Section R9-10-427. Quality Rating

A.      As required in A.R.S. § 36-425.02(A), the Department shall issue a quality rating to each licensed nursing care institution based on the results of a compliance survey.

B.       The following quality ratings are established:

1.        A quality rating of “A” for excellent is issued if the nurs- ing care institution achieves a score of 90 to 100 points,

2.        A quality rating of “B” is issued if the nursing care insti- tution achieves a score of 80 to 89 points,

3.        A quality rating of “C” is issued if the nursing care insti- tution achieves a score of 70 to 79 points, and

4.        A quality rating of “D” is issued if the nursing care insti- tution achieves a score of 69 or fewer points.

C.      The quality rating is determined by the total number of points awarded based on the following criteria:

1.        Nursing Services:

a.         15 points: The nursing care institution is implement- ing a system that ensures residents are provided nursing services to maintain the resident's highest practicable physical, mental, and psychosocial well- being according to the resident's comprehensive assessment and care plan.

b.        5 points: The nursing care institution ensures that each resident is free from medication errors that resulted in actual harm.

c.         5 points: The nursing care institution ensures the res- ident's representative is notified and the resident's attending physician is consulted if a resident has a significant change in condition or if the resident is in an incident that requires medical services.

2.        Resident Rights:

a.         10 points: The nursing care institution is implement- ing a system that ensures a resident's privacy needs are met.

b.        10 points: The nursing care institution ensures that a resident is free from physical and chemical restraints for purposes other than to treat the resident's medical condition.

c.         5 points: The nursing care institution ensures that a resident or the resident's representative is allowed to participate in the planning of, or decisions concern- ing treatment including the right to refuse treatment and to formulate a health care directive.

3.        Administration:

g. 1 point: An employee cleans the employee’s hands after each direct resident contact or when hand cleaning is indicated to prevent the spread of infec- tion.

5.        Food Services:

a.         1 point: The nursing care institution complies with 9

a.	10 points: The nursing care institution has no		A.A.C. 8, Article 1, for food preparation, storage
	repeat deficiencies that resulted in actual harm		and handling as evidenced by a current food estab-
	or immediate jeopardy to residents that were		lishment license.
	cited during the last survey or other survey or	b.	3 points: The nursing care institution provides each
	complaint investigation conducted between the		resident with food that meets the resident's needs as
	last survey and the current survey.		specified in the resident's comprehensive assessment
b.	5 points: The nursing care institution is imple-		and care plan.
	menting a system to prevent abuse of a resident	c.	2 points: The nursing care institution obtains input
	and   misappropriation   of   resident   property,		from each resident or the resident's representative
	investigate each allegation of abuse of a resi-		and implements recommendations for meal planning
	dent and misappropriation of resident's prop-		and  food  choices  consistent  with  the  resident's
	erty, and report each allegation of abuse of a		dietary needs.
	resident  and  misappropriation  of   resident's	d.	2 points: The nursing care institution provides assis-
	property to the Department and as required by		tance to a resident who needs help in eating so that
	A.R.S. § 46-454.		the resident's nutritional, physical, and social needs
c.	5 points: The nursing care institution is imple-		are met.
	menting a quality management program that	e.	1 point: The nursing care institution prepares menus
	addresses nursing care institution services pro-		at least one week in advance, conspicuously posts
	vided to residents, resident complaints, and res-		each  menu,  and   adheres  to  each   planned  menu
	ident concerns, and documents actions taken		unless an uncontrollable situation such as food spoil-
	for response, resolution, or correction of issues		age or non-delivery of a specified food requires sub-
	about nursing care institution services provided		stitution.
	to residents, resident complaints, and resident	f.	1 point: The nursing care institution provides food
	concerns.		substitution of similar nutritive value for residents
d.	1 point: The nursing care institution is imple-		who refuse the food served or who request a substi-
	menting a system to provide social services and		tution.

a program of ongoing recreational activities to meet the resident's needs based on the resident's comprehensive assessment.

e.         1 point: The nursing care institution is imple- menting a system to ensure that records docu- menting freedom from infectious pulmonary tuberculosis are maintained for each personnel member, volunteer, and resident.

f.         2 points: The nursing care institution is imple- menting a system to ensure that a resident is free from unnecessary drugs.

g.        1 point: The nursing care institution is imple- menting a system to ensure a personnel mem- ber attends in-service education according to policies and procedures.

4.        Environment and Infection Control:

a.         5 points: The nursing care institution environment is free from a condition or situation within the nursing care institution's control that may cause a resident injury.

b.        1 point: The nursing care institution establishes and maintains a pest control program.

c.         1 point: The nursing care institution develops a writ- ten disaster plan that includes procedures for pro- tecting the health and safety of residents.

d.        1 point: The nursing care institution ensures orienta- tion to the disaster plan for each personnel member is completed within the first scheduled week of employment.

e.         1 point: The nursing care institution maintains a clean and sanitary environment.

f.         5 points: The nursing care institution is implement- ing a system to prevent and control infection.

D.      A nursing care institution's quality rating remains in effect until a survey is conducted by the Department for the next renewal period except as provided in subsection (E).

E.       If the Department issues a provisional license, the current quality rating is terminated. A provisional licensee may submit an application for a substantial compliance survey. If the Department determines that, as a result of a substantial com- pliance survey, the nursing care institution is in substantial compliance, the Department shall issue a new quality rating according to subsection (C).

F.       The issuance of a quality rating does not preclude the Depart- ment from seeking a civil penalty as provided in A.R.S. § 36- 431.01, or suspension or revocation of a license as provided in

A.R.S. § 36-427.

Historical Note

Adopted effective January 28, 1980 (Supp. 80-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-427 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; effec- tive July 1, 2014 (Supp. 14-2).