Ala. Admin. Code ch. 420-5-17

Hospices

This Alabama regulation establishes comprehensive licensing and operating standards for hospice care programs, covering both in-home and inpatient hospice facilities. Operators must obtain a license from the State Board of Health, maintain an interdisciplinary team and individualized plan of care for each patient, ensure 24/7 care availability, and comply with requirements governing personnel, nursing services, medical social services, patient rights, contracted services, and physical plant standards. Facilities must report unusual occurrences, maintain medical records, and submit to state inspections.

ALABAMA STATE COMMITTEE OF PUBLIC HEALTH ALABAMA DEPARTMENT OF PUBLIC HEALTHADMINISTRATIVE CODE 
CHAPTER 420-5-17HOSPICES
TABLE OF CONTENTS
420-5-17-.01 Definitions420-5-17-.02 Licensing And Administrative Procedures420-5-17-.03 General Requirements For Hospice CarePrograms After Licensure420-5-17-.04 Patients' Rights420-5-17-.05 Governing Body420-5-17-.06 Personnel420-5-17-.07 Medical Director420-5-17-.08 Interdisciplinary Team AndInterdisciplinary Plan Of Care420-5-17-.09 Contracted Services420-5-17-.10 Volunteer Services420-5-17-.11 Nursing Services420-5-17-.12 Medical Social Services420-5-17-.13 Personal Care Services420-5-17-.14 Physician Services420-5-17-.15 Counseling And Bereavement Services420-5-17-.16 Admission Of Patients To The HospiceCare Program420-5-17-.17 Quality Assurance420-5-17-.18 Medical Records420-5-17-.19 Dietetic Services420-5-17-.20 Medical Supplies, Pharmaceuticals AndBiologicals420-5-17-.21 Laboratory And Radiological Services420-5-17-.22 Transfer Agreement420-5-17-.23 Infection Control420-5-17-.24 Disaster Preparedness420-5-17-.25 Physical Plant Inpatient Hospices420-5-17-A1 Addendum420-5-17-A2 Appendix
420-5-17-.01 Definitions.
(1) Definitions. A list of selected terms often used in connectionwith these rules:
(a) "Aide" means an individual who provides personal careservices for hospice patients and their families as set forthunder 420-5-17-.13.
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(b) "Applicant" means a person or public agency legallyresponsible for operation of the hospice.
(c) "Attending Physician" means the physician identified bythe hospice patient or the hospice patient's family as havingprimary responsibility for the hospice patient's medical care.
(d) "Biological" means a drug with a component containing avirus, therapeutic serum, toxin, antitoxin, or analogousproduct applicable to the prevention, treatment, or cure ofdiseases or injury in man.
(e) "Qualified Dietitian" means a person who graduated from anapproved school and is licensed in the State of Alabama inaccordance with Title 34, Chapter 34A Code of Ala. 1975.
(f) "Dietary Manager" is a person who 1) is a qualifieddietitian, or 2) is a graduate of a dietetic technicianprogram approved by the American Dietetic Association, or 3)is a graduate of a dietary managers training program, approvedby the Dietary Managers Association.
(g) "Governing Body" means the entity that has ultimateresponsibility and authority for the overall operation of aHospice Care Program, as set forth under 420-5-17-.05.
(h) "Hospice Care Program" or "program" means a coordinatedprogram of home, outpatient, and inpatient care and servicesincluding the coordination of the services listed below tohospice patients and families, through a medically directedinterdisciplinary team, under interdisciplinary plans of careestablished pursuant to Section 22-21-20 of the Code of Ala.1975, in order to meet the physical, psychological, social,spiritual, and other special needs that are experienced duringthe final stages of illness, dying, and bereavement:
1. Nursing care by or under the supervision of aregistered nurse.
2. Medical social services by a social worker under thedirection of a physician.
3. Services of an aide.
4. Medical supplies, including drugs and biologicals, andthe use of medical appliances.
5. Physician's services.
6. Short-term inpatient care, including both palliativeand respite care and procedures.
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7. Counseling for hospice patients and hospice patients'families.
8. Services of volunteers under the direction of theprovider of the hospice care program.
9. Bereavement services for hospice patients' families.
(i) "Hospice Patient" or "Patient" means a patient who hasbeen diagnosed as terminally ill, has a limited lifeexpectancy, and has voluntarily requested and is receivingpalliative care from a person or agency licensed to provide ahospice care program under Chapter 17.
(j) "Hospice Patient's Family" or "Family" means a hospicepatient's immediate family members, including a spouse,brother, sister, child, or parent, and any other relative orindividual who has significant personal ties to the patientand who is designated as a member of the patient's family bymutual agreement of the patient, the relative or individual,and the hospice program's interdisciplinary team.
(k) “Inhome Hospice” means a facility that provides hospicecare services in a patient’s home.
(l) "Inpatient Hospice" means a facility that either isoperated by or under contract with a hospice care program forthe purpose of providing inpatient care to the program'spatients.
(m) "Interdisciplinary Plan of Care" or "Plan of Care" meansthe interdisciplinary plan for care of a hospice patient andhis or her family.
(n) "Interdisciplinary Team" means a working unit composed ofprofessional and lay persons that includes at least aphysician, a registered nurse, a social worker, a chaplain,member of the clergy or a counselor, and a volunteercoordinator.
(o) "Legend Drug" means a prescription drug.
(p) "Licensed Practical Nurse" means a person ,licensed inaccordance with Code of Ala. 1975 Section 34-21-22.
(q) "Manager" means a person delegated the responsibility forthe interpretation, implementation, and proper application ofpolicies and programs established by the governing authority.This responsibility shall be accompanied by correspondingauthority.
(r) "May" indicates permission.
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(s) "Nurse" means registered nurse or licensed practicalnurse.
(t) "OTC Drug" means a non-prescription drug.
(u) "Palliative Care" means treatment directed at controllingpain, relieving other symptoms, and focusing on the specialneeds of a hospice patient and the hospice patient's family asthey experience the stress of the dying process, rather thantreatment aimed at investigation and intervention for thepurpose of cure or prolongation of life.
(v) "Person" means an individual, corporation, business trust,estate, trust, public agency, partnership, and/or association.
(w) "Pharmacist" means a person graduated from an approvedschool of pharmacy currently licensed to practice pharmacy inAlabama under the provisions of Title 34, Chapter 23 of Codeof Ala. 1975.
(x) "Physician" means a person currently licensed to practicemedicine in accordance with Title 34, Chapter 24, Article 8 of Code of Ala. 1975.
(y) "Respite Care" means hospice care program servicesprovided by the program to give temporary relief to a hospicepatient's family or other caregivers.
(z) "Registered Nurse" means a person licensed in accordancewith Code of Ala. 1975, Section 34-21-21.
(aa) "Shall" indicates mandatory requirements.
(bb) "Social Worker" means a person who holds at least abachelors degree in social work from an accredited school ofsocial work, and is currently licensed by the State of Alabamaor supervised in accordance with Title 34, Chapter 30 of Codeof.Ala. 1975
(cc) "Volunteer" means a lay or professional person who offersand provides his or her services to a hospice care programwithout compensation.
(dd) "Volunteer Coordinator" means a lay or professionalperson who is responsible for assigning volunteers topatients, families, and other duties, including recruiting,training, retaining volunteers and evaluating the volunteerprogram.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effective
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July 19, 2000. Amended: Filed January 15, 2003; effectiveFebruary 19, 2003.
420-5-17-.02 Licensing And Administrative Procedures.
(1) Legal Authority for Adoption of Regulations. Pursuant to theauthority granted by Code of Ala. 1975, Sections 22-21-20 toSections 22-21-33, and in accordance with the AlabamaAdministrative Procedures Act, Code of Ala. 1975, Sections 41-22-1to Section 41-22-27, the State Board of Health does hereby adoptand promulgate rules governing all nursing or hospices in Alabamaexcept those exempt by law from licensure.
(2) Type of license. All licenses are issued for the calendar yearand shall expire December 31 unless renewed by the owner for thesucceeding year.
(a) Regular license. A regular license shall be issued by theState Board of Health after the board has determined that thehospice is in substantial compliance with rules hereinadopted.
(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 hospice no longer substantially complies with the rulesadopted herein. However, the Board may issue a probationallicense only after determining that the health and safety ofpatients are adequately protected despite non-compliance, andthat the facility has submitted an adequate written plan tocorrect the non-compliance in a timely manner. Maximum lengthof time for probational status is one year.
(3) Application and Fee.
(a) Every hospice 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 in order for the application to beprocessed and considered.
(b) Each application for licensed shall be accompanied by afee as mandated by statute. No fee shall be refunded. Feesshall be paid by cash, check or money order made payable tothe Alabama Department of Public Health.
(4) Licensing.
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(a) Issue of License. The license document issued by the StateBoard of Health shall set forth the name and location of thehospice, the type of facility, the area of operation, the bedcapacity, if applicable, and the type of license (regular orprobational).
(b) Separate licenses. A separate license shall be requiredfor each hospice when more than one hospice is operated underthe same management, at a different location, and has aseparate professional staff and patient load.
(c) Name of hospice. Every hospice must be designated by apermanent and distinctive name which shall be used in applyingfor a license and shall not be changed without prior writtennotice to the Board specifying the name to be discontinued aswell as the new name.
(d) Location of hospice. A hospice must be physically locatedwithin the State of Alabama.
(5) Basis for Denial of License.
(a) The State Board of Health may deny a license to anycorporation, partnership or individual making application toown or operate any hospice if said corporation, partnership orindividual:
1. Has falsified any information or record required bythe application for license.
2. Has been found by a court or by a state or federalagency after the provision of appropriate due process tohave committed abuse or neglect of any individual or tohave misappropriated the property of a patient orresident of a health care facility.
3. Has been convicted of fraud in this or any state, orin any federal jurisdiction within the past five years.
4. Has previously been the subject of license revocationproceedings and does not demonstrate a present abilityand willingness to fully comply with State Board ofHealth rules, or
5. Is unable to demonstrate sufficient ability andresources to fully comply with State Board of Healthrules.
(b) Basis for license revocation. The State Board of Healthmay revoke a license to operate a hospice if the owner and/oroperator of said facility:
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1. Violates any of the provisions of these rules andregulations.
2. Permits, aids or abets the commission of any illegalact in such hospice, or
3. Engages in conduct or practices deemed by the StateBoard of Health to be detrimental to the welfare of thepatients of such hospice.
(6) 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 Alabama Administrativefor contested case proceedings under the Procedures Act, Code ofAla. 1975, Section 41-22-17, and Chapter Alabama AdministrativeCode420-1-3 of the .
(7) Research Projects. Any licensee who is, or contemplates being,engaged in a bona fide research program which may be in conflictwith one or more specific provisions of these rules may makeapplication for waiver of the specific provisions in conflict.Application for waiver shall be made in writing to the LicensureAdvisory Board who shall, upon completion of its investigation,send its findings, conclusions, and recommendations to the StateBoard of Health for final action.
(8) Reissuance of License. The following changes in the status ofthe hospice will require issuance of a new license, uponapplication and payment of a licensing fee.
(a) Change in hospice ownership. A change of ownership occurswhenever there is a change in the legal form under which thecontrolling entity is organized. Transactions constituting achange of ownership include, but are not limited to, thefollowing:
1. Sale or donation of the hospice's legal title.
2. Lease of the entire hospice's real and personalproperty.
3. A sole proprietor becomes a member of a partnership orcorporation, succeeding him as the new operator.
4. A partnership dissolves.
5. One partnership is replaced by another through theremoval, addition or substitution of a partner.
6. Two or more corporations merge and the originallylicensed corporation does not survive.
7. Corporations consolidate.
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8. A non-profit corporation becomes a generalcorporation, or a for-profit corporation becomes non-profit.
(b) Increase in bed capacity.
(c) Changes in type of care offered (home care to inpatient).
(d) The following status changes require issuance of a newlicense without payment of licensure fee:
1. Change in facility name.
2. Relocation of the hospice.
3. Change in service area.
(e) 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.
(9) Compliance Exceptions. At its discretion, the State Board ofHealth may grant an exception to or modify the application of oneor more provisions of these rules or referenced codes for a periodand under conditions, if any, determined by the Board. Theexceptions or modifications shall be based on hardship,impracticability, or economic infeasibility in complying with therules. The hospice's request shall be in writing, shall state thespecific provisions for which the exception or modification isrequested, and reasons for each requested exception ormodification.
(10) Compliance with State and Local Laws.
(a) Licensing of staff. Staff of the hospice shall be licensedor registered in accordance with applicable laws.
(b) Compliance with other laws. The hospice shall be incompliance with state and local laws relating to fire andsafety, sanitation, communicable and reportable diseases,certificate of need, if applicable, and other relevant healthand safety requirements.
(11) Inspections. Failure or refusal to submit to a survey willresult in initiation of license revocation proceedings. Findingsnoted during any survey shall be corrected by execution of a planof correction. The plan of correction shall be succinctly writtento address identified problems in a timely manner not to exceed 60days or such other time as may be required by the director.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.
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History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed January 15, 2003; effectiveFebruary 19, 2003.
420-5-17-.03 General Requirements For Hospice Care ProgramsAfter Licensure.
(1) Any person licensed to provide a hospice care program shall:
(a) Ensure the provision of the core services of nursing,social work, physician, pastoral or other counseling andvolunteer services. The majority of these services shall beprovided directly by hospice employees. Persons providingthese services directly or by contract shall be responsibleto, and function as part of, the interdisciplinary team. Aplanned and continuous hospice care program, the medicalcomponents of which shall be under the direction of aphysician, shall be provided.
(b) Ensure that care is available twenty-four hours a day andseven days a week.
(c) Establish a written interdisciplinary plan of care foreach hospice patient and family that:
1. Is coordinated by one designated individual who shallensure that all components of the plan of care areaddressed and implemented.
2. Addresses maintenance of patient-family participationin decision making.
3. Is periodically reviewed by the patient’s attendingphysician and by the patient’s interdisciplinary team.
4. Ensures that an interdisciplinary team provides orsupervises the provision of care and establishes thepolicies governing the provision of care.
5. Provides bereavement care for hospice patient’s familyfor at least one year, or until appropriately dischargedfrom the bereavement program.
6. Continues care regardless of a hospice patient’sability to pay for the care.
7. Maintains central clinical records on all hospicepatients under its care.
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8. Provides care in individual’s homes and provides orcoordinates care on an inpatient basis. Not more than 50%of the home care days shall be provided to residents ofnursing homes.
(2) Each licensed hospice care program shall notify the AlabamaDepartment of Public Health, in writing, of any of the following:
(a) Any change that would render the information submitted inthe license application inaccurate. Said information must besubmitted at least twenty-one days prior to the effective dateof the change.
(b) Any intent to cease operation of the program. Suchnotification shall be submitted at least 60 days prior toceasing operation, and shall include a plan for assuringcontinuity of care for the program’s patients and theirfamilies after the cessation.
(3) Vital Statistics Reports. A record shall be kept of allbirths, deaths, and stillbirths that occur within the inpatienthospice. By the fifth day of each month, the manager shall make areport of such births, deaths, and stillbirths for the precedingmonth on such forms as the State Board of Health shall provide tothe county health officer, or in counties without a county healthofficer, to the State Registrar. This report shall be in additionto the official birth, death, and stillbirth certificates. Ifthere are no births, deaths, or stillbirths in any month, a reportshall be made stating that fact to the county health officer.
(4) Unusual Occurrences. Occurrences such as catastrophes andunusual occurrences which threaten the welfare, safety of healthof patients, personnel, or visitors shall be reported by thehospice within 24 hours either by telephone (and confirmed inwriting) or by facsimile to the Alabama Department of PublicHealth and other agencies/authorities as required. Theseoccurrences include, but are not limited to, suspected cases ofpatient abuse, life threatening burns, fires, deaths under unusualcircumstances, and outbreaks of infectious reportable diseases.
(5) Patient Transport. If a patient is unable to ride in anupright position or if such patient’s condition is such that he orshe needs observation or treatment by Emergency Medical Servicespersonnel, or if the patient requires transportation on astretcher, gurney or cot, the facility shall arrange or requesttransportation services only from providers who are ambulanceservice operators licensed by the Alabama State Board of Health.If such patient is being transported to or from a health carefacility in another state, transportation services may be arrangedwith a transport provider licensed as an ambulance serviceoperator in that state. For the purposes of this rule, and uprightposition means no more than 20 degrees from vertical.Author: Rick Harris
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Statutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed June 23, 2004; effective July 28,2004.
420-5-17-.04 Patients' Rights.
(1) Policies and Procedures regarding the rights andresponsibilities of patients shall be written, implemented, andmade available to patients, to any guardians, to any sponsor,next-of-kin, sponsoring agency (or agencies), representativepayees, and to the public. Patients and sponsors will be informedon patient rights and given the toll-free complaint telephonenumber for the Alabama Department of Public Health, both verballyand in writing, at the time of admission. This shall be documentedin the patient’s record. The staff shall be trained and involvedin the implementation of these policies and procedures. Postersclearly stating patient rights will be visible in key locations inthe hospice. These posters will also include the toll-freecomplaint telephone number. These patients’ rights polices andprocedures ensure that, at least, each patient admitted to thehospice:
(a) Has the right to be fully informed, as evidenced by thepatient’s written acknowledgment prior to or at the time ofadmission and during stay, of these rights and of all rulesand regulations governing patient conduct andresponsibilities.
(b) Be fully informed of services available and of relatedcharges including any charges for services not covered bythird party payers.
(c) Be fully informed by a physician of his or her medicalcondition unless medically contraindicated (as documented by aphysician in the medical record); and, is afforded theopportunity to participate in the planning of his or hermedical treatment and the right to refuse treatment orparticipation in experimental research.
(d) Is not to be transferred or discharged except whentransfer or discharge is necessary for the patient's welfareand the patient's needs can no longer be met or when thepatient presents a direct threat to the health or safety ofothers, for medical reasons, or for his or her welfare or thatof other patients, or for nonpayment for his or her stay. Thehospice shall discuss discharge plans with the patient ortheir legal representative, the hospice Medical Director and/or attending physician and the appropriate interdisciplinaryteam members prior to the discharge. The hospice shall
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identify post hospice care needs and provide adequatedischarge planning. The hospice patient or their legalrepresentative shall be provided written dischargeinstructions on medication management and procurement, durablemedical equipment, availability of community resources andother identified needs at the time of discharge. The requireddischarge forms must be completed timely. Such actions shallbe documented in the medical record.
(e) Is encouraged and assisted throughout the period of stayto exercise rights as a patient and as a citizen, and to thisend may voice grievances and recommend changes in policies andservices to hospice staff and/or to outside representative ofhis or her choice without being subjected to restraint,interference, coercion, discrimination, or reprisal.
(f) May manage his or her personal financial affairs. Should apatient delegate responsibility to the hospice for themanagement of his or her financial affairs, said delegationshall be in writing, and the hospice shall provide the patientwith at least a quarterly accounting of financial transactionsmade on his or her behalf.
(g) Is free from mental and physical abuse; and free fromchemical and (except in emergencies) physical restraints,except as authorized in writing by a physician for a specifiedand limited period of time, or when necessary to protect thepatient from injury to self or to others.
(h) Is assured confidential treatment of personal and medicalrecords, and may approve or refuse their release to anyindividual outside the hospice except in case of transfer toanother health care institution or as required by law orthird-party payment contract.
(i) Is treated with consideration, respect, and with fullrecognition of his or her dignity in caring for personalneeds.
(j) Is not required to perform services for the hospice thatare not included for therapeutic purposes in the plan of care.The following apply to inpatient hospices:
1. May associate and communicate privately with personsof his or her choice, and send and receive personal mailunopened.
2. May meet with and participate in the activities ofsocial, religious, and community groups at his or herdiscretion.
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3. May retain and use personal clothing and possessionsas space permits, unless to do so would infringe uponrights of other patients.
(k) If married, is assured privacy for visits by his/herspouse. If both are inpatients in the hospice, they arepermitted to share a room. The following apply to allhospices:
(2) Responsible Party (Parties).
(a) In the case of a patient 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.
(b) In the case of a patient who has not been adjudgedincompetent by the state court, any legal surrogate designatedin accordance with state law may exercise the resident’srights to the extent provided by state law.
(3) Notification of Changes in Patient Status. The hospice shallhave appropriate written policies and procedures relating tonotification of the patient’s attending physician and otherresponsible persons in the event of accident involving thepatient, or other significant change in the patient’s physical,mental or emotional status. Except in medical emergency, a patientshall not be transferred or discharged, nor treatment alteredradically, without consultation with the patient or, if thepatient is incompetent, without prior consultation with next-of-kin or sponsor.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed July 22, 2013; effective August26, 2013.
420-5-17-.05 Governing Body.
(1) The overall conduct and operation of the hospice care program,including the quality of care and the provision of services, shallbe the full legal responsibility of a clearly defined, organizedgoverning body which shall perform the following functions:
(a) Establish and review policies for the management,operation, and evaluation of the hospice care program,including establishing qualifications of employees andindependent contractors.
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(b) Arrange for a physician to serve as medical director forthe hospice care program.
(c) Appoint in writing an individual who is responsible forthe day to day management of the hospice program.
(2) There must be an individual authorized in writing to act forthe manager during the manager’s absences.
(a) The manager serves as liaison between the governing bodyand the professional staff, consultants, and other agenciesand organizations.
(b) The manager acts upon recommendations of the hospice’scommittees, department heads and consultants.
(c) Written notification shall be made to the AlabamaDepartment of Public Health, within 15 days of the manager’sappointment.
(3) Financial. The accounting method and procedures used shall besufficient to permit an annual audit, accurate determination ofthe cost of operation, and the cost per patient per day.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.06 Personnel.
Each hospice care program shall utilize personnel to provideservices that have appropriate training and qualifications for theservices that they provide. Any staff member, including avolunteer, who functions in a professional capacity shall meet thestandards applicable to that profession, including but not limitedto, possessing applicable license, registration, or certification,if required by law, and practicing within the applicable scope ofpractice.
(1) The hospice care program shall provide each staff member,including volunteer and contracted staff members, with awritten job description delineating his or herresponsibilities. The program shall assure that all staffmembers, including volunteers, provide services to hospicepatients and their families in compliance with all of thefollowing standards:
(a) Services are provided in accordance with thepatient’s plans of care.
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(b) Services are provided in accordance with the policiesand procedures developed by the interdisciplinary team orteams.
(c) Services are provided in accordance with current andaccepted standards of practice.
(d) Services are provided by staff members who complywith the program’s employee health policies.
(e) All services are documented in the patient’s centralclinical record.
(2) Each hospice care program shall have a policy whichprovides for orientation and ongoing education programs forits personnel, including volunteers that is consistent withacceptable standards of hospice practice which emphasizes:
(a) The hospice care programs’ goals and services.
(b) Confidentiality and the protection of patient andfamily rights.
(c) Procedures for responding to medical emergencies ordeaths.
(d) The physiological and psychological aspects ofterminal illness.
(e) Family dynamics, coping mechanisms, and psychosocialissues surrounding terminal illness, death, andbereavement.
(f) Safety policies and procedures.
(g) General communication skills.
(h) Licensed nurses, in addition, shall be trained inpain and symptom management.
(i) Documentation of orientation and ongoing educationshall be maintained in the personnel or volunteer file.
(3) Each hospice care program shall evaluate the performanceof each staff member at least annually.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
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420-5-17-.07 Medical Director.
The medical director of a hospice care program shall be aphysician licensed to practice medicine in the State of Alabamaand shall have overall responsibility for the medical component ofthe program.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed January 15, 2003; effectiveFebruary 19, 2003.
420-5-17-.08 Interdisciplinary Team And Interdisciplinary PlanOf Care.
Each hospice care program shall have an interdisciplinary team orteams that provides or supervises the provision of hospice careand services.
(1) The interdisciplinary team or teams shall perform thefollowing functions:
(a) Establish policies and procedures governing theprovision of care.
(b) Establish an interdisciplinary plan of care for eachpatient and family.
(c) Coordinate and provide or supervise the provision ofall components of each interdisciplinary plan of care. Atleast one individual shall be designated to ensure all ofthe following:
1. There is ongoing assessment of the patient’s andfamily’s needs.
2. All components of the plan of care are addressedby the interdisciplinary team.
3. The plan of care is implemented in accordance withits terms.
4. Review the interdisciplinary plan of care at leastevery 30 days.
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5. Encourage and foster active involvement of thepatient and family in the development andimplementation of the interdisciplinary plan of care.
6. Evaluate the care and services provided andmonitor the continuity of care across all settingsfor the hospice care program’s patients and theirfamilies.
(2) A hospice care program shall ensure that each patient’sattending physician reviews the patient’s plan of care atleast every 90 days.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.09 Contracted Services.
A provider of a hospice care program may arrange for anotherperson or public agency to furnish a component or components ofthe hospice care program pursuant to a written contract.
(1) Any contract executed under the paragraph above, includinga contract to which paragraph (2) of this rule applies, shallbe legally binding on both parties and shall do all of thefollowing:
(a) Identify the services to be provided.
(b) Stipulate that services may be provided only with theexpress authorization of the hospice care program.
(c) Describe the manner in which the contracted servicesare coordinated, supervised, and evaluated by the hospicecare program.
(d) Delineate the role or roles of the hospice careprogram and the contractor in the admission process,patient and family assessment, and the interdisciplinaryteam reviews.
(e) Stipulate the requirements for documenting thatservices are furnished in accordance with the contractand the requirements of Section 22-21-20 of the revisedCode and this Chapter.
(f) Set forth the qualifications of the personnelproviding the services.
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(g) Stipulate that the hospice care program shall providehospice care orientation and training sufficient toprovide competent care to the person who provides thecare under the contract.
(2) When a provider of a hospice care program arranges for ahospital, a home providing nursing care, or home health agencyto furnish a component or components of the hospice careprogram to its patient, the care shall be provided by alicensed, certified, or accredited hospital, inpatienthospice, home providing nursing care, or home health agencypursuant to a written contract under which:
(a) The provider of a hospice care program furnishes tothe contractor a copy of the hospice patient’sinterdisciplinary plan of care which specifies the carethat is to be furnished by the contractor.
(b) The regimen described in the established plan of careis continued while the hospice patient receives care fromthe contractor, subject to the patient’s needs, and withapproval of the coordinator of the interdisciplinaryteam.
(c) All care, treatment, and services furnished by thecontractor are entered into the patient’s medical record.
(d) The designated coordinator of the interdisciplinaryteam ensures conformance with the established plan ofcare.
(e) The contractor complies with the requirements ofthese rules.
(f) Those hospices not providing inpatient care shallencourage any hospital contracting for inpatient care tooffer temporary limited privileges to the hospicepatient’s attending physician while the hospice patientis receiving inpatient care from the hospital.
(3) The hospice care program shall assure the continuity ofpatient and family care in the home, outpatient, and inpatientsettings.
(4) The hospice care program shall retain professionalmanagement responsibility for contracted services, shallensure that those services are furnished in a safe andeffective manner by persons meeting the qualificationsprescribed by this Chapter, and in accordance with thepatient’s plan of care and the other requirements of thisChapter.
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(5) The hospice care program shall retain responsibility forpayment for services provided by a contractor.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.10 Volunteer Services.
(1) Each hospice care program shall use trained volunteers toassist with the provision of administrative or direct patient careservices and shall have trained volunteers available to hospicepatients and hospice patients’ families as needed. Volunteersshall provide services under the supervision of a designated,qualified, and experienced hospice staff member.
(2) Each hospice care program shall document active and ongoingefforts to recruit and retain volunteers.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.11 Nursing Services.
(1) Each hospice care program shall provide nursing care andservices by or under the supervision of a registered nurse. Theprogram shall direct and staff nursing services sufficient to meetthe nursing needs of all of the hospice care program’s patients.The program shall specify the patient care responsibilities ofnursing personnel.
(2) Each inpatient hospice shall provide nursing services twenty-four hours a day. These services shall be sufficient to meet thetotal nursing needs of the hospice patients residing in thehospice. Each shift shall be staffed by a registered nurse whoprovides direct patient care and directs the care of LPNs andaides. This requirement does not apply to hospice patients who areadmitted to a Medicare or Medicaid certified facility such as askilled nursing facility for respite care only.
(3) Each hospice agency that provides respite care in a non-hospice inpatient facility shall have a written agreement withthat facility to ensure that:
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(a) Each patient receives all necessary care and services inaccordance with the patient’s individualized plan of care in asafe and effective manner by qualified personnel.
(b) The hospice agency retains administrative oversight forall staff qualifications, supervision and training in thehospice model for respite careAuthor: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed July 22, 2013; effective August26, 2013.
420-5-17-.12 Medical Social Services.
(1) Each hospice care program shall provide medical socialservices to each patient and family as needed. A social workershall provide these services under the direction of a physician.
(2) Each inpatient hospice facility shall provide medical socialservices sufficient to meet the social service needs of thehospice patients residing in the facility.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.13 Personal Care Services.
(1) Each hospice care program shall provide personal care servicesin the scope and frequency required to meet the needs of itspatients and their families. Personal care services includeassistance with activities of daily living, personal care,ambulation and exercise, household services essential to healthcare at home, assistance with self-administration of medications,and preparation of meals.
(2) Personal care services shall be provided by individuals whohave been selected on the basis of such factors as a caringattitude toward patients and their families, ability to read,write, and carry out instructions, and maturity and ability tocope with the demands of the job.
(3) The hospice care program shall ensure that those individualsproviding personal care services have been trained in methods ofassisting patients to achieve maximum self-reliance, principles ofnutrition and meal preparation, the aging process and emotional
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problems of illness, procedures for maintaining a clean,healthful, and pleasant environment, changes in a patient’scondition that should be reported, the philosophy of hospice careand of the hospice care program, ethics, confidentiality, andrecord keeping.
(4) A registered nurse shall prepare for each aide writteninstructions for patient care which are consistent with theinterdisciplinary plan of care.
(5) A registered nurse shall make and document a supervisory visitto the patient’s residence at least every two weeks to assess theperformance of the aide services.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.14 Physician Services.
(1) Patients in need of health care which can be met by thehospice are admitted to the hospice only upon the recommendationof, and remain under the care of, a physician. Each patient orsponsor designates a physician.
(2) There is made available prior to or at the time of admissionpatient information which includes current medical findings,diagnoses, and orders from the physician for the immediate care ofthe patient. A summary of prior treatments are made available atthe time of admission or within 48 hours thereafter. The followingprovisions are applicable:
(a) If orders are from a physician other than the attendingphysician, they shall be communicated to the attendingphysician and verification of such shall be entered into themedical record by the nurse who took the orders from thephysician.
(b) Physician’s verbal orders for drugs, treatments, diets,etc., (e.g., oral orders, telephone orders, recopied orders,standing orders) are reduced to writing on the physicians’order sheet by a licensed nurse, physician, or pharmacist.They are dated and signed by the person receiving ortranscribing the order. Such orders are dated and signed bythe attending physician at the time of the next visit, but inno case longer than 30 days after dating and recording theorder.
Dietary counseling means education and interventions providedto the patient and family regarding appropriate nutritional
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intake as the patient’s condition progresses and is providedby qualified individuals, which may include a registerednurse, dietitian, or nutritionist, when identified in thepatient’s plan of care.
(c) The attending physician shall designate an alternatephysician to attend the patient in his/her absence.
(d) The hospice has written procedures, available at thenurses’ station, that provides for having a physicianavailable to furnish necessary medical care in case ofemergency.
(e) In each inpatient hospice the physician shall write/dictate, date, and sign a progress note at the time of eachpatient’s visit or within 7 days.
(f) In each inpatient hospice any changes in theinterdisciplinary treatment team care plan shall be dated andsigned by the physician at the time of each visit or within 7days.
(g) The physician is responsible for the development of adischarge summary within 30 days after discharge or death.
(h) Each inpatient hospice must have a list of names andtelephone numbers of physicians to be called in the event ofan emergency.
(3) Documentation of emergencies, accidents and injuries. All thehospices shall have policies and procedures established relativeto documentation of emergencies, accidents, and injuries topatients and staff.
(a) Sufficient information shall be documented in the medicalrecord and/or on the accident and incident record to reflectfacts about the incident, injuries, actions taken, andphysician contacted. Dated and signed entries in the medicalrecord and/or the incident and accident record shall be madeby the physician and other appropriate hospice staff.
(b) The manager and appropriate staff shall be providedwritten reports of accidents and injuries.
(c) These reports shall serve the medical director and otherappropriate staff as a basis for a written recommendation forcorrective action.Author: Jimmy D. Prince, Dana BillingsleyStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Published March 31, 2022; effective May15, 2022.
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420-5-17-.15 Counseling And Bereavement Services.
(1) Each hospice care program shall make available counselingservices to the hospice patient and the patient’s family.Counseling services shall include dietary, spiritual, and anyother necessary counseling services while the patient is enrolledin the hospice care program. Counseling services shall be providedby a qualified interdisciplinary team member or one or more otherqualified individuals, as determined by the hospice care program.
(2) The hospice care program shall make reasonable efforts toarrange for contacts by clergy, chaplain, and other members ofreligious organizations in the community to patients who requestsuch services and shall apprise patients of this opportunity.
(3) Each hospice care program shall provide bereavement services,as needed, for hospice patients’ families. These services shall beprovided for at least one year after the patient’s death unlessdiscontinued by the family. Bereavement services shall be providedunder the supervision of a designated qualified professional.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.16 Admission Of Patients To The Hospice CareProgram.
(1) A hospice care program shall not admit any individual who doesnot meet the definition of a hospice patient.
(2) A hospice care program shall obtain informed consent from thepatient. The program shall require that the patient, or thepatient’s authorized representative, sign an informed consentform.
(3) A hospice care program shall permit a hospice patient towithdraw consent for hospice care at any time.
(4) Prior to or within forty-eight hours after admission of eachpatient, a hospice care program shall obtain an oral statementfrom the patient’s attending physician, if the patient has anattending physician, and the medical director of the hospice careprogram or the physician member of the interdisciplinary team,certifying that the patient is terminally ill. The program shallobtain written confirmation of the oral statement within thirtydays after admission or prior to billing for any services,
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whichever is earlier. The written certification statement shall besigned by the patient’s attending physician and the medicaldirector of the hospice care program or the physician member ofthe interdisciplinary team.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.17 Quality Assurance.
(1) Each hospice care program shall conduct an ongoing,comprehensive, integrated, self-assessment of the quality andappropriateness of care provided by the program includinginpatient care, home care, and care provided under contracts withother persons or public agencies.
(2) The hospice care program shall designate an individual orindividuals to be responsible for the quality assurance program.The designee or designees shall implement and report on activitiesand mechanisms for monitoring the quality of care, identify andresolve problems, and make suggestions for improving care. Thedesignee or designees shall provide their reports to the governingbody of the program.
(3) The hospice care program shall use the findings of the qualityassurance program to correct identified problems and to revisehospice care program policies if necessary.
(4) Documentation of findings, recommendations, and correctionsshall be maintained.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.18 Medical Records.
The hospice develops policies and procedures governing all aspectsof the medical record.
(1) Records Shall be Confidential. When an individual enters ahospice program, records and information regarding him areconfidential. Access to these records shall be limited to thepatient, designated team members, physicians, others havingprofessional responsibility, representatives of the State
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Board of Health, and such other persons as the patient maydelegate.
(2) Each hospice care program shall establish and maintain acentral clinical record for each hospice patient receivingcare and services from the program and his or her family. Therecord shall be established and maintained in accordance withaccepted principles of practice.
(3) The clinical record shall be a comprehensive compilationof information that is documented promptly for all servicesprovided. The record shall be organized systematically tofacilitate retrieval of information. Entries to the clinicalrecord shall be made and signed by the person providing theservice. All services, whether furnished by employees, personsunder contract, or volunteers, shall be documented in theclinical record.
(4) Each clinical record shall contain at least the followinginformation:
(a) Identification data.
(b) Pertinent medical history.
(c) Consent and authorization forms.
(d) Initial and subsequent assessments.
(e) The interdisciplinary plan of care.
(f) Documentation of all services and events, such asevaluations, treatments, and progress notes.
(g) The hospice care program shall provide for storage ofthe central clinical records to protect them againstloss, destruction, and unauthorized use.
(5) Completion of Records and Centralization of Reports.Medical records of discharged patients shall be completedwithin 60 days. All clinical information pertaining topatient’s stay is centralized in the patient’s medical record.
(6) Retention and Preservation. Medical records are retainedfor a period of time not less than five years from date ofdischarge or, in the case of a minor, three years after thepatient becomes of age under state law.
(7) Disposition of Medical Records. When a Hospice ceases tooperate either voluntarily or by revocation of its license,the governing body (licensee) at or prior to such action shalldevelop a proposed plan for the storage, access anddisposition of its medical records. Such plan shall be
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submitted in writing to the Alabama Department of PublicHealth for review and approval. The plan must containprovisions for proper storage, safeguarding andconfidentiality, as well as access to, transfer or disposal ofmedical records.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.19 Dietetic Services.
Those facilities located within a hospital or nursing home shallmeet the dietary licensure requirements of that facility. In theinpatient hospice classified as a health care-1imited carefacility, the provision of dietary services shall comply with thefollowing:
(1) Staffing. A consulting qualified dietitian is available toassist in nutritional assessment menu planning, inservicingstaff and evaluating safe food production. This informationshall be included in the quality assurance program. A facilitywhich does not provide the services of a certified dietarymanager must, as a minimum, train all employees through thecounty health departments’ food managers training course or acomparable course.
(a) If consultant dietetic services are used, theconsultant’s visits are at appropriate times and ofsufficient duration and frequency based upon the size andneeds of the hospice to provide continuing liaison withmedical and nursing staffs, advice to the manager,patient counseling, guidance to the supervisor and staffof dietetic service, approval of all menus, andparticipation in development or revision of dieteticpolicies and procedures and in planning and conductinginservice education programs.
(b) The hospice employees sufficient supportive dieteticpersonnel competent to provide a hygienic dietary servicethat meets the daily nutritional and special dietaryneeds of patients, and provides palatable and attractivemeals.
(2) Preparation and Service of Food. Foods are prepared bymethods that conserve nutritive value, flavor, and appearanceand are attractively served. Prepared food is maintained onthe serving line at 140 degree F. Cold food, particularlysusceptible food such as milk, etc., shall be maintained atless than 45 degree F. at serving. If a patient refuses food
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served, appropriate substitutes of similar nutritive value areoffered during that meal.
(a) If patients require assistance in eating, food shallbe maintained at 100 degree F. serving temperature untilassistance is provided.
(b) Dietetic service personnel shall practice hygienicfood handling techniques.
(c) Employees engaged in the handling, preparation, andserving of food shall:
1. Wear clean clothing at all times.
2. Shall have hair appropriately covered with hairnets or caps.
3. Wash their hands thoroughly before starting workeach day, immediately after contact with any soiledmatter, immediately after working with raw meats, andbefore returning to work after leaving the work area.Personnel with infections, or open cuts may nothandle foods.
(d) Food service employees shall not be assigned dutiesoutside the dietetic service that interfere with thesanitation, safety, or time required for dietetic workassignments.
(e) There shall be no use of tobacco products in thedietary department.
(f) The public, patients, and employees shall be allowedto eat or smoke only in designated areas.
(3) Sanitary Conditions. Food is procured from sourcesapproved or considered satisfactory by state authorities andstored, prepared, distributed, and served under sanitaryconditions. Waste is disposed of properly, i.e., kitchengarbage and trash shall be placed in containers with tightfitting lids and stored in a screened or refrigerated spacepending removal. Kitchen garbage and trash shall not beallowed to accumulate in the kitchen and shall be removed fromthe premises at frequent intervals. After emptying, all soiledgarbage and trash cans shall be washed thoroughly inside andout and dried before reuse.
(a) Protection from contamination. All foods and foodingredients shall be so packaged, stored, handled andserved as to be protected from dust, flies, roaches,rats, unsanitary handling, droplet infection, overheadleakage, sewage backflow, and any other contamination.
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Sugar, syrup and condiment receptacles shall be providedwith tight fitting lids, and shall be kept covered whennot in use. Refrigerated food shall be covered, labeledand dated. All foods removed from original containershall be properly protected and labeled.
(b) Ice. All ice used in the inpatient hospice shall bemade of water obtained from a source approved by theState Board of Health. Ice shall be protected fromsplash, drip, and hand contamination during storage andservice. All ice shall be free of visible trash andsediment. Ice scoops shall be stored in a manner so as toprotect them from becoming soiled or contaminated betweenusage.
(c) Families are allowed to store home cooked food fortheir patient. This storage shall be readily availableand meet the same standards as foods prepared by thehospice. Food brought from home will not be commingledwith the food prepared for other patients.
(4) Storage and Service of and Ice Cream. All milk and fluidmilk products shall be served only from the originalcontainers in which they were received from the distributorprovided, however, that this shall not apply to cream forcoffee, cereals, and milk mixed drinks which may be dispensedfrom a readily cleanable container approved for such use.
(a) Milk and fluid milk products shall not be stored sothat any bottle or container from which the milk or milkproducts is to be poured or consumed may become submergedin water, or so that their tops may become contaminatedfrom drip or contact with foods, ice, etc.
(b) All purchased ice cream and other frozen dessertsshall be from an approved source. No contaminatingsubstance shall be stored with or over containers of icecream. Ice cream dippers, spatulas, etc., shall be storedbetween uses in clean running water in a sanitary manner.
(c) Equipment used for dispensing or storage of ice creamor other frozen desserts shall be thoroughly cleanedfollowing each use.
(d) Raw eggs shall not be served.
(e) Dry milk powder may be used in cooked products orspecial formulas. Milk made from dry milk powder shallnot be served as a beverage.
(5) Physical Facilities. Location and space requirements. Foodservice facilities shall be located in a specifically
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designated area and shall include the following rooms and/orspaces: kitchen, dishwashing, food storage and dining room.
(a) Kitchen.
1. Size and dimensions. The kitchen shall be of suchsize and dimensions as to:
(i) Permit orderly and sanitary handling andprocessing of food.
(ii) Avoid overcrowding and congestion ofoperations.
(iii) Provide at least 3 feet between workingareas. Such space shall be wider than 3 feet ifit is used as a passageway.
(iv) Provide a ceiling height of at least 8 feet.
2. Equipment. As a minimum, the kitchen shall havethe following:
(i) Range. Facilities classified as large shallhave a heavy duty, institutional type range.
(ii) Refrigeration. Facilities classified aslarge shall provide institutional or commercialtype refrigeration. But in no case shall space beless than 2 cubic feet per bed for refrigeratedspace. Freezer space shall, as a minimum, beprovided at a rate of 1 cubic foot per bed offrozen food storage. Each unit shall be suppliedwith a thermometer.
(iii) Stainless steel cooking and baking counteror table.
(iv) Commercial type dishwashing machine, withclean dish counter and soiled dish counter.
(v) Ice machine/maker.
(vi) Fire extinguisher, 10 lb. carbon dioxide orother type approved by local or state firemarshal.
(vii) Rack, pots and pans.
(viii) Three-compartment sink with rinsingcompartments equipped to maintain supplied waterat a minimum of 180 degree F.
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(ix) Containers for flour, sugar, coffee, tea,etc.
(x) Garbage cans with tight-fitting covers.
(xi) Coffee maker.
(xii) Storage space for silverware and cutlery.
(xiii) Pots, pans, silverware, dishes, etc.
(xiv) Clock.
(xv) Separate sink for meat and vegetablepreparation.
(xvi) Food mixers.
(xvii) Adequate storage space.
(xviii) Tray set up facilities, adequate tomaintain food at proper temperatures (hot foods140 degree F. or greater - cold foods 45 degreeor below).
(xix) Storage for tray set up utensils (dishes,table flatware, trays, etc.).
(xx) Blender.
(b) Food storage. A well-ventilated, food storage room orpantry shall be provided. Adequate shelving, bins,suitable cans, and/or raised platforms shall beperformed. Perishable food shall be stored at least 4inches above the floor. The storage room shall be of suchconstruction as to prevent the invasion of rodents andinsects, the seepage of dust and water leakage, or anyother source of contamination.
(c) Water heating equipment. Facilities for heating anample supply of water, with adequate pressure, for allwashing purposes shall be provided. Equipment shall becapable of heating water to a temperature of not lessthan 180 degree F.
(d) Floors. Floors in food service areas shall be of suchconstruction as to be easily cleaned, sound, smooth,nonabsorbent, without cracks or crevices, and shall bekept in good repair. Painted concrete floors are notacceptable. Where wet cleaning methods are employed, thefloors shall be provided with approved and convenientlylocated facilities for the disposal of floor wash water.
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(e) Walls and ceilings. Walls and ceilings of foodservice area shall be of tight and substantialconstruction. The walls and ceilings shall be withouthorizontal ledges and shall be washable up to the highestlevel reached by splash and spray. Roofs and walls shallbe maintained free of leaks. All openings to the exteriorshall be provided with doors or windows which willprevent the entrance of rain or dust during inclementweather.
(f) Screens on outside openings. Openings to the outsideshall be effectively screened or suitable provisions madeequal to screening. Screen doors shall open outward andshall be equipped with self-closing devices.
(g) Lighting. The kitchen and dining room shall beprovided with unobstructed natural light through windowsequivalent to not less than 10 percent of the floor area.Artificial light properly distributed and of an intensityof not less than 50 foot candles shall be provided.
(h) Ventilation. The food service area shall beventilated in a manner that will maintain comfortableworking conditions, remove objectionable odors and fumes,and prevent excessive condensation.
(i) Employee toilet facilities. Toilet facilities shallbe provided for employees. Toilet rooms shall not opendirectly into any room in which food is prepared, stored,displayed, or served, nor into any room in which utensilsare washed or stored. Toilet rooms shall include alavatory, soap dispenser, towel cabinets, hot and coldwater, and covered receptacle and shall be well lightedand ventilated.
(j) Hand washing facilities. Hand washing facilitiesshall be provided in all food production and servingareas. Sinks shall be equipped with a soap dispenser anda supply of soap, disposable towels, covered receptacle,and hot and cold water through a mixing valve orcombination faucet. The use of a common towel isprohibited. Hands shall not be washed in sinks where foodis prepared.
(k) Refrigeration facilities. Where separaterefrigeration can be provided, temperatures for storingperishable foods are: 32 degrees to 38 degrees F. formeats, 40 degrees F. for dairy products, 45 degrees to 50degrees F. for fruits and vegetables. If it isimpractical to provide separate refrigeration, thetemperature shall be maintained at 38 degrees to 45degrees F.
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(l) Equipment and utensil construction. Equipment andutensils, except single service utensils, shall be soconstructed as to be easily cleaned and shall be kept ingood repair. No cadmium plated, lead, or readilycorrodible utensils or equipment shall be used.
(m) Separation of kitchen from patient room and sleepingquarters. Any room used for sleeping quarters shall beseparated from the food service area by a solid wallwithout communicating openings. Sleeping accommodations,such as a cot, bed, or couch, shall not be permittedwithin the food service area.
(6) Food handling procedures.
(a) Floors, walls, and ceilings of all rooms in the foodservice area shall be free of an accumulation of rubbish,dust, grease, dirt, insects, etc.
(b) All equipment within the food service area shall beclean and free from dust, grease, and dirt, etc.
(c) Tables and counters upon which food is served shallbe kept clean. Tablecloths, if used, shall be clean.Cloth napkins shall be laundered after each use. Clothsused for wiping tables, counters, fountains, etc., shallbe kept in a sanitizing solution between uses.
(d) All repeated service utensils shall be thoroughlycleaned after each use. Single service utensils shall beused only once. All multi-use utensils shall bethoroughly cleaned following each use or meal period.Multi-use utensils used for storage shall be thoroughlycleaned when emptied, or more often if necessary.
(e) Dishes and utensils washing, disinfection andstorage.
1. Dishwashing water shall be changed with sufficientfrequency to avoid contamination. Final rinse waterof a minimum of 180 degree F. shall be kept clean andclear.
2. All repeated service and multi-service utensilsand dishes, after washing and rinsing, shall besanitized by:
(i) Immersion for at least one-half minute inclean, hot water at a temperature of at least 180degree F.; or
(ii) Immersion for at least one minute in a cleansolution at least 50 parts per million of
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chlorine and at a temperature of at least 75degree F.; or
(iii) Immersion for at least one minute in aclean solution containing at least 12.5 parts permillion of available iodine, pH not higher than5.0, and at a temperature of at least 75 degreeF.; or
(iv) Other methods approved by the State Board ofHealth.
3. If properly maintained, 180 degree F. dishwashersmay be used for the cleaning of multi-use utensils.Procedures that must be followed for acceptableresults include:
(i) Adequate scraping of utensils.
(ii) Monitoring of predetermined temperature.
(iii) Maintaining clean equipment.
(iv) Residue-free solutions.
(v) Monitoring of cleaning and germicidalsolutions in the low temperature process (theconcentration of chemical in the rinse sprayshall be maintained at least 50 ppm or asrecommended by the manufacturer of the chemical).
(vi) Thoroughly air drying the cleaned utensils.
4. After washing, rinsing, disinfecting, and drying,all repeated service and multi-use utensils anddishes shall be stored in a clean place that is dry,protected from flies, roaches, dust, splash and othercontamination from hands and clothing.
5. All unused single service utensils shall be storedin the same manner as repeated service utensils.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
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420-5-17-.20 Medical Supplies, Pharmaceuticals AndBiologicals.
(1) Each hospice care program shall arrange for provision ofmedical supplies, appliances, drugs, and biologicals to patientsas needed for the palliation and management of the patient’sterminal illness and related conditions. The program shall ensurethat drugs and biologicals can be obtained at all times.
(2) Each hospice care program shall ensure that instruction isprovided to patient and/or family regarding proper administrationof drugs and biologicals and their side effects with documentationin the patient’s record.
(3) The inpatient hospice has written policies and procedures,developed with the advice of a pharmacist, which ensures thatdrugs and biologicals are obtained for patients on a timely basis,they are dispensed and administered according to all federal,state and local laws, and provide for appropriate handling andcontrol of all drugs and biologicals. Whether drugs or biologicalsare obtained from community or institutional pharmacies or stockedby the hospice, the hospice is responsible for ensuring theavailability of such drugs or biologicals for its patients andthat pharmaceutical services are provided in accordance withaccepted professional principles and all appropriate federal,state and local laws.
(4) All policies and procedures shall be reviewed and updated atleast annually by at least a pharmacist, the director of nursingservices, the manager and one physician.
(5) Supervision of services in the inpatient hospice.Pharmaceutical services are under the general supervision of aqualified, registered pharmacist. The pharmacist may serve theinpatient hospice on a full-time, part-time, or consultant basis.
(a) If the pharmacist is not employed full-time, a sufficientnumber of hours are devoted on a regularly scheduled visit tocarry out all responsibilities. The number of hours devotedare based on the size and needs of the hospice.
(b) The pharmacist reviews the drug regimen of each patient onadmission, every 14 days and reports any irregularities to theindividual who is authorized to make a change.
(c) The pharmacist submits a written report each month to themedical director, director of nurses, and the manager thatdefines his/her activities, drug regimen review resultfindings and recommendations. There shall be documented
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evidence by the director of nurses and/or the manager as tocorrective action taken.
(6) Hospice Pharmacy. If the hospice has a pharmacy, a licensedpharmacist is employed to administer the pharmacy.
(a) Facilities without a pharmacy must have provisions forpromptly and conveniently obtaining prescribed drugs andbiologicals from community or institutional pharmacies.
(b) In facilities without a pharmacy but maintaining a supplyof drugs, the pharmacist is responsible for assuring thecontrol of all drugs and the maintenance of readilyreconcilable records of receipt and disposition.
(7) Control and Accountability. All hospices shall have writtenpolicies and procedures for the control and accountability of alldrugs and biologicals throughout the hospice to preventunauthorized use and/or distribution. Drugs and biologicals usedin the hospice are obtained and dispensed and/or destroyed incompliance with federal and state laws.
(a) Hospices using experimental drugs or biologicals shallhave written procedures governing their use which are incompliance with all laws relative to their use.
(b) The inpatient hospice shall have readily available recordsof receipt and disposition (for all controlled drugs) thatprovide sufficient detail to enable an accuratereconciliation.
(c) The inpatient hospice shall maintain readily traceablecontrol records of schedule II and III drugs which lists onindividual patient’s records each type and strength of drugused along with the following information: date, timeadministered, name of patient, dose, physician’s name,signature of person administering the dose and balance onhand.
(d) The individual medication record may serve as a record ofreceipt and disposition of controlled drugs listed in scheduleIV and V and drugs not subject to frequent abuse as well asnon-controlled drugs.
(8) Destruction of Drugs. Each hospice program develops writtenpolicies and procedures for the destruction of drugs andbiologicals when those drugs are no longer needed by the patient.Controlled substances and legend drugs dispensed to patients, thatare unused because the medication is discontinued, or because thepatient dies, shall be destroyed within 30 days, except unusedlegend drugs may be donated to a charitable clinic pursuant toAlabama Administrative Code Chapter 420-11-11, et seq.
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(a) Discontinued medications and medications of discharged,deceased and transferred patients in the inpatient hospiceshall be destroyed within a reasonable period of time not toexceed 30 days.
(b) Medications of patients transferred from a home carehospice to a hospital or inpatient hospice may be retaineduntil the patient has returned. The physician’s order willdictate whether or not the patient is to use the same drugregimen as previously ordered. Medications not ordered by thephysician should be handled in accordance with the hospicepolicy regarding medication destruction.
(c) Destruction of outdated, unused or discontinuedmedications for patients, discharged patients, deceasedpatients, or patients transferred to another hospice shall becarried out on the premises of the inpatient hospice.
(d) Destruction records of controlled substances in theinpatient hospice must be completed to include:
1. Name and address of hospice.
2. Date of destruction.
3. Method used in destruction.
4. Prescription number, name of drugstore from which themedicine was dispensed, patient’s name, name and strengthof drug destroyed, amount destroyed and reason fordestruction.
(e) The pharmacist will verify that the list of drugs to bedestroyed is accurate and with the director of nurses orassistant director of nurses, will carry out destruction. Bothshall sign the destruction form indicating amounts listed arecorrect and have been destroyed. There shall be a thirdwitness who may be a law enforcement official, management orsupervisory personnel, i.e., manager, LPN charge nurse, etc.Copies of destruction records will be maintained by thepharmacist and the hospice.
(f) When destruction of medications is conducted within thepatient’s home by the hospice nurse, this procedure shall bewitnessed by one or more persons.
(g) When medications are destroyed, a destruction record shallbe completed for each drug destroyed and placed in thepatient’s completed medical record.
(h) If a separate file of destruction records is to bemaintained, they must be retained for a period of not lessthan two years.
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(i) In an inpatient hospice legend drugs and over-the-counterdrugs that are not controlled drugs may be destroyed in thesame way as controlled drugs. The exception would be when thepharmacist and director of nurses or assistant director ofnurses verify and destroy medications, a third person is notrequired. The records and filing shall be the same as forcontrolled drugs.
(9) Labeling of Drugs and Biologicals. All containers of medicinesand drugs shall be properly and plainly labeled, including nameand strength of drug, patient’s name, ordering physician, date offiling, directions for administration, prescription number,expiration date, number of tablets or capsules sent and anynecessary auxiliary labels. The prescription label shall conformwith any additional federal, state and local requirements.
(a) Use of and labeling of generic drugs shall comply withState Board of Pharmacy requirements.
(b) When authorized substitution of a drug takes place, themedication administration record and the label of themedication must contain the name of the actual drug dispensedin accordance with state pharmacy law.
(c) When over-the-counter (non-prescription) medicines anddrugs are maintained for inpatient hospice patients, eachmedication shall be plainly labeled with the patient’s name,the name and strength of the drug, and the expiration date.Additional labeling information may be at the discretion ofthe hospice as related in its policies and procedures exceptthat manufacturer’s labeling information must be present inthe absence of prescription labeling. Over-the-countermedications (non-prescription) to be maintained as stock bythe inpatient hospice shall be labeled with the name andstrength of the drug, lot and control number, and expirationdate except in those cases where the manufacturer’s label ispresent.
(d) In the inpatient hospice the contents of all individualprescriptions shall be kept in the original container bearingthe original label.
(e) Procedures shall be developed to assure proper control andlabeling for medications provided a patient upon leaving theinpatient hospice on a temporary absence.
(f) Unit dose medications shall be packaged according to anacceptable format to include product name, strength, controlnumber, and expiration date. Procedures for utilization of thesystem used are developed and approved by management, nursingand pharmacy personnel and must comply with federal and staterequirements.
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(10) Administration of Medicines and Drugs.
(a) Drugs are administered only by licensed nursing personnelor following instruction, the patient and his family inaccordance with all federal, state and local laws.
(b) Drugs and biologicals shall not be administered topatients unless ordered by a physician duly licensed toprescribe drugs. Such orders shall be in writing over thephysician’s signature. Medications, including over-the-counter (OTC) medications such as aspirin, bufferin, Tylenol,mild laxatives, gargles, ointments, etc., may be administeredfrom a “standing physician’s order” provided that they shallbe reduced to writing on the physician’s order sheet, signedby the individual transcribing the order, and signed and datedby the ordering physician.
(c) The method of medication administration for all inpatienthospices shall ensure:
1. Patients are accurately identified prior toadministration of a drug.
2. Physicians’ orders are checked at least daily toassure that changes are noted.
3. Drugs and biologicals are administered as soon aspossible after doses are prepared not to exceed two (2)hours and they are administered by the same person whoprepared the doses for administration, except when unitdose systems or similar systems are used where a licensedpharmacist has prepared the dose for administration.
4. Each patient has an individual medicationadministration record (MAR) on which the dose of eachdrug administered shall be properly recorded by theperson administering the drug to include:
(i) Name, strength and dosage of the medication.
(ii) Method of administration to include site ifapplicable.
(iii) Times of administration.
(iv) The initials of persons administering themedication, except that the initials shall beidentified on the MAR to identify the individual byname.
(v) Medications administered on a “PRN” or as neededbasis shall be recorded in a manner as to explain thereason for administration and the results obtained.
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The hospice shall have a procedure to define itsmethods of recording these medications.
(vi) Medications brought to the hospice by thepatient or other individuals for use by that patientshall be positively identified as to name andstrength, properly labeled, stored in accordance withfacility policy and shall be administered to thepatient only upon the written orders of the attendingphysician.
(vii) Medications shall not be retained at thepatients’ bedside nor shall self-administration bepermitted except when ordered by the physician. Thesemedications will be appropriately labeled and safetyprecautions taken to prevent unauthorized usage.
(viii) Medication errors and drug reactions areimmediately reported to the director of nurses,pharmacist and physician and an entry made in thepatients’ medical record and/or an incident report.This procedure shall include recording and reportingto the physician the failure to administer a drugand/or the refusal of a patient to take a drug.
(d) The nurses’ station or medicine room for all inpatienthospices shall have readily available items necessary for theproper administration and accounting of medications. Equipmentwould include items such as tablet counters, graduatedmeasuring device, mortar and pestle (or other method toprovide aseptic technique for the crushing of medications),medicine cups, drinking cups, sterile syringes and needles forinjectables, etc.
(e) Each hospice shall have available current referencematerials that provide information on the use of drugs, sideeffects and adverse reactions to drugs, and the interactionsbetween drugs.
(11) Conformance with Physicians’ Drug Orders. Each inpatienthospice shall have a procedure for at least quarterly monitoringof medication administration. This monitoring may be accomplishedby a registered professional nurse or a pharmacist to assureaccurate administration and recording of all medications.
(a) Each hospice shall establish procedures for release ofmedications upon discharge or transfer of the patient.Medications shall be released upon discharge or transfer onlyupon written authorization of the attending physician. Anentry of such release shall be entered in the medical recordto include drugs released, amounts, who received the drugs,and signature of the person carrying out the release.
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(12) Storage of Drugs and Biologicals. Procedures for storing anddisposing of drugs and biologicals shall be established andimplemented by the inpatient hospice.
(a) There shall be a drug or medicine room/drug preparationarea at each nurses’ station of sufficient size for theorderly storage of drugs, both liquid and solid dosage forms,and for the preparation of medications for patientadministration within the unit. In the event that a drug cartis used for storage and administration of drugs, the roomshall be of sufficient size for storage of the cart withoutcrowding.
1. Each drug preparation area shall have, as a minimum,80 square feet of floor space with an additional squarefoot for each bed in excess of 50 beds per unit. Wherethe hospice uses a drug cart for the storage,preparation, and administration of medications, thereshall be a storage area of sufficient size to accommodateplacement of the cart.
2. There shall be a separate area or cubicle for thestorage of each patient’s medications, except where acart is used for the administration of drugs andbiologicals.
3. There shall be an operable sink provided with hot andcold water within the medicine room or medicationpreparation area for washing hands or cleaning containersused in medicine preparation. Paper towels and soapdispenser shall be provided.
4. Sufficient artificial lighting shall be provided andthe temperature of the medicine storage area shall not belower than 48 degree F. or above 85 degree F. and theroom must be provided with adequate ventilation.
5. Drugs and biologicals, including those requiringrefrigeration, shall be stored within the medicine roomor shall have separate locks if outside the medicineroom. The refrigerator shall have a thermometer and becapable of maintaining drugs at the temperaturerecommended by the manufacturer of the drug.
6. No foods may be stored in the same storage area (i.e.,cupboard, refrigerator, or drawer) with drugs andbiologicals. The areas designated for drug and biologicalstorage should be clearly marked.
7. Medication refrigerators shall not be used to storelaboratory solutions or materials awaiting laboratorypickup.
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8. Controlled substances listed in the Comprehensive DrugAbuse Prevention and Control Act of 1970 and itssubsequent amendments, and other drugs subject to abuse,shall be stored in separately locked, permanently affixedcompartments provided for that purpose, except undersingle unit package drug distribution systems in whichthe quantity stored is minimal and a missing dose can bereadily detected and where drugs are stored on a drugcart.
9. The drug or medicine rooms shall be provided withsafeguards to prevent entrance of unauthorized personsincluding locks on doors and bars on accessible windows.
10. Only authorized, designated personnel shall haveaccess to the medicine storage area.
(b) Pharmacy. If a pharmacy is to be constructed within aninpatient hospice, plans shall be submitted to the AlabamaDepartment of Public Health for approval.
1. The pharmacy shall comply with the rules andregulations of the Alabama State Board of Pharmacygoverning physical and licensing requirements of apharmacy.
(c) Poisonous substances and/or “external use only” drugs mustbe plainly labeled and stored separate from drugs andbiologicals. No poisonous substance shall be kept in thefollowing areas: kitchen and dining area or any public spacesor rooms. This section shall not prohibit storage within thedrug or medicine room of approved poisonous substancesintended for legitimate medicinal use, provided that suchsubstances are properly labeled in accordance with applicablefederal and state law.
(d) First aid supplies shall be kept in a place readilyaccessible to the person or persons providing care in theinpatient hospice.
(e) 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. The contents of this kit will be determined by themedical staff and approved by the hospice. The kit shallbe stocked only with drugs of an emergency nature andshall not be used as a routine source of supply for non-emergency medications.
2. There shall be a list of contents attached to orplaced inside the emergency kit stating the name andstrength of the drug and quantities/amounts available.
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This list shall also contain supplies and/or equipmentavailable in the kit.
3. There shall be written procedures for removal of drugsfrom the kit, records to be kept, method of charging formedications, and ready replacement of removed items.
4. The pharmacist shall inspect the emergency kit atleast monthly and assure removal and replacement of anyoutdated medications.
5. Any discrepancies noted in the emergency kit shall bereported to the director of nurses and manager throughthe pharmacist’s monthly report.
6. Procedures shall outline the method for obtainingemergency medications which are not stocked in theemergency kit.
7. Emergency medication kits may contain controlledsubstances utilizing the following conditions:
(i) The source from which a hospice may obtaincontrolled substances must be a DEA registeredpharmacy or practitioner.
(ii) There shall be a maximum of three doses of anycontrolled substance stocked in the emergency kit.
(iii) The responsibility for proper control andaccountability of the emergency medication kit shallrest with both the inpatient hospice and the DEAregistrant providing the drug. The hospice and thedrug provider shall maintain complete and accuraterecords of the controlled substances placed in theemergency kit including receipt and disposition ofthe drugs as well as destruction of unused oroutdated drugs where appropriate.
(iv) Adequate security measures shall be provided forthe emergency medication kit (if the controlled drugsare to be maintained within the kit) or the drugs (ifthey are to be maintained in a separate area) toinclude double locks. Access to emergency drugs shallbe limited 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 it has been given.
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(vi) Violations in these rules and regulations mayresult in the revocation, denial or suspension of theprivilege of maintaining controlled substance drugsin the emergency kit.
(f) Each hospice may maintain one “STAT” medicine cabinet forthe purpose of keeping a minimum amount of stock medicationsthat may be needed quickly or after regular duty hours. Thefollowing rules apply to such a cabinet:
1. There shall be a minimum number of doses of anymedication in the “STAT” cabinet based upon theestablished needs of the hospice.
2. There must be a list of contents, approved by theinpatient hospice, giving the name and strength of drugand the quantity of each.
3. There shall be records available to show amountreceived, name of patient and amount used, prescribingphysician, time of administration, name of individualremoving and using the medication, and the balance onhand.
4. There shall be written procedures for utilization ofthe “STAT” medicine cabinet with provisions for promptreplacement of used items.
5. The pharmacist shall inspect the “STAT” medicinecabinet at least monthly replacing outdated drugs andreconciliation of its prior usage. Information obtainedshall be included in a monthly report.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed June 23, 2004; effective July 28,2004.
420-5-17-.21 Laboratory And Radiological Services.
(1) Policies and procedures list the source of laboratory andradiology services and defines whether these services are providedby the hospice or under arrangement with an outside source.
(2) A hospice which does not provide laboratory, radiology, orother diagnostic services, must make arrangements for obtainingthese services.
(3) Services provided must meet all applicable federal, state andlocal laws.
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(4) Laboratory services shall be obtained from a laboratory whichis CLIA (1988) certified to provide these services. X-ray servicesmay be provided by a portable X-ray supplier, a facility licensedby the state to provide X-ray services, or a radiologist’s office.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.22 Transfer Agreement.
(1) The home care hospice has a written transfer agreement withone or more hospitals sufficiently close to the hospice’s servicearea to make feasible the transfer of the patient and theirrecords. This agreement provides the basis for effective workingarrangements under which inpatient hospital care or other hospitalservices are available promptly to the facility’s patients whenneeded. The agreement delineates the responsibilities assumed byboth the hospital and the hospice.
(2) A hospital and a hospice shall be considered to have atransfer agreement in effect if, by reason of a written agreementbetween them or (in case the two institutions are under commoncontrol) by reason of a written understanding by the person orbody which controls them, there is reasonable assurance that:
(a) Timely transfer and admission of patients will be effectedwhenever such transfer is medically appropriate as determinedby the attending physician.
(b) There will be interchange of pertinent medical and otherinformation necessary to determine appropriateness and/ordegree of care required.
(c) Security and accountability for patients’ personal effectsare provided on transfer by the inpatient hospice.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.23 Infection Control.
All hospices shall establish an infection control policy. Theinpatient hospice shall also comply with the following:
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(1) Reasonable Accommodations. Reasonable accommodations shallbe made for all patients with contagious disease. The natureand extent of said accommodations shall be determined by theinterdisciplinary team.
(2) Housekeeping. The hospice employs sufficient housekeepingpersonnel and provides all necessary equipment to maintain asafe, clean, and orderly interior. An employee is designatedas responsible for the services and for supervision andtraining of personnel. Nursing personnel are not assignedhousekeeping duties. A hospice contracting with an outsidesource for housekeeping may be found to be in compliance withthis section provided the hospice and/or outside resourcesmeet the requirements of this section. Cleaning carts shallnot be carried into patient rooms.
(3) Linen. The inpatient hospice has available at all times aquantity of linen essential for proper care and comfort ofpatients.
(a) Linens are handled, stored, processed, andtransported in such a manner as to prevent the spread ofinfection.
(b) Linens on patients beds shall be free of tears andstains and shall be removed from linen storage when it isno longer suitable for patient use.
(c) Linens shall be washed in a final wash cycle of 160degree F. unless chemicals are used.
(4) Pest Control. The hospice is maintained essentially freefrom insects and rodents through operation of a pest controlprogram.
(5) Premises. The premises shall be kept neat and clean, andfree from accumulated rubbish, weeds, ponded water or otherconditions of a similar nature which would have a tendency tocreate a health hazard.
(6) Infectious Waste. Each hospice shall develop, maintain andimplement written policies and procedures for the definitionand handling of its infectious wastes. For the purposes ofthis rule, the following wastes shall be considered to beinfectious wastes:
(a) Wastes contaminated by patients who may be infectedwith communicable diseases.
(b) Any cultures or stocks or microorganisms.
(c) Waste human blood and blood products such as serum,plasma, and other blood components.
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(d) All discarded sharps (e.g., hypodermic needles,syringes, broken glass, scalpel blades, etc.).
(e) Other wastes determined to be infectious by thehospice, which should be set forth in a written policy.
(7) Standards for Handling Infectious Waste Within a Hospice.
(a) Segregation. Infectious wastes should be isolatedfrom other waste at the point of generation within thehospice.
(b) Packaging infectious waste must be packaged in amanner that will protect waste handlers and the publicfrom possible injury and disease that may result fromexposure to the waste. Such packaging should provide forcontainment of the infectious waste from the point ofgeneration up to the point of proper treatment ordisposal. Packaging must be selected and utilized for thetype of infectious waste the package will contain, howthe waste will be treated and disposed, and how it willbe handled and transported prior to treatment anddisposal.
1. Contaminated sharps should be directly placed inleakproof, rigid, and puncture-resistant containerswhich must then be tightly sealed (e.g., taped closedor tightly lidded).
2. All containers, bags, and boxes used forcontainment and disposal of infectious wastes must beconspicuously identified.
3. Reusable containers for infectious wastes must bethoroughly sanitized each time they are emptied,unless the surfaces of the containers have beencompletely protected from contamination by disposableliners or other devices removed with the waste.
(c) Handling and transporting. After packaging,infectious wastes must be handled and transported toensure and preserve by appropriate methods the integrityof the packaging, including the use of secondarycontainment where necessary.
1. Infectious wastes must not be compacted or ground(i.e., in a mechanical grinder) prior to treatment,except that pathological wastes may be ground todisposal.
2. Plastic bags of infectious wastes must not betransported by chute, dumbwaiter, conveyor belt, orsimilar device.
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(d) Storage. Infectious waste must be stored in a mannerwhich preserves the integrity of the packaging, inhibitsrapid microbial growth and putrefaction, and minimizesthe potential of exposure or access by unknowing persons.
1. Infectious waste must be stored in a manner andlocation which affords protection from animals,precipitation, and wind. It must be stored in amanner which does not provide a breeding place orfood source for insects or rodents and does notcreate a nuisance.
(e) Managing incidents of noncontainment. In the event ofspills, ruptured packaging, or other incidents wherethere is a loss of containment of infectious wastes, thehospice must ensure that proper actions are immediatelytaken to:
1. Isolate the area from the public and all non-essential personnel.
2. Repackage all spilled waste and containment debristo the extent practicable in accordance with therecommendations of sub paragraph (b) of thisparagraph.
3. Sanitize all containment equipment and surfacesappropriately.
4. Complete incident report.
5. Written policies and procedures must specify howthis will be done.
(f) Disposing of infectious wastes. Infectious wastes aredisposed of in accordance with acceptable stateregulations.
(8) Standards for Handling of Non-infectious Wastes. Allgarbage, trash, and other non-infectious wastes shall bestored and disposed of in a manner that must not permit thetransmission of disease, create a nuisance, provide a breedingplace for insects and rodents, or constitute a safety hazard.All containers for waste shall be water tight with tightfitting covers and shall be kept on elevated platformsconstructed of easily-cleanable material. A hospice mayincinerate non-infectious wastes in an on-site incineratorwhich is authorized to incinerate infectious/non-infectiouswaste in accordance with state regulations.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.
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History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.24 Disaster Preparedness.
(1) The inpatient hospice has a written plan with procedures to befollowed in the event of an internal or external disaster and forthe care of casualties (patients and personnel) arising from suchdisasters.
(2) The hospice has an acceptable disaster plan with procedures tobe followed in the event of fire, explosion, or other disaster.The plan is developed and maintained with the assistance ofqualified fire, safety, and other appropriate experts, andincludes procedures for prompt transfer/transport of casualtiesand records, instructions regarding the location and use of alarmsystems, signals, and fire fighting equipment, informationregarding methods of containing fire, procedures for notificationof appropriate persons, specifications of evacuation routes andprocedures, procurement of food, water, medical supplies, andother materials, detail personnel responsibilities relative topatient movement in and outside of the hospice for varioussituations such as tornadoes, fires, and other disasters. The planshall be located in each department in a conspicuous place andkept current.
(3) The disaster program includes orientation and on-goingtraining and drills for all personnel in all procedures so thateach employee promptly and correctly carries out his specific rolein case of a disaster.
(a) All employees are trained, as part of their employmentorientation, in all aspects of preparedness for any disaster,and a record of this training is maintained in the employee’spersonnel record.
(b) Fire drills shall be conducted at least quarterly for eachshift.
(c) Disaster drills shall be conducted at least semi-annuallyand all hospice personnel shall participate in at least onedrill annually.
(d) Written observations of the effectiveness of the planshall be filed and kept for at least three years for each firedrill and disaster drill. These observations shall include alist of all attendees.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.
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History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000.
420-5-17-.25 Physical Plant Inpatient Hospices.
The provisions of this section shall apply to all inpatienthospices licensed by the State Board of Health.
(1) General Requirements. The hospice shall have physicalspace for private patient and family visiting.
(a) The hospice shall provide accommodations for familymembers to remain with the patient throughout the night.
(b) The hospice shall provide accommodations for familyprivacy after a patient’s death.
(c) The patient areas in the hospice shall have decorwhich is homelike in design and function.
(d) Patients shall be permitted to receive visitors,including small children, at any hour.
(2) Location.
(a) Each hospice shall be located so that they are freefrom undue noises, smoke, dust, or foul odors and shallnot be located adjacent to railroads, freight yards,airports, industrial plants, disposal plants, cemeteries,funeral homes, or any other similar facility or activity.This rule shall not prevent additions to existingfacilities.
(b) The location and construction of all facilities shallcomply with local zoning, building and fire ordinances.Evidence to this effect, signed by local fire, building,and zoning officials, shall be furnished to the StateBoard of Health.
(c) Facilities shall be located on streets or roads whichare kept passable at all times. Facilities constructedafter the effective date of these rules shall be locatedon paved roads.
(3) Submission of Plans and Specifications. When constructionis contemplated, either for new buildings, conversions,additions, or major alterations to existing buildings comingwithin the scope of these rules, plans and specificationsshall be submitted for review and approval to the AlabamaDepartment of Public Health, in accordance with Alabama
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Administrative Code Rule 420-5-22, “Submission of Plans andSpecifications for Health Care Facilities.”
(a) Minor alterations and remodeling which do not affectthe structural integrity of the building, do not changefunctional operation, do not affect fire safety, and donot add beds over those for which the facility islicensed, need not be submitted for approval.
(4) Inspections. The State Board of Health and its authorizedrepresentative shall have access to the site for inspection.
(5) Remolding and Alterations. The remodeled area of existingfacilities shall be upgraded to comply with the currentrequirements for new construction.
(a) Any remodeling to existing facilities shall notdiminish the level of safety which existed prior to thestart of the work.
(6) General Requirements - Inpatient Hospices. The provisionsof this section shall apply to all inpatient hospices licensedby the State Board of Health on the effective date of theseregulations.
(a) All hospices shall comply with the applicableregulations of the State Board of Health and the codesand standards as adopted by the State Board of Health,see Alabama Administrative Code, Rule 420-5-22,“Submission of Plans and Specifications for Health CareFacilities.”
(b) The occupancy classification for all hospicefacilities shall be “health care - limited care facility”as defined in the NFPA 101 Life Safety Code.
1. Exception 1 - a hospice located within a hospitalshall meet the NFPA 101 Life Safety Code requirementfor “health care - hospital” and all requirements forhospitals by the Department of Public Health inaddition to those requirements contained within theseregulations.
2. Exception 2 - a hospice located within a nursinghome shall meet the NFPA 101 Life Safety Coderequirement for “healthcare - nursing home” and allrequirements for nursing homes by the Department ofPublic Health in addition to those requirementscontained within these regulations.
(c) Water supply.
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1. If at all possible, all water shall be obtainedfrom a public water supply. If it is impossible toconnect to a public water system, the private watersupply shall be approved by the State Board ofHealth.
2. Water under pressure of not less than 15 lbs. persquare inch shall be piped within the building to allsinks, toilets, lavatories, tubs, showers, and otherfixtures requiring water.
3. An adequate supply of hot water shall be providedat all times throughout the facility. Temperature ofhot water at plumbing fixtures used by patients shallbe automatically regulated thermostatically bycontrol valves and will not exceed 120 degree F.
4. In the laundry, provision shall be made toincrease the water temperature to 160 degree F.
5. There shall be procedures established to ensurethat water can be provided for all essential servicesin the event of loss of the normal water supply.
(d) Disposal of liquid and human wastes.
1. There shall be installed within the building aproperly designed waste disposal system connecting toall fixtures to which water under pressure is piped.
2. All liquid and human waste, including floor washwater and liquid waste from refrigerators, shall bedisposed of through trapped drains into a publicsanitary sewer system in localities where such systemis available.
3. In localities where a public sanitary sewer is notavailable, liquid and human waste shall be disposedthrough trapped drains into a sewage disposal systemapproved by the county health department and/or theState Board of Health.
4. The sewage disposal system shall be of a size andcapacity based on the number of patients andpersonnel housed and employed in the institution.Where the sewage disposal system is installed priorto the opening of the institution, it shall beassumed, unless otherwise proven, that the system wasdesigned for 10 or fewer persons.
5. Plumbing shall be sized, installed, and maintainedto carry adequate quantities of water to requiredlocations throughout the facility, to prevent
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contamination of the water supply, and to properlyconvey sewage and liquid wastes from theestablishment to the sewerage or sewage disposalsystem, in a manner not to constitute a source ofcontamination or create an unsanitary condition ornuisance.
(e) Solid waste.
1. Solid, non-infectious wastes shall be kept inleakproof, non-absorbent containers which shall bekept covered with tight-fitting lids, and shall bedisposed of with sufficient frequency and in a mannerto prevent a nuisance.
2. Solid wastes which are potentially infectiousshall be burned on the premises in an incineratorapproved by the State Board of Health or disposed ofin a manner approved by the State Board of Health orits appropriate designated agency.
3. Trash chutes are prohibited.
(f) No part of a hospice may be rented, leased, or usedfor any purpose that is disruptive to the operation ofthe facility. Building uses not necessary to the facilityoperation shall be distinctly separated from the licensedfacility operation. The State Board of Health shallapprove all plans for functions not necessary to theoperation of the facility. These areas shall be separatedfrom the licensed facility by a two-hour fire separation.
(g) Construction type. The construction type of allbuildings shall be classified according to National FireProtection Association 220. All buildings shall meet theminimum construction requirements called for in theapplicable occupancy sections of National Fire ProtectionAssociation 101 including automatic sprinkler system, ifrequired.
(h) The building shall be structurally sound from leaksand excessive moisture, in good repair, and painted atsufficient intervals to be reasonably attractive insideand out.
(i) Distance to property line or adjacent structures.
1. There shall be a minimum of 30 feet of clear spacemeasured perpendicular between a patient bedroomwindow and any building or the property line.
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2. There shall be, as a minimum, 30 feet between anypart of the building and any adjacent building(s) notconforming to the requirements of these regulations.
(j) The building area shall not occupy more than 40percent of the site.
(k) There shall be telephones, as necessary, to summonhelp in case of fire or other emergency.
(l) Lighting.
1. All lighting shall be electric.
2. Each patient’s room and bathroom shall haveartificial light adequate for eating and other usesas needed. All entrances, hallways, stairways, ramps,cellars, rooms, storerooms, kitchens, laundries, andservice units shall have sufficient artificiallighting to prevent accidents and promote efficiencyof service.
3. Night lights shall be provided in bedrooms,hallways, and toilets and/or bathrooms that open intopatient rooms. Glowing toggle switches are acceptablein toilets and/or bathrooms.
(m) Floors.
1. All floors are smooth and free from cracks andfinished so that they can be easily cleaned. Allfloors in the facility except mechanical rooms shallbe covered wall-to-wall with inlaid linoleums,resilient tile, hard tile, carpet, or the equivalent.A painted floor finish is not acceptable except inmechanical rooms and electrical rooms. Carpet is notacceptable in kitchens, utility rooms, toilets,baths, and janitor’s closets.
2. All carpet must meet NFPA 101 requirements for“Class I” interior floor finishes.
(n) Patient bedrooms shall have an outside window,installed so that it can be opened from the insidewithout the use of tools or keys. Screens shall beprovided on all operable windows.
(o) Walls and ceilings shall be of sound constructionwith an acceptable surface and maintained in good repair.
(p) A ceiling height of 8 feet or more (does not includefurred area) shall be provided throughout the facility.
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After the effective date of these regulations, a ceilingheight of 7 feet 6 inches is allowed in corridors.
(q) Doors. To avoid the danger of a patient falling andblocking the swing of a door, all doors to patients’baths and toilets shall swing out or be double-acting andequipped with an emergency stop release.
(r) Fire hydrants. All facilities shall have access topublic fire hydrant protection, or the equivalentapproved by the local fire department or state firemarshal. Access to fire hydrants shall be within 500feet.
(s) Handrails shall be installed on both sides of allcorridors and shall be maintained in safe repair.Handrails shall return to the wall at the end of eachhandrail section.
(t) Nurse call system.
1. The facility shall have an electrical nurse callsystem at the side of each bed which will provide anaudible and visual signal on an annunciator panel atthe nurses’ station.
2. Each facility shall have a light over the door tothe bedroom in the corridor.
3. Nurse call system shall be provided in eachpatient toilet and bath.
(u) Elevators.
1. Facilities with patients on one or more floorsabove the first floor shall be equipped with at leastone automatic elevator of a size sufficient to carrya patient on a stretcher.
2. Routine inspections shall be made of elevators inaccordance with codes and city ordinances.
(v) Exit signs. Exit signs shall be provided at allrequired exits. Additional exit signs shall be providedin corridors to indicate two directions of exit travelfrom any point. Additional exit signs for suites andplaces of assembly shall be installed as required.
(w) General storage. A general storage room shall beprovided for the central storage of equipment, supplies,etc., at the rate of 8 square feet per bed andconcentrated in one area. The storage room shall bedesigned to provide adequate and orderly storage so as to
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prevent the use of corridors and non-storage areas forstorage purposes. When any part of the facility isremodeled or renovated, general storage shall be providedat the rate of 8 square feet per bed. The general storageroom shall be adequately ventilated. Space under stairsshall not be used for storage purposes.
(x) Facilities for physically handicapped. Necessaryphysical accommodations shall be made to meet the needsof persons with physical disabilities, sight and hearingdisabilities, disabilities of coordination, as well asother disabilities in accordance with the standardsadopted by the State Board of Health.
(y) Heating ventilation and air conditioning. Thebuilding shall be well ventilated at all times. Patientsbedrooms shall be ventilated in such a manner as tosupply fresh air and to prevent accumulation ofobjectionable odors. Kitchens, laundries, service rooms,toilets, bathrooms, and all inside rooms shall be ventedto prevent offensive odors from entering other parts ofthe building.
1. Ventilating fans and blowers. Ventilating fans andblowers, if installed, shall not be so located thatthey will obstruct any required exit, stairway, orcorridor and shall not create a draft from one floorto another.
2. Temperature to be maintained. The heating andcooling system must be capable of maintaining atemperature of 70 degree F. throughout the patient/resident section of the building. The heating of allfacilities shall be restricted to steam, hot water,or warm air systems employing central heating plants,or UL listed electric heating. The use of portableheaters of any kind is prohibited.
3. A laboratory, if provided, shall be ventilated andtemperature controlled for proper equipment operationand/or test results.
(z) Ramps and inclines. Exterior and interior ramps andinclines, shall not be steeper than 1 footing rise in 12feet of run, shall be finished with a non-slip surfaceand shall be provided with handrails on both sides.
(aa) Basements.
1. The basement shall be considered as a story ifone-half or more of its perimeter is level with orabove grade.
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2. No patient/resident shall be housed in any roomthat is more than 50 percent below ground level.
(bb) Emergency power. An emergency generator shall beprovided to supply power to the following:
1. Emergency corridor illumination.
2. Exit signs.
3. An exterior light at each exit.
4. Fire alarm system.
5. Smoke detection system.
6. Sprinkler system.
7. Life support systems by providing wall receptaclesin the corridor at least every 50 feet and in atleast two bedrooms in each nursing unit.
8. Telephone system.
9. Public address system.
10. Nurses’ call system.
11. Medicine preparation area.
12. Sprinkler riser room.
13. Main electrical panel room.
14. Emergency generator location.
(cc) Existing mechanical and electrical systems.Mechanical and electrical systems installed prior to theeffective date of these rules shall be inspected by localbuilding, electrical, plumbing officials, or the statefire marshal or such other persons as the State Board ofHealth may request, and the recommendations regardingadequacy and safety shall be presented to the board.
(dd) Smoke dampers.
1. Smoke dampers shall be located in all ductspassing through smoke partitions. They shall bearranged to close upon activation of the fire alarmsystem by an initiating device.
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2. Dampers shall remain closed while the fire alarmsystem is in the silence mode and shall remain closeduntil the fire alarm system is reset to normal.
(ee) Fire alarm.
1. A manual fire alarm system shall be provided togenerate an audible and visual alarm throughout thefacility.
2. Manual pull stations shall be installed at eachexit.
3. The visual signal shall continue to flash whilethe alarm system is in the silence mode.
4. The fire alarm system shall sound upon activationof the automatic detection system, extinguishingsystem, and manual system.
5. In all buildings and additions connected by acommon wall and corridor, the fire alarm system shalloperate in all parts of the facility as one system.
(ff) Sprinkler. Building protection shall be providedthroughout by an approved supervised automatic sprinklersystem installed in accordance with NFPA 13 “standard forthe installation of sprinkler systems.”
(gg) Dead-end corridor shall not exceed 20 feet inlength.
(hh) Rooms, spaces and equipment.
1. Each nursing unit shall have:
(i) Nurses’ station.
(ii) Clean utility room.
(iii) Soiled utility room.
(iv) Medicine preparation area.
(v) Clean linen storage area. Cabinets on thecorridor are not allowable.
(vi) Wheelchair and stretcher storage areas.
(vii) Janitor’s closet.
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(viii) On a nursing unit, no patient bedroom doorshall be more than 120 feet from the nurses’station.
2. Bedrooms.
(i) Patients’ bedrooms shall be located so as tominimize the entrance of odors, noise and othernuisances.
(ii) Patients’ bedrooms shall be directlyaccessible from the main corridor of the nursingunit. In no case shall a patient’s bedroom beused for access to another patient’s room.
(iii) The bed capacity of any room shall notexceed four.
(iv) The minimum floor area of bedrooms(exclusive of toilets, closets, wardrobes,alcoves or vestibules) shall be as follows:
Private bedroom 120 square feet per bedMulti-patient bedroom 80 square feet per bed
(v) There shall be sufficient space to permitnursing procedures to be performed and to permitthe placing of beds at least 3 feet apart and 2feet from the wall at the side of the bed and 3feet from the wall at the foot of the bed.
(vi) Private bedrooms shall be provided at theratio of 1 per 15 beds, or a major fractionthereof, which may include the special care orisolation room(s).
(vii) Each multi-patient room shall havepermanently installed cubicle curtains and tracksto permit enclosing each bed with curtains toallow for the privacy of each patient withoutobstructing the passage of other patients to thecorridor, closet, and toilet/lavatory.
(viii) Cubicle curtains installed in sprinkleredbuilding shall have ½ inch mesh openingsextending 18 inches below the sprinklerdeflector.
3. Accommodations for patients. The minimumaccommodations for patient shall include thefollowing:
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(i) Bed patients shall be provided with anadjustable hospital bed with proper fittingmattress and personal care items.
(ii) Ambulatory patients shall be provided with astandard or adjustable hospital bed.
(iii) Pillows and necessary coverings.
(iv) Chair and bedside table.
(v) Chest for storage of clothing, toiletarticles, and personal belongings.
(vi) Bedside electrical call system for summoningaid.
(vii) Waste paper receptacle.
(viii) Closet or wardrobe unit for each bed.
(ix) All facilities shall have a bed lightmounted on the wall at the head of the bed,(operable by patient).
(x) All facilities shall provide a hand washinglavatory in each room. They may be omitted from asingle-bed or a two-bed room when a lavatory isprovided in an adjoining toilet or bathroom.
4. Isolation rooms shall be provided at the rate ofnot less than 1 private bedroom per 50 beds or majorfraction thereof for the isolation of patientssuffering from infectious diseases. The bedroom shallmeet all of the requirements for bedrooms in theserules. Isolation bedrooms may be used to provide forthe special care of patients with special needs.Isolation rooms shall have a private toilet.
5. The nurses’ station for each nursing unit shallinclude as a minimum the following:
(i) Annunciator board for receiving patients’calls.
(ii) Cabinet space.
(iii) Storage space for current patients’ charts.
(iv) Working space and accommodations forrecording and charting purposes by facilitystaff.
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(v) Medicine preparation room/area. (See storageof drugs and biologicals for specificrequirements.)
6. All facilities shall provide a separate clean andsoiled utility room for each nursing unit.
(i) The clean utility room shall contain as aminimum:
(I) Wall and base cabinets.
(II) Counter space.
(III) Single-compartment counter sink.
(IV) Paper towel cabinet.
(V) Soap dispenser.
(ii) The soiled utility room shall contain as aminimum:
(I) Paper towel and soap dispensers.
(II) Shelves.
(III) Cabinets for storage of poisonoussubstances; i.e., cleaning supplies, urinetest products, etc.
(IV) Table or counter.
(V) Service sink for chemical sterilizationof bed pans, urinals and commode pails, and/or pressure sterilizer.
(VI) Lavatory.
(VII) Soiled linen hamper.
7. Toilet and bathing facilities.
(i) For all patients bedrooms which do not haveadjoining toilet and bath facilities, plumbingfixtures shall be provided within the nursingunit according to the following ratio:
bathtubs or showers 1 per 12 bedslavatories 1 per 6 bedstoilets (water closets) 1 per 6 beds
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(ii) Non-skid mats or equivalent and grab barsshall be provided at tubs and showers. Grabhandles on soap dishes are not acceptable forgrab bars.
(iii) Grab bars shall be provided at each watercloset.
(iv) Only one tub or shower shall be installed ina bath or shower room. The room may also containa lavatory and a water closet.
8. Nourishment units.
(i) All facilities shall have a nourishmentstation containing the following:
(I) Work counter.
(II) Refrigerator.
(III) Hot plate or microwave.
(IV) Storage cabinet.
(V) Sink in the counter.
(VI) Ice machine.
(VII) Storage space for trays and dishes.
(VIII) Hand washing lavatory.
(ii) A clean utility room, separate from a soiledutility room, may be used as a nourishmentstation when the above requirements are met.
9. Patient dining and recreation areas shall beprovided in accordance with the following:
(i) The total area set aside for these purposesshall be at least 20 square feet per bed.
(ii) The area shall contain at least one sittingarea and a dining area.
(iii) Each nursing unit shall contain at leastone sitting area.
(iv) The dining room shall be of such size anddimensions as to permit placing of dining tablesand chairs to seat not less than 50 percent ofthe patients in the facility at one seating. The
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dining room may also be used for recreationalpurposes. The kitchen shall not be used as adining room for patients or personnel. Facilitiesshall provide a minimum of 12 square feet perperson in the dining room.
(v) Dietary manager’s office shall be locatedwithin the department and shall be equipped withnecessary equipment.
10. Physical therapy areas, if provided, shall be ina specifically designated area and shall includeequipment and areas as needed to meet specificpatient requirements and shall also include storagespace for linens, supplies, and equipment, a lavatoryand a sink.
11. The Administrative Department and services shallbe located in a specifically designated area andshall include the following:
(i) Administration.
(ii) Business Office/Accounting Services.
(iii) Lobby or waiting area.
12. All facilities shall provide maintenanceservices.
13. Employee toilets. Employee toilets shall beprovided and shall include the following:
(i) Water closet.
(ii) Lavatory.
(iii) Soap dispenser.
(iv) Disposable towel dispenser.
(v) Covered waste receptacle.Author: Jimmy D. PrinceStatutory Authority:Code of Ala. 1975, §§22-21-20, et seq.History:New Rule: Filed August 20, 1993; effective September23, 1993. Repealed and New Rule: Filed June 14, 2000; effectiveJuly 19, 2000. Amended: Filed June 18, 2002; effective July 23,2002. ADDENDUM National Fire Protection Association 1 BatteryMarch Park P.O. Box 9101 Quincy, MA 02269-9904 1-800-344-3555 Life Safety Code, NFPA-101 National Electrical Code, NFPA-70 Installation of Sprinkler Systems, NFPA-13 Air Conditioning andVentilation Systems, NFPA-90a & 90b Standard Building and PlumbingCodes Standard Plumbing Gas & Mechanical Southern Building Code
Chapter 420-5-17 Health
Revised 5/15/22 17-62
Congress International 900 Montclair Road Birmingham, AL 352131-205-591-1853 National Plumbing Code American Society ofHeating, Refrigeration and Air Conditioning Engineers (ASHREA) Publication Sales 1791 Tullie Circle, NE Atlanta, GA 30329-2305American Society of Mechanical Engineers United Engineering Center345 East 47th Street, NE New York, NY 10017 American GasAssociation 1515 Wilson Boulevard Arlington, VA 22209
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420-5-17-A1 Addendum.
National Fire Protection Association1 Battery March ParkP.O. Box 9101Quincy, MA 02269-99041-800-344-3555
Life Safety Code, NFPA-101National Electrical Code, NFPA-70Installation of Sprinkler Systems, NFPA-13Air Conditioning and Ventilation Systems, NFPA-90a & 90b
Standard Building and Plumbing CodesStandard Plumbing Gas & MechanicalSouthern Building Code Congress International900 Montclair RoadBirmingham, AL 352131-205-591-1853
National Plumbing Code
American Society of Heating, Refrigeration and AirConditioning Engineers (ASHREA)Publication Sales1791 Tullie Circle, NEAtlanta, GA 30329-2305
American Society of Mechanical EngineersUnited Engineering Center345 East 47th Street, NENew York, NY 10017
American Gas Association1515 Wilson BoulevardArlington, VA 22209Author:Statutory Authority:History:
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420-5-17-A2 Appendix.
§22-21-20. Definitions. For the purpose of this article, thefollowing terms shall have the meanings respectively ascribed tothem by this section:
(1) HOSPITALS. General and specialized hospitals, includingancillary services; independent clinical laboratories;rehabilitation centers; ambulatory surgical treatmentfacilities for patients not requiring hospitalization; endstage renal disease treatment and transplant centers,including free-standing hemodialysis units; abortion orreproductive health centers; hospices; health maintenanceorganizations; and other related health care institutions whensuch institution is primarily engaged in offering to thepublic generally, facilities and services for the diagnosisand/or treatment of injury, deformity, disease, surgical orobstetrical care. Also included within the term are long termcare facilities such as, but not limited to, skilled nursingfacilities, intermediate care facilities, homes for the aged,domiciliary care facilities and related health careinstitutions when such institution is primarily engaged inoffering room, board, laundry and personal assistance withactivities of daily living and incidentals thereto. The term"hospitals" relates to health care institutions and shall notinclude the private offices of physicians or dentists, whetherin individual, group, professional corporation or professionalassociation practice. This section shall not apply to countyor district health departments.
(2) PERSON. Such term includes individuals, partnerships,corporations and associations. (Acts 1975, 3rd Ex. Sess., No.140, p. 382, §1; Acts 1979, No. 79-798, p. 1461; Acts 1991,No. 91-548, p. 1010, §1; Act 1997, No. 97-632, §1.)
§22-21-21. Purpose of article. The purpose of this article is topromote the public health, safety and welfare by providing for thedevelopment, establishment and enforcement of standards for thetreatment and care of individuals in institutions within thepurview of this article and the establishment, construction,maintenance and operation of such institutions which will promotesafe and adequate treatment and care of individuals in suchinstitutions. (Acts 1949, No. 530, p. 835, §1; Acts 1962, Ex.Sess., No. 122, p. 157, §1.)
§22-21-22. License -- Required; exceptions. No person shallestablish, conduct or maintain any hospital as defined in Section22-21-20 without first obtaining the license provided in thisarticle. Hospitals operated by the federal government and mentalhospitals under the supervision of the board of trustees of theAlabama State Hospitals shall be exempt from the provisions ofthis article. (Acts 1949, No. 530, p. 835, §2; Acts 1962, Ex.Sess., No. 122, p. 157, §2.)
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§22-21-23. License -- Application. Any person desiring licensingunder this article shall apply to the State Board of Healththerefor. The applicant shall state the name of the applicant andwhether an individual, partnership, corporation or other entity,the type of institution for which a license is desired, thelocation thereof and the name of the person in direct supervisionand charge thereof. The person in charge of such hospital must beat least 19 years of age, of reputable and responsible characterand in sound physical and mental health. Like evidence of fitnessshall be submitted when required, except for age, as to thoseindividuals employed at, or in, such hospital in a supervisorycapacity. The applicant shall likewise submit evidence of abilityto comply with the minimum standards provided in this article orby regulations issued under its authority. (Acts 1949, No. 530, p.835, §4.)
§22-21-24. License -- Fees; term; form; nontransferable; posting;renewal; hospital licensable when accredited by joint commission.The application for a license to operate a hospital shall beaccompanied by a standard fee of $200.00, plus a fee of $5.00 perbed for each bed over 10 beds to be licensed in accordance withregulations promulgated under Section 22-21-28. Increase in ahospital's bed capacity during the calendar year is assessed atthe standard fee of $200.00 plus $5.00 each for the net gain inbeds. No fee shall be refunded. All fees received by the StateBoard of Health under the provision of this article shall be paidinto the State Treasury to the credit of the State Board of Healthand shall be used for carrying out the provisions of this article.All licenses issued under this article shall expire on December 31of the year in which it was issued. All licenses shall be on aform prescribed by said department, shall not be transferable orassignable, shall be issued only for the premises named in theapplication, shall be posted in a conspicuous place on thelicensed premises and may be renewed from year to year uponapplication, investigation and payment of the required licensefee, as in the case of procurement of the original license. Allfees collected under this article are hereby appropriated forexpenditure by the State Health Department. All hospitals whichare accredited by the joint commission on accreditation ofhospitals shall be deemed by the State Health Department to belicensable without further inspection or survey by the personnelof the State Department of Health. Further accreditation by thejoint commission on accreditation of hospitals shall in no wayrelieve that hospital of the responsibility of applying forlicensure and remitting the appropriate licensure fee as specifiedin this article. (Acts 1949, No. 530, p. 835, §5; Acts 1975, 3rdEx. Sess., No. 140, p. 382, §2; Acts 1980, No. 80-642, p. 1213;Acts 1988, 1st Ex. Sess., No. 88-902, p. 470.)
§22-21-25. License -- Issuance; suspension or revocation; newapplications after revocation.
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(a) The State Board of Health is hereby authorized to issuelicenses for the operation of hospitals which are found tocomply with the provisions of this article and any regulationslawfully promulgated by the said State Board of Health.
(b) The State Board of Health is hereby authorized to suspendor revoke a license issued under this article on any of thefollowing grounds:
(1) Violation of any of the provisions of this article orthe rules and regulations issued pursuant thereto;
(2) Permitting, aiding or abetting the commission of anyillegal act in such institution; or
(3) Conduct or practices deemed by the State Board ofHealth to be detrimental to the welfare of the patientsof said institution.
(c) Before any such license issued under this article issuspended or revoked, written notice shall be given thelicensee, stating the grounds of the complaint, and the date,time and place set for the hearing of said complaint, whichdate of hearing shall be not less than 30 days from the dateof the notice. Such a notice shall be sent by registered orcertified mail to the licensee at the address where theinstitution concerned is located. The licensee shall beentitled to be represented by legal counsel at the hearing.
(d) If a license is revoked as provided in this section, a newapplication for license shall be considered by the State Boardof Health if, when and after the conditions upon whichrevocation was based have been corrected and evidence of thisfact has been furnished. A new license shall then be grantedafter proper inspection has been made and all provisions ofthis article and rules and regulations promulgated under thisarticle have been satisfied. (Acts 1949, No. 530, p. 835, §7.)
§22-21-26. License -- Judicial review of suspension or revocation.Any party aggrieved by a final decision or order of the Board ofHealth suspending or revoking a license is entitled to a review ofsuch decision or order by taking an appeal to the circuit court ofthe county in which the hospital is located or is to be located.(Acts 1949, No. 530, p. 835, §11.)
§22-21-27. Advisory board.
(a) There shall be an advisory board of 12 members to assistin the establishment of rules, regulations and standardsnecessary to carry out the provisions of this article and toserve as consultants to the State Health Officer. The boardshall meet at least twice each year and at the call of the
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State Health Officer. The members of the board shall annuallyelect one of its members to serve as chairman.
(b) The advisory board shall be constituted in the followingmanner:
(1) Four representatives of hospitals, who shall beappointed by the Board of Trustees of the AlabamaHospital Association as follows:
a. One administrator of a governmental hospital;
b. One administrator of a nongovernmental nonprofithospital;
c. One owner or administrator of a proprietaryhospital; and
d. One member of a managing board of a nonprofithospital;
(2) Three representatives who shall be doctors ofmedicine appointed by the Board of Censors of the AlabamaState Medical Association;
(3) One representative who shall be a registered nurseappointed by the executive board of the Alabama StateNurses Association;
(4) One representative from the State Board of HumanResources to be appointed by the board;
(5) One registered pharmacist actively engaged in thepractices of pharmacy in the State of Alabama, to beappointed by the Alabama State Board of Pharmacy;
(6) One member of the advisory board shall be appointedby the executive committee of the Alabama Nursing HomeAssociation, who shall be the operator of a dulyqualified licensed nursing home; and
(7) One member shall be appointed by the Alabama HospiceAssociation and said person shall vote only on issuesrelating to hospices.
Of the original representatives appointed by the Board ofTrustees of the Alabama Hospital Association, one shallserve for three years, two shall serve for four years,and one shall serve for five years. One of therepresentatives appointed by the Board of Censors of theAlabama State Medical Association shall serve for twoyears, one shall serve for three years, and one shallserve for five years. The one representative appointed by
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the Alabama State Nurses Association shall serve for fouryears. The one representative from the State Board ofHuman Resources shall serve for four years, and the onerepresentative from the State Board of Pharmacy shallserve for four years. The representative appointed by theexecutive committee of the Alabama Nursing HomeAssociation shall serve for five years. Thereafter, eachnew appointee shall serve for five years or until hissuccessor is appointed; except, that in the case of avacancy, the appointee shall serve for the remainder ofthe unexpired term. Any vacancy shall be filled by theoriginal organization selecting said member.
(c) Members of the advisory board shall not be eligible tosucceed themselves after they have served one full five-yearterm, but shall be eligible for reappointment if they have notserved immediately preceding their reappointment.
(d) Members of the advisory board shall serve withoutcompensation, but shall be entitled to reimbursement forexpenses incurred in the performance of the duties of theiroffice pursuant to Article 2 of Chapter 7 of Title 36. (Acts1949, No. 530, p. 835, §9; Acts 1959, No. 134, p. 656; Acts1991, No. 91-548, p. 1010, §1.)
§22-21-28. Rules and regulations.
(a) In the manner provided in this section, the State Board ofHealth, with the advice and after approval by the advisoryboard, shall have the power to make and enforce, and maymodify, amend and rescind, reasonable rules and regulationsgoverning the operation and conduct of hospitals as defined inSection 22-21-20. All such regulations shall set uniformminimum standards applicable alike to all hospitals of likekind and purpose in view of the type of institutional carebeing offered there and shall be confined to setting minimumstandards of sanitation and equipment found to be necessaryand prohibiting conduct and practices inimicable to the publicinterest and the public health. The board shall not have powerto promulgate any regulation in conflict with law nor power tointerfere with the internal government and operation of anyhospital on matters of policy. Thirty days notice of anyproposed amendment, rescission or new regulations shall begiven in writing to all licensed hospitals of the date of suchhearing and of the substance of any new regulation, amendmentto or rescission of regulation proposed to be made. Allhearings shall be joint hearings set by the Board of Healthand the advisory board established in Section 22-21-27 atMontgomery, Alabama. At such hearing, any interested hospitalor any member of the public may be heard.
(b) Any person affected by any regulation, amendment orrescission thereof may appeal consideration thereof to the
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circuit court of the county of that person's residence or inwhich that person does business or to the Circuit Court ofMontgomery County, within 30 days from the adoption of thesame following the hearing provided in this section by givingsecurity for costs and the filing of a petition with court,setting forth the interest of the appellant, the rulingcomplained of and the facts upon which the petitioner reliesfor relief. And upon appeal the question of the reasonablenessof such regulation shall be a question of fact for the courtto determine, and no presumption shall be indulged that theregulation adopted was and is a reasonable regulation.
(c) Regulations adopted under this section shall becomeeffective upon the expiration of 30 days from the date ofadoption, amendment or rescission or, if an appeal has beentaken, upon the final disposition of the appeal. From anyjudgment of the circuit court in any case appealed to it, anappeal shall lie to the court of civil appeals of Alabamawithin 42 days from the date of entry of the judgment, in thesame manner as other appeals are now authorized by law, and nopresumption shall be indulged by the court of civil appeals asto the correctness of the trial court's finding of facts.(Acts 1949, No. 530, p. 835, §8.)
§22-21-29. Inspections.
(a) Every hospital licensed under this article shall be opento inspection to the extent authorized in this section by theState Board of Health, under rules as shall be promulgated bythe board with the advice and consent of the advisory board.Nothing in this section shall authorize the board to inspectquarters therein occupied by members of any religious group ornurses engaged in work in such hospital or places of refugefor members of religious orders for whom care is provided, butany inspection shall be limited and confined to the parts andportions of such hospital as are used for the care andtreatment of the patients and the general facilities for theircare and treatment. No hospital shall, by reason of thissection, be relieved from any other types of inspectionsauthorized by law.
(b) All inspections undertaken by the State Board of Healthshall be conducted without prior notice to the facility andits staff. Notwithstanding the foregoing, an inspection of ahospital or other health care facility, prior to itslicensure, may be scheduled in advance. An employee orcontract employee of the state shall not disclose in advancethe date or the time of an inspection of a hospital or otherhealth care facility to any person with a financial interestin any licensed health care facility, to any employee or agentof a licensed health care facility, to any consultant orcontractor who performs services for or on behalf of licensedhealth care facilities, or to any person related by blood or
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marriage to an owner, employee, agent, consultant, orcontractor of a licensed health care facility. For purposes ofthis section, the term inspection shall include periodic andfollow-up compliance inspections and surveys on behalf of theState Board of Health, complaint investigations and follow-upinvestigations conducted by the State Board of Health, andcompliance inspections and surveys, complaint investigations,and follow-up visits conducted on behalf of the United StatesDepartment of Health and Human Services, Health Care FinancingAdministration, or its successors. The board may prescribe byrule exceptions to the prohibition where considerations ofpublic health or safety make advance disclosure of inspectiondates or times reasonable. Disclosure in advance of inspectiondates when such disclosure is required or authorized pursuantto federal law or regulation shall not be a violation of thissection. Scheduling inspections of hospitals or other healthcare facilities by the board at regular, periodic intervalswhich may be predictable shall not be a violation of thissection.
(c) Any employee or contract employee of the state whodiscloses in advance the date or time of an inspection inviolation of subsection (b) shall be guilty of a Class Amisdemeanor. Any person who solicits an employee or contractemployee of the state to disclose in advance the date or timeof an inspection in violation of subsection (b) for thepurpose of disclosing the information to others shall beguilty of a Class A misdemeanor. (Acts 1949, No. 530, p. 835,§6; Act 1997, No. 97-632, §1.)
§22-21-30. Disclosure of information.
Information received by the State Board of Health through on-siteinspections conducted by the State Licensing Agency is subject topublic disclosure and may be disclosed upon written request.Information received through means other than inspection will betreated as confidential and shall not be directed publicly exceptin a proceeding involving the question of licensure or revocationof license. (Acts 1949, No. 530, p. 835, §10; Acts 1975, 3rd Ex.Sess., No. 140, p. 383, §3.)
§22-21-31. Practice of medicine, etc., not authorized; child-placing. Nothing in this article shall be construed as authorizingany person to engage in any manner in the practice of medicine orany other profession nor to authorize any person to engage in thebusiness of child-placing. Any child born in any such institutionwhose mother is unable to care for such child or any child who,for any reason, will be left destitute of parental support shallbe reported to the State Department of Health and Human Resourcesor to any agency authorized or licensed by the State Department ofHealth and Human Resources to engage in child placing for suchservice as the child and the mother may require. In the renderingof such service, representatives of the State Department of Health
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and Human Resources and agencies authorized or licensed by theState Department of Health and Human Resources shall have freeaccess to visit the child and the mother concerned. (Acts 1949,No. 530, p. 835, §2; Acts 1962, Ex. Sess., No. 122, p. 157, §2.)
§22-21-32. Repealed by Acts 1977, 1st Ex. Sess., No. 82, p. 1509,§19, effective June 16, 1977.
§22-21-33. Penalty for violation of article, etc. Any individualestablishing, conducting, managing or operating a hospital withoutfirst obtaining a license therefor as provided in this article orwho shall violate any of the provisions of this article, orregulations promulgated thereunder, shall be guilty of amisdemeanor and, upon conviction, shall be punished by a fine ofnot to exceed $100.00 or by imprisonment in the county jail for aperiod not to exceed 90 days, or by both such fine andimprisonment in the discretion of the court. Any association,corporation or partnership operating a hospital in violation ofany provisions of this article, or any regulation promulgatedthereunder, shall be subject to the payment of a penalty of $25.00per day for each day of such illegal operation, which may berecovered by the State Board of Health in an appropriate civilaction. The State Board of Health may, upon the advice of theAttorney General, maintain an action in the name of the state foran injunction to restrain any state, county or local governmentalunit, or any division, department, board or agency thereof, fromoperating, conducting or managing a hospital in violation of anyprovisions of this article, or any regulation promulgatedthereunder. (Acts 1949, No. 530, p. 835, §12.)Author:Statutory Authority:History:
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