hours per pationt day, allocated on a por shift basis as tho facility chooses, to appropriately moot tho patients' needs.—It iG also roquirod that rogardloGO of how low tho patient census, th e direot care nursing staff shall not fall below a registered nurse and a nurse aide I at any time during a 2 4 hour period. Statutory Authority G.S. 131E-104. .1130 ADMISSIONS TO THE HTV DESIGNATED UNIT If a faoility declines admission to a pationt known to have Human Immunodeficiency Virus disease, tho reasons for tho denial shall bo documented. Statutory Authority G.S. 131E-104. .1131 HIV DESIGNATED UNIT POLICES AND PROCEDURES —(a) In addition to Rule .0314 of this Subchapter, in units dedioatod—te—the — treatment—of patiento—with — Human Immunodofioionoy Virus diooaoo, policies and prooeduroo specific to tho specialized needs of tho patiento served shall bo developed. At a minimum they shall include staff training and education, and the availability of consultation by a physioian with specialized eduoation or knowledge in tho management of Human Immunodoficioncy Virus disease, (b) Policies and procedures for infection control shall bo « — conformance with 29 CFR 1910 (Occupational Safety and Health Standards) whioh is incorporated by reforonoo including subsequent amendments. Emphasis shall be placed on compliance with 29 CFR 1910 1030 (Bloodboumo Pathogens). Copieo of Title 29 Part 1910 may be purchased from the Superintendent of Dooumonto, U.S. Government Printing Office, Washington, D.C. 20402 for $38.00 or may bo purchased with a credit card by telephone to tho Govern ment Printing Offioe at (202) 783 323 8 . Infeotion control shall al so be in compliance with the Center of Disease Control Guidelines as publi shed by tho U.S. Department of Health and Human Sorvicoe, Public Health Sorvioo which is incorporated by referenoe including subsequent aroendmeBter Copies may be purohasod from the National Technical Information Sorvioo, U.S. Department of Commerce, 5285 Port Royal Road, Springfield, Virginia, 22161 for $15.95. Statutory Authority G.S. 131E-104. .1132 PHYSICIAN SERVICES IN A HTV DESIGNATED UNIT In facilities—with a Human Immunode fioi enoy—Virus designated unit, tho facility shall insure that attending physicians have documented, pro arranged aooooo in person or by telephone to a physioian with specialized eduoation or knowledge in the management of Human Immunodofioionoy Virus Disoaoo. Statutory Authority G.S. 13IE-104. . 1 133 SPECIAL NURSING REQUTCEMENTS FOR A HTV DESIGNATED UNIT —(a) — Faoilitieo with a Human Immunodefioienoy Virus designated unit shall have a registered nurse with specialized eduoation or knowledge in tho care of Human Immunodofi cioncy Virus disease. (b) Nursing peroonnel assigned to the Human ImmunGde-fioi enoy Virus unit shall be regularly assigned to the unit. Rotations are acceptable to olloviato staff burnout or staffing emergencies . Statutory Authority G.S. 13 IE-104. .1134 SPECIALIZED STAFF EDUCATION FOR HTV DESIGNATED UNITS 77 NORTH CAROLINA REGISTER April 17, 1995 10:2 PROPOSED RULES For facilitioo with a Human Immunodeficiency Virus dooignatod unit, an organized, dooumonted program of oduoation opooifio to the core of patients infected with the Human Immunodeficiency Virus shall bo provided and include at a minimum: —(4) Human Immunodofioienoy Virus and Acquired Immune Dofioienoy Syndrome diooaoo prooooooo; —(3) transmission modes, oauoos, and prevention of Human Immunodeficiency Virus; —(39 treatment of Human Immunodofioienoy Virus and Aoquired Immune Dofioienoy Syndrome ; —(4) psycho socio economic—needs—&f-—the — Human Immunodeficiency Virus and Acquired Immune Dofioienoy Syndrome patients; —(5} universal precautions and infection oontrol; and —(6} policies and procedures specific to the Human Immunodeficiency Virus designated unit. Statutory Authority G.S. 13IE-104. .1135 USE OF INVESTIGATIONAL DRUGS FOR HTV DESIGNATED UNITS —(a) The supervision and monitoring for the administration of investigational drugs i s the responsibility of the pharma cist and a licensed registered nurse, acting pursuant to the orders of a physioian duly authorized to proscribe or dispense such drugs.—Responsibilities shall include , but not bo limited to, the following! (4) insuring the provision of written guidelines for any investigational drug or study are provided; (3) training and determination of staffs abilities regarding administration—of drugs ,—policies, procedures and regulations. (b) The pharmacist or physioian dispensing the investiga tional drug is to provide the facility with information regarding at least the following! (4) a copy of the protocol, includ i ng drug informa- (2) a copy of the patient's informed consent; (3) drug storage; -(4) handling; (§} ftfiy — speoifio—preparation—and — administration instructions; (6) specific details for drug accountability, rosupply and return of unused drug; and (7) a copy of the signed oonoont to participate in the study. —(e) — Labeling of investigational drugs shall bo in aocor dance with writton guidelines of protocol and State and federal requirements regarding suoh drugs.—Proscription labels for investigational drugs are to bo distinguishable from other labels by an appropriate legend, "Investigational Drug" or "For Investigational Use Only". Statutory Authority G.S. 131E-104. .1136 ADDITIONAL SOCIAL WORK REQUHtEMENTS FOR HTV DESIGNATED UNITS In addition to the social work services specified in Rule .1307 of this Subchapter,—in facilities with a Human Immunodeficiency Virus diooaoo designated—unit, the oooial worker shall provide or arrange for the provision of spiri tual, pastoral and grief counseling and bereavement services for patients and staff whore appropriate.—Support services shall be provided to resident families and significant others. Where neoeooary, coordination with treatment services for substance—abuse,—legal—services—and other community resources shall bo identified. Statutory Authority G.S. 13 IE-104. .1150 DEFINITIONS The following definitions shall apply to inpatient rohabili tat ion facilities or units only: —(4) "Case management" moans the coordination of services, for a given patient, between di sciplines so that the patient may reaoh optimal rehabilitation through the judicious use of rooourooo. —(2) "Comprehensive, inpatient rehabilitation program" moans a program for the treatment of persons with functional limitations or ohronio disabling oondi tiono who have the potential to achieve a signifi cant improvement in activities of daily living:— A comprehensive, rehabilitation program utilizes a ooordinated—and — integrated,—interdisciplinary approaoh, directed by a physioian, to assess patient needs and to provide treatment and ovalua tion of physical,—psycho social—and cognitive deficits. —(3) "Inpatient rehabilitation faoility or unit" means a free standing facility or a unit (unit pertains to contiguous dedicated bods and spaces) within an existing lioonood health sorvioo faoility approved in accordance with G.S. 13 IE, Article 9 to establish inpatient, rehabilitation bods and to provide a comprehensive, inpatient rehabilitation program. —(4) "Medioal consultations" moans consultations whioh the rehabilitation physioian or the attending physi cian determine are necessary to moot tho acute medical needs of the patient and do not include routine modioal needs. —(5) "Occupational therapist" means any individual licensed in tho State of North Carolina as an occupational—therapist in accordance with tho provisions of G.S. 90, Artiole 1 8D. —(6) "Occupational—therapist—assistant"—means—any individual licensed in tho State of North Carolina as an occupational therapist assistant in accordance-with the provisions of G.S. 90, Artiole 1 8D. "Psychologist" means a person licensed as a practicing psychologist in accordance with G.S. 90, Article 1 8A. -(74- 10:2 NORTH CAROLINA REGISTER April 17, 1995 78 PROPOSED RULES -W-m-iW- -w- -QZh <m- -tf4)- "Phyoiatri et" means a licensed physician who has oomplotod a physioal medioine and rehabilitation residency—training—program—approved—by—the Accroditing Council of Graduate Modioal Educa tion of tho American Osteopathic AsBociation. "Physical therapist" means any person lioenoed in the State of North Carolina as a phyoioal therapist in accordance with tho provisions of G.S. 90, Article 18B. "Phyoioal therapist assistant" means any person lioonoed in the State of North Carolina ao a phyoi cal therapist assistant in accordance with the provisions of G.S. 90 270.24 , Article 1 8 B. "Rooroationol therapist" moans a person oertifi ed by the State of North Carolina Therapeutio Reore ational Certification Board. "Rehabilitation nurse" moans a registered nurse licensed in North Carolina, with training, eithef aoademio or on the job, in phyoioal rehabilitatio
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Title | North Carolina register |
Date | 1995-04-17 |
Description | Vol. 10, issue 2 (April 17, 1995) |
Publisher | Raleigh, N.C. : Office of Administrative Hearings |
Digital Characteristics-A | 148 p.; 11.72 MB |
Digital Format | application/pdf |
Pres File Name-M | pubs_serial_ncregister19950417.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_serial_ncregister\images_master |
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NORTH CAROLINA
REGISTER
VOLUME 10 • ISSUE 2 • Pages 54 -190
April 17, 1995
IN THIS ISSUE
Executive Orders
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List of Rules Codified
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APR 20 1995
KATHRINE R EYERETT
LAW LIBRARY
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INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE CODE
NORTH CAROLINA REGISTER
The North Carolina Register is published twice a month and
contains information relating to agency, executive, legislative and
ludicial actions required by or affecting Chapter 150B of the
General Statutes. All proposed administrative rules and notices of
public hearings filed under G.S. 150B-21.2 must be published in
the Register. The Register will typically comprise approximately
fifty pages per issue of legal text.
State law requires that a copy of each issue be provided free of
charge to each county in the state and to various state officials and
institutions.
The North Carolina Register is available by yearly subscription
at a cost of one hundred and twenty dollars ($120.00) for 24
issues. Individual issues may be purchased for ten dollars
($10.00).
Requests for subscription to the North Carolina Register should
be directed to the Office of Administrative Hearings, PO Drawer
27447, Raleigh, NC 27611-7447.
ADOPTION, AMENDMENT, AND REPEAL OF RULES
The following is a generalized statement of the procedures to be
followed for an agency to adopt, amend, or repeal a rule. For the
specific statutory authority, please consult Article 2A of Chapter
150B of the General Statutes.
Any agency intending to adopt, amend, or repeal a rule must
first publish notice of the proposed action in the North Carolina
Register. The notice must include the time and place of the public
hearing (or instructions on how a member of the public may
request a hearing); a statement of procedure for public comments;
the text of the proposed rule or the statement of subject matter; the
reason for the proposed action; a reference to the statutory
authority for the action and the proposed effective date.
Unless a specific statute provides otherwise, at least 15 days
must elapse following publication of the notice in the North
Carolina Register before the agency may conduct the public
hearing and at least 30 days must elapse before the agency can take
action on the proposed rule. An agency may not adopt a rule that
differs substantially from the proposed form published as part of
the public notice, until the adopted version has been published in
the North Carolina Register for an additional 30 day comment
period.
When final action is taken, the promulgating agency must file the
rule with the Rules Review Commission (RRC). After approval
by RRC, the adopted rule is filed with the Office of Administrative
Hearings (OAH).
A rule or amended rule generally becomes effective 5 business
days after the rule is filed with the Office of Administrative
Hearings for publication in the North Carolina Administrative
Code (NCAC).
Proposed action on rules may be withdrawn by the promulgating
agency at any time before final action is taken by the agency or
before filing with OAH for publication in the NCAC.
TEMPORARY RULES
Under certain emergency conditions, agencies may issue
temporary rules. Within 24 hours of submission to OAH, the
Codifier of Rules must review the agency's written statement of
findings of need for the temporary rule pursuant to the provisions
in G.S. 150B-21.1. If the Codifier determines that the findings
meet the criteria in G.S. 150B-21.1, the rule is entered into the
NCAC. If the Codifier determines that the findings do not meet
the criteria, the rule is returned to the agency. The agency may
supplement its findings and resubmit the temporary rule for an
additional review or the agency may respond that it will remain
with its initial position. The Codifier, thereafter, will enter the
rule into the NCAC. A temporary rule becomes effective either
when the Codifier of Rules enters the rule in the Code or on the
sixth business day after the agency resubmits the rule without
change. The temporary rule is in effect for the period specified in
the rule or 180 days, whichever is less. An agency adopting a
temporary rule must begin rule-making procedures on the
permanent rule at the same time the temporary rule is filed with
the Codifier.
NORTH CAROLINA ADMINISTRATIVE CODE
The North Carolina Administrative Code (NCAC) is a
compilation and index of the administrative rules of 25 state
agencies and 40 occupational licensing boards. Compilation and
publication of the NCAC is mandated by G.S. 150B-21.18.
The Code is divided into Tides and Chapters. Each state agency
is assigned a separate title which is further broken down by
chapters. Title 21 is designated for occupational licensing boards.
The NCAC is available in two formats.
(1) Single pages may be obtained at a minimum cost of
two dollars and 50 cents ($2.50) for 10 pages or less,
plus fifteen cents ($0.15) per each additional page.
Requests for pages of rules or volumes of the NCAC
should be directed to the Office of Administrative
Hearings.
(2) The full publication and supplement service is printed
and distributed by Barclays Law Publishers. It is
available in hardcopy, CD-ROM and diskette format.
For subscription information, call 1-800-888-3600.
CITATION TO THE NORTH CAROLINA REGISTER
The North Carolina Register is cited by volume, issue, page
number and date. 10:01 NCR 1-67, April 3, 1995 refers to
Volume 10, Issue 1, pages 1 through 67 of the North Carolina
Register issued on April 3, 1995.
t
FOR INFORMATION CONTACT: Office of Administrative Hearings, ATTN: Rules Division, PO Drawer 27447, Raleigh,
NC 27611-7447, (919) 733-2678, FAX (919) 733-3462.
•
NORTH CAROLINA IN THIS ISSUE
I. EXECUTIVE ORDERS
Executive Orders 73-74 .
•
Volume 1 O, Issue 2
Pages 54 - 190
April 17, 1995
This issue contains documents officially
filed through March 31, 1995.
n. IN ADDITION
NPDES Permit
Wildlife Resources Commission Proclamation
54- 55
56
57
Office of Administrative Hearings
Rules Division
424 North Blount Street (27601)
PO Drawer 27447
Raleigh, NC 27611-7447
(919) 733-2678
FAX (919) 733-3462
Julian Mann III, Director
James R. Scarcella St., Deputy Director
Molly Masich, Director of APA Services
Ruby Creech, Publications Coordinator
Teresa Kilpatrick, Editorial Assistant
Jean Shirley, Editorial Assistant
HI. PROPOSED RULES
Environment, Health, and Natural Resources
Sedimentation Control Commission 149 - 150
Human Resources
Medical Assistance 118- 122
Medical Care Commission 58-118
Mental Health, Developmental Disabilities and
Substance Abuse Services 118
Justice
Departmental Rules 122 - 142
Labor
Job Listing Services Act 149
Migrant Housing Act of NC 1 49
Retaliatory Employment Discrimination Act 149
Wage and Hour 142-149
Licensing Boards
Acupuncture Licensing Board 150- 151
Medical Examiners 151 - 157
Real Estate Commission 157 - 166
IV. LIST OF RULES CODIFIED 167-169
V. RRC OBJECTIONS 170
VI. CONTESTED CASE DECISIONS
Index to ALJ Decisions 171 - 175
Text of Selected Decisions
94 CPS 0237 176-178
94 EDC 0533 179-184
95 EHR 0140 185-186
VH. CUMULATIVE INDEX 188-190
NORTH CAROLINA REGISTER
Publication Schedule
(November 1994 - September 1995)
Volume
and
Issue
Number
Issue
Date
Last Day
for
Filing
Last Day
for Elec-tronic
Filing
Earliest
Date for
Public
Hearing
15 days
from
notice
* End of
Required
Comment
Period
30 days
from
notice
Last Day
to Submit
toRRC
** Earliest
Effective
Date
9:15 11/01/94 10/11/94 10/18/94 11/16/94 12/01/94 12/20/94 02/01/95
9:16 11/15/94 10/24/94 10/31/94 11/30/94 12/15/94 12/20/94 02/01/95
9:17 12/01/94 11/07/94 11/15/94 12/16/94 01/03/95 01/20/95 03/01/95
9:18 12/15/94 11/22/94 12/01/94 12/30/94 01/17/95 01/20/95 03/01/95
9:19 01/03/95 12/08/94 12/15/94 01/18/95 02/02/95 02/20/95 04/01/95
9:20 01/17/95 12/21/94 12/30/94 02/01/95 02/16/95 02/20/95 04/01/95
9:21 02/01/95 01/10/95 01/18/95 02/16/95 03/03/95 03/20/95 05/01/95
9:22 02/15/95 01/25/95 02/01/95 03/02/95 03/17/95 03/20/95 05/01/95
9:23 03/01/95 02/08/95 02/15/95 03/16/95 03/31/95 04/20/95 06/01/95
9:24 03/15/95 02/22/95 03/01/95 03/30/95 04/17/95 04/20/95 06/01/95
10:1 04/03/95 03/13/95 03/20/95 04/18/95 05/03/95 05/22/95 07/01/95
10:2 04/17/95 03/24/95 03/31/95 05/02/95 05/17/95 05/22/95 07/01/95
10:3 05/01/95 04/07/95 04/17/95 05/16/95 05/31/95 06/20/95 08/01/95
10:4 05/15/95 04/24/95 05/01/95 05/30/95 06/14/95 06/20/95 08/01/95
10:5 06/01/95 05/10/95 05/17/95 06/16/95 07/03/95 07/20/95 09/01/95
10:6 06/15/95 05/24/95 06/01/95 06/30/95 07/17/95 07/20/95 09/01/95
10:7 07/03/95 06/12/95 06/19/95 07/18/95 08/02/95 08/21/95 10/01/95
10:8 07/14/95 06/22/95 06/29/95 07/31/95 08/14/95 08/21/95 10/01/95
10:9 08/01/95 07/11/95 07/18/95 08/16/95 08/31/95 09/20/95 11/01/95
10:10 08/15/95 07/25/95 08/01/95 08/30/95 09/14/95 09/20/95 11/01/95
10:11 09/01/95 08/11/95 08/18/95 09/18/95 10/02/95 10/20/95 12/01/95
10:12 09/15/95 08/24/95 08/31/95 10/02/95 10/16/95 10/20/95 12/01/95
This table is published as a public service, and the computation of time periods are not to be deemed binding
or controlling. Time is computed according to 26 NCAC 2B . 0103 and the Rules of Civil Procedure, Rule 6.
* An agency must accept comments for at least 30 days after the proposed text is published or until the date
of any public hearing, whichever is longer. See G.S. 150B-21.2(f) for adoption procedures.
** The "Earliest Effective Date" is computed assuming that the agency follows the publication schedule above,
that the Rules Review Commission approves the rule at the next calendar month meeting after submission, and
that RRC delivers the rule to the Codifier of Rules five (5) business days before the 1st day of the next calendar
month.
Revised 10/94
EXECUTIVE ORDERS
EXECUTIVE ORDER NO. 73
SUSPENSION OF RULES
DURING LOCAL EMERGENCIES
WHEREAS, electric service is one of the most essential
services required by modern society, and the public welfare
is immediately threatened by any occurrences, natural or
manmade, which interrupt the delivery of electricity and
electrical services; and
WHEREAS, state and federal regulations prohibit electric
supplier vehicles and commercial motor vehicle drivers from
working extended hours to assist in the repair of damage
and restoration of the delivery of electricity and electrical
services; and
WHEREAS, federal law, specifically 49 C.F.R. Section
390.23, allows a Governor to suspend these rules and
regulations if the Governor determines that an emergency
condition exists.
NOW, THEREFORE, by the authority vested in me as
Governor by the laws and Constitution of the State of North
Carolina, IT IS ORDERED:
Section 1.
Electric supplier vehicles and commercial motor vehicle
drivers are exempt from the rules and regulations restricting
their participation in emergency relief efforts during a "local
emergency." A "local emergency" shall be considered to
be any power outage or interruption of electric service that
occurs within the State of North Carolina, including a near
term threat or occurrence of a meteorological condition or
other condition reasonably likely to result in power outages
or electric service interruption. A "local emergency" begins
when the affected electric supplier receives notice of the
power outage or interruption of electric service or receives
notice of the existence of conditions reasonably likely to
result in power outages or electric service interruption. The
"local emergency" continues until the necessary maintenance
or repair work is completed and personnel utilized to
perform necessary maintenance or repair work have returned
to their respective normal work routines.
This Executive Order is effective immediately.
Done in the City of Raleigh this the 15th day of March,
1995.
EXECUTIVE ORDER NO. 74
DESIGNATING THE YEAR OF THE
MOUNTAINS AND CREATING THE YEAR
OF THE MOUNTAINS COMMISSION
WHEREAS, North Carolina's mountains are among the
state's most valuable and unique assets; and
WHEREAS, North Carolina's mountains merit widespread
appreciation and understanding; and
WHEREAS, growth and change have brought new sets of
opportunities and challenges to people of the mountains; and
WHEREAS, regional efforts and partnerships with the
State are needed to address challenges facing mountain
communities today and in the future; and
WHEREAS, new initiatives for Western North Carolina
can honor and share the culture and history of the mountains
and enhance respect for the natural beauty and environment
of the region while fostering quality growth and develop-ment;
and
WHEREAS, the people of North Carolina's mountains are
pursuing a new vision for the mountains that integrates the
needs of young people, education, technology, industry, and
recreation while protecting the region's resources and
quality of life; and
WHEREAS, the people of North Carolina's mountains
seek to enhance Regional Identity and Recognition, to
cultivate Sustainable Communities, and to promote and
support Mountain Stewardship.
NOW, THEREFORE, by the power vested in me as
Governor by the Constitution and laws of North Carolina,
IT IS ORDERED:
Section 1. Year of the Mountains.
The Year of the Mountains is hereby designated July 1
,
1995 through June 30, 1996.
Section 2^ Establishment.
The Year of the Mountains Commission is hereby estab-lished.
Section 3. Membership and Terms.
The Governor shall appoint 15 persons to serve on the
Commission and shall designate one of its members to serve
as Chair. The Commission shall meet regularly to carry out
its duties at the call of the Chair.
Section 4. Powers and Duties of the Commission.
A. To develop a set of recommendations to effectuate
the purposes of this Order through such activities
as meetings, fact-finding tours, educational events,
and reports.
B. To focus statewide media and public attention on
the mountains to enhance quality growth and
development, protect the natural beauty, and
preserve the culture of the region.
C. To coordinate its efforts with local officials and to
help promote mountain events.
D. To perform and exercise such other duties and
10:2 NORTH CAROLINA REGISTER April 17, 1995 54
EXECUTIVE ORDERS
powers as may be necessary to accomplish the
purposes of this Executive Order.
Section 5^. Administration.
The Governor shall designate an Executive Coordinator to
provide professional assistance and background information
to the Commission, and coordinate its activities. The
Executive Coordinator shall maintain the official minutes
and other records of the Commission, and shall work in
partnership with local and state governmental agencies, the
community college and university system, and the private
nonprofit sector to furnish additional staff assistance,
educational and research materials, and any other adminis-trative
support which the Commission may require.
The Executive Coordinator shall report directly to the
Commission and shall carry out its goals as set forth in the
Commission's mission statement. Members of the Commis-sion
shall receive necessary travel and subsistence expenses
pursuant to N.C.G.S. 138-5. Funding for the Executive
Coordinator and the Commission shall be provided by
DEHNR, the Department of Commerce, the Department of
Cultural Resources, and monies appropriated by the General
Assembly.
The Commission is authorized to accept donations of in-kind
services and funds, subject to the Executive Budget
Act. Western North Carolina Tomorrow (WNCT), a
501(c)(3) nonprofit, has agreed to administer the funds,
including those previously appropriated to it by the General
Assembly.
The Commission shall be considered a "public body" and
its meetings shall be open to the public pursuant to General
Statutes Chapter 143, Article 33C. The Commission, for
administrative purposes only, shall be located in the
Governor's Office.
This Executive Order shall be effective immediately and
expire June 30, 1996.
Done in the Capital City of Raleigh, North Carolina, this
the 27th day of March, 1995.
<
I
i
55 NORTH CAROLINA REGISTER April 17, 1995 10:2
IN ADDITION
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
PUBLIC NOTICE OF INTENT TO ISSUE STATE GENERAL NPDES PERMITS
Public notice of intent to modify State National Pollutant Discharge Elimination System (NPDES) General Permits for Point
Source Discharges of Stormwater associated with the application requirements and clarifications of the visual monitoring
requirements in :
NPDES No. NCGO10000 governing the discharge of stormwater associated with construction activities including clearing,
grading and excavation activities resulting in the disturbance land areas.
On the basis of preliminary staff review and application of Article 21 of Chapter 143 of the General Statutes of North
Carolina, Public Law 92-500 and other lawful standards and regulations, the North Carolina Environmental Management
Commission proposes to modify State NPDES General Permits for the discharges as described above.
INFORMATION: Copies of the draft NPDES General Permits and Fact Sheets concerning the draft Permits are available
by writing or calling:
Bill Mills
Water Quality Section
N.C. Division of Environmental Management
P.O. Box 29535
Raleigh, North Carolina 27626-0535
Telephone (919) 733-5083 ext. 548
Persons wishing to comment upon or object to the proposed determinations are invited to submit their comments in writing
to the above address no later than May 26. 1995 . All comments received prior to that date will be considered in the final
determination regarding permit issuance. A public meeting may be held where the Director of the Division of Environmental
Management finds a significant degree of public interest in any proposed permit issuance.
The draft Permits, Fact Sheets and other information are on file at the Division of Environmental Management, 512 N.
Salisbury Street, Room 925-C, Archdale Building, Raleigh, North Carolina. They may be inspected during normal office
hours. Copies of the information of file are available upon request and payment of the costs of reproduction. All such
comments and requests regarding these matters should make reference to the draft Permit Number, NCG010000.
Date: March 29, 1995
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
10:2 NORTH CAROLINA REGISTER April 17, 1995 56
IN ADDITION
North Carolina Wildlife Resources Commission
512 N. Salisbury Street, Raleigh, North Carolina 27604-1188, 919-733-3391
Charles R. Fullwood, Executive Director
PROCLAMATION
Charles R. Fullwood, Executive Director, North Carolina Wildlife Resources Commission, acting pursuant to North
Carolina General Statute §113-292 (cl) and authority duly delegated by the Wildlife Resources Commission, hereby declares
that the season for harvesting striped bass by hook-and-line shall close in all waters of the Roanoke River Striped Bass
Management Area downstream of the Edwards Ferry Boating Access Area at US 258 bridge on the Roanoke River in Halifax
County at 12:00 midnight on Sunday April 9, 1995.
In the Roanoke River and its tributaries upstream of the Edwards Ferry Boating Access Area at US 258 bridge
striped bass may be harvested from 12:01 a.m. on Saturdays through 12:00 midnight on Sundays, and from 12:01 a.m.
through 12:00 midnight on Wednesdays. On all other days all striped bass caught, regardless of condition, shall be
immediately returned to the waters where taken and no striped bass may be possessed.
The Roanoke River Striped Bass Management Area is defined as the inland and joint fishing waters of the Roanoke
River and its tributaries, extending from its mouth to Roanoke Rapids Dam, including the Cashie, Middle, and Eastmost
rivers and their tributaries.
This proclamation shall be effective at 12:00 midnight on April 9, 1995 and shall remain in effect until a new
proclamation closing described waters or portions thereof for striped bass fishing is issued.
This proclamation supercedes and replaces all prior proclamations.
NOTES:
a) This Proclamation is issued under the authority of N.C.G.S. §§113-132; 113-134; 113-292; 113-304; and
113-305.
b) All striped bass regardless of condition caught during the closed season shall be immediately returned to
the waters where taken and no striped bass may be possessed.
c) Any person who violates this Proclamation also violates applicable law and is subject to the sanctions
provided by law.
NORTH CAROLINA WILDLIFE RESOURCES COMMISSION
By: Charles R. Fullwood
Executive Director
Date: 4/3/95
57 NORTH CAROLINA REGISTER April 17, 1995 10:2
PROPOSED RULES
TITLE 10 - DEPARTMENT OF
HUMAN RESOURCES
Notice is hereby given in accordance with G.S.
150B-21.2 that the NC Medical Care Commission
intends to repeal rules cited as 10 NCAC 3H .0108 - .0109,
.0206 -.0220, .0306- .0318, .0407 - .0409, .0505 - .0507,
.0510 - .0517, .0605 - .0609, .0705 - .0712, .0810 - .0812,
.0903 - .0911, .1003 - .1008, .1105 - .1109, .1130 - .1136,
.1150 -.1163, .1204- .1208, .1210, .1306- .1308, .1405
- .1406, .1408- .1410, .1501 - .1503, .1612 - .1613, .1703
- .1704, . 1804 - . 1807; and adopt rules cited as 10 NCAC
3H .2001, .2101 - .2110, .2201 - .2212, .2301 - .2308,
.2401 - .2402, .2501 - .2506, .2601 - .2607, .2701, .2801
- .2802, .2901 - .2902, .3001 - .3005, .3011 - .3016, .3021
- .3032, .3101 - .3104, .3201 - .3202, .3301 - .3302, .3401
- .3404.
Proposed Effective Date: September 1, 1995.
A Public Hearing will be conducted at 9:30 a. m. on June
9, 1995 at the Council Building, Room 201, 701 Barbour
Drive, Raleigh, NC.
Reason for Proposed Action: To update state regulations
for nursing homes to be compatible with federal regulations.
Comment Procedures: In order to allow the Commission
sufficient time to review and evaluate your written comments
prior to the hearing, please submit your comments to Mr.
Jackie Sheppard, APA Coordinator, DFS, P. O. Box 29530,
Raleigh, NC 27626-0530, telephone (919) 733-2342 by May
31, 1995, but in no case later than the hearing on June 9,
1995.
Fiscal Note: These Rules do not affect the expenditures or
revenues of local government or state funds.
CHAPTER 3 - DIVISION OF FACILITY
SERVICES
SUBCHAPTER 3H - RULES FOR THE
LICENSING OF NURSING HOMES
SECTION .0100 - GENERAL INFORMATION
.0108 DEFINITIONS
The following definitions will apply throughout this
Subohaptor:
~m "Abuse" moans the willful infliction of physical
pain, injury, mental anguish or unreasonable
confinement whioh may oauoo or result in tempo
rnry or permanent mental or physioal injury, pain,
harm, or death.—Abuse includes, but is not limited
to, the following!
(ft) Verbal abuse—any use of oral, written or gos
-&-
-(e)-
-(d)-
-(e)-
-O)-
-m-
-w-
-&-
-m-
&-
-(*>-
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language whioh a reasonable person would
view as disparaging and derogatory tormo to a
patient rogardlooo of his or her ago, ability to
comprehend or disability;
Sexual abuse—sexual harassment, sexual coor
oion or sexual assault of a patient;
Physioal abuse
—
hitting, clapping, kicking or
corporal punishment of a patient;
Mental abuse language or treatment which
would be viewed by a reasonable person as
involving humiliation, harassment, threats of
punishment or deprivation of a patient; —Unreasonable confinement—the separation of a
patient from other persons, or from hio or her
room, against the patient's will or the will of the
patient's legal representative. Unreasonable
confinement does not include emergency—e*
short term monitored separation used as them
poutio intervention to reduoe agitation until a
plan of care is developed to moot the patient's
needs.
"Accident" moans an unplanned or unwanted event
resulting in the injury or wounding, no matter how
slight, of a patient or other individual.
"Adequate"—moans,—when applied—to various
servioos, that the sorvioos are at least satisfactory
in mooting a referred to need when moaaured
against contemporary professional standards of
practice.
"Administrator" means the person who has author
ity for and is responsible for the overall operation
of a facility.
"Appropriate" moans right for the specified use or
purpose, suitable or proper when used as an
adj ective.—When used as a transitive verb it moans
to sot aside for some specified exclusive use.
"Brain injury long term care" is defined as an
interdisc i plinary, intensive maintenance program
for patients who have incurred brain damage
caused by external physical trauma and who have
completed—a primary—course of rehabilitative
treatment and have reaohod a point of no gain or
progress for more than three consecuti ve months.
Services are provided through a medically super
vised interdisciplinary process and are directed
toward maintaining the individual at the optimal
level of physioal, oognitive and behavioral funo
tions .
"Capacity" moans the maximum number of patient
or resident beds for whioh the faoility is licensed
to maintain at any given time.—
"Combination facility" moans a combination home
as defined in G.S. 13 IE 101.
Convalescent care"—means oaro givon for the
purpose of assisting the patient or resident to
regain health or strength.
-(40) "Department" means the North Carolina Depart
10:2 NORTH CAROLINA REGISTER April 17, 1995 58
PROPOSED RULES
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