This Oregon administrative rule division establishes operating standards for licensed nursing facilities, covering administration, staffing, nursing services, resident care, assessments, care planning, and ancillary services such as dietary, pharmaceutical, dental, and social services. Facility operators must maintain qualified administrators and directors of nursing, meet minimum staffing ratios for licensed nurses and certified nursing assistants, conduct comprehensive resident assessments and care plans, and comply with admission, notification, and documentation requirements. The rules also address infection control, emergency planning, employee training, and resident rights including LGBTQIA2S+ nondiscrimination protections.
View official sourceOREGON DEPARTMENT OF HUMAN SERVICES
AGING AND PEOPLE WITH DISABILITIES
OREGON ADMINISTRATIVE RULES
CHAPTER 411
DIVISION 86
NURSING FACILITIES/LICENSING –
ADMINISTRATION AND SERVICES
Table of Contents
Effective 09/25/2024
411-086-0010 Administrator ..................................................................... 1
411-086-0020 Director of Nursing Services (DNS) .................................. 2
411-086-0030 RN Care Manager ............................................................... 5
411-086-0040 Admission of Residents .................................................... 6
411-086-0050 Admission of Day Care Residents .................................... 9
411-086-0060 Comprehensive Assessment and Care Plan ................. 11
411-086-0100 Nursing Services: Staffing .............................................. 14
411-086-0110 Nursing Services: Resident Care.................................... 21
411-086-0120 Nursing Services: Changes of Condition ....................... 23
411-086-0130 Nursing Services: Notification ........................................ 24
411-086-0140 Nursing Services: Problem Resolution and Preventive
Care ......................................................................................................... 25
411-086-0150 Nursing Services: Restorative Care ............................... 28
411-086-0160 Nursing Services: Discharge Summary ......................... 29
411-086-0200 Physician Services .......................................................... 29
411-086-0210 Dental Services ................................................................ 33
411-086-0220 Rehabilitative Services .................................................... 34
411-086-0230 Activity Services .............................................................. 35
411-086-0240 Social Services ................................................................ 38
411-086-0250 Dietary Services ............................................................... 40
411-086-0260 Pharmaceutical Services ................................................. 48
411-086-0300 Clinical Records ............................................................... 51
411-086-0310 Employee Orientation and In-Service Training .............. 54
411-086-0320 Emergency and Disaster Planning ................................. 59
411-086-0330 Infection Control and Universal Precautions ................. 61
411-086-0340 Pets ................................................................................... 63
411-086-0350 Smoking ........................................................................... 64
411-086-0360 Resident Furnishings, Equipment .................................. 65
EXHIBIT 86-1: 36-Hour Activities Workshop Required Curriculum ..... 67
EXHIBIT 86-2: Dining Assistant Training Curriculum .......................... 69
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OREGON DEPARTMENT OF HUMAN SERVICES
AGING AND PEOPLE WITH DISABILITIES
OREGON ADMINISTRATIVE RULES
CHAPTER 411
DIVISION 86
NURSING FACILITIES/LICENSING –
ADMINISTRATION AND SERVICES
411-086-0010 Administrator
(Adopted 10/1/1990)
(1) Full-Time. Each licensed nursing facility shall be under the supervision
of a full-time Oregon licensed nursing home administrator:
(a) In facilities physically connected with an Oregon licensed general
hospital, the nursing home administrator shall be considered "full-
time" if the administrator works full-time based on time worked in both
nursing facility and hospital, and if the administrator is available to the
nursing facility staff on a full-time basis;
(b) In facilities with 40 or fewer beds and which admit only residents
requiring intermediate care, a person who meets the requirements for
both administrator and director of nursing services (DNS) may
function simultaneously in both capacities.
(2) Responsibility:
(a) The administrator shall ensure that the facility uses its resources
effectively and efficiently to attain and maintain the highest
practicable physical, mental and psychosocial well-being of each
resident;
(b) The administrator shall comply with the rules of the Board of
Examiners of Nursing Home Administrators;
(c) The administrator shall provide a comprehensive review of
Division survey reports and inspections to the licensee.
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(3) Temporary Absence of Administrator:
(a) The licensee shall designate, by written policy, an individual who
is familiar with the operation of the facility to assume administration in
the temporary absence of the administrator. If the designee is the
DNS, another RN shall assume the DNS' responsibilities for this
period;
(b) If the absence of the administrator is to exceed 30 days, the
facility must notify the Division and obtain approval for the
arrangements prior to the absence. The Division shall determine
whether a licensed administrator shall serve in the administrator's
absence.
(4) Change of Administrator:
(a) Upon termination of the administrator, the licensee shall
immediately replace the administrator with a full-time administrator;
(b) The licensee shall notify the Division and the Board of Examiners
of Nursing Home Administrators within seven days from the date the
administrator leaves employment of the facility.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 678.720
411-086-0020 Director of Nursing Services (DNS)
(Adopted 10/1/1990)
(1) Full-Time. Each facility shall have a director of nursing services who
shall be full-time (40-hours per week) in a single nursing facility. Time spent
in professional association workshops, seminars and continuing education
may be counted in considering whether or not the DNS is full-time.
(2) Qualifications. The DNS shall be a registered nurse who has specific
knowledge about nursing administration in a nursing facility:
(a) The DNS shall have at least six months experience in a nursing
facility, hospital, or inpatient rehabilitation facility;
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(b) Within nine months of employment the DNS shall have:
(A) Successfully completed six credit hours in management or
supervision, pertinent to long-term care, from an accredited
college or university; or
(B) A baccalaureate or master's degree in nursing and
documentation of course work which includes management or
supervision.
(c) The DNS shall successfully complete every two years at least 30
continuing education hours pertinent to nursing administration in a
nursing facility.
(3) Responsibility:
(a) The DNS shall have written administrative authority, responsibility,
and accountability for assuring functions and activities of the nursing
services department. The DNS shall participate in the development of
any facility policies that affect the nursing services department (OAR
411-085-0210). The DNS shall organize and direct the nursing
service department to include as a minimum:
(A) Develop and maintain a nursing service philosophy,
objectives, standards of practice, policy and procedure
manuals, and job descriptions for each level of nursing service
personnel;
(B) Develop and maintain personnel policies of recruitment,
orientation, in-service education, supervision, evaluation and
termination of nursing service staff;
(C) Develop and maintain policies and procedure for
determination of nursing staff's capacity for providing nursing
care for any person seeking admission to the facility;
(D) Develop and maintain a quality assurance program for
nursing services;
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(E) Coordinate nursing service departmental functions and
activities with the functions and activities of other departments;
(F) Develop nursing service department budget
recommendations and participate with the facility administrator
and other department directors in the allocation of funds for the
facility;
(G) Participate with the facility administrator and other
department directors in development and maintenance of
practices and procedures that promote infection control, fire
safety, and hazard reduction;
(H) Ensure that all medications and treatments are given
promptly as ordered;
(I) Ensure that only licensed nurses or physicians administer
injectable medications;
(J) Ensure adequate nursing services staffing (see OAR 411-
086-0100), including development of a written staffing plan; and
(K) Ensure that all nursing staff perform their respective duties
in a timely, efficient and professional manner.
(b) The DNS shall designate, in writing, a specific registered nurse,
licensed to practice in Oregon, to be available immediately in person
or by telephone to direct the functions and activities of the nursing
services department when the DNS is not available in person or by
telephone. This information shall be posted at each nursing station;
(c) The DNS shall be informed regarding residents' conditions,
including when a significant change in a resident's condition warrants
nursing or medical intervention;
(d) Effective October 1, 1990, or in the event of delay of the actual
federal requirement, effective the actual implementation date, the
DNS may serve as the charge nurse only if the facility has a licensed
bed capacity of 60 or less and does not provide care for residents
requiring skilled nursing care.
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Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0030 RN Care Manager
(Adopted 10/1/1990)
The RN care manager is a registered nurse who is responsible and
accountable for managing the nursing care of his/her assigned residents.
Each resident shall have an RN care manager responsible for his/her care:
(1) Training:
(a) Within nine months of hire each RN care manager shall have
successfully completed three credit hours from an accredited school,
or 30 continuing education hours, pertinent to gerontology,
rehabilitation, or long-term care;
(b) Within nine months of hire each RN care manager shall have
successfully completed three credit hours from an accredited college
or university, or 15 continuing education hours, pertinent to
management or supervision.
(2) Responsibility:
(a) The RN care manager shall be responsible and accountable for
managing the nursing care of his/her assigned residents. The RN
care manager shall ensure maximum independence and self-
direction for residents;
(b) The RN care manager shall coordinate the nursing functions and
tasks for those residents with physicians and other health care
providers. The responsible RN care manager shall ensure the nursing
plan and resident care plan are developed and documented, and that
residents' care needs are met;
(c) Delegated authority:
(A) The RN care manager shall delegate to other licensed
personnel only those nursing functions and tasks that the
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licensee is competent and qualified to perform and that are
permitted by ORS Chapter 678;
(B) The RN care manager, or an RN or LPN with delegated
authority from the RN care manager, shall ensure that the
nursing assistant is assigned and performs only those tasks for
which he/she is competent and qualified to perform and that are
permitted by ORS Chapter 678.
(3) Documentation. The name of the responsible RN care manager shall be
documented in each resident's clinical record.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0040 Admission of Residents
(Amended 09/25/2024)
(1) Admission Conditions:
(a) The facility shall not accept or retain residents whose care needs
cannot be met by the facility;
(b) No person shall be admitted to the facility except on the order of a
physician;
(c) Admission medical information shall include a statement
concerning the diagnosis and general condition of the resident, a
medical history and physical, or a medical summary. Other pertinent
medical information, orders for medication, diet, and treatments shall
also be provided;
(d) Each resident record must, before admission and when updated,
include the following information:
(A) Legal name for billing purposes.
(B) To promote person-centered care, any variance from legal
records, as indicated by the resident regarding:
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(i) Name.
(ii) Pronouns.
(iii) Gender identity.
(e) No resident shall be admitted to a bed in any location other than
those locations shown in the most recent floor plan filed with the
Division and under which the license was issued;
(f) No facility shall admit an individual who is mentally ill or mentally
retarded unless the Division or local representative thereof has
determined that such placement is appropriate.
(g) Upon admission of a resident, the facility shall provide the resident
or the resident’s representative with information developed by the
Long-Term Care Ombudsman describing the availability and services
of the ombudsman. The facility shall document that the facility
provided this information as required.
(h) Upon admission, the facility shall provide to the resident a copy of
the LGBTQIA2S+ Protections policy that includes the following
statement:
“(Name of care facility) does not discriminate and does not
permit discrimination, including but not limited to bullying, abuse
or harassment, based on an individual’s actual or perceived
sexual orientation, gender identity, gender expression or human
immunodeficiency virus status, or based on an individual’s
association with another individual on account of the other
individual’s actual or perceived sexual orientation, gender
identity, gender expression or human immunodeficiency virus
status. If you believe you have experienced this kind of
discrimination, you may file a complaint with the Oregon
Department of Human Services at (provide current contact
information).”
(i) Upon admission, the facility shall provide to the resident a copy of
the nondiscrimination policy as described in OAR 411-085-
0210(1)(w).
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(2) Admission Status, Preliminary Care Plan, Preliminary Nursing
Assessment:
(a) A licensed nurse shall document the admission status of the
resident within eight hours, including but not limited to skin condition,
nutritional status, hydration status, mental status, vital signs, mobility,
and ability to perform ADLs. This review of resident status shall be
sufficient to ensure that the immediate needs of the resident are met;
(b) A licensed nurse shall develop a preliminary resident care plan
within 24 hours of admission. Staff providing care for the resident
shall have access to, be familiar with, and follow this plan;
(c) Social services shall be provided to the resident in accordance
with the preliminary resident care plan not later than three days after
admission;
(d) A registered nurse shall complete and document a comprehensive
nursing assessment within 14 days of admission; (e) A resident care
plan shall be completed pursuant to OAR 411- 086-0060.
(3) Directives for Medical Treatment. Each resident shall be provided the
following information and materials in written form within five days of
admission, but in any event before discharge:
(a) A copy of "Your Right to Make Health Care Decisions in Oregon,"
copyright 1991, by the Oregon State Bar Health Law Section, which
summarizes the rights of individuals to make health care decisions,
including the right to accept or refuse any treatment or medication
and the right to execute directives and powers of attorney for health
care;
(b) Information on the facility's policies with respect to implementation
of those rights;
(c) A copy of the Advance Directive form set forth in ORS 127.531
and a copy of the Power of Attorney for Health Care form set forth in
ORS 127.610, along with a disclaimer attached to each form in at
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least 16-point bold type stating "You do not have to fill out and sign
this form"; and
(d) The name and location of a person who can provide additional
information concerning the forms for directives and powers of
attorney for health care.
(4) Contracts, Agreements. Contracts, agreements and all other documents
provided to, or required to be signed by, the resident shall not misrepresent
or be inconsistent with the requirements of Oregon law. See OAR 411-085-
0300 - 411-085-0350.
Stat. Auth.: ORS 410.070, 410.090, 441.055, 441.122
Stats. Implemented: ORS 441.055, 441.112, 441.114, 441.615
411-086-0050 Admission of Day Care Residents
(Adopted 10/1/1990)
Day care residents may be admitted to the facility only if the facility has
written approval from the Division to admit day care residents, the facility is
in compliance with OAR 411, divisions 85-89, and provided admittance
does not interfere with care needs of other residents. Day care residents
are considered "residents" for the purpose of OAR 411, divisions 85-89,
unless specifically stated otherwise:
(1) Application. Application for permission to accept day care residents
shall be made to the Division on a form provided by the Division.
(2) Physical Environment:
(a) The number of day care residents shall not exceed one for every
40 square feet of floor space available for use by day care residents;
(b) Provision shall be made for dining, such as tray service or dining
area. Day care residents shall be served meals at the same times as
other residents;
(c) Each day care resident shall have either an unassigned bed or a
folding cot in an area where rest and privacy can be provided;
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(d) There shall be one toilet and one lavatory available to every 15
day care residents. Such facilities shall be in close proximity to the
area used by day care residents;
(e) All space required for day care residents shall be in addition to
space required for other residents.
(3) Physician. Day care residents shall be under the care of a licensed
physician. The physician shall provide the facility with a statement on
admission concerning the diagnosis and general condition of the resident
and with orders for prescribed care.
(4) Medications. Day care residents taking medication prescribed by their
physicians may bring such medication in the original containers to the
facility.
(5) Activities. The day care resident shall be encouraged to participate in a
program of activities which are suitable to the needs and interests of the
day care resident, and which promote learning by and independence of the
resident.
(6) Care Plan. Each day care resident shall have a preliminary care plan
which includes a nursing assessment and addresses dietary
needs/restrictions and activities.
(7) Documentation:
(a) There shall be available for each day care resident an admission
summary sheet including resident's name, address, telephone
number, sex, social security number; name, address, and telephone
number of nearest relative or personal representative and attending
physician;
(b) There shall be available for each day resident a medication sheet
including date, time, dosage, method of administration, and any
reaction to a medication. Such medication sheet shall be signed by
the nursing personnel administering the medication.
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Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0060 Comprehensive Assessment and Care Plan
(Amended 09/25/2024)
(1) Comprehensive Assessment:
(a) An RN shall ensure completion and documentation of a
comprehensive assessment of the resident's capabilities and needs
for nursing services within 14 days of admission. Comprehensive
assessments shall be updated promptly after any significant change
of condition and reviewed no less often than quarterly. This
assessment shall be on a form specified by the Division. The
assessment shall include the following:
(A) Medically defined conditions and medical history;
(B) Medical status measurement;
(C) Functional status;
(D) Sensory and physical impairments;
(E) Nutritional status and requirements;
(F) Treatments and procedures;
(G) Psychosocial status (see OAR 411-086-0240);
(H) Discharge potential (see OAR 411-086-0160);
(I) Dental condition;
(J) Activities potential (see OAR 411-086-0230);
(K) Rehabilitation and restorative potential (see OAR 411-086-
0150 and 411-086-0220);
(L) Cognitive status; and
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(M) Drug therapy.
(b) Social services, activities and dietary personnel shall complete an
assessment within 14 days of admission.
(2) Care Plan Preparation and Implementation. The facility, through the
nursing services department and the interdisciplinary staff, shall provide
services to attain or maintain the highest practicable physical, mental and
psychosocial well-being of each resident in accordance with a written,
dated, care plan:
(a) The plan shall be completed within seven days after completion of
the comprehensive assessment. The care plan shall be reviewed and
updated whenever the resident's needs change, but no less often
than quarterly;
(b) The care plan shall describe the medical, nursing, and
psychosocial needs of the resident and how the facility will actively
meet those needs. This description of needs shall include
measurable objectives and time frames in which the objectives will be
met;
(c) The plan shall provide for and promote personal choice and
independence of the resident;
(d) The resident care plan must address the following, if indicated by
the resident,
(A) Name.
(B) Pronouns.
(C) Gender identity.
(e) The plan shall be reviewed and completed at an interdisciplinary
care planning conference with participation from the resident's RN
care manager and personnel from dietary, activities and social
services. The resident's attending physician will participate in the
development and any revision of the care plan. Physician
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participation may be in person, through communication with the DNS
or RN Care Manager, or via telephone conference;
(f) The resident, the resident's legal representative, and anyone
designated by the resident shall be requested to participate. The
request shall be documented in the resident's clinical record;
(g) The plan shall be prepared and implemented with participation of
the resident and in accordance with the resident's wishes;
(h) Unless required or allowed by state or federal law, a facility shall
not disclose any personally identifiable information regarding:
(A) A resident’s sexual orientation;
(B) Whether a resident is LGBTQIA2S+;
(C) A resident’s gender transition status; or
(D) A resident’s human immunodeficiency virus status.
(i) The facility shall take appropriate steps to minimize the likelihood
of inadvertent or accidental disclosure of information described in
subsection (h) of this section to other residents, visitors or facility
staff, except to the minimum extent necessary for facility staff to
perform their duties.
(j) Facilities must notify the resident or resident’s representative if the
facility inadvertently or accidentally discloses such information to
unauthorized persons.
(k) The plan shall include an assessment of the resident's potential
for discharge and the facility's efforts to work toward discharge;
(l) The plan shall be available to and followed by all staff involved with
care of the resident.
(3) Documentation:
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(a) The care plan shall be written in ink and made a part of the
resident's clinical record;
(b) Participation in development of the care plan by interdisciplinary
staff will be clearly documented.
Stat. Auth.: ORS 410.070, 410.090, 441.055, 441.122
Stats. Implemented: ORS 441.055, 441.111, 441.114, 441.615
411-086-0100 Nursing Services: Staffing
(Amended 11/01/2023)
(1) STAFFING PLAN.
(a) The facility must have and implement a written plan that:
(A) Ensures staffing sufficient to meet the minimum staffing
requirements described in sections (3), (4), and (5) of this rule;
(B) Ensures staffing sufficient to meet the needs of each
resident; and
(C) Identifies procedures to obtain required staff when
absences occur.
(b) The facility must maintain a written, weekly staffing schedule
showing the number and category of staff assigned to each shift and
the person to be called in the event of any absence.
(2) DAILY STAFF PUBLIC POSTING.
(a) The facility must have the number of on-duty nursing staff publicly
posted 24 hours each day using form SDS 0717 and the Nursing
Assistant (NA) Staff Ratio Chart form SDS 0717A.
(A) The posted forms must be prominently displayed in a public
area and readily accessible to residents and visitors as
described in OAR 411-085-0030(1)(b).
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(B) The posted forms must be at least 8.5 x 14 inches and
printed in a minimum font size of 16.
(C) The staffing information must be an accurate reflection of
the actual staff working each shift.
(b) The posted staffing forms must include:
(A) Facility name;
(B) Current date;
(C) Current resident census per shift;
(D) The total number and actual hours worked by registered
nurses (RNs), licensed practical nurses (LPNs), and nursing
assistants (CNAs and NAs) directly responsible for resident
services per shift; and
(E) The minimum staffing standard, nursing assistant to
resident ratio, referenced in section (5)(c) of this rule.
(c) Upon oral or written request, the facility must make direct care
staffing data available to the public for review at a cost not to exceed
the community standard.
(d) The facility must maintain the posted nurse staffing data for a
minimum of 18 months.
(3) MINIMUM STAFFING, GENERALLY. Resident service needs must be
the primary consideration in determining the number and categories of
nursing personnel needed. Nursing staff must be sufficient in quantity and
quality to provide nursing services for each resident as needed, including
restorative services that enable each resident to achieve and maintain the
highest practicable degree of function, self-care, and independence, as
determined by the resident's care plan. Such staffing must be provided
even though it exceeds other requirements specified by this rule or
specified in any waiver.
(4) MINIMUM LICENSED NURSE STAFFING.
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(a) Licensed nurse hours must include no less than one RN hour per
resident per week.
(b) When an RN serves as the administrator in the temporary
absence of the administrator, the RN's hours must not be used to
meet minimum nursing hours.
(c) In facilities with 41 or more beds, the hours of a licensed nurse
who serves as facility administrator must not be included in any
licensed nurse coverage required by this rule.
(d) The licensed nurse serving as a charge nurse must not be
counted toward the minimum staffing requirement under section
(5)(c) of this rule.
(e) The facility must have a licensed charge nurse on each shift 24
hours per day.
(A) An RN must serve as the licensed charge nurse for no less
than eight consecutive hours between the start of day shift and
the end of evening shift, seven days a week.
(B) The Director of Nursing Services may serve as the charge
nurse only when the facility has 60 or fewer residents.
(C) Section (4)(e) of this rule may be waived by the Department
of Human Services (Department). The request for waiver must
comply with OAR 411-085-0040 and must be reviewed
annually. The waiver shall be considered by the Department if
the facility certifies that:
(i) The facility has been unable to recruit appropriate
personnel despite diligent efforts, including offering wages
at the community prevailing rate for nursing facilities;
(ii) The waiver does not endanger the health or safety of
residents; and
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(iii) An RN or physician is available and obligated to
immediately respond to telephone calls from the facility.
(5) MINIMUM CERTIFIED NURSING ASSISTANT STAFFING.
(a) The facility must determine the specific time frame for beginning
and ending each consecutive eight-hour shift using one of the
following options:
(A) Option 1.
(i) Day shift from 5:30 a.m. to 1:30 p.m.
(ii) Evening shift from 1:30 p.m. to 9:30 p.m.
(iii) Night shift from 9:30 p.m. to 5:30 a.m.
(B) Option 2.
(i) Day shift from 6 a.m. to 2 p.m.
(ii) Evening shift from 2 p.m. to 10 p.m.
(iii) Night shift from 10 p.m. to 6 a.m.
(C) Option 3.
(i) Day shift from 6:30 a.m. to 2:30 p.m.
(ii) Evening shift from 2:30 p.m. to 10:30 p.m.
(iii) Night shift from 10:30 p.m. to 6:30 a.m.
(D) Option 4.
(i) Day shift from 7 a.m. to 3 p.m.
(ii) Evening shift from 3 p.m. to 11 p.m.
(iii) Night shift from 11 p.m. to 7 a.m.
Page 18
(b) Each resident must have assigned and be informed of the nursing
assistant responsible for his or her care and services on each shift.
The numbers listed in this rule represent the minimum staffing
requirement. The numbers do not represent sufficient nursing staff.
The number of staff necessary to meet the needs of each resident
determines sufficient nursing staff.
(c) The number of residents per nursing assistant must not exceed
the following ratios:
(A) Prior to October 1, 2013:
(i) DAY SHIFT: 1 nursing assistant per 7 residents.
(ii) EVENING SHIFT: 1 nursing assistant per 11 residents.
(iii) NIGHT SHIFT: 1 nursing assistant per 18 residents.
(B) Effective October 1, 2013 to March 30, 2014, each facility
must, in addition to the nursing assistant staff to resident ratios
listed in subsection (A) of this section, increase nursing
assistant staffing to the minimum standard of 2.46 hours per
resident day in a 24-hour period of time from the start of day
shift until the end of night shift seven days a week.
(C) Effective March 31, 2014:
(i) DAY SHIFT: 1 nursing assistant per 7 residents.
(ii) EVENING SHIFT: 1 nursing assistant per 9.5
residents.
(iii) NIGHT SHIFT: 1 nursing assistant per 17 residents.
(d) Each facility must submit a quarterly staffing report to the
Department using the Department's approved method and format.
The report must provide an accurate daily account of resident census
and nursing assistant staffing levels for each shift.
Page 19
(A) The facility must submit the report to the Department no
later than the end of the month immediately following the end of
each calendar quarter. (Example: For the calendar quarter
ending March 31, the report must be received no later than
April 30.)
(B) The report must specify the shifts in which the minimum
staffing standards as set forth in section (5)(c) of this rule were
not met.
(C) Upon the Department's request, the facility must provide
documents to support the quarterly staffing report, including
payroll records.
(e) This rule does not prohibit nursing assistants from providing
services to a resident to whom they are not assigned.
(f) The facility must ensure that nursing assistants only perform those
tasks for which they are competent and qualified to perform and that
are permitted by ORS chapter 678 and OAR 851-063-0030.
(g) Nursing assistants with a restricted duty status may be counted
toward meeting the minimum staffing ratio as set forth in section
(5)(c) of this rule if the nursing assistant is able to perform 90 percent
of the authorized duties and responsibilities, with or without
accommodation, required by a certified nursing assistant as
determined by the Oregon State Board of Nursing (OAR 851-063-
0030).
(h) The facility must ensure that a nursing assistant is not assigned
more residents than the number for which the nursing assistant is
able to meet the individual service needs.
(i) The facility must have a minimum of two nursing staff on duty
within the facility at all times.
(j) Nursing staff must be present at all times in each detached
building, distinct and segregated area including those separated by
closed doors, and on each level or floor where residents are housed.
Page 20
(k) Nursing assistants do not include dining assistants.
(l) Nursing assistants serving as restorative aides must not be
counted toward the minimum staffing requirement under section
(5)(c) of this rule.
(m) A facility must not employ any person as a nursing assistant for
longer than four months from the date of hire without an Oregon State
Board of Nursing issued CNA 1 certification.
(n) The facility must ensure no more than 25 percent of the nursing
assistants assigned to residents per shift pursuant to section (5)(c) of
this rule are uncertified nursing assistants.
(o) If an individual meets the criteria documented in OAR 411-070-
0087, and the Department has authorized the bariatric rate, the
facility must provide one (1) additional Certified Nursing Assistant
(CNA), for each shift, above the licensing staffing standard in OAR
411-086-0100(5), for the third through fifth approved individuals for
the bariatric rate. Another CNA is then required, for each shift, for
every additional five (5) individuals receiving the bariatric rate. For
example:
(A) For the first two (2) approved individuals, the facility must meet
the requirements in OAR 411-086-0100(3).
(B) For three (3) to five (5) approved individuals, one (1) CNA would
be required above staffing standard, for each shift.
(C) For six (6) to ten (10) approved individuals, two (2) CNAs would
be required above staffing standard, for each shift.
(6) CERTIFIED MEDICATION AIDES.
(a) The facility must ensure that all nursing assistants administering
non-injectable medications are certified as nursing assistants and as
medication aides. Documentation of these two certifications must be
maintained in the facility.
Page 21
(b) The certified medication aide assigned to administer medications
must not be counted toward meeting the minimum staffing
requirements for direct service of residents referenced at section
(5)(c) of this rule.
Stat. Auth.: ORS 410.070, 410.090, 441.055, 441.073, 441.615
Stats. Implemented: ORS 410.070, 410.090, 441.055, 441.073, 441.615
411-086-0110 Nursing Services: Resident Care
(Adopted 10/1/1990)
(1) Nursing Services Generally. Nursing services staff shall provide and
document nursing services for each resident. Nursing staff shall provide
services to attain and maintain the highest practicable physical, mental and
psychosocial well-being, independence, self-direction, and self-care of
each resident, including:
(a) Good grooming and cleanliness of body, skin, nails, hair, eyes,
ears, and face, including removal or shaving of hair in accordance
with resident wishes, and prompt assistance with toileting needs and
care for incontinence;
(b) Good body alignment and adequate exercise or range-of-motion,
including, when practicable, ambulation;
(c) Adequate fluid and nutritional intake:
(A) Assistance or supervision with eating and drinking shall be
provided as required;
(B) Fluids shall be offered at least three times a day (in addition
to meal times) to residents who are unable to help themselves;
and
(C) Weigh each resident on admission and quarterly thereafter
or more often if resident's condition warrants it.
(d) Adequate sleep and rest;
(e) Oral hygiene;
Page 22
(f) Bowel and bladder evacuation and continence;
(g) Optimal freedom from pain; and
(h) Resident ability to:
(A) Dress, bathe and groom;
(B) Transfer and ambulate;
(C) Appropriately interact with others; and
(D) Effective October 1, 1990, or in the event of delay of the
federal requirement, effective the actual federal implementation
date, self-medicate based on nursing and physician
assessment and provision of instruction to the resident if
necessary.
(2) Coordination of Services. The DNS and RN care manager shall
coordinate the provision of nursing services for the resident with other
disciplines and providers. The DNS and RN care manager shall ensure
provision and documentation of resident care interventions prescribed by
other health care professionals, including timely medications and
treatments ordered by the resident's physician.
(3) Questionable Care. When any RN questions the efficacy, need or safety
of medications or treatments, the RN shall report that question to the
attending physician or nurse practitioner. The RN shall seek and document
instructions received and all actions taken to ensure problem resolution.
(4) Standards of Practice. Nursing care staff shall provide nursing services
in accordance with the Oregon Nurse Practice Act (ORS Chapter 678).
(5) Documentation. Licensed nursing staff shall evaluate and accurately
document in the clinical record the effectiveness of services provided to the
resident, including required preventive care, at least quarterly.
Page 23
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0120 Nursing Services: Changes of Condition
(Adopted 10/1/1990)
(1) Change of Condition (Generally). Nursing staff shall observe, assess,
document, and report to the DNS and the resident's physician any
significant change in resident condition that warrants medical or nursing
intervention, including any significant change in:
(a) Vital signs;
(b) Skin integrity (i.e., decubitus ulcer);
(c) Hydration;
(d) Ability to take or retain food or fluids;
(e) Weight gain/loss;
(f) Bowel or bladder function;
(g) Behavior;
(h) Level of comfort (i.e., pain, injury); or
(i) Level of consciousness.
(2) Acute Condition Change. The nursing staff shall ensure that any
significant and acute condition change is promptly assessed and
documented by a registered nurse and that appropriate measures are
immediately instituted.
(3) Documentation. Documentation shall include assessment, appropriate
interventions, monitoring and outcome until point of resolution.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
Page 24
411-086-0130 Nursing Services: Notification
(Adopted 10/1/1990)
(1) Notification of Significant Other(s). The nursing care staff or other
designated staff shall notify the resident's significant others as soon as
possible whenever:
(a) The resident has had a change of physical, mental or
psychosocial status, including death or accident resulting in injury, or
change in type of care needed;
(b) The resident has wandered from the facility.
(2) Notification of Division. The nursing care staff shall notify the Division of
any situation in which the health or safety of the resident(s) was/is
endangered such as:
(a) Suspected abuse;
(b) Fire;
(c) Lost resident;
(d) Accidental or unusual death.
(3) Notification of Physician. The nursing care staff shall notify the
resident's physician of possible changes in the type of care the resident
needs and document such notification in the resident's clinical record. Such
notification shall be timely. The physician's determination shall be
documented in the resident's clinical record.
NOTE: See requirements for physician visits under OAR 411-086-
0200.
(4) Documentation. The nursing care staff, except as provided by section
(3) of this rule, shall document all notification/consultation required by this
rule in the resident's clinical record.
Page 25
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0140 Nursing Services: Problem Resolution and Preventive
Care
(Amended 10/1/1993)
(1) Problem Resolution and Prevention:
(a) Conditions to be Prevented. The licensee shall take all reasonable
measures consistent with resident choice to resolve and to prevent
undesirable conditions such as:
(A) Decubitus ulcers and other skin breakdowns;
(B) Loss of mobility, or development of contractures or foot
drop;
(C) Dehydration;
(D) Impaction;
(E) Infections;
(F) Weight loss/gain;
(G) Loss of range of motion;
(H) Loss of bowel and bladder control; and
(I) Loss of self-esteem or dignity.
(b) Reasonable Measures. Reasonable measures which are required
to be taken include, but are not limited to:
(A) Assessment of residents who are at risk;
(B) Implementation of preventive measures; and
Page 26
(C) Reassessment and modification of treatment program when
the program implemented is not effective.
(2) Safe Environment. The licensee shall ensure the provision of a safe
environment to protect residents from injury. Actions taken by the facility
staff shall be consistent with each resident's right to fully participate in his
or her own care planning and shall not limit any resident's ability to care for
herself/himself:
(a) Dangerous Conditions. The licensee shall take all reasonable
precautions to protect a resident from possible injury from dangerous
conditions;
(b) Falling, Wandering, Negligence. The licensee shall take all
reasonable precautions to protect a resident from possible injury from
falling, wandering, other resident(s), staff and staff negligence;
(c) Reasonable Precautions. Reasonable precautions include, but are
not limited to, provision and documentation of an assessment and
evaluation of resident's condition, medications, and treatments, and
completion of a care plan, consistent with OAR 411-086-0060; and,
when appropriate:
(A) Physician notification;
(B) Provision of additional in-service training; and/or
(C) Evaluation/adjustment of staffing patterns and supervision.
(d) The licensee shall take all reasonable precautions to protect a
resident from dangerous conditions relating to remodeling or
construction.
(3) Restraints. The licensee shall ensure that, except when required in an
emergency, physical and chemical restraints are only applied in
accordance with the resident's care plan. Restraints may be used only to
ensure the physical safety of the resident or other residents:
(a) Freedom of Choice. When restraints are considered in the
interdisciplinary care planning conference to reduce the risk of injury
Page 27
related to falls, the resident or his/her legal guardian or person acting
under the resident's power of attorney for health care must be
informed of the potential risks of falling and the risks associated with
restraints;
(b) Physician Orders Required. Except as provided in subsection
(3)(c) of this rule, physical and chemical restraints may be applied
only when a physician orders restraints. An order for restraints must
clearly identify the reason for the restraints and the duration and
circumstances under which they are to be applied;
(c) Emergencies. In an emergency situation, a registered nurse may
use physical restraints without physician orders if necessary to
prevent injury to the resident or to other residents and when
alternative measures do not work. If restraints are used in an
emergency situation, the registered nurse shall document in the
resident's clinical record the use of restraints and what alternative
measures did not work. A licensed nurse shall contact the physician
for restraint orders within 12 hours of application;
(d) Re-evaluation. Whenever restraints are used, circumstances
requiring the restraints and the need must be continually re-evaluated
and documented in the clinical record;
(e) Staff Convenience/Discipline. Restraints shall not be used for
discipline or staff convenience;
(f) Periodic Release. Residents who are physically restrained must
have the restraints released at least every two hours for a minimum
of ten minutes and be repositioned, exercised or provided range of
motion during this period;
(g) Toileting. Toileting and incontinence care shall be provided when
necessary;
(h) Quick Release. All physical restraints must allow for quick release.
Locked restraints may not be used;
(i) Fixed Objects. Residents shall not be physically restrained to a
fixed object.
Page 28
(4) Documentation. All preventive measures taken by the facility staff shall
be clearly documented. Such documentation shall include assessment of
resident(s) at risk, preventive measures taken, results and evaluation of
measures taken, and revision of measures as appropriate.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0150 Nursing Services: Restorative Care
(Adopted 10/1/1990)
(1) Restorative Program. Nursing services staff shall provide a restorative
program which re-establishes and maintains to the greatest extent practical
the functional abilities of residents. Such functional abilities shall include
but not be limited by the abilities identified in OAR 411-086-0110(1). The
facility shall have written policies governing the provision and
documentation of restorative services pursuant to OAR 411-085-0210.
(2) Director. The Director of Nursing Services or his/her designee shall
ensure the development and implementation of an effective restorative
services program.
(3) Staffing. Restorative services shall be provided by facility nursing staff
in accordance with the resident's care plan.
(4) Restorative Plan. Each resident shall have a restorative plan based on
an assessment of resident's needs and delivered in accordance with the
resident care plan:
(a) Restorative services shall be provided to the resident in
accordance with the preliminary resident care plan not later than 24
hours after admission;
(b) The restorative services plan shall be reviewed and updated as
frequently as the resident's condition changes, but no less often than
quarterly.
(5) Documentation. All restorative services provided and results of those
services shall be clearly documented in the resident's clinical record.
Page 29
Progress notes relevant to the plan shall be documented in the resident's
clinical record as frequently as the resident's condition or ability changes,
but no less often than quarterly.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0160 Nursing Services: Discharge Summary
(Amended 10/1/1993)
(1) Discharge Summary Required. A discharge summary shall be
completed for each resident before discharge.
(2) Contents. The discharge summary shall include:
(a) A recapitulation of the resident's stay;
(b) A final summary of the resident's status, including the most recent
nursing assessment as defined in OAR 411-086-0060; and
(c) A post-discharge plan of care developed in accordance with OAR
411-086-0060 which will assist the resident to adjust to his/her new
living environment. A post-discharge plan is not required when the
resident is discharged to acute care or to the morgue.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0200 Physician Services
(Amended 3/6/2008)
(1) MEDICAL DIRECTOR. Each nursing facility shall have a physician
medical director designated in writing. The medical director shall:
(a) Serve on the Quality Assessment and Assurance Committee;
(b) Assist the facility to assure that adequate medical care is provided
on a timely basis in accordance with OAR 411-085-0210 (Facility
Policies); and
Page 30
(c) Serve as attending physician for those residents who are not able
to obtain services of another physician or ensure another physician is
available to serve as attending physician.
(2) ATTENDING PHYSICIAN. Each resident shall be under the care of a
physician who is responsible for the resident's medical care.
(a) Physician Assistant. The physician may delegate tasks to a
physician assistant pursuant to ORS chapter 677 and rules adopted
by the Board of Medical Examiners. The physician assistant must be
under the direction and supervision of the resident's physician.
(b) Nurse Practitioner. The physician may delegate tasks to a nurse
practitioner pursuant to ORS chapter 678 and the rules adopted by
the Oregon State Board of Nursing.
(c) Clinical Nurse Specialist in Gerontological Nursing. The physician
may delegate responsibilities identified in section (4)(a) of this rule to
a registered nurse who is certified by the American Nurses
Association's Credentialing Center as a "Clinical Specialist in
Gerontological Nursing." The specific tasks which may be delegated
to the clinical nurse specialist are governed by the scope of practice
as specified by the Oregon State Board of Nursing.
(d) Delegation.
(A) Except as provided in section (4) of this rule, a physician
may delegate tasks to a physician assistant, nurse practitioner
or clinical nurse specialist who is acting within the scope of
practice as defined by Oregon law and who is under the
supervision of a physician.
EXCEPTION: A physician may not delegate a task in a
Medicare-certified facility when federal regulations specify
the physician must perform it personally.
(B) The physician assistant, nurse practitioner or clinical nurse
specialist substituting for physician visits as described in
section (4)(a) of this rule may not be an employee of the
nursing facility.
Page 31
(3) MEDICATIONS AND TREATMENTS.
(a) Authorization. Physician's orders shall either be initially written
and signed by the physician, nurse practitioner (NP) or physician
assistant (PA), or given verbally or by telephone. If given verbally or
by telephone, the orders shall be accepted only by a licensed nurse
and must be written and mailed to the physician, NP or PA within 72
hours to be signed and returned to the facility for filing in the
resident's chart.
(b) Promptly Carried Out. All physician orders shall be promptly
carried out unless inconsistent with the resident's expressed wishes.
(c) Orders Required. Medications and treatments shall be
administered only on the order of a physician or a designee pursuant
to ORS chapters 677, 678, and 679.
(d) Standing Orders. Therapies and drugs not requiring prescription
under ORS chapter 689 may be ordered from standing orders of the
attending physician, NP or PA. Therapies and drugs so ordered shall
be reviewed and signed at least annually by the attending physician.
Use of standing orders shall be authorized by licensed personnel and
transcribed to the physician order form.
(4) PHYSICIAN VISITS.
(a) Frequency. Physician visits shall be according to resident's needs.
The physician shall comply with Medicare or Medicaid requirements
when applicable. Physician visits shall conform to the following
schedule.
(A) Medicare Covered Stay. When Medicare is the primary
payor source for a resident’s stay, the resident must be seen by
the physician at least every 30 days for the first 90 days after
admission, then every 60 days thereafter. If authorized by the
physician, every other visit after the first visit may be conducted
by a physician's assistant, a clinical nurse specialist as
specified in section (2) of this rule, or nurse practitioner.
Page 32
(B) Medicare and/or Medicaid Certified Facilities. For residents
in facilities which are certified for Medicare and/or Medicaid,
and Medicare is not the primary payor source, each resident
must be seen by the physician at least every 30 days for the
first 90 days after admission, then every 60 days thereafter. If
authorized by the physician, all visits may be conducted by a
physician's assistant, a clinical nurse specialist as specified in
section (2) of this rule, or nurse practitioner.
(C) Licensed Only Facilities. For residents in all facilities which
are not certified for either Medicaid or Medicare, each resident
shall be visited by the physician every 30 days for the first 90
days, then every 180 days thereafter. If authorized by the
physician, all visits may be conducted by a physician's
assistant, a clinical nurse specialist as specified in section (2) of
this rule, or nurse practitioner.
(D) Timely Visit. A visit required pursuant to sections (4)(a)(A),
(B), or (C) of this rule will be considered "timely" if it occurs not
later than ten days after the date the visit was required.
(b) Assessments, Observation. The facility shall ensure a physician's
assessment and determination of type of care needed is performed
for each resident. The results and observations shall be recorded in
the physician's progress notes at time of admission and at least
annually thereafter.
(c) Policies. The facility shall establish policies to assure physician
services are provided in all cases when the attending physician or the
attending physician's alternate cannot or does not respond to the
resident's needs.
(d) Failure to Visit. If the physician or physician designee fails to visit
the resident according to resident's need, fails to respond to requests
for assistance in resident's care, or fails to return verbal or telephone
orders reduced to writing and forwarded to the physician by the
facility, then the facility administrator shall ensure:
Page 33
(A) Reasonable and repeated attempts are made and
documented in the clinical record to get the physician or
physician designee to visit resident or return signed orders;
(B) The medical director is notified and the Quality Assessment
and Assurance Committee reviews the situation;
(C) The County Medical Society, State Medical Society, and the
Board of Medical Examiners are notified in writing of the
problem;
(D) The Seniors and People with Disabilities Division is notified
in writing of the physician's failure to visit resident(s) or
complete progress notes or signed orders; and
(E) The resident and the resident's significant other(s) are
notified.
(e) Emergency Backup. Each facility shall provide for one or more
physicians to be called in the event of a medical emergency. The
names and telephone numbers of such physicians shall be posted at
each nurses' station.
(5) DOCUMENTATION. All physician orders, physician visits, and
responses thereto shall be promptly documented in the resident's clinical
record.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0210 Dental Services
(Adopted 10/1/1990)
(1) Consulting Dentist. The facility shall have an consulting dentist who
shall:
(a) Participate in the development of written policies and procedures
for routine dental care, dental emergencies, and oral hygiene (OAR
411-085-0210);
Page 34
(b) Be available in case of a dental emergency or arrange for another
dentist to be available;
(c) Recommend procedures for oral health in-service training. This
training shall be provided to appropriate staff at least annually; and
(d) Instruct or arrange for a dental hygienist to instruct registered
nurses on the facility staff in how to perform oral screenings.
(2) Physician Participation. The dentist's written treatment orders shall be
followed upon documented verbal approval of the attending physician.
(3) Dentures Marked. The facility shall cause the resident's dentures to be
marked for identification.
(4) Documentation. Oral and dental care services shall be documented in
the resident's clinical record.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0220 Rehabilitative Services
(Adopted 10/1/1990)
(1) Rehabilitation Program. The facility shall provide rehabilitative services,
when applicable, which re-establishes and maintains to the greatest extent
practical the functional abilities of residents. The facility shall have written
policies governing the provision and documentation of rehabilitative
services pursuant to OAR 411-085-0210.
(2) Director. The Director of Nursing Services or his/her designee shall
ensure the development and implementation of an effective rehabilitation
services program when applicable.
(3) Staffing. When a resident requires rehabilitative services, the services
shall be ordered by the attending physician and provided or supervised by
personnel qualified under state law to provide that service.
Page 35
(4) Rehabilitation Plan. Each resident shall have a rehabilitation plan based
on an assessment of resident's needs and delivered in accordance with the
resident care plan:
(a) The rehabilitation plan shall be implemented within seven days of
admission;
(b) The rehabilitation plan shall be reviewed and updated as
frequently as the resident's condition changes, but no less often than
quarterly.
(5) Documentation. All rehabilitative services provided and results of those
services shall be clearly documented in the resident's clinical record.
Progress notes relevant to the plan shall be documented in the resident's
clinical record as frequently as the resident's condition or ability changes,
but no less often than quarterly.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0230 Activity Services
(Amended 10/1/1993)
(1) Activity Program. The facility shall have an activity program available to
all residents which encourages each resident to maintain normal activity
and to return to self-care. The program shall address the intellectual, social,
spiritual, creative, and physical need(s), capabilities, and interests of each
resident, and shall encourage resident self-direction:
(a) The program shall encourage involvement and allow each
resident to attain and maintain function at his/her highest practical
level, and shall include both group and individual activities;
(b) Residents and staff will be informed of scheduled activities;
(c) The program shall include activities meaningful to the residents at
least six days per week including:
(A) Gross motor activities (e.g., exercise, dancing, gardening,
crafts);
Page 36
(B) Individual self-care activities designed to enhance personal
responsibility and choice (e.g., dressing, personal hygiene);
(C) Social activities (e.g., games, outside activities, field trips);
and
(D) Sensory enhancement activities (e.g., pictures, music,
olfactory and tactile stimulation, reminiscing, pet therapy).
(d) The facility shall provide equipment, supplies and space to meet
individual and group activity needs.
(2) Activity Director. The facility shall employ an Activity Director. He/she
shall have a written job description which identifies the duties and
responsibilities of the position, including the requirements set forth by this
rule:
(a) Qualifications. The Director shall meet one of the following:
(A) Have two years' experience in a social or recreational
program within the past five years, one of which was full-time in
a patient activities program in a health care setting; or
(B) Be eligible for certification as a therapeutic recreation
specialist by a recognized accrediting body; or
(C) Be a qualified occupational therapist or occupational
therapy assistant; or
(D) Have completed a 36-hour activities workshop. The
workshop must be conducted by an individual with a master's or
bachelor's degree in recreation therapy or a closely related
field, or by a registered occupational therapist. Such individual
must have at least one year of experience in long-term care
services. The course must cover the subject matters identified
in Exhibit 1, which is attached to and made a part of these
rules.
(b) Responsibilities. The Director shall:
Page 37
(A) Ensure the provision of an activities program as required by
this rule and adherence to facility policy (OAR 411-085-0210);
(B) Plan and participate in activities in-service required by OAR
411-086-0310.
(3) Staffing. The facility shall have adequate staffing to carry out the activity
program.
(4) Activities Plan. Each resident shall have an activities plan for
independent and group activities which is incorporated into the
comprehensive care plan. The plan shall include, but not be limited to, past
and current interests and activities, skills, medical limitations, and cognitive
and emotional functioning:
(a) Activity services shall be available to the resident in accordance
with the preliminary resident care plan not later than 24 hours after
admission;
(b) The activities plan shall be reviewed and updated as frequently as
the resident's condition or needs change, but no less often than
quarterly;
(c) The clinical record shall contain written instructions or orders from
the resident's attending physician stating the level of activity allowed
and any activity restrictions.
(5) Documentation:
(a) The involvement of each resident shall be documented in the
resident's clinical record, including the type of activity and the degree
of participation;
(b) Progress notes relevant to the activities plan shall be documented
in the resident's clinical record as frequently as the resident's
condition changes, but no less often than quarterly.
Page 38
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0240 Social Services
(Amended 10/1/1993)
(1) Social Services Program. A social services program shall be provided
which identifies, attains and maintains the highest practicable physical,
mental and psychosocial well-being of each resident:
(a) The program shall assist facility staff, family and friends of the
resident to help meet the resident's personal and emotional needs;
(b) The facility shall provide space and furnishings for social services
which are readily accessible and assure privacy for interviewing,
counseling and telephone conversations.
(2) Social Services Director. The facility shall employ a Social Services
Director. The Director shall have a written job description which identifies
the duties and responsibilities of the position and includes the requirements
to be met by this rule:
(a) Qualifications. The Social Services Director shall:
(A) Have a bachelor's or master's degree in behavioral sciences
(e.g., human development, psychology, sociology or
counseling) with at least one year's experience in a health care
setting; or
(B) An associate degree in behavioral sciences with two years'
experience in a health care setting; or
(C) Receive regular on-site consultation, no less often than
quarterly, from an individual who has a bachelor's or master's
degree in social work or a related behavioral science, and one
year's experience in a long-term care setting working directly
with individual residents, and have written procedures for
referring residents in need of social services to appropriate
resources;
Page 39
(D) The Social Services Director of a facility with more than 120
beds shall be full-time and shall meet the requirements in either
paragraph (2)(a)(A) or (B) of this rule.
(b) Responsibilities. The Social Services Director shall:
(A) Interview residents and family;
(B) Assess the psychosocial and emotional needs of the
residents;
(C) Participate in resident care planning conferences and social
service in-services for facility staff;
(D) Identify and document changes in affect, behavior and
personality;
(E) Maintain liaison with community agencies and ensure
needed ancillary services are available and provided when
requested;
(F) Help ensure that the resident's rights are provided and
protected;
(G) Make referrals as needed and document outcomes;
(H) Plan and participate in facility in-service required by OAR
411-086-0310; and
(I) Prepare for resident's discharge as appropriate:
(i) The social services program staff shall educate the
resident and the resident's significant others regarding the
resident's rights, the resident's potential for discharge and
the availability of alternate living services;
(ii) The social services staff shall assess the resident's
potential for discharge and the availability of alternate
living services no less often than quarterly;
Page 40
(iii) The social services staff shall assist with the
development and coordination of services required to
effect the resident's discharge.
(J) Assist the resident in obtaining appropriate prosthetics that
will allow for resident's optimal functioning and quality of life.
(3) Staffing. The facility shall have adequate staffing to carry out the social
services program in accordance with facility policy (OAR 411-085-0210).
(4) Social Services Plan. Each resident shall have a social services plan
incorporated into the comprehensive care plan based on the psychosocial
and comprehensive assessments. The social services plan shall be
reviewed and updated as frequently as the resident's condition changes,
but no less often than quarterly.
(5) Documentation. Progress notes relevant to the plan shall be
documented in the clinical record as frequently as the resident's condition
changes, but no less often than quarterly.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0250 Dietary Services
(Amended 8/1/2004)
(1) DIETARY SERVICES DEPARTMENT. The facility shall have a dietary
services department which complies with the Food Sanitation Rules, OAR
chapter 333, division 150.
(a) Admittance to the kitchen shall be restricted to those who must
enter to perform their duties, to government inspectors, or for peer
review.
(b) Written procedures for cleaning equipment and work areas shall
be prepared and enforced.
(c) Foods shall be protected from contamination during
transportation.
Page 41
(d) There shall be a minimum of one week supply of staple foods and
two-day supply of perishable foods on the premises.
(2) DIETARY SERVICES DIRECTOR.
(a) Qualifications. Overall supervision of the dietary service shall be
assigned to a full-time dietary service director who is a registered
dietician, or:
(A) Is a graduate of a dietetic technician training program
(correspondence or classroom) approved by the American
Dietetic Association or dietary management training approved
by the American Dietary Manager Association; and
(B) Has on-site consultation provided at least monthly.
(i) The consultant shall be a registered dietician or a
person with a baccalaureate degree or higher with major
studies in food, nutrition, diet therapy, or food service
management.
(ii) The consultant shall have at least one year of
supervisory experience in an institutional dietary service
and shall participate in continuing education annually.
(iii) The visits of the consultant shall be of sufficient
duration to review dietary systems and assure quality
food to the resident.
(b) Responsibilities. The dietary services director has responsibility,
with guidance from the consultant if the director is not a registered
dietician, for:
(A) Orientation, work assignments, supervision of work, and
food handling technique for dietary service staff. The director
shall assure that employees who have or exhibit signs of a
communicable disease do not remain on duty;
(B) Participation in regularly scheduled conferences with the
administrator and department heads and in the development of
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dietary policy (OAR 411-085-0210), procedures, and staff
development programs; and
(C) Menu planning, recommending and/or ordering food and
supplies to be purchased, and record-keeping.
(3) STAFFING. The facility shall employ supportive personnel to carry out
functions of the dietary service. There shall be food service personnel on
duty at least 12 consecutive hours each day.
(4) DIETS AND MENUS.
(a) Diets shall be prescribed by the attending physician. Therapeutic
menus shall be prepared and served as ordered.
(b) A diet manual, approved by a dietitian, shall be readily available to
the attending physician, nursing and dietary service personnel. The
manual shall be reviewed at least annually by the dietician.
(A) Menus for regular and routine therapeutic diets shall be
planned in writing at least three weeks in advance.
(B) The current week's menu shall be posted in the dietary
department and in a location accessible and conspicuous to
residents.
(C) A different menu shall be followed for each day for a
minimum of twenty-one days (this does not apply to facilities
using selective menus).
(D) Menus shall include fresh fruits and vegetables in season.
(E) Records of menus, as served, shall be retained for sixty
days (this does not apply to facilities using selective menus).
(c) Menus shall be planned and followed to meet nutritional needs of
the resident in accordance with physician orders and, to the extent
medically possible, in accordance with the recommended dietary
allowances in the facility diet manual (see subsection (4)(b) of this
rule).
Page 43
(5) FOOD PREPARATION AND SERVICE.
(a) Foods shall be prepared by methods which conserve nutritive
value, flavor, and appearance. A file of recipes adjusted to
appropriate yield shall be maintained.
(b) Foods shall be attractively served in a form cut, chopped, ground,
or pureed to meet individual needs and delivered to residents at
customarily acceptable temperatures.
(c) Residents requiring assistance with feeding shall receive timely
assistance while food is at customarily acceptable temperatures.
(d) An identification system shall be established to ensure that each
resident receives diet as ordered.
(e) At least three meals or their equivalent shall be served daily at
regular hours with not more than a 14 hour span between the
beginning of the substantial evening meal and the beginning of
breakfast. A substantial evening meal is an offering of three or more
menu items at one time, one of which includes a high quality protein
such as meat, fish, eggs, or cheese. The meal represents no less
than 25 percent of the day's total nutritional requirements.
(f) Bedtime snacks of nourishing quality shall be offered routinely to
residents who desire one and for whom it is not medically prohibited.
Snacks of nourishing quality are those which provide substantive
nutrients in addition to carbohydrates and calories, e.g., milk and milk
drinks and fruit juice.
(g) If a resident refuses a food served, substitute foods of necessary
nutritional food elements shall be offered.
(6) DOCUMENTATION. Resident's response to diet shall be recorded in
the clinical record when there are significant dietary problems.
(7) DINING ASSISTANT. Facilities may use dining assistants to assist
residents with feeding and hydration. "Dining Assistant" means a person 16
years of age or older who has successfully completed a Department-
Page 44
approved Dining Assistant training course and competency evaluation.
Dining assistants include volunteers participating in facility volunteer
programs who feed residents.
(a) Resident selection criteria:
(A) The facility must ensure that a dining assistant feeds and
hydrates only residents who have no complicated feeding
problems including, but not limited to, difficulty swallowing,
recurrent lung aspirations and tube or parenteral/IV feedings.
(B) The facility Director of Nursing Services, RN Care Manager
or RN Charge Nurse must assess and document resident
selection for dining assistance. The resident assessment must
be based on, but is not limited to:
(i) The resident's appropriateness for dining assistance;
(ii) The resident's feeding and hydration needs;
(iii) The resident's communication, behavior and
interpersonal skills;
(iv) Risk factors including nausea (acute and ongoing),
difficulty swallowing, seizure disorders, acute
gastrointestinal issues, vomiting; and
(v) The resident's latest MDS assessment and plan of
care.
(C) The documented assessment must be updated promptly
after any significant change of condition and reviewed quarterly.
(b) Scope of Duties:
(A) Permitted Duties:
(i) Assist residents with eating and drinking;
(ii) Transport residents to and from dining area;
Page 45
(iii) Distribute meal trays;
(iv) Ensure accurate meal delivery by verification with
accompanying meal card;
(v) Provide assistance in preparing residents for meals
including, but not limited to, placement of eye glasses,
washing hands and face and placement of clothing
protector;
(vi) Assist with insertion of dentures for residents that can
self-direct care;
(vii) Set up meal tray for residents including, but not
limited to, opening food packets, positioning and cutting
the food;
(viii) Provide minimal assistance with positioning, as
needed, for feeding and hydration and;
(ix) Measure and record food and fluid intake.
(B) Prohibited Duties:
(i) Transfer residents;
(ii) Assist with tube feeding or IV nutrition;
(iii) Assist with insertion of dentures for residents unable
to self-direct care;
(iv) Provide standby assistance with ambulation or
activities requiring gait belt;
(v) Assist with food containing medication;
(vi) Turn, lift or extensively reposition residents; and
(vii) Other CNA tasks including oral care.
Page 46
(c) Training. A Department-approved facility Dining Assistant training
course must include, at a minimum, 16 hours of training and
evaluation in the following topics and subject matters and as
identified in Exhibit 86-2, which is attached to and made a part of
these rules
(A) Training Topics:
(i) Scope of authorized duties and prohibited tasks.
(ii) Feeding and hydration techniques.
(iii) Skills for assisting with feeding and hydration.
(iv) Communication and interpersonal skills.
(v) Appropriate responses to resident behavior.
(vi) Recognizing changes in residents that are
inconsistent with their normal behavior and the reporting
of those changes to the registered nurse (RN) or licensed
practical nurse (LPN).
(vii) Safety and emergency procedures including the
abdominal thrust.
(viii) Infection control.
(ix) Assisting residents with dementia.
(x) Resident rights.
(xi) Abuse prevention and reporting.
(B) Instructors of the Department-approved facility Dining
Assistant training course must be licensed/certified in one of the
following disciplines: registered nurse, registered dietician,
occupational therapist or speech language pathologist.
Page 47
(C) "Successful completion" means a passing score on a
written exam for a Department-approved facility Dining
Assistant training course and satisfactory completion of
competency evaluation as determined by the instructor. A
Department-approved certificate will be issued to each dining
assistant upon successful completion.
(D) The Department will evaluate, select and approve at least
one Dining Assistant training course curriculum which includes
the topic and subject matters contained in Exhibit 86-2. The
Department will periodically re-evaluate its selection and
approval.
(d) Supervision of dining assistants
(A) Dining assistants must work under the supervision of a
registered nurse or licensed practical nurse. A registered nurse
or licensed practical nurse must be readily available to respond
to urgent or emergent resident needs.
(B) In an emergency, dining assistants must immediately obtain
appropriate staff assistance including the use of the resident
call system.
(e) Facilities must ensure that dining assistants perform only those
tasks for which they are trained and permitted to perform.
(f) It is the responsibility of the facility Director of Nursing Services,
RN Care Manager or licensed Charge Nurse to ensure that dining
assistants are oriented to the specific residents to whom they are
assigned prior to providing dining assistance
(g) Maintenance of records. Facilities must maintain a record of all
facility dining assistants. The record must contain a copy of each
dining assistant's certificate for successful completion of a
Department-approved Dining Assistant training course. Upon request,
a facility will share copies of dining assistant training certificates with
other facilities
Page 48
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0260 Pharmaceutical Services
(Adopted 10/1/1990)
(1) Consulting Pharmacist. Each facility shall have a consulting pharmacist
who shall ensure compliance with ORS Chapter 689, facility policy (OAR
411-085-0210) and this rule.
(2) Pharmaceutical Services Review. The Quality Assessment and
Assurance Committee shall:
(a) Develop written policies and procedures for safe and effective
drug therapy, distribution and use;
(b) Oversee pharmaceutical services in the facility, monitor the
service to ensure accuracy and adequacy and make
recommendations for improvement; and
(c) Meet at least quarterly and document its activities, findings and
recommendations.
(3) Drug Supply, Storage and Labeling:
(a) Drug Room. Facilities without a pharmacy shall have a drug room
as defined in ORS Chapter 689, supervised by the consulting
pharmacist. Drug rooms shall contain only prescribed (legend and
non-legend) drugs, non-prescription (non-legend) stock drug supply
and the emergency medication kit authorized pursuant to this rule.
Locked carts or locked cupboards shall be used to prevent pilferage;
(b) Labels:
(A) All medications purchased or designated for specific
residents shall be labeled as prescribed for such resident;
(B) If facility policy allows medications accompanying the
resident on admission to be used, the medication must be
identified as to the resident and medication and shall be
Page 49
authorized for use only on the written order of the attending
physician.
(c) Storage. Except as provided in subsection (4)(b) of this rule, all
medications shall be stored in the facility pharmacy, a drug room, or
in a locked medication cart;
(d) Stock Supply:
(A) Except as provided in section (6) of this rule, a stock supply
of prescription (legend) drugs may be maintained only within a
licensed pharmacy;
(B) A stock supply of non-prescription drugs may be maintained
in a drug room or locked medication cart, but there must be a
doctor's order for administering such drugs. A stock supply of
non-prescription drugs means those non-legend medications
supplied in the manufacturer's original package or repackaged
by a registered pharmacist and labeled in accordance with ORS
Chapter 689.
(e) Resident Discharge. Medication to accompany the resident upon
discharge must be on the written order of the physician;
(f) References. References regarding use, dosage, contraindications,
drug interactions, and adverse reactions shall be available on drug
products used in the facility.
(4) Drug Administration:
(a) Medications prescribed to one resident shall not be administered
to another;
(b) Self-administration. Facilities shall have written policies and
procedures allowing self-administration of medication:
(A) All bedside medications, except nitroglycerine, shall be
stored in closed, locked cupboards or drawers;
Page 50
(B) The consulting pharmacist shall specify maximum quantities
of medications to be stored at bedside to ensure prevention of
poisoning by confused or suicidal residents.
(c) Stop Order Policy. An automatic stop order policy shall be
adopted and enforced. This policy shall provide guidance when
medications ordered are not specifically limited as to time or number
of doses. The policy shall be developed by the Quality Assessment
and Assurance Committee.
(5) Medication Review. Medications shall be reviewed monthly by the
consulting pharmacist and reordered by the physician as necessary, but no
less often than quarterly. The pharmacist shall alert the DNS when drugs
designated "less-than effective" ("DESI" drugs) by the Federal Food and
Drug Administration have been ordered and what alternative medications
may be available. The DNS shall notify the physician.
(6) Emergency Medication Kit:
(a) An emergency medication kit shall be prepared and authorized by
a registered pharmacist for use in the facility in accordance with
written facility policy. The contents shall be selected by the Quality
Assessment and Assurance Committee;
(b) The kit shall be sealed and stored in a manner to prevent loss of
drugs, but available to authorized personnel. The vendor pharmacist
shall be notified when the seal is broken. A record shall be made that
identifies each use of an emergency drug. The contents shall be
plainly indicated on the outside of the container;
(c) Any drug removed from the kit shall be covered by a prescription
and signed by the physician within 72 hours.
(7) Charges for Drugs; Choice of Supplier. See OAR 411-085-0340.
(8) Documentation. The nursing staff shall clearly and accurately document
administration of pharmaceuticals and the response thereto.
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Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0300 Clinical Records
(Amended 12/2/1991)
(1) Clinical Records Department. The facility shall ensure the preparation,
completeness, accuracy, preservation, and filing of a clinical record for
each resident in accordance with facility policy (OAR 411-085-0210). This
rule does not apply to nonmedical records.
(2) Director. The facility shall designate in writing a staff person to function
as clinical records coordinator who shall ensure compliance with this rule.
Services of a qualified medical record consultant (RRA or ART) shall be
provided as needed.
(3) Staffing, Equipment. There shall be personnel, space, and equipment to
provide efficient, systematic processing of clinical records including but not
limited to reviewing, indexing, filing, and prompt retrieval.
(4) Filing. A system of identification and filing to ensure the rapid location of
resident clinical records shall be maintained. A resident master index
containing at least the full name of each resident, date of birth, clinical
record number as applicable, date of admission, date of discharge, legal
representative and physician of record shall be maintained.
(5) Content of Clinical Record. A clinical record shall be maintained for
each resident. Each record shall contain supporting data, written in
sequence of events to justify the diagnosis and warrant the treatment and
results. All entries shall be kept current, accurate, dated and signed. All
clinical records shall be either typewritten or recorded legibly in ink and
shall include but not be limited to the following information:
(a) Admitting diagnosis and identification data including the resident's
name, previous address, date and time of admission, sex, date of
birth, marital status, religious preference and social security number;
name, address, and telephone number of nearest relative or personal
agent; place admitted from; attending physician; alternate physician
(clinic or service); dentist; legal representative and RN care manager;
Page 52
(b) A medical history and physical exam or medical summary as to
the resident's condition which is signed by a physician. If a resident is
re-admitted within 30 days for the same condition, the previous
history and physical or medical summary, with an interval note signed
by a physician, will suffice. If an ongoing clinical record is maintained
in a comprehensive care facility, it may be used if accompanied by a
physical exam report completed within the previous 30 days;
(c) Clinical reports, current, dated, and signed. Such reports include,
but are not limited to, laboratory, x-ray, and results of tests/exams
including those for communicable diseases;
(d) Physician's orders, current, dated and signed;
(e) Physician's progress notes dated and signed;
(f) Timely, written, dated, pertinent, complete and signed clinical
observations. Clinical observations shall include changes in condition,
results of treatments and medications, and unusual events. Clinical
observations shall include outcome of the resident care plan and shall
be summarized by nursing staff at least quarterly unless the
resident's condition dictates otherwise;
(g) Record of medication administration including name of drug,
dosage, frequency, mode of administration, date, time and signature
of the person administering medication. Documentation shall also
include, when applicable, site of injection, reaction, reason for
withholding any medication, and reason for administering any "prn"
(as needed) medication;
(h) Record of treatments administered which shall be dated, timed
and signed by those performing treatments;
(i) Miscellaneous items such as releases, consent forms, mortician's
receipts, valuables list and medical correspondence as applicable;
(j) Discharge summary prepared in accordance with OAR 411-086-
0160 and signed by the attending physician. The summary shall
include admitting diagnosis/reason for admission, summary of the
Page 53
course of treatment in the facility, final diagnosis with a follow-up plan
if appropriate, condition on discharge or cause of death; and
(k) The "Directive to Physicians" ("Living Will"), the Power of Attorney
for Health Care and similar legal documents regarding resident care
directives, if any, shall be filed in the resident's clinical record in a
manner which makes them prominent and conspicuous.
(6) Record Retention. All clinical records shall be kept for a period of five
years after the date of last discharge of the resident. A clinical record for
each resident for whom care has been provided in the previous six months
shall be immediately available for review by Division representatives upon
request.
(7) Resident Transfer. When a resident is transferred to another facility, the
following information shall accompany the resident:
(a) The name of the facility from which transferred;
(b) The names of attending physicians prior to transfer;
(c) The name of physician to assume care;
(d) The date and time of discharge;
(e) Most recent history and physical;
(f) Current diagnosis, orders from a physician for immediate care of
the resident, nursing, and other information germane to the resident's
condition;
(g) A copy of the discharge summary. If the discharge summary is not
available at time of transfer, it shall be transmitted as soon as
available, but no later than seven days after transfer; and
(h) A copy of the current Directive and Power of Attorney for Health
Care, if any.
(8) Ownership of Records. Clinical records are the property of the licensee.
The clinical record, either in original or microfilm form, shall not be removed
Page 54
from the control of the facility except where necessary for a judicial or
administrative proceeding. Authorized representatives of the Division shall
be permitted to review and obtain copies of clinical records as necessary to
determine compliance with OAR 411:
(a) If a facility changes ownership all clinical records in original or
microfilm form shall remain in the facility and ownership shall be
transferred to the new licensee;
(b) In the event of dissolution of a facility, the administrator shall
ensure that clinical records are transferred to another health care
facility or to the resident's primary care physician, and shall notify the
Division as to the location of each clinical record. The party to whom
the records are transferred must have agreed to serve as custodian
of the records.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0310 Employee Orientation and In-Service Training
(Amended 09/25/2024)
(1) Orientation. The nursing facility shall ensure that each employee,
temporary employee, and volunteer completes an orientation program
sufficient to ensure that the safety and comfort of all residents is assured in
accordance with facility policies (OAR 411-085-0210). Orientation to each
task must be completed prior to the employee or volunteer performing such
task independently. Orientation for nursing staff and nursing assistants in
training shall be supervised by a registered nurse. The orientation shall
include:
(a) Explanation of facility organizational structure;
(b) Philosophy of care of the facility, including purpose of nursing
facility requirements as defined in these administrative rules;
(c) Description of resident population;
(d) Employee rules;
Page 55
(e) Facility policy and procedures; and
(f) RESIDENTS’ RIGHTS. Residents' rights and the values of nursing
facility care, including the Department-approved LGBTQIA2S+
trainings.
(A) Effective December 31, 2024, all facility staff must have
completed the required training. All new facility staff, hired on or
after January 1, 2025, must complete the required training prior
to beginning job responsibilities.
(B) The Department-approved LGBTQIA2S+ trainings shall
address the elements described in paragraph (3)(d) of this rule
(2) Inservice. The Administrator or his/her designee shall coordinate all
inservice training. Inservice training shall be designed to meet the needs of
all facility staff in accordance with facility policy (OAR 411-085-0210). Each
certified nursing assistant shall receive a minimum of three hours of in-
service training each calendar quarter. Each calendar year the Inservice
training agenda shall include at least the following:
(a) Resident rights, including, but not limited to, those rights included
in ORS 441.600-441.625;
(b) Rules and statutes pertaining to abuse, including, but not limited
to, ORS 441.630-441.675;
(c) The transfer/discharge rules, including, but not limited to, the
obligations of facility personnel to forward requests for conferences
and hearings to the appropriate authorities;
(d) Measures to prevent cross-contamination, including universal
precautions;
(e) Oral care, including oral screenings (required for nursing staff
only);
(f) Emergency procedures, including, but not limited to, the disaster
plan;
Page 56
(g) Procedures for life-threatening situations, including, but not limited
to, cardiopulmonary resuscitation and the life-saving techniques for
choking victims (including abdominal thrust and chest thrust);
(h) Application and use of physical restraints (required for nursing
staff only);
(i) Procedures to prevent residents from wandering away from the
facility and how to deal with the wandering resident;
(j) Restorative services, including benefits thereof (required for
nursing staff only);
(k) Activity program, including benefits thereof;
(l) The social services program, including benefits thereof;
(m) Accident prevention;
(n) Alzheimer's disease and other dementias, including recognition of
symptoms, treatments, and behavioral management; and
(o) Other special needs of the facility population.
(3) Biennial LGBTQIA2S+ training requires the following:
(a) Administrators and employees shall be required to complete
biennial training addressing LGBTQIA2S+ protections, as described
in this section. The facility is responsible for the cost of providing this
training to all facility staff.
(A) Each facility shall designate two employees, one who
represents management and one who represents direct care
staff by July 1, 2024. It is acceptable for the designated
employee representing management to generally be housed
offsite, but the direct care representative must be onsite.
(B) The designated employees shall serve as points of contact
for the facility regarding compliance with the biennial training
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requirements. These individuals shall develop a general training
plan for the facility.
(b) Facilities must select the LGBTQIA2S+ training to be used by the
facility by either:
(A) Choosing to use the standard Department-approved
biennial LGBTQIA2S+ training, or
(B) Applying to the Department to request approval of a biennial
LGBTQIA2S+ training to be developed and provided by the
facility.
(c) ORS 441.116 requires all LGBTQIA2S+ trainings address:
(A) Caring for LGBTQIA2S+ residents and residents living with
human immunodeficiency virus.
(B) Preventing discrimination based on a resident’s sexual
orientation, gender identity, gender expression or human
immunodeficiency virus status.
(C) The defined terms commonly associated with LGBTQIA2S+
individuals and human immunodeficiency virus status.
(D) Best practices for communicating with or about
LGBTQIA2S+ residents and residents living with human
immunodeficiency virus, including the use of an individual’s
chosen name and pronouns.
(E) A description of the health and social challenges historically
experienced by LGBTQIA2S+ residents and residents living
with human immunodeficiency virus, including discrimination
when seeking or receiving care at care facilities and the
demonstrated physical and mental health effects within the
LGBTQIA2S+ community associated with such discrimination.
(F) Strategies to create a safe and affirming environment for
LGBTQIA2S+ residents and residents living with human
immunodeficiency virus, including suggested changes to care
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facility policies and procedures, forms, signage, communication
between residents and their families, activities, in-house
services and staff training.
(G) The facility, individual or entity providing the training must
demonstrate a commitment to advancing quality care for
LGBTQIA2S+ residents and residents living with human
immunodeficiency virus in this state.
(d) The proposal for training submitted by a facility, individual or entity
shall include:
(A) The regulatory criteria described in paragraph (c) of this
section as part of the proposal.
(B) The following elements must be included in the proposal:
(i) A statement of the qualifications and training
experience of the facility, individual or entity providing the
training.
(ii) The proposed methodology for providing the training
either online or in person.
(iii) An outline of the training.
(iv) Copies of the materials to be used in the training.
(C) The Department will review the materials and determine
whether to approve or deny the training. No later than 90 days
after the request is received, the Department will inform the
facility in writing of the Department’s decision.
(4) Contractors who provide services or supports directly to residents must
complete the required LGBTQIA2S+ trainings outlined in paragraph (3)(c)
of this rule.
(a) Contractors who must be trained include, but are not limited to,
RN and administrative consultants, housekeeping services, dietary
Page 59
services, beauticians, barbers, or other contractors who provide
services or supports directly to residents.
(b) Exempt from this training requirement are contractors who
contract directly with the resident or the resident’s representative, and
contractors who do not generally provide services or supports directly
to residents, including but not limited to contractors for landscaping,
pest control, deliveries and building repairs.
(c) By December 31, 2024, facilities shall ensure that all contracts
entered into with entities described in paragraph (a) of this section
shall include language requiring contractors provide Department-
approved LGBTQIA2S+ training to their employees within 12 months
of entering into the contract with the facility and every two years
thereafter.
(d) For existing contracts in effect January 1, 2025, facilities shall
require contractors to provide Department-approved LGBTQIA2S+
training to employees by December 31, 2025, and every two years
thereafter.
(e) For new contracts created after January 1, 2025, facilities shall
require contractors to provide the Department-approved
LGBTQIA2S+ training to employees within 12 months of entering into
the contract with the facility, and every two years thereafter.
(f) Facilities must inform contractors the cost of all LGBTQIA2S+
trainings for contracted employees shall be paid by the contractor.
(5) Documentation. Inservice training, Biennial LGBTQIA2S+ training and
orientation shall be documented and shall include the date, content, and
names of attendees.
Stat. Auth.: ORS 410.070, 410.090, 441.055, 441.122
Stats. Implemented: ORS 441.055, 441.116, 441.118, 441.615
411-086-0320 Emergency and Disaster Planning
(Amended 10/1/2009)
Page 60
An emergency preparedness plan is a written procedure that identifies a
facility's response to an emergency or disaster for the purpose of
minimizing loss of life, mitigating trauma, and to the extent possible,
maintaining services for residents, and preventing or reducing property
loss.
(1) The nursing facility must prepare and maintain a written emergency
preparedness plan in accordance with the Oregon Fire Code (OFC) in OAR
chapter 837, division 040 and the 2009 National Fire Protection Association
(NFPA) 101 Life Safety Code.
(2) The emergency preparedness plan must:
(a) Include analysis and response to potential emergency hazards
including but not limited to:
(A) Evacuation of a facility;
(B) Fire, smoke, bomb threat, or explosion;
(C) Prolonged power failure, water, or sewer loss;
(D) Structural damage;
(E) Hurricane, tornado, tsunami, volcanic eruption, flood, and
earthquake;
(F) Chemical spill or leak; and
(G) Pandemic.
(b) Address the medical needs of the residents including:
(A) Access to medical records necessary to provide care and
treatment; and
(B) Access to pharmaceuticals, medical supplies, and
equipment during and after an evacuation.
Page 61
(c) Include provisions and supplies sufficient to shelter in place for a
minimum of five days without electricity, running water, or
replacement staff.
(3) The facility must notify SPD, or the local AAA office or designee, of their
status in the event of an emergency that requires evacuation and during
any emergent situation when requested.
(4) The facility must conduct a drill of the emergency preparedness plan at
least twice a year in accordance with the OFC in OAR chapter 837, division
040 and other applicable state and local codes as required. One of the
practice drills may consist of a walk-through of the duties or a discussion
exercise with a hypothetical event, commonly known as a tabletop
exercise. These simulated drills do not take the place of the required fire
drills.
(5) The facility must annually review or update the emergency
preparedness plan as required by the OFC in OAR chapter 837, division
040 and the emergency preparedness plan must be available on-site for
review upon request.
(6) A summary of the facility's emergency preparedness plan must be
submitted to SPD annually on July 1, and at a change of ownership, in a
format provided by SPD.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615, OL 2007 chapter 205
411-086-0330 Infection Control and Universal Precautions
(Amended 03/18/2022)
(1) Infection Control:
(a) The Quality Assurance and Assessment Committee shall
establish, maintain and enforce an infection control program,
including universal precautions and isolation procedures, which
assures protection of residents and staff from infections;
(b) The committee shall meet quarterly and as needed to review
facility policies, procedures, and monitor staff performance relative to
Page 62
infection control. These meetings and the results thereof shall be
documented;
(c) In reviewing and developing facility infection control policies and
procedures, the committee shall consider all guidelines relative to
infection control issued by the Division and by the Center for Disease
Control, Atlanta, GA.
NOTE: Copies available through National Technical Information
Service, 1-703-487-4650.
(d) Facilities must comply with masking requirements as prescribed in
OAR 333-019-1011 or, if applicable, OAR 437-001-0744, to control
the spread of COVID-19.
(e) Facilities must comply with vaccination requirements for COVID-
19 as prescribed in OAR 333-019-1010. Facilities must maintain
proof of vaccination or documentation of a medical or religious
exemption as required in OAR 333-019-1010(4).
(2) Simultaneous Duties. Personnel shall not be simultaneously responsible
for duties which are incompatible with sanitation. This includes prohibiting
personnel from being assigned to both resident care and work in the
kitchen, laundry, or housekeeping. This also prohibits personnel from
having responsibility for work in the kitchen combined with laundry,
housekeeping or other such conflicting tasks.
(3) Communicable Disease. Each nursing facility shall maintain compliance
with the Health Division rules for communicable disease, including rules
relating to tuberculosis examinations for facility personnel and residents.
(4) Soiled Laundry. Soiled linen, toweling, clothing, and sickroom
equipment shall not be sorted, laundered, rinsed, or stored in bathroom,
kitchen, resident rooms or clean utility areas. Soiled linen, toweling and
clothing shall be stored in a separate, ventilated room. Soiled clothing shall
be washed separately from soiled linen. Soiled laundry must be transported
and stored in a covered container impervious to moisture.
(5) Waste Disposal. All garbage, refuse, soiled surgical dressings and other
similar wastes shall be disposed of in a manner that will not create a
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nuisance or a public health hazard and which is consistent with the State
Health Division's rules for infectious waste (OAR 333, division 056). When
community garbage collections and disposal service are not available,
garbage and refuse shall be disposed of by some other equally effective
and sanitary manner approved by the local health officer.
(6) Clean Linen Storage. All clean linen shall be stored in clean storage
rooms or cupboards easily accessible to nursing personnel. Laundry carts
used for storing clean linen shall be kept covered when not in use.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0340 Pets
(Adopted 10/1/1990)
(1) Pets Allowed. Household pets (dogs, cats, birds, fish, hamsters, etc.)
are permitted in the nursing facility under the following conditions:
(a) Pets must be clean and disease-free;
(b) Immediate environment of pets must be kept clean;
(c) Small pets (e.g., birds, hamsters) must be kept in appropriate
enclosures;
(d) Pets not confined in enclosures must be hand held, under leash
control, or under voice control; and
(e) Pets that are kept at the facility (or are frequent visitors) shall have
current vaccinations as recommended by a designated licensed
veterinarian (including, but not limited to, rabies).
(2) Areas Pets Prohibited. Pets are not permitted in food preparation or
storage areas. Pets shall not be permitted in any area where their presence
would create a significant risk or annoyance to residents.
(3) Administrative Control. The administrator or his/her designee shall
determine which pets may be brought into the facility. Family members may
bring resident's pets to visit provided they have approval from the
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administrator and offer reasonable assurance that the pets are clean,
disease-free, and vaccinated as appropriate.
(4) Overnight Stay. Facilities with pets that are kept overnight shall have
written policies and procedures for the care, feeding, and housing of such
pets and for the proper storage of pet food and supplies.
(5) Birds. Facilities with birds shall have procedures which protect
residents, staff, and visitors from psittacosis. Procedures should ensure
minimum handling of droppings. Droppings shall be placed in a plastic bag
for disposal. Persons caring for the bird(s) shall not have nursing care or
food handling responsibilities.
(6) Exotic Pets Prohibited. Exotic pets (i.e., iguanas, snakes, other reptiles,
monkeys, ferrets) shall not be kept at the facility. If exotic pets are brought
in for a visit, they must be attended at all times by their owners. Skunks,
foxes, and raccoons are not permitted in nursing facilities.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
411-086-0350 Smoking
(Amended 10/1/2009)
(1) A nursing facility must be in compliance with:
(a) The Oregon Indoor Clean Air Act, ORS 433.835 to 433.875;
(b) The rules in OAR chapter 333, division 015; and
(c) Any other applicable state and local laws.
(2) A facility must provide a place of employment that is free of tobacco
smoke for all employees.
(3) Smoking may only be allowed outside the facility as prescribed by OAR
333-015-0064.
(4) The facility must take adequate precautions to protect all residents from
injury where residents are allowed and choose to smoke.
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(5) The facility must develop and implement a smoking policy that includes
resident assessment and care planning.
(6) If the facility's smoking policy changes, the licensee must provide
written notice to all residents 30 days' prior to such change.
(7) Nothing in this rule shall prevent the licensee from designating any part
of the facility or the entire facility as a non-smoking area. If the facility
decides to designate the entire facility as a non-smoking area, all persons
admitted thereafter must be so notified by the facility prior to or at the time
of admission. Such facility must continue to provide an outdoor smoking
area as prescribed by OAR 333-015-0064 for residents who smoke and
were admitted prior to the facility decision.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 433.835 - 433.990, 441.055, 441.615
411-086-0360 Resident Furnishings, Equipment
(Adopted 10/1/1990)
(1) Resident Equipment:
(a) Each resident shall be provided a bed, mattress, pillow with water-
proof protection, necessary bed coverings, bedside table and chair,
reading light, and electrically operated call system which registers at
the nurses' station. The call system cord shall be secured in a
manner which makes it accessible to the resident and which prevents
the resident from injuring himself/herself with it;
(b) According to his/her needs, each resident shall be provided with
individual equipment, such as bedpans, bedpan covers, urinals,
washbasins, emesis basins, mouthwash cups, soap, washcloths,
towels, and drinking glasses;
(c) Equipment such as wheelchairs, walkers, geri-chairs and crutches
shall be readily available for residents needing this equipment;
(d) After the discharge of any resident, the bed, bed furnishings,
bedside furniture, and all multiple-use resident equipment shall be
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thoroughly cleansed and disinfected prior to re-use. Mattresses shall
be professionally renovated when necessary;
(e) Single resident use items must be identified with resident name
and disposed of upon resident discharge;
(f) Hot water bags and electric heating pads or blankets may be used
only on the written order of the physician;
(g) In nursing facilities caring for pediatric residents, an emergency
signaling system for use by attendants summoning assistance and a
two-way voice intercommunication system between the nurses'
station and rooms or wards housing pediatric residents shall be
provided.
(2) Storage Space. Separate storage space for clothing, toilet articles, and
other personal belongings of residents shall be provided.
(3) Privacy. In multiple-bed rooms, opportunity for privacy shall be provided
by flame retardant curtains or screens. Cubicle curtains or screens are not
required for beds assigned to pediatric residents.
(4) Linen Supply. The use of torn or unclean bed linen is prohibited.
Facilities shall have a linen supply available for at least three times the
usual bed occupancy.
Stat. Auth.: ORS 410.070, 410.090, 441.055
Stats. Implemented: ORS 441.055, 441.615
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EXHIBIT 86-1: 36-Hour Activities Workshop Required Curriculum
1. State and Federal Requirements for Activity Services
a. Resident abuse and mandatory reporting
b. Role of the activity director, including job description and role on
the interdisciplinary team
c. Developing and conducting in-services for staff
2. Quality of Life
a. Resident rights and self-determination
b. Maintaining resident dignity
c. Avoiding restraints through effective activity programs
d. Maintaining a sense of self; giving power to the resident
3. Resident Care Planning Process
a. Assessing resident capabilities and potential, including cognitive,
affective, physical and social strengths, needs, interests and
problems
b. Why individualized care plans are needed
c. How individualized, measurable and realistic goals are developed
d. Coordination with other disciplines and family
e. Connecting the resident with his/her past
4. Communication
a. Communicating with residents; treating residents with respect
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b. How to approach the resident
c. Interview techniques: residents and families
d. Resident and family councils
5. Program Planning and Activity Analysis
a. Creative and meaningful activities for groups and individuals
b. Planning, justifying and evaluating activities to meet physical,
mental, and social needs; measuring outcome
c. Activities for low-functioning and bedridden residents
d. Sensory stimulation
e. Increasing resident self-esteem through independence and self-
direction
f. Psycho-social issues, including impact of institutionalization
g. Utilizing community resources; volunteer recruitment, training and
retention
6. Medical Terminology, Documentation Skills, Orientation to Medications
and Behavioral Side-Effects
7. Clinical Record Documentation, Taking Histories
8. Physical and Behavioral Changes Associated with the Aging Process
9. Working with Combative, Aggressive and Wandering Residents, and
Other Behaviors
10. Ethics for the Care Provider; Confidentiality
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EXHIBIT 86-2: Dining Assistant Training Curriculum
1. Definition of Dining Assistant and Permitted and Prohibited Duties.
2. Dining, Hydration and Other Techniques.
a. Hand over hand
b. Cuing and prompting
c. Use of proper utensils and assistive devices (rim plates, weighted
spoons, nose and sippy cups, straws, etc.)
d. Proper positioning of dining assistant and residents
e. Visually Impaired Clock Method
f. Setting up the meal
g. Pace of feeding methods
h. Preparation of dentures for application (not to include oral care)
i. Proper transportation techniques to and from dining area
(wheelchair, walker, geri-chair and meri-walker)
3. Dining and Hydration Concepts.
a. Diet types, textures and fluid consistencies
b. Food pyramid
c. Importance and promotion of fluid intake
d. Environmental considerations while feeding
e. Measurement and recording of foods and fluids
f. Assessing information regarding specific feeding directives
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g. Basic anatomy of chewing and swallowing (introduction of
Dysphasia, aspiration, choking and signs of difficulty swallowing)
h. Methods of serving trays
4. Communication and Interpersonal Skills.
a. Definitions of communication (verbal, nonverbal, etc.)
b. Techniques and adaptations to resident needs (cuing, prompting)
c. Significance of positive and negative communication on nutrition
d. Residents with sensory deficits
e. Resident social interactions during dining
f. Access and use of plan of care
5. Appropriate Responses to Resident Behaviors.
a. Understanding resident behaviors (refusing to eat, taking of other
residents' food, biting down on spoon, etc.)
b. Responding to expected and unexpected behaviors
c. How to describe resident behavior(s)
d. What to report regarding resident behavior(s)
e. Understanding and feeding residents with Dementia
f. Characteristics of Dementia
g. Causes of Dementia (head injury, alcohol abuse, Parkinson's, etc.)
h. Progression of Dementia and how it may affect dining and
hydration
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i. Approaches and techniques for assisting residents with Dementia
6. Recognizing and Reporting Resident Changes in Condition.
a. Definition of observation and opinion
b. How and to whom changes in condition are reported
c. Identify types and timing of information that needs to be reported.
7. Safety and Emergency Procedures.
a. Introduction to safety and emergency procedures
b. Finger Sweep and Abdominal Thrust emergency techniques
c. Choking prevention and detection
d. What not to do during a choking episode
e. Scalds and burns
8. Infection Control.
a. Standard precautions
b. Proper glove use (when and how to use)
c. Food sanitation
d. How infections spread
e. Reporting of open wounds or illness
9. General Food Safety.
a. Basics of food borne illnesses
b. Understanding and maintaining safe and palatable food
temperature
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10. Resident Rights, Abuse and Reporting Abuse.
a. Residents rights in general
b. Rights specific to dining and hydration (right to refuse, choice,
dignity, etc.)
c. Abuse definition and reporting
d. Abusive conduct
e. Requirements for reporting abuse and to whom
f. Consequences of abuse findings
g. Roles of Office to Long Term Care Ombudsman, Protective
Services, Client Care Monitoring Units and surveyors
h. Confidentiality and how it applies to dining assistants
11. Skills Competency Testing.
a. Hand washing
b. Assisting a resident with dining