OAC 310:675

Nursing and Specialized Facilities

This Oklahoma regulation establishes minimum licensing and operating standards for nursing facilities and specialized facilities (long-term care) under the Nursing Home Care Act. It covers application and renewal procedures, physical plant requirements, staff identification, tobacco policies, resident relocation in emergencies, and waiver processes. Facility operators must obtain and maintain a license, comply with staffing and physical plant standards, and follow prescribed procedures for ownership changes, license suspension, and resident rights.

1 
 
CHAPTER 675. NURSING AND SPECIALIZED FACILITIES 
 
[Authority: 63 O.S., §§ 1-104 and 1-1901 et seq.] 
[Source: Codified 12-31-91] 
 
EDITOR’S NOTE: Numerous rules in this Chapter were added or revised by the Oklahoma State 
Department of Health in 2007. However, after these rules, as identified below, had been promulgated in 
the Oklahoma Register and published in the 2007 OAC Supplement, the Department discovered that an 
earlier draft of the rules, which had NOT been adopted by the State Board of Health, had been 
inadvertently submitted to the Legislature, Governor, and Secretary of State for review, final adoption, 
and promulgation [see 24 Ok Reg 2030, effective 6-25-07]:310:675-1-2310:675-7-5.1310:675-7-
12.1310:675-7-17.1310:675-7-18.1310:675-7-21310:675-9-13.1310:675-13-7310:675-21-1 through 
310:675-21-5Appendix BUpon discovery of this error, the agency initiated another rulemaking action, 
and the rules were readopted in 2008. After review and final adoption, those rules were promulgated at 
25 Ok Reg 2482, effective 7-11-08. [See also Editor's Note published at 25 Ok Reg 2482] 
 
SUBCHAPTER 1. GENERAL PROVISIONS 
 
310:675-1-1. Purpose 
The purpose of this Chapter is to implement the "Nursing Home Care Act" (63 O.S. 1991, §§ 1-1901 
et seq.) and to establish the minimum criteria for the issuance or renewal of a nursing or specialized 
facility license. 
[Source: Amended at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-1-2. Definitions 
The following words and terms, when used in this Chapter, shall have the following meaning unless 
the context clearly indicates otherwise: 
"Act" means Title 63 of the Oklahoma Statutes, Sections 1-1901 and following as amended also 
known as the Nursing Home Care Act. 
 "Allied health professional" means one of the following persons: physician assistant, physical, 
speech, or occupational therapist, occupational therapy assistant, physical therapy assistant, or qualified 
social worker. 
 "Antipsychotic drug" means a drug, sometimes called a major tranquilizer, used to treat symptoms 
of severe psychiatric disorders, including but not limited to schizophrenia and bipolar disorder. 
 "Attendant" means the person having control of an animal/pet visiting or in residence in a facility. 
 "Approval" means the mandatory state government process by which an agency or program is 
reviewed, and publicly proclaimed, to render a service worthy of note. 
 "CEP" means the nurse aide competency evaluation program. 
 "Certification" means the process by which a non-governmental agency, or association, or 
governmental agency attests that an individual or facility has met certain predetermined standards 
specified by the certifying body. 
 "Certified medication aide" means a person who has passed a Department approved program for 
administering medications. 
 "Certified nurse aide" means any person who provides, for compensation, nursing care or health-
related services to residents of a facility, who is not a licensed health professional and has completed a 
Department approved training and competency program. 
 "Charge nurse" means a registered nurse or licensed practical nurse responsible for supervising 
nursing services on a specific shift. 
 "Chemical restraints" means the use of a medication for the purpose of discipline, convenience, or 
in an emergency situation to control mood or behavior and not required to treat the resident's symptoms. 
2 
 
"Consultant registered nurse" means a registered nurse who provides consultation to the director of 
nursing and administrator concerning the delivery of nursing care for all residents in the facility. 
 "Denial" means a decision made by the appropriate body to disapprove an application. 
"Direct care staff" means nursing, activity, social and therapy staff. 
 "Director of nursing" means either a registered nurse or licensed practical nurse, who has the 
authority and responsibility to administer nursing services within the facility. 
 "Emergency" means, for the purposes of Title 63 O.S. § 1-1912, a serious, potentially life-
threatening or life-endangering situation in which immediate action is necessary to ensure the health, 
safety, or welfare of residents, and for which the facility: 
(A) does not have a plan acceptable to the Department to ensure health, safety or welfare of 
residents; or 
(B) refuses to remedy the situation. 
 "Health related services" means any medically directed service provided by any person in a facility 
that may include but is not limited to, the following: 
(A) Positioning and turning of residents; 
(B) Self-help skill training; 
(C) Assistance with prosthetic/assistive devices; 
(D) Medication administration; 
(E) Nutrition and hydration; 
(F) Monitoring of resident vital signs; 
(G) Catheter and nasogastric care; 
(H) Behavior modification programs; 
(I) Administering a medically related care plan; and 
(J) Restorative services. 
 "In charge" and "supervision" means the administrator must have the requisite authorization from 
the licensee to make those purchases and incur those necessarily attendant debts in order to comply with 
the rules promulgated by the Board and all pertinent state statutes. 
 "Inservice education" means activities intended to assist the individual to acquire, maintain, and/or 
increase competence in fulfilling the assigned responsibilities specific to the employer's expectations. 
 "Licensed health professional" means one of the following: a physician; dentist, podiatrist, 
chiropractor, physician assistant, nurse practitioner; pharmacist; physical, speech, or occupational 
therapist; registered nurse, licensed practical nurse; licensed or certified social worker; or 
licensed/registered dietician. 
 "Licensed nurse" means a registered nurse or a licensed practical nurse who is currently licensed by 
the Oklahoma Board of Nursing. 
 "Licensed pharmacist" means a person who is a graduate of an accredited pharmacy program and is 
currently licensed by the Oklahoma Board of Pharmacy. 
 "Licensed practical nurse" means a person who is a graduate of a state approved practical nursing 
education program, or who meets other qualifications established by the Oklahoma Board of Nursing, and 
is currently licensed by the Oklahoma Board of Nursing. 
 "Licensure" means the process by which the Department grants to persons or entities the right to 
establish, operate, or maintain any facility. 
 "Local law enforcement" means: 
(A) The municipal police department, if the facility is within the jurisdiction of any municipality 
of this state, or 
(B) The county sheriff, if the facility is outside the jurisdiction of any municipality within this 
state. 
 "Long-term care facility" means: 
(A) a nursing facility as defined in 63 O.S. § 1-1902; 
(B) a continuum of care facility as defined under the Continuum of Care and Assisted Living Act; 
or 
3 
 
(C) the nursing care component of a life care community as defined by the Long-term Care 
Insurance Act. 
"Manager" or "supervisor" means the person or entity which performs administrative services for 
the licensee. The manager or supervisor is not legally responsible for the decisions and liabilities of the 
licensee, and does not stand to gain or lose financially as a result of the operation of the facility. The 
manager is paid a fee or salary for services, and the primary remuneration shall not be based upon the 
financial performance of the facility. 
"Misappropriation of resident's property" means the taking, secretion, misapplication, 
deprivation, transfer, or attempted transfer to any person not entitled to receive any property, real or 
personal, or anything of value belonging to or under the legal control of a resident, without the effective 
consent of the resident or other appropriate legal authority, or the taking of any action contrary to any 
duty imposed by federal or state law prescribing conduct relating to the custody or disposition of 
resident's property. 
 "Nurse aide" means any person providing nursing or nursing related services to residents in a 
facility, but does not include an individual who is a licensed health professional, or who volunteers to 
provide such services without monetary compensation. 
"Nurse aide trainee" means any person who has been employed by a facility to provide nursing care 
or health related services, and is enrolled in but has not completed a Department approved training and 
competency program. 
 "Orientation" means the training for a particular job activity given to all employees. 
"Perishables" means food supplies, to include dietary supplements and intravenous feedings, 
medical supplies, and medications. 
"Physical restraints" means any manual method or physical or mechanical device, material or 
equipment attached or adjacent to the resident's body that the resident cannot remove easily, that is not 
used for the purpose of therapeutic intervention or body alignment as determined by resident assessment 
and care planning, and which restricts the resident's desired freedom of movement and access to his or her 
body. 
 "Prescribing clinician" means: 
(A) an allopathic or osteopathic physician licensed by and in good standing with the Oklahoma 
State Board of Medical Licensure and Supervision or the Oklahoma State Board of Osteopathic 
Examiners, as appropriate; 
(B) a physician assistant licensed by and in good standing with the Oklahoma State Board of 
Medical Licensure and Supervision; or 
(C) an Advanced Practice Registered Nurse licensed by and in good standing with the Oklahoma 
Board of Nursing. 
 "Qualified nutritionist" is a Department approved person who holds a baccalaureate with major 
studies in food and nutrition, dietetics, or food service management; has one year experience in the 
dietetic service of a health care institution; and participates in continuing education annually. 
"Registered/licensed dietitian" means a person who is registered as a dietitian by the American 
Dietetic Association and licensed by the Oklahoma Board of Medical Licensure and Supervision. 
"Registered nurse" means a person who is a graduate of a state approved registered nursing 
education program, and who is currently licensed by the Oklahoma Board of Nursing. 
"Registry" means a Department maintained list of individuals who have successfully completed a 
nurse aide training and competency evaluation program, or a competency evaluation program, approved 
by the Department. 
 "Representative of a resident" means a representative of a resident as defined by 63 O.S. § 1-1902. 
"Resident" means a resident as defined by 63 O.S. § 1902. 
 "Revoke" means to rescind approval of a previous action. 
 "Specialized facility" means any facility which offers or provides inpatient long-term care services 
on a twenty-four hour basis to a limited category of persons requiring such services, including, but not 
4 
 
limited to, a facility providing health or habilitation services for developmentally disabled persons, infants 
and/or children, or Alzheimer's and dementia residents. 
 "Standards of nursing practice" means an authoritative statement that describes a level of care or 
performance common to the profession of nursing by which the quality of nursing practice can be judged. 
Standards of nursing practice include both standards of care and standards of professional performance. 
 "Standards of care" means a description of a competent level of care demonstrated by a process of 
accurate assessment and diagnosis, planning, appropriate interventions, and predicted patient outcomes. 
(Appendix B of this Chapter.) 
 "Standards of professional performance" means a description of a competent level of behavior in 
the professional role including activities related to quality assurance, education, consultation, research, 
ethics, resource utilization, accountability, peer review, and interdisciplinary collaboration. 
 "Suspended license" means a license that is issued for a period not to exceed three years to a facility 
which has temporarily closed or ceased operations. 
"Training and competency evaluation program" means a program approved by the Department to 
instruct and evaluate individuals to act as nurse aides. 
 "Transfer" means the move of a resident from one facility to another facility. 
 "Intra-facility transfer" means the moving of a resident from one room to another within a facility. 
 "Transfer of ownership" means a change of substantial, or controlling interest, in the ownership of a 
facility. A change of less than five percent (5%) of the interest of the owner does not constitute a transfer 
of ownership unless it also results in a change of control of the owner. 
 "Willful violation" means: 
(A) a pattern of violation of staffing requirement; 
(B) a violation of staffing requirement in which the facility knew or should have known staffing 
would be insufficient to meet the requirement yet took no action to avert the violation; or 
(C) the reporting of materially inaccurate or misleading information of staffing to the Health Care 
Authority. 
 
EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), the text of 310:675-1-2 
reverted back to the permanent text that became effective 6-25-01, as was last published in the 2001 
Edition of the OAC, and remained as such until amended again by permanent action on 7-11-03. 
 
EDITOR’S NOTE: 2See Editor's Note at beginning of this Chapter. 
[Source: Amended at 37 Ok Reg 1448, eff 9-11-20] 
 
EDITOR’S NOTE: 2See Editor's Note at beginning of this Chapter. 
 
310:675-1-3. Staff identification 
 Each facility shall ensure that each staff member wears an identification badge that clearly indicates 
the staff member's name and title. 
[Source: Added at 18 Ok Reg 2533, eff 6-25-01] 
 
310:675-1-4. Purpose, authority and indoor tobacco smoke 
(a) The purpose of this section is to establish a prevention program for several non-communicable 
diseases, which will improve the health of Oklahomans by eliminating exposure to secondhand tobacco 
smoke and its deadly effects. This section abates the public health nuisance of secondhand smoke under 
the authority of the Commissioner of Health as specified under Section 1-106(b)(1) of Title 63 of the 
Oklahoma Statutes. This section also further specifies how compliance with the Smoking in Public Places 
Act will be accomplished. [63 O.S. §§ 1-1521 et seq.] 
 
5 
 
(b) The Commissioner of Health has conducted a study and is recommending these measures to the Board 
of Health under his authority as stated in section 1-106 of the Public Health Code. [63 O.S. § 1-106] The 
Board has the authority to establish prevention programs for non-communicable disease and to 
promulgate rules for the control of causative or toxic substances, which can cause disease under section 1-
502b of the Public Health Code. [63 O.S. § 1-502b] The Board is adopting this rule under its authority in 
sections 1-104 and 1-1526 of Title 63 of the Oklahoma Statutes. [63 O.S. §§ 1-104 & 1-1526] 
(c) Smoking or possessing a lighted tobacco product is prohibited in a facility and within fifteen (15) feet 
of each entrance to a facility and of any air intakes; provided however, the facility may provide a smoking 
room available to the residents and their guests and another room available to the employees. 
(d) An indoor smoking room may be provided if: 
(1) It is completely enclosed; 
(2) It is exhausted directly to the outside and maintained under negative pressure sufficient to prevent 
any tobacco smoke from entering non-smoking areas of the building; 
(3) It allows for visual observation of the residents from outside of the smoking room; and 
(4) The plans are reviewed and approved by the Department. 
(e) To enable better observation and supervision of residents who wish to smoke outside, a facility may 
designate a smoking area outside an entrance other than the main entrance which may be closer than 
fifteen (15) feet to the entrance providing consideration is given to minimizing the possibility of smoke 
entering the building. 
(f) The walkway to the main entrance shall also be smoke free. 
(g) No ashtray shall be located closer than fifteen (15) feet to an entrance, except in an indoor smoking 
room or a designated outdoor smoking area under paragraph "c" above. 
(h) Should construction requirements not be in agreement with this rule, the stricter rule shall apply. 
(i) The facility's tobacco use policy shall be clearly posted near the main entrance, and prospective 
residents or their legal representatives shall be notified of the policy prior to the residents' acceptance for 
admission. 
[Source: Added at 19 Ok Reg 2098, eff 7-1-02] 
 
310:675-1-5. Relocation of a resident by the Department in emergency 
(a) The Department may relocate a resident in an emergency when: 
(1) The Department determines that the resident is in immediate jeopardy which cannot be rectified 
without relocation; or 
(2) The facility has substantial quality of care non-compliance with the rules and/or certification 
standards and when actual harm has occurred in the facility; or 
(3) The facility is unable to meet the needs of the resident. 
(b) The Department may order the removal of all the residents to close the facility. 
(c) The Department shall involve the resident and the resident's family or representative in the decision to 
relocate the resident; however, the Department may move the resident without the consent of the resident 
or the family if necessary to preserve the health, welfare or safety of the resident. If the resident does not 
consent, then if possible a member of the Adult Protective Services staff must agree in writing that the 
resident needs to be moved. 
(d) The Department shall give written notice to the resident and to the facility of the reasons for the 
discharge or transfer if the resident or the resident's families do not agree to transfer the resident. 
(e) If the resident has no specific preference, the Department shall relocate the residents to the nearest 
facility capable of care for the resident if acceptable to the resident. 
(f) Should a resident be aggrieved by the decision of the Department to relocate or transfer that resident, 
the Department shall conduct a hearing before relocating the resident unless to do so will fail to preserve 
the health, welfare or safety of the resident. 
(g) The hearing will be conducted following Chapter 2 of this title and the Administrative Procedures Act. 
6 
 
(h) The hearing will be conducted at the facility, and will be attended by the Administrative Law Judge 
and the Department's legal counsel. The Department will maintain a record on the case as it would for 
another individual proceeding. 
(i) The Administrative Law Judge shall make this case a priority and shall issue a written opinion within 
one working day from the close of the hearing. 
(j) The Administrative Law Judge's order shall include findings of fact, conclusions of law and an order 
that the transfer was according to law or not. 
(k) The order may be appealed to District Court as in any other individual proceeding under the 
Administrative Procedures Act. 
[Source: Added at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-1-6. Waiver 
(a) The Commissioner of Health, in accordance with 63 O.S. Section 1-1900.2, may waive provisions of 
the Nursing Home Care Act and this Chapter, if the Department of Health determines that such waiver 
would not endanger the life, safety or health of any resident of a nursing facility and the waiver 
application meets the requirements specified in this section and 63 O.S. Section 1-1900.2. 
(b) Any facility requesting a waiver shall apply in writing to the Department of Health. Such application 
shall include: 
(1) The specific statute(s) or regulation(s) for which the waiver is requested; 
(2) Reason(s) for requesting a waiver; 
(3) An explanation of how the requested waiver fosters the development of resident autonomy, 
individualization and culture change in support of a deinstitutionalization model; 
(4) The specific relief requested; and 
(5) Any documentation which supports the application for waiver. 
(c) In consideration of any application for waiver, the Commissioner of Health may consider the 
following: 
(1) Compliance with 63 O.S. Section 1-1900.2; 
(2) The level of care provided; 
(3) The maximum resident capacity; 
(4) The impact of a waiver on care provided; 
(5) Alternative policies or procedures proposed; and 
(6) Compliance history with provisions of the Nursing Home Care Act and this Chapter. 
(d) The Department of Health shall consider each request for a waiver and shall approve or disapprove the 
request in writing within sixty (60) business days of receipt of the request. 
(e) If the Department of Health finds that an application is incomplete, the Department shall advise the 
applicant in writing and offer an opportunity to submit additional or clarifying information. The applicant 
shall have thirty (30) business days to submit additional or clarifying information in writing to the 
Department of Health upon receipt of written notification. 
(f) The facility that is granted a waiver shall notify residents of the facility or, where appropriate, the 
guardians or legal representatives of such residents of the waiver in writing. 
(g) An applicant who disagrees with the Department's decision regarding the waiver application may file 
a written petition requesting review by an administrative law judge in an individual proceeding under the 
Oklahoma Administrative Procedures Act. 
(h) The Department may revoke a waiver through an administrative proceeding in accordance with the 
Oklahoma Administrative Procedures Act upon finding the nursing facility is operating in violation of the 
waiver or the waiver endangers the life, safety or health of any resident in the nursing facility. 
[Source: Added at 28 Ok Reg 1371, eff 6-25-11] 
 
SUBCHAPTER 3. LICENSES 
 
310:675-3-1. License required [REVOKED] 
7 
 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-3-1.1. Application for licensure 
(a) No person or entity shall operate a facility without first obtaining a license. 
(b) The applicant shall file a licensure application in a timely manner, on the forms provided by the 
Department, with a check for the filing fee payable to the Oklahoma State Department of Health. The 
filing fee is set by statute, and currently is calculated as Ten Dollars ($10.00) per licensed bed. 
(c) The facility owner shall be the applicant for the license, unless a receiver has been appointed. If there 
is a receiver, the receiver shall be the applicant. 
(d) If the facility is leased, then the person or entity to whom the facility is leased shall be the applicant. If 
the lessee does not assume all rights to the facility and the lessor reserves some participatory rights in the 
operation of the facility, then both entities shall make joint application for the license. 
(e) The applicant for license shall disclose the name, address, and tax identification number of a person or 
entity who has the legal duties of filing employment tax returns and paying employment taxes with 
respect to staff required to meet the needs of facility residents, including but not limited to administrators, 
nurses, nurse aides, certified medication aides, dieticians, nutritionists, food service staff, qualified 
intellectual disability professional, and activities, social services, maintenance and housekeeping 
personnel. 
(f) An application is not considered to be filed unless it is accompanied by the application fee. The 
application fee, however, shall not be required from a receiver or temporary manager appointed by, or at 
the request of, the Department. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-3-2. Application for licensure/relicensure [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-3-2.1. Deadlines for filing 
 The license application shall be filed in accordance with the following deadlines. 
(1) The application for an initial license of a new facility shall be filed at least thirty days before 
beginning operations. 
(2) The application for an initial license, following a transfer of ownership or operation, shall be filed 
at least thirty days before the final transfer. In the case of the appointment of a receiver as operator, 
this thirty day advance filing requirement may be waived if the Commissioner finds that an 
emergency exists which threatens the welfare of the facility residents. If an emergency is found to 
exist, the receiver shall file the license application before beginning operation of the facility. 
(3) The application for renewal of license of an existing facility, with no transfer of ownership or 
operation, shall be filed by the renewal date specified on the existing license. 
(4) An application for a suspended license, with no transfer of ownership or operation, shall be filed 
within thirty (30) days of relocation of all residents or the date the facility ceases operation. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-3-3. Probationary and conditional licenses [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-3-3.1. Where to file 
(a) Each initial, renewal or suspended license application, and each Notice of Change requesting an 
increase in beds, and the applicable license fee shall be delivered or sent to the Department at the address 
specified on the application or notice form. The effective date of filing shall be the date the application or 
notice and any required fee are received. No initial or renewal license or increase in licensed beds shall 
bear an effective date of issuance that is earlier than the effective date of filing. 
8 
 
(b) The completed application forms and the license fee shall not be given to Department personnel at the 
facility site. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-3-4. Denial of license 
The Department's consideration of financial insufficiency as a reason for denial of a license pursuant 
to 63 O.S. Section 1-1906(C)(4), may include, but is not limited to, the following bases: 
(1) The applicant or any person or entity disclosed pursuant to 310:675-3-1.1(e) is not current with 
filing and payment requirements for state and/or federal taxes; 
(2) The State of Oklahoma has filed a tax warrant or warrants against the applicant or any person or 
entity disclosed pursuant to 310:675-3-1.1(e); or 
(3) The Internal Revenue Service has filed a notice of federal tax lien against the applicant or any 
person or entity disclosed pursuant to 310:675-3-1.1(e). 
[Source: Added at 21 Ok Reg 2805, eff 7-12-04] 
 
310:675-3-4.1. Forms 
The applicant for a license shall file application forms as follows: 
(1) For an initial license of a new facility, or for an existing facility following a transfer of ownership 
or operation, the applicant shall file these forms: License Application; Disclosure Statement of 
Owner, Lessee and Manager, with Detail Attachment and Affirmation Attachment; the Staffing 
Projection and Professional Certification; and the Certification of Tax Liens and Timely Payment of 
Taxes. 
(2) For renewal or suspension of a current license, the applicant shall file the License Application 
form, and the Certification of Tax Liens and Timely Payment of Taxes. The application forms shall 
provide for the facility to file an abbreviated report if no change has been made since the time of the 
last application. 
[Source: Amended at 24 Ok Reg 2043, eff 6-25-07] 
 
310:675-3-5. Suspension/revocation of license 
(a) The period for an extension granted pursuant to 63 O.S. Supp. 2002 Section 1-1906(H)(2) shall not 
exceed three (3) years. 
(b) During the period of suspension, the licensee shall file a Periodic Report for Suspended License that 
demonstrates the facility's progress towards reopening the facility or the extenuating or unusual 
circumstances for requesting the extension of the suspended license, in the form of, but not limited to: 
contract for sale, contract with real estate agent or builder, or a pending Certificate of Need application. 
(c) The facility shall file periodic reports at least once every six months. The Department shall send a 
notice to each facility's contact, at least thirty (30) days prior to the due date of the periodic report. 
(d) The Department's consideration of financial insufficiency as a reason for suspension or revocation of a 
license pursuant to 63 O.S. Section 1-1906(E)(4), may include, but is not limited to, the following bases: 
(1) The applicant or any person or entity disclosed pursuant to 310:675-3-1.1(e) is not current with 
filing and payment requirements for state and/or federal taxes; 
(2) The State of Oklahoma has filed a tax warrant or warrants against the applicant or any person or 
entity disclosed pursuant to 310:675-3-1.1(e); or 
(3) The Internal Revenue Service has filed a notice of federal tax lien against the applicant or any 
person or entity disclosed pursuant to 310:675-3-1.1(e). 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-3-5.1. Description of forms 
(a) The forms used to apply for a facility license are the following. 
(1) The License Application for a Nursing or Specialized Facility (Form 953-A) requires: 
identification of the type of license; the name and address of the facility; the administrator's name; the 
9 
 
number and type of beds; the applicant's name; confirmation of changes in the owner, lessee, manager 
or any person or entity disclosed pursuant to 310:675-3-1.1(e); a zoning statement for new facilities; 
and an oath affirming the truth, correctness and completeness of the information provided. 
(2) The Disclosure Statement of Owner, Lessee and Manager for a Nursing or Specialized Facility 
(Form 953-B) requires: the names and types of legal entities for the owner, lessee and manager; 
name, address and tax identification number for any person or entity disclosed pursuant to 310:675-3-
1.1(e); and an oath affirming the truth, correctness and completeness of the information provided. 
(3) The Detail Attachment (Form 953-C) supplements the Disclosure Statement (Form 953-B) and 
requires the names and addresses for the following as applicable: 
(A) All shareholders owning 5% or more of a corporate entity and all officers of a corporate 
entity; 
(B) All partners of a general partnership; 
(C) All general partners and all limited partners that own 5% or more of a limited partnership; 
(D) All members that own 5% or more of a limited liability company and all managers of a 
limited liability company; 
(E) All beneficiaries that hold a 5% or more beneficial interest in a trust and all trustees of the 
trust; 
(F) All persons or entities that own a 5% or more interest in a joint venture; 
(G) All persons or entities that own a 5% or more interest in an association; 
(H) The owners holding a 5% or more interest of any other type of legal entity; and 
(I) Any other person holding at least a five percent (5%) interest in any entity which owns, 
operates, or manages the facility. 
(J) As a substitute to submitting a Disclosure Statement and Detail Attachment, if the owner, 
lessee and/or manager is an entity that is publicly traded and is required to file periodic reports 
under the Securities and Exchange Act of 1934, or is a wholly owned subsidiary of such a 
publicly held company, the applicant may submit the applicable portions of the most recent 
annual and quarterly reports required by the Securities and Exchange Commission (SEC). The 
applicant shall include an index reflecting where each item of information required to be 
disclosed pursuant to the Disclosure Statement and Detail Attachment may be located in the SEC 
filings. Submission of the complete SEC filing is not required. Only those portions applicable to 
the Disclosure Statement and Detail Attachment are to be submitted. 
(K) The required disclosure shall also be made by all persons or entities with an ownership 
interest in any entity required to be disclosed in paragraphs (A) through (I) of this section that is 
equal to a 5% or more indirect ownership interest in the owner, lessee and/or manager. The 
disclosure shall be made at each level of the organization to the extent required by this 
subsection. 
(L) For purposes of subsection (K), the percentage of indirect ownership interest in the owner, 
lessee and/or manager is determined by multiplying the percentages of ownership in each entity. 
For example, if A owns 10 % of the stock in a corporation that owns 80 % of the applicant for 
license, A's interest equates to an 8 % indirect ownership interest in the applicant and must be 
reported. Conversely, if B owns 80 percent of the stock of a corporation that owns a 5% interest 
of the stock of the applicant, B's interest equates to a 4% indirect ownership interest in the 
applicant and need not be reported. 
(4) The Affirmation Attachment (Form 953-D) supplements the Disclosure Statement (Form 953-B) 
and requires the following: the names and addresses of individuals, members, officers and/or 
registered agents required to be disclosed for the applicant pursuant to 310:675-3-5.1(a)(3); and an 
affirmation from each of the above concerning their age, character and health. 
(5) The Staffing Projection and Professional Certification for a Nursing or Specialized Facility (Form 
953-E) requires: a projected staffing pattern; and a certification from the director of nursing, the 
physician on call for medical emergencies, and the pharmacist providing consultation and emergency 
pharmacy services. 
10 
 
(6) The Periodic Report for Suspended License (Form 953-F) requires: the name and address of the 
facility; the applicant's name and address, contact person and address; report of progress in reopening 
the facility; request for extension based on extenuating circumstances; and an oath affirming the truth, 
correctness and completeness of the information provided. 
(b) The Notice of Change requests information on the name and address of the facility; the administrator; 
the number and type of beds; the applicant; confirmation of changes in the owner, lessee or manager; and 
any change in disclosure of persons or entities pursuant 310:675-3-1.1(e). 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-3-6. Transfer of ownership [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-3-7. Certificate of approval [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-3-8. Notice of change 
(a) If changes occur so that information previously submitted in a facility's license application is no 
longer correct, the facility shall notify the Department. Notice is required of changes to the following 
information: 
(1) Facility identification including facility business name, mailing address, telephone number or 
facsimile number; 
(2) Changes in licensed bed capacity, including proposed increases; 
(3) The administrator; 
(4) Owner, lessee or manager disclosure or detail information that does not otherwise necessitate an 
initial license; 
(5) Disclosure of persons or entities required to be disclosed pursuant 310:675-3-1.1(e); and 
(b) The facility shall file the Notice of Change form with the Department on or before the effective date 
of the change, with the following exceptions. 
(1) When a change is unexpected or beyond the control of the facility, the facility shall provide notice 
to the Department within five (5) working days after the change. 
(2) For an increase in licensed bed capacity, the facility shall file the notice of change prior to the 
requested license amendment date. The notice of change shall be accompanied by the $10 per-bed 
license fee pursuant to 63 O.S. Section 1-1905(A), prorated by the number of beds to be added and 
the proportion of time remaining on the license until expiration. Prior to occupying additional beds, 
the facility shall obtain an amended license from the Department. 
(c) Following receipt of information that an applicant or any person or entity disclosed pursuant 310:675-
3-1.1(e) is not in compliance with the tax filing, payment or disclosure requirements of 310:675-3-1.1. or 
63 O.S. Section 1-1930.1, the Department may require an applicant or licensee to submit proof that the 
applicant or person or entity disclosed pursuant to 310:675-3-1.1(e) is in compliance with state or federal 
taxes. Such proof may include a letter from the taxing agency, a file-stamped copy of a return, a receipt 
for a tax payment, or a tax transcript or account. 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 

SUBCHAPTER 5. PHYSICAL PLANT 
 
310:675-5-1. Application 
(a) The requirements of this Subchapter shall be applicable to all new construction of, or modification to, 
long-term care facilities. 
(b) In the determination of compliance with fire safety regulations, the State Fire Marshal and the 
Department may utilize a system of value equivalents, such as the NFPA 101A Guide on Alternative 
11 
 
Approaches to Life Safety, 2010 Edition, which provides alternative methods for achieving compliance 
with the regulations. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-5-2. General considerations 
(a) Facilities shall be available and accessible to the physically handicapped (public, staff, and patients). 
(b) Each facility shall have parking space to satisfy the minimum needs of residents, employees, staff, and 
visitors. Space shall be provided for emergency and delivery vehicles. 
 
310:675-5-3. Nursing unit 
Each nursing unit shall provide the following: 
(1) Resident room with a maximum capacity of four residents. 
(2) Resident room with a minimum room area exclusive of toilet rooms, closets, lockers, wardrobes, 
alcoves or vestibules, shall be 100 sq. ft. in single bed rooms and 80 sq. ft. per bed in multi-bed 
rooms. Except that in specialized facilities serving only infants and/or children the minimum space 
per unit shall be 60 sq. ft. per crib. The maximum capacity of pediatric nurseries or rooms for infants 
or children utilizing cribs shall be twenty. 
(3) One lavatory shall be provided in each resident room. The lavatory may be omitted from a single-
bed or a 2-bed room when a lavatory is located in an adjoining toilet room which serves that room 
only. 
(4) Each resident shall have access to a toilet room without entering the general corridor area. One 
toilet room shall serve no more than four (4) beds and no more than two (2) resident rooms. The toilet 
room shall contain a water closet and a lavatory. The lavatory may be omitted from a toilet room 
which serves single-bed and 2-bed rooms if each such resident's room contains a lavatory. 
(5) Each resident shall have a wardrobe, locker, or closet with minimum clear dimensions of 1′10″ 
(55.9cm.) by 1′8″ (50.8 cm.). A clothes rod and adjustable shelf shall be provided. 
(6) Visual privacy shall be provided each resident in multi-bed rooms. Design for privacy shall not 
restrict resident access to entry, lavatory, or toilet. 
(7) No resident room shall be located more than 120 ft. (36.6 m.) from the soiled workroom or the 
soiled holding room. 
 
310:675-5-4. Service areas 
The following shall be located in or readily available to each nursing unit: 
(1) Nurses' station with space for nurse's charting, doctor's charting, storage for administrative 
supplies, and handwashing facilities. (This handwashing facility could serve the drug distribution 
station, if conveniently located.) 
(2) Toilet room(s) for nursing staff. 
(3) Room for examination and treatment of residents may be omitted if all resident rooms are single-
bed rooms. This room shall have a minimum floor area of 120 sq. ft. (11.15 sq. m.), excluding space 
for vestibule, toilet, closets and work counters (whether fixed or moveable). The minimum room 
dimension shall be 10′0″ (3.05 m.) and shall contain a lavatory or sink equipped for handwashing, a 
work counter, storage facilities, and a desk, counter, or shelf space for writing. 
(4) Clean workroom/clean holding room. 
(A) The clean workroom shall contain a work counter, handwashing, and storage facilities. 
(B) The clean holding room shall be part of a system for storage and distribution of clean and 
sterile supply materials and shall be similar to the clean workroom except that the work counter 
and handwashing facilities may be omitted. 
(5) Soiled workroom/soiled holding room. 
(A) The soiled workroom shall contain a clinical sink or equivalent flushing rim fixture, sink 
equipped for handwashing, work counter, waste receptacle, and linen receptacle. 
12 
 
(B) A soiled holding room shall be part of a system for collection and disposal of soiled materials 
and shall be similar to the soiled workroom except that the clinical sink and work counter may be 
omitted. 
(6) Drug distribution station. Provision shall be made for convenient and prompt 24 hour distribution 
of medicine to residents. This may be a medicine preparation room or unit, a self-contained medicine 
dispensing unit, or another approved system. If used, a medicine preparation room shall be under the 
nursing staff's visual control and contain a work counter, refrigerator, and locked storage for 
biologicals and drugs and shall have a minimum area of 50 sq. ft. (4.65 sq. m.). A medicine 
dispensing unit may be located at the nurse's station, in the clean workroom, or in an alcove or other 
space under direct control of the nursing or pharmacy staff. 
(7) Clean linen storage. Provide a separate closet or a designated area within the clean workroom. If a 
closed cart system is used, storage may be in an alcove. 
(8) Equipment storage room. This shall be for equipment such as I.V. Stands, inhalators, air 
mattresses, and walkers. A parking for stretchers and wheelchairs shall be located out of path of 
normal traffic. 
(9) Residents' bathing facilities. Bathtubs or showers shall be provided at the rate of at least one (1) 
for each twenty (20) beds which are not otherwise served by bathing facilities within residents' rooms. 
At least one bathtub shall be provided in each nursing unit. The Department may require more than 
one (1) bathtub or shower for each twenty (20) beds depending on the design of the facility and on the 
needs of any special population being served. Each tub or shower shall be in an individual room or 
enclosure which provides space for the private use of the bathing fixture, for drying and dressing, and 
for a wheelchair and an attendant. Showers in central bathing facilities shall be at least 4′0″ (1.22 m.) 
square, without curbs, and designed to permit use by a wheelchair resident with an assisting attendant. 
(10) Resident's toilet facilities. The minimum dimensions of a room containing only a water closet 
shall be 3′0″ (91 cm.) by 6′0″ (1.83 m.). Additional space shall be provided if a lavatory is located 
within the same room. Water closets may be located to be usable by wheelchair residents. A toilet 
room shall be accessible to each central bathing area without going through the general corridor. 
(11) Sterilizing facilities. A system for the sterilization of equipment and supplies shall be provided. 
[Source: Amended at 13 Ok Reg 2511, eff 6-27-96] 
 
310:675-5-5. Resident's dining and recreation areas 
The total areas set aside for these purposes shall not be less than 30 sq. ft. (2.79 sq. m.) per bed for the 
first 100 beds with a minimum size of not less than 225 sq. ft. (20.9 sq. m.) and 27 sq. ft. (2.51 sq. m.) per 
bed for all beds in excess of 100. Additional space shall be provided for outpatients if they participate in a 
day care program or are regularly fed in the facility. Storage space shall be provided for recreation 
equipment and supplies. 
 
310:675-5-6. Physical therapy facilities 
The following elements shall be provided in skilled nursing facilities: 
(1) Treatment areas shall have space and equipment for all modalities to be utilized. Provision shall 
be made for cubicle curtains around each individual treatment area, handwashing facility(ies) (One 
lavatory or sink may serve more than one cubicle), and facilities for the collection of soiled linen and 
other material. 
(2) Exercise area. 
(3) Storage for clean linen, supplies, and equipment. 
(4) Resident's dressing areas, showers, lockers, and toilet rooms. 
(5) Service sink. 
 
310:675-5-7. Occupational therapy facilities 
The following elements shall be provided in skilled nursing facilities: 
13 
 
(1) Activities area shall include sink or lavatory and facilities for collection of waste products prior to 
disposal. 
(2) Storage for supplies and equipment. (May be planned and arranged for shared use by physical 
therapy patients and staff.) 
(3) Resident's dressing areas, showers, lockers, and toilet rooms. (May be planned and arranged for 
shared use by physical therapy patients and staff.) 
 
310:675-5-8. Personal care unit 
Separate room and appropriate equipment shall be provided for hair care and grooming needs of 
residents. 
 
310:675-5-9. Dietary facilities 
Shall be provided in such size as required to implement the type of food service system selected: 
(1) Control station for receiving food supplies. 
(2) Storage space for four (4) days' supply including cold storage. 
(3) Food preparation facilities as required by program. Conventional food preparation systems require 
space and equipment for preparing, cooking, and baking. Convenience food service systems such as 
frozen prepared meals, bulk packaged entrees, individual packaged portions, or systems using 
contractual commissary services will require space and equipment for thawing, portioning, cooking, 
and/or baking. 
(4) Handwashing facility(ies) in the food preparation Area. 
(5) Resident meal service space including facilities for tray assembly and distribution. 
(6) Dining Area for ambulatory residents, staff, and visitors. 
(7) Warewashing in a room or an alcove separate from food preparation and serving areas. This shall 
be provided for receiving, scraping, sorting, and stacking soiled tableware and for transferring clean 
tableware to the using areas. A lavatory shall be conveniently available. 
(8) Potwashing facilities. 
(9) Sanitizing facilities and storage areas for cans, carts, and mobile tray conveyors. 
(10) Waste storage facilities in a separate room which is easily accessible to the outside for direct 
pickup or disposal. 
(11) Office or suitable work space for the dietitian or the dietary service manager. 
(12) Toilets for dietary staff with handwashing facility immediately available. 
(13) Janitor's closet located within the dietary department. It shall contain a floor receptor or service 
sink and storage space for housekeeping equipment and supplies. 
(14) Self-dispensing icemaking facilities. May be in area separate from food preparation area but 
must be easily cleanable and convenient to dietary facilities. Bulk ice dispensing units must be 
accessible only to authorized staff members. 
 
310:675-5-10. Pharmacy unit 
Provision shall be made for the procurement, storage, administration and accounting of drugs and 
other pharmacy products. This may be by arrangement with convenient off-site facility but must include 
provision for 24 hour emergency service. 
 
310:675-5-11. Administration and public areas 
The following elements shall be provided: 
(1) Entrance at grade level sheltered from the weather and able to accommodate wheelchairs. 
(2) Lobby. It shall include: 
(A) Reception and information counter or desk. 
(B) Waiting space(s). 
(C) Public toilet facilities. 
(D) Public telephone(s). 
14 
 
(E) Drinking fountain(s). 
(3) General or individual office(s) for business transactions, private interviews, medical and financial 
records, and administrative and professional staff 
(4) Multipurpose room for conferences, meetings, and health education purposes including facilities 
for showing visual aids. 
(5) Storage for office equipment and supplies. 
 
310:675-5-12. Linen services 
(a) If linen is to be processed on the site, the following shall be provided: 
(1) Laundry processing room with commercial type equipment which can process seven (7) days' 
needs within a regularly scheduled work week. Handwashing facilities shall be provided. 
(2) Soiled linen receiving, holding, and sorting room with handwashing facilities. 
(3) Storage for laundry supplies. 
(4) Clean linen inspection and mending room or area. 
(5) Clean linen storage, issuing, and holding room or area. 
(6) Janitor's closet containing a floor receptor or service sink and storage space for housekeeping 
equipment and supplies. 
(7) Sanitizing facilities and storage area for carts. The sanitizing facilities may be combined with 
those required for dietary facilities. 
(b) If linen is processed off the site, the following shall be provided: 
(1) Soiled linen holding room. 
(2) Clean linen receiving, holding, inspection and storage room(s). 
(3) Sanitizing facilities and storage area for carts. 
 
310:675-5-13. General stores 
(a) Facility storage. General storage room(s) shall have a total area of not less than ten (10) sq. ft. (.93 sq. 
m.) per bed and shall generally be concentrated in one area. 
(b) Resident storage. Separate storage space with provisions for locking and security control shall be 
provided for resident's personal effects which are not kept in resident's room. 
 
310:675-5-14. Employee's facilities 
Employees facilities such as lounges and toilets, to accommodate the needs of all personnel and 
volunteers shall be provided. 
 
310:675-5-15. Janitor's closets 
Janitor's closets shall be provided throughout the facility to maintain a clean and sanitary 
environment. These shall contain a floor receptor or service sink and storage space for housekeeping 
equipment and supplies. 
 
310:675-5-16. Engineering service and equipment area 
The following shall be provided: 
(1) Equipment room(s) or separate building(s) for boilers, mechanical equipment, and electrical 
equipment. 
(2) Maintenance shop(s) of size and equipment to support functions described in narrative program. 
(3) Storage room(s) for building maintenance supplies (may be part of maintenance shop in nursing 
homes of less than 100 beds). 
(4) Yard equipment storage. A separate room or building for yard maintenance equipment and 
supplies, if applicable. Any fuel or oil for mowers or other yard implements must be stored under 
cover at least 30 ft. away from any building utilized by residents. 
 
310:675-5-17.1 Waste processing services 
15 
 
Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, 
mechanical destruction, compaction, containerization, removal, or by a combination of these techniques. 
 
EDITOR’S NOTE: 1In the initial codification of this agency's rules on 12-31-91, this Section was 
misnumbered as 310:675-3-17. Upon discovery of this error on 9-12-94, the number was changed to 
310:675-5-17. 
 
EDITOR’S NOTE: 1In the initial codification of this agency's rules on 12-31-91, this Section was 
misnumbered as 310:675-3-17. Upon discovery of this error on 9-12-94, the number was changed to 
310:675-5-17. 
 
310:675-5-18. Design and construction 
The requirements in applicable portions of the National Fire Protection Association (NFPA) 101: Life 
Safety Code, 2012 Edition and 2012 Life Safety Code Tentative Interim Amendments (TIA) 12-1, 12-2, 
12-3, and 12-4; and NFPA 99 Health Care Facility Code (HCFC), 2012 edition, excluding chapters 7, 8, 
12 and 13, and 2012 HCFC TIA 12-2, 12-3, 12-4, 12-5 and 12-6, adopted in 81 Federal Register 26871 
by the Centers for Medicare and Medicaid Services on July 5, 2016, are incorporated by reference. For 
Medicare or Medicaid certified nursing or specialized facilities, the Life Safety Code adopted by the 
Centers for Medicare & Medicaid Services prevails if there is a conflict between the Life Safety Code and 
this Chapter. A high degree of safety for the occupants shall be provided to minimize the incidence of 
accidents with special consideration for residents who will be ambulatory to assist them in self care. 
Hazards such as sharp corners shall be avoided. 
(1) Existing facilities. Nonconforming portions which because of financial hardship are not being 
totally modernized, shall comply with NFPA 101, 2012 Edition, Chapters 19 or 43. 
(2) New construction projects including additions and alterations. Details and finishes shall 
comply with the following: 
(A) Items such as drinking fountains, telephone booths, vending machines, and portable 
equipment shall be located so as not to restrict corridor traffic or reduce the corridor width below 
the required minimum. 
(B) All rooms containing bathtubs, sitz baths, showers, and water closets, subject to occupancy by 
residents, shall be equipped with doors and hardware which will permit access from the outside in 
any emergency. When such rooms have only one opening or are small, the doors shall be capable 
of opening outward or be otherwise designed to be opened without need to push against a resident 
who may have collapsed within the room. 
(C) The minimum width of all doors to resident rooms and rooms needing access for beds shall 
be 3'8" (1.12 m.). Doors to rooms needing access for stretchers and to resident's toilet rooms and 
other rooms needing access for wheelchairs shall have a minimum width of 2'10" (86.3 cm.). 
(D) Doors on all openings between corridors and rooms or spaces subject to occupancy, except 
elevator doors, shall be swing type. Openings to showers, baths, resident's toilets, and other small 
wet type areas not subject to fire hazard are exempt from this requirement. 
(E) Windows and outer doors which may be frequently left in an open position shall be provided 
with insect screens. Windows shall be designed to prevent accidental falls when open. 
(F) Resident rooms intended for occupancy of 24 hours or more shall have windows operable 
without the use of tools and shall have sills not more than 3'0" (91 cm.) above the floor. Windows 
in buildings designed with an engineered smoke control system in accordance with NFPA 90A 
are not required to be operable. However, attention is called to the fact that natural ventilation 
possible with operable windows may in some areas permit a reduction in energy requirements. 
(G) Doors, except doors to spaces such as small closets which are not subject to occupancy, shall 
not swing into corridors in a manner that might obstruct traffic flow or reduce the required 
corridor width. (Large walk-in type closets are considered as occupiable spaces.) 
16 
 
(H) Safety glazing shall be of materials and at locations required by the Oklahoma Safety Glazing 
Material Law. 
(I) Thresholds and expansion joint covers shall be made flush with the floor surface to facilitate 
use of wheelchairs and carts and shall be constructed to restrict the passage of smoke. 
(J) Grab bars shall be provided at all residents' toilets, showers, tubs, and sitz baths. The bar shall 
have 1 1/2" (3.8 cm.) clearance to walls and shall have sufficient strength and anchorage to 
sustain a concentrated load of 250 lbs. (113.4 kg.). 
(K) Recessed soap dishes shall be provided in showers and bathrooms. 
(L) Handrails shall be provided on both sides of corridors used by residents. A clear distance of 1 
1/2" (3.8 cm.) shall be provided between the handrail and the wall. Ends of handrails and grab 
bars shall be constructed to prevent snagging the clothes of residents. 
(M) Location and arrangement of handwashing facilities shall permit their proper use and 
operation. 
(N) Lavatories and handwashing facilities shall be securely anchored to withstand an applied 
vertical load of not less than 250 lbs. (113.4 kg.) on the front of the fixture. 
(O) Mirrors shall be arranged for convenient use by residents in wheelchairs as well as by 
residents in a standing position. Mirrors shall not be installed at handwashing fixtures in food 
preparation areas. 
(P) Provisions for hand drying shall be included at all handwashing facilities. These shall be 
single-use separate, individual paper or cloth units enclosed in such a way as to provide 
protection against the dust or soil and ensure single unit dispensing. Hot air dryers are permitted 
provided that installation is such to preclude possible contamination by recirculation of air. 
(Q) The minimum ceiling height shall be 8'0" (2.44 m.) with the following exceptions: 
(i) Boiler rooms shall have ceiling clearances not less than 2'6" (76 cm.) above the main 
boiler header and connecting piping. 
(ii) Rooms containing ceiling-mounted equipment shall have height required to accommodate 
the equipment. 
(iii) Ceilings in corridors, storage rooms, toilet rooms, and other minor rooms shall be not 
less than 7'8" (2.34 m.). 
(iv) Suspended tracks, rails and pipes located in path of normal traffic shall not be less than 
6'8" (2.03 m.) above the floor. 
(R) Recreation rooms, exercise rooms, and similar spaces where impact noise may be generated 
shall not be located directly over resident bed areas unless special provisions are made to 
minimize such noise. 
(S) Rooms containing heat producing equipment (such as boiler or heater rooms and laundries) 
shall be insulated and ventilated to prevent any floor surface above from exceeding a temperature 
10° F. (6° C.) above the ambient room temperature. 
(3) Finishes. 
(A) Floor materials shall be easily cleanable and have wear resistance appropriate for the location 
involved. Floors in areas used for food preparation or food assembly shall be water-resistant and 
grease-proof. Joints in tile and similar material in such areas shall be resistant to food acids. In all 
areas frequently subject to wet cleaning methods, floor materials shall not be physically affected 
by germicidal and cleaning solutions. Floors that are subject to traffic while wet (such as shower 
and bath areas, kitchens, and similar work areas) shall have a non-slip surface. 
(B) Wall bases in kitchens, soiled workrooms, and other areas which are frequently subject to wet 
cleaning methods shall be made integral and covered with the floor, tightly sealed within the wall, 
and constructed without voids that can harbor insects. 
(C) Wall finishes shall be washable and, in the immediate area of plumbing fixtures, shall be 
smooth and moisture resistant. Finish trim, and wall and floor constructions in dietary and food 
preparation areas shall be free from spaces that can harbor rodents and insects. 
17 
 
(D) Floor and wall penetrations by pipes, ducts, and conduits shall be tightly sealed to minimize 
entry of rodents and insects. Joints of structural elements shall be similarly sealed. 
(E) Ceilings throughout shall be easily cleanable. Ceilings in the dietary and food preparation 
areas shall have a finished ceiling covering all overhead piping and duct work. Finished ceilings 
may be omitted in mechanical and equipment spaces, shops, general storage areas, and similar 
spaces, unless required for fire-resistive purposes. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-5-19. Elevators 
 All buildings having resident's facilities (such as bedrooms, dining rooms, or recreation areas) or 
resident services (such as diagnostic or therapy) located on other than the main entrance floor shall have 
electric or electrohydraulic elevators. 
(1) Number of elevators. 
(A) At least one (1) hospital-type elevator shall be installed where one (1) to fifty-nine (59) 
resident beds are located on any floor other than the main entrance floor. 
(B) At least two (2), one of which shall be hospital-type, shall be installed where 60 to 200 
resident beds are located on floors other than the main entrance floor, or where the major resident 
services are located on a floor other than those containing resident beds. (Elevator service may be 
reduced for those floors which provide only partial resident services). 
(C) At least three (3), one of which shall be hospital-type, shall be installed where 201 to 350 
resident beds are located on floors other than the main entrance floor, or where the major resident 
services are located on a floor other than those containing resident beds. (Elevator service may be 
reduced for those floors which provide only partial resident services.) 
(D) For facilities with more than 350 resident beds, the number of elevators shall be determined 
from a study of the facility plan and the estimated vertical transportation requirements. 
(2) Cars and platforms. Cars of hospital-type elevators shall have inside dimensions that will 
accommodate a resident bed and attendants, and shall be at least 5′10″ (1.52 m.) wide by 7′6″ (2.29 
m.) deep. The car door shall have a clear opening of not less than 3′8″ (1.12 m.). 
(3) Leveling. Elevators shall be equipped with an automatic leveling device of the two-way automatic 
maintaining type with an accuracy of 1/2″ (1.3 cm.). 
(4) Operation. Elevators, except freight elevators, shall be equipped with a two-way special service 
switch to permit cars to bypass all landing button calls and be dispatched directly to any floor. 
(5) Elevator controls, alarm buttons, and telephones. These shall be accessible to wheelchair 
occupants. 
(6) Elevator call buttons, controls, and door safety stop. These shall be of a type that will not be 
activated by heat or smoke. 
(7) Control buttons and signals. These shall be such as to be usable by the blind. 
(8) Field inspection and tests. These shall be made and the owner shall be furnished written 
certification that the installation meets the requirements set forth in this Section and all applicable 
safety regulations and codes. Installation shall comply with ANSI 17.1-1971. 
 
310:675-5-20. Mechanical requirements 
(a) Steam and hot water systems. 
(1) Boilers shall have the capacity, based upon the net ratings published by Hydronics Institute, to 
supply the normal requirements of all systems and equipment. The number and arrangement of 
boilers shall be such that when one boiler breaks down or routine maintenance requires that one boiler 
be temporarily taken out of service, the capacity of the remaining boiler(s) shall be at least 70% of the 
total required capacity, except that in areas with a design temperature of 20 ° F. (-7 ° C.) or more, 
based on the Median of Extremes in the American Society of Heating, Refrigerating and Air-
Conditioning Engineers (ASHRAE) Handbook of Fundamentals, the remaining boiler(s) do not have 
to include boiler capacity for space heaters. 
18 
 
(2) Boiler feed pumps, heating circulating pumps, condensate return pumps, and fuel oil pumps shall 
be connected and installed to provide normal and standby service. 
(3) Supply and return mains and risers of cooling, heating and process systems shall be valved to 
isolate the various sections of each system. Each piece of equipment shall be valved at the supply and 
return ends, except that vacuum condensate return need not be valved at each piece of equipment. 
(b) Heating and ventilating systems. 
(1) Design. The design of heating and ventilating systems shall comply with the requirements of 
ASHRAE 170, 2008 Edition, as referenced by NFPA99, 2012 Edition. 
(2) Ventilation system details. All air-supply and air-exhaust systems shall be mechanically 
operated. All fans serving exhaust systems shall be located at the discharge end of the system. 
(A) Outdoor air intakes shall be located as far as practical but not less than 25' 0" (7.62 m.) from 
exhaust outlets or ventilating systems, combustion equipment stacks, medical vacuum systems, 
plumbing vent stacks, or from areas which may collect vehicular exhaust and other noxious 
fumes (plumbing and vacuum vents that terminate above the level of the top of the air intakes 
may be located as close as 10' 0" (3.05 m.)). The bottom of outdoor air intakes serving central 
systems shall be located as high as practical but not less than 6' 0" (1.83 m.) above ground level, 
or if installed above the roof, 3' 0" (91 cm.) above roof level. 
(B) The bottoms of ventilation openings shall not be less than 3" (7.6 cm.) above the floor of any 
room. 
(C) All central ventilation or air conditioning systems shall be equipped with filters. the filter bed 
shall be located upstream of the air conditioning equipment, unless a prefilter is employed. In this 
case, the prefilter shall be upstream of the equipment and the main filter bed may be located 
further downstream. 
(D) Filter frames shall be durable and carefully dimensioned and shall provide an airtight fit with 
the enclosing ductwork. All joints between filter segments and the enclosing ductwork shall be 
gasketed or sealed to provide a positive seal against air leakage. 
(c) Plumbing and other piping systems. These systems shall be designed and installed in accordance 
with the requirements of PHCC National Standard Plumbing Code, Chapter 14, "Medical Care Facility 
Plumbing Equipment." 
(d) Plumbing fixtures. The material used for plumbing fixtures shall be of non-absorptive acid resistant 
material. 
(1) The water supply spout for lavatories and sinks required in resident care areas of skilled nursing 
facilities only shall be mounted so that its discharge point is a minimum distance of 5" (12.7 cm.) 
above the rim of the fixture. In all facilities all fixtures used by medical and nursing staff, and all 
lavatories used by residents and food handlers shall be trimmed with valves which can be operated 
without the use of hands (single lever devices may be used subject to the above). Where blade 
handles are used for this purpose, they shall not exceed 4 1/2" (11.4 cm.) in length, except that 
handles on clinical sinks shall be not less than 6" (15.2 cm.) long. 
(2) Clinical sinks shall have an integral trap in which the upper portion of a visible trap seal provides 
a water surface. 
(3) Shower bases and tubs shall provide non-slip surfaces for standing residents. 
(e) Water supply systems. 
(1) Systems shall be designed to supply water at sufficient pressure to operate all fixtures and 
equipment during maximum demand periods. 
(2) Each water service main, branch main, riser, and branch to a group of fixtures shall be valved. 
Stop valves shall be provided at each fixture. 
(3) Backflow preventers (vacuum breakers) shall be installed on hose bibbs, janitors' sinks, bedpan 
flushing attachments, and on all other fixtures to which hoses or tubing can be attached. 
(4) Flush valves installed on plumbing fixtures shall be of a quiet operating type, equipped with 
silencers. 
(f) Hot water heaters and tanks. 
19 
 
(1) The hot water heating equipment shall have sufficient capacity to supply water at the temperature 
and amounts indicated. (See Appendix A). Water temperatures to be taken at hot water points of use 
or inlet to processing equipment. 
(2) Storage tank(s) shall be fabricated of corrosion-resistant metal lined with non-corrosive material. 
(g) Drainage systems. 
(1) Insofar as possible, drainage piping shall not be installed within the ceiling nor installed in an 
exposed location in food preparation centers, food serving facilities, food storage areas, and other 
critical areas. Special precautions shall be taken to protect these areas from possible leakage or 
condensation from necessary overhead piping systems. 
(2) Building sewers shall discharge into a community sewerage system. Where such a system is not 
available, a facility providing sewage treatment must conform to applicable local and State 
regulations. 
(h) Identification. All piping in the HVAC service water systems shall be color coded or otherwise 
marked for easy identification. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-5-21. Electrical requirements 
 All material including equipment, conductors, control, and signaling devices shall be installed to 
provide a complete electrical system with the necessary characteristics and capacity to supply the 
electrical facilities shown in the specifications or indicated on the plans. All materials shall be listed as 
complying with available standards of Underwriter's Laboratories, Inc., or other similarly established 
standards. All electrical installations and systems shall be tested to show that the equipment is installed 
and operates as planned or specified. 
(1) Panelboards. Panelboards serving lighting and appliance circuits shall be located on the same 
floor as the circuits they serve. This requirement does not apply to emergency system circuits. 
(2) Lighting. All spaces occupied by people, machinery, equipment within buildings, approaches to 
buildings, and parking lots shall have lighting. 
(A) Residents' rooms shall have general lighting and night lighting. A reading light shall be 
provided for each resident. Flexible light arms shall be mechanically controlled to prevent the 
bulb from coming in contact with bed linen. At least one light fixture for night lighting shall be 
switched at the entrance to each resident room. All switches for control of lighting in resident 
areas shall be of quiet operating type. 
(B) Nursing unit corridors shall have general illumination with provisions for reduction of light 
level at night. 
(3) Receptacles (convenience outlets). 
(A) Resident room shall have duplex grounding type receptacles as follows: One location each 
side of the head of each bed, one for television if used, and one on another wall. 
(B) Duplex grounding receptacles for general use shall be installed in all corridors approximately 
50'0" (15.24 m.) apart and within 25'0" (7.62 m.) of ends of corridors. 
(4) Notification system. 
(A) Resident areas. Each room, toilet and bathing area shall have a means for residents to directly 
contact nursing staff. This communication may be through audible or visual signs, electronic 
systems and may include "wireless systems." 
(B) Wireless nurse call system. Facilities may substitute a wireless nurse call system for wired 
call systems or operate both a wireless and a wired nurse call system in parallel. 
(C) Resident's emergency. A nurse's call emergency button shall be provided for resident's use at 
each resident's toilet, bath, and shower room. Such button shall be usable by a collapsed resident 
lying on the floor (inclusion of a pull cord will satisfy this item.) 
(5) Emergency electric service. Emergency electric service shall be provided in accordance with NFPA 
99, 2012 Edition. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
20 

310:675-5-22. Exceptions and temporary waivers 
(a) These standards are not intended to restrict innovations and improvements in design or construction 
techniques. Accordingly, the Department may approve plans and specifications which contain deviations 
if it is determined that the respective intent or objective of this Chapter has been met. 
(b) A nursing facility may submit a request for exception or temporary waiver if the rules in this Chapter 
create an unreasonable hardship, or if the design and construction for the nursing facility property offers 
improved or compensating features with equivalent outcomes to this Chapter. 
(c) The Department may permit exceptions and temporary waivers of this Chapter if the Department 
determines that such exceptions or temporary waivers comply with the requirements of 63 O.S. Section 1-
1901 et seq., and the following: 
(1) Any nursing facility requesting an exception or temporary waiver shall apply in writing on a form 
provided by the Department. The form shall include: 
(A) The section(s) of this Chapter for which the exception or temporary waiver is requested; 
(B) Reason(s) for requesting an exception or temporary waiver; 
(C) The specific relief requested; 
(D) Any supporting requirements in the Facility Guidelines Institute (FGI): Guidelines for Design 
and Construction of Residential Health, Care, and Support Facilities, 2014 Edition; and 
(E) Any documentation which supports the application for exception. 
(2) In consideration of a request for exception or temporary waiver, the Department shall consider the 
following: 
(A) Compliance with 63 O.S. Section 1-1901 et seq.; 
(B) The level of care provided; 
(C) The impact of an exception on care provided; 
(D) Alternative policies or procedures proposed; 
(E) Compliance with the Facility Guidelines Institute (FGI): Guidelines for Design and 
Construction of Residential Health, Care, and Support Facilities, 2014 Edition; and 
(F) Compliance history with provisions of the Life Safety Code and this Chapter. 
(3) The Department shall permit or disallow the exception or waiver in writing within forty-five (45) 
calendar days after receipt of the request. 
(4) If the Department finds that a request is incomplete, the Department shall advise the nursing 
facility in writing and offer an opportunity to submit additional or clarifying information. The 
applicant shall have thirty (30) calendar days after receipt of notification to submit additional or 
clarifying information in writing to the Department of Health, or the request shall be considered 
withdrawn. 
(5) A nursing facility which disagrees with the Department's decision regarding the exception or 
temporary waiver may file a written petition requesting relief through an individual proceeding 
pursuant to OAC 310:2 (relating to Procedures of the State Department of Health). 
(6) The Department may revoke an exception or temporary waiver through an administrative 
proceeding in accordance with OAC 310:2 and the Oklahoma Administrative Procedures Act upon 
finding the nursing facility is operating in violation of the exception or temporary waiver, or the 
exception or temporary waiver jeopardizes patient care and safety or constitutes a distinct hazard to 
life. 
(7) The Department shall publish decisions on requests for exceptions and waivers and make them 
available to facilities and the public. 
[Source: Added at 34 Ok Reg 1305, eff 10-1-17] 
 
310:675-5-23. Submission of plans and specifications and related requests for services 
(a) Submission of plans. Before construction is begun, plans and specifications, covering the 
construction of new buildings or major alterations to existing buildings shall be submitted to the 
Department for review as provided in OAC 310:675-5-24 or OAC 310:675-5-25. 
21 
 
(1) Plans and specifications are required for the following alterations: 
(A) Changes that affect path of egress; 
(B) Change of use or occupancy; 
(C) Repurposing of spaces; 
(D) Structural modifications; 
(E) Heating, ventilation and air conditioning (HVAC) modifications; 
(F) Electrical modifications that affect the essential electrical system; 
(G) Changes that require modification or relocation of fire alarm initiation or notification devices; 
(H) Changes that require modification or relocation of any portion of the automatic fire sprinkler 
system; 
(I) Replacement of fixed medical equipment if the alteration requires any work noted in (A) 
through (H) of this paragraph; 
(J) Replacement of or modifications to any required magnetic or radiation shielding; 
(K) Changes to or addition of any egress control devices or systems. 
(2) Plans and specifications are not required for the following alterations: 
(A) Painting, papering tiling, carpeting, cabinets, counter tops and similar finish work provided 
that the new finishes shall meet the requirements of this Chapter; 
(B) Ordinary repairs and maintenance; 
(C) Modifications to nurse call or other signaling/communication/information technology systems 
provided the modifications meet the requirements of this Chapter; or 
(D) Replacement of fixed or moveable medical equipment that does not affect electrical, HVAC, 
or shielding requirements noted above. 
(b) Fees. Each construction project submission shall be accompanied by the appropriate review fee based 
on the cost of design and construction of the project. Fees for plan and specification reviews and related 
Department services are as follows: 
(1) Design and construction plans and specifications fee: two one-hundredths percent (0.02%) of the 
cost of design and construction of the project, with a minimum fee of Fifty Dollars ($50.00) and a 
maximum fee of One Thousand Dollars ($1,000.00); 
(2) Request for exception or temporary waiver fee: Five Hundred Dollars ($500.00); 
(3) Application for self-certification fee: Five Hundred Dollars ($500.00); 
(4) Courtesy construction inspection fee: Five Hundred Dollars ($500.00); 
(5) Professional consultation or technical assistance fee: Five Hundred Dollars ($500.00) for each 
eight hours or major fraction thereof of staff time. For technical assistance requiring travel, the fee 
may be increased to include the Department's costs for travel. 
(c) Fees when greater than two (2) submittals required. The fee for review of design and construction 
plans and specifications shall cover the cost of review for up to two (2) stage one and two (2) stage two 
submittals and one final inspection. If a stage one or stage two submittal is not approved after two (2) 
submissions, another review fee shall be required with the third submittal. If a fast-track stage package is 
not approved after the second submittal, another review fee based on the cost of the project shall be 
required with the third submittal of the package. 
(d) Review process. Design and construction plans and specifications shall be reviewed in accordance 
with the following process. 
(1) Unless otherwise provided in this Subchapter, the Department shall have ten (10) calendar days in 
which to initially determine if the filed application is administratively complete 
(A) Upon determining that the application is not administratively complete, the Department shall 
immediately notify the applicant in writing and shall indicate with reasonable specificity the 
inadequacies and measures necessary to complete the application. Such notification shall not 
require nor preclude further review of the application and further requests for specific 
information. If the Department fails to notify the applicant as specified in this Paragraph, the 
period for technical review shall begin at the close of the administrative completeness review 
22 
 
period. Upon submission of correction of inadequacies, the Department shall have an additional 
ten (10) calendar days to review the application for completeness. 
(B) Upon determination that the application is administratively complete, the Department shall 
immediately notify the applicant in writing. The period for technical review begins. 
(2) The Department shall have forty-five (45) calendar days from the date a completed application is 
filed to review each application for technical compliance with the relevant regulations and reach a 
final determination. The Department shall provide the results of the review, including a statement of 
any deficiencies, in writing. The written notice shall offer the applicant an opportunity to discuss the 
results of the review with the Department. 
(A) The time period for technical review is tolled (the clock stops) when the Department has 
asked for supplemental information and advised the applicant that the time period is tolled 
pending receipt. 
(B) To make up for time lost in reviewing inadequate materials, a request for supplemental 
information may specify that up to 30 additional calendar days may be added to the deadline for 
technical review, unless the request for supplemental information is a second or later request that 
identifies new deficiencies not previously identified 
(C) An application shall be deemed withdrawn if the applicant fails to supplement an application 
within 90 calendar days after the Department's request, unless the time is extended by agreement 
for good cause. 
(D) Extensions may be made as provided by law. 
[Source: Added at 34 Ok Reg 1305, eff 10-1-17] 
 
310:675-5-24. Preparation of plans and specifications 
(a) Stage one. Preliminary plans and outline specifications shall be submitted and include sufficient 
information for approval by the Department of the following: scope of project; project location; required 
fire-safety and exiting criteria; building-construction type, compartmentation showing fire and smoke 
barriers, bed count and services; the assignment of all spaces, areas, and rooms for each floor level, 
including the basement. A nursing facility has the option, at its own risk, to bypass the stage one submittal 
and proceed directly to submittal of stage two documents. After the first review and before Department 
approval of stage one plans, the nursing facility at its own risk may choose to make a stage two submittal; 
a nursing facility electing this option would not be eligible for the fast track process. 
(b) Stage two. A proposed construction document shall be submitted that includes final drawings and 
specifications adequate for approval by the Department. All final plans and specifications shall be 
appropriately sealed and signed by an architect registered by the State of Oklahoma. All construction 
modifications of approved documents are subject to review and approval, and shall be submitted timely. 
(1) Fast-track projects. The fast track process applies only to stage two submittals. A stage one 
submittal and functional program must be approved before entering the fast track process. 
(A) Equipment and built-in furnishings are to be identified in the stage one submittal. 
(B) The nursing facility has the option to submit two packages: civil, landscaping and structural 
in stage one, and the balance of the components in stage two. 
(C) Fast-track projects shall have prior approval and be submitted in no more than four (4) 
separate packages. 
(i) Site work, foundation, structural, underslab mechanical, electrical, plumbing work, and 
related specifications. 
(ii) Complete architectural plans and specifications. 
(iii) All mechanical, electrical, and plumbing plans and specifications. 
(iv) Equipment and furnishings. 
(2) Radiation protection. Any project that includes radiology or special imaging equipment used in 
medical diagnosis, treatment, and therapy of residents, shall include plans, specifications, and shielding 
criteria, prepared by a qualified medical physicist. These plans shall be submitted and approved by the 
Department prior to installation of the equipment. 
23 
 
(c) Reserved. 
(d) Floor plan scale. Floor plans are to be submitted at a scale of one-eighth (1/8) inch equals one (1) 
foot, with additional clarifying documents as required. 
(e) Application form. The submittal shall be made using a Department application form which requests 
information required by this Chapter and specifies the number of copies and format for document 
submittal. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-5-25. Self-certification of plans 
(a) The Department shall make available consultation and technical assistance services covering the 
requirements of this section to a nursing facility considering self-certification of plans. The consultation 
and technical assistance is subject to the fees specified in OAC 310:675-5-23. The consultation is optional 
and not a prerequisite for filing a request through the self-certification review process. 
(b) The nursing facility and the project architect or engineer may elect to request approval of design and 
construction plans through a self-certification review process. The nursing facility and the project 
architect or engineer shall submit a self-certification request on a form provided by the Department, along 
with the review fee specified in OAC 310:675-5-23. The form shall be signed by the nursing facility and 
the project architect or engineer attesting that the plans and specifications are based upon and comply 
with the requirements of this Chapter. The form shall require information necessary to demonstrate 
compliance with OAC 310:675-5-25(c). 
(c) To be eligible for self-certification, projects must comply with the following requirements: 
(1) The project involves any portion of the nursing facility where residents are intended to be 
examined or treated and the total cost of design and construction is two million and five hundred 
thousand dollars ($2,500,000) or less; or 
(2) The project involves only portions of the nursing facility where residents are not intended to be 
examined or treated; and 
(3) The project architect or engineer attesting the application has held a license to practice 
architecture or engineering for at least five (5) years prior to the submittal of the application, is 
licensed to practice in Oklahoma; and 
(4) The nursing facility owner/operator acknowledges that the Department retains the authority to: 
(A) Perform audits of the self-certification review program and select projects at random for 
review; 
(B) Review final construction documents; 
(C) Conduct on-site inspections of the project; 
(D) Withdraw approval based on the failure of the nursing facility or project architect or engineer 
to comply with the requirements of this Chapter; and 
(5) The nursing facility agrees to make changes required by the Department to bring the construction 
project into compliance with this Chapter. 
(d) Within twenty-one (21) days after receipt of a complete application, the Department shall approve or 
deny the application for self-certification and send notification to the nursing facility. If the application is 
denied, the nursing facility shall have thirty (30) calendar days to submit additional or supplemental 
information demonstrating that the application complies with the requirements for self-certification of 
plans and specifications. The Department shall have fourteen (14) calendar days after receipt of 
supplemental information to reconsider the initial denial and issue a final approval or denial of the self-
certification request. 
(e) After denial of the application for self-certification and prior to the start of construction, the nursing 
facility shall pay the applicable fee for plan review specified in OAC 310:667-47-1(b)(1) through (5). 
Upon receipt of the plan review fee, the Department shall review the nursing facility's plans in accordance 
with the process in OAC 310:675-5-23. 
[Source: Added at 34 Ok Reg 1305, eff 10-1-17] 
 
24 
 
SUBCHAPTER 7. ADMINISTRATION 
 
310:675-7-1. Governing authority [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-1.1. Administrator 
(a) The administrator shall be a person who has the authority and responsibility for the total operation of 
the facility, subject only to the policies adopted by the governing authority and who is licensed by the 
Oklahoma State Board of Examiners for Nursing Home Administrators. 
(b) The administrator, or the owner, shall designate a person in the facility to act on behalf of the 
administrator during the administrator's absence from the facility. Authority shall be granted to the 
designated person to allow normal management responsibilities to be exercised. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-2. Administrator [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-2.1. Medical director 
The facility shall designate a licensed physician to serve as medical director. The medical director is 
responsible for implementation of resident medical care policies and the coordination of medical care in 
the facility. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-3. Residents' rights and responsibilities 
 Each resident or resident's representative shall receive a copy of the resident statutory rights at the 
time of admission. A copy of the resident rights shall be posted in an easily accessible, conspicuous place 
in the facility. The facility shall ensure that its staff is familiar with, and observes, the resident rights. [63 
O.S. 1991 § 1-1918.) 
[Source: Amended at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-4. Resident transfers or discharge 
(a) Reasons for transfer or discharge. Involuntary transfer or discharge of a resident may be initiated by 
a facility only for one or more of the following: 
(1) Medical reasons, including needs that the facility is unable to meet, as documented by the 
attending physician, in consultation with the medical director if the medical director and attending 
physician are not the same person. 
(2) The resident's safety, or for the safety of other residents, as documented by the clinical record. The 
facility shall show through medical records that: 
(A) the resident has had a comprehensive assessment by an interdisciplinary team and alternative 
measures have been attempted unsuccessfully; or 
(B) the resident is a danger to himself, herself or other resident as documented by the medical 
record and the facility is not capable of managing that resident. 
(3) The non-payment of charges for the resident's care as documented by the facility's business 
records for services for more than 30 days. 
(b) Procedures. Procedures for involuntary transfer or discharge by the facility are as follows: 
(1) Written notice shall be provided at least thirty (30) days in advance of the transfer or discharge 
date to the resident, resident's legal representative, person responsible for payment of charges for the 
resident's care, if different from any of the foregoing, and the Department. 
(2) The ten day requirement shall not apply when an emergency transfer is mandated by the resident's 
health care needs and is in accordance with the attending physician's written orders and medical 
justification; or the transfer or discharge is necessary for the physical safety of other residents as 
25 
 
documented in the clinical record. The facility shall not use a discharge to a hospital as a reason for 
failing to re-admit a resident after release from the hospital to the first available bed in a semi-private 
room. Such action shall be considered to be an involuntary discharge subject to all the requirements 
of this section, unless the discharge was required by the Department. 
(3) The written notice shall include: 
(A) A full explanation of the reasons for the transfer or discharge; 
(B) The date of the notice; 
(C) The date notice was given to the resident and the resident's representative; 
(D) The date by which the resident must leave the facility; and 
(E) Information that the resident's representative or person responsible for payment of the 
resident's care who is aggrieved by the facility's decision, may file within ten (10) days of notice a 
written request for a hearing with the Department by sending a letter to the Hearing Clerk, 
Oklahoma State Department of Health, 1000 NE Tenth Street, Oklahoma City, OK 73117. 
(4) Failure of the facility to give the notice as substantially specified above shall result in an order 
without hearing from the Department denying the right of the facility to discharge the resident. 
(5) If a written request for a hearing is properly filed by an eligible aggrieved party, the Department 
shall convene a hearing within ten working days of receipt of the request. The request may be in the 
form of a letter or a formal request for hearing from the resident or resident's representative. In the 
event that the resident is unable to write, a verbal request made to the hearing clerk shall be sufficient. 
The Department shall reduce the verbal request to writing and send a copy to the resident. The request 
should state the reason for the discharge and attach a copy of the letter from the facility. 
(6) During the pendency of the hearing, the facility shall not discharge the resident unless the 
discharge was required by the Department or is an emergency situation. If the resident relocates from 
the facility but wants to be readmitted, the Department may proceed with the hearing and the facility 
shall be required to readmit the resident to the first available bed in a semi-private room if the 
discharge is found not to meet the requirements of the Nursing Home Care Act and OAC 310:675. 
(7) The Department shall provide the Administrative Law Judge and the space for the hearing. The 
parties, including the resident and the facility, may be represented by counsel or may represent 
themselves. 
(8) The hearing shall be conducted at the Oklahoma State Department of Health building unless there 
is a request for the hearing to be held at the facility or at another place. Providing the hearing room in 
such a case shall be the responsibility of the parties. The Department shall maintain a record on the 
case as it does for any other individual proceeding. 
(9) The hearing shall be conducted in accordance with the Department's procedures, Chapter 2 of this 
Title. The Administrative Law Judge's order shall include findings of fact, conclusions of law and an 
order as to whether or not the transfer or discharge was according to law. If a facility receives federal 
funds for services, it shall also comply with the certification standards. The more restrictive rule 
toward the facility shall be applied. 
(10) If the Administrative Law Judge finds that the discharge was not according to law, the 
Department shall review, investigate and issue deficiencies as appropriate. 
(11) If the discharge is according to law, the order shall give the facility the right to discharge the 
resident. 
(12) The scope of the hearing may include: 
(A) Inadequate notice; 
(B) Discharge based on reason not stated in the law; 
(C) Sufficiency of the evidence to support the involuntary discharge; or 
(D) The finding of emergency. 
(13) The Administrative Law Judge shall render a written decision within ten working days of the 
close of the record. 
(14) If the Administrative Law Judge sustains the facility, the facility may proceed with the discharge. 
If the Administrative Law Judge finds in favor of the resident, the facility shall withdraw its notice of 
26 
 
intent to transfer or discharge the resident. The decision of the Administrative Law Judge shall be 
final and binding on all parties unless appealed under the Administrative Procedures Act. 
(c) Room relocation 
(1) If a facility wants to relocate a resident from one room to another, the facility shall give the 
resident at least forty-eight hours written notice. The notice shall include the cost of transferring the 
resident's telephone, if applicable. 
(2) If the resident or the resident's representative agrees in writing to the relocation, the relocation 
may take place in less than forty-eight hours. 
(3) No hearing is required if the resident requests or agrees to relocation from one room to another. 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-7-4.1. Resident admission and continued residency based on administration of 
antipsychotic drugs 
(a) Reasons for denial of admission or continued residency. No long-term care facility shall deny 
admission or continued residency to a person on the basis of the person's or his or her representative's 
refusal to the administration of antipsychotic drugs, unless: 
(1) The prescribing clinician or care facility can demonstrate that the resident's refusal would place 
the health and safety of the resident, the facility staff, other residents or visitors at risk. 
(2) The alleged risk shall be documented in detail and presented to the resident or the representative 
of the resident, to the State Department of Health and to the Long-Term Care Ombudsman; and shall 
inform the resident or the representative of the resident of the resident's right to appeal. 
(b) Procedures. Procedures for resident appeal are as follows: 
(1) Written documentation of the alleged risk associated with the administration of antipsychotic 
drugs shall be provided to the resident or representative of the resident, to the State Department of 
Health and to the Long-Term Care Ombudsman; and shall inform the resident or the representative of 
the resident of the resident's right to appeal the denial of admission or denial of continued residency 
to the State Department of Health. The documentation of the alleged risk shall include: 
(A) A description of all nonpharmacological or alternative care options attempted; and 
(B) Why all nonpharmacological or alternative care options attempted were unsuccessful; and 
(C) Why the prescribing clinician determined alternative treatments were not medically 
appropriate for the condition following a physical examination. 
(2) Procedures for antipsychotic drug refusal and the facility's notice of admission denial or continued 
residency are as follows: 
(A) If a resident or a resident's representative is aggrieved by the facility's decision to deny 
admission or continued residency regarding the refusal of antipsychotic drugs at 63 O.S. 1-
881(E)(2) the resident or resident's representative may file within ten (10) days of notice a written 
request for a hearing with the Department by sending a letter to the Hearing Clerk, Oklahoma 
State Department of Health, 1000 NE Tenth Street, Oklahoma City, OK 73117. 
(B) The written notice shall include: 
(i) A full explanation of the reason for the denial of admission of residency or denial of 
continued residency; 
(ii) The date of the notice; and 
(iii) The date notice was given to the resident and the resident's representative. 
(3) Failure of the facility to give the notice as substantially specified shall result in an order without 
hearing from the Department denying the right of the facility to discharge or deny admission to the 
resident. 
(4) If a written request for a hearing is properly filed by an eligible aggrieved party, the Department 
shall convene a hearing within ten working days of receipt of the request. The request may be in the 
form of a letter or a formal request for hearing from the resident or resident's representative. In the 
event that the resident is unable to write, a verbal request made to the hearing clerk shall be sufficient. 
The Department shall reduce the verbal request to writing and send a copy to the resident. The request 
27 
 
shall state the objection to the notice of denial of admission of residency or denial of continued 
residency and attach a copy of the notice from the facility. 
(5) During the pendency of the hearing, the facility shall not discharge or deny admission or 
readmission for the resident unless the discharge or admission denial was required by the Department 
or is an emergency situation. If the resident relocates from the facility but wants to be admitted or 
readmitted, the Department may proceed with the hearing and the facility shall be required to admit or 
readmit the resident to the first available bed in a semi-private room if the discharge is found not to 
meet the requirements of the Nursing Home Care Act and OAC 310:675. 
(6) The Department shall provide the Administrative Law Judge and the space for the hearing. The 
parties, including the resident and the facility, may be represented by counsel or may represent 
themselves. 
(7) The hearing shall be conducted at the Oklahoma State Department of Health building unless there 
is a request for the hearing to be held at the facility or at another place. Providing the hearing room in 
such a case shall be the responsibility of the parties. The Department shall maintain a record on the 
case as it does for any other individual proceeding. 
(8) The hearing shall be conducted in accordance with the Department's procedures, Chapter 2 of this 
Title. The Administrative Law Judge's order shall include findings of fact, conclusions of law and an 
order as to whether or not the transfer or discharge was according to law. If a facility receives federal 
funds for services, it shall also comply with the certification standards. The more restrictive rule 
toward the facility shall be applied. 
(9) If the Administrative Law Judge finds the notice of continued residency or denied admission was 
not according to law, the Department shall review, investigate and issue deficiencies as appropriate. 
(10) If the notice of continued residency or denied admission is according to law, the order shall give 
the facility the right to discharge or deny admission to the resident. 
(11) The scope of the hearing may include: 
(A) Inadequate notice; 
(B) Continued residency or admission denial based on reason not stated in the law; 
(C) Sufficiency of the evidence to support the continued residency or admission denial; or 
(D) The finding of emergency. 
(12) The Administrative Law Judge shall render a written decision within ten working days of the 
close of the record. 
(13) If the Administrative Law Judge sustains the facility, the facility may proceed with the discharge. 
If the Administrative Law Judge finds in favor of the resident, the facility shall withdraw its notice of 
intent to transfer, discharge or deny admission of the resident. The decision of the Administrative 
Law Judge shall be final and binding on all parties unless appealed under the Administrative 
Procedures Act. 
[Source: Added at 37 Ok Reg 1448, eff 9-11-20] 
 
310:675-7-5. Complaint procedures [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-5.1. Reports to state and federal agencies 
(a) Timeline for reporting. All reports to the Department shall be made within twenty-four (24) hours of 
the reportable incident unless otherwise noted. A follow-up report of the incident shall be submitted to the 
Department within five (5) Department business days after the incident. The final report shall be filed 
with the Department within ten (10) Department business days after the incident. 
(b) Reporting abuse, neglect or misappropriation. The facility shall report to the Department 
allegations and incidents of resident abuse, neglect or misappropriation of residents' property [63 O.S. 
§1-1939(A)(1)(e)]. This requirement does not supersede reporting requirements in Title 43A of the 
Oklahoma Statutes (relating to the Protective Services for the Elderly and for Incapacitated Adults Act). 
28 
 
(d) Reporting to licensing boards. The facility shall also report allegations and incidents of resident 
abuse, neglect, or misappropriation of residents' property by licensed personnel to the appropriate 
licensing board. 
(d) Reporting communicable diseases. The facility shall report communicable diseases [63 O.S. §1-
1939(A)(1)(a)] and injuries as specified by the Department in OAC 310:515 (relating to communicable 
disease and injury reporting). 
(e) Reporting certain deaths. The facility shall report deaths by unusual occurrence, such as accidental 
deaths or deaths other than by natural causes, and deaths that may be attributed to a medical device, [63 
O.S. §1-1939(A)(1)(b)] according to applicable state and federal laws. The facility shall also report such 
deaths to the Department. 
(f) Reporting missing residents. The facility shall report missing residents to the Department after a 
search of the facility and facility grounds and a determination by the facility that the resident is 
missing. In addition, the facility shall make a report to local law enforcement agencies within two (2) 
hours if the resident is still missing [63 O.S. §1-1939(A)(1)(c)]. 
(g) Reporting criminal acts. The facility shall report situations arising where a criminal intent is 
suspected. Such situations shall also be reported to local law enforcement [63 O.S. §1-1939(A)(1)(d)]. 
Where physical harm has occurred to a resident as a result of a suspected criminal act, a report shall 
immediately be made to the municipal police department or to the sheriff's office in the county in which 
the harm occurred. A facility that is not clear whether the incident should be reported to local law 
enforcement should consult with local law enforcement. 
(h) Reporting utility failures. The facility shall report to the Department utility failures of more than 
eight (8) hours. 
(i) Reporting certain injuries. The facility shall report to the Department incidents that result in: 
fractures, injury requiring treatment at a hospital, a physician's diagnosis of closed head injury or 
concussion, or head injuries that require more than first aid. 
(j) Reporting storm damage. The facility shall report to the Department storm damage resulting in 
relocation of a resident from a currently assigned room. 
(k) Reporting fires. The facility shall report to the Department all accidental fires and fires not planned 
or supervised by facility staff occurring on the licensed real estate. 
(l) Reports made following local emergency response. In lieu of making incident reports during an 
emergency response to a natural or man-made disaster, the facility may coordinate its communications, 
status reports and assistance requests through the local emergency response coordinator, and file a final 
report with the Department within ten (10) days after conclusion of the emergency response. 
(m) Reporting nurse aides. The facility shall report to the Department allegations and incidents of abuse, 
neglect, or misappropriation of resident property by a nurse aide by submitting a completed Nurse Aide 
Abuse, Neglect, Misappropriation of Resident Property Form (ODH Form 718), which requires the 
following: 
(1) facility name, address, and telephone; 
(2) facility type; 
(3) date; 
(4) reporting party name or administrator name; 
(5) employee name and address; 
(6) employee certification number; 
(7) employee social security number; 
(8) employee telephone number; 
(9) termination action and date; 
(10) other contact person name and address; and 
(11) facts of abuse, neglect, or misappropriation of resident property. 
(n) Content of reports to the department. Reports to the Department made pursuant to this section shall 
contain the following: 
(1) The preliminary report shall, at the minimum, include: 
29 
 
(A) who, what, when, and where; and 
(B) measures taken to protect the resident(s) during the investigation. 
(2) The follow-up report shall, at the minimum, include: 
(A) preliminary information; 
(B) the extent of the injury or damage if any; and 
(C) preliminary findings of the investigation. 
(3) The final report shall, at the minimum, include preliminary and follow-up information and: 
(A) a summary of investigative actions; 
(B) investigative findings and conclusions based on findings; and 
(C) corrective measures to prevent future occurrences. 
(D) if items are omitted, why the items are omitted and when they will be provided. 
(o) Form for incident reports to the Department. Facilities shall use the Incident Report Form, ODH 
Form 283, to report incidents required to be reported to the Department under OAC 310:675-7-5.1. The 
ODH Form 283 shall require: the facility name, address and identification number; the date, location and 
type of incident; parties notified in response to the incident; description of the incident; the relevant 
resident history; summary of the investigation; and name of person completing the report. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Amended at 34 Ok Reg 1305, eff 10-1-17] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-7-6. Resident's advisory council [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-6.1. Complaints 
(a) Complaints to the facility. The facility shall make available to each resident or the resident's 
representative a copy of the facility's complaint procedure. The facility shall ensure that all employees 
comply with the facility's complaint procedure. The facility's complaint procedure shall include at least 
the following requirements. 
(1) The facility shall list in its procedures and shall require to be posted in a conspicuous place 
outside the administrator's office area the following information: 
(A) The names, addresses and telephone numbers of facility staff persons designated to receive 
complaints for the facility; 
(B) Notice that a good faith complaint made against the facility shall not result in reprisal against 
the person making the complaint; and 
(C) Notice that any person with a complaint is encouraged to attempt to resolve the complaint 
with the facility's designated complaint staff, but that the person may submit a complaint to the 
Department without prior notice to the facility. 
(2) If a resident, resident's representative or facility employee submits to the administrator or 
designated complaint staff a written complaint concerning resident abuse, neglect or misappropriation 
of resident's property, the facility shall comply with the Protective Services for Vulnerable Adults 
Act, Title 43A O.S. Sections 10-101 through 10-110. 
(b) Complaints to the Department. The following requirements apply to complaints filed with the 
Department. 
(1) The Department shall provide to each facility a notice identifying the telephone number and 
location of the Department's central call center to which complaints may be submitted. The facility 
shall post such notice in a conspicuous place outside the administrator's office area. 
(2) Any person may submit a complaint to the Department in writing, by phone, or personally. The 
Department shall reduce to writing a verbal complaint received by phone or in person. 
30 
 
(3) If the complainant is a facility resident, the resident's representative, or a current employee of the 
facility, the Department shall keep the complainant's identity confidential. For other complainants the 
Department shall ask the complainant's preference regarding confidentiality. 
(4) The Department shall receive and triage complaints at a central call center. The complaints shall 
be classified and investigated according to the following priorities: 
(A) A complaint alleging a situation in which the facility's noncompliance with state or federal 
requirements relating to nursing facilities has caused or is likely to cause serious injury, harm, 
impairment or death to a resident shall be classified as immediate jeopardy and shall be 
investigated by the Department within two (2) working days; 
(B) A complaint alleging minimal harm or more than minimal harm to a resident but less than an 
immediate jeopardy situation shall be classified as actual harm and shall be investigated by the 
Department within ten (10) working days; and 
(C) A complaint alleging other than immediate jeopardy or actual harm shall be scheduled for an 
onsite survey and investigated during the next onsite survey or sooner if deemed necessary by the 
Department; and 
(D) A complaint alleging a violation that caused no actual harm but the potential for more than 
minimal harm to a resident, that repeats a violation cited by the Department within the preceding 
twelve (12) months, and that is alleged to have occurred after the Department determined the 
facility corrected the previous violation, shall be classified as continuing and investigated the 
earlier of the next onsite survey or ninety (90) calendar days. 
(5) In addition to scheduling investigations as provided in paragraph (4) of this subsection, the 
Department shall take necessary immediate action to remedy a situation that alleges a violation of the 
Nursing Home Care Act, any rules promulgated under authority of the Act, or any federal 
certification laws or rules, if that situation represents a serious threat to the health, safety and welfare 
of a resident. 
(6) In investigating complaints, the Department shall: 
(A) Protect the identity of the complainant if a current or past resident or resident's representative 
or designated guardian or a current or past employee of the facility by conforming to the 
following: 
(i) The investigator shall select at least three (3) records for review, including the record of 
the resident identified in the complaint. The three records shall be selected based on residents 
with similar circumstances as detailed in the complaint if possible. All three (3) records shall 
be reviewed to determine whether the complaint is substantiated and if the alleged deficient 
practice exists; and 
(ii) The investigator shall interview or observe at least three (3) residents during the facility 
observation or tour, which will include the resident referenced in the complaint if identified. 
If no resident is identified, then the observations used of the three residents shall be used to 
assist in either substantiating or refuting the complaint; 
(B) Review the facility's quality indicator profile using resident assessments filed pursuant to 
OAC 310:675-9-5.1 to determine whether the facility has been "flagged", if the complaint 
involves resident abuse, pressure ulcers, weight loss or hydration; 
(C) Review surveys completed within the last survey cycle to identify tendencies or patterns of 
non-compliance by the facility; 
(D) Attempt to contact the State or Local Ombudsman prior to the survey; and 
(E) Interview the complainant, the resident, if possible, and any potential witness, collateral 
resource or affected resident. 
(7) The Department shall limit the complaint report to the Health Care Financing Administration 
Form 2567 if applicable and the formal report of complaint investigation. 
(A) The Form 2567 shall be issued to the facility within ten (10) business days after completion 
of the investigation. 
31 
 
(B) The formal report of complaint investigation shall be issued to the facility and the 
complainant, if requested, within ten (10) business days after completion of the investigation. The 
formal report of investigation shall include at least the following: 
(i) Nature of the allegation(s); 
(ii) Written findings; 
(iii) Deficiencies, if any, related to the complaint investigation; 
(iv) Warning notice, if any; 
(v) Correction order, if any; and 
(vi) Other relevant information. 
[Source: Amended at 34 Ok Reg 1305, eff 10-1-17] 
 
310:675-7-7. Administrative records [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-7.1. Resident's advisory council 
(a) Each facility shall establish a residents advisory council. 
(b) Members of the residents advisory council shall consist of all current nursing facility residents or their 
designated representative. The administrator shall designate a member of the facility staff to coordinate 
the council and render assistance to the council, and respond to the requests from the council's meetings. 
(c) No employee or affiliate of the facility shall be a member of the council. The facility shall provide the 
council with private meeting space. 
(d) Minutes of the residents advisory council meetings shall be prepared by the facility staff and 
maintained in the facility. A copy of the meeting minutes shall be provided to those residents or 
representatives requesting them. Information identifying a resident shall not be included in the minutes. 
(e) The residents advisory council shall communicate to the administrator the residents' opinions and 
concerns known to the council. 
(f) The residents advisory council shall be a forum for: 
(1) Early identification of problems and recommendations for orderly problem resolution. 
(2) Soliciting and adopting recommendations for facility programs and improvements. 
(3) Obtaining information from, and disseminating information to, the residents. 
(g) The residents advisory council may present complaints to the Department on behalf of a resident. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-8. Written administrative policies [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-8.1. Administrative records 
(a) The administrator shall be responsible for the preparation, supervision, and filing of records. 
(b) There shall be a separate, organized file in the business office for each resident. The file shall include 
current information about the resident and the resident's family. The file shall also include a written 
record of all financial arrangements and transactions involving the individual resident's funds. A written 
contract between the resident, or his representative, or, if the resident is a minor, his parent, or 
representative, and the facility or its agent or the waiver of same shall also be in this file. 
(1) If the source of payment for the resident's care is, in full or in part, from public funds, there shall 
be a contract between the facility and the agency providing the funds. An individual contract between 
such resident and the nursing facility is not required. 
(2) A resident may sign a waiver if the resident does not wish to have a contract with the facility. 
(c) Each facility shall provide safe storage for administrative records and all current records shall be 
readily available to the Department upon request. 
(d) Administrative records of the facility shall include the following information: 
(1) A copy of the current statement of ownership. 
32 
 
(2) The current administrator's name, license number, and date of employment. 
(3) The name of the individual responsible for the facility's operation in the absence of the 
administrator. 
(4) Copies of credentials of all personnel and consultants working in the facility who are licensed, 
registered or certified. 
(5) Copies of criminal background checks on all required current employees. 
(6) A copy of all contracts with individuals or firms providing any services to the facility. 
(7) Written admission and discharge policies. 
(8) A description of the services provided by the facility and the rates charged for those services and 
services for which a resident may be charged separately; limitations of available services; causes for 
termination of services; and refund policies if services are terminated. Documentation shall show that 
each resident, and/or representative received this information prior to, or at, the time of admission. 
(9) Copies of affiliation agreements, contracts, or written arrangements for advice, consultation, 
services, training, or transportation with other organizations or individuals, and public or private 
agencies. 
(10) Written transfer agreements with other health facilities to make the services of such facilities 
readily accessible, and to facilitate the transfer of residents and essential resident information with the 
resident. 
(11) Records of residents advisory council meetings. 
(12) Copies of inspection reports from the local, county, and state agencies during the past three 
years. 
(13) All adverse actions instituted against the facility during the past three years, including warning 
letters, administrative penalties, notice of hearing, hearing officer's findings, final orders, and court 
proceedings. 
(14) Written disaster plan/emergency evacuation plan. 
(15) A record of all nurse aide competency and certification records and contacts to Oklahoma and 
other state's nurse aide registries. 
(16) Current resident census records. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-9. Personnel records [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-9.1. Written administrative policies and procedures 
(a) The facility shall maintain written policies to govern the administration of the facility. These policies 
shall be reviewed annually and revised as necessary. 
(b) The facility shall not admit any person unless it has the personnel and resources to provide all services 
and care prescribed for that person. 
(c) All persons seeking admission shall be evaluated as to their medical, nursing and social needs. The 
scope of care and service to be provided by the facility, or through contract, shall be included in the 
resident care plan following admission. 
(d) All residents shall have accommodations that are as close to their normal living arrangements as 
possible. Special care and arrangements shall be provided to ensure, if possible, that the accommodations 
support the resident's physical, mental and psycho-social needs in terms of sanitary environment, 
aesthetics and associations. 
(e) Residents shall be accepted and cared for without discrimination on the basis of race, sex, color, 
religion, ancestry, disability, or national origin. 
(f) Emergency care shall be provided to residents in case of sudden illness or accident, including persons 
to be contacted in case of an emergency. 
(g) Conflict resolution procedures shall be adopted for processing complaints received from residents and 
employees. 
33 
 
(h) Job descriptions shall be developed that detail the functions of each classification of employee. 
(i) Procedures shall be adopted for handling residents' funds and providing access to the written records 
regarding a resident's funds by the resident or representative. 
(j) The facility has the following responsibilities concerning physicians: 
(1) The health care services for each resident shall be under a physician's supervision. 
(2) All physician orders shall be written in ink or indelible pencil and signed by the physician. 
(3) No medication or treatment shall be administered except on a physician's order. 
(4) The facility shall have a written policy that provides for physician services to be available twenty-
four hours per day. 
(5) A list of physicians shall be posted at the nursing station for use if the resident's attending 
physician is not available. 
(6) The facility shall arrange for one, or more, physicians to be available in an emergency and to 
advise the facility. The physician called at the time of any emergency shall be noted in the records. If 
unable to contact a physician, the resident shall be transferred to a hospital emergency room. 
(k) The facility shall adopt a nursing policy and procedure manual, which shall detail all nursing 
procedures performed within the facility. All procedures shall be in accordance with accepted nursing 
practice standards, and shall include, but not be limited to, the following: 
(1) Ambulation, body alignment and positioning, and routine range of motion unless contraindicated 
by the resident's physician. 
(2) Elimination, including a bowel and bladder training program, or frequent toileting for incontinent 
residents, when applicable. 
(3) Colostomy and ileostomy care. 
(4) Nutrition and meal service. 
(5) Oral suctioning and tracheotomy care. 
(6) Treatments. 
(7) Nasogastric care. 
(8) Oral hygiene. 
(9) Isolation procedures. 
(10) Universal precautions. 
(11) Emergency procedures. 
(12) Medication Administration. 
(13) Pain assessment and treatment. 
(l) Each nursing station shall have a copy of the nursing policy and procedure manual, isolation 
techniques, and emergency procedures for fire and natural disasters. 
(m) The facility shall adopt policies and procedures for the administration of social services, activities, 
dietary, housekeeping, maintenance and personnel. 
(n) The facility shall adopt a policy that any person working in the facility who shows signs or symptoms 
of a communicable disease, shall be excluded from work, and shall be permitted to return to work only 
after approval of the director of nursing or charge nurse. 
(o) The facility shall adopt a procedure for taking inventory of and inconspicuously marking, for 
identification, the resident's personal effects (clothing and property) which shall be completed on 
admission of the resident and subsequently when new clothing or property is received by the resident. 
Identification marking shall be by a method that shall withstand repeated laundering or cleaning without 
loss of legibility. Jewelry, watches and similar articles of value shall not be subject to the marking 
requirement. 
(p) The facility shall adopt a policy that requires reporting of the loss of personal effects to the 
administrator, the resident, and the resident's representative. The policy shall require the staff to assist the 
resident in attempting to locate the lost property and may, at the request of the resident, require the 
reporting of such losses to law enforcement authorities. The policy shall also indicate that a resident has 
the right to report losses directly to law enforcement authorities without fear of reprisal from the facility's 
administration or staff. 
34 
 
[Source: Amended at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-7-10. Resident's records [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-10.1. Resident's clinical record 
(a) There shall be an organized, accurate, clinical and personal record, either typewritten or legibly 
written with pen and ink, for each resident admitted or accepted for treatment. The resident's clinical 
record shall document all nursing services provided. 
(b) The resident clinical record shall be retained for at least five years after the resident's discharge or 
death. A minor's record shall be retained for at least two years after the minor has reached the age of 
eighteen but, in no case, less than five years. 
(c) All required records, either original or microfilm copies, shall be maintained in such form as to be 
legible and readily available upon request of the attending physician, the facility, and any person 
authorized by law to make such a request. 
(d) Information contained in the resident record shall be confidential and disclosed only to the resident, 
persons authorized by the resident, and persons authorized by law. 
(e) Resident's records shall be filed and stored to protect against loss, destruction, or unauthorized use. 
(f) The Department shall be informed in writing immediately whenever any resident's records are defaced, 
or destroyed, before the end of the required retention period. 
(g) If a facility ceases operation, the Department shall be notified immediately of the arrangements for 
preserving the resident's record. The record shall be preserved for the required time and the information in 
the records shall be available to the health professionals or facilities assuming care of the resident so that 
continuity of care is available. 
(h) If the ownership of the facility changes, the new licensee shall have custody of the residents records 
and the records shall be available to the former licensee and other authorized persons. 
(i) A person employed by the owner shall be in charge of resident records and properly identifiable to 
others concerned. 
(j) The resident clinical record shall include: 
(1) An admission record sheet which shall include: 
(A) Identification of the resident (name, sex, age, date of birth, marital status). 
(B) Identification numbers as applicable: i. e., Medicare number, Medicaid number. 
(C) Date and time of admission. 
(D) Diagnosis and known allergies. 
(E) Name, address, and telephone number of responsible party, next of kin, pharmacist, and 
funeral home. 
(2) Physician's orders for medications, diet, treatment, and therapy. 
(3) Orders dated and signed by the physician giving the order. Verbal or telephone orders shall be 
signed by the physician within five working days, excluding weekends and holidays. 
(4) Initial orders given by the physician at the time of admission shall be signed by the physician and 
placed in the clinical record within five working days of admission, excluding weekends and 
holidays. 
(5) The most recent medical history and physical examination signed and dated by the physician. 
(6) Nurse's notes, dated and signed at the time of entry. 
(7) Temperature, pulse, respirations, blood pressure and weight when indicated by physician's orders 
or by a change in the resident's condition. 
(8) Progress notes generated by all health care professionals and allied health personnel. 
(9) An assessment and care plan based on the assessment. 
(10) An inventory of personal effects including clothing and property on admission, and as necessary. 
(11) Written acknowledgement by the resident or legal representative of receipt of the resident's rights 
upon admission and as needed. 
35 
 
(12) Discharge summary signed by the attending physician that shall include the diagnosis or reason 
for admission, summary of the course of treatment in the facility, final diagnosis with a follow-up 
plan, if appropriate, condition on discharge or transfer, or cause of death, date and time of discharge, 
and diagnosis on discharge. 
(13) A transfer or discharge form when a resident is transferred, or discharged, to the hospital, another 
facility or released from care. Transfer or discharge forms may be excluded when a resident is 
discharged to his/her home when the stay in the facility is for respite care only. The transfer form 
shall include, but not be limited to, the following information: 
(A) Identification of the resident and his attending physician. 
(B) Diagnosis, medications and medication administration schedule. 
(C) Name of transferring facility. 
(D) Name of receiving facility. 
(E) Date of transfer. 
(F) Family or legal representative. 
(G) Condition on transfer. 
(H) Reason for transfer. 
(I) Known allergies. 
(J) Pertinent medical history. 
(K) Any advance directive for medical care. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-11. Physician records and reports [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-11.1. Medication records 
(a) The facility shall maintain written policies and procedures for safe and effective acquisition, storage, 
distribution, control, and use of medications and controlled drugs. 
(b) The facility shall establish a policy for providing information about administering prescribed 
medications to residents who are on leave from the facility. 
(c) The facility shall maintain records of consultation and services provided by the consultant registered 
pharmacist at the facility. 
(d) The facility shall maintain a system to account for controlled medications prescribed for each resident, 
and an individual inventory record on all Schedule II medications. 
(e) The facility shall maintain a medication regimen review record on each resident. 
[Source: Added at 10 Ok Reg 163, eff 6-1-93] 
 
310:675-7-12. Pharmaceutical records [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-12.1. Internal facility incident reports 
(a) Incident defined. An incident is any accident or unusual occurrence where there is apparent injury or 
where injury may or may not have occurred. The incident report shall cover all unusual occurrences 
within the facility, or on the premises, affecting residents, and incidents within the facility or on the 
premises affecting visitors or employees. 
(b) Incident records. Each facility shall maintain an incident report record and shall have incident report 
forms available. 
(c) Incident report format. The incident report shall include, at a minimum: the date, location and type 
of incident; parties notified in response to the incident; description of the incident; the relevant resident 
history; summary of the investigation; and name of person completing the report. 
(d) Incident report preparation. At the time of the incident, the administrator, or the person designated 
by the facility with authority to exercise normal management responsibilities in the administrator's 
36 
 
absence, shall be notified of the incident and prepare the report. The report shall include the names of the 
persons witnessing the incident and their signatures where applicable. 
(e) Incident records on file. A copy of each incident report shall be on file in the facility. 
(f) Incident in clinical record. The resident's clinical record shall describe the incident and indicate the 
findings on evaluation of the resident for injury. 
(g) Incidents: reviewers. All incident reports shall be reviewed by the director of nursing and the 
administrator and shall include corrective action taken where health and safety are affected. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Amended at 34 Ok Reg 1305, eff 10-1-17] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-7-13. Incident reports [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-13.1. Consultation reports 
The facility shall maintain a report of all services rendered by health professionals and allied health 
personnel each consultation visit. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-14. In-service training classes [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-14.1. Facility maintenance 
(a) Each facility shall have a maintenance program, which ensures continuing maintenance of the facility 
and equipment, promotes good housekeeping and sanitary practices throughout the facility. 
(b) The maintenance records shall include: 
(1) A written orientation program for maintenance personnel. 
(2) A plan for reporting problems and responding to maintenance, housekeeping, or sanitation needs. 
(3) Response to major maintenance problems, if any, and plans for addressing any problem that 
cannot be corrected within three calendar days. 
(4) A copy of the service record from a sprinkler or fire alarm company that provides service for the 
automatic sprinkler and fire alarm system. 
(5) Verification that facility maintenance personnel are certified or licensed as required by state law. 
(c) The facility shall be maintained free of infestations of insects, pests and rodents. 
(1) The facility shall have a pest control program provided by maintenance personnel, or by contract 
with a pest control company, using the least toxic, least flammable, and most effective pesticides. If 
maintenance employees are used, they shall be currently licensed as commercial pesticide applicators. 
(2) Pesticides shall be stored in locked storage areas and not be stored in resident or food areas, 
(3) In the absence of other effective controls, screens shall be provided on all building exterior 
openings except doors. 
(d) All sewage shall be discharged into a public sewer system, or if such is not available, shall be 
disposed of in a manner approved by state and local health authorities. 
(1) When a private sewage disposal system is used, maintenance records and system design plans 
shall be at the facility. 
(2) No exposed sewer lines shall be located directly above working, storage, or eating surfaces in the 
kitchens, dining rooms, pantries, or food storage rooms, or where medical or surgical supplies are 
prepared, processed, or stored. 
37 
 
(e) All plumbing in the facility shall be installed and maintained in accordance with state and local 
plumbing codes. All plumbing shall be maintained free of the possibility of back-flow and back 
siphonage through the use of vacuum breakers and fixed air gaps. 
(f) If an incinerator is used, it shall comply with state and local air pollution regulations, and shall be 
constructed to prevent insect and rodent breeding and harborage. 
(g) Entrances, exits, steps and outside walkways shall be kept reasonably free from ice, snow, and other 
hazards. 
(h) Buildings, grounds, and parking areas shall be maintained in a clean, orderly condition, in good repair, 
and be monitored for possible hazards. 
(i) Storage areas, attics, roofs, and basements shall be kept safe and free from accumulations of 
extraneous materials such as refuse, discarded furniture, and old newspapers. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-15. Consultation reports [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-15.1. Housekeeping laundry, and general storage 
(a) Housekeeping. Each facility shall have housekeeping services that are planned, operated, and 
maintained to provide a pleasant, safe and sanitary environment. 
(1) The facility shall employ housekeeping personnel suitable by training, experience, and in 
sufficient number. 
(2) Housekeeping personnel, using accepted practices and procedures, shall keep the facility free from 
offensive odors, accumulations of dirt, rubbish, dust and safety hazards. 
(3) Deodorizers shall not be used to cover up odors caused by unsanitary conditions or poor 
housekeeping practices. 
(4) Suitable equipment and supplies shall be provided for all cleaning activities and shall be 
maintained in a safe, sanitary condition. 
(5) Cleaning shall be performed in a manner that minimizes the spread of pathogenic organisms. 
(A) Floors shall be cleaned regularly. 
(B) Any polish used on floors shall provide a non-slip finish. 
(C) Used mop water shall not be stored in mop buckets and the mop shall be stored properly. 
(6) Housekeeping personnel shall receive effective supervision, orientation and training. 
Housekeeping personnel shall be skilled in the six basic functions of sweeping, mopping, dusting, 
cleaning, waxing, and polishing. 
(7) Resident rooms, furniture, bedding and equipment shall be thoroughly cleaned and sanitized 
before use by another resident. 
(8) All garbage and rubbish not disposable as sewage shall be collected in impervious containers in 
such a manner as not to become a nuisance or a health hazard and shall be removed to an approved 
storage area at least once a day. 
(A) The refuse and garbage storage area shall be kept clean and orderly. 
(B) There shall be a sufficient number of impervious containers with tight fitting lids that are 
clean and in good repair. 
(9) The containers used to transport refuse within the building shall be constructed of impervious 
materials, be lid or door enclosed, used solely for refuse, and maintained in a clean manner. All 
kitchen waste, contaminated refuse, and patient room trash shall be securely bagged before placed in 
these containers. 
(10) Bathtubs, showers or lavatories shall not be used for laundering, cleaning of bedside utensils, 
mops, nursing utensils or equipment, nor for the dumping of waste water, nor for storage. 
(11) Draperies and furniture shall be kept clean and in good repair. 
(b) Laundry. Each facility shall have laundry services that are planned, operated, and maintained to 
provide sufficient, safe and sanitary laundering of linen, supplies, and clothing. 
38 
 
(1) If the facility does not provide laundry services it shall contract with a commercial laundry service 
that provides these standards. 
(2) Laundry facilities shall be provided with the necessary washing and drying equipment. 
(3) Laundry equipment shall be designed and installed that complies with applicable laws. 
(4) Laundry processing and procedures shall render soiled linens and resident clothing clean, dry, soft 
and free of detergent, lint and soap. 
(5) Soiled laundry shall be processed frequently to prevent the accumulations of soiled linens and 
resident's clothing. 
(6) The facility's linen supply shall include at least two complete changes of linen for each resident 
bed. All linen shall be clean, sorted, and in good repair. When linen is not in use all shall be properly 
stored. 
(7) Soiled linen, including blankets, shall be placed in bags or impervious linen hampers/carts with 
lids tightly closed and shall be removed to the laundry area from the resident care unit at least every 
eight hours. 
(8) Sorting and pre-rinsing of all clothing shall be done in the soiled utility and laundry areas. 
(9) All soiled linen shall be enclosed in bags before placing them in the laundry chute. Laundry 
chutes shall be cleaned as scheduled in the facility's policy and procedure manual. 
(10) Carts and hampers used to transport soiled linen shall be constructed of, or lined with, 
impervious materials, which can be cleaned and disinfected after each use, and used only for 
transporting soiled linen. Tight fitting lids or covers shall be used. 
(11) Soiled linen and clothing shall be stored in the utility rooms and not in the halls. 
(12) All personnel shall wash their hands or use alcohol gel thoroughly after handling soiled linen. 
(13) There shall be at least one storage area for clean linen. 
(c) General storage. The facility shall provide general storage as follows: 
(1) Combustibles, such as cleaning rags and compounds, shall be in closed, metal containers. 
(2) Cleaning compounds and hazardous substances shall be labeled properly and stored in safe places. 
Food substances shall not be stored in the same cabinets, shelves, or in close proximity to prevent 
accidental selection of the hazardous substance in the place of the food substance. 
(3) Residents shall not have access to storage areas for cleaning agents, bleaches, insecticides or any 
other dangerous, poisonous or flammable substances. 
(4) Paper towels, tissues, and other supplies shall be stored in a manner to prevent their contamination 
prior to use. 
(5) Closed storage shall be provided for pillows, blankets, sheepskins, draw sheets, weight 
distribution pads, and pressure padding. 
(6) Equipment shall not be stored in a hallway or corridor. 
(7) No item shall be stored directly on the floor. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-16. Facility maintenance records [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-16.1. Quality assessment and assurance 
(a) The facility shall maintain a quality assessment and assurance committee to address facility and 
resident's needs. 
(b) The committee shall include the director of nursing, a physician designated by the facility, and at least 
one other appropriate staff. 
(c) The quality assessment and assurance committee shall meet at least quarterly to identify quality 
assessment and assurance activities. 
(d) The committee shall develop and implement appropriate plans of action to correct identified quality 
deficiencies. 
39 
 
(e) The Department shall not require disclosure of the records of the committee unless such disclosure is 
related to the committee's compliance with the requirements of this section. 
(f) Good faith attempts by the committee to identify and correct quality deficiencies shall not be used as a 
basis for sanctions. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-7-17. Housekeeping, general sanitation and infection control [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-17.1. Infection Control 
(a) The facility shall have an infection control policy and procedures to provide a safe environment. The 
policy shall address the prevention and transmission of disease and infection. The facility, and its 
personnel, shall practice the universal precautions identified by the Centers for Disease Control. All 
personnel shall demonstrate their knowledge of universal precautions through performance of duties. 
(b) The facility shall maintain a sanitary environment and prevent the development and transmission of 
infection in the following areas. 
(1) Food handling practices; 
(2) Laundry practices including linen handling. 
(3) Disposal of environmental and resident wastes. 
(4) Pest control measures. 
(5) Traffic control for high-risk areas. 
(6) Visiting rules for high-risk residents. 
(7) Sources of air-borne infections. 
(8) Health status of all employees and residents. 
(9) Isolation area for residents with communicable diseases. 
(c) Infection control policies to prevent the transmission of infection shall include the following: 
(1) Excluding Personnel and visitors with communicable infections. 
(2) Limiting traffic in dietary and medication rooms. 
(3) Using aseptic and isolation techniques including hand washing techniques. 
(4) Bagging each resident's trash and refuse. 
(5) Issuing daily damp wipe cloths, treated dust cloths and clean wet mops, as needed. 
(6) Laundering the used wet mops and cleaning cloths every day. 
(7) Cleaning the equipment for resident use daily, and the proper disposal of infected materials. 
(8) Providing properly identifiable plastic bags for the proper disposal of infected materials. 
(9) Tuberculosis risk assessment. An annual facility tuberculosis risk assessment is to be performed 
by a licensed nurse or physician using a Department approved risk assessment tool. 
(d) When scheduled to be cleaned, the toilet areas, utility rooms, and work closets, shall be cleaned with a 
disinfectant solution and fresh air shall be introduced to deodorize. 
(e) Test for tuberculosis and tuberculin skin test for residents. Within thirty (30) days from admission, 
all residents admitted to the facility after the adoption of this rule shall receive a test for tuberculosis. All 
tests and examinations shall be in conformance with the "Tuberculosis Screening, Testing, and Treatment 
of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers 
Association and CDC, 2019" guidelines for preventing the transmissions of mycobacterium tuberculosis 
in healthcare settings as published by the Centers for Disease Control and Prevention. 
(1) Tests for tuberculosis shall be administered by a licensed nurse or physician. 
(2) Where a skin test is contra-indicated, a chest radiograph, interpreted by a medical consultant in 
collaboration with the city, county or state health department, is acceptable. 
(3) Residents claiming a prior positive tuberculin skin test shall have documentation in their medical 
record, obtained from a licensed health care professional, of their test results and interpretation; 
otherwise, a two-step tuberculin skin test shall be done. 
 
40 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
[Source: Amended at 37 Ok Reg 1448, eff 9-11-20] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-7-18. Animals allowed to visit or reside [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-7-18.1. Personnel records 
Each facility shall maintain a personnel record for each current employee containing: 
(1) Application for employment. An application for employment which contains employee's full 
name, social security number, professional license or registration number, if any, employment 
classification, and information about past employment, including: place of employment, position 
held, length of employment, and reason for leaving. 
(2) Employee time records. Copies of current employee time records, signed by the employee, shall 
be maintained by the facility for at least thirty-six (36) months. 
(3) Training, arrest check, and certification. Documentation of orientation and training (may be 
kept in separate file), continuing education, a copy of the criminal arrest check, and appropriate 
certification and licensure. 
(4) Health examination on hire. Record of health examination conducted within thirty days of 
employment which shall include, but not be limited to, a complete medical history, physical 
examination by body system and, a test for tuberculosis. All tests and examinations shall be in 
conformance with the "Tuberculosis Screening, Testing, and Treatment of U.S. Health Care 
Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 
2019" guidelines for preventing the transmission of mycobacterium tuberculosis in healthcare settings 
as published by the Centers for Disease Control and Prevention. 
(A) Tests for tuberculosis shall be administered by a licensed nurse or physician. 
(B) Where a skin test is contra-indicated, a chest radiograph, interpreted by a medical consultant 
in collaboration with the city, county or state health department, is acceptable. 
(C) Employees claiming a prior positive tuberculin skin test shall have documentation in their 
file, obtained from a licensed health care professional, of their test results and interpretation, 
otherwise, a two-step tuberculin skin test shall be done. 
(5) Tests for tuberculosis. Results of subsequent tests for tuberculosis performed based on facility TB 
risk classification established in OAC 310:675-7-17(c)(9) (relating to annual facility tuberculosis risk 
assessment) or results of a physician's examination for signs and symptoms of tuberculosis for those 
employees who react significantly to a tuberculin skin test.. All tests and examinations shall be in 
conformance with the "Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: 
Recommendations from the National Tuberculosis Controllers Association and CDC, 2019" guidelines 
for preventing the transmissions of mycobacterium tuberculosis in healthcare settings as published by the 
Centers for Disease Control and Prevention. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Amended at 37 Ok Reg 1448, eff 9-11-20] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-7-19. Residential and visiting pets 
(a) Each facility that allows residential or visiting animals shall adopt and comply with policies that meet 
or exceed 310:675-7-19(a) and 310:675-7-19(b). The facility's policies shall describe the schedule of 
41 
 
animal care and zoonotic infection control for the respective facility. The facility shall not allow any 
animal to reside in the facility until all of the following requirements are met: 
(1) The animal is a dog, cat, fish, bird, rabbit, or guinea pig. If a facility desires to include other types 
of animals in their program, the facility shall submit a supplemental request accompanied by its 
policies, procedures, and guidelines to the Department and receive written approval from the 
Department prior to implementation. 
(2) For residential pets, excluding fish, the number of animals in a facility shall be limited to no more 
than one dog per 50 residents; 1 cat, rabbit, or guinea pig per 30 residents; or 1 bird per 20 residents, 
unless the facility has received the Department's prior approval of a greater number of pets through a 
supplemental request pursuant to 310:675-7-19(a)(1). 
(3) The facility adopts policies ensuring non-disruption of the facility. 
(4) All pets are housed and controlled in a manner that ensures that neither the pet nor the residents 
are in danger. A pet cage or container must not obstruct an exit or encroach on the required corridor 
width. 
(5) The following veterinary medical services are obtained for each pet, when applicable to species, 
and a record of service is maintained on file at the facility: 
(A) A health certificate from a veterinarian licensed to practice in Oklahoma stating the animal is 
healthy on physical exam and of acceptable temperament to be placed in the facility; 
(B) Proof of evaluation by a veterinarian licensed to practice in Oklahoma for presence of internal 
parasites on a semi-annual basis and for the presence of external parasites as needed; 
(C) Proof of current rabies immunization for dogs and cats, and leptospirosis immunization for dogs 
administered by a licensed veterinarian; 
(D) Proof of spaying/neutering for dogs and cats over six months of age; and 
(E) Statement from a licensed veterinarian certifying that each bird tested negative for Chlamydia 
psittaci infection (psittacosis) within 30 days prior to placement in the facility. Birds equal in size to 
or larger than a parakeet shall receive a serologic test. Culture from fresh droppings or cloacal swab 
will be acceptable test in smaller birds, such as canaries and finches. 
(6) The pet's skin appears normal, and its coat or feathers are free of ectoparasites, matted hair, feces, 
and other debris. 
(7) Residential pets shall be the responsibility of the administrator, who shall designate at least one 
attendant to supervise the care and maintenance of resident animals. The administrator and the 
designated attendants shall at least annually review the facility's policy on residential and visiting 
pets, and shall document that they have read and understood the policy. 
(8) The facility provides for the cleaning and disinfecting of any areas contaminated by urine or 
excrement, and for the regular cleaning of aviaries, aquariums, and animal cages. Water in aquariums 
and fish bowls shall be appropriately maintained to prevent bacterial growth in the water. 
(9) Residential dogs and cats shall not be allowed to remain in the resident areas after visiting hours. 
No animal shall be allowed in an area used for food storage or preparation, dining, medication 
preparation or administration, or clean or sterile supply storage. 
(10) If there is more than one resident per room, permission shall be obtained from each resident in 
the room before allowing animal visitation. 
(b) The facility may allow other animals to visit the facility. Visiting animals shall be under the control of 
the person bringing the pet into the facility. The attendant of visiting animals shall adhere to the facility's 
policies and procedures for residential pets. Proof of current rabies immunization must be provided to the 
administrator before any dog, cat or ferret can be allowed as a visiting pet in the facility. 
(c) The Department shall publish and distribute to facilities recommended husbandry and veterinary care 
guidelines for residential pets. The guidelines shall include but not be limited to recommendations for 
housing, cleaning needs, exercise, diet, fecal examinations, grooming, attendant training on animal care 
and nutrition, and preventive health care. The guidelines shall be used for the information and education 
of facilities. 
(d) Section 310:675-7-19 does not supersede any local or state rules that regulate animals. 
42 
 
[Source: Added at 18 Ok Reg 2533, eff 6-25-01] 
 
310:675-7-20. Financial solvency and reports 
(a) The facility shall maintain financial solvency sufficient to ensure its operation as evidenced by the 
timely payment of obligations including but not limited to: 
(1) Employee payrolls; 
(2) Amounts owed to consultants, medical directors, vendors, suppliers, and utility service providers; 
(3) Taxes and provider fees; and 
(4) Leases, rents and mortgages. 
(b) The owner shall report to the Department the occurrence of financial events as required in 63 O.S. 
Section 1-1930.1. 
(1) The owner shall: 
(A) File a written report within 24 hours of the reportable event; or 
(B) Make an oral report by telephone within 24 hours of the reportable event, and file written 
confirmation within five days of the reportable event. 
(2) Notice of a judgment against the facility or any of the assets of the facility or the licensee shall be 
required from the date the judgment becomes final. 
(3) The owner shall include information in the written notification to accurately identify the event, 
including but not limited to: 
(A) The date of each action or event; 
(B) The name of each person involved in the event, including each legal entity, governmental 
agency, financial institution or trustee, and each employee whose regular payroll check has not 
been honored; 
(C) The amount of each judgement, lien, payroll, or tax payment related to the event; and 
(D) The style of the case and index or docket numbers as applicable. 
(E) Bankruptcy or appointment of trustee by the bankruptcy court. 
(4) Notification provided by the owner pursuant to 63:1-1930.1 does not relieve the owner of the 
obligation to provide ninety (90) days' notice prior to voluntarily closing a facility or closing any part of a 
facility, or prior to closing any part of a facility if closing such part will require the transfer or discharge 
of more than ten percent (10%) of the residents [63:1-1930]. 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-7-21. Sex or violent offender status 
(a) Determination of status. A facility subject to the provisions of this Chapter shall determine whether 
the following individuals have registered pursuant to the Sex Offenders Registration Act or the Mary 
Rippy Violent Crime Offenders Registration Act: 
(1) An applicant for admission or participation, 
(2) A resident, client or participant of a facility subject to the provisions of this Chapter, and 
(3) All employees of facilities subject to the provisions of this Chapter, in addition to the required 
criminal arrest check in 63 O.S. §1-1950.1 and 63 O.S. §1-1950.8 (relating to criminal arrest checks). 
(b) Procedures for determination of status. Prior to admission or employment but no later than three (3) 
business days from acceptance of any resident or participant, the employing or receiving facility subject 
to the provisions of this Chapter shall determine from local law enforcement, the Department of 
Corrections, or the Department of Corrections' Sex Offender and Mary Rippy Violent Crime Offender 
registries, whether the prospective employee or accepted resident or participant is registered or qualifies 
for registration on either registry. 
(c) Recommended registry search strategy. A facility subject to the provisions of this Chapter may 
utilize the first three letters of the last name and an asterisk, and the first letter of the first name and 
asterisk, any known alias, and appearance criteria as provided for search within the Department of 
Correction's Internet based sex and violent crime offender registries. 
43 
 
(d) Change in status after employment or admission. A facility subject to the provisions of this 
Chapter shall repeat the screening in OAC 310:675-7-21(b) (regarding procedures for determination of 
status) subsequent to the receipt of any information that an employee, resident or participant's registration 
status may have been altered or updated after the initial screening. 
(e) Posting of offender status. Pursuant to 63 O.S. §1-1909(4), a facility subject to the provisions of this 
Chapter shall conspicuously post for display in an area of its offices accessible to residents, employees 
and visitors a copy of any notification from the local law enforcement authority regarding the registration 
status of any person residing in the facility who is required to register pursuant to the Sex Offenders 
Registration Act or the Mary Rippy Violent Crime Offenders Registration Act. 
(f) Notice to Department of sex or violent offender's presence. When a facility subject to the 
provisions of this Chapter is notified, or has determined, that an individual who is required to register 
pursuant to the Sex Offenders Registration Act or the Mary Rippy Violent Crime Offenders Registration 
Act is residing or participating at such facility, the facility shall immediately, in writing, notify the State 
Department of Health.[63 O.S. §1-1946(A)(3)] 
(g) Content of notice of sex or violent offender's presence. Notice provided to the Department shall 
include the name, and identifying information used to make the determination in 310:675-7-
21(b)(regarding determination of status). 
(h) Notification through other means. Where a facility subject to the provisions of this Chapter 
determines through other means, excepting written notification by the Department, of an employee, 
resident or participant required to register pursuant to the Sex Offenders Registration Act or the Mary 
Rippy Violent Crime Offenders Registration Act, the facility shall notify the Department and shall be 
subject to all other requirements within this section. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Added at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
SUBCHAPTER 9. RESIDENT CARE SERVICES 
 
310:675-9-1. Activities [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-1.1. Nursing and personal care services 
(a) The facility shall ensure that resident rights are respected in the provision of care. 
(b) Basic nursing and personal care shall be provided for residents as needed. 
(1) Nursing care shall include, but not be limited to: 
(A) Encouraging residents to be active and out of bed for reasonable time periods. 
(B) Measuring resident temperature, blood pressure, pulse and respirations at least once every 
thirty days and more frequently if warranted by the resident's condition, with the results recorded 
in the clinical record. 
(i) Measuring resident weight at least once every thirty days and more frequently if warranted 
by the resident's condition, with the results recorded in the clinical record. 
(ii) Measuring resident pain whenever vital signs are taken and more frequently if warranted 
by the resident's condition, with the results recorded in the clinical record. 
(C) Offering fluids, and making fluids available, to maintain proper hydration. 
(D) Following proper nutritional practices for diets, enteral and parenteral feedings and assistance 
in eating. 
(E) Providing proper skin care to prevent skin breakdown. 
(F) Providing proper body alignment. 
(G) Providing supportive devices to promote proper alignment and positioning. 
44 
 
(H) Turning bed residents every two hours or as needed, to prevent pressure areas, contractures, 
and decubitus. 
(I) Performing range of motion exercises in accordance with individual assessment and care 
plans. 
(J) Ensuring that residents positions are changed every two hours or as needed when in a chair 
and are toileted as needed. 
(K) Establishing and implementing bowel and bladder programs to promote independence, or 
developing toileting schedules to promote continence. 
(L) Performing catheter care with proper positioning of bag and tubing at all times. 
(M) Recording accurate intake and output records for residents with tube feedings or catheters. 
(N) Assessing the general mental and physical condition of the resident on admission. 
(O) Updating the assessment and individual care plan when there is a significant change in the 
resident's physical, mental, or psychosocial functioning. 
(P) Recognizing and recording signs and symptoms of illness or injury with action taken to treat 
the illness or injury, and the response to treatments and medications. 
(2) Personal care shall include, but not be limited to: 
(A) Keeping residents clean and free of odor. 
(B) Keeping bed linens clean and dry. 
(C) Keeping resident's personal clothing clean and neat. 
(D) Ensuring that residents are dressed appropriately for activities in which they participate; 
bedfast/chairfast residents shall be appropriately dressed and provided adequate cover for comfort 
and privacy. 
(E) Ensuring that the resident's hair is clean and groomed. 
(F) Providing oral hygiene assistance at least twice daily with readily available dental floss, 
toothbrush and dentifrice. A denture cleaning/soaking device and brush shall be available and 
maintained for each resident as needed. 
(G) Keeping toenails and fingernails clean and trimmed. 
(c) The facility shall assist the resident in securing other services recommended by a physician such as, 
but not limited to, optometry or ophthalmology, audiology or otology, podiatry, laboratory, radiology or 
hospital services. The administration shall, through social services or other means, assist each resident 
desiring or needing medical related services. 
[Source: Amended at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-9-2. Social services [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-2.1. Dental and oral hygeine services 
(a) A dental history shall be obtained as part of the medical history on admission. The dental history shall 
include past dental problems, description of any prosthetic appliance used, current assessment and the 
resident's current dentist. 
(b) The facility shall have all dental prosthetic appliances such as dentures and partial dentures, marked 
and identified as belonging to that resident at the time of admission. A resident shall be promptly referred 
to a dentist when prosthetics are lost or damaged. 
(c) The facility shall arrange for one or more dentists to be available in an emergency and to act in an 
advisory capacity to the facility. The dentist notified for any emergency shall be recorded in the clinical 
record. If unable to contact the resident's dentist, the emergency physician or dentist shall be notified. 
(d) The facility shall maintain a list of referral dentists. 
(e) The facility shall assist the resident with, or make arrangements for the resident's transportation to and 
from the dentist's office. 
45 
 
(f) All residents shall have oral hygiene procedures provided at least daily, and as needed. Oral hygiene 
procedures shall include, but not be limited to, the resident's teeth being brushed and dentures and partial 
dentures being cleaned. Any exception shall be ordered by the resident's dentist or physician. 
(g) Oral hygiene supplies and equipment shall be available in sufficient quantities to meet the residents 
needs including but not limited to, toothbrushes, toothpaste, dental floss, lemon glycerin swabs or 
equivalent products, denture cleaners, denture adhesives, and containers for dental prosthetic appliances, 
such as dentures and partial dentures. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-3. Religion [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-3.1. Rehabilitative or restorative nursing services 
(a) Rehabilitative services promote restoration of the resident's maximum potential. Rehabilitative 
services shall be provided or obtained by the facility or an outside source according to the resident 
assessment. An evaluation shall address the residents rehabilitative needs, on admission, annually, and as 
the resident's condition indicates. Rehabilitative services shall be ordered by the physician, and provided 
under the direction of licensed or qualified staff. These services shall include, but not be limited to, the 
following: 
(1) Physical therapy. 
(2) Speech therapy. 
(3) Audiology. 
(4) Occupational therapy. 
(5) Psychological or psychiatric counseling/therapy. 
(6) Nutritional counseling. 
(b) Restorative nursing services may be provided by the nursing staff according to the care plan. These 
services shall include, but not be limited to, the following: 
(1) Range of motion to prevent contracture. 
(2) Bowel and bladder training to restore continence. 
(3) Self-help skill training. 
(4) Behavioral modification under the direction of a qualified consultant. 
(5) Ambulation. 
(6) Remotivation. 
(7) Reality orientation. 
(8) Reminiscent therapy. 
(c) There shall be an ongoing in-service education program for all restorative nursing staff. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-4. Recreation areas [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-4.1. Supplies and equipment 
(a) There shall be a sufficient quantity of supplies and, equipment in working condition, to meet the 
residents' medical, nursing, nutritional, social and activity needs. 
(b) The minimum level of supplies including but not limited to food and other perishables is a three (3) 
day supply. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-9-5. Community involvement [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
46 
 
310:675-9-5.1. Assessment and care plans 
(a) A resident assessment and an individual care plan shall be completed and implemented for each 
resident. The care plan shall indicate the resident's current status and accurately identify the resident's 
needs. 
(b) The written resident assessment and care plan shall be reviewed and updated, at least quarterly, and as 
needed when the resident's condition indicates. 
(c) Efforts shall be made to include the resident and resident's representative in development and 
implementation of the care planning process. 
(1) Resident assessment. 
(A) The facility shall conduct, initially and periodically, a comprehensive, accurate, standardized, 
reproducible assessment for each resident's functional capacity. 
(B) Each resident shall have an assessment coordinated or conducted by a registered nurse. 
(C) Each individual completing a portion of the assessment shall sign, date, and certify the 
accuracy of that portion. 
(D) An assessment shall be completed within fourteen days after admission of the resident. 
(E) The resident assessment shall include a minimum data set (MDS) in the form required under 
42 CFR 483.20. Each facility, with the exception of Intermediate Care Facilities for Individuals 
with Intellectual Disabilities (ICF/IID), accurately shall complete the MDS for each resident in 
the facility, regardless of age, diagnosis, length of stay or payment category. 
(F) The MDS form shall require the following, as applicable: 
(i) Admission assessment; 
(ii) Annual assessment; 
(iii) Significant change in status assessment; 
(iv) Significant correction of prior full assessment; 
(v) Significant correction of prior quarterly assessment; 
(vi) Quarterly review; and 
(vii) A subset of items upon a resident's transfer, reentry, discharge, and death. 
(2) Resident pain assessment. 
(A) Residents shall be screened for the presence of pain at least once every 30 days and whenever 
vital signs are taken. 
(i) Licensed nursing staff shall perform the screening at least once every 30 days. Certified 
nurse aides may perform the screening more frequently as needed. 
(ii) The screening instrument shall grade the intensity and severity of pain using a resident-
specific pain scale; 
(B) An individualized pain assessment shall be conducted by a registered nurse for each resident: 
(i) In conjunction with the admission, quarterly and annual assessments required at OAC 
310:675-9-5.1.(c)(1)(F); and 
(ii) With onset of pain not previously addressed in a care plan or physician's orders. 
(C) The goal is to alleviate or minimize pain while assisting the resident to maintain as high a 
level of functioning as possible. The pain assessment shall include, but not be limited to: 
(i) A statement of how the resident describes the pain; 
(ii) Intensity and severity of pain graded using a resident-specific pain scale; 
(iii) Recent changes in pain; 
(iv) Location(s); 
(v) Onset and duration of pain, such as new pain within the last 3 days, recent pain within the 
last 3 months, or more distant pain greater than 3 months; 
(vi) Type of pain reported or represented by resident, such as constant or intermittent, and 
duration or frequency of pain; 
(vii) Current pain measured at its least and greatest levels; 
(viii) Aggravating and relieving factors; 
47 
 
(ix) Treatment including a review of all therapies, including medication, and the regimen 
used to minimize pain; 
(x) Effects of pain and effectiveness of therapy on physical and social functions; 
(xi) Resident's treatment preferences and emotional responses to pain, including resident's 
expectations and how resident coped with pain; and 
(xii) If applicable, refer to pain assessment tool for the cognitively impaired. 
(D) Results shall be recorded in the resident's clinical record showing changes in pain scale and 
changes in level of functioning. The physician shall be contacted as necessary. 
(E) Pain shall be treated promptly, effectively and for as long as necessary. 
(3) Individual care plan. 
(A) An individual care plan shall be developed and implemented for each resident to reflect the 
resident's needs. 
(B) The care plan shall be developed by an interdisciplinary team that includes a registered nurse 
with responsibility for the resident, and other appropriate staff in disciplines determined by the 
resident's needs. 
(C) The care plan shall include measurable objectives and timetables to meet the resident's 
medical, nursing, mental and psychosocial needs identified in the assessment. 
(D) The care plan shall be available to appropriate personnel providing care for the resident. 
(E) An initial care plan shall be completed at the time of admission. The individualized care plan 
shall be completed within twenty-one days after admission. 
(F) A care plan shall be completed within seven calendar days after the completion of the 
assessment. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-9-6. Physical plant [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-6.1. Restraints 
(a) The resident has the right to be free from any physical or chemical restraints imposed for discipline or 
convenience. Restraints may be used in emergency situations, or for the purpose of treating a resident's 
medical condition. All physical restraints shall allow for quick release. Locked restraints shall not be 
used. 
(b) In an emergency situation, physical restraints may be used only to ensure the physical safety of the 
resident, staff, or other residents. When restraints are used in an emergency, the facility shall comply with 
the following process: 
(1) A licensed nurse may use physical restraints, without a physician's order, if necessary to prevent 
injury to the resident, or to other residents, when alternative measures are not effective. The licensed 
nurse shall document in the clinical record the application of the physical restraint and the alternative 
measures that were not effective. A licensed nurse shall contact the physician for physical restraint 
orders within six hours after application. 
(2) The facility staff shall continually monitor the resident during the restraint period. An 
interdisciplinary team shall evaluate alternative placement if the resident requires physical restraints 
for longer than forty-eight consecutive hours. 
(3) Circumstances requiring the physical restraints shall be re-evaluated every thirty minutes and 
documented in the clinical record. 
(4) A resident who is physically restrained shall have the restraints released for at least ten minutes 
every two hours. Such residents shall also be repositioned, exercised and toileted as needed. 
(c) In an emergency situation, chemical restraints may be used only to ensure the physical safety of the 
resident, staff, or other residents. When chemical restraints are used, the facility shall comply with the 
following process: 
48 
 
(1) The written order for the use of a chemical restraint shall be signed by a physician who specifies 
the duration and circumstances under which the chemical restraint is to be used. 
(2) The physician's orders may be oral when an emergency necessitates parenteral administration of 
the chemical restraint but is valid only until a written order can be obtained within forty-eight hours. 
(3) An emergency order for chemical restraints shall not be in effect for more than twelve hours and 
may be administered only if the resident is continually monitored for the first thirty minutes after 
administration and every fifteen minutes until such time as the resident appears stable to ensure that 
any adverse side effects are noticed and appropriate action taken as soon as possible. The clinical 
record shall accurately reflect monitoring. 
(4) A licensed nurse shall document in the resident's clinical record any alternative measures that 
were not effective and precipitated the use of the chemical restraint. 
(5) An interdisciplinary evaluation shall be made to consider alternative placement if the resident 
requires chemical restraints for longer than twelve continuous hours. 
(d) When restraints are required for the resident's medical symptoms, the nursing staff shall ensure that 
physical and chemical restraints are administered only in accordance with the resident's care plan and 
under the following circumstances. 
(1) When restraints are used to prevent falling, or for the purpose of positioning the resident, the 
resident and resident's representative shall be informed of the risk and benefits, and written consent 
shall be obtained. 
(2) Restraints may be applied only on a physician's written order and shall identify the type and 
reason for the restraint. The physician shall also specify the period of time, and the circumstances 
under which the restraint may be applied. 
(3) Alternative measures to the use of restraints shall be evaluated prior to their use. Circumstances 
requiring the restraints, and alternative measures, shall be re-evaluated and documented in the clinical 
record every thirty days. 
(4) A restrained resident shall have the restraints released every two hours for at least ten minutes; 
and the resident shall be repositioned, exercised, or provided range of motion and toileted as 
necessary. 
(e) Antipsychotic drug administration shall be consistent with 63 O.S. 1-881. 
[Source: Amended at 37 Ok Reg 1448, eff 9-11-20] 
 
310:675-9-7. Diets [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-7.1. Physician services 
Each resident shall be under the care of a licensed physician, who shall be responsible for the 
resident's overall medical care. The physician's duties shall include but not be limited to: 
(1) Completing an admission history and physical that includes chief complaints, course of present 
illness, past medical history, and examination findings by body systems and diagnosis within two 
weeks of admission unless a physical was conducted within the previous sixty days. 
(2) Prescribing diet, treatments and medications. 
(3) Noting the resident's specific advance directives, if known. 
(4) Continuing supervision, as required by the resident's care including, but not limited to: 
(A) Writing progress notes at each visit. 
(B) Visiting as needed. 
(C) Participating in developing, and reviewing, the resident's care plan. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-8. Food storage and sanitation [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
49 
 
310:675-9-8.1. Clinical laboratory 
(a) The facility shall provide, or obtain, clinical laboratory services to meet the resident's needs. The 
facility shall be responsible for the quality and timeliness of the services. If the facility provides clinical 
laboratory services, the services shall meet the applicable conditions of the services furnished by 
independent laboratories. If the facility provides blood bank and transfusion services, it shall meet the 
applicable conditions for independent laboratories and hospitals. 
(b) If the laboratory refers specimens for testing to another laboratory, the receiving laboratory shall meet 
applicable conditions as an independent laboratory. 
(c) If the facility does not provide laboratory services on site, it shall have an agreement to obtain such 
services only from a laboratory that meets applicable conditions as an independent laboratory, either as a 
hospital or an independent laboratory. 
(d) The facility shall: 
(1) Provide or obtain laboratory services only when ordered by the physician. 
(2) Promptly notify the physician of the findings. 
(3) Assist the resident in arranging transportation to and from the source of service, if the resident 
needs assistance. 
(4) File signed and dated reports of clinical laboratory services in the resident's clinical record. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-9. Refrigeration [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-9.1. Medication services 
(a) Storage. 
(1) Medications shall be stored in a medication room, a locked cabinet, or a locked medication cart, 
used exclusively for medication storage. 
(2) The medication storage area temperature shall be maintained between 60° F. (15.5° C.) to 80° 
F.(26.6° C.) 
(3) The medication room, the medication storage cabinet, and medication cart shall be locked when 
not in use. 
(4) The key to the medication storage areas shall be in the possession of the person responsible for 
administering medications. 
(5) Scheduled medications shall be in a locked box within the locked medication area or cart. 
(6) Medications for external use shall be stored separately from medications for internal use. 
(7) Medications requiring refrigeration shall be kept within a temperature range of 36° F. (2.2° C.) to 
48° F. (8.8° C.) and separated from food and other items. There shall be a method for locking these 
medications. 
(8) The medication areas shall be well lighted, clean and organized. 
(9) Running water shall be in close proximity to the medication area. 
(10) Powdered over-the-counter medication for topical use may be kept in the resident's room for 
administration by a nurse aide if: 
(A) The facility develops and implements policies and procedures for safe storage and application 
of the powder; and 
(B) Each aide who applies the over-the-counter topical medication is trained in accordance with 
the established policies and procedures of the facility. 
(b) Emergency medications. Emergency medication, policies and equipment shall include but not be 
limited to: 
(1) An electric suction machine with necessary aseptic aspirator tips. 
(2) An emergency tray or cart with the following items labeled and accessible to licensed personnel 
only: resuscitation bag; tongue depressors; and assorted airways; sterile hypodermic syringes in 2 cc, 
5 cc, and 20 cc or larger sizes and appropriate needles. The content shall be limited to emergency 
50 
 
medications and contain no scheduled medications. Only two single dose vials of the following 
medications may be on the tray or cart: 50% Dextrose, respiratory stimulant, a cardiac stimulant, 
injectable lasix, injectable dilantin and injectable benadryl. 
(3) A certified medication aide shall not administer injectable medications from any emergency tray 
or cart, but shall have access to resuscitation bags, tongue depressors, and assorted sizes of airways. 
(c) Medication accountability. 
(1) Medications shall be administered only on a physician's order. 
(2) The person responsible for administering medications shall personally prepare the dose, observe 
the swallowing of oral medication, and record the medication. Medications shall be prepared within 
one hour of administration. 
(3) An accurate written record of medications administered shall be maintained. The medication 
record shall include: 
(A) The identity and signature of the person administering the medication. 
(B) The medication administered within one hour of the scheduled time. 
(C) Medications administered as the resident's condition may require (p.r.n.) are recorded 
immediately, including the date, time, dose, medication, and administration method. 
(D) Adverse reactions or results. 
(E) Injection sites. 
(F) An individual inventory record shall be maintained for each Schedule II medication 
prescribed for a resident. 
(G) Medication error incident reports. 
(4) A resident's adverse reactions shall be reported at once to the attending physician. 
(d) Medication labels and handling. 
(1) All prescribed medications shall be clearly labeled indicating the resident's full name, physician's 
name, prescription number, name and strength of medication, dosage, directions for use, date of issue 
and expiration, and name, address and telephone number of pharmacy or physician issuing the 
medication, and the quantity. If a unit dose system is used, medications shall indicate, at least, the 
resident's full name, physician's name and strength of medication, and directions for use. 
(2) When over-the-counter medications are prescribed and obtained in the original manufacturers 
container, the package directions shall be considered part of the label. The resident's name shall be on 
the package. 
(3) Each resident's medications shall be kept or stored in the originally received containers. Paper 
envelopes shall not be considered containers. 
(4) Medication containers having soiled, damaged, illegible or makeshift labels shall be relabeled by 
the issuing pharmacy or physician. Labels on containers shall be clearly legible and firmly affixed. 
No label shall be superimposed on another label on a medication container except for over-the-
counter medication containers. 
(5) No person shall change labels on medication containers. If the attending physician orders a change 
of directions, there shall be a procedure to mark the container indicating a label change is needed at 
the next prescription refill. 
(6) A pharmacist shall dilute, reconstitute and label medications, whenever possible. If not possible, a 
registered nurse may reconstitute, dilute and label medications. A distinctive, indelible, 
supplementary label shall be affixed to the medication container when diluted or reconstituted for 
other than immediate use. A licensed practical nurse may reconstitute oral medications only. The 
label shall include the following: resident's name, dosage and strength per unit/volume, nurse's 
initials, expiration date, and date and time of dilution or reconstitution. 
(7) When a resident is discharged, or is on therapeutic leave, the unused medication shall be sent with 
the resident, or with the resident's representative, unless there is a written physician's order to the 
contrary, or the medication has been discontinued, or unless the resident or the resident's 
representative donates unused prescription medications for dispensation to medically indigent persons 
in accordance with the Utilization of Unused Prescription Medications Act. The clinical record shall 
51 
 
document the quantity of medication sent, and returned or donated, and the signature of the person 
receiving or transferring the medications. 
(8) All medication orders shall be automatically stopped after a given time period, unless the order 
indicates the number of doses to be administered, or the length of time the medication is to be 
administered. The automatic stop order may vary for different types of medications. The facility shall 
develop policies and procedures, in consultation with the medical director and pharmacist, to review 
automatic stop orders on medications. The policy shall be available to personnel administering 
medications. 
(9) No resident shall be allowed to keep any medications unless the attending physician or 
interdisciplinary team has indicated on the resident's clinical record that the resident is mentally and 
physically capable of self-administering medications. 
(10) A resident who has been determined by the physician or interdisciplinary team as capable of self-
administering medication may retain the medications in a safe location in the resident's room. The 
facility shall develop policies for accountability. Scheduled medications shall not be authorized for 
self-administration, except when delivered by a patient controlled analgesia pump. 
(11) A physician's telephone orders shall be conveyed to, recorded in the clinical record, and initialed 
by the licensed nurse receiving the orders. 
(12) Medications shall be administered only by a physician, registered nurse, a licensed practical 
nurse, or a certified medication aide. The only injectables which a certified medication aide may 
administer are insulin and vitamin B-12 and then only when specifically trained to do so. 
(13) A pharmacy, operating in connection with a facility, shall comply with the State pharmacy law 
and the rules of the Oklahoma State Board of Pharmacy. 
(14) Powdered over-the-counter medication for topical use may be administered by a trained nurse 
aide when designated in writing by the attending physician and delegated by a licensed nurse. The 
licensed nurse shall ensure that the aide demonstrates competency in reporting skin changes, storage, 
application and documentation policies and procedures. The licensed nurse or the attending physician 
shall document in the resident's record a skin assessment at least twice each week and more often if 
required by the facility's approved policy. 
(e) Medication destruction. 
(1) Non-controlled medications prescribed for residents who have died and non-controlled 
medications which have been discontinued shall be destroyed by both the director of nursing and a 
licensed pharmacist or another licensed nurse. Controlled medication shall be destroyed by a licensed 
pharmacist and the Director of Nursing. The facility may transfer unused prescription drugs to city-
county health department pharmacies or county pharmacies in compliance with the Utilization of 
Unused Prescription Medications Act and all rules promulgated thereunder. Prescription only 
medications including controlled medications shall not be returned to the family or resident 
representatives. The destruction and the method used shall be noted on the clinical record. 
(2) Medications prescribed for one resident may not be administered to, or allowed in the possession 
of, another resident. 
(3) There shall be policies and procedures for the destruction of discontinued or other unused 
medications within a reasonable time. The policy shall provide that medications pending destruction 
shall not be retained with the resident's current medications. The destruction of medication shall be 
carried out in the facility and a signed record of destruction shall be retained in the facility. 
(f) Medication regimen review. The facility shall ensure that each resident's medications are reviewed 
monthly, by a registered nurse or a licensed pharmacist. The reviewer shall notify the physician and 
director of nursing, in writing, when irregularities are evident. 
(g) Consultant pharmacist. The facility shall have a consultant licensed pharmacist to assist with the 
medication regimen review and medication destruction. The consultant pharmacist shall discuss policies 
and procedures for the administration, storage, and destruction of medications with the administrator, 
director of nursing and other appropriate staff. 
52 
 
(h) Emergency pharmacy. The facility shall have a contract, or letter of agreement, with a licensed 
pharmacy that agrees to serve as the emergency pharmacy. The emergency pharmacy shall be available 
twenty-four hours a day. 
(i) Bulk nonprescription drugs. A facility may maintain nonprescription drugs for dispensing from a 
common or bulk supply as ordered or otherwise authorized by a physician currently licensed to practice 
medicine in this state [63:1-1950(B)] if all of the following are accomplished. 
(1) Policy of facility. The facility must have and follow a written policy and procedure to assure 
safety in dispensing and documentation of medications given to each resident. 
(2) Acquisition. The facility shall maintain records which document the name of the medication 
acquired, the acquisition date, the amount and the strength received for all medications maintained in 
bulk. 
(3) Dispensing. Only licensed nurses, physicians, pharmacists or certified medication aides (CMA) 
may dispense these medications. 
(4) Storage. Bulk medications shall be stored in the medication area and not in resident rooms. 
(5) Records. The facility shall maintain records of all bulk medications which are dispensed on an 
individual signed medication administration record (MAR). 
(6) Labeling. The original labels shall be maintained on the container as it comes from the 
manufacturer or on the unit-of-use (blister packs) package. 
(7) Package size. The maximum size of packaging shall be established by the facility in its policy and 
procedures and shall insure that each resident receives the correct dosage; provided however, that no 
liquid medications shall be acquired nor maintained in a package size which exceeds 16 fluid ounces. 
(8) Allowed nonprescription drugs. Facilities may have only oral analgesics, antacids, and laxatives 
for bulk dispensing and/or drugs listed in a facility formulary developed or approved by the 
consultant pharmacist, medical director and director of nurses. Non formulary over the counter 
medications may be prescribed if the resident has therapeutic failure, drug allergy, drug interaction or 
contraindications to the formulary over the counter medication. 
[Source: Amended at 33 Ok Reg 1530, eff 9-11-16] 
 
310:675-9-10. Ice supply [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-10.1. Activity services 
(a) Activities program. The facility shall provide an ongoing activities service designed to meet the 
resident's interests and physical, mental, and psycho-social needs based on a comprehensive assessment 
and care plan. 
(b) Activities director. There shall be a designated staff member, qualified by experience or training, 
responsible for the direction and supervision of the activities service. The activities director shall develop 
appropriate activities for each resident with identified needs. Activities staff hours shall be sufficient to 
meet the resident's needs. 
(c) Clinical record. The activities rendered shall be recorded in the clinical record. Progress notes shall 
be written at least monthly or when a significant change in the resident's condition occurs. 
(d) Program requirements. 
(1) All activities shall be resident related. 
(2) The program shall be designed to encourage rehabilitation and restoration to self care and normal 
activity. 
(3) There shall be at least two organized group activities, daily, Monday through Friday and at least 
one organized group activity on Saturday and Sunday provided or coordinated by staff. 
(4) The activities program shall recognize the resident's right to choose to participate in social, 
community and religious activities, as long as that choice does not interfere with other facility 
residents. 
53 
 
(5) Varied and specific programs shall be developed for all residents, including those that are room 
bound, comatose or who demonstrate symptoms of dementia, mental illness or developmental 
disabilities. 
(6) Socialization and self-help skills shall be addressed in the care plan based on resident's needs. 
(7) Provisions shall be made to address each resident's spiritual needs. 
(8) The program shall provide remotivation, reality orientation or sensory stimulation programs to 
orient and stimulate residents. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-11. Milk supply [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-11.1. Social services 
(a) Service. The facility shall provide medically related social services to identify and meet the resident's 
social and emotional needs, and assist each resident and family in adjusting to the effects of the illness, 
treatment, and stay in the facility. 
(b) Director. There shall be a designated staff member, qualified by training or experience, responsible 
for directing and supervising the social services. The social services director shall develop appropriate 
social services for each resident with identified needs. 
(c) Clinical record. The social services rendered shall be recorded in the resident's record. Progress notes 
shall be written at least monthly, or when a significant change in a resident's condition occurs. 
(d) Program requirements. 
(1) Assist the resident in identifying issues and conditions related to admission to the facility. 
(2) Assist the resident in obtaining needed services within the facility or the community. 
(3) Assist the resident in obtaining needed transportation. 
(4) Assist the resident in maintaining and developing relationships with family and other significant 
persons. 
(5) Assist the staff in understanding the resident's actions and behavior. 
(6) Assist the staff in treating the residents with respect, and promote resident independence. 
(7) Counsel with the resident and his family in securing and enhancing participation in the resident's 
care. 
(8) Engage in related activities as determined by the resident's individual needs. 
(9) Encourage the resident to express his/her rights as United States citizens. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-12. Food supply [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-12.1. Dietary services 
(a) Services. The facility shall provide dietary services to meet the resident's nutritional needs. There shall 
be a designated staff person qualified by experience or training, responsible for directing or supervising 
the dietary services. The food service supervisor, in conjunction with a qualified nutritionist or 
registered/licensed dietitian, shall develop a dietary care plan for each resident. There shall be sufficient 
dietary staff to meet the needs of all residents. 
(b) Clinical record. The dietary services provided to residents needing dietary intervention shall be 
recorded in the clinical record. Progress notes for these residents shall be written at least monthly, or 
when a significant change in the resident's condition occurs. 
(c) Nutritional assessment. A nutritional assessment shall be completed for each resident that addresses 
all pertinent dietary problems such as chewing or swallowing, elimination, appetite or eating habits, 
pertinent lab results, weight and height, diet and medication interactions, food preferences and assistive 
devices. The dietary staff shall have input into the resident's individual care plan. 
54 
 
(d) Diet. The facility shall provide a nourishing, palatable, well-balanced diet that meets the resident's 
daily nutritional and special dietary needs. 
(1) Meals. 
(A) The facility shall serve at least three regularly scheduled meals, or their equivalent daily. 
There shall be at least four hours between each meal. 
(B) Diets shall be prescribed by the resident's physician and shall be planned, in writing, 
reviewed, approved and dated by a qualified nutritionist or registered/licensed dietitian. A 
therapeutic diet shall be served with skillful attention to the diet control system. Portioning of 
menu servings shall be accomplished with portioned control serving utensils. 
(C) Substitutes of similar nutritive value shall be offered when a resident refuses served menu 
items. 
(D) Residents at nutritional risk shall have timely and appropriate nutrition intervention. 
(E) Nourishments shall be available and may be offered at any time in accordance with approved 
diet orders and resident preference. Bedtime nourishment shall be offered to all residents. 
(F) There shall be an identification system established and updated, as needed, to ensure that each 
resident receives the prescribed diet. 
(G) The percentages of consumed meals, supplements and meal replacements ingested shall be 
observed and recorded in the clinical record at the time of observation. 
(2) Menus. 
(A) Menus shall be posted, planned, and followed to meet the resident's nutritional needs in 
accordance with the physician's orders. 
(B) The menus shall, to the extent medically possible, be in accordance with the daily 
recommended dietary allowances of the Food and Nutrition Board of the National Research 
Council, National Academy of Sciences. 
(C) Menus covering all prescribed diets shall be approved, dated, and periodically reviewed by a 
qualified nutritionist or registered/licensed dietician. The facility shall maintain a thirty day 
record of past menus. 
(D) The facility shall maintain a file of tested recipes that includes therapeutic alterations for 
quantity food preparation for menu items. 
(e) Tube feeding. Tube feeding orders shall be evaluated for nutritional adequacy. The requirements for 
caloric intake, protein, fluid and percentage of the daily recommended dietary allowances shall be 
calculated to determine nutritional adequacy. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-13. Dishwashing [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-13.1. Food storage, supply and sanitation 
(a) Food shall be stored, prepared and served in accordance with Chapter 257 of this Title (relating to 
food service establishments) with the following additional requirements. 
(b) Ice machines available to the residents, or the public, shall be a dispenser type, or have a locking 
enclosure. 
(c) A whole, intact, fruit or vegetable is an approved food source. The food supply shall be sufficient in 
quantity and variety to prepare menus for three (3) days. Leftovers that are potentially hazardous foods 
shall be used, or disposed of, within twenty-four (24) hours. Non-potentially hazardous leftovers that have 
been heated or cooked may be refrigerated for up to forty-eight (48) hours. 
(d) Milk, milk products and eggs. 
(1) Only grade A pasteurized fluid milk, as defined by the Oklahoma Grade A Milk and Milk 
Products Act, Title 2 O.S. §7-401 through 2 O.S. §7-421, shall be used for beverage and shall be 
served directly into a glass from a milk dispenser or container. 
55 
 
(2) Powdered or evaporated milk products approved under the U.S. Department of Health and Human 
Services' Grade "A" Pasteurized Milk Ordinance (2003 Revision), may be used only as additives in 
cooked foods. This does not include the addition of powdered or evaporated milk products to milk or 
water as a milk for drinking purposes. Powdered or evaporated milk products may be used in instant 
desserts and whipped products, or for cooking. When foods, in which powdered or evaporated milk 
has been added, are not cooked, the foods shall be consumed within twenty-four (24) hours. 
(3) Milk for drinking shall be stored at a temperature of 41° or belowand shall not be stored in a 
frozen state. 
(4) Only clean, whole eggs with shell intact, pasteurized liquid, frozen, dry eggs, egg products and 
commercially prepared and packaged hard boiled eggs may be used. All eggs shall be thoroughly 
cooked except pasteurized egg products or pasteurized in-shell eggs may be used in place of pooled 
eggs or raw or undercooked eggs. 
(e) Applicability. This section shall only apply to food prepared or served by the facility, within the 
licensed facility. 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Amended at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-9-14. Physical responsibilities [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-15. Reports to state agencies [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-16. Specialized services [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-17. Medical findings and physician's orders [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-18. Resident supervision by physician [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-19. Availability of physicians for emergency resident care [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-20. Fulfilling resident's needs [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-21. Dental care [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-22. Medications: storage, preparation and handling [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-23. Nursing service [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-24. Nursing and personal care of residents [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
56 

310:675-9-25. Nursing services: policy and procedure [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-26. Rehabilitative and/or restorative nursing [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-27. Health care plan [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-28. Transfer forms [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-29. Nursing service personnel minimum staffing requirements [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-30. Nursing in-service [REVOKED] 
[Source: Revoked at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-9-31. Influenza and pneumococcal vaccinations 
(a) Each facility shall document evidence of the offering of annual vaccination against influenza for each 
resident and for each employee, in accordance with the Recommendations of the Advisory Committee on 
Immunization Practices for the Centers for Disease Control and Prevention most recent to the time of 
vaccination. 
(b) Each facility shall document evidence of the offering of vaccination against pneumococcal disease for 
each resident, in accordance with the Recommendations of the Advisory Committee on Immunization 
Practices for the Centers for Disease Control and Prevention most recent to the time of vaccination. 
(c) The immunizations provided for in this section may be waived because of medical contraindication or 
may be refused. Documentation of the vaccination, medical contraindication or refusal shall be recorded 
in the resident's medical or care record. If the resident is not vaccinated, the documentation in the resident 
record shall include a statement signed by the resident, the resident's representative, or the resident's 
physician as appropriate. 
(d) Attending physicians may establish standing orders for the administration of influenza and 
pneumococcal immunizations in accordance with the Recommendations of the Advisory Committee on 
Immunization Practices for the Centers for Disease Control and Prevention most recent to the time of 
vaccination. 
[Source: Amended at 18 Ok Reg 2533, eff 6-25-01] 
 
SUBCHAPTER 11. INTERMEDIATE CARE FACILITIES OF 16 BEDS AND LESS FOR 
INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID-16) 
 
310:675-11-1. Scope 
This Subchapter is applicable to small facilities serving individuals with intellectual disabilities which 
provide residential accommodations and transitional living training to aid residents in adapting to live in 
the general society. Resident accommodations are limited to not more than 16 residents, plus any required 
"live-in" staff. Facilities qualifying under this subsection shall be exempt from other subsections of this 
Chapter, except for the definitions provided in 310:675-1-2 and as may be specifically referenced in this 
subsection. In addition to these requirements, all facilities must meet the provisions of the Nursing Home 
Care Act. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
57 
 
310:675-11-2. Active Treatment 
In institutions for individuals with intellectual disabilities, active treatment requires the following: 
(1) The individual's regular participation, in accordance with an individual plan of care, in 
professionally developed and supervised activities, experience or therapies. 
(2) An individual written plan of care that sets forth measurable goals or objectives stated in terms of 
desirable behavior and that prescribes an integrated program of activities, experience or therapies 
necessary for the individual to reach those goals or objectives. The overall purpose of the plan is to 
help the individual function at the greatest physical, intellectual, social or vocational level he can 
presently or potentially achieve. 
(3) An interdisciplinary professional evaluation that consists of complete medical, social and 
psychological diagnosis and evaluations and an evaluation of the individual's need for institutional 
care; and is made by a physician, a social worker and other professionals, at least one of whom is a 
qualified intellectual disability professional. 
(4) Reevaluation medically, socially and psychologically at least annually by the staff involved in 
carrying out the resident's individual plan of care. This must include review of the individual's 
progress toward meeting the plan objectives, the appropriateness of the individual plan of care, 
assessment of the resident's continuing need for institutional care, and consideration of alternate 
methods of care. 
(5) An individual postinstitutionalization plan, as part of the individual plan of care, developed before 
discharge by a qualified intellectual disability professional and other appropriate professionals. This 
must include provision for appropriate services, protective supervision, and other follow-up services 
in the resident's new environment. 
(6) Individuals assigned for specific purpose of direct personal care to residents, including those 
conducting a training program to develop the resident's self-help and socialization skills. Does not 
include professionals performing duties related to their profession. 
[Source: Amended at 39 Ok Reg 1394, eff 9-11-22] 
 
310:675-11-3. Qualified intellectual disability professional 
A person who has specialized training or one (1) year of experience in treating or working with 
individuals with intellectual disabilities and is one of the following: 
(1) A psychologist. 
(2) A licensed doctor of medicine or osteopathy. 
(3) An educator with a degree in education from an accredited program. 
(4) A social worker with a bachelor's degree in: 
(A) Social work from an accredited program; or 
(B) A field other than social work and at least three (3) years of social work experience under the 
supervision of a qualified social worker. 
(5) A physical or occupational therapist. 
(6) A speech pathologist or audiologist. 
(7) A registered nurse. 
(8) A therapeutic recreation specialist who: 
(A) Is a graduate of an accredited program; and 
(B) If the State has a licensing or registration procedure, is licensed or registered in the State. 
(9) A rehabilitation counselor who is certified by the Committee of Rehabilitation Counselor 
Certification. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-11-4. Occupancy 
Residents selected for ICF/IID-16 occupancy shall receive active treatment, and be capable of 
direction and emergency evacuation from the facility, as determined by a physician or nurse or qualified 
intellectual disability professional. 
58 
 
[Source: Amended at 39 Ok Reg 1394, eff 9-11-22] 
 
310:675-11-5. Physical plant 
(a) ICF/IID-16 facilities shall be of one hour (minimum) fire resistant construction as approved by the 
Department and the State Fire Marshal, or shall be fully protected by an automatic sprinkler system 
approved by the Department and the State Fire Marshal. In addition, ICF/IID-16 facilities shall comply 
with the requirements of the National Fire Protection Association (NFPA) 101: Life Safety Code, 2012 
Edition, adopted in 81 Federal Register 26871 by the Centers for Medicare & Medicaid Services on July 
5, 2016 applicable to residential board and care occupancies for small facilities are incorporated by 
reference. For Medicare or Medicaid certified ICF/IID-16s, the Life Safety Code adopted by the Centers 
for Medicare & Medicaid Services prevails if there is a conflict between the Life Safety Code and this 
Chapter. 
(b) Prior to issuance of license, the essential operation functions of the physical plant shall be submitted to 
licensing agency for review and approval. This submittal shall be in such detail as will depict compliance 
with applicable codes, including emergency evacuation and day to day living accommodations. 
(c) Each facility must have a license. Any facility licensed under this part shall consist of contiguous 
construction. 
(1) Resident rooms. The following requirements shall be provided: 
(A) Capacity shall be a maximum of four (4) residents. 
(B) Minimum area shall be 80 square feet per occupant in multi-bed rooms and 100 square feet in 
single bed rooms. 
(C) Each resident shall have a minimum of three square feet of closet or locker space which shall 
contain at least a clothes rod and one adjustable shelf. 
(2) Service areas. The following shall be provided: 
(A) Toilet and bathing facilities shall be provided in an arrangement similar to general domestic 
residential facilities, except that bathrooms combining toilet, lavatory, tub and/or shower shall be 
no less than 60 square feet in size. 
(B) Bathing and toilet facilities shall be provided on a ratio of one facility for each five residents. 
(C) Resident staff offices shall be provided at the facility in sufficient size and number to permit 
the safe storage and handling of prescription medications used by the individual residents, space 
for private counseling of residents, space for the business affairs of the ICF/IID-16 to be 
conducted in private, and space for the maintenance of records pertaining to resident care. 
(D) Linen and supply areas shall be provided in a manner which permits the separation of the 
clean and soiled materials. Clean linen and supplies shall be stored separately from the area in 
which the soiled materials are collected. 
(E) Meal service space shall be provided as follows: 
(i) Kitchen. Space for conventional food preparation and baking with sufficient storage for 
maintaining at least a four day supply of all foods required for a general diet, including cold 
storage. 
(ii) Dining. There shall be 15 square feet per person allocated to permit residents and on-duty 
staff to dine at the same time. 
(iii) Warewashing shall be in accordance with the requirements of the care facilities as stated 
in Chapter 257 (relating to Food Service Establishments) of this Title. 
(F) Housekeeping materials and supplies shall be maintained in a designated area which is apart 
from the food service and sleeping areas. 
(3) Recreation, lounge and public areas. Each ICF/IID-16 shall provide interior lounge and 
recreation space at a rate of no less than 20 square feet per bed. If public visitation areas are included, 
the lounge and recreation space shall be no less than 25 square feet per bed. Outside recreation lounge 
areas shall be provided. These areas shall have sufficient lighting to permit utilization after sundown. 
(4) Natural lighting and ventilation of rooms. All habitable and occupiable rooms or spaces shall 
contain windows, skylights, monitors, glazed doors, transoms, glass block panels or other light 
59 
 
transmitting media opening to the sky or on a public street, yard or court. The light transmitting 
properties and the area of the devices used shall be adequate to meet the minimum day lighting and 
ventilating requirements specified herein. 
(5) Window size. Windows and exterior doors may be used as a natural means of light and 
ventilation, and when so used their aggregate glass area shall amount to not less than eight percent of 
the floor area served, and with not less than one half of this required area available for unobstructed 
ventilation. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-11-5.1. Plans and specifications requirements applicable to ICF/IID-16 
The following sections of this Chapter shall apply to ICF/IID-16 facilities: 310:675-5-22 (relating to 
exceptions and temporary waivers), 310:675-5-23 (relating to submission of plans and specifications and 
related requests for services), 310:675-5-24 (relating to preparation of plans and specifications) and 
310:675-5-25 (relating to self-certification of plans). 
[Source: Added at 34 Ok Reg 1305, eff 10-1-17] 
 
310:675-11-6. Institutional and operational relationships 
The ICF/IID-16 may be free standing in a community or may be on campus with a parent institution. 
The ICF/IID-16 may be an independent ownership and operation or may be part of a larger institutional 
ownership and operation. In any case, however, the ICF/IID-16 may have an effective, continuous 
relationship with a full scope ICF/IID which allows all necessary support and professional services as 
well as the expeditious transfer of residents if and when necessary. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-11-7. Staffing 
(a) The ICF/IID-16 shall have available enough qualified staff and support personnel to carry out the 
residential living, professional and special programs and services for residents as required by their 
individual needs, and of sufficient size that the facility does not depend on residents or volunteers for 
services. 
(b) Each ICF/IID-16 shall maintain at least the minimum direct-care-staff ratios specified in OAC 
310:675-13-12(a). 
(c) In living units for the severely impaired client, the present and on duty direct care staff ratio would be: 
(1) 1 to 4 from 7:00 a.m. to 3:00 p.m.; 
(2) 1 to 4 from 3:00 p.m. to 11:00 p.m.; and 
(3) 1 to 8 from 11:00 p.m. to 7:00 a.m. 
(d) There should be sufficient dietary, nursing, housekeeping and administrative staff to serve the needs 
of the facility. 
 
EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), the text of 310:675-11-7 
reverted back to the permanent text that became effective 6-25-01, as was last published in the 2001 
Edition of the OAC and republished in the 2006, 2011 and 2016 Editions of the OAC, and remained as 
such until amended again by permanent action on 9-13-19. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), the text of 310:675-11-7 
reverted back to the permanent text that became effective 6-25-01, as was last published in the 2001 
60 
 
Edition of the OAC and republished in the 2006, 2011 and 2016 Editions of the OAC, and remained as 
such until amended again by permanent action on 9-13-19. 
 
310:675-11-8. Administration 
All sections of Subchapter 7 of this Chapter shall be applicable to the ICF/IID-16 facilities and 
operations. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
310:675-11-9. Resident care services 
 In accordance with the needs of the residents, Subchapter 9 of this Chapter shall be applicable to the 
16 ICF/IID-16 . 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
 
SUBCHAPTER 13. STAFF REQUIREMENTS 
 
310:675-13-1. Required staff 
Sufficient, adequately trained staff shall be on duty, twenty-four hours a day, to meet the needs of all 
residents residing in the facility without regard to the direct staff ratios. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-2. Staff orientation 
All staff shall complete orientation, and specific training, for their respective responsibilities before 
working without supervision. Staff shall immediately be oriented to the use and location of fire 
extinguishers, procedures to be followed in the event of a fire and resident rights. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-3. Administrator 
(a) The administrator shall be licensed by the State Board of Examiners for Nursing Home Administrators 
and has the authority and responsibility for the total operation of the facility, subject only to the policies 
adopted by the governing authority. 
(b) The facility shall designate a person to act for the administrator during his/her absence. The 
designated person shall have the authority to exercise normal management responsibilities. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-4. Medical director 
(a) The facility shall designate an Oklahoma licensed medical doctor or osteopathic physician to serve as 
its medical director. 
(b) The medical director shall coordinate the medical services within the facility. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-5. Nursing service 
(a) General. The nursing facility shall be organized, staffed, and equipped to provide nursing and health 
related services to all residents on a continuous basis. 
(b) Licenses. All licensed nurses shall hold a current license issued by the Oklahoma Board of Nursing. 
(c) Director of nursing 
(1) A registered nurse or licensed practical nurse shall be designated as the director of nursing. 
(2) The director of nursing shall be on duty on the day shift and be responsible for all resident care 
including, but not limited to, the physical, mental, and psycho-social needs. The director of nursing or 
designee shall be available by telephone when needed by facility staff. 
(3) When necessary, the director of nursing may work other than the day shift but for no more than 
three shifts a week. This exception shall not exceed three consecutive weeks in a three month period. 
61 
 
(d) Licensed nurses 
(1) The facility shall employ licensed nurses for a sufficient number of hours to meet the residents' 
needs. 
(2) A licensed nurse shall supervise direct care staff and shall direct nursing care for the residents. 
(3) The facility shall use licensed practical nurses only for the medical procedures for which they are 
trained. 
(e) Consultant registered nurse 
(1) If the director of nurses is a licensed practical nurse, a registered nurse shall be employed for at 
least eight hours per week as a consultant. 
(2) A consultant registered nurse shall evaluate and consult with the director of nursing concerning 
residents' needs and shall coordinate the assessment and care plan of each resident. 
(3) A consultant registered nurse's visit shall document the date and the hours spent in consultation. 
The documentation shall be signed and reviewed by the director of nursing. 
(f) Certified medication aide 
(1) Each medication aide shall be a certified nurse aide who has passed a Department approved 
medication administration program. 
(2) A graduate nurse or a graduate practical nurse, who has not yet been licensed, may administer 
medications if the nurse has passed an approved competency test for medication administration. 
(3) A certified medication aide may administer physician ordered medications and treatments under 
the direction of a licensed nurse. 
(4) The facility shall have a licensed nurse or physician on-call to handle medical emergencies. The 
charge person shall notify the designated person when a medical emergency arises. 
(5) A certified medication aide shall complete eight hours of continuing education a year that is 
approved by the Department. 
(g) Nurse aide 
(1) No facility shall use, on a full-time basis, any person as a nurse aide for more than 120 days unless 
that person is enrolled in a training program. 
(2) No facility shall use, on a temporary, per diem, or other basis, any person as a nurse aide unless 
the individual is listed on the Department's nurse aide registry. 
(3) The facility shall contact the Department's nurse aide registry prior to employing a nurse aide to 
determine if the person is listed on the registry, and if there is any record of abuse, neglect, or 
misappropriation of resident property. 
(h) Nursing students. Facilities participating in a state approved nursing education program may allow 
nursing students to administer medications to residents. The facility shall have a written agreement with 
the nursing education program. The agreement shall specify the scope of activities, education level, and 
required supervision. The facility shall maintain a current roster of nursing students in the program. 
Details about the program and its operation within the facility shall be included in the facility's policy and 
procedure manual. 
(i) Inservice. The facility shall provide all direct care staff with two hours of inservice training specific to 
their job assignment per month. This training shall include, at least, the following: 
(1) Fire safety and first aid classes semi-annually. 
(2) Resident rights and resident adjustment to institutional life annually. 
(3) Cardiopulmonary resuscitation and Heimlich maneuver procedures annually. 
(4) All supervisory staff shall receive training in regards to applicable local, state, and federal 
regulations governing the facility. 
(5) Each staff person shall be provided training in pain recognition at the time of orientation and at 
least once a year thereafter. 
(6) Each certified nurse aide shall be provided training in pain screening at the time of orientation and 
at least once every year thereafter. 
(7) Each licensed practical nurse shall be provided training in pain screening and pain management at 
the time of orientation and at least once every year thereafter. 
62 
 
(8) Each registered nurse shall be provided training in pain assessment and pain management at the 
time of orientation and at least once every year thereafter. 
[Source: Amended at 27 Ok Reg 2545, eff 7-25-10] 
 
310:675-13-6. Registered/licensed dietician or qualified nutritionist 
(a) The facility shall have a registered/licensed dietician or qualified nutritionist to sufficiently meet the 
needs of all residents. The registered/licensed dietician or qualified nutritionist shall consult with the food 
service supervisor, director of nursing, administrator and physicians. 
(b) The registered/licensed dietician or qualified nutritionist shall supervise and direct the residents' 
nutritional care, advise and consult with appropriate staff, and provide inservice training for food service 
personnel and direct care staff. 
(c) A qualified nutritionist shall complete eight hours of continuing education a year approved by the 
Department. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-7. Food service staff 
(a) Food service supervisor. 
(1) The food service supervisor shall be responsible for all aspects of food service preparation and 
delivery. The food service supervisor may serve only one facility. The food service supervisor hours 
shall be sufficient to meet the residents' needs. 
(2) The food service supervisor shall complete certification as a dietary manager within three (3) 
years of beginning employment. 
(3) The food service supervisor shall complete, and maintain continuous, ServeSafe food safety 
certification, or a Department approved alternative, within ninety (90) days of beginning employment. 
(b) Food service staff. 
(1) The facility shall have food service staff on duty sufficient to meet the residents' needs. There 
shall be at least one (1) hour of food service staff per three (3) residents, a day based on the daily 
census. 
(2) The food service staff shall complete a basic orientation program before working in the food 
service area. This orientation shall include, but not be limited to: fire and safety precautions, infection 
control, and sanitary food handling practices. 
(3) Each food service staff member shall successfully complete a food service training program 
offered or approved by the Department within ninety (90) days of beginning employment. Food 
service training shall be renewed as required by the authorized training program. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Amended at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-13-8. Activities personnel 
(a) The facility shall have sufficient, trained activities program staff, on duty, to meet the resident's needs. 
There shall be at least twenty hours per week of designated activity staff. 
(b) The activities director shall be qualified by training, or experience, under one of the following: 
(1) An associate degree or a baccalaureate from an accredited university or college in art, music, 
physical education, recreational therapy, education, or similar program. 
(2) A licensed occupational therapist or an occupational therapy assistant. 
(3) Successful completion of a Department approved training course. 
(4) One year experience in a recreational activity or long term care environment, and is enrolled 
within 180 days of employment, in a Department approved course for activities directors. 
63 
 
(c) Department approval of activities director course. Any person or entity seeking to conduct an 
approved activities director-qualifying course pursuant to 310:675-13-8(b)(3) (pertaining to successful 
completion of a department approved course) shall make application to the Department. 
(1) Application Content. Applications shall include the following information: 
(A) Name and address of the individual or entity applying 
to sponsor the course; 
(B) Contact person and his or her address, telephone number and fax number; 
(C) Course outlines, which list the summarized topics covered in the course and the time allotted 
for each topic and, upon request, a copy of any course materials; 
(D) Information as to how the proposed course meets the course content standard provided in 
Section 310:675-13-8(c)(9); 
(E) A sample certificate of completion; 
(F) Procedures for monitoring attendance; and 
(G) Procedures for evaluating successful course completion. 
(2) Application Review. The Department shall complete review of the application within thirty (30) 
calendar days. If the Department finds the application has not addressed all requirements in 310:675-
13-8(c)(1) (relating to application content) written notice shall be provided detailing the requirements 
not met and providing opportunity for amendment to the application. 
(3) Program affiliation. Training shall be provided through a program sponsored or approved by a 
nationally affiliated association of providers subject to this chapter, regionally accredited institution 
of higher learning, Oklahoma career technology center, or nationally recognized professional 
accrediting body for activity professionals. 
(4) Loss of approval. The Department may, upon notice and right to hearing, withhold or withdraw 
approval of any course for violation of or non-compliance with any provision of this section. 
(5) Advertisement. No person or entity sponsoring or conducting a course shall advertise that it is 
endorsed, recommended, or accredited by the Department. Nor shall any person or entity sponsoring 
or conducting a course advertise or advise program participants that completion of the program grants 
a certification. Such person or entity may indicate that the Department has approved the course to 
qualify for employment as an activities director. 
(6) Failure to prepare. The Department may, upon notice and right to hearing, decline to renew, or 
revoke the approval of, any previously approved course upon a showing or demonstration that the 
course, instructor or entity has substantially failed to adequately prepare its attendees or participants 
as activity directors. 
(7) Instructor requirements. Instructors shall have a degree or substantial recent experience in the 
subject matter being taught, or other educational, teaching, or professional qualifications determined 
by the course provider. 
(8) Course content. The course shall address the following content: 
(A) The guidance and regulations for activities as detailed in the Centers for Medicare and 
Medicaid Services, State Operations Manual, Appendix PP - Guidance to Surveyors for Long 
Term Care Facilities and the Code of Federal Regulations at CFR § 483.15(f); 
(B) Oklahoma regulation for activity services as specified at OAC 310:675-9-10.1; 
(C) Resident rights as detailed in state and federal statute and regulation; 
(D) State and federal statute and regulation for resident protection from abuse, neglect and 
misappropriation; 
(E) Working with volunteers and the community to enhance activity options; 
(F) Specialized programming for Alzheimer's and related dementias; 
(G) Role play or actual experience in leading group and one-on-one activities programming; 
(H) Issues in aging; and, 
(I) Infection Control. 
64 
 
(J) Where course content is delivered through Internet or other self-directed media, course content 
shall include not less than twelve (12) hours of role play or actual experience in leading group 
and one-on-one activities programming. 
(9) Duration. The approved course will consist of not less than twenty-four (24) hours of instruction. A 
course taught in combination with social services director training may share eight (8) hours of 
programming. 
(10) Certificate. Participants shall be issued a certificate of attendance indicating the name of the 
sponsoring entity; participant name; course name; course dates; printed name and signature of official 
representing the sponsoring entity. 
(11) Course approval expires. Course approval shall be for a period of three (3) years from the date of 
approval issuance. In the interest of updated curriculum, reflecting the latest best practice, a new 
application, and curriculum review are required triennially. Currently approved training programs shall 
apply under this section within twelve (12) months of the effective date of this rule. 
(12) Continuing education. This section creates no obligation for continuing education beyond 
requirements specified otherwise in this Chapter. The Department will not approve continuing education 
or update courses for activity directors. 
(13) Records retention. The course sponsor shall maintain course records for at least five (5) years. The 
Department may order an examination of the records for good cause shown. 
(14) Fee. A non-refundable application fee of one hundred dollars ($100) shall be included with each 
application for course approval. 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-13-9. Social services personnel 
(a) The facility shall provide sufficient, trained social services staff to meet the resident's needs. There 
shall be at least thirty (30) minutes per resident a week of designated social service staff based on the 
daily census. The facility shall have at least twenty (20) hours per week, of designated social service staff, 
regardless of the number of residents. 
(b) The social services director shall be qualified by training, or experience, under one of the following: 
(1) A baccalaureate, from an accredited college or university, in social work or in a human services 
field including, but not limited to, sociology, special education, rehabilitation, counseling or 
psychology. 
(2) Successful completion of the Department approved training course. 
(3) One year experience in social work or long term care environment, and is enrolled within 180 
days of employment, in a course approved by the Department. 
(c) Department approval of social services director course. Any person or entity seeking to conduct an 
approved social services director-qualifying course pursuant to 310:675-13-9(b)(2) (pertaining to 
successful completion of a department approved course) shall make application to the Department. 
(1) Application Content. Applications shall include the following information: 
(A) Name and address of the individual or entity applying to sponsor the course; 
(B) Contact person and his or her address, telephone number and fax number; 
(C) Course outlines, which list the summarized topics covered in the course and the time allotted 
for each topic and, upon request, a copy of any course materials; 
(D) Information as to how the proposed course meets the course content standard provided in 
Section 310:675-13-(c)(9); 
(E) A sample certificate of completion; 
(F) Procedures for monitoring attendance; and 
(G) Procedures for evaluating successful course completion. 
(2) Application Review. The Department shall complete review of the application within thirty (30) 
calendar days. If the Department finds the application has not addressed all requirements in 310:675-
13-9(c)(1) (relating to application content) written notice shall be provided detailing the requirements 
not met and providing opportunity for amendment to the application. 
65 
 
(3) Program affiliation. Training shall be provided through a program sponsored or approved by a 
nationally affiliated association of providers subject to this chapter, regionally accredited institution 
of higher learning, Oklahoma career technology center, or nationally recognized professional 
accrediting body for activity professionals. 
(4) Loss of approval. The Department may, upon notice and right to hearing, withhold or withdraw 
approval of any course for violation of or non-compliance with any provision of this section. 
(5) Advertisement. No person or entity sponsoring or conducting a course shall advertise that it is 
endorsed, recommended, or accredited by the Department. Nor shall any person or entity sponsoring 
or conducting a course advertise or advise program participants that completion of the program grants 
a certification. Such person or entity may indicate that the Department has approved the course to 
qualify for employment as a social services director. 
(6) Failure to prepare. The Department may, upon notice and right to hearing, decline to renew, or 
revoke the approval of, any previously approved course upon a showing or demonstration that the 
course, instructor or entity has substantially failed to adequately prepare its attendees or participants 
as activity directors. 
(7) Instructor requirements. Instructors shall have a degree or substantial recent experience in the 
subject matter being taught, or other educational, teaching, or professional qualifications determined 
by the course provider. 
(8) Course content. The course shall address the following content: 
(A) The guidance and regulations for social services as detailed in the Centers for Medicare and 
Medicaid Services, State Operations Manual, Appendix PP - Guidance to Surveyors for Long 
Term Care Facilities and the Code of Federal Regulations at CFR § 483.15(g); 
(B) Oklahoma regulation for social services as specified at OAC 310:675-9-11.1; 
(C) Resident rights as detailed in state and federal statute and regulation; 
(D) State and federal statute and regulation for resident protection from abuse, neglect and 
misappropriation; 
(E) Alzheimer's and social services; 
(F) Issues in Aging; and 
(E) Ombudsman services. 
(9) Duration. The approved course will consist of not less than twenty-four (24) hours of instruction. 
A course taught in combination with activity director training may share eight (8) hours of 
programming. 
(10) Certificate. Participants shall be issued a certificate of attendance indicating the name of the 
sponsoring entity; participant name; course name; course dates; printed name and signature of official 
representing the sponsoring entity. 
(11) Course approval expires. Course approval shall be for a period of three (3) years from the date 
of approval issuance. In the interest of updated curriculum, reflecting the latest best practice, a new 
application, and curriculum review are required triennially. Currently approved training programs 
shall apply under this section within twelve (12) months of the effective date of this rule. 
(12) Continuing education. This section creates no obligation for continuing education beyond 
requirements specified otherwise in this Chapter. The Department will not approve continuing 
education or update courses. 
(13) Records retention. The course sponsor shall maintain course records for at least five (5) years. 
The Department may order an examination of the records for good cause shown. 
(14) Fee. A non-refundable application fee of one hundred dollars ($100) shall be included with each 
application for course approval. 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-13-10. Maintenance personnel 
(a) The facility shall employ maintenance staff to maintain the facility and equipment in safe working 
condition. 
66 
 
(b) Maintenance services may be provided by staff or by a contract. If services are provided by a contract, 
the facility shall designate an employee to coordinate the maintenance services. 
(c) Each person who provides maintenance services shall have a current license from the state or political 
subdivision if required to provide such service. 
(d) The maintenance staff shall complete one hour of inservice each quarter relevant to maintenance 
services. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-11. Housekeeping personnel 
(a) The facility shall employ housekeeping staff in sufficient numbers to maintain the facility in a safe and 
sanitary manner. 
(b) Housekeeping personnel shall receive effective supervision, orientation and training. 
(c) Housekeeping personnel shall be skilled in the six basic functions of sweeping, mopping, dusting, 
cleaning, waxing, and polishing. 
(d) The housekeeping staff shall complete one hour of inservice per quarter about housekeeping practices. 
[Source: Added at 10 Ok Reg 1639, eff 6-1-93] 
 
310:675-13-12. Direct care staffing 
(a) Each facility shall maintain at least the minimum direct-care-staff-to-resident ratios specified in the 
Act at 63:1-1925.2. 
(b) A licensed nurse shall be on duty eight hours a day, seven days a week on the day shift. 
(c) If the director of nursing is a licensed practical nurse, a registered nurse shall be employed for at least 
eight hours per week as a consultant. 
(d) There shall be a licensed nurse on duty twenty-four hours per day; provided however, that a facility 
licensed as a specialized facility for individuals with intellectual disabilities shall only be required to 
provide 24 hour nursing when it has a resident who has a medical care plan. The department may waive 
this requirement when the facility demonstrates it has been unable, despite diligent effort, to recruit 
licensed nurses. The Department shall determine that a waiver of this requirement will not endanger the 
health or safety of the residents. 
(e) There shall be at least one certified medication aide on duty when any shift is not covered by a 
licensed nurse. 
(f) At least two direct care staff persons shall be on duty and awake at all times regardless of the number 
of residents. 
(g) Willful violation of the requirements regarding direct-care staff shall be determined based on a review 
of facility staffing records and interviews with staff, residents, resident family members and/or guardians, 
and other parties which may have information relevant to the investigation. The determination by the 
Department of Health will include, but will not be limited to, the following factors: 
(1) The nature, circumstances and gravity of the violations; 
(2) The repetitive nature of the violations at the facility or others operated by the same or related 
entities; 
(3) The previous degree of difficulty in obtaining compliance with the rules at the facility or others 
operated by the same or related entities; and 
(4) Any substantial showing of good faith in attempting to achieve continuing compliance with the 
provisions of the Nursing Home Care Act. 
 
EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), the text of 310:675-13-12 
reverted back to the permanent text that became effective 6-25-01, as was last published in the 2001 
Edition of the OAC, and remained as such until amended by permanent action on 7-11-03. 
[Source: Amended at 36 Ok Reg 1748, eff 9-13-19] 
67 

EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), the text of 310:675-13-12 
reverted back to the permanent text that became effective 6-25-01, as was last published in the 2001 
Edition of the OAC, and remained as such until amended by permanent action on 7-11-03. 
 
310:675-13-13. Assignment of deficiency to staff shortages [EXPIRED] 
EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency action enacting a new Section, the Section is no longer effective. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), Section 310:675-13-13 was 
no longer effective. For the official text of the emergency rule that was in effect from 8-22-01 through 7-
14-02, see 18 Ok Reg 3599. 
[Source: Added at 18 Ok Reg 3599, eff 8-22-01 through 7-14-02 (emergency)1] 
 
EDITOR’S NOTE: 1This emergency action expired without being superseded by a permanent action. 
Upon expiration of an emergency action enacting a new Section, the Section is no longer effective. 
Therefore, on 7-15-02 (after the 7-14-02 expiration of the emergency action), Section 310:675-13-13 was 
no longer effective. For the official text of the emergency rule that was in effect from 8-22-01 through 7-
14-02, see 18 Ok Reg 3599. 
 
310:675-13-14. Twenty-four-hour-based staff-scheduling and eligibility requirements 
(a) Implementing twenty-four-hour-based staff scheduling. Nursing facilities subject to the Nursing 
Home Care Act and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) 
with seventeen or more beds may implement twenty-four-hour-based staff scheduling consistent with the 
requirements established by law at 63 O.S. 1-1925.2(B)(5). 
(b) Loss of twenty-four-hour-based staffing privileges. The Department shall require a facility to 
maintain the shift based staff-to-resident ratios provided in 63 O.S. 1-1925(B)(3), if the facility has been 
determined by the Department to meet the disqualifying criteria in 63 O.S. 1-1925.2(B)(6), relating to 
staffing levels, fraudulent Quality of Care reports, or findings of substandard quality of care as a result of 
insufficient staffing. For intermediate care facilities for individuals with intellectual disabilities, loss of 
eligibility shall include findings of non-compliance with the Condition of Participation at 42 CFR 
483.430 (2011), Facility Staffing. 
(c) Eligibility requirements following loss of twenty-four-hour-based staffing. Prior to a facility 
resuming eligibility for twenty-four-hour-based staffing privileges, the Department shall require that the 
facility maintain the shift-based, staff-to-resident ratios in 63 O.S. 1-1925.2(B)(3) for at least three (3) 
months and has corrected any deficiency described in (b) of this section. 
(d) Right to Appeal. Facilities shall have the right to appeal and to the informal dispute resolution 
process with regard to penalties and sanctions imposed due to staffing noncompliance. [63:1-1925.2(E)]. 
(e) Quality of Care Report Requirement. Staffing hours reported to the Oklahoma Health Care 
Authority shall be submitted electronically through OHCA's Quality of Care (QOC) portal. 
(f) Twenty-four-hour-based staffing in intermediate care facilities for individuals with intellectual 
disabilities (ICFs/IIDs) with sixteen or less beds. ICFs/IIDs with sixteen or less beds shall be 
authorized to use the twenty-four-hour-based staffing requirements specified in (c) and (d) of 42 CFR 
483.430 (2011). 
(g) 
 Shift-based ratios for noncompliant facilities. This paragraph implements 63:1-1925.2(F)(4). 
(1) When the provisions of 63:1-1925.2(F)(1) are in effect, pursuant to 63:1-1925.2(B)(7), the 
following minimum direct-care-staff-to-resident ratios for non-compliant facilities shall apply in 
addition to other state and federal requirements related to the staffing of nursing facilities: 
(A) From 7:00 a.m. to 3:00 p.m., one direct-care staff to every five residents, 
68 
 
(B) From 3:00 p.m. to 11:00 p.m., one direct-care staff to every seven residents, and 
(C) From 11:00 p.m. to 7:00 a.m., one direct-care staff to every thirteen residents. 
(2) When the provisions of 63:1-1925.2(F)(2) are in effect, pursuant to 63:1-1925.2(B)(7), the 
following minimum direct-care-staff-to-resident ratios for non-compliant facilities shall apply in 
addition to other state and federal requirements related to the staffing of nursing facilities: 
(A) From 7:00 a.m. to 3:00 p.m., one direct-care staff to every five residents, 
(B) From 3:00 p.m. to 11:00 p.m., one direct-care staff to every six residents, and 
(C) From 11:00 p.m. to 7:00 a.m., one direct-care staff to every eleven residents. 
(3) When the provisions of 63:1-1925.2(F)(3) are in effect, pursuant to 63:1-1925.2(B)(7), the 
following minimum direct-care-staff-to-resident ratios for non-compliant facilities shall apply in 
addition to other state and federal requirements related to the staffing of nursing facilities: 
(A) From 7:00 a.m. to 3:00 p.m., one direct-care staff to every four residents, 
(B) From 3:00 p.m. to 11:00 p.m., one direct-care staff to every six residents, and 
(C) From 11:00 p.m. to 7:00 a.m., one direct-care staff to every eleven residents. 
[Source: Amended at 37 Ok Reg 1453, eff 9-11-20] 
 
SUBCHAPTER 15. TEMPORARY MANAGER OR RECEIVER 
 
310:675-15-1. Qualifications 
To be qualified as a temporary manager, any individual involved shall: 
(1) be at least twenty-one (21) years of age; 
(2) Meet the requirements for certificate of need as specified in 63 O.S. § 1-853 and in OAC 310:4-1-
7.1; 
(3) have never been convicted of a felony that would have a bearing on the operation of a facility or 
any offense involving dishonesty or any crime as listed in 63 O.S. §1-1950.1; 
(4) have never been disciplined for misconduct by any licensing board or professional society in any 
state; 
(5) have no financial interest, either direct or through an immediate family member as detailed in 
OAC 310:675-15-2(a)(6), in the facility proposed to be managed; 
(6) have not served within the past two (2) years as a member of the staff or as an owner of the 
facility proposed to be managed, or as an employee of the owner of the facility proposed to be 
managed; and 
(7) be an Oklahoma licensed nursing home administrator or employ an Oklahoma licensed nursing 
home administrator. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-2. Temporary manager list 
(a) Any person may apply to be a qualified temporary manager by filing a written request with the 
Department. The request shall be made on a form published by the Department that shall require 
information sufficient to establish the person's or corporation's qualifications, including: 
(1) age of each person with a controlling interest; 
(2) education of each person with a controlling interest; 
(3) names and locations of facilities with which the person or corporation has been involved, dates of 
involvement and descriptions of responsibilities and duties and specific deficiencies which required 
significant corrections in a timely or emergency manner; 
(4) disclosure of any felony conviction of each person to work in the facility or be responsible for 
resident or facility funds, regardless of whether or not the person believes the conviction bears on the 
operation of a facility and submission of the results of a check, conducted no more that thirty (30) 
days prior to application, of criminal arrest records maintained by the Oklahoma State Bureau of 
Investigation; 
69 
 
(5) disclosure of any disciplinary action against any person who will provide services to the facility 
by any licensing board or professional society in any state; 
(6) disclosure of any financial interest in any facility in Oklahoma on the part of the proposed 
manager or the manager's immediate family, including the manager's husband or wife, child or 
sibling, stepparent, stepchild, stepbrother or stepsister, father-in-law, mother-in-law, son-in-law, 
daughter-in-law, brother-in-law, sister-in-law, grandparent or grandchild or of any other person who 
will provide services to the facility; 
(7) the Oklahoma nursing home administrator's license number of the manager or the nursing home 
administrator to be employed; 
(8) a list of any person who will work at a the facility along with their qualifications and information 
as listed above; 
(9) a statement of the expected involvement in the operation of the facility of each principal, 
including an estimate of the amount of time that will be spent by each principal at the facility and the 
services to be provided by you or your company as part of the temporary manager fee or as additional 
costs to the facility; 
(10) the basis on which the amount of the fee will be calculated; 
(11) an attestation to the truthfulness of the information submitted; and 
(12) the address, telephone number, fax number, and email address for contacting the temporary 
manager at all times. 
(b) Within thirty (30) days after receipt of the complete request, the Commissioner shall approve or deny 
the person's request to be included on the temporary manager list. The criteria for approval to serve as a 
temporary manager shall be: 
(1) Evaluation of the information submitted and the requirements of the temporary manager program 
as specified in OAC 310:675-15-1; 
(2) If the applicant has operated a facility, the operational history of the applicant; 
(3) If the applicant has served as a temporary manager anywhere in the United states, the operational 
history of any managership; 
(4) The history of the applicant in complying with orders of the Department or Commissioner or 
those of other states or the federal government or a final order of a court of record. 
(c) The approval or denial of inclusion on the list of temporary managers is a discretionary function and 
does not create any rights to due process for the applicant. 
(d) The Commissioner shall specify the reasons the applicant is disqualified from managing any facility. 
(e) No former employee of the Department shall be eligible to serve as a temporary manager or be 
employed by a temporary manager until at least twelve (12) months has passed since the termination of 
that employment. The circumstances of that termination shall be considered in the review of the 
application. 
(f) No person who has been convicted of any crime listed in 63 O.S. §1-1950.1 shall be appointed as a 
temporary manager nor shall any such person be an employee of a temporary manager or work for the 
temporary manager in the service of the facility. 
(g) Placement of a person or corporation on the temporary manager list does not ensure that that entity 
will ever be appointed. Placement on the list of temporary managers does not create a right to 
appointment. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-3. Power and duties of temporary manager 
(a) The temporary manager shall have the power and duty to: 
(1) be oriented to the facility's conditions, including uncorrected deficiencies; 
(2) hire, terminate, or reassign staff; 
(3) obligate facility funds; 
(4) alter facility procedures; 
(5) manage the facility in order to correct deficiencies in the facility's operation; 
70 
 
(6) assure health and safety of the facility's residents while corrections are being made; 
(7) oversee the facility's orderly closure, if necessary; 
(8) maintain confidentiality of facility information; and 
(9) Pay all usual and customary operating expenses incurred during the managership in an orderly 
business fashion. 
(b) A temporary manager shall not: 
(1) Commingle the funds of one facility with the funds of another; 
(2) Loan the funds derived from the operation of the facility; 
(3) Contract with any entity in which he has any ownership interest or in which he serves as an officer 
or director or in which a person related to him by blood or marriage has an ownership interest or in 
which the family member serves as an officer or director unless the Commissioner reviews and 
approves the contract as on common terms within the industry; or 
(4) Use a method of accounting other than the accrual method unless approved in advance in writing 
by the Commissioner. The temporary manager's use of any other accounting method not approved by 
the Commissioner is a material breach of the temporary manager's fiduciary duty. 
(c) The temporary manager shall report to the Commissioner on a monthly basis as specified in OAC 
310:675-15-12. The report shall include at least the following: 
(1) Resident census and staffing levels at the facility during the last month; 
(2) A statement of income and expenses during the last month using the accrual method of 
accounting, unless the Commissioner approves the use of another accounting method; 
(3) A financial statement of the residents' trust funds; 
(4) A list of all persons provided to the facility by the temporary manager and, if any were not 
included in the original application, current information as required in OAC 310:675-15-1; 
(5) Any changes needed in the approved work plan; and 
(6) The specific number of hours the temporary manager and each person employed by the temporary 
manager was in the facility and a list of the services provided to the facility. 
(d) The temporary manager shall provide a preliminary work plan to the Department within 5 business 
days of assuming control of the facility and a final plan within 14 days. The Department shall review the 
plan and make any recommended changes at the first status conference. 
(e) The temporary manager shall contract with the owner of the building and the licensee in which the 
facility is being operated. Those contract(s) shall be presented at the first status conference. The 
Department shall have the opportunity to evaluate the contract and make suggestions. The Commissioner 
must approve or reject the contract by the second status conference. 
(f) If immediate jeopardy exists in the facility, the first status conference shall be conducted on or before 
the fourteenth day of control by the temporary manager. 
(g) In using the accrual method of accounting, the temporary manager shall recognize revenue in the 
period earned whether actually received or not. Additionally, the temporary manager shall recognize 
expenses when incurred and matched with the related revenue of the period, whether such expenses are 
actually paid or not. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-15-3.1. Advance of funds to temporary manager 
(a) A temporary manager appointed by the Commissioner may request an advance of funds from the 
Department pursuant to 63 O.S. Supp. 2005 Section 1-1914.2(G) to assist in the continuation of care to 
facility residents if sufficient funds are not available from other sources. Continuation of care to facility 
residents may include closure of the facility and transfer of residents to another facility. 
(b) The temporary manager shall submit the request for an advance of funds to the Department on the 
form described in (c) of this section. The request shall include a demonstration to the Commissioner's 
satisfaction that funds are needed but not available from sources including but not limited to: 
(1) The facility's owner; 
71 
 
(2) Revenues due from residents and third-party payers, including Medicare and Medicaid revenues; 
and 
(3) The facility's operating accounts. 
(c) The application form for request of funds shall require the following: 
(1) Documentation that the temporary manager has attempted to secure funds from other sources, 
including documentation showing that the temporary manager has made a funding request to the 
facility's owner; 
(2) Projections of the funds needed to support the facility's operations based on information 
reasonably available to the temporary manager such as the facility's financial records and/or cost 
reports filed with third-party payers; 
(3) An affidavit to be completed by the temporary manager if the owner fails to provide funds to the 
temporary manager as required by order of the Commissioner; and 
(4) A statement to be signed under oath by the temporary manager that the information provided in 
the application is true and complete. 
(d) Upon receipt of a completed application that demonstrates to the Commissioner's satisfaction the 
unavailability of sufficient funds from other sources, the Commissioner shall issue a written order with 
the following provisions: 
(1) Direction to the facility owner to respond to the Department in writing and to make funds 
available to the temporary manager within 48 hours of issuance of the order; 
(2) Notice to the facility owner that the owner's failure to provide sufficient funds shall result in 
action against the owner under the Nursing Home Care Act to suspend, revoke, and/or refuse to issue 
or renew the facility's license, and to impose an administrative penalty; 
(3) Notice to the facility owner of the provision in 63 O.S. Supp. Section 1-1914.2(G) that such 
advances by the Department if not repaid in full shall constitute a lien against any and all assets of the 
owner; and 
(4) Direction to the temporary manager to advise the Department immediately if funds are provided 
as required by the facility owner, and/or to submit to the Department the completed and sworn form 
confirming that funds were not provided to the temporary manager as ordered in (f)(1) of this section. 
(e) If the Commissioner determines that the Department will advance funds to the temporary manager, the 
amount of funds advanced by the Department shall not exceed one month of projected operating expenses 
for the facility. 
(f) The temporary manager shall notify the Department within 24 hours after a change in the information 
presented in the application, including changes in the operating budget or in the availability of funds from 
other sources. 
(g) The advance of funds pursuant to this section is solely at the discretion of the Commissioner. The 
request may be denied for reasons including but not limited to the Commissioner's assessment that the 
Department does not have discretionary funds adequate to support the request, that other funding sources 
are available to the temporary manager, or that the funds are not needed to support operation of the 
facility. The temporary manager has no right to funds from the Department. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-15-4. Conditions for a temporary manager 
(a) The owner of the building and the licensee of a facility which is placed under a temporary manager 
shall: 
(1) relinquish control of the facility and the building, equipment, food and supplies to the temporary 
manager which makes the temporary manager an agent of the licensee; 
(2) not attempt to retain final authority to approve personnel changes or expenditures of facility funds; 
and 
(3) give the temporary manager access to all facility financial accounts, including access to Medicare 
and Medicaid receipts and resident trust funds. 
72 
 
(b) The owner of the building and the licensee shall contract with the temporary manager subject to the 
approval of the Department. The contract(s) shall include the method by which the temporary manager 
shall be paid for particular services, the use of facility funds by the temporary manager for the cost 
incurred for operation of the facility and payment to the building owner for use of the building as a usual 
cost of operation of a facility. 
(c) Should an existing lease be cancelled by the owner of the building, the owner shall contract with the 
temporary manager for use of the facility on terms not to exceed the original lease. 
(d) Should a licensee be unable to contract with the temporary manager, the owner of the building will be 
asked to contract with the temporary manager for operations of the facility. The licensee and any 
individual owners of the licensee remain responsible for any liability incurred in the operation of the 
facility. If the temporary manager cannot contract with the licensee or owner of the facility, the temporary 
manager shall move to close the facility following the procedures established otherwise in this Chapter. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-5. Notice of placing a temporary manager 
(a) Before placing a temporary manager in a facility, the Department shall give the owner of the building 
and the licensee, if different, advance written notice of intent as follows: 
(1) fifteen (15) days notice if residents have experienced widespread actual harm but are not in 
immediate jeopardy; or 
(2) two (2) days notice if residents are in immediate jeopardy; or 
(3) two (2) days notice if the facility is operating without a license. 
(b) If the Commissioner determines that conditions at a facility represent immediate jeopardy to residents 
and that the notice required in (a) of this section is likely to result in irreparable harm to residents, the 
Commissioner shall declare an emergency and appoint a temporary manager without prior notice to the 
owner of the building or the licensee. Upon appointing a temporary manager without prior notice, the 
Commissioner shall notify the owner of the building and the licensee of the right to a hearing as provided 
in 63 O.S. Section 1-1914.2(B) and (C). 
(c) Written notice shall also be given to the Oklahoma Health Care Authority. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-6. Procedures for appointing qualified temporary managers 
(a) Prior to appointing a temporary manager, the Commissioner shall serve a written notice and request 
for information to be sent by facsimile or electronic mail to each qualified temporary manager, to include: 
(1) A statement of the size, location and current occupancy of the facility, and a general statement of 
the anticipated justification for appointing a temporary manager; 
(2) A request for confirmation of the temporary manager's current availability to accept appointment; 
(3) A request for confirmation of the temporary manager's lack of financial interest in the facility, in 
other facilities operated by the same entity that operated the facility to be managed, or in any entity 
related to the entity that operated the facility to be managed; and 
(4) A deadline for reply from each potential temporary manager. 
(b) The potential temporary manager shall reply by the date and time specified on the notice and shall 
include all information requested in the notice. The Department may give short notice in the case of an 
emergency and the temporary manager may be required to take over a facility in less that 24 hours. This 
information shall be included in the notice of pending appointment. 
(c) The decision of the Commissioner and Department to appoint a specific temporary manager is a 
discretionary decision and does not create any individual rights including the right to an administrative 
hearing or appeal of that decision. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-7. Criteria for appointment 
73 
 
The Commissioner shall not appoint a temporary manager to a facility unless the Commissioner 
determines in writing that: 
(1) The temporary manager has submitted a complete application as required in OAC 310:675-15-2; 
(2) The temporary manager meets all qualifications required in OAC 310:675-15-1; 
(3) The temporary manager has the requisite resources to provide for the continued protection of the 
health and safety of all residents of the facility; 
(4) The temporary manager has not been given undue preference in the appointment, taking into 
consideration the length of time since the qualified temporary manager was last appointed relative to 
the appointments of other temporary managers; and 
(5) If the temporary manager is a corporation it has: 
(A) Disclosed for all the persons with a controlling interest, officers and directors of the 
corporation in the application along with the information required for each individual in 310:15-
1-1; 
(B) Disclosed a list of all persons who will serve in the facility as part of the services provided by 
or through the temporary manager along with attestation that each person serving in the facility 
meets the qualification in 310:675-15-1(a)(1), (3), (4), (5) & (7) above; and 
(C) Provided evidence of the experience of the corporation and the team in providing services to a 
facility in danger of decertification or loss of license. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-8. Procedures for appointment 
(a) Prior to appointing a temporary manager the Department shall contact the Office of the Long Term 
Care Ombudsman to advise of the likely appointment, and to request information from that office 
concerning the temporary manager's record of involvement with the Ombudsman. 
(b) Failure of the Office of the Long Term Care Ombudsman to respond by the deadline shall not prohibit 
the Commissioner from appointing the temporary manager. 
(c) The Department shall comply with applicable requirements in 42 CFR Sections 488.410, 488.415 and 
488.424 when appointing a temporary manager to correct deficiencies or remove an immediate jeopardy 
to resident health or safety in a facility pursuant to Title XVIII or XIX of the Social Security Act. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-15-9. Required findings 
The Commissioner shall not appoint a temporary manager to a facility unless the Commissioner 
determines in writing that: 
(1) The temporary manager has submitted a complete application as required in OAC 310:675-15-2; 
(2) The temporary manager meets all qualifications required in OAC 310:675-15-1 and 15-7; and 
(3) The temporary manager has the requisite resources to provide for the continued protection of the 
health and safety of all residents of the facility. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-10. Periodic review 
A potential temporary manager's qualification shall be effective for one year from the date of 
approval of the application to be listed as a qualified temporary manager. In order to be renewed for 
qualification, the potential temporary manager shall submit a new application for review and approval 
pursuant to OAC 310:675-15-2. 
[Source: Amended at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-11. Bond 
(a) A temporary manager may be required to obtain a bond in the amount of up to $100,000.00 or 150% 
of the average revenue of the facility for the last three full months before placement of the temporary 
74 
 
manager, whichever is greater, as necessary to ensure that the assets relinquished by the facility to the 
temporary manager are used for the benefit of residents. 
(b) A bond shall be posted upon appointment and payable to the Department. 
(c) The requirement for the amount of the bond may be established and modified from time to time by the 
Commissioner based on the amount of revenue and other financial assets relinquished by the facility to 
the temporary manager. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-15-12. Monthly status conference 
(a) Whenever a temporary manager is appointed, the Commissioner shall establish a schedule for the 
submission and review of monthly reports. Each monthly report shall be filed in the Department by the 
temporary manager not later than 25 days following the end of each month. The temporary manager shall 
send a copy of each report to the licensee and owner of the facility. 
(b) The temporary manager shall provide: 
(1) All information to be submitted as specified in OAC 310:675-15-3. 
(2) Progress report or amendments to a plan of correction for outstanding deficiencies or violations of 
the law; 
(3) Any desired amendments to the management plan and reasons therefore; 
(c) The Department shall present to the Commissioner, the temporary manager, and the licensee and 
owner: 
(1) An independent report on the status of the facility based on a visit to the facility by a team 
sufficient to evaluate the current status. 
(2) Recommendations on any changes to the management plan; 
(d) The Commissioner may schedule hearings for presentations and decisions on differences between the 
Department and the Temporary Manager. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-15-13. Removal of the temporary manager 
(a) A temporary manager may be removed at the discretion of the Commissioner. 
(b) A temporary manager shall be removed in the following situations: 
(1) A conflict of interest arises which would have prohibited the initial appointment; 
(2) Another facility owned or operated by the temporary manager has been given notice of potential 
termination or other enforcement action taken by the Department; 
(3) The temporary manager has filed for bankruptcy protection for any business or personal operation 
during the pendency of the managership; 
(4) Conviction of a crime as specified in 63 O.S. § 1-1950.1; 
(5) Failure to comply with requirements of this subchapter; or 
(6) The facility is and will continue to be in substantial compliance with the Nursing Home Care 
Act [63:1-1914.2(L)(1)] and OAC 310:675. 
(c) A temporary manager shall be removed when the Department approves a new owner or operator. 
(d) The temporary managership continues and the temporary manager remains responsible for facility 
funds until released by the Department after distribution of all assets held by the temporary manager. 
[Source: Added at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-14. Administrative penalties 
The Department may assess administrative penalties against a temporary manager for failure to 
follow the Nursing Home Care Act or this Chapter under the procedure used for all licensees unless the 
responsibility was that of the former operator. 
[Source: Added at 19 Ok Reg 2099, eff 6-27-02] 
 
310:675-15-15. License 
75 
 
Upon the temporary manager's appointment, compliance with the bonding provisions of section 15-11 
above, and submittal of a license application, the Department shall issue a license to the facility 
identifying the temporary manager. Such license shall not create any property rights with the temporary 
manager and shall terminate with termination of the managership. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-15-16. Final accounting 
(a) Within 30 days of the end of a temporary managership for any reason, the temporary manager shall 
file a written final accounting with the Department. The temporary manager shall use the accrual method 
of accounting, unless the Commissioner finds good cause for the temporary manager to use another 
method of accounting. The accounting shall include all documents specified in the "Administrative Order 
Removing the Temporary Manager and Revoking the Conditional License" which is issued by the 
Commissioner of Health. 
(b) No funds shall be paid to the former licensee, the owner of the building or the new licensee without 
the express consent of the Commissioner. The Commissioner shall issue an order for distribution of any 
excess operating revenue over expenses at the close of the managership. 
(c) The temporary manager shall continue to report to the Department until released by the 
Commissioner. 
[Source: Amended at 20 Ok Reg 2399, eff 7-11-03] 
 
310:675-15-17. Receiver 
(a) The Department may petition the court to place a facility under control of a receiver pursuant to 63:1-
1930.2, instead of or in addition to appointing a temporary manager. 
(b) Any person may submit a written request to the Department to be included as a receiver on the list 
maintained by the Department pursuant to 63 O.S. Section 1-1930.3. A person's inclusion on the receiver 
list shall not be represented as an approval or qualification by the Department to operate a facility. The 
list provided by the Department to the court may include information on the requirements for a facility 
license. 
[Source: Added at 20 Ok Reg 2399, eff 7-11-03] 
 
SUBCHAPTER 17. INSPECTION PROTOCOLS 
 
310:675-17-1. Duties of quality assurance officer 
The department shall employ a Quality Assurance Officer to perform the following tasks: 
(1) review statistical reports of survey finding frequency by surveyor and survey team; 
(2) review statistical reports of survey team time spent on survey; and 
(3) review written deficiencies to compare findings by surveyor and survey team. 
[Source: Added at 18 Ok Reg 2533, eff 6-25-01] 
 
310:675-17-2. Quality assurance observations and reviews 
The Quality Assurance Officer shall observe individual surveyor and survey team performance for 
adherence to survey protocol no less than once every 6 months. The results of these observations and 
reviews in conjunction with the Federal Oversight and Support Survey findings will be used by the 
Quality Assurance Officer to identify and implement necessary training interventions. 
[Source: Added at 18 Ok Reg 2533, eff 6-25-01] 
 
310:675-17-3. Acceptable Plan of Correction 
(a) All facilities having deficiencies must submit an acceptable plan of correction within ten (10) working 
days after receipt of notice of violation [63:1-1914.A.]. An acceptable plan of correction must: 
(1) Address how corrective action will be accomplished for those residents and/or clients found to 
have been affected by the deficient practice. 
76 
 
(2) Address how the facility will identify other residents and/or clients having the potential to be 
affected by the same deficient practice. Plans of correction specific to residents identified on the 
deficiency statement are acceptable only where the deficiency is determined to be unique to that 
resident and not indicative of a possible systemic problem. 
(3) Address what measures will be put into place or systemic changes made to ensure that the 
deficient practice will not recur. 
(4) Indicate how the facility plans to monitor its performance to make sure that solutions are 
sustained. The facility shall develop a plan for ensuring that correction is achieved and sustained. This 
plan must be implemented, and the corrective action evaluated for its effectiveness. The plan of 
correction shall be incorporated into the quality assurance system. At the revisit, the quality assurance 
plan shall be reviewed to determine the earliest date of compliance. If there is no evidence of quality 
assurance being implemented, the earliest correction date will be the date of the revisit. 
(5) Include dates when corrective action will be completed for each violation. The corrective action 
completion dates shall not exceed sixty (60) days [63:1-1914.A.]from receipt of notice of violation. 
(6) Be signed by the administrator. 
(b) Upon written request from the facility, the Department may extend the time period within which the 
violations are to be corrected where correction involves substantial structural improvement [63:1-
1914.A.]. 
(c) The department shall provide written notice of the acceptance or rejection of a plan of correction. If 
the Department finds that the plan of correction does not meet the requirements for an acceptable plan of 
correction as specified in OAC 310:675-17-3(a) the Department shall provide notice of the rejection and 
the reason for the rejection to the facility. The facility shall have ten (10) working days after receipt of the 
notice of rejection in which to submit a modified plan. If the modified plan is not timely submitted, or if 
the modified plan is rejected, the Department shall impose a plan of correction, which the facility shall 
follow [63:1-1914.A.]. 
(d) Acceptance of the plan of correction by the Department does not absolve the facility of the 
responsibility for compliance should the implementation not result in correction and compliance. 
Acceptance indicates the Department's acknowledgment that the facility indicated a willingness and 
ability to make corrections adequately and timely. 
(e) If the violation has been corrected prior to submission and approval of a plan of correction, the 
facility may submit a report of correction in place of a plan of correction [63:1-1914.B.]. The report of 
correction shall address those requirements specified in OAC 310:675-17-3(a). 
(f) As specified in 63 O.S. § 1-1914.C., facilities may request an extended correction time. 
(g) As specified in 63 O.S. § 1-1914.D., facilities may contest any Department action under this section. 
[Source: Added at 20 Ok Reg 2399, eff 7-11-03] 
 
SUBCHAPTER 19. FEEDING ASSISTANTS 
 
310:675-19-1. Purpose 
This Subchapter establishes standards for training and registration of feeding assistants in Oklahoma 
in accordance with 42 Code of Federal Regulations Parts 483 and 488. The intent is to give nursing, 
specialized nursing, and skilled nursing facilities the option to use paid feeding assistants, allowing them 
to provide more residents with help in eating and drinking and reduce the incidence of unplanned weight 
loss and dehydration. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-19-2. Definitions 
The following words and terms, when used in this Subchapter, shall have the following meaning, 
unless the context clearly indicates otherwise: 
77 
 
"Feeding assistant"means an individual who is paid to feed residents by a facility or who is used 
under an arrangement with another agency or organization and meets the requirements cited in 42 CFR 
Parts 483 and 488 [63:1-1951(F)(1)]. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-19-3. Training course 
(a) The following training curricula are approved as training courses and meet the requirements specified 
in 42 CFR 483.160(a): 
(1) Eating Matters: A Training Manual for Feeding Assistants, published by the American Dietetic 
Association, 2003 edition; and Eating Matters: Feeding Assistants Manual, published by the 
American Dietetic Association, 2003 edition; or 
(2) Assisted Dining: The Role and Skills of Feeding Assistants, published by the American Health 
Care Association, 2003 edition. 
(b) A feeding assistant training course must consist of at least eight (8) hours of training in the required 
areas of instruction. 
(c) A feeding assistant training course instructor must hold a current valid license as: 
(1) A registered nurse; 
(2) A licensed practical nurse; 
(3) A registered dietitian; 
(4) A speech-language pathologist or speech therapist; or 
(5) An occupational therapist. 
(d) Successful completion of a training course is based upon the instructor's assessment using a staff 
competency checklist that conforms to OAC 310:675-19-8. 
(e) The training course must provide a certificate of completion within 30 days of course completion to 
each individual who successfully completed the course. The certificate shall conform to OAC 310:675-
19-8. 
(f) The Department will not restrict an individual from repeating a training course. The training course 
may establish limits on the number of times an individual may repeat the course after unsuccessful 
attempts. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-19-4. Facility requirements 
(a) The nursing facility, specialized nursing facility, or skilled nursing facility must maintain a record of 
each individual who has successfully completed the approved training course. For each individual feeding 
assistant employed by the facility, the facility must maintain: 
(1) A copy of a staff competency checklist completed and signed by the instructor on the form 
specified in OAC 310:675-19-8; 
(2) A copy of a certificate of completion signed by the instructor on the form specified in OAC 
310:675-19-8; 
(3) Verification that the facility checked with the Feeding Assistant Registry to ensure the individual 
is eligible for employment; and 
(4) Verification of compliance with the Criminal History Background Check in 63 O.S. Supp. 2004, 
Section 1-1950.1. 
(b) Each feeding assistant must work under the supervision of a registered nurse or licensed practical 
nurse. In an emergency, the feeding assistant must call a supervisory nurse for help using the resident call 
system if the nurse is not present during the feeding of a resident. 
(c) The facility must ensure that a feeding assistant only assists residents who have no complicated 
feeding problems. The facility must base resident selection on the charge nurse's assessment and the 
resident's latest assessment and plan of care. Complicated feeding problems include but are not limited to: 
(1) Difficulty swallowing; 
(2) Recurrent lung aspirations; or 
78 
 
(3) Tube or parenteral/IV feedings. 
(d) Instructor time shall not count toward minimum staffing requirements. 
(e) The facility shall check the Feeding Assistant Registry before hiring a person to work as a feeding 
assistant. If the registry indicates that the individual has been found to be personally responsible for 
abuse, neglect, exploitation, or misappropriation of resident property, that individual shall not be hired by 
the facility. 
(f) The facility must maintain proof of compliance with this subchapter at all times at the facility site. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-19-5. Feeding assistant registry 
The Department shall maintain a feeding assistant registry consistent with the registry operation 
described in OAC 310:677-5-2(c). The registry shall contain information consistent with that described in 
63 O.S. Supp. 2004, Section 1-1951(D)(3). 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-19-6. Feeding assistant registration 
(a) An individual may perform the services of a feeding assistant upon successful completion of an 
approved training course and shall submit a Feeding Assistant Registration Application to the Department 
on the form specified in 310:675-19-8. 
(b) Each registered feeding assistant shall renew individual registration once every twenty-four (24) 
months. The individual shall submit a Feeding Assistant Renewal Application with proof that within the 
past twenty-four (24) months they have: 
(1) Worked at least eight (8) hours for compensation as a feeding assistant; or 
(2) Completed another eight (8) hour training course that complies with OAC 310:675-19-3. 
(c) A non-refundable application fee of ten dollars ($10) shall be included with an application for initial 
or renewal registration. 
[Source: Amended at 26 Ok Reg 2059, eff 6-25-09] 
 
310:675-19-7. Revocation, suspension and denial 
(a) The State Health Department's procedure afforded a feeding assistant for purposes of investigating, 
hearing, and making findings on allegations of abuse, neglect, exploitation, or misappropriation of 
resident property, shall be not less than the process afforded nurse aides pursuant to Title 63 O.S. Supp. 
2004 Section 1-1951(D)(4) through (12). 
(b) A feeding assistant's registration may be revoked, suspended or denied if the Department determines 
with clear and convincing evidence that an individual has been responsible for any of the following: 
(1) Abuse; 
(2) Neglect; 
(3) Exploitation; or 
(4) Misappropriation of resident or client property. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
310:675-19-8. Feeding assistant forms 
The forms used for this subchapter are the following. 
(1) Staff competency checklist. A training course using the curriculum specified in 310:675-19-
3(a)(1) may use the checklist provided with that curriculum or the checklist provided by the 
Department. Other training courses shall use the checklist provided by the Department. The 
competency checklist provided by the Department requires the following: 
(A) The name of the person being trained; 
(B) Evaluation of skills task performances including: 
(i) Safety and emergency procedures including the Heimlich maneuver; 
(ii) Sanitation and washing hands; 
79 
 
(iii) Serving a meal tray; 
(iv) Assistance with resident requiring total feeding; 
(v) Serving supplemental nourishments; and 
(vi) Serving fresh drinking water; 
(C) The date of the evaluation; and 
(D) Name and signature of the instructor. 
(2) Certificate of completion. A training course using the curriculum specified in 310:675-19-3(a)(1) 
may use the certificate of completion provided with that curriculum or the certificate provided by the 
Department. Other training courses shall use the certificate provided by the Department. The certificate of 
completion provided by the Department requires the following: 
(A) Name of the person being trained; 
(B) Name of the curriculum; 
(C) Location where the training occurred; 
(D) Date training was completed; 
(E) A statement that the person successfully completed eight hours of training to become a 
feeding assistant; and 
(F) Name and signature of the instructor. 
(3) Feeding assistant registration application. The application form requires the following for each 
individual: 
(A) Name; 
(B) Date of birth; 
(C) Contact information; 
(D) Information sufficient to identify the individual including social security number; 
(E) A copy of the certificate of completion from a training course that meets the requirements of 
OAC 310:675-19-3; and 
(F) Applicant's signature affirming the truthfulness and completeness of the application. 
(4) Feeding assistant renewal application. The application form requires the following for each 
individual: 
(A) Name; 
(B) Date of birth; 
(C) Contact information; 
(D) Information sufficient to identify the individual including social security number; 
(E) Proof of work experience or retraining as required in OAC 310:675-19-6(c); and 
(F) Applicant's signature affirming the truthfulness and completeness of the application. 
[Source: Added at 23 Ok Reg 2415, eff 6-25-06] 
 
SUBCHAPTER 21. ENFORCEMENT AND REGISTRY HEARINGS FOR NONTECHNICAL 
SERVICES WORKERS 
 
310:675-21-1. Purpose 
The purpose of this Subchapter is to implement the Nontechnical Services Workers Abuse Registry, 
63 O.S. Section 1-1950.6 through 1-1950.9. For the purposes of this subchapter, abuse, verbal abuse, and 
exploitation, shall have the meaning assigned in Section 10-103 of Title 43A of the Oklahoma Statutes. 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
[Source: Added at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-21-2. Complaint investigation 
80 
 
(a) Process. Upon receipt of a complaint against a non-technical service worker alleging abuse, verbal 
abuse, or exploitation of a resident within a nursing facility, or upon completion of a survey of a nursing 
facility by the Department with a finding that a non-technical service worker abused, verbally abused, or 
exploited a resident, the Department shall conduct an investigation. Upon completion of the investigation, 
a written report will be prepared. If sufficient evidence exists to initiate an individual proceeding, notice 
of the investigative findings and an opportunity for hearing will be prepared and served upon the 
nontechnical services worker. 
(b) Timeline for reporting. The facility shall report to the Department allegations and incidents of abuse, 
verbal abuse, or exploitation by a non-technical service worker within twenty-four (24) hours. 
(c) Reporting non-technical service workers. The facility shall report to the Department allegations and 
incidents of abuse, verbal abuse, or exploitation by a non-technical service worker by submitting the 
following: 
(1) facility name, address, and telephone; 
(2) facility type; 
(3) date; 
(4) reporting party name or administrator name; 
(5) employee name and address; 
(6) employee certification number; 
(7) employee social security number; 
(8) employee telephone number; 
(9) termination action and date, if any; 
(10) other contact person name and address; and 
(11) facts of resident abuse, verbal abuse, or exploitation. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Added at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-21-3. Right to a hearing 
Before the registry is notified that a finding of resident abuse, verbal abuse, or exploitation of a 
resident in a nursing facility has been made against a nontechnical services worker, the Department shall 
offer the nontechnical services worker an opportunity for a hearing. If the nontechnical services worker 
fails to request a hearing in writing within thirty (30) days from the date of the notice, the Department 
shall include on the registry a finding of resident abuse, verbal abuse, or exploitation of a resident in a 
nursing facility against the nontechnical services worker. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Added at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-21-4. Petition and hearing 
(a) Petition. If the nontechnical services worker requests a hearing, the Department shall commence an 
individual proceeding by filing a petition against the nontechnical services worker that states the facts 
supporting the allegation. 
(b) Notice of hearing. All parties shall be given notice of the date, time and place of the hearing. The 
notice of hearing served upon the non-technical service worker shall include a copy of the petition. 
(c) Time. The hearing shall be scheduled at least fifteen (15) working days after the nontechnical services 
worker has received notice of the hearing. 
81 
 
(d) The hearing shall be conducted in accord with the Oklahoma Administrative Procedures Act and 
Chapter 2 of this Title. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Added at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
310:675-21-5. Orders 
(a) Authority. The Administrative Law Judge shall issue a decision within fifteen (15) working days 
following the close of the hearing record. The decision shall include Findings of Fact and Conclusions of 
Law separately stated. 
(b) Delegation. The Commissioner of Health may delegate the authority to issue a final decision in these 
matters as specified in 75 O.S. Section 311.1 and OAC 310:002. 
(c) Registry notification. The decision shall direct the nontechnical services worker registry to include the 
findings as they relate to the nontechnical services worker. The decision shall direct the nontechnical 
services worker registry to include a statement by the nontechnical services worker disputing the decision 
if the nontechnical services worker chooses to submit such statement. If such a statement is submitted the 
statement of the nontechnical services worker shall be submitted to the nontechnical services worker 
registry within thirty (30) days after the decision is issued. 
(d) Notice. Each party and attorney of record shall be mailed a copy of the Final Order. The Department 
shall transmit a copy of the Final Order to the nontechnical services worker registry when the Order is 
mailed. 
(e) Appeal. An appeal of the Final Order shall be perfected pursuant to 75 O.S. Section 318 of the 
Administrative Procedures Act. 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
[Source: Added at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter. 
 
82 

APPENDIX A. HOT WATER USE 
 
Figure 1 

83 
 
APPENDIX B. REFERENCE LIST FOR STANDARDS OF PRACTICE 
 
Figure 1 

84 

Figure 2 

85 
 
Editor's Note: 1See Editor's Note at beginning of this Chapter. 
[Source: Revoked and reenacted at 25 Ok Reg 2482, eff 7-11-08] 
 
EDITOR’S NOTE: 1See Editor's Note at beginning of this Chapter.