•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
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"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