Section R9-10-403. Administration

A.      A governing authority shall:

1.        Consist of one or more individuals responsible for the organization, operation, and administration of a nursing care institution;

2.        Establish, in writing, the nursing care institution’s scope of services;

3.        Designate, in writing, a nursing care institution adminis- trator licensed according to A.R.S. Title 36, Chapter 4, Article 6;

4.        Adopt a quality management program according to R9- 10-404;

5.        Review and evaluate the effectiveness of the quality man- agement program at least once every 12 months;

6.        Designate, in writing, an acting administrator licensed according to A.R.S. § Title 36, Chapter 4, Article 6, if the administrator is:

a.         Expected not to be present on the nursing care insti- tution’s premises for more than 30 calendar days, or

b.        Not present on the nursing care institution’s prem- ises for more than 30 calendar days; and

7.        Except as permitted in subsection (A)(6), when there is a change of administrator, notify the Department according to A.R.S. § 36-425(I) and submit a copy of the new administrator's license under A.R.S. Title 36, Chapter 4, Article 6 to the Department.

B.       An administrator:

1.        Is directly accountable to the governing authority of a nursing care institution for the daily operation of the nurs- ing care institution and all services provided by or at the nursing care institution;

2.        Has the authority and responsibility to manage the nurs- ing care institution;

3.        Except as provided in subsection (A)(6), designates, in writing, an individual who is present on the nursing care institution's premises and accountable for the nursing care institution when the administrator is not present on the nursing care institution’s premises;

4.        Ensures the nursing care institution’s compliance with

A.R.S. § 36-411; and

5.        If the nursing care institution provides feeding and nutri- tion assistant training, ensures the nursing care institution complies with the requirements for the operation of a feeding and nutrition assistant training program in R9-10- 116.

C.      An administrator shall ensure that:

1.        Policies and procedures are established, documented, and implemented to protect the health and safety of a resident that:

a.         Cover job descriptions, duties, and qualifications, including required skills, knowledge, education, and experience for personnel members, employees, vol- unteers, and students;

b.        Cover orientation and in-service education for per- sonnel members, employees, volunteers, and stu- dents;

c.         Include how a personnel member may submit a complaint relating to resident care;

d.        Cover the requirements in A.R.S. Title 36, Chapter 4, Article 11;

e.         Cover cardiopulmonary resuscitation training including:

i.         Which personnel members are required to obtain cardiopulmonary resuscitation training,

ii.        The method and content of cardiopulmonary resuscitation training,

iii.      The qualifications for an individual to provide cardiopulmonary resuscitation training,

iv.       The time-frame for renewal of cardiopulmo- nary resuscitation training, and

v.        The documentation that verifies an individual has received cardiopulmonary resuscitation training;

f.         Cover first aid training;

g.        Include a method to identify a resident to ensure the resident receives physical health services and behav- ioral health services as ordered;

h.        Cover resident rights, including assisting a resident who does not speak English or who has a disability to become aware of resident rights;

i.         Cover specific steps for:

i.         A resident to file a complaint, and

ii.        The nursing care institution to respond to a res- ident’s complaint;

j.         Cover health care directives;

k.        Cover medical records, including electronic medical records;

l.         Cover  a  quality  management  program,  including incident reports and supporting documentation;

m.       Cover contracted services;

n.        Cover resident’s personal accounts;

o.        Cover petty cash funds;

p.        Cover fees and refund policies;

q.        Cover misappropriation of resident property; and

r.         Cover when an individual may visit a resident in a nursing care institution; and

2.        Policies and procedures for physical health services and behavioral health services are established, documented, and implemented to protect the health and safety of a res- ident that:

a.         Cover   resident   screening,   admission,   transport, transfer, discharge planning, and discharge;

b.        Cover the provision of physical health services and behavioral health services;

c.         Include when general consent and informed consent are required;

d.        Cover storing, dispensing, administering, and dis- posing of medication;

e.         Cover infection control;

f.         Cover how personnel members will respond to a res- ident’s sudden, intense, or out-of-control behavior to prevent harm to the resident or another individual;

g.        Cover telemedicine, if applicable; and

h.        Cover environmental services that  affect  resident care;

3.        Policies and procedures are reviewed at least once every three years and updated as needed;

4.        Policies and procedures are available to personnel mem- bers, employees, volunteers, and students; and

5.        Unless otherwise stated:

a.         Documentation required by this Article is provided to the Department within two hours after a Depart- ment request; and

b.        When documentation or information is required by this Chapter to be submitted on behalf of a nursing care institution, the documentation or information is provided to the unit in the Department that is respon- sible for licensing and monitoring the nursing care institution.

D.      Except for health screening services, an administrator shall ensure that medical services, nursing services, health-related services, behavioral health services, or ancillary services pro- vided by a nursing care institution are only provided to a resi- dent.

E.       If abuse, neglect, or exploitation of a resident is alleged or sus- pected to have occurred before the resident was admitted or while the resident is not on the premises and not receiving ser- vices from a nursing care institution’s employee or personnel member, an administrator shall report the alleged or suspected abuse, neglect, or exploitation of the resident as follows:

1.        For a resident 18 years of age or older, according to

A.R.S. § 46-454; or

2.        For a resident under 18 years of age, according to A.R.S.

§ 13-3620;

F.       If an administrator has a reasonable basis, according to A.R.S.

§  13-3620  or  46-454,  to  believe  that  abuse,   neglect,  or exploitation has occurred on the premises or while a resident is

receiving services from a nursing care institution’s employee or personnel member, an administrator shall:

1.        If applicable, take immediate action to stop the suspected abuse, neglect, or exploitation;

2.        Report the suspected abuse, neglect, or exploitation of the resident as follows:

a.         For a resident 18 years of age or older, according to

A.R.S. § 46-454; or

b.        For a resident under 18 years of age, according to

A.R.S. § 13-3620;

3.        Document:

a.         The suspected abuse, neglect, or exploitation;

b.        Any action taken according to subsection (F)(1); and

c.         The report in subsection (F)(2);

4.        Maintain the documentation in subsection (F)(3) for at least 12 months after the date of the report in subsection (F)(2);

5.        Initiate an investigation of the suspected abuse, neglect, or exploitation and document the following information within five working days after the report required in sub- section (F)(2):

a.         The dates, times, and description of the suspected abuse, neglect, or exploitation;

b.        A description of any injury to the resident related to the suspected abuse or neglect and any change to the resident's physical, cognitive, functional, or emo- tional condition;

c.         The  names  of  witnesses   to  the  suspected  abuse, neglect, or exploitation; and

d.        The actions taken by the administrator to prevent the suspected abuse, neglect, or exploitation from occur- ring in the future; and

6.        Maintain a copy of the documented information required in subsection (F)(5) and any other information obtained during the investigation for at least 12 months after the date the investigation was initiated.

G.      An administrator shall:

1.        Allow a resident advocate to assist a resident, the resi- dent's representative, or a resident group with a request or recommendation, and document in writing any complaint submitted to the nursing care institution;

2.        Ensure that a monthly schedule of recreational activities for residents is developed, documented and implemented; and

3.        Ensure that the following are conspicuously posted on the premises:

a.         The current nursing care institution license and qual- ity rating issued by the Department;

b.        The name, address, and telephone number of:

i.         The Department's Office of Long Term Care,

ii.        The State Long-Term Care Ombudsman Pro- gram, and

iii.      Adult Protective Services of the Department of Economic Security;

c.         A notice that a resident may file a complaint with the Department concerning the nursing care institution;

d.        The monthly schedule of recreational activities; and

e.         One of the following:

i.         A copy of the current license survey report with information identifying residents redacted, any subsequent reports issued by the Department, and any plan of correction that is in effect; or

ii.        A notice that the current license survey report with information identifying residents redacted, any subsequent reports issued by the Depart-

ment, and any plan of correction that is in effect are available for review upon request.

H.      An administrator shall provide written notification to the Department of a resident’s:

1.        Death, if the resident’s death is required to be reported according to A.R.S. § 11-593, within one working day after the resident’s death; and

2.        Self-injury, within two working days after the resident inflicts a self-injury that requires immediate intervention by an emergency medical services provider.

I.        If an administrator administers a resident's personal account at the request of the resident or the resident's representative, the administrator shall:

1.        Comply with policies and procedures established accord- ing to subsection (C)(1)(n);

2.        Designate a personnel member who is responsible for the personal accounts;

3.        Maintain a complete and separate accounting of each per- sonal account;

4.        Obtain written authorization from the resident or the resi- dent's representative for a personal account transaction;

5.        Document an account transaction and provide a copy of the documentation to the resident or the resident's repre- sentative upon request and at least every three months;

6.        Transfer all money from the resident's personal account in excess of $50.00 to an interest-bearing account and credit the interest to the resident's personal account; and

7.        Within 30 calendar days after the resident's death, trans- fer, or discharge, return all money in the resident's per- sonal account and a final accounting to the resident, the resident’s representative, or the probate jurisdiction administering the resident's estate.

J.        If a petty cash fund is established for use by residents, the administrator shall ensure that:

1.        The policies and procedures established according to sub- section (C)(1)(o) include:

a.         A prescribed cash limit of the petty cash fund, and

b.        The hours of the day a resident may access the petty cash fund; and

2.        A resident's written acknowledgment is obtained for a petty cash transaction.

Historical Note

New Section R9-10-403 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 19 A.A.R. 3334, effective October 1, 2013 (Supp. 13-4). Amended by exempt rulemaking at 20 A.A.R. 1409, pursuant to Laws 2013, Ch. 10, § 13; effective July 1, 2014 (Supp. 14-2).