Ala. Admin. Code ch. 420-5-10

Nursing Facilities

This chapter establishes comprehensive licensing and operating standards for nursing facilities in Alabama, covering administrative procedures, staffing qualifications, resident rights, clinical records, quality assurance, and physical plant requirements. Facility operators must obtain and maintain a license from the Alabama State Board of Health, comply with all applicable federal and state laws, employ qualified and properly credentialed staff, and maintain detailed clinical records for each resident. The rules also address nurse aide training and registry requirements, disaster preparedness, transfer agreements with hospitals, and quality assessment and assurance committees.

ALABAMA STATE COMMITTEE OF PUBLIC HEALTHDIVISION OF LICENSURE AND CERTIFICATIONADMINISTRATIVE CODE 
CHAPTER 420-5-10NURSING FACILITIES
TABLE OF CONTENTS
420-5-10-.01 Definitions420-5-10-.02 Licensing And Administrative Procedures420-5-10-.03 Administrative Managment420-5-10-.04 Personnel420-5-10-.05 Resident Rights420-5-10-.06 Admission, Transfer, Transport AndDischarge Rights420-5-10-.07 Resident Behavior And Facility Practices420-5-10-.08 Quality Of Life420-5-10-.09 Resident Assessment420-5-10-.10 Quality Of Care420-5-10-.11 Nursing Services420-5-10-.12 Dietary Services420-5-10-.13 Physician Services420-5-10-.14 Specialized Rehabilitative Services420-5-10-.15 Dental Services420-5-10-.16 Pharmacy Services420-5-10-.17 Infection Control420-5-10-.18 Physical Plant
420-5-10-.01 Definitions.
(1) Definitions - (a list of selected terms often used inconnection with these rules):
(a) "AAC Rule" - Alabama Administrative Code Rule.
(b) "These Rules" - Rules 420-5-10-.01 through 420-5-10-.11,Chapter 420-5-10, Nursing Facilities, Alabama AdministrativeCode.
(c) "Accredited Medical Record Technician (ART)" - A persontrained in record maintenance and preservation, and accreditedby the American Health Information Management Association.
(d) "Administrator" - A person who holds a valid AlabamaNursing Home Administrator's license who is delegated theresponsibility and authority for the interpretation,implementation, and proper application of policies andprograms established by the governing authority. The
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Administrator is delegated responsibility for theestablishment of safe and effective administrative management,control and operation of the services provided.
(e) "Advisory Board" - See Section 22-21-27 of Appendix A.
(f) "Applicant" - The person, partnership, corporation,association, city, county, or other organization legallyresponsible for operation of the facility.
(g) "Assisted Living Facility" - A facility as defined in theRules of Alabama State Board of Health, Division of Licensureand Certification, Chapter 420-5-4.
(h) "Board or State Board of Health" - The Alabama State Boardof Health.
(i) "Combination Facility" - A facility which provides morethan one level of care and is licensed under one license,e.g., general hospital and skilled nursing facility, skillednursing facility and assisted living facility.
(j) "Communicable" - Conditions that are capable of beingtransmitted from one person to another. For reportingpurposes, nursing facilities shall refer to the NotifiableDisease Case Report, Alabama Department of Public Health, FormADPH-EPI-22/Rev. 1-88 (exception AIDS).
(k) "Dentist" - A person currently licensed to practicedentistry in Alabama under the provisions of current statestatutes.
(l) "Director of Food Services/Dietary Manager" - A who is afull-time employee, and if not a qualified dietitian, is onewho: (1) is a graduate of a dietary manager's trainingprogram, approved by the Dietary Manager's Association, or (2)is a graduate of a dietetic technician program approved by theAmerican Dietetic Association, or (3) is a graduate from acollege or university who has received a B.S. degree in thefield of dietetics, food and nutrition or food servicemanagement which included course work in diet therapy andquantity food production.
(m) "Duly Licensed and/or Registered" - The person to whom theterm is applied is duly licensed and/or registered by theproper authority to follow his or her profession within theState of Alabama, and when applied to an institution, shallmean that the institution is duly licensed by the State Boardof Health.
(n) "Governing Authority" - Owner(s), hospital association,county hospital board, board of directors, board of trustees,or any other comparable designation of an individual or group
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of individuals who have the purpose of owning, acquiring,constructing, equipping, operating, and/or maintaining anursing facility and exercising control over the affairs ofsaid nursing facility.
(o) "Hospital" - A facility as defined in the Rules of AlabamaState Board of Health, Division of Licensure andCertification, Chapter 420-5-7.
(p) "Independent Clinical Laboratory" - A facility as definedin the Rules of Alabama State Board of Health, Division ofLicensure and Certification, Chapter 420-5-8.
(q) "License" - The document issued by the State Board ofHealth and signed by the State Health Officer. The licenseshall constitute the authority to receive residents andperform the services included within the scope of theapplicable rules. The license shall be posted in a conspicuousplace on the premises.
(r) "Licensed Practical Nurse" - A person currently licensedin the State of Alabama in accordance with the Code ofAlabama.
(s) "Licensee" - The individual owner, partnership,corporation, association, city, county or other organizationto whom the license is issued and upon whom rests theresponsibility for compliance with these rules.
(t) "Long Term Care" - Prolonged care of residents in licensedinstitutions and/or organized departments within a licensedinstitution where the average length of resident stay is 25days or longer.
(u) "May" indicates permission.
(v) "Medical Laboratory Technician" - A person who meets atleast one of the following requirements:
(i) Successful completion of two years of academic study(a minimum of 60 semester hours or equivalent) in anaccredited college or university with an associate degreein Medical Technology, or four years of academic studywith a bachelor degree in Medical Technology; or
(ii) Graduation from high school and, subsequent tograduation, has had two years of documented experience asa technician trainee in a clinical laboratory of ahospital, a health department, a university, or a medicalresearch institution or in a clinical laboratoryproviding equivalent training accepted by the State Boardof Health as defined under "Independent ClinicalLaboratory" (420-5-10-.01 (1)(p); or
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(iii) Graduation from high school and successfulcompletion of an official military laboratory procedurescourse of at least twelve calendar months of study andhas had at least one year of experience as a techniciantrainee in a clinical laboratory of a hospital, a healthdepartment, a university, or a medical researchinstitution or in a clinical laboratory providingequivalent training accepted by the State Board ofHealth.
(iv) Achieve a satisfactory grade on a proficiencyexamination for technologists approved by the UnitedStates Secretary of Health and Human Services.
(w) "Medical Staff" - Licensed physicians, osteopaths anddentists who are privileged by agreement with the licensee toattend to residents within the institution.
(x) "Medication" - All substances having medicinal propertiesintended for external and/or internal use for the treatment,prevention, diagnosing or curing of any disease, illness,malady, etc., in humans. The term "medication" as defined inthe Pharmacological Basis of Therapeutics and shall encompassall other synonymous terms such as drugs, biologicals,chemicals, potions, remedies, or poisons.
(y) "Medicine or Drug Room" - A specific area, not subject tolicensure by the Alabama State Board of Pharmacy, in alicensed nursing facility, used for the purpose of storingand/or preparing medications for administration and equipmentnecessary to administer medications to the residents of thatfacility.
(z) “Nurse Aide" - Any individual providing nursing relatedservices to residents in a facility who is not a licensedhealth professional, a registered dietitian, or someone whovolunteers to provide such services without pay.
(aa) “Nursing Facility” – A business entity that is engaged inproviding housing, meals and care to sick or disabledindividuals who require, on a daily basis or more frequently,medical care, nursing care, or rehabilitation services. Thisdefinition shall not include any business, operation, orfacility that is exempt from licensure pursuant to Alabamalaw, nor shall it include any business, operation, or facilitythat is (1) licensed by the Alabama State Board of Health asanother kind of facility, and (2) functioning within the scopeof applicable law and administrative rules.
(bb) "Owner" - The person, partnership, corporation,association, city, county, or other entity who through assetownership, lease or sublease is entitled to responsibility forand control of operation of the facility.
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(cc) "Resident Activities Consultant" - A person who:
(i) Is registered or meets requirements for registrationas a professional level Therapeutic Recreation Specialistby the National Recreation and Park Association; or
(ii) Is a qualified occupational therapist oroccupational therapy assistant; or
(iii) Has two years of experience in a social orrecreations program within the past five years, one yearof which was full time in a resident activities programin a health care setting.
(dd) "Resident Activities Coordinator" - A person who isregistered or meets the requirements for a resident activitiesconsultant or a person who serves under the supervision of aqualified resident activities consultant or has the equivalentof two years of full-time experience, under the supervision ofa qualified resident activities consultant.
(ee) "Pharmacist" - A person currently licensed to practicepharmacy in Alabama under the provisions contained in currentstate statutes and rules of the Alabama State Board ofPharmacy.
(ff) "Pharmacist Consultant" - A person currently licensed andregistered by the Alabama State Board of Pharmacy to provideconsultative services as defined by current state statutes andrules of the Alabama State Board of Pharmacy.
(gg) "Pharmacy" - A place licensed by the Alabama State Boardof Pharmacy in which prescriptions, drugs, medicines,chemicals, and poisons are sold, offered for sale, compoundedor dispensed, and shall include all places whose title mayimply the sale, offering for sale, compounding or dispensingof prescription drugs, medicines, chemicals, or poisons or thestorage of such items.
(hh) "Physician" - A person currently licensed to practicemedicine and/or surgery in Alabama under the provisionscontained in current state statutes.
(ii) "Qualified Dietetic Consultant" - A person who iseligible for registration by the Commission on DieteticRegistration (CDR), has at least one year of full-timeexperience in the dietetic service of a health careinstitution in a supervisory capacity, or has satisfactorilycompleted the test for registration administered by CDR andmeets the annual requirements in continuing education requiredby CDR.
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(jj) "Qualified Dietitian" – A person currently licensed inthe State of Alabama in accordance with the provisionscontained in current state statutes as governed by the AlabamaBoard of Examiners for Dietetic/Nutrition Practice.
(kk) "Registered Nurse" - A person registered and currentlylicensed in the State of Alabama in accordance with theprovisions contained in current state statutes.
(ll) "Registered Records Administrator (RRA)" - A personskilled in record maintenance and preservation, and who isregistered by the American Medical Record Association.
(mm) "Rehabilitation" - An organized or well-defined programof therapeutics designed to help residents overcome physical,social, vocational or economic limitations as a result of adisability. Rehabilitation includes helping residents to reachthe highest functional level of physical, psychological andsocio-economic adjustment compatible with their disability.
(nn) "Resident" - A person admitted to a nursing facility byand upon the order of a physician.
(oo) "Shall" indicates mandatory requirements.
(pp) "Skilled Nursing Facility" - A facility providing skillednursing and other related services which meets the AlabamaState Board of Health's Rules for Nursing Facilities.
(qq) "Social Service Consultant" - An individual who meets therequirements of and is certified by the State of Alabama Boardof Social Work Examiners.
(rr) "Social Service Designee" - A person employed by afacility with less than 120 beds on a full-time basis to meetthe Social Service needs of residents. These persons must havea minimum of a G.E.D. or High School Diploma and haveexperience in dealing with the public.
(ss) "Social Worker" - A person who has either a Baccalaureateof Social Work or Masters of Social Work degree and islicensed in accordance with the Code of Alabama.
(tt) "Therapist" - A professionally trained and/or dulylicensed and/or registered person, when required by statestatutes, (such as physical therapist, occupational therapist,speech therapist, respiratory therapist, audiologist, etc.)who is skilled in the application of treatment techniques andprocedures to residents under the general direction of aphysician.
(uu) "Training and Abuse Registry"
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(i) Abuse or Neglect or Misappropriation of ResidentProperty. The Department of Public Health shall establishand maintain such registry. The registry shall providefor the inclusion of specific documented findings by theAlabama Department of Public Health of resident neglector abuse or misappropriation of resident property by anyindividual used by a nursing facility, as well as anybrief statement of the individual disputing the findings.In the case of inquiries to the registry concerning anindividual listed in the registry, any informationdisclosed concerning such a finding shall also includedisclosure of any such statement in the registry relatingto the finding or a clear and accurate summary of such astatement. Individuals must be notified in writing priorto the inclusion of findings in the registry and allowedthe opportunity for a hearing in the event the individualdisputes the findings.
(ii) Nurse Aide Training. The names and addresses of allnurse aides who attended an approved training program andwho have successfully passed the approved competencyevaluation will be included on the registry. The onlyexception of the requirement for attendance at anapproved training program is those nurses' aides who arehired by a nursing facility prior to July 1, 1989, andwho successfully pass the approved competency evaluationprior to January 1, 1990.
(vv) “Health Care Professional” - A physician, physicianassistant, nurse practitioner, physical, speech oroccupational therapist; physical or occupational therapyassistant; registered professional nurse; licensed practicalnurse; licensed or certified social worker, or dietitian.
(ww) “Special Focus Facility” (SFF) – A federally certifiednursing facility that has been identified as one with anoteworthy history of poor performance and is involuntarilyenrolled in a special program with increased oversight andenhanced enforcement activity designed to stimulateimprovements in quality of care and quality of life. Onceselected as an SFF, the Alabama Department of Public Healthconducts twice the number of standard surveys and appliesprogressive enforcement until the nursing home either (a)graduates from the SFF program or (b) their provider agreementwith Medicare/Medicaid is terminated.Author: Rick Harris, Walter T. Geary, J., M.D.Statutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed November 18, 1999; effectiveDecember 23, 1999. Amended: Filed September 18, 2003; effectiveOctober 23, 2003. Amended: Filed June 23, 2004; effective July28, 2004. Amended: Filed April 20, 2005; effective May 25, 2005. Amended: Filed June 15, 2016; effective July 30, 2016.
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420-5-10-.02 Licensing And Administrative Procedures.
(1) Legal Authority for Adoption of Regulations. Pursuant to theauthority granted by Code of Ala. 1975, §22-21-20 et seq. and inaccordance with the Alabama Administrative Procedures Act, Code ofAla. 1975, §41-22-1 et seq., the State Board of Health does herebyadopt and promulgate rules governing all nursing facilities inAlabama except those exempt by law from licensure.
(2) Types of License. All licenses are issued for the calendaryear and shall expire December 31, unless renewed by the owner forthe succeeding year.
(a) Regular License. A regular license shall be issued by theState Board of Health after the Board has determined that thenursing facility is in substantial compliance with the rulesherein adopted.
(b) Probational License. The State Board of Health may, in itsdiscretion and in lieu of license revocation, issue aprobational license to a facility when inspection shows thatthe maintenance and operation of the facility are such thatthe facility no longer substantially complies with the rulesadopted herein. However, the Board may issue a probationallicense only after determining that the health and safety ofresidents are adequately protected despite the non-compliance,and that the facility has submitted an adequate written planto correct the non-compliance in a timely manner.
(3) Application and Fee
(a) Every facility shall be required to submit an applicationfor license accompanied by the required statutory fee, inaccordance with the provisions of Section 22-21-24 of the Codeof Ala. 1975. Every application must be submitted on a formsupplied by the Board and must contain all the informationrequested on said form, along with the required fee, in orderfor the application to be processed and considered.
(b) Name of Facility. Every facility shall be designated by apermanent and distinctive name, which shall be used inapplying for a license and shall not be changed without priorwritten notice to the Board specifying the name to bediscontinued as well as the new name.
(4) Licensing.
(a) Issuance of License. The license document issued by theState Board of Health shall set forth the name and location ofthe facility, the type of facility, and the bed capacity for
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which the institution is licensed, and the type of license(temporary, regular, or probational).
(b) Separate License. A separate license shall be required foreach nursing facility when more than one facility is operatedunder the same management; (Separate licenses are not requiredfor separate buildings on the same grounds used by the samefacility). Facilities offering different types of health careservices in one building or complex of buildings (e.g., abuilding housing a nursing facility and a hospital) shall alsobe separately licensed.
(c) Basis for Denial of License.
1. The State Board of Health may deny a license to anycorporation, partnership or individual making applicationto own or operate any nursing facility if saidcorporation, partnership or individual:
(i) Falsified any information or record required bythe application or license; or
(ii) Has been convicted of a felony, in this or anyother state or federal jurisdiction, for physical,mental, or verbal abuse or neglect of an individualor misappropriation of property of a nursing facilityresident or financial abuse of residents; or
(iii) Has been convicted of fraud in this or anyother state or federal jurisdiction; or
(iv) Has previously been the subject of licenserevocation proceedings and does not demonstrate arecent ability and willingness to fully comply withState Board of Health rules; or
(v) Does not demonstrate adequate resources, ability,or intent, to fully comply with the State Board ofHealth rules.
(d) Basis for License Revocation. The State Board of Healthmay revoke a license to operate a nursing facility if theowner and/or operator of said facility:
1. Violates any of the provisions of Code of Ala. 1975,§22-21-20 et seq., or the rules and regulations issuedpursuant thereto;
2. Permits, aides or abets the commission of any illegalact in such facility; or
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3. Engages in conduct or practices deemed by the StateBoard of Health to be detrimental to the welfare of theresidents of such facility.
(5) Right of Review. Whenever a license is denied or revoked, theapplicant or licensee will be afforded an opportunity for ahearing in accordance with the requirements for contested caseproceedings under the Alabama Administrative Procedures Act, Codeof Ala. 1975, §41-22-1 et seq., and Chapter 420-1-3 of the AlabamaAdministrative Code.
(a) In the case of a license revocation, prior notice of thegrounds for proposed revocation and the date, time and placeset for the hearing shall be given in accordance with theAlabama Administrative Procedures Act, Code of Ala. 1975,41-22-1 et seq. and Chapter 420-1-3, of the AlabamaAdministrative Code (AAC).
(b) All due process and procedural protection granted to thelicensee or applicant by the Alabama Administrative ProceduresAct shall be provided.
(c) All appeals from adverse hearing proceedings shall besubject to the requirements of the Alabama AdministrativeProcedures Act.
(6) Re-issuance of License.
(a) The following changes in the status of the facility willrequire issuance of a new license, upon application andpayment of license fee:
1. Change in facility ownership.
(i) A change of ownership occurs whenever there is achange in the legal form under which the controllingentity is organized. Transactions constituting achange of ownership include, but are not limited to,the following:
(I) Sale or donation of the facility's legaltitle
(II) Lease of the entire facility's real andpersonal property
(III) A sole proprietor becomes a member of apartnership or corporation, succeeding him as thenew operator
(IV) A partnership dissolves
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(V) One partnership is replaced by anotherthrough the removal, addition or substitution ofa partner
(VI) A general partnership becomes a limitedpartnership, or a limited partnership becomesgeneral
(VII) Two (2) or more corporations merge and theoriginally licensed corporation does not survive
(VIII) Corporations consolidate
(IX) A non-profit corporation becomes a generalcorporation, or a for-profit corporation becomes;non-profit
(X) Transfers between levels of government
2. Increase in bed capacity
(b) The following status changes require issuance of a newlicense without payment of licensure fee:
1. Change in type of care offered (e.g., nursing facilityto skilled, distinct part SNF changes)
2. Change of location
3. Change in name of the facility
(c) The governing authority shall file with the State Board ofHealth, an application for license 30 days before any proposedchange requiring a new license, in order to permit processingof the application and issuance of the license prior to thedesired effective date of the change.
(7) Compliance Exceptions. At its discretion, the State Board ofHealth may grant an exception to, or modify the application of,one or more provisions of these rules or referenced codes, for aperiod and under conditions, if any, determined by the Board. Theexceptions or modification shall be based on hardship,impracticability, or economic infeasibility in complying with therules. The facility's request shall be in writing, shall state thespecific provisions for which the exception or modification isrequested, and reasons for each requested exception ormodification.
(8) Compliance with State and Local Laws.
(a) Licensing of Staff. Staff of the facility shall becurrently licensed or registered in accordance with theapplicable laws.
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(b) Compliance with Other Laws. The facility shall be incompliance with laws relating to fire and safety, sanitation,communicable and reportable diseases, Certificate of Need, andother relevant health and safety requirements.
(9) Inspections. Failure or refusal to submit to a survey willresult in initiation of license revocation proceedings. Findingsnoted during a survey shall be corrected by execution of anacceptable plan of correction. The plan of correction shall besuccinctly written to address identified problems in a timelymanner and returned to Alabama Department of Public Health notlater than 10 calendar days after receipt of Statement ofDeficiencies.
(10) A renewal application and an annual Licensure fee must besubmitted to arrive at the Alabama Department of Public Health,not later than December 15 each year to assure continued Licensurestatus.Author: Patricia E. Ivie, Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed November 18, 1999; effectiveDecember 23, 1999. Amended: Filed September 18, 2003; effectiveOctober 23, 2003.
420-5-10-.03 Administrative Managment.
(1) A facility must be administered in a manner that enables it touse its resources effectively and efficiently to attain ormaintain the highest practicable physical, mental, andpsychosocial well-being of each resident.
(2) A facility must be licensed under applicable State and locallaw
(3) The facility must operate and provide services in compliancewith all applicable Federal, State, and local laws, regulations,and codes, and with accepted professional standards and principlesthat apply to professionals providing services in such a facility.
(4) Facilities must meet the applicable provisions of HHSregulations pertaining to nondiscrimination on the basis of race,color, or national origin; nondiscrimination on the basis ofhandicap; nondiscrimination on the basis of age; protection ofhuman subjects of research and fraud and abuse. Although theseregulations are not in themselves considered requirements underthis part, their violation may result in the revocation of thefacility license.
(5) Governing body. The facility must have a governing body, ordesignated persons functioning as a governing body, that is
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legally responsible for establishing and implementing policiesregarding the management and operation of the facility; and
(6) The governing body appoints the administrator who is:
(a) Licensed by the State where licensing is required, and;
(b) Responsible for the management of the facility.
(7) A current roster of the governing authority members shall bemaintained in the nursing facility. At its discretion, the AlabamaDepartment of Public Health may request that a copy of this rosterbe placed on file with the Division.
(a) The facility must supply full and complete information tothe Alabama Department of Public Health as to theidentity: (1) of each officer and director of the corporationwhere the nursing facility is organized as a corporationand (2) where a nursing facility is organized as apartnership.
(b) Of each person who has any direct or indirect ownershipinterest of 10 per centum or more in such nursing facility orwho is the owner (in whole or in part) of any mortgage, deedof trust, note, or other obligation secured (in whole or inpart) by such nursing facility or any of the property orassets of such nursing facility, and
(c) In case a nursing facility is organized as a corporation,of each officer and director of the corporation, and
(d) In case a nursing facility is organized as a partnership,the name of each partner.
(e) The governing authority shall submit to the state agencywithin 15 days any changes in the information herein required.
(f) There must be an individual authorized in writing to actfor the administrator during absences.
(g) Written notification shall be made to the AlabamaDepartment of Public Health, within 15 days of theAdministrator's appointment.
(h) The accounting method and procedures shall be sufficientto permit an annual audit, accurate determination of the costof operation, the cost per resident day, and accounting forresident's funds.
(i) Whenever there is found to be evidence of fraud ormisrepresentation to secure money or property from residents,or applicants, or there is any evidence of misappropriation orconversion of money or property of residents or applicants,
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this must be reported to the proper authorities at the AlabamaDepartment of Public Health.
(j) Unusual Occurrences. Occurrences such as catastrophes andunusual occurrences which threaten the welfare, safety orhealth of residents, personnel, or visitors shall bedocumented within 24 hours of the incident or occurrence. Thisdocumentation shall be retained in the facility for at least 2years. All records required by this subsection shall be, uponrequest, made immediately available to surveyors employed bythe Alabama Department of Public Health. Copies of suchrecords shall be forwarded to the Alabama Department of PublicHealth promptly upon request. The term “Unusual occurrences”includes life threatening burns, and deaths under unusualcircumstances.
(k) Fires shall be reported within 24 hours of the occurrenceto the Technical Services Unit of the Alabama Department ofHealth.
(8) Required training of nursing aides - Definition Licensedhealth professional means a physician; physician assistant; nursepractitioner; physical, speech, or occupational therapist;physical or occupational therapy assistant; registeredprofessional nurse; licensed practical nurse; licensed orcertified social worker, or Dietitians. Nurse aide means anyindividual providing nursing related services to residents in afacility who is not a licensed health professional, a registereddietitian, or someone who volunteers to provide such serviceswithout pay.
(9) General rule. A facility must not use any individual workingin the facility as a nurse aide for more than four months, on afull-time basis, unless:
(a) That individual is competent to provide nursing relatedservices; and
(b) That individual has completed a training and competencyevaluation program; or
(c) That individual has been deemed or determined competent bythe Alabama Nurse Aide Registry.
(10) Non-permanent employees. A facility must not use on atemporary, per diem, leased, any basis other than a permanentemployee any individual who does not meet the requirements inparagraphs B & C above as a nurse aide.
(11) Competency A facility must not use any individual who hasworked less than four months as a nurse aide in that facilityunless the individual:
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(a) Is a full-time employee in a State-approved training andcompetency evaluation program
(b) Has demonstrated competence through satisfactoryparticipation in a State-approved nurse aide training andcompetency evaluation program; or
(c) Has been deemed or determined competent by the AlabamaNurse Aide Registry.
(12) Registry verification Before allowing an individual to serveas a nurse aide, a facility must receive registry verificationthat the individual has met competency evaluation requirementsunless:
(a) The individual is a full-time employee in a training andcompetency evaluation program approved by the State; or
(b) The individual can prove that he or she has recentlysuccessfully completed a training and competency evaluationprogram approved by the State and has not yet been included inthe registry Facilities must follow up to ensure that such anindividual actually becomes registered
(13) Multi-state registry verification. Before allowing anindividual to serve as a nurse aide, a facility must contact theAlabama Nurse Aide Registry to seek information from every Stateregistry the facility believes includes information on theindividual.
(14) Required retraining. If, since an individuals most recentcompletion of a training and competency evaluation program, therehas been a continuous period of 24 consecutive months during noneof which the individual provided nursing related services formonetary compensation, the individual must complete a new trainingand competency evaluation program.
(15) Regular in-service education. The facility must complete aperformance review of every nurse aide at least once every 12months, and must provide regular in-service education based on theoutcome of these reviews The in-service training must:
(a) Be sufficient to ensure that continuing competence ofnurse aides, but must be no less than 12 hours per year;
(b) Address areas of weakness as determined in nurse aides'performance reviews and may address the special needs ofresidents as determined by the facility staff; and
(c) For nurse aides providing services to individuals withcognitive impairments, also address the care of thecognitively impaired.
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(16) Proficiency of Nurse aides. The facility must ensure thatnurse aides are able to demonstrate competency in skills andtechniques necessary to care for residents' needs, as identifiedthrough resident assessments, and described in the plan of care.
(17) Staff qualifications. The facility must employ on a full-time, part-time or consultant basis those professionals necessaryto carry out the provisions of these requirements.
(18) Professional staff must be licensed, certified, or registeredin accordance with applicable State laws.
(19) Use of outside resources. If the facility does not employ aqualified professional person to furnish a specific service to beprovided by the facility, the facility must have that servicefurnished to residents by a person or agency outside the facilityunder an arrangement described in section 1861(w) of the SocialSecurity Act as amended or an agreement described in paragraph(20) of this section.
(20) Arrangements as described in Section 1861(w) of the SocialSecurity Act as amended or agreements pertaining to servicesfurnished by outside resources must specify in writing that thefacility assumes responsibility for:
(a) Obtaining services that meet professional standards andprinciples that apply to professionals providing services insuch a facility; and
(b) The timeliness of the services
(21) Medical director. The facility must designate a physician toserve as medical director
(22) The medical director is responsible for:
(a) Implementation of resident care policies; and
(b) The coordination of medical care in the facility
(23) The facility must provide or obtain laboratory services tomeet the needs of its residents. The facility is responsible forthe quality and timeliness of the services.
(24) If the facility provides its own laboratory services, i.e.,bedside testing including glucose or glucometer, the services mustmeet the applicable condition for coverage of the servicesfurnished by laboratories specified in Part 493 of Title 42 Codeof Federal Regulations revised 10/1/93.
(25) If the facility does not provide laboratory services on site,it must have an agreement to obtain these services only from a
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laboratory that meets the requirements of Part 493 of Title 42Code of Federal Regulations revised 10/1/93.
(26) The facility must:
(a) Provide or obtain laboratory services only when ordered bythe attending physician;
(b) Promptly notify the attending physician of the findings;
(c) Assist the resident in making transportation arrangementto and from the source of service if the resident needsassistance; and
(d) File in the resident's clinical record laboratory reportsthat are dated and contain the name and address of the testinglaboratory
(27) If the laboratory chooses to refer specimens for testing toanother laboratory, the referral laboratory must be certified inthe appropriate specialties and sub-specialties of services inaccordance with the requirements of Part 493 of Title 42 Code ofFederal Regulations revised 10/1/93.
(28) Radiology and other diagnostic services. The facility mustprovide or obtain radiology and other diagnostic services to meetthe needs of its residents. The facility is responsible for thequality and timeliness of the services.
(29) If the facility provides its own diagnostic services, theservices must meet the applicable conditions of participation fourhospitals contained in Section 482.26 of Title 42 Code of FederalRegulations revised 10/1/93.
(30) If the facility does not provide its own diagnostic services,it must have an agreement to obtain these services from a provideror supplier that is approved to provide these services underMedicare.
(31) The facility must:
(a) Provide or obtain radiology and other diagnostic servicesonly when ordered by the attending physician;
(b) Promptly notify the attending physician of the finding;
(c) Assist the resident in making transportation arrangementsto and from the source of service, if the resident needsassistance; and
(d) File in the resident's clinical record signed and datedreports of x-ray and other diagnostic services.
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(32) Clinical records. The facility must maintain clinical recordson each resident in accordance with accepted professionalstandards and practices that are:
(a) Complete;
(b) Accurately documented;
(c) Readily accessible; and
(d) Systematically organized.
(33) Clinical records must be retained for:
(a) Five years from the date of discharge when there is norequirement in State law; or
(b) For a minor, three years after a resident reaches legalage under State law.
(34) The facility must safeguard clinical record informationagainst loss, destruction, or unauthorized use.
(35) The facility must keep confidential all information containedin the resident's records, regardless of the form or storagemethod of the records, except when release is required by:
(a) Transfer to another health care institution;
(b) Law;
(c) Third party payment contract; or
(d) The resident.
(36) The clinical record must contain:
(a) Sufficient information to identify the resident;
(b) A record of the resident's assessments;
(c) The Plan of Care and services provided;
(d) The results of any pre-admission screening conducted bythe State; and
(e) Progress notes.
(37) Disaster and emergency preparedness. The facility must havedetailed written plans and procedures to meet all potentialemergencies and disasters, such as fire, severe weather, andmissing residents.
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(a) The facility must train all employees in emergencyprocedures when they begin to work in the facility;
(b) Periodically review the procedures with existing staff;and
(c) Carry out unannounced staff drills using those procedures.
(38) The facility must have in effect a written transfer agreementwith one or more hospitals approved for participation under theMedicare and Medicaid programs that reasonably assures that:
(a) Residents will be transferred from the facility to thehospital, and ensured of timely admission to the hospital whentransfer is medically appropriate, as determined by theattending physician; and
(b) Medical and other information needed for care andtreatment of residents, and, when the transferring facilitydeems it appropriate, for determining whether such residentscan be adequately cared for in a less expensive setting thaneither the facility or the hospital, will be exchanged betweenthe institutions.
(39) The facility is considered to have a transfer agreement ineffect if the facility has attempted in good faith to enter intoan agreement with a hospital sufficiently close to the facility tomake transfer feasible.
(40) Quality assessment and assurance. A facility must maintain aquality assessment and assurance committee consisting of:
(a) The director of nursing services;
(b) A physician designated by the facility; and
(c) At least three other members of the facility's staff.
(41) The quality assessment and assurance committee:
(a) Meets at least quarterly to identify issues with respectto which quality assessment and assurance activities arenecessary; and
(b) Develops and implements appropriate plans of action tocorrect identified quality deficiencies.
(42) A State or the Secretary may not require disclosure of therecords of such committee except insofar as such disclosure isrelated to the compliance of such committee with the requirementsof this section.
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(43) Disclosure of ownership. The facility must comply with theDisclosure requirements of Sections 420.206 and 455.104 of Title42 Code of Federal Regulations revised 10/1/93.
(44) The facility must provide written notice to the AlabamaDepartment of Public Health, if a change occurs in:
(a) Persons with an ownership or control interest, as definedby 420-5-10.02(6)(a)(i) - (x);
(b) The officers, directors, agents, or managing employees;
(c) The corporation, association, or other company responsiblefor the management of the facility; or
(d) The facility's administrator or director of nursing
(45) The notice specified in the paragraph (44) of this sectionmust include the identity of each new individual or company.
(46) Any facility designated as a federal “Special Focus Facility”must place signage on their main entrance door informing thepublic of this designation. The signage must remain posted untilthe facility is taken off the Special Focus Facility listing orthe provider agreement with CMS is terminated.
(a) The signage must state in bold print: This nursing homehas been designated as a Special Focus Facility.
(b) The signage must further state: A Special Focus Facilityis one with a noteworthy history of poor performance. ASpecial Focus Facility nursing home is required to haveincreased oversight and is subject to enhanced enforcementactivity designed to stimulate improvement. Additionalinformation about the federal Special Focus Facility programand process can be obtained from the administrator of thisfacility; by a search of the federal web site: www.cms.gov/sff; or by reviewing the information on the web site of theAlabama Department of Public Health: www.adph.org by searchingkeyword: sff.
(c) The signage lettering must be printed in block letterscomparable to Times New Roman with font of at least 24 points.The notice must be on paper the size of at least 8 1/2’’ by11’’ and of adequate size as to be readily noticed by all whoenter.Author: Rick Harris, Walter T. Geary, Jr. M.D.Statutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed November 18, 1999; effectiveDecember 23, 1999. Amended: Filed September 18, 2003; effectiveOctober 23, 2003. Amended: Filed June 23, 2004; effective July28, 2004. Amended: Filed June 15, 2016; effective July 30, 2016.
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420-5-10-.04 Personnel.
(1) General. The administrator shall be responsible forimplementation and maintenance of written personnel policies andprocedures that support sound resident care and personnelpractices. Personnel records shall be in effect current andavailable for each employee and contain sufficient information tosupport placement in the position to which assigned. Writtenpolicies for control of communicable disease shall be in effect toensure that employees with symptoms or signs of communicabledisease or infected skin lesions are not permitted to work, andthat safe and sanitary environment for personnel exists. Incidentsand accidents to personnel shall be reviewed to identify healthand safety hazards.
(2) Personnel Records. Each nursing facility shall maintain apersonnel record for each employee. As a minimum, the record shallinclude:
(a) Application for employment which contains informationregarding education, training, experience, and if applicable,registration, and/or licensure information of the applicant.
(b) A job description.
(c) General administrative and job related orientation
(3) In addition to requirements at 420-5-10-.17, each facilityshall:
(a) Establish vaccination requirements for employees, that areconsistent with current recommendations from the Center fordisease Control and Prevention (CDC) and the federalOccupational Safety and Health Administration (OSHA).
(b) Personnel absent from duty because of any communicabledisease shall not return to duty until examined by a physicianor freedom from any condition that might endanger the healthof residents or employees. Documentation of freedom fromcommunicable disease shall be available in facility records.
(4) Personnel Qualifications, Requirements and Training.
(a) Qualifications of Personnel. The name and qualificationsof all professional employees shall be kept on file forinspection by the State Board of Health.
(b) Staff Development. Each employee shall receive appropriateorientation to the facility and its policies and to his/herposition and job duties, to ensure competency in the job
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placement. All employees shall participate in in-serviceeducational programs planned and conducted for the developmentand improvement of their skills.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.05 Resident Rights.
(1) Resident rights. The resident has a right to a dignifiedexistence, self-determination, and communication with and accessto persons and services inside and outside the facility. Afacility must protect and promote the rights of each resident,including each of the following rights
(2) Exercise of rights.
(a) The resident has the right to exercise his or her rightsas a resident of the facility and as a citizen or resident ofthe United States
(b) The resident has the right to be free of interference,coercion, discrimination, and reprisal from the facility inexercising his or her rights
(c) In the case of a resident adjudged incompetent under thelaws of a State by a court of competent jurisdiction, therights of the resident are exercised by the person appointedunder State law to act on the resident's behalf.
(d) In the case of a resident who has not been judgedincompetent by the State court, any legal-surrogate designatedin accordance with State law may exercise the resident's rightto the extent provided by State law.
(3) Notice of rights and services
(a) The facility must inform the resident both orally and inwriting in a language that the resident understands of his orher rights and all rules and regulations governing residentconduct and responsibilities during the stay in the facility.Such notification must be made prior to or upon admission andduring the resident's stay. Receipt of such information, andmany amendments to it, must be acknowledged in writing.
(b) The resident or his or her legal representative has theright:
1. Upon an oral or written request, to access all recordspertaining to himself or herself including current
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clinical records within 24 hours(excluding weekends andholidays); and
2. After receipt of his or her records for inspection, topurchase at a cost not to exceed the community standardphotocopies of the records or any portions of them uponrequest and two working days advance notice of thefacility.
(c) The resident has the right to be fully informed inlanguage that he or she can understand of his or her totalhealth status, including but not limited to, his or hermedical condition.
(d) The resident has the right to refuse treatment, to refuseto participate in experimental research, and to formulate anadvance directive as specified in paragraph (h) of thissection; and
(e) The facility must:
1. Inform each resident who is entitled to Medicaidbenefits, in writing, at the time of admission to thenursing facility or, when the resident becomes eligiblefor Medicaid of:
(i) The items and services that are included innursing facility services under the State plan forwhich the resident may not be charged.
(ii) Those other items and services that the facilityoffers and for which the resident may be charged, andthe amount of charges for those services; and
2. Inform each resident when changes are made to theitems and services specified in paragraphs (e)1(i) & (ii)above.
(f) The facility must inform each resident before, or at thetime of admission, and periodically during the resident'sstay, of services available in the facility and of charges forthose services, including any charges for services not coveredunder Medicare or by the facility's per diem rate.
(g) The facility must furnish a written description of legalrights which includes:
1. A description of the manner of protecting personalfunds.
2. A description of the requirements and procedures forestablishing eligibility for Medicaid, including theright to request an assessment by the State Medicaid
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Agency to determine the extent of a couple's non-exemptresources at the time of institutionalization andattributes to the community spouse an equitable share ofresources which cannot be considered available forpayment toward the cost of the institutionalized spouse'smedical care in his or her process of spending down toMedicaid eligibility levels;
3. A posting of names, addresses, and telephone numbersof all pertinent State client advocacy groups such as theState survey and certification agency, the Statelicensure office, the State ombudsman program, theprotection and advocacy network, and the Medicaid fraudcontrol unit; and
4. A statement that the resident may file a complaintwith the State survey and certification agency concerningresident abuse, neglect, and misappropriation of residentproperty in the facility.
(h) The facility must maintain written policies and proceduresregarding advance directives. These requirements includeprovisions to inform and provide written information to alladult residents concerning the right to accept or refusemedical or surgical treatment and, at the individual's option,formulate an advance directive. This includes a writtendescription of the facility's policies to implement advancedirectives.
(i) The facility must inform each resident of the name,specialty, and a way of contacting the physician responsiblefor his or her care.
(j) The facility must prominently display in the facilitywritten information, and provide to residents and applicantsfor admission oral and written information about how to applyfor and use Medicare and Medicaid benefits, and how to receiverefunds for previous payments covered by such benefits.
(k) Notification of changes. A facility must immediatelyinform the resident; consult with the resident's physician;and if known, notify the resident's legal representative or aninterested family member when there is:
1. An accident involving the resident which results ininjury and has the potential for requiring physicianintervention;
2. A significant change in the resident's physical,mental, or psychosocial status (i.e., a deterioration inhealth, mental, or psychosocial status in either life-threatening conditions or clinical complications);
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3. A need to alter treatment significantly (i.e., a needto discontinue an existing form of treatment due toadverse consequences, or to commence a new form oftreatment); or
4. A decision to transfer or discharge the resident fromthe facility as specified in Section 420-5-10-.06.
(l) The facility must also promptly notify the resident and,if known, the resident's legal representative or interestedfamily member where there is:
1. A change in room or roommate assignment; or
2. A change in resident rights under Federal or State lawor regulations.
(m) The facility must record and periodically update theaddress and phone number of the resident's legalrepresentative or interested family member.
(n) Protection of Resident Funds. The resident has the rightto manage his or her financial affairs, and the facility maynot require residents to deposit their personal funds with thefacility.
(o) Management of personal funds. Upon written authorizationof a resident, the facility must hold, safeguard, manage, andaccount for the personal funds of the resident deposited withthe facility.
(p) Deposit of funds.
1. Funds in excess of $50. The facility must deposit anyresident's personal funds in excess of $50 in an interestbearing account (or accounts) that is separate from anyof the facility's operating accounts, and that creditsall interest earned on residents funds to that account.(In pooled accounts, there must be a separate accountingfor each resident's share).
2. Funds less than $50. The facility must maintain aresidents personal funds that do not exceed $50 in a non-interest bearing account, interest-bearing account, orpetty cash fund.
(q) Accounting and records. The facility must establish andmaintain a system that assures a full and complete andseparate accounting, according to generally acceptedaccounting principles, of each resident's personal fundsentrusted to the facility on the resident's behalf.
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1. The system must preclude any co-mingling of residentfunds with facility funds or with the funds of any personother than another resident.
2. The individual financial records must be availablethrough quarterly statements and on request to theresident or his or her legal representative.
(r) Notice of certain balances. The facility must notify eachresident that receives Medicaid benefits:
1. When the amount in the resident's account reaches $200less than the SSI resource limit for one person; and
2. That, if the amount in the account, in addition to thevalue of the resident's other nonexempt resources,reaches the SSI resource limit for one person, theresident may lose eligibility for Medicaid or SSI.
(s) Conveyance upon death. Upon the death of a resident with apersonal fund deposited with the facility, the facility mustconvey within 30 days the resident's funds, and a finalaccounting of those funds, to the individual or probatejurisdiction administering the resident's estate.
(t) Assurance of financial security. The facility mustpurchase a surety bond, or otherwise provide assurancesatisfactory to the Secretary, to assure the security of allpersonal funds of residents deposited with the facility.
(u) Limitation on charges to personal funds. The facility maynot impose a charge against the personal funds of a residentfor any item or service for which payment is made underMedicaid and Medicare.
(v) Free choice. The resident has the right to:
1. Choose a personal attending physician;
2. Be fully informed in advance about care and treatmentand of any changes in that care or treatment that mayaffect the resident's well-being; and
3. Unless adjudged incompetent or otherwise found to beincapacitated under the laws of the State, participate inplanning care and treatment or changes in care andtreatment.
(w) Privacy and confidentiality. The resident has the right topersonal privacy and confidentiality of his or her personaland clinical records.
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1. Personal privacy includes accommodations, medicaltreatment, written and telephone communications, personalcare, visits, and meetings of family and resident groups,but this does not require the facility to provide aprivate room for each resident;
2. Except as provided in paragraph (i)(ii) below, theresident may approve or refuse the release of personaland clinical records to any individual outside thefacility;
3. The resident's right to refuse release of personal andclinical records does not apply when:
(i) The resident is transferred to another healthcare institution; or
(ii) Record release is required by law.
(x) Grievances. A resident has the right to:
1. Voice grievances without discrimination or reprisal.Such grievances include those with respect to treatmentwhich has been furnished as well as that which has notbeen furnished; and
2. Prompt efforts by the facility to resolve grievancesthe resident may have, including those with respect tothe behavior of other residents.
(y) Examination of survey results. A resident has the rightto:
1. Examine the results of the most recent survey of thefacility conducted by Federal or State surveyors and anyplan of correction in effect with respect to thefacility.
2. In a place readily accessible to residents, thefacility must make the results available for examinationand must post either the results themselves or a noticeof their availability; and
3. Receive information from agencies acting as clientadvocates, and be afforded the opportunity to contactthese agencies.
(z) Work. The resident has the right to:
1. Refuse to perform services for the facility;
2. Perform services for the facility, if he or shechooses, when:
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(i) The facility has documented the need or desirefor work in the plan of care;
(ii) The plan specifies the nature of the servicesperformed and whether the services are voluntary orpaid;
(iii) Compensation for paid services is at or aboveprevailing rates; and
(iv) The resident agrees to the work arrangementdescribed in the plan of care.
(aa) Mail. The resident has the right to privacy in writtencommunications, including the right to:
1. Send and promptly receive mail that is unopened; and
2. Have access to stationery, postage, and writingimplements at the resident's own expense.
(bb) Access and visitation reports. The resident has the rightand the facility must provide immediate access to any residentby the following:
1. Any representative of the Secretary;
2. Any representative of the State;
3. The resident's individual physician;
4. The State long term care ombudsman (established underSection 712 of the Older Americans Act of 1965 asamended);
5, The Alabama Developmental Disabilities AdvocacyProgram (ADDAP) at the University of Alabama School ofLaw.
6. Subject to the resident's right to deny or withdrawconsent at any time, immediate family or other relativesof the resident; and
7. Subject to reasonable restrictions and the resident'sright to deny or withdraw consent at any time, others whoare visiting with the consent of the resident.
(cc) The facility must provide reasonable access to anyresident by any entity or individual that provides health,social, legal, or other services to the resident, subject tothe resident's right to deny or withdraw consent at any time.
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(dd) The facility must allow representatives of the StateOmbudsman, described in paragraph (bb)4 above of this section,to examine a resident's clinical records with the
permission of the resident or the resident's legalrepresentative, and consistent with State law.
(ee) Telephone. The resident has the right to have reasonableaccess to the use of a telephone where calls can be madewithout being overheard.
(ff) Personal property. The resident has the right to retainand use personal possessions, including some furnishings, andappropriate clothing, as space permits, unless to do so wouldinfringe upon the rights or health and safety of otherresidents.
(gg) Married couples. The resident has the right to share aroom with his or her spouse when married residents live in thesame facility and both spouses consent to the arrangement.
(hh) Self-Administration of Drugs. An individual resident mayself-administer drugs if the interdisciplinary team, hasdetermined that this practice is safe.
(ii) Refusal of Certain Transfers. An individual has the rightto refuse a transfer to another room within the facility, ifthe purpose of the transfer is to relocate.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.06 Admission, Transfer, Transport And DischargeRights.
(1) Admissions, transfers, transport and discharge.
(a) Transfer and discharge includes movement of a resident toa bed outside of the certified facility whether that bed is inthe same physical plant or not. Transfer and discharge doesnot refer to movement of a resident to a bed within the samecertified facility.
(b) The facility must permit each resident to remain in thefacility, and not transfer or discharge the resident from thefacility unless--
1. The transfer or discharge is necessary for theresident's welfare and the resident's needs cannot be metin the facility;
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2. The transfer or discharge is appropriate because theresident's health has improved sufficiently so theresident no longer needs the services provided by thefacility;
3. The safety of individuals in the facility isendangered;
4. The health of individuals in the facility wouldotherwise be endangered;
5. The resident has failed, after reasonable andappropriate notice, to pay for (or to have paid underMedicare or Medicaid) a stay at the facility. For aresident who becomes eligible for Medicaid afteradmission to a nursing facility, the nursing facility maycharge a resident only allowable charges under Medicaid;or
6. The facility ceases to operate.
(c) Documentation. When the facility transfers or discharges aresident under any of the circumstances specified in thissection, the resident's clinical record must be documented.The documentation must be made by--
1. The resident's physician when transfer or discharge isnecessary under paragraph (1)(b)1 or paragraph (1)(b)2 ofthis section; and
2. A physician when transfer or discharge is necessaryunder paragraph (1)(b)4 of this section.
(d) Notice before transfer. Before a facility transfers ordischarges a resident, the facility must--
1. Notify the resident and, if known, a family members orlegal representative of the resident of the transfer ordischarge and the reasons for the move in writing and ina language and manner they understand.
2. Record the reasons in the resident's clinical record;and
3. Include in the notice the items described in paragraph(f)l of this section.
(e) Timing of the notice. Except when specified in paragraph(e)1 of this section, the notice of transfer or dischargerequired under paragraph (d) 1 of this section must be made bythe facility at least 30 days before the resident istransferred or discharged.
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1. Notice may be made as soon as practicable beforetransfer or discharge when--
(i) The safety of individuals in the facility wouldbe endangered, under paragraph (1) (b)3 of thissection.
(ii) The health of individuals in the facility wouldbe endangered, under (1)(b)4 of this section.
(iii) The resident's health improves sufficiently toallow a more immediate transfer or discharge, underparagraph (1)(b)2 of this section;
(iv) An immediate transfer or discharge is requiredby the resident's urgent medical needs, underparagraph (1)(b)1 of this section; or
(v) A resident has not resided in the facility for 30days.
(f) Contents of the notice. The written notice specified inparagraph (d) of this section must include the following:
1. The reason for transfer or discharge;
2. The effective date of transfer or discharge;
3. The location to which the resident is transferred ordischarged;
4. A statement that the resident has the right to appealthe action to the State;
5. The name, address and telephone number of the Statelong term care ombudsman;
6. For nursing facility residents with developmentaldisabilities, or are mentally ill, the mailing addressand telephone number of the Alabama DevelopmentalDisabilities Advocacy Program (ADDAP) at the Universityof Alabama School of Law; and
(g) Orientation for transfer or discharge. A facility mustprovide sufficient preparation and orientation to residents toensure safe and orderly transfer or discharge from thefacility.
(h) Resident Transport. If a resident is unable to ride in anupright position or if such resident’s condition is such thathe or she needs observation or treatment by Emergency MedicalServices personnel, or if the resident requires transportationon a stretcher, gurney or cot, the facility shall arrange or
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request transportation services only from providers who areambulance service operators licensed by the Alabama StateBoard of Health. If such resident is being transported to orfrom a health care facility in another state, transportationservices may be arranged with a transport provider licensed asan ambulance service operator in that state. For the purposesof this rule, and upright position means no more than 20degrees from vertical.
(2) Notice of bed-hold policy and readmission--
(a) Notice before transfer. Before a nursing facilitytransfers a resident to a hospital or allows a resident to goon therapeutic leave, the nursing facility must providewritten information to the resident and a family member orlegal representative that specifies--
1. The duration of the bed-hold policy under the Stateplan, if any, during which the resident is permitted toreturn and resume residence in the nursing facility; and
2. The nursing facility's policies regarding bed-holdperiods, which must be consistent with paragraph (2)(c)of this section, permitting a resident to return.
(b) Bed-hold notice upon transfer. At the time of a transferof a resident for hospitalization or therapeutic leave, anursing facility must provide to the resident and a familymember or legal representative written notice which specifiesthe duration of the bed hold policy described in paragraph (2)(a)1 and 2 of this section.
(c) Permitting resident to return to facility. A nursingfacility must establish and follow a written policy underwhich a resident whose hospitalization or therapeutic leaveexceeds the bed-hold period under the State plan, isreadmitted to the facility immediately upon the firstavailability of a bed in a semi-private room if the resident--
1. Requires the services provided by the facility; and
2. Is eligible for Medicaid nursing facility services.
(3) Equal access to quality care.
(a) A facility must establish and maintain identical policiesand practices regarding transfer, discharge, and the provisionof services under the State plan for all individualsregardless of source of payment;
(b) The facility may charge any amount for services furnishedto non-Medicaid residents consistent with the notice
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requirement in 420-5-10.05(3)(a)(e) and (f) describing thecharges; and
(c) The State is not required to offer additional services onbehalf of a resident other than services provided in the Stateplan.
(4) Admissions policy.
(a) The facility must--
1. Not require residents or potential residents to waivetheir rights to Medicare or Medicaid; and
2. Not require oral or written assurance that residentsor potential residents are not eligible for, or will notapply for, Medicare or Medicaid benefits.
(b) Medicare/Medicaid facilities must not require a thirdparty guarantee of payment to the facility as a condition ofadmission or expedited admission, or continued stay in thefacility. However, the facility may require an individual whohas legal access to a resident's income or resources availableto pay for facility care to sign a contract, without incurringpersonal financial liability, to provide facility payment fromthe resident's income or resources.
(c) In the case of a person eligible for Medicaid, a nursingfacility must not charge, solicit, accept, or receive, inaddition to any amount otherwise required to be paid under theState plan, any gift, money, donation, or other considerationas a precondition of admission, expedited admission orcontinued stay in the facility. However,--
1. A nursing facility may charge a resident who iseligible for Medicaid for items and services the residenthas requested and received, and that are not specified inthe State plan as included in the term "nursing facilityservices" so long as the facility gives proper notice ofthe availability and cost of these services to residentsand does not condition the resident's admission orcontinued stay on the request for and receipt of suchadditional services; and
2. A nursing facility may solicit, accept, or receive acharitable, religious, or philanthropic contribution froman organization or from a person unrelated to a Medicaideligible resident or potential resident, but only to theextent that the contribution is not a condition ofadmission, expedited admission, or continued stay in thefacility for a Medicaid eligible resident.
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(d) States or political subdivisions may apply stricteradmissions standards under State or local laws than arespecified in this section, to prohibit discrimination againstindividuals entitled to Medicaid.Author: Rick Harris Statutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed July 20, 1998; effective August25, 1998. Amended: Filed June 23, 2004; effective July 28, 2004.
420-5-10-.07 Resident Behavior And Facility Practices.
(1) Resident behavior and facility practices.
(a) Restraints. The resident has the right to be free from anyphysical or chemical restraints imposed for purposes ofdiscipline or convenience, and not required to treat theresident's medical symptoms.
(b) Abuse. The resident has the right to be free from verbal,sexual, physical, and mental abuse, corporal punishment, andinvoluntary seclusion.
(c) Staff treatment of residents. The facility must developand implement written policies and procedures that prohibitmistreatment, neglect, and abuse of residents andmisappropriation of resident property.
1. The facility must--
(i) Not use verbal, mental, sexual, or physicalabuse, corporal punishment, or involuntary seclusion;
(ii) Not employ individuals who have been--
(I) Found guilty of abusing, neglecting, ormistreating residents by a court of law; or
(II) Have has a finding entered into the Statenurse aide registry concerning abuse, neglect,mistreatment of residents or misappropriation oftheir property; and
(III) Report any knowledge it has of actions by acourt of law against an employee, which wouldindicate unfitness for service as a nurse aide orother facility staff to the State nurse aideregistry or licensing authorities.
(d) The facility must ensure that all alleged violationsinvolving mistreatment, neglect, or abuse, including injuries
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unknown source and misappropriation of resident property arereported immediately to the administrator of the facility andto other officials in accordance with State law throughestablished procedures (including to the State survey andcertification agency).
(e) The facility must have evidence that all allegedviolations are thoroughly investigated, and must preventfurther potential abuse while the investigation is inprogress.
(f) The results of all investigations must be reported to theadministrator or his designated representative and to otherofficials in accordance with State law (including to the Statesurvey and certification agency) within 5 working days of theincident, and if the alleged violation is verified appropriatecorrective action must be taken.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.08 Quality Of Life.
(1) Quality of Life. A facility must care for its residents in amanner and in an environment that promotes maintenance orenhancement of each resident's quality of life.
(a) Dignity. The facility must promote care for residents in amanner and in an environment that maintains or enhances eachresident's dignity and respect in full recognition of his orher individuality.
(b) Self-determination and participation. The resident has theright to
1. Choose activities, schedules, and health careconsistent with his or her interests, assessments, andplans of care;
2. Interact with members of the community both inside andoutside the facility; and
3. Make choices about aspects of his or her life in thefacility that are significant to the resident.
(c) Participation in resident and family groups.
1. A resident has the right to organize and participatein resident groups in the facility;
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2. A resident's family has the right to meet in thefacility with the families of other residents in thefacility;
3. The facility must provide a resident or family group,if one exists, with private space;
4. Staff or visitors may attend meetings at the group'sinvitation;
5. The facility must provide a designated staff personresponsible for providing assistance and responding towritten requests that result from group meetings;
6. When a resident or family group exists, the facilitymust listen to the views and act upon the grievances andrecommendations of residents and families concerningproposed policy and operational decisions affectingresident care and life in the facility.
(d) Participation in other activities. A resident has theright to participate in social, religious, and communityactivities that do not interfere with the rights of otherresidents in the facility.
(e) Accommodation of needs. A resident has the right to
1. Reside and receive services in the facility withreasonable accommodations of individual needs andpreferences, except when the health or safety of theindividual or other residents would be endangered; and
2. Receive notice before the resident's room or roommatein the facility is changed.
(f) Activities.
1. The facility must provide for an ongoing program ofactivities designed to meet, in accordance with thecomprehensive assessment, the interests and the physical,mental, and psychosocial well-being of each resident.
2. The activities program must be directed by a qualifiedprofessional who-
(i) Is a qualified therapeutic recreation specialistor an activities professional who--
(I) Is registered by the Alabama Department ofPublic Health; and
(II) Is eligible for certification as atherapeutic recreation specialist or as an
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activities professional by a recognizedaccrediting body on or after October 1, 1990; or
(III) Has 2 years of experience in a social orrecreational program within the last 5 years, 1of which was full-time in a resident activitiesprogram in a health care setting; or
(IV) Is a qualified occupational therapist oroccupational therapy assistant; or
(V) Has completed a training course approved bythe State.
(g) The program coordinator, if not qualified, must functionunder the supervision of a consultant to assure the ActivityProgram meets needs of residents until the coordinator isqualified.
1. Activities shall be planned at least one month inadvance.
2. An activity calendar(s) shall be prominentlydisplayed.
(i) If a pet therapy program is implemented, thefollowing guidelines must be met:
(I) Pets chosen shall be free of contagiousdisease or sickness (diarrhea, ringworm, etc.).This includes pets residing at the facility.
(II) Pets shall be inoculated or vaccinated asrequired by law, with written verification ofcurrent inoculations for pets residing infacilities must be on file at the facility.
3. Participation records shall be maintained to reflectthat activities have been conducted on a group andindividual basis and by whom.
4. Participation records for bed-bound/bed-to-chairresidents shall reflect the activities conducted, theresponse to those activities and who offered activities.
(h) Social Services.
1. The facility must provide medically-related socialservices to attain or maintain the highest practicablephysical, mental, and psychosocial well-being of eachresident.
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2. A facility with more than 120 beds must employ aqualified social worker on a full-time basis.
3. Qualifications of a social worker. A qualified socialworker is an individual with--
(i) A Baccalaureate Degree or Masters Degree and iseligible for Licensure and has successfully madeapplication for Licensure or is licensed inaccordance with the Code of Ala. 1975; and
(ii) One year of supervised social work experience ina health care setting working directly withindividuals.
(i) Environment. The facility must provide--
1. A safe, clean, comfortable, and homelike environment,allowing the resident to use his or her personalbelongings to the extent possible;
2. Housekeeping and maintenance services necessary tomaintain a sanitary, orderly, and comfortable interior;
3. Clean bed and bath linens that are in good condition;
4. Private closet space in each resident room;
5. Adequate and comfortable lighting levels in all areas;
6. Comfortable and safe temperature levels maintained ata range of 71-81° F; and
7. For the maintenance of comfortable sound levels.
(j) Facilities
1. Social Service personnel must be located in an area ofthe facility which:
(i) is easily accessible to residents, families, andstaff,
(ii) is identified as the Social Service Office/Department and;
(iii) insures privacy for interviews.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed November 18, 1999; effectiveDecember 23, 1999.
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420-5-10-.09 Resident Assessment.
(1) Resident assessment. The facility must conduct initially andperiodically a comprehensive, accurate, standardized, reproducibleassessment of each resident's functional capacity.
(2) Admission orders. At the time each resident is admitted, thefacility must have physician orders for the resident's immediatecare.
(3) Comprehensive assessments. The facility must make acomprehensive assessment of a resident's needs which-
(a) For Medicare/Medicaid certified facilities only, is basedon a uniform data set specified by the Secretary and uses aninstrument that is specified by the State and approved by theSecretary; and
(b) Describes the resident's capability to perform daily lifefunctions and significant impairments in functional capacity.
(4) The comprehensive assessment must include at least thefollowing information:
(a) Medically defined conditions and prior medical history;
(b) Medical status measurement;
(c) Physical and mental functional status;
(d) Sensory and physical impairments;
(e) Nutritional status and requirements;
(f) Special treatments or procedures;
(g) Mental and psychosocial status;
(h) Discharge potential;
(i) Dental condition;
(j) Activities potential;
(k) Rehabilitation potential;
(l) Cognitive status; and
(m) Drug therapy
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(5) Frequency. Assessments must be conducted--
(a) No later than 14 days after the date of admission;
(b) Promptly after a significant change in the resident'sphysical or mental condition; and
(c) In no case less often than once every 12 months.
(6) Review of assessments. the nursing facility must examine eachresident no less than once every 3 months, (quarterly) and asappropriate, revise the resident's assessment to assure thecontinued accuracy of the assessment.
(7) The results of the assessment are used to develop, review, andrevise the resident's comprehensive plan of care.
(8) Coordination.
(a) Each assessment must be conducted or coordinated by aregistered nurse who signs and certifies the completion of theassessment.
(9) Certification. Each individual who completes a portion of theassessment must sign and certify the accuracy of that portion ofthe assessment.
(a) Penalty for Falsification. An individual who willfully andknowingly certifies (or causes another individual to certify)a material and false statement in a resident assessment issubject to civil money penalties, as specified by theEnforcement Regulations for SNFs and NFs as published in theFederal Register on November 10, 1994, and become effective onJuly 1, 1995.
(b) Use of independent assessors. If a State determines, undera survey or otherwise, that there has been a knowing andwillful certification of false statements under paragraph 9(a)of this section, the State may require (for a period specifiedby the State) that resident assessments under this paragraphbe conducted and certified by individuals who are independentof the facility and who are approved by the State.
(10) Comprehensive care plans. The facility must develop acomprehensive care plan for each resident that includes measurableobjectives and timetables to meet a resident's medical, nursing,and mental and psychosocial needs that are identified in thecomprehensive assessment. The plan of care must deal with therelationship of items or services ordered to be provided (orwithheld) to the facility's responsibility for fulfilling otherrequirements in these regulations.
(11) A comprehensive care plan must be--
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(a) Developed within 7 days after the completion of thecomprehensive assessment;
(b) Prepared by an interdisciplinary team, that includes theattending physician, a registered nurse with responsibilityfor the resident, and other appropriate staff in disciplinesas determined by the resident's needs, and, to the extentpracticable, the participation of the resident, the resident'sfamily of the resident's legal representative; and
(c) Periodically reviewed and revised by a team of qualifiedpersons after each assessment.
(12) The services provided or arranged by the facility must--
(a) Meet professional standards of quality; and
(b) Be provided by qualified persons in accordance with eachresident' written plan of care.
(13) Discharge summary. When the facility anticipates discharge, aresident must have a discharge summary that includes--
(a) A recapitulation of the resident's stay;
(b) A final summary of the resident's status to include itemsin paragraph (4)(a) through (m) of this section, at the timeof the discharge that is available for release to authorizedpersons and agencies, with the consent of the resident orlegal representative; and
(c) A post-discharge plan of care that is developed with theparticipation of the resident and his or her family, whichwill assist the resident to adjust to his or her new livingenvironment.
(14) Pre-admission screening for mentally ill individuals andindividuals with mental retardation. A nursing facility must notadmit any new resident with-
(a) Mental illness as defined in paragraph (c)(1) of thissection, unless the State mental health authority hasdetermined, based on an independent physical and mentalevaluation performed by a person or entity other than theState mental health authority, prior to admission,
1. That, because of the physical and mental condition ofthe individual, the individual requires the level ofservices provided by a nursing facility; and
2. If the individual requires such level of services,whether the individual requires specialized services formental illness; or
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(b) Mental retardation, as defined in paragraph (c)(2) of thissection, unless the State mental retardation or developmentaldisability authority has determined prior to admission--
1. That, because of the physical and mental condition ofthe individual, the individual requires the level ofservices provided by a nursing facility; and
2. If the individual requires such level of services,whether the individual requires specialized services formental retardation.
(c) Definition. for purposes of this section--
1. An individual is considered to have "mental illness"if the individual has a serious mental illness as definedat 483.102(b)(1), of Title 42 Code of Federal Regulationsrevised 10/1/93.
2. An individual is considered to be "mentally retarded"if the individual is mentally retarded as defined in483.102(b)(3) of Title 42 Code of Federal Regulationsrevised 10/1/93, or is a person with a related conditionas described in 435.1009 of Title 42 Code of FederalRegulations revised 10/1/93.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History: epealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.10 Quality Of Care.
(1) Each resident must receive and the facility must provide thenecessary care and services to attain or maintain the highestpracticable physical, mental, and psychosocial well-being, inaccordance with the comprehensive assessment and plan of care.
(2) Activities of daily living. Based on the comprehensiveassessment of a resident, the facility must ensure that-
(a) A resident's abilities in activities of daily living donot diminish unless circumstances of the individual's clinicalcondition demonstrate that diminution was unavoidable. thisincludes the resident's ability to-
1. Bathe, dress, and groom;
2. Transfer and ambulate;
3. Toilet;
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4. Eat; and
5. Use speech, language, or other functionalcommunication systems.
(b) A resident is given the appropriate treatment and servicesto maintain or improve his or her abilities specified inparagraph (2)a above; and
(c) A resident who is unable to carry out activities of dailyliving receives the necessary services to maintain goodnutrition, grooming, and personal hygiene.
(3) Vision and hearing. To ensure that residents receive propertreatment and assistive devices to maintain vision and hearingabilities, the facility must, if necessary, assist the resident-
(a) In making appointments, and
(b) By arranging for transportation to and from the office ofa practitioner specializing in the treatment of vision orhearing impairment or the office of a professionalspecializing in the provision of vision or hearing assistivedevices.
(4) Pressure sores. Based on the comprehensive assessment of aresident, the facility must ensure that-
(a) A resident who enters the facility without pressure soresdoes not develop pressure sores unless the individual'sclinical condition demonstrates that they were unavoidable;and
(b) A resident having pressure sores receives necessarytreatment and services to promote healing, prevent infectionand prevent new sores from developing.
(5) Urinary Incontinence. Based on the resident's comprehensiveassessment, the facility must ensure that-
(a) A resident who enters the facility without an indwellingcatheter is not catheterized unless the resident's clinicalcondition demonstrates that catherization was necessary; and
(b) A resident who is incontinent of bladder receivesappropriate treatment and services to prevent urinary tractinfections and to restore as much normal bladder function aspossible.
(6) Range of motion. Based on the comprehensive assessment of aresident, the facility must ensure that-
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(a) A resident who enters the facility without a limited rangeof motion does not experience reduction in range of motionunless the resident's clinical condition demonstrates that areduction in range of motion is unavoidable; and
(b) A resident with a limited range of motion receivesappropriate treatment and services to increase range of motionand/or to prevent further decrease in range of motion.
(7) Mental and Psychosocial functioning. Based on thecomprehensive assessment of a resident, the facility must ensurethat--
(a) A resident who displays mental or psychosocial adjustmentdifficulty, receives appropriate treatment and services tocorrect the assessed problem; and
(b) A resident whose assessment did not reveal a mental orpsychosocial adjustment difficulty does not display a patternof decreased social interaction and/or increased withdrawn,angry or depressive behaviors, unless the resident's clinicalcondition demonstrates that such a pattern was unavoidable.
(8) Naso-gastric tubes. Based on the comprehensive assessment of aresident, the facility must ensure that--
(a) A resident who has been able to eat enough alone or withassistance is not fed by a naso-gastric tube unless theresident' clinical condition demonstrates that use of a naso-gastric tube was unavoidable; and
(b) A resident who is fed by a naso-gastric or gastrostomytube receives the appropriate treatment and services toprevent aspiration pneumonia, diarrhea, vomiting, dehydration,metabolic abnormalities, and nasal-pharyngeal ulcers and torestore, if possible, normal feeding function.
(9) Accidents. The facility must ensure that--
(a) The resident environment remains as free of accidenthazards as is possible; and
(b) Each resident receives adequate supervision and assistancedevices to prevent accidents.
(10) Nutrition. Based on a resident's comprehensive assessment,the facility must ensure that a resident -
(a) Maintains acceptable parameters of nutritional status,such as body weight and protein, unless the resident'sclinical condition demonstrates that this is not possible; and
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(b) Receives a therapeutic diet when there is a nutritionalproblem.
(11) Hydration. The facility must provide each resident withsufficient fluid intake to maintain proper hydration and health.
(12) Special needs. The facility must ensure that residentsreceive proper treatment and care for the following specialservices:
(a) Injections;
(b) Parenteral and enteral fluids;
(c) Colostomy, ureterostomy, or ileostomy care;
(d) Tracheotomy care;
(e) Tracheal suctioning;
(f) Respiratory care;
(g) Foot care; and
(h) Prostheses.
(13) Unnecessary drugs.
(a) General. Each resident's drug regimen must be free fromunnecessary drugs. An unnecessary drug is any drug when used:
1. in excessive dose (including duplicate therapy); or
2. for excessive duration; or
3. without adequate monitoring; or
4. without adequate indications for its use; or
5. in the presence of adverse consequences which indicatethe dose should be reduced or discontinued; or
6. any combination of the reason above.
(b) Antipsychotic Drugs. Based on a comprehensive assessmentof a resident, the facility must ensure that--
1. Residents who have not used antipsychotic drugs arenot given these drugs unless antipsychotic drug therapyis necessary to treat a specific condition as diagnosedand documented in the clinical record; and
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2. Residents who used antipsychotic drugs receive gradualdose reductions, and behavioral interventions, unlessclinically contraindicated, in an effort to discontinuethese drugs.
(14) Medication Errors. The facility must ensure that-
(a) It is free of medication error rates of five percent orgreater; and
(b) Residents are free of any significant medication errors.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.11 Nursing Services.
(1) The facility must have sufficient nursing staff to providenursing and related services to attain or maintain the highestpracticable physical, mental, and psychosocial well-being of eachresident, as determined by resident assessments and individualplans of care.
(2) Sufficient staff. The facility must provide services bysufficient numbers of licensed nurses and other nursing personnelon a 24-hour basis to provide nursing care to all residents inaccordance with resident care plans:
(a) The facility must use the services of a registered nursefor at least 8 consecutive hours a day, 7 days a week.
(b) The facility must designate a registered nurse to serve asthe director of nursing on a full time basis.
(c) The director of nursing may serve as a charge nurse onlywhen the facility has an average daily occupancy of 60 orfewer residents.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.12 Dietary Services.
(1) The facility must provide each resident with a nourishing,palatable, well balanced diet that meets the daily nutritional andspecial dietary needs of each resident.
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(a) Staffing. The facility must employ a qualified dietitianeither full-time, part-time, or on a consultant basis.
1. If a qualified dietitian is not employed full-time,the facility must designate a person to serve as thedirector of food service who receives frequentlyscheduled consultation from a qualified dietitian.
2. "Qualified Dietitian" – means one who is currentlylicensed in the State of Alabama in accordance with theprovisions contained in current state statutes asgoverned by the Alabama Board of Examiners for Dietetic/Nutrition Practice.
(2) Sufficient staff. The facility must employ sufficient supportpersonnel competent to carry out the functions of the dietaryservice.
(3) Menus and nutritional adequacy. Menus must:
(a) Meet the nutritional needs of residents in accordance withthe recommended dietary allowances of the Food and NutritionBoard of the National Research Council, National Academy ofSciences;
(b) Be prepared in advance; and
(c) Be followed.
(4) Food. Each resident receives and the facility provides:
(a) Food prepared by methods that conserve nutritive value,flavor and appearance;
(b) Food that is palatable, attractive, and at the propertemperature;
(c) Food prepared in a form designed to meet individual needs;and
(d) Substitutes offered of similar nutritive value toresidents who refuse food served.
(5) Therapeutic diets. Therapeutic diets must be prescribed by theattending physician or by a dietitian licensed by the AlabamaBoard of Examiners for Dietetics and Nutritionists as authorizedby the medical director.
(6) Frequency of meals.
(a) Each resident receives and the facility provides at leastthree meals daily, at regular times comparable to normalmealtimes in the community.
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(b) There must be no more than 14 hours between a substantialevening meal and breakfast the following day, except asprovided in (d) below.
(c) The facility must offer snacks at bedtime daily.
(d) When a nourishing snack is provided at bedtime, up to 16hours may elapse between a substantial evening meal, andbreakfast the following day, if a resident group agrees tothis meal span, and a nourishing snack is served.
(7) Assistive devices. The facility must provide special eatingequipment and utensils for residents who need them.
(8) Sanitary conditions. The facility must:
(a) Procure food from sources approved or consideredsatisfactory by Federal, State or local authorities;
(b) Store, prepare, distribute, and serve food under sanitaryconditions; and
(c) Dispose of garbage and refuse properly.
(9) Feeding Assistant Program Requirements.
(a) Facility staff who are not health care personnel, (thefacility administrator, activity staff, clerical staff,laundry and housekeeping staff, or other), can be used asfeeding assistants upon successful completion of an approvedtraining program.
(1) Volunteers and family members may assist residentswith feeding and drinking, without completing an approvedtraining program. A feeding assistant shall only assistresidents to eat or drink who have no complicated feedingproblems and who have no known behaviors at meal time. Ifa resident is determined, by the facility, to meet thecriteria of having a feeding assistant, then the facilitymust specify that the resident will be assisted by afeeding assistant on the care plan.
(b) Examples of complicated feeding problems include:difficulty swallowing, recurrent lung aspirations, and tube orparenteral/IV feedings. Residents with a clinical condition,such as the conditions listed above, require the employeeproviding feeding or hydration services to be a licensedhealth care professional or certified nurse aide.
(c) The facility must base resident selection on the chargenurse’s assessment and the resident’s atest assessment andplan of care. A feeding assistant must work under the direct
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supervision of a registered nurse or licensed practical nursein a dining room or other common area.
(d) The feeding assistant is not permitted to perform othernursing or nursing-related duties (for example, measuring orrecording output, transferring, and toileting). In anemergency, a feeding assistant must immediately call asupervisory nurse on the resident call system, or otherappropriate means of emergency notification.
(e) Feeding Assistant Definition. Paid feeding assistant meansa person who does not meet the definition of health carepersonnel and who is paid by a nursing home, to assistresidents who have no feeding complications with theactivities of eating and drinking. The feeding assistant isnot permitted to provide any other nursing or nursing relatedservice. Paid feeding assistants must be at least 16 yearsold. A feeding assistant must work under the directsupervision of a registered nurse or licensed practical nursein a dining room or other common area.
1. Nurse aides who are on the nurse aide abuse registryand who have been disqualified from working as a nurseaide may not work as a feeding assistant. A feedingassistant does not include a person who is a:
(i) Licensed health professional or registereddietitian;
(ii) Volunteers without money compensation; orfamilies
(iii) Certified nurse aide.
(f) Feeding Assistant Training Requirements.
1. Feeding assistant training programs must requireenrolled individuals to successfully complete an approvedtraining program, which includes the following federally-mandated topics, covered during 9 hours of classroominstruction and hands on training.
(i) Feeding techniques.
(ii) Assistance with feeding and hydration.
(iii) Communication and interpersonal skills.
(iv) Appropriate responses to resident behavior.
(v) Safety and emergency procedures, including theHeimlich maneuver.
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(vi) Infection control.
(vii) Resident rights.
(viii) Recognizing changes in residents that areinconsistent with their normal behaviors and theimportance of reporting these changes to thesupervisory nurse.
(ix) Abuse, neglect and misappropriation of residentproperty including reporting requirements.
(x) Dementia.
2. Training must include an experienced staff memberdemonstrating the correct way to feed a resident whorequires minimal assistance with feeding, includingappropriate cueing, moderate assistance with feeding, anda resident who requires total assistance with feeding.
3. The feeding assistant training program must alsoprovide instruction on the following topics:
(i) The resident population who will be served by thefeeding assistant in a facility-based program. Thefacility based training program curriculum mustinclude training specific to the identifiedpopulation type(s). This training must include, butis not limited to:
I. Characteristics of the population, such as thepopulation member’s physical, social and mentalhealth needs, and specific medications ortreatment needed by the residents.
II. Meeting the needs of persons with a dualdiagnosis (co-occurrences of mental healthdisorders and alcohol and/or drug dependence orabuse), and maintaining or increasing his or hersocial participation.
4. Feeding assistants who have been trained by anotherfacility’s training program, must be trained for thespecific needs of a facility’s population.
5. Programs may choose to add increased trainingrequirements.
6. Training programs must stress the only direct, hands-on duty a feeding assistant is permitted to perform isassisting residents to eat or drink who have nocomplicated feeding problems and who has no knownbehaviors at meal time.
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7. Feeding assistant training programs must use atraining curriculum, which has been pre-approved by thedepartment and determined to comply with the federalrequirements. Entities are allowed to choose one of thefollowing pre-approved, standardized curriculum models:
Assisting with Nutrition and Hydration in Long-TermCare. Hartman Publishing Inc. 2004.
Assisted Dining: The Role and Skills of FeedingAssistants. Walker, Bonnie L and Cole, Claire S.American Health Care Association. 2004.
8. In addition to the pre-approved, standardizedcurriculum models facilities must also utilize thefollowing Dementia Education Training Act Care Seriesvideotapes:
Tape 1 - Understanding Dementia
Tape 2 - Staff Communication
Tape 4 - Feeding Techniques and Nutrition
Tape 5 - Assuring Proper Hydration
Tape 11 - Recognizing Changes in Health Status
Tape 12 - Keeping Dementia Residents Within theSafety of the Facility
9. Although the pre-approved standardized trainingcurriculums include additional skill information (e.g.,output, special care needs for resident with dysphagia,etc.), the instructor must stress the feeding assistantwill not be permitted to perform any other hands-on duty,beyond assisting residents to eat and drink who have nocomplicated feeding problems and who have no knownbehaviors at meals.
10. An individual may not provide hands-on assistancewith feeding or hydrating residents unless the individualhas successfully completed the following:
(i) A state-approved training program for feedingassistants, including additional instruction on anyselected resident population.
(ii) After completing the training course, theindividual must pass a State-approved standardizedwritten quiz with a minimum score of 80 percent. Theindividual may request the quiz to be administeredorally. Instructors should consider the needs of
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persons who have limited English proficiency orreading difficulties
(iii) Successfully completing demonstration of 1)feeding residents with minimal assistance/moderateassistance with cueing and total feeding of resident;2) Heimlich maneuver; and 3) appropriate hand washingtechniques
11. Programs may choose to add increased testingrequirements.
12. Students who do not successfully pass the initialcompetency evaluation will be allowed the opportunity toreview the training materials and retake the test amaximum of 2 additional times. Therefore, the student mayonly take the test a total of 3 times. The program mustdocument the failure, opportunity for review, andsubsequent retake testing date.
g. Feeding Assistant Instructor Requirements. Only thefollowing licensed health care professionals can serve as leadinstructors: R.N., L.P.N., R.D., S.T., O.T. These individualsmust have experience in long term care with 6 monthsexperience in the management of persons with dementia.Experienced Certified Nursing Assistants CNAs and otherindividuals may assist with the training and feedingdemonstrations, if appropriately supervised.
(h) Records. Feeding assistants must receive an annualinservice on relevant feeding assistant topics (any topic areaincluded in the curriculum is appropriate). In addition,feeding assistants must be evaluated on a yearly basis todocument that skill performance and feeding competence issatisfactory.
1. Feeding assistant training programs must maintain thefollowing records:
(i) For a minimum of 3 years, all students’ writtenexaminations, (skills checklists) and other relevanttraining records
(ii) Documentation of the training conducted andidentification of the instructor conducting thetraining.
(iii) Record of all individuals who have successfullycompleted the feeding assistant training andcompetency testing program.
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2. Training programs must maintain the security of thetest materials to ensure disclosure or forgery does notoccur.
3. Facilities employing feeding assistants must maintainthe following records:
(i) Feeding assistants must have in their personnelfile evidence of the following:
I. Evidence of having successfully completed anapproved feeding assistant training andcompetency testing program.
II. Evidence of annual inservice sessions(s),relating to feeding assistant duties.
III. Evidence of an annual evaluation,determining a feeding assistant’s continuedcompetence in feeding residents.
(ii) Feeding assistant roster, recording allindividuals employed by the facility as feedingassistants who successfully completed the feedingassistant training and competency evaluation.
(iii) The selected resident’s medical record,documenting no complicated feeding condition exists.
(i) Approval Process of Feeding Assistant Training Programs. Afacility must submit to the Division of Health Care Facilities(DHCF) in writing the curriculum the facility will utilize intheir feeding assistant training program.Author: Rick Harris, Dana BillingsleyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed April 20, 2005; effective May 25,2005. Amended: Published March 31, 2022; effective May 15, 2022.
420-5-10-.13 Physician Services.
(1) A physician must personally approve in writing arecommendation that an individual be admitted to a facility. Eachresident must remain under the care of a physician.
(2) Physician supervision. The facility must ensure that--
(a) The medical care of each resident is supervised by aphysician; and
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(b) Another physician supervises the medical care of residentswhen their attending physician is unavailable.
(3) Physician visits. The physician must--
(a) Review the resident's total program of care, includingmedications and treatments, at each visit required byparagraph (4)(a) of this section;
(b) Write, sign, and date progress notes at each visit; and
(c) Sign and date all orders.
(4) Frequency of physician visits.
(a) The resident must be seen by a physician at least onceevery 30 days for the first 90 days after admission, and atleast once every 60 days thereafter.
(b) A physician visit is considered timely if it occurs notlater than 10 days after the date the visit was required.
(c) Except as provided in paragraphs (4)(d) of this section,all required physician visits must be made by the physicianpersonally.
(d) At the option of the physician, required visit, mayalternate between personal visits by the physician and visitsby a physician assistant, nurse practitioner or clinical nursespecialist in accordance with paragraph (5)(a)1, 2, and 3 ofthis section.
(5) Availability of physicians for emergency care. The facilitymust provide or arrange for the provision of physician services 24hours a day, in case of an emergency.
(a) Except as specified in paragraph (5)(b) of this section, aphysician may delegate tasks to a physician assistant, nursepractitioner, or clinical nurse specialist who--
1. Agrees to and has signed specific Protocolsestablished by the facility and the physician and is onfile in the facility;
2. Is acting within the scope of practice as defined byState law; and
3. Is under the supervision of the physician.
(b) A physician may not delegate a task when the regulationsspecify that the physician must perform it personally, or whenthe delegation is prohibited under State law or by thefacility's own policies.
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Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.14 Specialized Rehabilitative Services.
(1) Provision of services. If specialized rehabilitative servicessuch as, but not limited to, physical therapy, speech-languagepathology, occupational therapy, and health rehabilitativeservices for mental illness and mental retardation are required inthe resident's comprehensive plan of care, the facility must:
(a) Provide the required services; or
(b) Obtain the required services from an outside resource (inaccordance with Section 483.75(h) of Title 42 Code of FederalRegulation revised 10/1/93) from a provider of specializedrehabilitative services.
(2) Qualifications. Specialized rehabilitative services must beprovided under the written order of a physician by qualifiedpersonnel.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.15 Dental Services.
(1) The facility must assist residents in obtaining routine and24-hour emergency dental care.
(a) Skilled nursing facilities. A facility:
1. Must provide or obtain from an outside resource, inaccordance with Section 483.75(h) of Title 42 Code ofFederal Regulations revised 10/1/93, routine andemergency dental services to meet the needs of eachresident;
2. May charge a Medicare resident an additional amountfor routine and emergency dental services;
3. Must, if necessary, assist the resident:
(i) In making appointments; and
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(ii) By arranging for transportation to and from thedentist's office; and
(iii) Promptly refer residents with lost or damageddentures to a dentist.
(b) Nursing Facilities. The facility:
1. Must provide or obtain from an outside resource thefollowing dental services to meet the needs of eachresident:
(i) Routine dental services (to the extent coveredunder the State plan); and
(ii) Emergency dental services;
2. Must, if necessary, assist the resident-
(i) In making appointments; and
(ii) By arranging for transportation to and from thedentist's office; and
(iii) Promptly refer residents with lost or damageddentures to a dentist.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996.
420-5-10-.16 Pharmacy Services.
(1) The facility must provide routine and emergency drugs andbiologicals to its residents, or obtain them under an agreementdescribed in §483.75(h) of Title 42 Code of Federal Regulationsrevised 10/1/93.
(a) Procedures. A facility must provide pharmaceuticalservices (including procedures that assure the accurateacquiring, receiving, dispensing, and administering of alldrugs and biologicals) to meet the needs of each resident.
(b) Service consultation. The facility must employ or obtainthe services of a licensed pharmacist who-
1. Provides consultation on all aspects of the provisionof pharmacy services in the facility;
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2. Establishes a system of records of receipt anddisposition of all controlled drugs in sufficient detailto enable an accurate reconciliation; and
3. Determines that drug records are in order and that anaccount of all controlled drugs is maintained andperiodically reconciled.
(c) Drug regimen review.
1. The drug regimen of each resident must be reviewed atleast once a month by a licensed pharmacist.
2. The pharmacist must report any irregularities to theattending physician and the director of nursing, andthese reports must be acted upon.
(d) Storage of drugs and biologicals.
1. In accordance with State and Federal laws, thefacility must store all drugs and biologicals in lockedcompartments under proper temperature controls and permitonly authorized personnel to have access to the keys.
2. The facility must provide separately locked,permanently affixed compartments for storage ofcontrolled drugs listed in Schedule II of theComprehensive Drug Abuse Prevention and Control Act of1976 and other drugs subject to abuse, except when thefacility uses single unit package drug distributionsystems in which the quantity stored is minimal and amissing dose can be readily detected.
3. The facility must maintain readily traceable recordsof receipt and disposition of all controlled drugs.
(e) Destruction of Drugs.
1. The nursing facility develops policies and proceduresfor the destruction of drugs and biologicals.
2. Controlled substances and legend drugs dispensed toresidents, that are unused because the medication isdiscontinued, or because the resident dies shall bedestroyed within 30 days, except unused legend drugs maybe donated to a charitable clinic pursuant to AlabamaAdministrative Code Chapter 420-11-11, et seq.
3. Medications of residents transferred to a hospital maybe retained until the resident is returned to thefacility. Upon return of the resident to the facility,the physician's order will dictate whether or not theresident is to continue the same drug regimen as
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previously ordered. Medications not reordered by thephysician must be destroyed.
4. Medications ordered to be used on an "as needed" basisshall be destroyed after 90 days if they have not beenused during that period of time. Medications shall bedestroyed upon expiration of the drug.
5. Both controlled substances and non-controlledsubstances may be destroyed on the premises or may bepicked up by an environmental agency that provides suchservice. Drugs to be destroyed shall not be returned tothe drug store for destruction.
6. Records must be completed and maintained by thefacility that include:
(i) Name and address of the facility
(ii) Date of destruction/date drugs picked up
(iii) Method used in destruction (If picked up by anenvironmental agency, the record/receipt mustindicate the proposed date and method of destruction.
(iv) Prescription number, name of drug store fromwhich the medicine was dispensed, resident's name,name and strength of drug destroyed, amount destroyedand reason for destruction.
7. The pharmacist will verity that the list of drugs tobe destroyed is accurate and with a Registered Nurse,will carry out destruction. Both will sign thedestruction form indicating amounts listed are correctand have been destroyed. For destruction of controlledsubstances there shall be a third witness who may be alaw enforcement official, management or supervisorypersonnel, i.e., administrator, LPN charge nurse, etc. Ifmedications are to be picked up and destroyed by anenvironmental agency, the RN should verify the list ofdrugs to be destroyed and should obtain a signed copy ofthe destruction form as a receipt.
8. If records of destruction are maintained in resident'smedical record, they must be retained for as long as themedical record is kept. If a separate file of destructionrecords is to be maintained, they must be retained for aperiod of not less than two years.
(f) Labeling of Drugs and Biologicals.
1. All containers of medicines and drugs shall beproperly and plainly labeled, including name and strength
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of drug, resident's name, ordering physician, date offilling, directions for administration, prescriptionnumber, expiration date, number of tablets or capsulessent and any necessary auxiliary labels. The prescriptionlabel shall conform with any additional federal, stateand local requirements.
2. Use of and labeling of generic drugs shall comply withState Board of Pharmacy requirements.
3. When authorized substitution of a drug takes place,there will be established policies and procedures toprovide accurate identification.
4. Over-the-counter (non-prescription) medicines shall beplainly labeled with the name and strength of the drug.Additional labeling information may be at the discretionof the facility as related in its policies and proceduresexcept that manufacturer's labeling information must bepresent in the absence of prescription labeling.
5. The contents of all individual prescriptions shall bekept in the original dispensed container bearing theoriginal prescription label.
6. Procedures shall be developed to assure proper controland labeling for medications provided a resident uponleaving the facility on a temporary absence.
7. Unit dose medications shall be packaged according toan acceptable format to include product name, strength,control number, and expiration date. Procedures forutilization of the system used are developed and approvedby administration, nursing and pharmacy personnel andmust comply with federal and state regulations.
(g) Emergency medication kits will be kept in accordance withChapter 680-x-2 of the Alabama State Board of Pharmacy Rulesand Regulations governing institutional pharmacies.
1. Emergency kits may contain controlled substancesutilizing the following conditions:
(i) The source from which a long term care facilitymay obtain controlled substances must be a DEAregistered pharmacy or practitioner.
(ii) There shall be a maximum three day supply of anycontrolled substance stocked in the emergency kit.
(iii) The responsibility for proper control andaccountability of the emergency kit shall rest withboth the nursing facility and the DEA registrant
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providing the drug. The facility and the drugprovider shall maintain complete and accurate recordsof the controlled substances placed in the emergencykit including receipt and disposition of the drugs aswell as destruction of unused or outdated drugs whereappropriate.
(iv) Adequate security measures shall be provided forthe emergency kit (if the controlled drugs are to bemaintained within the kit) or the drugs (if they areto be maintained in a separate area) to includedouble locks. Access to emergency drugs shall belimited to those with an actual need, i.e.,medication nurse and/or director of nurses and thepharmacist.
(v) Controlled drugs maintained for emergency use maybe used only upon the written or telephone orders ofthe attending physician, who must sign a telephoneorder as soon as possible after giving it.
(vi) Violations in these rules and regulations mayresult in the revocation, denial or suspension of theprivilege of maintaining controlled substance drugsin the emergency kit.
(h) "Stat" Medicine Cabinets
1. Each nursing facility may maintain one "stat" medicinecabinet for the purpose of keeping a minimum amount ofstock medications that may be needed quickly or afterregular duty hours. If a facility wants more than one"stat" medicine cabinet, it must be approved by the StateBoard of Health. The following rules apply to such acabinet:
(i) There shall be a minimum number of doses of anymedication in the "stat" cabinet based upon theestablished needs of the facility.
(ii) There must be a list of contents, approved bythe nursing facility, giving the name and strength ofthe drug and the quantity of each.
(iii) There shall be records available to show amountreceived, name of resident and amount used,prescribing physician, time of administration, nameof individual removing and using the medication andthe balance on hand.
(iv) There shall be written procedures forutilization of the "stat” medicine cabinet withprovisions for prompt replacement of used items.
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(v) The pharmacist shall inspect the “stat” medicinecabinet at least monthly replacing outdated drugs andreconciliation of its prior usage. Informationobtained shall be included in a monthly report.Author: Patricia E. IvieStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed June 23, 2004; effective July 28,2004.
420-5-10-.17 Infection Control.
(1) The facility must establish and maintain an infection controlprogram designed to provide a safe, sanitary, and comfortableenvironment and to help prevent the development and transmissionof disease and infection.
(a) Infection control program. The facility must establish aninfection control program under which it--
1. Investigates, controls, and prevents infections in thefacility;
2. Decides what procedures, such as isolation should beapplied to an individual resident; and
3. Maintains a record of incidents and corrective actionsrelated to infections.
(b) Preventing spread of infection.
1. When the infection control program determines that aresident needs isolation to prevent the spread ofinfection, the facility must isolate the resident.
2. The facility must prohibit employees with acommunicable disease or infected skin lesions from directcontact with residents or their food, if direct contactwill transmit the disease.
3. The facility must require staff to wash their handsafter each direct resident contact for which handwashingis indicated by accepted professional practice.
(c) Linens. Personnel must handle, store, process, andtransport linens so as to prevent the spread of infection.
(2) Tuberculosis (TB) Screening:
(a) Resident Screening
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1. As part of the resident admission procedure, a two-step tuberculin (PPD-Mantoux) skin test shall beadministered prior or upon admission to all new residentsunless there is documentation of a previous positivereaction. The two-step method should detect the boostingphenomenon that might be misinterpreted as a skin testconversion. Testing administered prior to admission shallbe within 30 days of admission date. Results shall berecorded in the permanent records of the facility.
2. History of Bacille Calmetta Guerin (BCG) vaccinationdoes not preclude an initial screening test, and areaction of 10 mm or more indurations shall be managed asa tuberculous infection.
3. At the time of admission any resident found to have asignificant tuberculin skin test reaction (10 mm orgreater) or with symptoms suggestive of TB shall beevaluated for active TB disease by clinical examinationand chest roentgenogram. Sputum specimen, if obtainable,shall be collected and sent to the State HealthDepartment Laboratory for smear and culture studies.Routine chest roentgenogram at admission remains anoption at the discretion of the nursing facility. In theabsence of clinical symptoms, annual chest roentgenogramsare not recommended.
4. Sputum of acid-fast smear and mycobacerial cultureshall be obtained promptly on any tuberculin reactor whodevelops a persistent cough or fever, or manifests anabnormal chest roentgenogram compatible with TB. Anyresident, regardless of skin test results, with apersistent cough or fever or other symptoms suggestive ofTB shall first have sputum collected and submittedimmediately to the State Health Department Laboratory forsmear and culture studies, followed by a clinicalexamination and chest roentgenogram.
5. Residents who have a documented history of a positive(greater than 10 mm induration) PPD tuberculin test,adequate treatment for disease, or adequate preventivetherapy for infection shall be exempt from furtherscreening unless they develop signs or symptomssuggestive of TB.
6. Routine annual TB skin testing of residents is notrecommended for every nursing facility. The InfectionControl Plan for each facility shall establish the needand frequency of repeat or annual TB skin testing basedupon the risk of transmission of TB infection in thatfacility and the surrounding community.
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7. All residents with a documented negative tuberculintest shall be retested within seven working days afternotice of exposure to a suspected or diagnosed case,using the single-step Mantoux method. Contacts having atuberculin skin test with a 5 mm or greater induration,and tuberculin converters should have follow-upexaminations including a chest roentgenogram and clinicalevaluation. Converters are defined as newly infectedpersons, without documented exposure information, whosetuberculin skin test increases as follows:
(i) for persons under age 35 the skin test mustincrease by at least 10 mm from most recent testresults.
(ii) for persons aged 35 and older the skin test mustincrease by at least 15 mm from most recent testresults.
(b) Employee Screening
1. As part of the pre-employment procedure, a two steptuberculin (PPD-Mantoux) skin test shall be administeredto all new employees as soon as employment begins unlessthere is documentation of a previous positive reaction ordocumentation of a negative skin test within the past 12months. A single-step skin test is sufficient for newemployees with documented negative test within theprevious 12 months. The two-step tuberculin skin testingshould detect the boosting phenomenon that might bemisinterpreted as a skin test conversion. Results shallbe recorded in the permanent records of the facility.
2. A history of BCG vaccination does not preclude aninitial screening test, and a reaction of 10 mm or moreindurations shall be managed as a TB infection.
3. Any health care worker (HCW), at the time ofemployment, found to have a significant tuberculin skintest reaction (10 mm or greater) or with symptomssuggestive of TB shall be evaluated by clinicalexamination and chest roentgenogram. Sputum specimen, ifobtainable, shall be collected and sent to the StateHealth Department Laboratory for smear and culture.
4. HCWs who have a documented history of a positive PPDtest, adequate treatment for disease, or adequatepreventive therapy for infection shall be exempt fromfurther screening unless they develop signs or symptomssuggestive of TB.
5. Routine annual TB skin testing of HCWs is notrecommended for every nursing facility. PPD-negative HCWs
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shall undergo repeat PPD testing at regular intervals asdetermined by the nursing facility’s risk assessment. TheInfection Control Plan for each facility should establishthe need and frequency of repeat or annual TB skintesting based upon the risk of transmission of TB in thatfacility and surrounding community.
6. All HCWs with documented negative tuberculin testshall be retested using the single step Mantoux methodwithin seven working days after notice of exposure to asuspected or diagnosed case of TB if appropriateprecautions were not in place at the time of exposure.All HCWs with newly recognized positive PPD test resultsshall be evaluated promptly for active TB. Contactshaving a tuberculin skin test with a 5 mm or greaterinduration, and tuberculin converters shall have follow-up examinations including a chest roentgenogram andclinical evaluation. Sputum specimen, if obtainable,should be sent to the State Health Department Laboratoryfor smear and culture. Converters are defined as newlyinfected persons, without documented exposureinformation, whose tuberculin test increases as follows:
(i) for persons under age 35 the test must increaseby a least 10 mm within the past two years
(ii) for persons aged 35 and older the skin test mustincrease by at lease 15 mm within the past two years.
(7) Routine chest radiographs are not required forasymptomatic, PPD-negative HCWs. HCWs with positive PPDtest results shall have chest radiographs as part of theinitial evaluation of their PPD test; if negative, repeatchest radiographs are not needed unless symptoms developthat could be attributed to TB. However, more frequentmonitoring for symptoms of TB may be considered forrecent converters and other PPD-positive HCWs who are atincreased risk for developing active TB (e.g., HIV-infected or otherwise severely immunocompromised HCWs).
(c) Treatment of Latent Infection
1. Infected employees and residents with no currentdisease, who are 34 years of age and under, shall beoffered preventive therapy (isoniazid) in accordance withthe American Thoracic Society, Center for DiseaseControl, American College of Chest Physicians and theAlabama State TB Control Program Guidelines. Employeesand residents aged 35 and over who have significant skintests may be offered preventive therapy depending uponeach individual’s complete evaluation.
(d) Role of the Health Department
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1. Any employee or resident with suspected or diagnosedTB disease must be reported to the local healthdepartment immediately.
2. Epidemiologic investigation will be performed bytrained health department staff on all employees andresidents with diagnosed or suspected disease.
3. Further information regarding TB screening ofemployees and residents may be obtained by contacting thelocal county health department or the Division of TBControl of the State Health Department.
(e) Two-Step Testing
1. Nursing homes may choose to use either of the methodsoutlined below when administering the two-step (test-retest) tuberculin skin test. The Infection Control Planfor each facility shall designate which method is moreappropriate for the facility and that method must beconsistently utilized. The use of the two-step tuberculinskin test should detect the boosting phenomenon thatmight be misinterpreted as a skin test conversion. Theprocess is particularly important when repeat testing islikely.
 Method 1:
Apply first test
Read result in 7 days
If result is positive (greater than 10 mm ofinduration), follow recommendation for appropriatefollow-up of positive skin test
If result is negative (0-9 mm of induration), applysecond test (same day)
Read result of second test 48-72 hours later Useresult of second test as baseline
 Method 2:
Apply first test
Read test in 48-72 hours
If result is positive (greater than 10 mm ofinduration), follow recommendation for appropriatefollow-up of positive skin test
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If result is negative (0-9 mm of induration), applysecond test
1-3 weeks later
Read result of second test 48-72 hours later Useresult of second test as baselineAuthor: Patricia E. Ivie, Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed November 18, 1999; effectiveDecember 23, 1999.
420-5-10-.18 Physical Plant.
(1) Location.
(a) The nursing facility site shall provide space toaccommodate staff and visitor parking, service access,emergency access, outdoor resident activity space and otherareas required to provide for the care and proper operation ofthe facility.
(b) The location and construction of all nursing facilitiesshall comply with local zoning, building, and fire ordinances.Evidence to this effect, signed by local fire, building, andzoning officials shall be furnished to the Alabama Departmentof Public Health.
(c) Nursing facilities shall be located on streets or roadswhich are kept passable at all times. Facilities constructedafter the effective date of these rules shall be located onpaved roads.
(2) Submission of Plans and Specifications.
(a) When construction is contemplated, either for newbuildings, conversions, additions, or alterations to existingbuildings coming within the scope of these rules, plans andspecifications shall be submitted for review and approval tothe Alabama Department of Public Health, in accordance withAlabama Administrative Code Rule 420-5-22, "Submission ofPlans and Specifications for Health Care Facilities."
(b) Minor alterations and remodeling which do not affect thestructural integrity of the building, which does not changefunctional operation, which does not affect fire safety, andwhich does not add beds over those for which the facility islicensed, need not be submitted for approval. Documentationshall be maintained for interior wall covering finishes.
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(c) The renovation area of an existing nursing facility shallcomply with the current requirements for new construction tothe extent possible.
(3) Inspections. The Alabama Department of Public Health and itsauthorized representative shall have access to the site forinspection.
(4) General Requirements - The provisions of this section shallapply to all nursing facilities.
(a) Codes.
1. Nursing facilities in existence at the time of currentcode adoption shall comply with the code requirements foran existing building.
2. New nursing facilities, additions or alterations shallcomply with the currently adopted code requirement for anew building.
(b) Renovations within an existing facility shall comply withthe applicable codes and requirements for new work.
(c) The building shall be structurally sound, free from leaksand excessive moisture, in good repair, and painted atsufficient intervals inside and out.
(d) The interior and exterior of the building shall be keptclean and orderly.
(e) Maintain an effective pest control program so that thefacility is free of pests and rodents.
(f) There shall be a minimum of twenty feet of clear spacemeasured perpendicularly between a resident bedroom window andany structure outside the window. A peripheral view of theexterior shall be provided from newly constructed bedrooms.
(g) All water is to be obtained from a public water supply. Ifit is impossible to connect to a public water system, theprivate water system shall be approved by the AlabamaDepartment of Public Health or its appropriate designatedagency.
1. Water under pressure of not less than 15 lbs. persquare inch is piped within the building to all sinks,toilets, lavatories, tubs and other fixtures requiringwater.
2. An adequate supply of hot water for resident andservice uses is available at all times. Temperature ofhot water used by residents is automatically regulated by
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tempering valves and shall not exceed 110 degreesFahrenheit.
3. In the laundry, provision shall be made to increasethe water temperature to 160 degrees Fahrenheit unlessmanufacturer documentation can be provided for thechemical being used at a lower temperature.
4. There shall be procedures established to ensure thatwater can be provided for all essential services in theevent of loss of the normal water supply.
(h) All liquid and human waste, including floor wash water andliquid waste from refrigerators, is disposed of throughtrapped drains into a public sanitary sewer system inlocalities where such system is available. In localities wherea public sanitary sewer system is not available, liquid andhuman waste shall be disposed of through trapped drains and ina manner approved by the Alabama Department of Public Healthor its appropriate designated agency.
1. Plumbing is so sized, installed and maintained tocarry adequate quantities of water to required locationsthroughout the facility, to prevent contamination of thewater supply, and to properly convey sewage and liquidwastes from the establishment to the sewerage or sewagedisposal system, in such a manner and so that it does notconstitute a source of contamination or create anunsanitary condition or nuisance.
2. Solid, non-infectious wastes are kept in leak proof,non-absorbent containers which shall be kept covered withtight fitting lids, and are disposed of in a mannerapproved by the Alabama Department of Public Health orits appropriate designated agency.
3. Solid wastes which are potentially infectious shall beburned on the premises in an incinerator approved by theAlabama Department of Public Health or disposed of in amanner approved by the Alabama Department of PublicHealth or its appropriate designated agency.
(i) Lighting shall meet the following requirements:
1. Lighting in nursing facilities shall meet therequirement as in the Illuminating Engineers Society(IES) Lighting Handbook Application volume.
2. Night lights shall be provided in bedrooms, hallways,toilet rooms and bathrooms. Glowing toggle switches areacceptable in toilet rooms and bathrooms.
(j) Screens shall be provided for all operable windows.
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(k) All floors shall be smooth and free from cracks andfinished so that they can be easily cleaned.
(l) Walls and ceilings shall be of sound construction andmaintained in good repair.
(m) Each room occupied by residents shall have a ceilingheight of eight feet or more (does not include furred area).
(n) Doors.
1. Hardware on all toilet and bathroom doors shall beoperable from outside the room.
2. Bedroom doors shall not be equipped with hardware thatwill permit a resident to lock himself within the room.
3. Bedroom doors shall open into the bedroom.
4. To avoid danger of a resident falling and blocking theswing of a door, all doors to residents’ central bathsand toilets shall swing out or be double-acting andequipped with an emergency stop release.
(o) Panic hardware shall be installed on each required exitdoor, as well as doors to and from exit stairs.
(p) All differences in floor levels within the building shallbe accomplished by steps of not less than three, six-inchrisers or ramps. Either shall be equipped with handrails onboth sides. (See Ramps.)
(q) The nursing facility shall be well ventilated at alltimes.
1. Resident bedrooms shall be ventilated in such a manneras to supply fresh air and to prevent accumulation ofobjectionable odors.
2. All service areas shall be ventilated as permitted bycodes.
(r) All facilities shall have access to public fire hydrantprotection, or the equivalent approved by the local firedepartment or State Fire Marshal.
(s) Handrails shall be installed on both sides of allcorridors normally used by residents except for areas betweendoors of 24 inches or less.
(t) A corridor smoke detection system shall be provided andconsist of listed devices connected to the facility’s firealarm system. When the nursing facility is not totally
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sprinkled, smoke detectors shall be installed in living/recreation rooms, barber/beauty shops, examination rooms andhazardous areas.
(u) When heat detectors are installed in any area, they shallbe listed self-restoring type, and electrically connected tothe fire alarm system.
(v) Nurse Call System.
1. Existing nursing facilities shall have an electricalnurse call system at the side of each bed which willprovide an initial audible signal and a visual signal onan annunciator panel at the nurses' station untildeactivated. (Nursing facilities licensed after theeffective date of theses rules, both audible and visualsignals must function until deactivated in the residentroom.)
2. Nursing facilities licensed after December 26, 1988,shall have an electrical nurse call station at each bedand a light over the door to the bedrooms on thecorridor.
3. An electrical nurse call system shall be provided ineach resident toilet and bathroom and in additions toexisting buildings and in remodeling after the effectivedate of these rules. This signal shall be distinct fromthe regular nurse call signal and turned off only at theemergency calling station.
4. On new call systems, additional visible signals shallbe installed at corridor intersections or in maincorridor area where rooms are recessed if patient roomcall lights are not visible from the nurses’ stationarea.
(w) Trash chutes are prohibited in nursing facilities.
(x) Elevators.
1. New facilities with residents on one or more floorsabove the first floor shall be equipped with at least oneautomatic elevator of a size sufficient to carry aresident on a stretcher.
2. If an elevator is not installed in the existingnursing facility due to exits on each floor, each floorshall have a dining room, living room, and sunroom.
3. Annual inspections shall be made of elevators byqualified inspection service personnel and inspectiondocuments maintained in the facility.
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(y) Sufficient general storage space shall be provided for thestorage of equipment, supplies, etc., to prevent the need forstorage in hallways or other non-storage areas of the facilityand be adequately ventilated.
(z) Facilities for Physically Handicapped.
1. Necessary accommodations shall be made to meet theneeds of persons with semi-ambulatory disabilities, sightand hearing disabilities, disabilities of coordination,as well as other disabilities in accordance with theAmerican National Standard Institute (ANSI), A117.1 -1992, American National Standard for Buildings andFacilities - Providing Accessibility and Usability forPhysically Handicapped People.
2. In nursing facilities existing prior to these rules,provisions shall be made to accommodate the handicapped.
(aa) Ramps and inclines, where installed, shall not exceed arise of one foot in twelve feet of run, shall be finished witha non-slip surface and provided with handrails on both sides.
(bb) Open fire escapes are permitted in institutions licensedprior to October 9, 1957, provided such fire escapes meet thefollowing requirements:
1. Must be of non-combustible material.
2. Must have a railing or guard at least four feet highon each unenclosed side.
3. Wall openings adjacent to fire escapes are protectedwith fire resistive doors and protected windows.
4. Doors leading to fire escapes shall open in thedirection of exit and be provided with panic hardware.
(cc) Emergency Power.
1. Nursing facilities and additions to nursing facilitiesconstructed after October 20, 1967, shall have anemergency generator.
2. Nursing facilities and additions to nursing facilitiesconstructed prior to October 20, 1967, may have anautomatic battery-powered system which will provide theemergency power required for at least 1½ hours. Anemergency generator shall be provided if life supportequipment systems are used.
3. As a minimum, emergency power shall be provided to thefollowing:
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(i) Corridor Illumination.
(ii) Exit and Directional Signs.
(iii) Stair Illumination.
(iv) Nurse's Station Illumination.
(v) Medicine Preparation Rooms/Medicine Cart StorageRoom.
(vi) Recreational Areas such as living rooms, diningrooms, day rooms, and chapels - in facilities builtand renovated after December 28, 1988.
(vii) Electrical Equipment Room, Generator Room andBoiler Room - in facilities built and renovated afterDecember 28, 1988. Electricity may be switchcontrolled in these rooms.
(viii) An Exterior Light at Each Exit.
(ix) Fire/Smoke Alarm System.
(x) Sprinkler pump system, if provided, and sprinklerriser room lighting.
(xi) Telephone and paging system.
(xii) Nurse call system and
(xiii) Refrigerator for storage of drugs, ifprovided.
(dd) Mechanical, electrical, plumbing, heating, airconditioning, and water systems shall be installed to meet therequirements of local codes and ordinances and the applicableregulations of the State Board of Health at the time ofconstruction.
(ee) All essential mechanical, electrical and resident careequipment shall be maintained in safe operating condition. Thefacility shall establish a written preventive maintenanceprogram to ensure that all equipment is operative.
(ff) The use of portable heaters of any kind is prohibitedexcept during emergency situations caused by severe weatherthat disables the normal heating system.
(gg) When life support systems are used, emergency electricalservice shall comply with NFPA 99 and shall be provided by anemergency electrical generator located on the premises.
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(hh) Fire alarm systems shall be tested monthly by an alarminitiating device to verify proper functioning of the alarmsystem. Documentation of the testing shall be maintained,noting the proper functioning of notification devices,releasing of door holders and locks, operation of smokedampers, and air handling unit shutdown.
(5) New Construction Requirements.
(a) The provisions of this section, in addition to theprovisions of Chapter 420-5-10-.18(4), (6) & (7), shall applyto all new nursing facilities or additions or renovations tonursing facilities initially licensed after the effective dateof these rules or to any existing nursing facility which meetsor can readily be improved to meet these requirements.
(b) Facilities initially licensed, as well as additions oralterations to existing facilities, constructed after theeffective date of these rules shall be classified as HealthCare Occupancy, and shall comply, at the time of planapproval, with codes and standards adopted by the State Boardof Health. See Alabama Administrative Code, Rule 420-5-22, forlisting of adopted codes and standards.
(c) Doors.
1. All doors in line of exit travel shall be hinged andshall swing in the line of travel.
2. All exit doors serving residents including doors tostairs shall be as a minimum 44 inches wide.
3. Doors to toilets used by residents in additions or newfacilities shall be at least 34 inches wide.
4. Where rated doors are required by code, a permanentlabel from an independent testing laboratory shall beattached to the door.
(d) Corridors in resident areas shall be at least eight feetwide, except as permitted by code.
(e) Exit passageways other than corridors in resident areasshall not be less than four feet wide.
(f) Corridors and passageways shall be unobstructed and shallnot lead through any room or space used for a purpose that mayobstruct free passage.
(g) Handrails shall be installed on both sides of allcorridors normally used by residents except between doors inspaces 24 inches or less.
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1. The handrails shall have a circular grip, a clearanceof 1½ inch from the wall and be mounted 30-34 inches fromthe floor to the top of the rail.
2. Handrails shall return to the wall at allterminations.
3. Handrails may be omitted where service corridors arenot part of a required exit from resident areas, thecorridor is not a path of circulation from one residentarea to another and cross corridor doors are installed.These doors shall separate resident corridors fromservice corridors and shall normally remain closed.
(h) Each tub or shower shall be in an individual room orenclosure with space for the private use of the bathingfixture, for drying and dressing. A separate toilet shall beavailable for each central bathing area without requiringentry into the general corridor.
(i) If a facility chooses to admit or retain residentsrequiring life support equipment, essential electricaldistribution systems shall conform to a Type II System asrequired in NFPA 99. As a minimum, life support systems shallbe provided in 10% of the bedrooms and receptacles every 50feet on alternating walls in the corridor.
(6) Rooms, Spaces and Equipment - New and Existing Facilities.
(a) Nursing Unit. A nursing unit consists of the number ofbeds served from one nurses’ station and includes all of thenecessary support areas required to provide care to theresidents.
1. Each nursing unit shall have:
(i) Nurses station.
(ii) Clean utility room.
(iii) Medicine preparation room.
(iv) Soiled utility room or soiled holding room.
(v) Clean linen storage room.
(vi) Wheelchair and stretcher storage areas.
(vii) Janitor’s closet with mop sink or floorreceptor and storage shelving.
(viii) Nourishment room.
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(ix) Staff restroom.
2. On a nursing unit, no residents’ bedroom door shall bemore than 150 feet from the nurses’ station.
(b) Bedrooms.
1. All bedrooms shall have window(s) with the windowsillsnot more than three feet above the floor. Windows shallnot be below grade.
2. The window area shall not be less than one-tenth ofthe floor area.
3. Residents' bedrooms shall be located so as to minimizethe entrance of odors, noise and other nuisances.
4. Residents' bedrooms shall be directly accessible fromthe main corridor of the nursing unit. Existing residentbedrooms may be accessible from any public space otherthan the dining room. In no case shall a resident'sbedroom be used for access to another resident's room.
5. The capacity of any new room shall not exceed tworesidents, and the capacity of existing rooms shall notexceed four residents.
6. The minimum floor area of bedrooms, exclusive oftoilets, closets, wardrobes, alcoves, or vestibules infacilities and additions to existing facilitiesconstructed after October 20, 1967, shall be as follows:
Private Room 100 Square Feet
Multi-Resident Room 80 Square Feet Per Resident
7. There shall be sufficient space to permit nursingprocedures to be performed and to permit the placing ofbeds at least three feet apart, and three feet from thewall at the foot of the bed. Sides of beds shall maintaina minimum clearance of 12 inches from electrical outletsin walls, unless electrical outlet and plug protection ismaintained.
(c) Provisions for privacy. Each multi-resident room shallhave permanently installed cubicle curtain tracks to permitenclosing each bed with curtains to allow for the privacy ofeach resident without obstructing the passage of otherresidents either to the corridor, closet, or to the toilet/lavatory adjacent to the resident room.
(d) Accommodations for Residents. The minimum accommodationsfor residents shall include the following:
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1. Residents shall be provided with a standard oradjustable bed.
2. Chair and bedside table.
3. Storage space for clothing, toilet articles andpersonal belongings.
4. Bedside electrical call system for summoning aid.
5. Waste paper receptacle.
6. A headwall bed light must be mounted so that it isoperable by the resident from the bed.
7. Nursing facilities or additions to nursing facilitiesconstructed after November 16, 1988, shall provide handwashing lavatory in each bedroom. It may be omitted frombedroom when a lavatory is provided in an adjoiningtoilet or bathroom.
(e) Isolation Room.
1. Isolation rooms shall be provided at the rate of notless than one private bedroom per 50 beds or majorfraction thereof for the isolation of residents sufferingfrom infectious diseases as defined by the Centers forDisease Control (CDC). The bedroom shall meet all of therequirements for bedrooms as previously stated in theseregulations. Isolation bedrooms may be used to providefor the special care of residents who develop acuteillnesses, have personality problems, or residents interminal phases of illness. If central heating/cooling isprovided, the air from the room shall be exhausteddirectly to the outside.
2. Isolation rooms in nursing facilities shall have alavatory within the room or within a private toilet.
(f) Nurses’ Station. The nurses’ station for each nursing unitshall include as a minimum the following:
1. Annunciator board for receiving residents’ calls.
2. Cabinet space.
3. Storage space for current residents’ charts.
4. Working space and accommodations for recording andcharting purposes by facility staff.
5. Medicine preparation room. The room at each nurses’station shall have, as a minimum, 80 square feet of floor
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space with an additional square foot for each bed inexcess of 50 beds per unit. This requirement pertains toany construction or renovation after November 16, 1988.If medication carts are utilized, sufficient storagespace for the carts and over-the-counter stockmedications must be provided in lieu of a medicationpreparation room.
(g) Utility Rooms. In new nursing facilities and in additionsto existing nursing facilities after December 26, 1988, aseparate clean and soiled utility room shall be provided foreach nursing unit.
1. The clean utility room shall contain as a minimum:
(i) Wall and base cabinets.
(ii) Counter space.
(iii) Counter top sink.
(iv) Paper towel dispenser.
(v) Soap dispenser.
2. The soiled utility room shall contain as a minimum:
(i) Paper towel and soap dispensers.
(ii) Shelves.
(iii) Cabinets for storage of poisonous substances;i.e., cleaning supplies, urine test products, etc.
(iv) Counter top.
(v) Large single compartment counter or freestandingservice sink for chemical sterilization of bedpans,urinals and commode pails.
(vi) Wall mounted or counter top hand washinglavatory, separate from the service sink.
(vii) Soiled linen hamper(s).
(viii) Clinical sink or equivalent flushing-rimfixture unless toilet with bedpan lug and bedpanwasher are provided in adjoining toilets to allbedrooms in the nursing unit.
3. In nursing facilities constructed prior to December26, 1988, each nursing unit shall have at least a clean/
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soiled utility room, but it is recommended that aseparate clean and soiled utility room be provided.
(h) Toilet and Bathing Facilities.
1. For all resident bedrooms, which do not have adjoiningtoilet and bath facilities, plumbing fixtures shall beprovided within the nursing unit, according to thefollowing ratio:
Bathtubs or Showers 1 per 25 BedsLavatories 1 per 6 BedsToilets (water closets) 1 per 6 Beds
2. Non-skid mats, or equivalent and grab bars shall beprovided at tubs and showers. Grab handles on soap dishesare not acceptable for grab bars.
3. Grab bars shall be provided at each water closet.
(i) Nourishment Room.
1. Nursing units in facilities and additions tofacilities constructed after August 23, 1996, shall havea nourishment room containing a work counter,refrigerator, storage cabinet, and a sink for servingnourishments between meals. Ice for residents'consumption shall be provided by icemaker units. Thenourishment room shall include space for trays and dishesused in non-scheduled meal service.
2. Existing facilities shall provide a nourishment roomin accordance with the above paragraph when the nursingunit is remodeled or expanded.
3. Nourishment room shall be separated from corridor bywall and door.
(j) Dining/Recreation/Sitting. In new nursing facilities oradditions to nursing facilities, there shall be residentdining, and recreation/sitting areas in accordance with thefollowing:
1. The total area set aside for these purposes shall beat least 20 square feet per bed for new facilities andfor expanded facilities.
(i) Dining Room. The dining room shall be capable ofseating 50% of the bed capacity.
(ii) Recreation/sitting area. These areas shall notinclude exterior porches and lobby/waiting room.
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2. As a minimum, facility shall include two separaterecreation/sitting areas and a dining area.
3. Each nursing unit shall contain at least onerecreation/sitting area.
4. A minimum of at least one porch and/or glass enclosedsun parlor shall be provided for the use of residents.
(k) Physical Therapy. Physical therapy areas, if provided,shall be in a specifically designated area and shall includeequipment and areas as needed to meet specific residentrequirements and shall also include storage space for linens,supplies, and equipment, a counter top or wall hung handwashlavatory and a service sink in a counter or freestanding.
(l) Laundry.
1. The existing laundry room, or storage and countingarea shall be located so that soiled linens are notcarried through the food service area.
2. Laundries built, renovated, or added to after August23, 1996, shall provide the following rooms and shallcomply with the additional requirements:
(i) Adequate holding, and sorting room for controland distribution of soiled linen. Discharge fromsoiled linen chutes may be received within this roomor in a separate room (soiled linen room).
(ii) The laundry shall be vented so that odors do notenter the nursing facility. Air shall not berecirculated into a heating or cooling system servingother areas of the nursing facility.
(iii) Corridors shall not be used to store or holdsoiled linen or clean linen carts at any time of theday. Adequate space shall be provided in the soiledlinen room and laundry processing room to preventthis.
(m) Beauty/Barber Shop. Nursing facilities or additions tonursing facilities licensed after November 16, 1988, shallhave space and equipment for resident hair care and grooming.The room shall open to a corridor.
(n) Administration. The administrative department and servicesshall be located in a specifically designated area and shallinclude the following:
1. Administrator's office.
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2. Business office.
3. Public lobby or waiting room.
4. Public toilets.
5. For facilities constructed after August 23, 1996, orwhen existing lobbies are renovated, handicapped publictoilets accessible from the lobby/waiting room shall beprovided.
(o) Support Offices. Nursing facilities or additions tonursing facilities constructed after August 23, 1996, shallprovide office space for all support staff.
(p) Nursing facilities and additions to nursing facilitiesconstructed after August 23, 1996, shall provide adequatecloset or locker storage space for staff's work relatedpersonal items.
(q) Maintenance. Each facility shall provide facilities/room(s) to accommodate routine maintenance appropriate to theneeds.
(7) Dietary (applies to all facilities).
(a) Food service facilities shall be located in a designatedarea and shall include the following rooms and spaces: foodproduction, food service, food storage, dishwashing, diningroom, dietary manager's office, water heating equipment, andjanitor closet (mops, brooms, mop sink) in all facilitiesbuilt after August 23, 1996.
(b) The dietetic service area shall be of such size anddimensions as to permit orderly and sanitary handling andprocessing of food. Avoid overcrowding and congestion ofoperations.
(c) Hand washing facilities. Hand washing facilities shall beprovided in all food production and serving areas. Sinks shallbe equipped with a soap dispenser and adequate supply of soap,disposable towels, and hot and cold running water. The use ofa common towel is prohibited. Hands must not be washed insinks where food is prepared.
(d) Refrigeration. Where separate refrigeration can beprovided, temperatures for storing perishable foods are: 32 to38 degrees Fahrenheit for meats, 40 degrees Fahrenheit fordairy products, 45 to 50 degrees Fahrenheit for fruits andvegetables. If it is impractical to provide separaterefrigeration, the temperature shall be maintained at 38 to 40degrees Fahrenheit at all times. Frozen food shall bemaintained at 0 degrees Fahrenheit or below.
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(e) Dish and Utensils Washing, Disinfection and Storage.Facilities shall comply with current requirements of the Rulesof Alabama State Board of Health for Food EstablishmentSanitation, Alabama Administrative Code Chapter 420-3-22-.15“Equipment and Utensil Cleaning and Sanitation,” and Chapter420-3-22-.16, “Equipment and Utensil Storage.”
(8) Sprinkler Systems. Provisions of AAC Chapter 420-5-10-.18notwithstanding:
(a) By January 1, 2006, all totally unsprinklered nursingfacilities, and nursing facilities in multi-story buildingswith sections of a nursing facility unsprinklered, shall beprotected throughout by a fire sprinkler system. By July 1,2005, completed sprinkler plans for these systems shall besubmitted to Public Health for review and approval. Wheremeans of egress passes through building areas outside of anursing facility, those areas shall be separated fromthenursing facility by a 2-hour rated wall or shall beprotected by a fire sprinkler system.
(b) By September 1, 2006, all nursing facilities in one-storybuildings with unsprinklered building areas shall be protectedthroughout by a fire sprinkler system. By March 1, 2006,completed sprinkler plans for these systems shall be submittedto Public Health for review and approval. Where means ofegress passes through building areas outside of a nursingfacility, those areas shall be separated from the nursingfacility by a 2-hour rated wall or shall be protected by afire sprinkler system.
(c) By February 1, 2007, all remaining nursing facilities(those having isolated unsprinklered rooms) shall be protectedthroughout by a fire sprinkler system. By August 1, 2006,completed sprinkler plans for these systems shall be submittedto Public Health for review and approval. Where means ofegress passes through building areas outside of a nursingfacility, those areas shall be separated from the nursingfacility by a 2-hour rated wall or shall be protected by afire sprinkler system.Author: Victor HuntStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:Repealed and Replaced: Filed July 19, 1996; effectiveAugust 23, 1996. Amended: Filed November 18, 1999; effectiveDecember 23, 1999. Amended: Filed June 18, 2002; effective July23, 2002. Amended: Filed September 18, 2003; effective October23, 2003. Amended: Filed June 23, 2004; effective July 28, 2004.
Ed. Note: History: Chapter 420-5-10 “Nursing Homes” (Rules420-5-10-.01 through 420-5-10-.11 filed September 1, 1982. Rule420-05-10-.05. Amended: Filed November 19, 1987. Rule 420-5-10-.07. Amended: Filed November 19, 1987. Entire Chapter repealed andnew chapter adopted in lieu thereof: Filed November 21, 1988.
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Entire Chapter repealed and new chapter adopted in lieu thereof:Filed July 19, 1996.
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