Arizona Secretary of State - Ken Bennett


 
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Supp. 13-4
RULE INTERPRETATION:
The Office of the Secretary of State does not interpret or enforce rules in the Administrative Code. Questions should be directed to the state agency responsible for the promulgation of the rule as provided:
Name: Cara Christ, M.D., Assistant Director
Address: Arizona Department of Health Services
Division of Licensing Services
150 N. 18th Ave., Suite 510
Phoenix, AZ 85007-3248
Telephone: (602) 364-3064

TITLE 9. HEALTH SERVICES

CHAPTER 10. DEPARTMENT OF HEALTH SERVICES
HEALTH CARE INSTITUTIONS: LICENSING

Editor’s Note: The heading for 9 A.A.C. 10 changed from “Licensure” to “Licensing” per a request from the Department of Health Services (Supp. 03-4).

Editor’s Note: The Office of the Secretary of State publishes all Chapters on white paper (Supp. 01-2).

Editor’s Note: This Chapter contains rules which were adopted, amended, and repealed under exemptions from the provisions of the Administrative Procedure Act (A.R.S. Title 41, Chapter 6) pursuant to Laws 1993, Ch. 163, § 3(B); Laws 1996, Ch. 329, § 5; Laws 1998, Ch. 178 § 17, and Laws 1999, Ch. 311. Exemption from A.R.S. Title 41, Chapter 6 means that the Department of Health Services did not submit these rules to the Governor’s Regulatory Review Council for review; the Department may not have submitted notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; the Department was not required to hold public hearings on these rules; and the Attorney General did not certify these rules. Because this Chapter contains rules which are exempt from the regular rulemaking process, the Chapter is printed on blue paper.

ARTICLE 1. GENERAL

Section

R9-10-101. Definitions

R9-10-102. Health Care Institution Classes and Subclasses; Requirements

R9-10-103. Licensure Exceptions

R9-10-104. Approval of Architectural Plans and Specifications

R9-10-105. Initial License Application

R9-10-106. Fees

R9-10-107. Renewal License Application

R9-10-108. Time-frames

R9-10-109. Changes Affecting a License

R9-10-110. Enforcement Actions

R9-10-111. Denial, Revocation, or Suspension of License

R9-10-112. Tuberculosis Screening

R9-10-113. Clinical Practice Restrictions for Hemodialysis Technician Trainees

R9-10-114. Behavioral Health Paraprofessionals; Behavioral Health Technicians

R9-10-115. Nutrition and Feeding Assistant Training Programs

R9-10-116. Counseling Facilities

R9-10-117. Collaborating Health Care Institutions

R9-10-118. Reserved

R9-10-119. Reserved

R9-10-120. Reserved

R9-10-121. Repealed

R9-10-122. Renumbered

R9-10-123. Repealed

R9-10-124. Repealed

ARTICLE 2. HOSPITALS

Article 2, consisting of Sections R9-10-201 through R9-10-233, adopted effective February 23, 1979.

Former Article 2, consisting of Sections R9-10-201 through R9-10-250, renumbered as Sections R9-10-301 through R9-10-335 as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days.

Section

R9-10-201. Definitions

R9-10-202. Supplemental Application Requirements

R9-10-203. Administration

R9-10-204. Quality Management

R9-10-205. Contracted Services

R9-10-206. Personnel

R9-10-207. Medical Staff

R9-10-208. Admissions

R9-10-209. Discharge Planning; Discharge

R9-10-210. Transport

R9-10-211. Transfer

R9-10-212. Patient Rights

R9-10-213. Medical Records

R9-10-214. Nursing Services

R9-10-215. Surgical Services

R9-10-216. Anesthesia Services

R9-10-217. Emergency Services

R9-10-218. Pharmaceutical Services

R9-10-219. Clinical Laboratory Services and Pathology Services

R9-10-220. Radiology Services and Diagnostic Imaging Services

R9-10-221. Intensive Care Services

R9-10-222. Respiratory Care Services

R9-10-223. Perinatal Services

R9-10-224. Pediatric Services

R9-10-225. Psychiatric Services

R9-10-226. Behavioral Health Observation/Stabilization Services

R9-10-227. Rehabilitation Services

R9-10-228. Multi-organized Service Unit

R9-10-229. Social Services

R9-10-230. Infection Control

R9-10-231. Dietary Services

R9-10-232. Disaster Management

R9-10-233. Environmental Standards

R9-10-234. Physical Plant Standards

ARTICLE 3. BEHAVIORAL HEALTH INPATIENT FACILITIES

Article 3, consisting of Sections R9-10-311 through R9-10-333, repealed at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

Article 3, consisting of Sections R9-10-301 through R9-10-333, adopted effective February 4, 1981.

Former Article 3, consisting of Sections R9-10-301 through R9-10-335, repealed effective February 4, 1981.

Section

R9-10-301. Definitions

R9-10-302. Supplemental Application Requirements

R9-10-303. Administration

R9-10-304. Quality Management

R9-10-305. Contracted Services

R9-10-306. Personnel

R9-10-307. Admissions; Assessment

R9-10-308. Treatment Plan

R9-10-309. Discharge

R9-10-310. Transport; Transfer

R9-10-311. Patient Rights

R9-10-312. Medical Records

R9-10-313. Patient Outings

R9-10-314. Physical Health Services

R9-10-315. Behavioral Health Services

R9-10-316. Restraint and Seclusion

R9-10-317. Behavioral Health Observation/Stabilization Services

R9-10-318. Detoxification Services

R9-10-319. Medication Services

R9-10-320. Food Services

R9-10-321. Emergency and Safety Standards

R9-10-322. Environmental Standards

R9-10-323. Physical Plant Standards

ARTICLE 4. NURSING CARE INSTITUTIONS

Article 4, consisting of Sections R9-10-411 through R9-10-438, repealed at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

Section

R9-10-401. Definitions

R9-10-402. Supplemental Application Requirements

R9-10-403. Administration

R9-10-404. Quality Management

R9-10-405. Contracted Services

R9-10-406. Personnel

R9-10-407. Admissions

R9-10-408. Discharge

R9-10-409. Transport; Transfer

R9-10-410. Resident Rights

R9-10-411. Medical Records

R9-10-412. Nursing Services

R9-10-413. Medical Services

R9-10-414. Comprehensive Assessment; Care Plan

R9-10-415. Behavioral Health Services

R9-10-416. Clinical Laboratory Services

R9-10-417. Dialysis Services

R9-10-418. Radiology Services and Diagnostic Imaging Services

R9-10-419. Respiratory Care Services

R9-10-420. Rehabilitation Services

R9-10-421. Medication Services

R9-10-422. Infection Control

R9-10-423. Food Services

R9-10-424. Emergency and Safety Standards

R9-10-425. Environmental Standards

R9-10-426. Physical Plant Standards

R9-10-427. Quality Rating

R9-10-428. Repealed

R9-10-429. Repealed

R9-10-430. Repealed

R9-10-431. Repealed

R9-10-432. Repealed

R9-10-433. Repealed

R9-10-434. Repealed

R9-10-435. Repealed

R9-10-436. Repealed

R9-10-437. Repealed

R9-10-438. Repealed

R9-10-439. Repealed

ARTICLE 5. RECOVERY CARE CENTERS

Article 5, consisting of Sections R9-10-501 through R9-10-514, adopted effective April 4, 1994 (Supp. 94-2).

Article 5, consisting of Sections R9-10-501 through R9-10-518, repealed effective April 4, 1994 (Supp. 94-2).

Article 5, consisting of Sections R9-10-501 through R9-10-518, adopted as permanent rules effective October 30, 1989.

Article 5, consisting of Sections R9-10-501 through R9-10-518, readopted as an emergency effective July 31, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

Article 5, consisting of Sections R9-10-501 through R9-10-518, readopted as an emergency effective April 27, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

Article 5, consisting of Sections R9-10-501 through R9-10-518, readopted as an emergency effective January 27, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

New Article 5, consisting of Sections R9-10-501 through R9-10-518, adopted as an emergency effective October 26, 1988 pursuant to A.R.S. § 41-1026, valid for only 90 days. Emergency expired.

Former Article 5, consisting of Sections R9-10-501 through R9-10-574, repealed effective October 20, 1982.

Section

R9-10-501. Definitions

R9-10-502. Administration

R9-10-503. Quality Management

R9-10-504. Contracted Services

R9-10-505. Personnel

R9-10-506. Medical Staff

R9-10-507. Admissions

R9-10-508. Discharge

R9-10-509. Transfer

R9-10-510. Patient Rights

R9-10-511. Medical Records

R9-10-512. Nursing Services

R9-10-513. Medication Services

R9-10-514. Ancillary Services

R9-10-515. Food Services

R9-10-516. Emergency and Safety Standards

R9-10-517. Environmental Standards

R9-10-518. Physical Plant Standards

ARTICLE 6. HOSPICES

Article 6, consisting of Sections R9-10-601 through R9-10-618, made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Article 6, consisting of Sections R9-10-611 through R9-10-624, repealed effective November 1, 1998, under an exemption from the Administrative Procedure Act; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Section

R9-10-601. Definitions

R9-10-602. Supplemental Application Requirements

R9-10-603. Administration

R9-10-604. Quality Management

R9-10-605. Contracted Services

R9-10-606. Personnel

R9-10-607. Admissions

R9-10-608. Transfer

R9-10-609. Patient Rights

R9-10-610. Medical Records

R9-10-611. Care Plan

R9-10-612. Hospice Services

R9-10-613. Medication Services

R9-10-614. Infection Control

R9-10-615. Food Services for a Hospice Inpatient Facility

R9-10-616. Emergency and Safety Standards for a Hospice Inpatient Facility

R9-10-617. Environmental Standards for a Hospice Inpatient Facility

R9-10-618. Physical Plant Standards for a Hospice Inpatient Facility

ARTICLE 7. BEHAVIORAL HEALTH RESIDENTIAL FACILITIES

Article 7, consisting of Sections R9-10-701 through R9-7-710, repealed; New Article 7, consisting of Sections R9-10-701 through R9-7-724 adopted; both actions effective November 1, 1998 under an exemption from the Administrative Procedure Act; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Article 7, consisting of Sections R9-10-701 through R9-10-710, adopted as permanent rules effective October 30, 1989.

Article 7, consisting of Sections R9-10-701 through R9-10-710, readopted as an emergency effective July 31, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

Article 7, consisting of Sections R9-10-701 through R9-10-710, readopted as an emergency effective April 27, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

Article 7, consisting of Sections R9-10-701 through R9-10-710, readopted as an emergency effective January 27, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

New Article 7, consisting of Sections R9-10-701 through R9-10-710, adopted as an emergency effective October 26, 1988 pursuant to A.R.S. § 41-1026, valid for only 90 days. Emergency expired.

Former Article 7, consisting of Sections R9-10-701 through R9-10-737, repealed effective October 20, 1982.

Section

R9-10-701. Definitions

R9-10-702. Supplemental Application Requirements

R9-10-703. Administration

R9-10-704. Quality Management

R9-10-705. Contracted Services

R9-10-706. Personnel

R9-10-707. Admission; Assessment

R9-10-708. Treatment Plan

R9-10-709. Discharge

R9-10-710. Transport; Transfer

R9-10-711. Resident Rights

R9-10-712. Medical Records

R9-10-713. Resident Outings

R9-10-714. Resident Time Out

R9-10-715. Physical Health Services

R9-10-716. Behavioral Health Services

R9-10-717. Outdoor Behavioral Health Care Programs

R9-10-718. Medication Services

R9-10-719. Food Services

R9-10-720. Emergency and Safety Standards

R9-10-721. Environmental Standards

R9-10-722. Physical Plant Standards

R9-10-723. Repealed

R9-10-724. Repealed

ARTICLE 8. ASSISTED LIVING FACILITIES

Article 8 (Sections R9-10-801 through R9-10-812) adopted as permanent rules effective October 30, 1989.

Article 8, consisting of Sections R9-10-801 through R9-10-812, readopted as an emergency effective July 31, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

Article 8, consisting of Sections R9-10-801 through R9-10-812, readopted as an emergency effective April 27, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

Article 8, consisting of Sections R9-10-801 through R9-10-812, readopted as an emergency effective January 27, 1989 pursuant to A.R.S. § 41-1026, valid for only 90 days.

New Article 8, consisting of Sections R9-10-801 through R9-10-812, adopted as an emergency effective October 26, 1988 pursuant to A.R.S. § 41-1026, valid for only 90 days. Emergency expired.

Former Article 8, consisting of Sections R9-10-801 through R9-10-867, repealed effective October 20, 1982.

Section

R9-10-801. Definitions

R9-10-802. Supplemental Application Requirements

R9-10-803. Administration

R9-10-804. Quality Management

R9-10-805. Contracted Services

R9-10-806. Personnel

R9-10-807. Residency and Residency Agreements

R9-10-808. Service Plans

R9-10-809. Transport; Transfer

R9-10-810. Resident Rights

R9-10-811. Medical Records

R9-10-812. Behavioral Care

R9-10-813. Behavioral Health Services

R9-10-814. Personal Care Services

R9-10-815. Directed Care Services

R9-10-816. Medication Services

R9-10-817. Food Services

R9-10-818. Emergency and Safety Standards

R9-10-819. Environmental Standards

R9-10-820. Physical Plant Standards

ARTICLE 9. OUTPATIENT SURGICAL CENTERS

Article 9, consisting of Sections R9-10-901 through R9-10-917 adopted effective February 17, 1995 (Supp. 95-1).

Article 9, consisting of Sections R9-10-911 through R9-10-925, repealed effective February 17, 1995 (Supp. 95-1).

Article 9, consisting of Sections R9-10-911 through R9-10-925, adopted effective October 20, 1982 (Supp. 82-5).

Section

R9-10-901. Definitions

R9-10-902. Administration

R9-10-903. Quality Management

R9-10-904. Contracted Services

R9-10-905. Personnel

R9-10-906. Medical Staff

R9-10-907. Admission

R9-10-908. Transfer

R9-10-909. Patient Rights

R9-10-910. Medical Records

R9-10-911. Surgical Services

R9-10-912. Nursing Services

R9-10-913. Behavioral Health Services

R9-10-914. Medication Services

R9-10-915. Infection Control

R9-10-916. Emergency and Safety Standards

R9-10-917. Environmental Standards

R9-10-918. Physical Plant Standards

R9-10-919. Repealed

R9-10-920. Repealed

R9-10-921. Repealed

R9-10-922. Repealed

R9-10-923. Repealed

R9-10-924. Repealed

R9-10-925. Repealed

Attachment 1. Repealed

Attachment 2. Repealed

ARTICLE 10. OUTPATIENT TREATMENT CENTERS SECTION

Article 10, consisting of Sections R9-10-1001 through R9-10-1017, made new by final rulemaking at 14 A.A.R. 294, effective March 8, 2008 (Supp. 08-1).

Article 10, consisting of Sections R9-10-1011 through R9-10-1030, repealed by final rulemaking at 5 A.A.R. 1222, effective April 5, 1999 (Supp. 99-2).

The proposed summary action repealing R9-10-1011 through R9-10-1030 was remanded by the Governor’s Regulatory Review Council which revoked the interim effectiveness of the summary rules. Sections in effect before the proposed summary action have been restored (Supp. 97-1).

Article 10, consisting of R9-10-1011 through R9-10-1030, repealed by summary action, interim effective date of July 21, 1995.

Section

R9-10-1001. Definitions

R9-10-1002. Supplemental Application Requirements

R9-10-1003. Administration

R9-10-1004. Quality Management

R9-10-1005. Contracted Services

R9-10-1006. Personnel

R9-10-1007. Transport; Transfer

R9-10-1008. Patient Rights

R9-10-1009. Medical Records

R9-10-1010. Medication Services

R9-10-1011. Behavioral Health Services

R9-10-1012. Behavioral Health Observation/Stabilization Services

R9-10-1013. Court-ordered Evaluation

R9-10-1014. Court-ordered Treatment

R9-10-1015. Clinical Laboratory Services

R9-10-1016. Crisis Services

R9-10-1017. Diagnostic Imaging Services

R9-10-1018. Dialysis Services

R9-10-1019. Emergency Room Services

R9-10-1020. Opioid Treatment Services

R9-10-1021. Pain Management Services

R9-10-1022. Physical Health Services

R9-10-1023. Pre-petition Screening

R9-10-1024. Rehabilitation Services

R9-10-1025. Respite Services

R9-10-1026. Sleep Disorder Services

R9-10-1027. Urgent Care Services Provided in a Freestanding Urgent Care Setting

R9-10-1028. Infection Control

R9-10-1029. Emergency and Safety Standards

R9-10-1030. Physical Plant, Environmental Services, and Equipment Standards

ARTICLE 11. ADULT DAY HEALTH CARE FACILITIES

Article 11, consisting of Sections R9-10-1101 through R9-10-1109 adopted effective July 22, 1994 (Supp. 94-3).

Article 11, consisting of Sections R9-10-1111 through R9-10-1127 repealed effective July 22, 1994 (Supp. 94-3).

Section

R9-10-1101. Definitions

R9-10-1102. Administration

R9-10-1103. Quality Management

R9-10-1104. Contracted Services

R9-10-1105. Personnel

R9-10-1106. Enrollment

R9-10-1107. Care Plan

R9-10-1108. Discharge

R9-10-1109. Participant Rights

R9-10-1110. Medical Records

R9-10-1111. Participant’s Council

R9-10-1112. Adult Day Health Services

R9-10-1113. Food Services

R9-10-1114. Emergency and Safety Standards

R9-10-1115. Environmental Standards

R9-10-1116. Physical Plant Standards

R9-10-1117. Repealed

R9-10-1118. Repealed

R9-10-1119. Repealed

R9-10-1120. Repealed

R9-10-1121. Repealed

R9-10-1122. Repealed

R9-10-1123. Repealed

R9-10-1124. Repealed

R9-10-1125. Repealed

R9-10-1126. Repealed

R9-10-1127. Repealed

ARTICLE 12. HOME HEALTH AGENCIES

Article 12, consisting of Sections R9-10-1201 through R9-10-1230, repealed by final rulemaking at 8 A.A.R. 3721, effective August 9, 2002 (Supp. 02-3).

Article 12, consisting of Sections R9-10-1201 through R9-10-1230, adopted effective February 4, 1981.

Section

R9-10-1201. Definitions

R9-10-1202. Supplemental Application Requirements

R9-10-1203. Administration

R9-10-1204. Quality Management

R9-10-1205. Contracted Services

R9-10-1206. Personnel

R9-10-1207. Care Plan

R9-10-1208. Patient Rights

R9-10-1209. Medical Records

R9-10-1210. Home Health Services

R9-10-1211. Supportive Services

R9-10-1212. Repealed

R9-10-1213. Repealed

R9-10-1214. Repealed

R9-10-1215. Repealed

R9-10-1216. Repealed

R9-10-1217. Repealed

R9-10-1218. Repealed

R9-10-1219. Repealed

R9-10-1220. Repealed

R9-10-1221. Repealed

R9-10-1222. Repealed

R9-10-1223. Repealed

R9-10-1224. Repealed

R9-10-1225. Reserved

R9-10-1226. Repealed

R9-10-1227. Repealed

R9-10-1228. Repealed

R9-10-1229. Reserved

R9-10-1230. Repealed

ARTICLE 13. BEHAVIORAL HEALTH SPECIALIZED TRANSITIONAL FACILITY

New Article 13, consisting of Sections R9-10-1301 through R9-10-1317, made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Article 13, consisting of Sections R9-10-1301 through R9-10-1314, repealed effective November 1, 1998, under an exemption from the Administrative Procedure Act; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Article 13, consisting of Sections R9-10-1301 through R9-10-1314, adopted as permanent rules effective November 25, 1992 (Supp. 92-4).

Article 13, consisting of Sections R9-10-1301 through R9-10-1314, adopted again as an emergency effective August 27, 1992, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 92-3).

Article 13, consisting of Sections R9-10-1301 through R9-10-1314, adopted again as an emergency effective May 28, 1992, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 92-2).

Article 13, consisting of Sections R9-10-1301 through R9-10-1314, adopted again as an emergency effective February 28, 1992, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 92-1).

Article 13, consisting of Sections R9-10-1301 through R9-10-1314, adopted as an emergency effective November 29, 1991, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 91-4).

Article 13, consisting of Sections R9-10-1301 through R9-10-1306, adopted as an emergency effective March 29, 1990, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 90-1). Emergency expired.

Section

R9-10-1301. Definitions

R9-10-1302. Administration

R9-10-1303. Quality Management

R9-10-1304. Contracted Services

R9-10-1305. Personnel Requirements and Records

R9-10-1306. Admission Requirements

R9-10-1307. Discharge or Conditional Release to a Less Restrictive Alternative

R9-10-1308. Transport

R9-10-1309. Patient Rights

R9-10-1310. Behavioral Health Services

R9-10-1311. Ancillary Services

R9-10-1312. Patient Records

R9-10-1313. Medication Services

R9-10-1314. Food Services

R9-10-1315. Emergency and Safety Standards

R9-10-1316. Environmental Standards

R9-10-1317. Physical Plant Standards

ARTICLE 14. SUBSTANCE ABUSE TRANSITIONAL FACILITIES

Article 14, consisting of Sections R9-10-1401 through R9-10-1412, adopted effective February 1, 1994 (Supp. 94-1).

Section

R9-10-1401. Definitions

R9-10-1402. Supplemental Application Requirements

R9-10-1403. Administration

R9-10-1404. Quality Management

R9-10-1405. Contracted Services

R9-10-1406. Personnel

R9-10-1407. Admission; Assessment

R9-10-1408. Discharge

R9-10-1409. Transfer

R9-10-1410. Participant Rights

R9-10-1411. Medical Records

R9-10-1412. Behavioral Health Services

R9-10-1413. Medication Services

R9-10-1414. Food Services

R9-10-1415. Emergency and Safety Standards

R9-10-1416. Environmental Standards

R9-10-1417. Physical Plant Standards

ARTICLE 15. ABORTION CLINICS

Article 15, consisting of Sections R9-10-1501 through R9-10-1514, adopted under an exemption from the Arizona Administrative Procedure Act pursuant to Laws 1999, Chapter 311, filed in the Office of the Secretary of State December 23, 1999 (Supp. 99-4).

Article 15, consisting of Sections R9-10-1501 through R9-10-1514, repealed effective November 1, 1998, under an exemption from the Administrative Procedure Act; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Section

R9-10-1501. Definitions

R9-10-1502. Application Requirements

Exhibit A. Repealed

R9-10-1503. Administration

R9-10-1504. Incident Reporting

R9-10-1505. Personnel Qualifications and Records

R9-10-1506. Staffing Requirements

R9-10-1507. Patient Rights

R9-10-1508. Abortion Procedures

R9-10-1509. Patient Transfer and Discharge

R9-10-1510. Medications and Controlled Substances

R9-10-1511. Medical Records

R9-10-1512. Environmental and Safety Standards

R9-10-1513. Equipment Standards

R9-10-1514. Physical Facilities

ARTICLE 16. BEHAVIORAL HEALTH SUPPORTIVE HOMES

Article 16, consisting of Sections R9-10-1601 through R9-10-1611, made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Section

R9-10-1601. Definitions

R9-10-1602. Administration

R9-10-1603. Resident Rights

R9-10-1604. Providing Services

R9-10-1605. Assistance in the Self-Administration of Medication

R9-10-1606. Resident Records

R9-10-1607. Food Services

R9-10-1608. Emergency and Safety Standards

R9-10-1609. Environmental Standards

R9-10-1610. Adult Behavioral Health Therapeutic Homes

R9-10-1611. Children’s Behavioral Health Respite Homes

ARTICLE 17. UNCLASSIFIED HEALTH CARE INSTITUTIONS

Article 17, consisting of Sections R9-10-1701 through R9-10-1713, adopted effective July 6, 1994 (Supp. 94-3).

Article 17, consisting of Sections R9-10-1711 through R9-10-1713, R9-10-1715 through R9-10-1723, and R9-10-1731 through R9-10-1734, repealed effective July 6, 1994 (Supp. 94-3).

Section

R9-10-1701. Definitions

R9-10-1702. Administration

R9-10-1703. Quality Management

R9-10-1704. Contracted Services

R9-10-1705. Personnel

R9-10-1706. Transport; Transfer

R9-10-1707. Patient Rights

R9-10-1708. Medical Records

R9-10-1709. Medication Services

R9-10-1710. Food Services

R9-10-1711. Emergency and Safety Standards

R9-10-1712. Physical Plant, Environmental Services, and Equipment Standards

R9-10-1713. Repealed

R9-10-1714. Reserved

R9-10-1715. Repealed

R9-10-1716. Repealed

R9-10-1717. Repealed

R9-10-1718. Repealed

R9-10-1719. Repealed

R9-10-1720. Repealed

R9-10-1721. Repealed

R9-10-1722. Repealed

R9-10-1723. Repealed

R9-10-1724. Reserved

R9-10-1725. Reserved

R9-10-1726. Reserved

R9-10-1727. Reserved

R9-10-1728. Reserved

R9-10-1729. Reserved

R9-10-1730. Reserved

R9-10-1731. Repealed

R9-10-1732. Repealed

R9-10-1733. Repealed

R9-10-1734. Repealed

ARTICLE 1. GENERAL

R9-10-101. Definitions

In addition to the definitions in A.R.S. § 36-401(A), the following definitions apply in this Chapter unless otherwise specified:

1. “Abuse” means:

a. The same:

i. For an adult, as in A.R.S. § 46-451; and

ii. For a child, as in A.R.S. § 8-201;

b. A pattern of ridiculing or demeaning a patient;

c. Making derogatory remarks or verbally harassing a patient; or

d. Threatening to inflict physical harm on a patient.

2. “Accredited” has the same meaning as in A.R.S. § 36-422.

3. “Activities of daily living” means ambulating, bathing, toileting, grooming, eating, and getting in or out of a bed or a chair.

4. “Adjacent” means not intersected by:

a. Property owned, operated, or controlled by a person other than the applicant or licensee; or

b. A public thoroughfare.

5. “Administrative completeness review time-frame” has the same meaning as in A.R.S. § 41-1072.

6. “Administrative office” means a location used by personnel for recordkeeping and record retention but not for providing medical services, nursing services, or health-related services.

7. “Admission” means, after completion of an individual’s screening or registration by a health care institution, the individual begins receiving physical health services or behavioral health services and is accepted as a patient of the health care institution.

8. “Adult” has the same meaning as in A.R.S. § 1-215.

9. “Adult behavioral health therapeutic home” means a behavioral health supportive home that provides room and board, assists an individual 18 years of age or older in acquiring daily living skills, coordinates transportation to scheduled appointments, monitors behaviors, assists in the self-administration of medication, and provides feedback to a case manager related to behavior for the individual based on the individual’s behavioral health issue and need for behavioral health services.

10. “Adverse reaction” means an unexpected outcome that threatens the health or safety of a patient as a result of a medical service, nursing service, or health-related service provided to the patient.

11. “Ancillary services” means services other than medical services, nursing services, or health-related services provided to a patient.

12. “Anesthesiologist” means a physician granted clinical privileges to administer anesthesia.

13. “Applicant” means a governing authority requesting:

a. Approval of a health care institution’s architectural plans and specifications, or

b. A health care institution license.

14. “Application packet” means the information, documents, and fees required by the Department for the:

a. Approval of a health care institution's modification or construction, or

b. Licensure of a health care institution.

15. “Assessment” means an analysis of a patient’s need for physical health services or behavioral health services to determine which services a health care institution will provide to the patient.

16. “Assistance in the self-administration of medication” means restricting a patient’s access to the patient’s medication and providing support to the patient while the patient takes the medication to ensure that the medication is taken as ordered.

17. “Attending physician” means a physician designated by a patient to participate in or coordinate the medical services provided to the patient.

18. “Authenticate” means to establish authorship of a document or an entry in a medical record by:

a. A written signature;

b. An individual's initials, if the individual's written signature appears on the document or in the medical record;

c. A rubber-stamp signature; or

d. An electronic signature code.

19. “Available” means:

a. For an individual, the ability to be contacted and to provide an immediate response by any means possible;

b. For equipment and supplies, physically retrievable at a health care institution; and

c. For a document, retrievable a health care institution or accessible according to the applicable time-frames in this Chapter.

20. “Behavioral health facility” means a behavioral health inpatient facility, a behavioral health residential facility, a substance abuse transitional facility, a behavioral health specialized transitional facility, an outpatient treatment center that provides only behavioral health services, or a behavioral health supportive home.

21. “Behavioral health inpatient facility” means a health care institution that provides continuous treatment to an individual experiencing a behavioral health issue that causes the individual to:

a. Have a limited or reduced ability to meet the individual's basic physical needs;

b. Suffer harm that significantly impairs the individual’s judgment, reason, behavior, or capacity to recognize reality;

c. Be a danger to self;

d. Be a danger to others;

e. Be persistently or acutely disabled as defined in A.R.S. § 36-501; or

f. Be gravely disabled.

22. “Behavioral health issue” means an individual's condition related to a mental disorder, a personality disorder, substance abuse, or a significant psychological or behavioral response to an identifiable stressor or stressors.

23. “Behavioral health observation/stabilization services” means crisis services provided, in an outpatient setting, to an individual whose behavior or condition indicates that the individual:

a. Requires nursing services,

b. May require medical services, and

c. May be a danger to others or a danger to self.

24. “Behavioral health paraprofessional” means an individual who is not a behavioral health professional who provides behavioral health services at or for a health care institution according to the health care institution’s policies and procedures that:

a. If the behavioral health services were provided in a setting other than a licensed health care institution, the individual would be required to be licensed as a behavioral professional under A.R.S. Title 32, Chapter 33; and

b. Are provided under supervision by a behavioral health professional.

25. “Behavioral health professional” means an individual licensed under A.R.S. Title 32 whose scope of practice allows the individual to:

a. Independently engage in the practice of behavioral health as defined in A.R.S. § 32-3251; or

b. Except for a licensed substance abuse technician, engage in the practice of behavioral health as defined in A.R.S. § 32-3251 under direct supervision as defined in A.A.C. R4-6-101.

26. “Behavioral health residential facility” means a health care institution that provides treatment to an individual experiencing a behavioral health issue that:

a. Limits the individual’s ability to be independent, or

b. Causes the individual to require treatment to maintain or enhance independence.

27. “Behavioral health services” means medical services, nursing services, health-related services, or ancillary services provided to an individual to address the individual's behavioral health issue.

28. “Behavioral health specialized transitional facility” means a health care institution that provides behavioral health services and physical health services to an individual determined to be a sexually violent person according to A.R.S. Title 36, Chapter 37.

29. “Behavioral health supportive home” means an adult behavioral health therapeutic home or a children’s behavioral health respite home.

30. “Behavioral health technician” means an individual who is not a behavioral health professional who provides behavioral health services at or for a health care institution according to the health care institution’s policies and procedures that:

a. If the behavioral health services were provided in a setting other than a licensed health care institution, the individual would be required to be licensed as a behavioral professional under A.R.S. Title 32, Chapter 33; and

b. Are provided with clinical oversight by a behavioral health professional.

31. “Biohazardous medical waste” has the same meaning as in A.A.C. R18-13-1401.

32. “Calendar day” means each day, not including the day of the act, event, or default from which a designated period of time begins to run, but including the last day of the period unless it is a Saturday, Sunday, statewide furlough day, or legal holiday, in which case the period runs until the end of the next day that is not a Saturday, Sunday, statewide furlough day, or legal holiday.

33. “Case manager” means an individual assigned by an entity other than a health care institution to coordinate the physical health services or behavioral health services provided to a patient at the health care institution.

34. “Certification” means, in this Article, a written statement that an item or a system complies with the applicable requirements incorporated by reference in A.A.C. R9-1-412.

35. “Certified health physicist” means an individual recognized by the American Board of Health Physics as complying with the health physics criteria and examination requirements established by the American Board of Health Physics.

36. “Change in ownership” means conveyance of the ability to appoint, elect, or otherwise designate a health care institution's governing authority from an owner of the health care institution to another person.

37. “Chief administrative officer” or “administrator” means an individual designated by a governing authority to implement the governing authority's direction in a health care institution.

38. “Children’s behavioral health respite home” means a behavioral health supportive home where respite services are provided to an individual under 18 years of age based on the individual’s behavioral health issue and need for behavioral health services and includes assistance in the self-administration of medication.

39. “Clinical laboratory services” means the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of a disease or impairment of a human being, or for the assessment of the health of a human being, including procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body.

40. “Clinical oversight” means:

a. Monitoring the behavioral health services provided by a behavioral health technician to ensure that the behavioral health technician is providing the behavioral health services according to the health care institution's policies and procedures,

b. Providing on-going review of a behavioral health technician's skills and knowledge related to the provision of behavioral health services,

c. Providing guidance to improve a behavioral health technician's skills and knowledge related to the provision of behavioral health services, and

d. Recommending training for a behavior health technician to improve the behavioral health technician's skills and knowledge related to the provision of behavioral health services.

41. “Clinical privileges” means authorization to a medical staff member to provide medical services, granted by a governing authority or according to medical staff bylaws.

42. “Collaborating health care institution” means a health care institution licensed to provide behavioral health services that has a written agreement with a provider to:

a. Coordinate behavioral health services provided to a resident, and

b. Work with the provider to ensure a resident receives behavioral health services according to the resident’s assessment or treatment plan.

43. “Communicable disease” has the same meaning as in A.R.S. § 36-661.

44. “Conspicuously posted” means placed at a location that is visible and accessible within the area where the public enters the premises of a health care institution.

45. “Consultation” means an evaluation of a patient requested by a medical staff member or personnel member.

46. “Contracted services” means medical services, nursing services, health-related services, ancillary services, or environmental services provided according to a documented agreement between a health care institution and the person providing the medical services, nursing services, health-related services, ancillary services, or environmental services.

47. “Contractor” has the same meaning as in A.R.S. § 32-1101.

48. “Controlled substance” has the same meaning as in A.R.S. § 36-2501.

49. “Counseling” has the same meaning as “practice of professional counseling” in A.R.S. § 32-3251.

50. “Counseling facility” means an outpatient treatment center that only provides and was licensed before October 1, 2013 to provide one or more of the following services:

a. Counseling;

b. DUI screening, education, or treatment according to the requirements in 9 A.A.C. 20, Article 1; or

c. Misdemeanor domestic violence offender treatment according to the requirements in 9 A.A.C. 20, Article 2.

51. “Court-ordered evaluation” has the same meaning as “evaluation” in A.R.S. § 36-501.

52. “Court-ordered pre-petition screening” has the same meaning as in A.R.S. § 36-501.

53. “Court-ordered treatment” means treatment provided according to A.R.S. Title 36, Chapter 5.

54. “Crisis services” means immediate and unscheduled behavioral health services provided to a patient to address an acute behavioral health issue affecting the patient.

55. “Current” means up-to-date, extending to the present time.

56. “Daily living skills” means activities necessary for an individual to live independently and include meal preparation, laundry, housecleaning, home maintenance, money management, and appropriate social interactions.

57. “Danger to others” has the same meaning as in A.R.S. § 36-501.

58. “Danger to self” has the same meaning as in A.R.S. § 36-501.

59. “Detoxification services” means behavioral health services and medical services provided to an individual to:

a. Reduce or eliminate the individual's dependence on alcohol or other drugs, or

b. Provide treatment for the individual's signs or symptoms of withdrawal from alcohol or other drugs.

60. “Diagnostic procedure” means a method or process performed to determine whether an individual has a medical condition or behavioral health issue.

61. “Dialyzer” means an apparatus containing semi-permeable membranes used as a filter to remove wastes and excess fluid from a patient's blood.

62. “Disaster” means an unexpected occurrence that adversely affects a health care institution’s ability to provide services.

63. “Discharge” means a documented termination of services to a patient by a health care institution.

64. “Discharge instructions” means documented information relevant to a patient’s medical condition or behavioral health issue provided by a health care institution to the patient or the patient’s representative at the time of the patient’s discharge.

65. “Discharge planning” means a process of establishing goals and objectives for a patient or resident in preparation for the patient’s or resident’s discharge.

66. “Discharge summary” means a documented brief review of services provided to a patient, current patient status, and reasons for the patient’s discharge.

67. “Disinfect” means to clean in order to prevent the growth of or to destroy disease-causing microorganisms.

68. “Documentation” or “documented” means information in written, photographic, electronic, or other permanent form.

69. “Drill” means a response to a planned, simulated event.

70. “Drug” has the same meaning as in A.R.S. § 32-1901.

71. “Electronic” has the same meaning as in A.R.S. § 44-7002.

72. “Electronic signature” has the same meaning as in A.R.S. § 44-7002.

73. “Emergency” means an immediate threat to the life or health of a patient.

74. “Emergency medical services provider” has the same meaning as in A.R.S. § 36-2201.

75. “Environmental services” means activities such as housekeeping, laundry, facility maintenance, or equipment maintenance.

76. “Equipment” means, in this Article, an apparatus, a device, a machine, or a unit that is required to comply with the specifications incorporated by reference in A.A.C. R9-1-412.

77. “Exploitation” has the same meaning as in A.R.S. § 46-451.

78. “Factory-built building” has the same meaning as in A.R.S. § 41-2142.

79. “Family” or “family member” means an individual’s spouse, sibling, child, parent, grandparent, or another individual designated by the individual.

80. “Food services” means the storage, preparation, serving, and cleaning up of food intended for consumption in a health care institution.

81. “Garbage” has the same meaning as in A.A.C. R18-13-302.

82. “General consent” means documentation of an agreement from an individual or the individual’s representative to receive physical health services to address the individual’s medical condition or behavioral health services to address the individual’s behavioral health issues.

83. “General hospital” means a subclass of hospital that provides surgical services and emergency services.

84. “Gravely disabled” has the same meaning as in A.R.S. § 36-501.

85. “Hazard” or “hazardous” means a condition or situation where a patient or other individual may suffer physical injury.

86. “Health care directive” has the same meaning as in A.R.S. § 36-3201.

87. “Hemodialysis” means the process for removing wastes and excess fluids from a patient’s blood by passing the blood through a dialyzer.

88. “Home health agency” has the same meaning as in A.R.S. § 36-151.

89. “Home health aide” means an individual employed by a home health agency to provide home health services under the direction of a registered nurse or therapist.

90. “Home health aide services” means those tasks that are provided to a patient by a home health aide under the direction of a registered nurse or therapist.

91. “Home health services” has the same meaning as in A.R.S. § 36-151.

92. “Hospice inpatient facility” means a subclass of hospice that provides hospice services to a patient on a continuous basis with the expectation that the patient will remain on the hospice’s premises for 24 hours or more.

93. “Hospital” means a class of health care institution that provides, through an organized medical staff, inpatient beds, medical services, continuous nursing services, and diagnosis or treatment to a patient.

94. “Immediate” means without delay.

95. “Incident” means an unexpected occurrence that harms or has the potential to harm a patient, while the patient is:

a. On the premises of a health care institution, or

b. Not on the premises of a health care institution but directly receiving physical health services or behavioral health services from a personnel member who is providing the physical health services or behavioral health services on behalf of the health care institution.

96. “Infection control” means to identify, prevent, monitor, and minimize infections.

97. “Informed consent” means advising a patient of a proposed treatment, surgical procedure, psychotropic drug, or diagnostic procedure; advising the patient of alternatives to the treatment, surgical procedure, psychotropic drug, or diagnostic procedure; associated risks and possible complications; and obtaining documented authorization for the proposed treatment, surgical procedure, psychotropic drug, or diagnostic procedure from the patient or the patient’s representative.

98. “In-service education” means organized instruction or information that is related to physical health services or behavioral health services and that is provided to a medical staff member, personnel member, employee, or volunteer.

99. “Interval note” means documentation updating a patient’s:

a. Medical condition after a medical history and physical examination is performed, or

b. Behavioral health issue after an assessment is performed.

100. “Isolation” means the separation, during the communicable period, of infected individuals from others, to limit the transmission of infectious agents.

101. “Leased facility” means a facility occupied or used during a set time period in exchange for compensation.

102. “License” means:

a. Written approval issued by the Department to a person to operate a class or subclass of health care institution, except for a behavioral health facility, at a specific location; or

b. Written approval issued to an individual to practice a profession in this state.

103. “Licensee” means an owner approved by the Department to operate a health care institution.

104. “Manage” means to implement policies and procedures established by a governing authority, an administrator, or an individual providing direction to a personnel member.

105. “Medical condition” means the state of a patient’s physical or mental health, including the patient’s illness, injury, or disease.

106. “Medical history” means an account of a patient’s health, including past and present illnesses, diseases, or medical conditions.

107. “Medical practitioner” means a physician, physician assistant, or registered nurse practitioner.

108. “Medical record” has the same meaning as “medical records” in A.R.S. § 12-2291.

109. “Medical staff” means physicians and other individuals licensed pursuant to A.R.S. Title 32 who have clinical privileges at a health care institution.

110. “Medical staff by-laws” means standards, approved by the medical staff and the governing authority, that provide the framework for the organization, responsibilities, and self-governance of the medical staff.

111. “Medical staff member” means an individual who is part of the medical staff of a health care institution.

112. “Medication” means one of the following used to maintain health or to prevent or treat a medical condition or behavioral health issue:

a. Biologicals as defined in A.A.C. R18-13-1401,

b. Prescription medication as defined in A.R.S. § 32-1901, or

c. Nonprescription medication as defined in A.R.S. § 32-1901.

113. “Medication administration” means the provision or application of a medication to the body of a patient by a medical practitioner or a nurse or as otherwise provided by law.

114. “Medication error” means:

a. The failure to administer an ordered medication;

b. The administration of a medication not ordered; or

c. A medication administered:

i. In an incorrect dosage,

ii. More than 60 minutes from the ordered time of administration unless ordered to do so, or

iii. By an incorrect route of administration.

115. “Mental disorder” means the same as in A.R.S. § 36-501.

116. “Mobile clinic” means a movable structure that:

a. Is not physically attached to a health care institution's facility;

b. Provides medical services, nursing services, or health related service to an outpatient under the direction of the health care institution's personnel; and

c. Is not intended to remain in one location indefinitely.

117. “Monitor” or “monitoring” means to check systematically on a specific condition or situation.

118. “Neglect” has the same meaning:

a. For an individual less than 18 years of age, as in A.R.S. § 8-201; and

b. For an individual 18 years of age or older, as in A.R.S. § 46-451.

119. “Nephrologist” means a physician who is board eligible or board certified in nephrology by a professional credentialing board.

120. “Nurse” has the same meaning as “registered nurse” or “practical nurse” as defined in A.R.S. § 32-1601.

121. “Nursing personnel” means individuals authorized according to A.R.S. Title 32, Chapter 15 to provided nursing services.

122. “Observation chair” means a physical piece of equipment that:

a. Is located in a designated area where behavioral health observation/stabilization services are provided,

b. Allows an individual to fully recline, and

c. Is used by the individual while receiving crisis services.

123. “Occupational therapist” has the same meaning as in A.R.S. § 32-3401.

124. “Occupational therapist assistant” has the same meaning as in A.R.S. § 32-3401.

125. “On-call” means a time during which an individual is available and required to come to a health care institution when requested by the health care institution.

126. “Order” means instructions to provide:

a. Physical health services to a patient from a medical practitioner or as otherwise provided by law; or

b. Behavioral health services to a patient from a behavioral health professional.

127. “Orientation” means the initial instruction and information provided to an individual before starting work or volunteer services in a health care institution.

128. “Outing” means a social or recreational activity that:

a. Occurs away from the premises,

b. Is not part of a behavioral health residential facility’s daily routine, and

c. Lasts longer than four hours.

129. “Outpatient surgical center” means a class of health care institution that has the facility, staffing, and equipment to provide surgery and anesthesia services to a patient whose recovery, in the concurring opinions of the surgeon performing the surgery and the anesthesiologist, does not require inpatient care in a hospital.

130. “Outpatient treatment center” means a class of health care institution without inpatient beds that provides physical health services or behavioral health services for the diagnosis and treatment of patients.

131. “Overall time-frame” means the same as in A.R.S. § 41-1072.

132. “Owner” means a person who appoints, elects, or designates a health care institution's governing authority.

133. “Patient,” “resident,” or “participant” means an individual receiving physical health services or behavioral health services from a health care institution.

134. “Patient follow-up instructions” means information relevant to a patient's medical condition or behavioral health issue that is provided to the patient, the patient's representative, or a health care institution.

135. “Patient’s representative,” means a patient’s legal guardian, an individual acting on behalf of the patient with the written consent of the patient, or a surrogate as defined in A.R.S. § 36-3201.

136. “Person” means the same as in A.R.S. § 1-215 and includes a governmental agency.

137. “Personnel member” means, except as defined in specific Articles in this Chapter and excluding a medical staff member, an individual providing physical health services or behavioral health services to a patient.

138. “Pest control program” means activities that minimize the presence of insects and vermin in a health care institution to ensure that a patient’s health and safety is not at risk.

139. “Pharmacist” has the same meaning as in A.R.S. § 32-1901.

140. “Physical examination” means to observe, test, or inspect an individual’s body to evaluate health or determine cause of illness, injury, or disease.

141. “Physical health services” means medical services, nursing services, health-related services, or ancillary services provided to an individual to address the individual's medical condition.

142. “Physical therapist” has the same meaning as in A.R.S. § 32-2001.

143. “Physical therapist assistant” has the same meaning as in A.R.S. § 32-2001.

144. “Physician assistant” has the same meaning as in A.R.S. § 32-2501.

145. “Premises” means property that is designated by an applicant or licensee and licensed by the Department as part of a health care institution where physical health services or behavioral health services are provided to a patient.

146. “Professional credentialing board” means a non-governmental organization that designates individuals who have met or exceeded established standards for experience and competency in a specific field.

147. “Progress note” means documentation by a medical staff member, nurse, or personnel member of:

a. An observed patient response to a physical health service or behavioral health service provided to the patient,

b. A patient’s significant change in condition, or

c. Observed behavior of a patient related to the patient’s medical condition or behavioral health issue.

148. “PRN” means pro re nata or given as needed.

149. “Project” means specific construction or modification of a facility stated on an architectural plans and specifications approval application.

150. “Provider” means an individual to whom the Department issues a license to operate an adult behavioral health therapeutic home or a children’s behavioral health respite home in the individual’s place of residence.

151. “Provisional license” means the Department's written approval to operate a health care institution issued to an applicant or licensee that is not in substantial compliance with the applicable laws and rules for the health care institution.

152. “Psychotropic medication” means a chemical substance that:

a. Crosses the blood-brain barrier and acts primarily on the central nervous system where it affects brain function, resulting in alterations in perception, mood, consciousness, cognition, and behavior; and

b. Is provided to a patient to address the patient’s behavioral health issue.

153. “Quality management program” means ongoing activities designed and implemented by a health care institution to improve the delivery of medical services, nursing services, health-related services, and ancillary services provided by the health care institution.

154. “Recovery care center” has the same meaning as in A.R.S. § 36-448.51.

155. “Referral” means providing an individual with a list of the class or subclass of health care institution or type of health care professional that may be able to provide the behavioral health services or physical health services that the individual may need and may include the name or names of specific health care institutions or health care professionals.

156. “Registered dietitian” means an individual approved to work as a dietitian by the American Dietetic Association’s Commission on Dietetic Registration.

157. “Registered nurse” has the same meaning as in A.R.S. § 32-1601.

158. “Registered nurse practitioner” has the same meaning as A.R.S. § 32-1601.

159. “Regular basis” means at recurring, fixed, or uniform intervals.

160. “Research” means the use of a human subject in the systematic study, observation, or evaluation of factors related to the prevention, assessment, treatment, or understanding of a medical condition or behavioral health issue.

161. “Respiratory care services” has the same meaning as “practice of respiratory care” as defined in A.R.S. § 32-3501.

162. “Restraint” means any physical or chemical method of restricting a patient’s freedom of movement, physical activity, or access to the patient’s own body.

163. “Risk” means potential for an adverse outcome.

164. “Room” means space contained by a floor, a ceiling, and walls extending from the floor to the ceiling that has at least one door.

165. “Rural general hospital” means a subclass of hospital having 50 or fewer inpatient beds and located more than 20 surface miles from a general hospital or another rural general hospital that requests to be and is licensed as a rural general hospital rather than a general hospital.

166. “Satellite facility” has the same meaning as in A.R.S. § 36-422.

167. “Scope of services” means a list of the behavioral health services or physical health services the governing authority of a health care institution has designated as being available to a patient at the health care institution.

168. “Seclusion” means the involuntary solitary confinement of a patient in a room or an area where the patient is prevented from leaving.

169. “Sexual abuse” means the same as in A.R.S. § 13-1404(A).

170. “Sexual assault” means the same as in A.R.S. § 13-1406(A).

171. “Shift” means the beginning and ending time of a continuous work period established by a health care institution’s policies and procedures.

172. “Signature” means:

a. The first and last name of an individual written with his or her own hand as a form of identification or authorization, or

b. An electronic signature or code.

173. “Significant change” means an observable deterioration or improvement in a patient’s physical, cognitive, behavioral, or functional condition that may require an alteration to the physical health services or behavioral health services provided to the patient.

174. “Social worker” means an individual licensed according to A.R.S. Title 32, Chapter 33 to engage in the “practice of social work” as defined in A.R.S. § 32-3251.

175. “Social work services” has the same meaning as “practice of social work” in A.R.S. § 32-3251.

176. “Special hospital” means a subclass of hospital that:

a. Is licensed to provide hospital services within a specific branch of medicine; or

b. Limits admission according to age, gender, type of disease, or medical condition.

177. “Student” means an individual attending an educational institution and working under supervision in a health care institution through an arrangement between the health care institution and the educational institution.

178. “Substantial” when used in connection with a modification means:

a. An addition or deletion of an inpatient bed or a change in the use of one or more of the inpatient beds;

b. A change in a health care institution's licensed capacity;

c. A change in the physical plant, including facilities or equipment, that costs more than $300,000; or

d. A change in a health care institution that affects compliance with applicable physical plant codes and standards incorporated by reference in A.A.C. R9-1-412.

179. “Substance abuse” means an individual’s misuse of alcohol or other drug or chemical that:

a. Alters the individual’s behavior or mental functioning;

b. Has the potential to cause the individual to be psychologically or physiologically dependent on alcohol or other drug or chemical; and

c. Impairs, reduces, or destroys the individual’s social or economic functioning.

180. “Substance abuse transitional facility” means a class of health care institution that provides behavioral health services to an individual who is intoxicated or may have a substance abuse problem.

181. “Supportive services” has the same meaning as in A.R.S. § 36-151.

182. “Substantive review time-frame” means the same as in A.R.S. § 41-1072.

183. “Surgical procedure” means the excision of a part of or incision in a patient’s body for the:

a. Correction of a deformity or defect,

b. Repair of an injury, or

c. Diagnosis, amelioration, or cure of disease.

184. “Swimming pool” has the same meaning as “semipublic swimming pool” in A.A.C. R18-5-201.

185. “System” means interrelated, interacting, or interdependent elements that form a whole.

186. “Tax ID number” means a numeric identifier that a person uses to report financial information to the United States Internal Revenue Services.

187. “Telemedicine” has the same meaning as in A.R.S. § 36-3601.

188. “Therapeutic diet” means foods or the manner in which food is to be prepared that are ordered for a patient.

189. “Time out” means providing a patient a voluntary opportunity to regain self-control in a designated area from which the patient is not physically prevented from leaving.

190. “Transfer” means a health care institution discharging a patient and sending the patient to another licensed health care institution as an inpatient or resident without intending that the patient be returned to the sending health care institution.

191. “Transport” means a health care institution:

a. Sending a patient to another licensed health care institution for outpatient services with the intent of returning the patient to the sending health care institution, or

b. Returning a patient to a sending licensed health care institution after the patient received outpatient services.

192. “Treatment” means a procedure or method to cure, improve, or palliate an individual’s medical condition or behavioral health issue.

193. “Unclassified health care institution” means a health care institution not classified or subclassified in statute or in rule.

194. “Vascular access” means the point on a patient's body where blood lines are connected for hemodialysis.

195. “Volunteer” means an individual authorized by a health care institution to work for the health care institution on a regular basis without compensation from the health care institution and does not include a medical staff member who has clinical privileges at the health care institution.

196. “Working day” means a Monday, Tuesday, Wednesday, Thursday, or Friday that is not a state and federal holiday or a statewide furlough day.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-102. Health Care Institution Classes and Subclasses; Requirements

A. A person may apply for a license as an unclassified health care institution; a health care institution class or subclass in A.R.S. Title 36, Chapter 4 or 9 A.A.C. 10; or one of the following classes or subclasses:

1. General hospital,

2. Rural general hospital,

3. Special hospital,

4. Behavioral health inpatient facility,

5. Nursing care institution,

6. Recovery care center,

7. Hospice inpatient facility,

8. Hospice service agency,

9. Behavioral health residential facility,

10. Assisted living center,

11. Assisted living home,

12. Adult foster care home,

13. Outpatient surgical center,

14. Outpatient treatment center,

15. Abortion clinic,

16. Adult day health care facility,

17. Home health agency,

18. Substance abuse transitional facility,

19. Behavioral health specialized transitional facility,

20. Counseling facility,

21. Adult behavioral health therapeutic home,

22. Children’s behavioral health respite home, or

23. Unclassified health care institution.

B. A person shall apply for a license for the class or subclass that authorizes the provision of the highest level of physical health services or behavioral health services the proposed health care institution plans to provide. The Department shall review the proposed health care institution’s scope of services to determine whether the requested health care institution class or subclass is appropriate.

C. A health care institution shall comply with the requirements in 9 A.A.C. 10, Article 17 if:

1. There are no specific rules in 9 A.A.C. 10 for the health care institution's class or subclass, or

2. The Department determines that the health care institution is an unclassified health care institution.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-103. Licensure Exceptions

A. A health care institution license is required for each health care institution except:

1. A facility exempt from licensure under A.R.S. § 36-402, or

2. A health care institution's administrative office.

B. The Department does not require a separate health care institution license for:

1. A satellite facility of a hospital under A.R.S. § 36-422(F);

2. An accredited facility of an accredited hospital under A.R.S. § 36-422(G);

3. A facility operated by a licensed health care institution that is:

a. Adjacent to and contiguous with the licensed health care institution premises; or

b. Not adjacent to or contiguous with the licensed health care institution but connected to the licensed health care institution facility by an all-weather enclosure and:

i. Owned by the health care institution, or

ii. Leased by the health care institution with exclusive rights of possession;

4. A mobile clinic operated by a licensed health care institution; or

5. A facility located on grounds that are not adjacent to or contiguous with the health care institution premises where only ancillary services are provided to a patient of the health care institution.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-104. Approval of Architectural Plans and Specifications

A. For approval of architectural plans and specifications for the construction or modification of a health care institution that is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412, an applicant shall submit to the Department an application packet including:

1. An application in a format provided by the Department that contains:

a. For construction of a new health care institution:

i. The health care institution's name, street address, city, state, zip code, telephone number, and fax number;

ii. The name and address of the health care institution's governing authority;

iii. The requested health care institution class or subclass; and

iv. If applicable, the requested licensed capacity and licensed occupancy for the health care institution;

b. For modification of a licensed health care institution:

i. The health care institution’s license number,

ii. The name and address of the licensee,

iii. The health care institution’s class or subclass, and

iv. The health care institution’s existing licensed capacity or licensed occupancy and the requested licensed capacity or licensed occupancy for the health care institution;

c. The health care institution’s contact person's name, street address, city, state, zip code, telephone number, and fax number;

d. If the application includes a copy of architectural plans and specifications:

i. A statement signed by the governing authority or the licensee that the architectural plans and specifications comply with applicable licensure requirements in A.R.S. Title 36, Article 4 and 9 A.A.C. 10 and the health care institution is ready for an onsite inspection by a Department representative;

ii. The project architect's name, street address, city, state, zip code, telephone number, and fax number; and

iii. A statement signed and sealed by the project architect, according to the requirements in 4 A.A.C. 30, Article 3, that the project architect has complied with A.A.C. R4-30-301 and the architectural plans and specifications are in substantial compliance with applicable licensure requirements in A.R.S. Title 36, Article 4 and 9 A.A.C. 10;

e. A narrative description of the project;

f. If providing or planning to provide medical services, nursing services, or health-related services that require compliance with specific physical plant codes and standards incorporated by reference in A.A.C. R9-1-412, the number of rooms or inpatient beds designated for providing the medical services, nursing services, or health-related services; and

g. If providing or planning to provide behavioral health observation/stabilization services, the number of behavioral health observation/stabilization chairs designated for providing the behavioral health observation/stabilization services;

2. If the health care institution is located on land under the jurisdiction of a local governmental agency, one of the following:

a. A building permit for the construction or modification issued by the local governmental agency; or

b. If a building permit issued by the local governmental agency is not required, zoning clearance issued by the local governmental agency that includes:

i. The health care institution's name, street address, city, state, zip code, and county;

ii. The health care institution's class or subclass and each type of medical services, nursing services, or health-related services to be provided; and

iii. A statement signed by a representative of the local governmental agency stating that the address listed is zoned for the health care institution's class or subclass;

3. The following information on architectural plans and specifications that is necessary to demonstrate that the project described on the application complies with applicable codes and standards incorporated by reference in A.A.C. R9-1-412:

a. A table of contents containing:

i. The architectural plans and specifications submitted,

ii. The physical plant codes and standards incorporated by reference in A.A.C. R9-1-412 that apply to the project or are required by a local governmental agency,

iii. An index of the abbreviations and symbols used in the architectural plans and specifications, and

iv. The facility’s specific International Building Code construction type and International Building Code occupancy type;

b. If the facility is larger than 3,000 square feet and is or will be occupied by more than 20 individuals, the seal of an architect on the architectural plans and drawings according to the requirements in A.R.S. Title 32, Chapter 1;

c. A site plan, drawn to scale, of the entire premises showing streets, property lines, facilities, parking areas, outdoor areas, fences, swimming pools, fire access roads, fire hydrants, and access to water mains;

d. For each facility, on architectural plans and specifications:

i. A floor plan, drawn to scale, for each level of the facility, showing the layout and dimensions of each room, the name and function of each room, means of egress, and natural and artificial lighting sources;

ii. A diagram of a section of the facility, drawn to scale, showing the vertical cross-section view from foundation to roof and specifying construction materials;

iii. Building elevations, drawn to scale, showing the outside appearance of each facility;

iv. The materials used for ceilings, walls, and floors;

v. The location, size, and fire rating of each door and each window and the materials and hardware used, including safety features such as fire exit door hardware and fireproofing materials;

vi. A ceiling plan, drawn to scale, showing the layout of each light fixture, each fire protection device, and each element of the mechanical ventilation system;

vii. An electrical floor plan, drawn to scale, showing the wiring diagram and the layout of each lighting fixture, each outlet, each switch, each electrical panel, and electrical equipment;

viii. A mechanical floor plan, drawn to scale, showing the layout of heating, ventilation, and air conditioning systems;

ix. A plumbing floor plan, drawn to scale, showing the layout and materials used for water and sewer systems including the water supply and plumbing fixtures;

x. A floor plan, drawn to scale, showing the communication system within the health care institution including the nurse call system, if applicable;

xi. A floor plan, drawn to scale, showing the automatic fire extinguishing, fire detection, and fire alarm systems; and

xii. Technical specifications describing installation and materials used in the health care institution;

4. The estimated total project cost including the costs of:

a. Site acquisition,

b. General construction,

c. Architect fees,

d. Fixed equipment, and

e. Movable equipment;

5. The following, as applicable:

a. If the health care institution is located on land under the jurisdiction of a local governmental agency, one of the following provided by the local governmental agency:

i. A copy of the Certificate of Occupancy,

ii. Documentation that the facility was approved for occupancy, or

iii. Documentation that a certificate of occupancy for the facility is not available;

b. A certification and a statement that the construction or modification of the facility is in substantial compliance with applicable licensure requirements in A.R.S. Title 36, Article 4 and 9 A.A.C. 10 signed by the project architect, the contractor, and the owner;

c. A written description of any work necessary to complete the construction or modification submitted by the project architect;

d. If the construction or modification affects the health care institution's fire alarm system, a contractor certification and description of the fire alarm system in a format provided by the Department;

e. If the construction or modification affects the health care institution's automatic fire extinguishing system, a contractor certification of the automatic fire extinguishing system in a format provided by the Department;

f. If the construction or modification affects the health care institution's heating, ventilation, or air conditioning, a copy of the heating, ventilation, air conditioning, and air balance tests and a contractor certification of the heating, ventilation, or air conditioning systems;

g. If draperies, cubicle curtains, or floor coverings are installed or replaced, a copy of the manufacturer's certification of flame spread for the draperies, cubicle curtains, or floor coverings;

h. For a health care institution using inhalation anesthetics or nonflammable medical gas, a copy of the Compliance Certification for Inhalation Anesthetics or Nonflammable Medical Gas System required in the National Fire Codes incorporated by reference in A.A.C. R9-1-412;

i. If a generator is installed, a copy of the installation acceptance required in the National Fire Codes incorporated by reference in A.A.C. R9-1-412;

j. For a health care institution providing radiology, a written report from a certified health physicist of the location, type, and amount of radiation protection; and

k. If a factory-built building is used by a health care institution:

i. A copy of the installation permit and the copy of a certificate of occupancy for the factory-built building from the Office of Manufactured Housing; or

ii. A written report from an individual registered as an architect or a professional structural engineer under 4 A.A.C. 30, Article 2, stating that the factory-built building complies with applicable design standards;

6. A statement signed by the project architect that final architectural drawings and specifications have been submitted to the person applying for a health care institution license or the licensee of the health care institution; and

7. The applicable fee required by R9-10-106.

B. Before an applicant submits an application for approval of architectural plans and specifications for the construction or modification of a health care institution, an applicant may request an architectural evaluation by submitting the documents in subsection (A)(3) to the Department.

C. The Department shall approve or deny an application for approval of architectural plans and specifications of a health care institution in this Section according to R9-10-108.

D. In addition to obtaining an approval of a health care institution’s architectural plans and specifications, a person shall obtain a health care institution license before operating the health care institution.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-105. Initial License Application

A. A person applying for a health care institution license shall submit to the Department an application packet that contains:

1. An application in a format provided by the Department including:

a. The health care institution’s:

i. Name, street address, mailing address, telephone number, fax number, and e-mail address;

ii. Tax ID number; and

iii. Class or subclass listed in R9-10-102 for which licensure is requested;

b. As applicable, the specific services for which authorization is requested;

c. Except for a home health agency, hospice service agency, or behavioral health facility, whether the health care institution is located within 1/4 mile of agricultural land;

d. Whether the health care institution is located in a leased facility;

e. Whether the health care institution is ready for a licensing inspection by the Department;

f. If the health care institution is not ready for a licensing inspection by the Department, the date the health care institution will be ready for a licensing inspection;

g. Owner information including:

i. The owner’s name, address, telephone number, and fax number;

ii. Whether the owner is a sole proprietorship, a corporation, a partnership, a limited liability partnership, a limited liability company, or a governmental agency;

iii. If the owner is a partnership or a limited liability partnership, the name of each partner;

iv. If the owner is a limited liability company, the name of the designated manager or, if no manager is designated, the names of any two members of the limited liability company;

v. If the owner is a corporation, the name and title of each corporate officer;

vi. If the owner is a governmental agency, the name and title of the individual in charge of the governmental agency or the name of an individual in charge of the health care institution designated in writing by the individual in charge of the governmental agency;

vii. Whether the owner or any person with 10% or more business interest in the health care institution has had a license to operate a health care institution denied, revoked, or suspended; the reason for the denial, suspension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license;

viii. Whether the owner or any person with 10% or more business interest in the health care institution has had a health care professional license or certificate denied, revoked, or suspended; the reason for the denial, suspension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license or certificate; and

ix. The name, title, address, and telephone number of the owner's statutory agent or the individual designated by the owner to accept service of process and subpoenas;

h. The name and address of the governing authority;

i. The chief administrative officer's:

i. Name,

ii. Title,

iii. Highest educational degree, and

iv. Work experience related to the health care institution class or subclass for which licensing is requested; and

j. Signature required in A.R.S. § 36-422(B);

2. If the health care institution is located in a leased facility, a copy of the lease showing the rights and responsibilities of the parties and exclusive rights of possession of the leased facility;

3. If applicable, a copy of the owner's articles of incorporation, partnership or joint venture documents, or limited liability documents;

4. If applicable, the name and address of each owner or lessee of any agricultural land regulated under A.R.S. § 3-365 and a copy of the written agreement between the applicant and the owner or lessee of agricultural land as prescribed in A.R.S. § 36-421(D);

5. Except for a home health agency or a hospice service agency, one of the following:

a. If the health care institution or a part of the health care institution is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412, documentation of the health care institution's architectural plans and specifications approval in R9-10-104; or

b. If a health care institution or a part of the health care institution is not required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412:

i. One of the following:

(1) Documentation from the local jurisdiction of compliance with applicable local building codes and zoning ordinances; or

(2) If documentation from the local jurisdiction is not available, documentation of the unavailability of the local jurisdiction compliance and documentation of a general contractor’s inspection of the facility that states the facility is safe for occupancy as the applicable health care institution class or subclass;

ii. The licensed capacity requested by the applicant for the health care institution;

iii. If applicable, the licensed occupancy requested by the applicant for the health care institution;

iv. A site plan showing each facility, the property lines of the health care institution, each street and walkway adjacent to the health care institution, parking for the health care institution, fencing and each gate on the health care institution premises, and, if applicable, each swimming pool on the health care institution premises; and

v. A floor plan showing, for each story of a facility, the room layout, room usage, each door and each window, plumbing fixtures, each exit, and the location of each fire protection device;

6. The health care institution’s proposed scope of services; and

7. The applicable application fee required by R9-10-106.

B. In addition to the initial application requirements in this Section, an applicant shall comply with the initial application requirements in specific rules in 9 A.A.C. 10 for the health care institution class or subclass for which licensure is requested.

C. The Department shall approve or deny an application in this Section according to R9-10-108.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-106. Fees

A. An applicant who submits to the Department architectural plans and specifications for the construction or modification of a health care institution shall also submit an architectural drawing review fee as follows:

1. Fifty dollars for a project with a cost of $100,000 or less;

2. One hundred dollars for a project with a cost of more than $100,000 but less than $500,000; or

3. One hundred fifty dollars for a project with a cost of $500,000 or more.

B. An applicant submitting an initial application or a renewal application for a health care institution license shall submit to the Department an application fee of $50.

C. Except as provided in subsection (D) or (E), an applicant submitting an initial application or a renewal application for a health care institution license shall submit to the Department a licensing fee as follows:

1. For an adult day health care facility, assisted living home, or assisted living center:

a. For a facility with no licensed capacity, $280;

b. For a facility with a licensed capacity of one to 59 beds, $280, plus the licensed capacity times $70;

c. For a facility with a licensed capacity of 60 to 99 beds, $560, plus the licensed capacity times $70;

d. For a facility with a licensed capacity of 100 to 149 beds, $840, plus the licensed capacity times $70; or

e. For a facility with a licensed capacity of 150 beds or more, $1,400, plus the licensed capacity times $70;

2. For a behavioral health facility:

a. For a facility with no licensed capacity, $375;

b. For a facility with a licensed capacity of one to 59 beds, $375, plus the licensed capacity times $94;

c. For a facility with a licensed capacity of 60 to 99 beds, $750, plus the licensed capacity times $94;

d. For a facility with a licensed capacity of 100 to 149 beds, $1,125, plus the licensed capacity times $94; or

e. For a facility with a licensed capacity of 150 beds or more, $1,875, plus the licensed capacity times $94;

3. For a nursing care institution:

a. For a facility with a licensed capacity of one to 59 beds, $290, plus the licensed capacity times $73;

b. For a facility with a licensed capacity of 60 to 99 beds, $580, plus the licensed capacity times $73;

c. For a facility with a licensed capacity of 100 to 149 beds, $870, plus the licensed capacity times $73; or

d. For a facility with a licensed capacity of 150 beds or more, $1,450, plus the licensed capacity times $73;

4. For a hospital, a home health agency, a hospice service agency, a hospice inpatient facility, an abortion clinic, a recovery care center, an outpatient surgical center, an outpatient treatment center that is not a behavioral health facility, or an unclassified health care institution:

a. For a facility with no licensed capacity, $365;

b. For a facility with a licensed capacity of one to 59 beds, $365, plus the licensed capacity times $91;

c. For a facility with a licensed capacity of 60 to 99 beds, $730, plus the licensed capacity times $91;

d. For a facility with a licensed capacity of 100 to 149 beds, $1,095, plus the licensed capacity times $91; or

e. For a facility with a licensed capacity of 150 beds or more, $1,825, plus the licensed capacity times $91.

D. Subsection (C) does not apply to a health care institution operated by a state agency according to state or federal law or to an adult foster care home.

E. All fees are nonrefundable except as provided in A.R.S. § 41-1077.

Historical Note

New Section R9-10-106 renumbered from R9-10-122 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-107. Renewal License Application

A. A licensee applying to renew a health care institution license shall submit an application packet to the Department at least 60 calendar days but not more than 120 calendar days before the expiration date of the current license that contains:

1. A renewal application in a format provided by the Department including:

a. The health care institution's:

i. Name, license number, mailing address, telephone number, fax number, and e-mail address;

ii. Class or subclass; and

iii. Scope of services;

b. Owner information including:

i. The owner’s name, address, telephone number, and fax number;

ii. Whether the owner is a sole proprietorship, a corporation, a partnership, a limited liability partnership, a limited liability company, or a governmental agency;

iii. If the owner is a partnership or a limited liability partnership, the name of each partner;

iv. If the owner is a limited liability company, the name of the designated manager or, if no manager is designated, the names of any two members of the limited liability company;

v. If the owner is a corporation, the name and title of each corporate officer;

vi. If the owner is a governmental agency, the name and title of the individual in charge of the governmental agency or the individual designated in writing by the individual in charge of the governmental agency;

vii. Whether the owner or any person with 10% or more business interest in the health care institution has had a license to operate a health care institution denied, revoked, or suspended since the previous license application was submitted; the reason for the denial, suspension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license;

viii. Whether the owner or any person with 10% or more business interest in the health care institution has had a health care professional license or certificate denied, revoked, or suspended since the previous license application was submitted; the reason for the denial, suspension, or revocation; the date of the denial, suspension, or revocation; and the name and address of the licensing agency that denied, suspended, or revoked the license or certificate; and

ix. The name, title, address, and telephone number of the owner's statutory agent or the individual designated by the owner to accept service of process and subpoenas;

c. The name and address of the governing authority;

d. The chief administrative officer’s:

i. Name,

ii. Title,

iii. Highest educational degree, and

iv. Work experience related to the health care institution class or subclass for which licensing is requested; and

e. Signature required in A.R.S. § 36-422(B);

2. If the health care institution is located in a leased facility, a copy of the lease showing the rights and responsibilities of the parties and exclusive rights of possession of the leased facility; and

3. The applicable renewal application and licensing fees required by R9-10-106.

B. In addition to the renewal application requirements in this Section, a licensee shall comply with the renewal application requirements in specific rules in 9 A.A.C. 10 for the health care institution's class or subclass.

C. If a licensee submits a health care institution’s current accreditation report from a nationally recognized accrediting organization, the Department shall not conduct an onsite compliance inspection of the health care institution during the time the accreditation report is valid.

D. The Department shall approve or deny a renewal license according to R9-10-108.

E. The Department shall issue a renewal license for:

1. One year; or

2. Three years, if:

a. A licensee’s health care institution is a hospital accredited by a nationally recognized accreditation organization, and

b. The licensee submits a copy of the hospital's current accreditation report.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-108. Time-frames

A. The overall time-frame for each type of approval granted by the Department is listed in Table 1.1. The applicant and the Department may agree in writing to extend the substantive review time-frame and the overall time-frame. The substantive review time-frame and the overall time-frame may not be extended by more than 25% of the overall time-frame.

B. The administrative completeness review time-frame for each type of approval granted by the Department as prescribed in this Article is listed in Table 1.1. The administrative completeness review time-frame begins on the date the Department receives a complete application packet or a written request for a change in a health care institution license according to R9-10-109(F):

1. The application packet for an initial health care institution license is not complete until the applicant provides the Department with written notice that the health care institution is ready for a licensing inspection by the Department.

2. If the application packet or written request is incomplete, the Department shall provide a written notice to the applicant specifying the missing document or incomplete information. The administrative completeness review time-frame and the overall time-frame are suspended from the date of the notice until the date the Department receives the missing document or information from the applicant.

3. When an application packet or written request is complete, the Department shall provide a written notice of administrative completeness to the applicant.

4. For an initial health care institution application, the Department shall consider the application withdrawn if the applicant fails to supply the missing documents or information included in the notice described in subsection (B)(2) within 180 calendar days after the date of the notice described in subsection (B)(2).

5. If the Department issues a license or grants an approval during the time provided to assess administrative completeness, the Department shall not issue a separate written notice of administrative completeness.

C. The substantive review time-frame is listed in Table 1.1 and begins on the date of the notice of administrative completeness.

1. The Department may conduct an onsite inspection of the facility:

a. As part of the substantive review for approval of architectural plans and specifications;

b. As part of the substantive review for issuing a health care institution initial or renewal license; or

c. As part of the substantive review for approving a change in a health care institution's license.

2. During the substantive review time-frame, the Department may make one comprehensive written request for additional information or documentation. If the Department and the applicant agree in writing, the Department may make supplemental requests for additional information or documentation. The time-frame for the Department to complete the substantive review is suspended from the date of a written request for additional information or documentation until the Department receives the additional information or documentation.

3. The Department shall send a written notice of approval or a license to an applicant who is in substantial compliance with applicable requirements in A.R.S. Title 36, Chapter 4 and 9 A.A.C. 10.

4. After an applicant for an initial health care institution license receives the written notice of approval in subsection (C)(3), the applicant shall submit the applicable license fee in R9-10-106 to the Department within 60 calendar days after the date of the written notice of approval.

5. The Department shall provide a written notice of denial that complies with A.R.S. § 41-1076 to an applicant who does not:

a. For an initial health care institution application, submit the information or documentation in subsection (C)(2) within 120 calendar days after the Department's written request to the applicant;

b. Comply with the applicable requirements in A.R.S. Title 36, Chapter 4 and 9 A.A.C. 10; or

c. Submit the fee required in R9-10-106.

6. An applicant may file a written notice of appeal with the Department within 30 calendar days after receiving the notice described in subsection (C)(5). The appeal shall be conducted according to A.R.S. Title 41, Chapter 6, Article 10.

7. If a time-frame’s last day falls on a Saturday, a Sunday, or an official state holiday, the Department shall consider the next working day to be the time-frame’s last day.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by final rulemaking at 11 A.A.R. 859, effective April 2, 2005 (Supp. 05-1). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

 

Table 1.1

Type of Approval
Statutory
Authority
Overall
Time-frame
Administrative
Completeness
Time-frame
Substantive Review
Time-frame

Approval of architectural plans and specifications

R9-10-104

A.R.S. §§ 36-405,

36-406(1)(b), and 36-421

105 calendar days

45 calendar days

60 calendar days

Health care institution initial license

R9-10-105

A.R.S. §§ 36-405,

36-407, 36-421,

36-422, 36-424, and 36-425

120 calendar days

30 calendar days

90 calendar days

Health care institution renewal license

R9-10-107

A.R.S. §§ 36-405,

36-407, 36-422,

36-424, and 36-425

90 calendar days

30 calendar days

60 calendar days

Approval of a change to a health care institution license

R9-10-109(F)

A.R.S. §§ 36-405,

36-407, and 36-422

75 calendar days

15 calendar days

60 calendar days

Historical Note

New Table 1 made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by final rulemaking at 11 A.A.R. 859, effective April 2, 2005 (Supp. 05-1). Table 1 title and contents amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-109. Changes Affecting a License

A. A licensee shall ensure that the Department is notified in writing at least 30 calendar days before the effective date of:

1. A change in the name of:

a. A health care institution, or

b. The licensee; or

2. A change in the address of a health care institution that does not provide medical services, nursing services, or health-related services on the premises.

B. If a licensee intends to terminate the operation of a health care institution either during or at the expiration of the health care institution’s license, the licensee shall ensure that the Department is notified in writing of:

1. The termination of the health care institution’s operations, as required in A.R.S. § 36-422(D), at least 30 days before the termination; and

2. The address and contact information for the location where the health care institution’s medical records will be retained as required in A.R.S. § 12-2297.

C. A licensee of a health care institution that is required by this Chapter to comply with any of the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412 shall submit an application for approval of architectural plans and specifications for a modification of the health care institution.

D. A governing authority shall submit an initial license application required in R9-10-105 for:

1. A change in ownership of a health care institution;

2. A change in the address or location of a health care institution that provides medical services, nursing services, health-related services, or behavioral health services on the premises; or

3. A change in a health care institution's class or subclass.

E. A governing authority is not required to submit documentation of a health care institution's architectural plans and specifications required in R9-10-105(A)(5) for an initial license application if:

1. The health care institution has not ceased operations for more than 30 calendar days,

2. A modification has not been made to the health care institution,

3. The services the health care institution is authorized by the Department to provide are not changed, and

4. The location of the health care institution's premises is not changed.

F. A licensee of a health care institution that is not required to comply with the physical plant codes and standards incorporated by reference in A.A.C. R9-1-412 shall submit a written request for a change in the services the health care institution is authorized by the Department to provide or another modification of the health care institution including documentation of compliance with requirements in this Chapter for the change or the modification that contains:

1. The health care institution's name, address, and license number;

2. A narrative description of the change or modification;

3. The governing authority's name and dated signature; and

4. Any documentation that demonstrates that the requested change or modification complies with applicable requirements in this Chapter.

G. The Department shall approve or deny a request for a change in services or another modification described in subsection (C) or (F) according to R9-10-108.

H. A licensee shall not implement a change in services or another modification described in subsection (C) or (F) until an approval or amended license is issued by the Department.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-110. Enforcement Actions

A. If the Department determines that an applicant or licensee is violating applicable statutes and rules and the violation poses a direct risk to the life, health, or safety of a patient, the Department may:

1. Issue a provisional license to the applicant or licensee under A.R.S. § 36-425,

2. Assess a civil penalty under A.R.S. § 36-431.01,

3. Impose an intermediate sanction under A.R.S. § 36-427,

4. Remove a licensee and appoint another person to continue operation of the health care institution pending further action under A.R.S. § 36-429,

5. Suspend or revoke a license under A.R.S. § 36-427 and R9-10-111,

6. Deny a license under A.R.S. § 36-425 and R9-10-111, or

7. Issue an injunction under A.R.S. § 36-430.

B. In determining which action in subsection (A) is appropriate, the Department shall consider the direct risk to the life, health, or safety of a patient in the health care institution based on:

1. Repeated violations of statutes or rules,

2. Pattern of violations,

3. Types of violation,

4. Severity of violation, and

5. Number of violations.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-111. Denial, Revocation, or Suspension of License

A. The Department may deny, revoke, or suspend a license to operate a health care institution if an applicant, a licensee, or an individual in a business relationship with the applicant including a stockholder or controlling person:

1. Provides false or misleading information to the Department;

2. Has had in any state or jurisdiction any of the following:

a. An application or license to operate a health care institution denied, suspended, or revoked, unless the denial was based on failure to complete the licensing process within a required time-frame; or

b. A health care professional license or certificate denied, revoked, or suspended; or

3. Has operated a health care institution, within the ten years preceding the date of the license application, in violation of A.R.S. Title 36, Chapter 4 or this Chapter, that posed a direct risk to the life, health, or safety of a patient.

B. The Department shall suspend or revoke a hospital’s license if the Department receives, pursuant to A.R.S. § 36- 2901.08(H), notice from the Arizona Health Care Cost Containment System that the hospital’s provider agreement registration with the Arizona Health Care Cost Containment System has been suspended or revoked.

Historical Note

Amended effective February 4, 1981 (Supp. 81-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 20 A.A.R. 97, effective January 1, 2014 (Supp. 13-4).

R9-10-112. Tuberculosis Screening

A health care institution's chief administrative officer shall ensure that the health care institution complies with the following if tuberculosis screening is required at the health care institution:

1. For each individual required to be screened for infectious tuberculosis, the health care institution obtains from the individual:

a. On or before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution, one of the following as evidence of freedom from infectious tuberculosis:

i. Documentation of a negative Mantoux skin test or other tuberculosis screening test recommended by the U.S. Centers for Disease Control and Prevention (CDC) administered within six months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution that includes the date and the type of tuberculosis screening test; or

ii. If the individual had a positive Mantoux skin test or other tuberculosis screening test, a written statement that the individual is free from infectious tuberculosis signed by a medical practitioner dated within six months before the date the individual begins providing services at or on behalf of the health care institution or is admitted to the health care institution; and

b. Every 12 months after the date of the individual's most recent tuberculosis screening test or written statement, one of the following as evidence of freedom from infectious tuberculosis:

i. Documentation of a negative Mantoux skin test or other tuberculosis screening test recommended by the CDC administered to the individual within 30 calendar days before or after the anniversary date of the most recent tuberculosis screening test or written statement that includes the date and the type of tuberculosis screening test; or

ii. If the individual has had a positive Mantoux skin test or other tuberculosis screening test, a written statement that the individual is free from infectious tuberculosis signed by a medical practitioner dated within 30 calendar days before or after the anniversary date of the most recent tuberculosis screening test or written statement; or

2. Establish, document, and implement a tuberculosis infection control program that complies with the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-care Settings, 2005, published by the U.S. Department of Health and Human Services, Atlanta, GA 30333 and available at http://www.cdc.gov/mmwr/PDF/rr/rr5417.pdf, incorporated by reference, on file with the Department, and including no future editions or amendments and includes:

a. Conducting tuberculosis risk assessments, conducting tuberculosis screening testing, screening for signs or symptoms of tuberculosis, and providing training and education related to recognizing the signs and symptoms of tuberculosis; and

b. Maintaining documentation of any:

i. Tuberculosis risk assessment;

ii. Tuberculosis screening test of an individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution; and

iii. Screening for signs or symptoms of tuberculosis of an individual who is employed by the health care institution, provides volunteer services for the health care institution, or is admitted to the health care institution.

Historical Note

Amended effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). New Section made by exempt rulemaking at 9 A.A.R. 526, effective April 1, 2003 (Supp. 03-1). Section R9-10-112 renumbered to R9-10-113; new Section R9-10-112 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-113. Clinical Practice Restrictions for Hemodialysis Technician Trainees

A. The following definitions apply in this Section:

1. “Assess” means collecting data about a patient by:

a. Obtaining a history of the patient,

b. Listening to the patient’s heart and lungs, and

c. Checking the patient for edema.

2. “Blood-flow rate” means the quantity of blood pumped into a dialyzer per minute of hemodialysis.

3. “Blood lines” means the tubing used during hemodialysis to carry blood between a vascular access and a dialyzer.

4. “Central line catheter” means a type of vascular access created by surgically implanting a tube into a large vein.

5. “Clinical practice restriction” means a limitation on the hemodialysis tasks that may be performed by a hemodialysis technician trainee.

6. “Conductivity test” means a determination of the electrolytes in a dialysate.

7. “Dialysate” means a mixture of water and chemicals used in hemodialysis to remove wastes and excess fluid from a patient's body.

8. “Dialysate-flow rate” means the quantity of dialysate pumped per minute of hemodialysis.

9. “Directly observing” or “direct observation” means a medical person stands next to an inexperienced hemodialysis technician trainee and watches the inexperienced hemodialysis technician trainee perform a hemodialysis task.

10. “Direct supervision” has the same meaning as “supervision” in A.R.S. § 36-401.

11. “Electrolytes” means chemicals, such as sodium, potassium, and calcium, that break apart into electrically charged particles when dissolved in water.

12. “Experienced hemodialysis technician trainee” means an individual who has passed all didactic, skills, and competency examinations provided by a health care institution that measure the individual’s knowledge and ability to perform hemodialysis.

13 “Fistula” means a type of vascular access created by a surgical connection between an artery and vein.

14. “Fluid-removal rate” means the quantity of wastes and excess fluid eliminated from a patient's blood per minute of hemodialysis to achieve the patient's prescribed weight, determined by:

a. Dialyzer size,

b. Blood-flow rate,

c. Dialysate-flow rate, and

d. Hemodialysis duration.

15. “Germicide-negative test” means a determination that a chemical used to kill microorganisms is not present.

16. “Germicide-positive test” means a determination that a chemical used to kill microorganisms is present.

17 “Graft” means a type of vascular access created by a surgical connection between an artery and vein using a synthetic tube.

18. “Hemodialysis machine” means a mechanical pump that controls:

a. The blood-flow rate,

b. The mixing and temperature of dialysate,

c. The dialysate-flow rate,

d. The addition of anticoagulant, and

e. The fluid-removal rate.

19. “Hemodialysis technician” has the same meaning as in A.R.S. § 36-423.

20. “Hemodialysis technician trainee” means an individual who is working in a health care institution to assist in providing hemodialysis and who is not certified as a hemodialysis technician according to A.R.S. § 36-423(A).

21. “Inexperienced hemodialysis technician trainee” means an individual who has not passed all didactic, skills, and competency examinations provided by a health care institution that measure the individual's knowledge and ability to perform hemodialysis.

22. “Medical person” means:

a. A doctor of medicine licensed under A.R.S. Title 32, Chapter 13, and experienced in dialysis;

b. A doctor of osteopathy licensed under A.R.S. Title 32, Chapter 17, and experienced in dialysis;

c. A registered nurse practitioner licensed under A.R.S. Title 32, Chapter 15, and experienced in dialysis;

d. A nurse licensed under A.R.S. Title 32, Chapter 15, and experienced in dialysis;

e. A hemodialysis technician who meets the requirements in A.R.S. § 36-423(A) approved by the governing authority; and

f. An experienced hemodialysis technician trainee approved by the governing authority.

23. “Not established” means not approved by a patient's nephrologist for use in hemodialysis.

24. “Patient” means an individual who receives hemodialysis.

25. “pH test” means a determination of the acidity of a dialysate.

26. “Preceptor course” means a health care institution's instruction and evaluation provided to a nurse or a hemodialysis technician trainee that enables the nurse or the hemodialysis technician trainee to provide direct observation and education to other hemodialysis technician trainees.

27. “Respond” means to mute, shut off, reset, or troubleshoot an alarm.

28. “Safety check” means successful completion of tests recommended by the manufacturer of a hemodialysis machine, a dialyzer, or a water system used for hemodialysis before initiating a patient's hemodialysis.

29. “Water-contaminant test” means a determination of the presence of chlorine or chloramine in a water system used for hemodialysis.

B. An experienced hemodialysis technician trainee may:

1. Perform hemodialysis under direct supervision, and

2. Provide direct observation to another hemodialysis technician trainee only after completing the health care institution's preceptor course approved by the governing authority.

C. An experienced hemodialysis technician trainee shall not access a patient's:

1. Fistula that is not established, or

2. Graft that is not established.

D. An inexperienced hemodialysis technician trainee may perform the following hemodialysis tasks only under direct observation:

1. Access a patient's central line catheter;

2. Respond to a hemodialysis-machine alarm;

3. Draw blood for laboratory tests;

4. Perform a water-contaminant test on a water system used for hemodialysis;

5. Inspect a dialyzer and perform a germicide-positive test before priming a dialyzer;

6. Set up a hemodialysis machine and blood lines before priming a dialyzer;

7. Prime a dialyzer;

8. Test a hemodialysis machine for germicide presence;

9. Perform a hemodialysis machine safety check;

10. Prepare a dialysate;

11. Perform a conductivity test and a pH test on a dialysate;

12. Assess a patient;

13. Check and record a patient's vital signs, weight, and temperature;

14. Determine the amount and rate of fluid removal from a patient;

15. Administer local anesthetic at an established fistula or graft, administer anticoagulant, or administer replacement saline solution;

16. Perform a germicide-negative test on a dialyzer before initiating hemodialysis;

17. Initiate or discontinue a patient's hemodialysis;

18. Adjust blood-flow rate, dialysate-flow rate, or fluid-removal rate during hemodialysis; or

19. Prepare a blood, water, or dialysate culture to determine microorganism presence.

E. An inexperienced hemodialysis technician trainee shall not:

1. Access a patient's:

a. Fistula that is not established, or

b. Graft that is not established; or

2. Provide direct observation.

F. When a hemodialysis technician trainee performs hemodialysis tasks for a patient, the patient's medical record shall include:

1. The name of the hemodialysis technician trainee;

2. The date, time, and hemodialysis task performed;

3. The name of the medical person directly observing or the nurse or physician directly supervising the hemodialysis technician trainee; and

4. The initials or signature of the medical person directly observing or the nurse or physician directly supervising the hemodialysis technician trainee.

G. If the Department determines that a health care institution is not in substantial compliance with this Section, the Department may take enforcement action according to R9-10-110.

Historical Note

Former Section R9-10-113 repealed, new Section R9-10-113 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). New Section R9-10-113 renumbered from R9-10-112 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-114. Behavioral Health Paraprofessionals; Behavioral Health Technicians

If a health care institution is licensed as a behavioral health inpatient facility, behavioral health residential facility, substance abuse transitional facility, or behavioral health specialized transitional facility, or is authorized to provide behavioral health services, an administrator shall ensure that policies and procedures are established, documented, and implemented that:

1. For a behavioral health paraprofessional providing services at the health care institution:

a. Delineate the services a behavioral health paraprofessional is allowed to provide at or for the health care institution;

b. If a behavioral health paraprofessional provides services under the practice of marriage and family therapy, the practice of professional counseling, the practice of social work, or the practice of substance abuse counseling as defined in A.R.S. § 32-3251, ensure that the behavioral health paraprofessional is under the supervision of an individual licensed pursuant to A.R.S. Title 32, Chapter 33 to provide the specific service being provided by the behavioral health paraprofessional;

c. Establish the qualifications for individuals providing supervision to a behavioral health paraprofessional; and

d. Establish documentation requirements for the supervision required in subsection (1)(b);

2. For a behavioral health technician providing services at the health care institution:

a. Delineate the services a behavioral health technician is allowed to provide at or for the health care institution;

b. Establish the qualifications for a behavioral health professional providing clinical oversight to a behavioral health technician;

c. If the behavioral health technician provides services under the practice of marriage and family therapy, the practice of professional counseling, the practice of social work, or the practice of substance abuse counseling as defined in A.R.S. § 32-3251, ensure that the behavioral health technician is under the clinical oversight of a behavioral health professional licensed pursuant to A.R.S. Title 32, Chapter 33 to provide the specific service being provided by the behavioral health technician;

d. Delineate the methods used to provide clinical oversight including when clinical oversight is provided on an individual basis or in a group setting;

e. If clinical oversight is provided electronically, ensure that:

i. The clinical oversight is provided verbally with direct and immediate interaction between the behavioral health professional providing and the behavioral health technician receiving the clinical oversight,

ii. A secure connection is used, and

iii. The identities of the behavioral health professional providing and the behavioral health technician receiving the clinical oversight are verified before clinical oversight is provided;

f. Ensure that a behavioral health technician receives clinical oversight at least once during each two week period, if the behavioral health technician provides services related to patient care at the health care institution during the two week period;

g. Establish the duration of clinical oversight provided to a behavioral health technician to ensure that patient needs are met based on, for each behavioral health technician:

i. The scope and extent of the services provided,

ii. The acuity of the patients receiving services, and

iii. The number of patients receiving services;

h. Establish documentation requirements for the clinical oversight required in subsection (2)(c); and

i. Establish the process by which information pertaining to services provided by a behavioral health technician is provided to the behavioral health professional who is responsible for the clinical oversight of the behavioral health technician.

Historical Note

Former Section R9-10-114 repealed, new Section R9-10-114 adopted effective February 4, 1981 (Supp. 81-1). Amended by adding paragraph (7) as an emergency effective November 17, 1983 pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 83-6). Amended by adding paragraph (7) as a permanent amendment effective August 2, 1984 (Supp. 84-4). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). New Section R9-10-114 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-115. Nutrition and Feeding Assistant Training Programs

A. For the purposes of this Section, “agency” means an entity other than a nursing care institution that provides the nutrition and feeding assistant training required in A.R.S. § 36-413.

B. An agency shall apply for approval to operate a nutrition and feeding assistant training program by submitting:

1. An application in a format provided by the Department that contains:

a. The name of the individual in charge of the proposed nutrition and feeding assistant training program;

b. The address where the nutrition and feeding assistant training program records are maintained;

c. A description of the training course being offered by the nutrition and feeding assistant training program including for each topic in subsection (I):

i. The information presented for each topic,

ii. The amount of time allotted to each topic,

iii. The skills an individual is expected to acquire for each topic, and

iv. The testing method used to verify an individual has acquired the stated skills for each topic; and

d. The signature of the individual in charge of the proposed nutrition and feeding assistant training program and the date signed; and

2. A copy of the materials used for providing the nutrition and feeding assistant training program.

C. For an application for an approval of a nutrition and feeding assistant training program, the administrative review time-frame is 30 calendar days, the substantive review time-frame is 30 calendar days, and the overall time-frame is 60 calendar days.

D. Within 30 calendar days after the receipt of an application in subsection (B), the Department shall:

1. Issue an approval of the agency’s nutrition and feeding assistant training program;

2. Provide a notice of administrative completeness to the agency that submitted the application; or

3. Provide a notice of deficiencies to the agency that submitted the application, including a list of the information or documents needed to complete the application.

E. If the Department provides a notice of deficiencies to an applicant:

1. The administrative completeness review time-frame and the overall time-frame are suspended from the date of the notice of deficiencies until the date the Department receives the missing information or documents from the applicant;

2. If the applicant does not submit the missing information or documents to the Department within 30 calendar days, the Department shall consider the application withdrawn; and

3. If the applicant submits the missing information or documents to the Department within the time-frame in subsection (E)(2), the substantive review time-frame begins on the date the Department receives the missing information or documents.

F. Within the substantive review time-frame, the Department:

1. Shall issue or deny an approval of a nutrition and feeding assistant training program; and

2. May make one written comprehensive request for more information, unless the Department and the applicant agree in writing to allow the Department to submit supplemental requests for information.

G. If the Department issues a written comprehensive request or a supplemental request for information:

1. The substantive review time-frame and the overall time-frame are suspended from the date of the written comprehensive request or the supplemental request for information until the date the Department receives the information requested, and

2. The applicant shall submit to the Department the information and documents listed in the written comprehensive request or supplemental request for information within 10 working days after the date of the comprehensive written request or supplemental request for information.

H. The Department shall issue:

1. An approval for an agency to operate a nutrition and feeding assistant training program, if the Department determines that the agency and the application comply with A.R.S. § 36-413 and this Section; or

2. A denial for an agency that includes the reason for the denial and the process for appealing the Department’s decision if:

a. The Department determines that the applicant does not comply with A.R.S. § 36-413 and this Section; or

b. The applicant does not submit information and documents listed in the written comprehensive request or supplemental request for information within 10 working days after the date of the comprehensive written request or supplemental request for information.

I. An individual in charge of a nutrition and feeding assistant training program shall ensure that:

1. The materials and coursework for the nutrition and feeding assistant training program includes the following topics:

a. Feeding techniques;

b. Assistance with feeding and hydration;

c. Communication and interpersonal skills;

d. Appropriate responses to resident behavior;

e. Safety and emergency procedures, including the Heimlich maneuver;

f. Infection control;

g. Resident rights;

h. Recognizing a change in a resident that is inconsistent with the resident’s normal behavior; and

i. Reporting a change in subsection (I)(1)(h) to a nurse at a nursing care institution;

2. An individual providing the training course is:

a. A physician,

b. A physician assistant,

c. A registered nurse practitioner,

d. A registered nurse,

e. A registered dietitian,

f. A licensed practical nurse,

g. A speech-language pathologist, or

h. An occupation therapist; and

3. An individual taking the training course completes:

a. At least eight hours of classroom time, and

b. Demonstrates that the individual has acquired the skills the individual was expected to acquire.

J. An individual in charge of a nutrition and feeding assistant training program shall issue a certificate of completion to an individual who completes the training course and demonstrates the skills the individual was expected to acquire as a result of completing the training course that contains:

1. The name of the agency approved to operate the nutrition and feeding assistant training program;

2. The name of the individual completing the training course;

3. The date of completion;

4. The name, signature, and professional license of the individual providing the training course; and

5. The name and signature of the individual in charge of the nutrition and feeding assistant training program.

K. The Department may deny, revoke, or suspend an approval to operate a nutrition and feeding assistant training program if an applicant for or an agency operating a nutrition and feeding assistance training program:

1. Provides false or misleading information to the Department;

2. Does not comply with the applicable statutes and rules;

3. Issues a training completion certificate to an individual who did not:

a. Complete the nutrition and feeding assistant training program, or

b. Demonstrate the skills the individual was expected to acquire; or

4. Does not implement the nutrition and feeding assistant training program as described in or use the materials submitted with the agency’s application.

L. In determining which action in subsection (K) is appropriate, the Department shall consider the following:

1. Repeated violations of statutes or rules,

2. Pattern of non-compliance,

3. Types of violations,

4. Severity of violations, and

5. Number of violations.

Historical Note

Adopted effective February 4, 1981 (Supp. 81-1). Amended by final rulemaking 16 A.A.R. 688, effective November 1, 2010 (Supp. 10-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-116. Counseling Facilities

An administrator of a counseling facility shall ensure that the counseling facility complies with the requirements in this Article and 9 A.A.C. 10, Article 10.

Historical Note

Adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-117. Collaborating Health Care Institutions

If a collaborating health care institution has an agreement with an adult behavioral health therapeutic home or children’s behavioral health respite home, an administrator shall ensure that:

1. A description of the required skills and knowledge for a provider, based on the type of adult behavioral health therapeutic services or children’s behavioral health respite services being provided, is established and documented;

2. A copy of an assessment or treatment plan for a resident that includes information necessary for a provider to meet the resident’s needs for adult behavioral health therapeutic services or children’s behavioral health respite services is completed and forwarded to the provider before the resident is admitted to the provider’s behavioral health supportive home;

3. A resident’s assessment or treatment plan is reviewed and updated at least once every twelve months and a copy of the resident’s updated assessment or treatment plan is forwarded to the resident’s provider;

4. If documentation of a significant change in a resident’s behavioral, physical, cognitive, or functional condition and the action taken by a provider to address the resident’s changing needs is received by the collaborating health care institution, a behavioral health professional or behavioral health technician reviews the documentation and:

a. Documents the review; and

b. If applicable:

i. Updates the resident’s assessment or treatment plan, and

ii. Forwards the updated assessment or treatment plan to the provider within 10 working days after receipt of the documentation of a significant change;

5. If the review and updated assessment or treatment plan required in subsection (4) is performed by a behavioral health technician, a behavioral health professional reviews and signs the review and updated assessment or treatment plan to ensure the resident is receiving the appropriate behavioral health services:

a. Before the updated assessment or treatment plan is forwarded to a provider, and

b. Within 10 working days after receipt of the documentation of a significant change;

6. Training for a provider, other than a provider who is a medical practitioner or a nurse, in the assistance in the self-administration of medication:

a. Is provided by a medical practitioner or registered nurse or by the collaborating health care institution’s personnel member trained by a medical practitioner or registered nurse;

b. Includes:

i. A demonstration of the provider’s skills and knowledge necessary to provide assistance in the self-administration of medication,

ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

iii. The process for notifying the appropriate entities when an emergency medical intervention is needed; and

c. Is documented;

7. The following documents are maintained as long as the written agreement with a provider of a behavioral health supportive home is in effect:

a. A copy of the written agreement with the provider;

b. Documentation of required skills and knowledge for the provider; and

c. Documentation of training in the assistance in the self-administration of medication; and

8. Documentation required in subsection (4) is maintained by the collaborating health care institution in the resident’s medical record.

Historical Note

Adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-118. Reserved

R9-10-119. Reserved

R9-10-120. Reserved

R9-10-121. Repealed

Historical Note

Amended effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3).

R9-10-122. Repealed

Historical Note

New Section made by final rulemaking at 7 A.A.R. 2145, effective May 1, 2001 (Supp. 01-2). Amended by final rulemaking at 8 A.A.R. 3578, effective July 26, 2002 (Supp. 02-3). Amended by exempt rulemaking at 14 A.A.R. 3958, effective September 26, 2008 (Supp. 08-3). Amended by exempt rulemaking at 15 A.A.R. 2100, effective January 1, 2010 (Supp. 09-4). Section repealed by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-123. Repealed

Historical Note

Amended effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3).

R9-10-124. Repealed

Historical Note

Former Section R9-10-124 repealed, new Section R9-10-124 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3).

ARTICLE 2. HOSPITALS

R9-10-201. Definitions

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definitions apply in this Article unless otherwise specified:

1. “Acuity” means a patient's need for hospital services based on the patient's medical condition.

2. “Acuity plan” means a method for establishing nursing personnel requirements by unit based on a patient’s acuity.

3. “Adult” means an individual the hospital designates as an adult based on the hospital's criteria.

4. “Care plan” means a documented guide for providing nursing services and rehabilitation services to a patient that includes measurable objectives and the methods for meeting the objectives.

5. “Continuing care nursery” means a nursery where medical services and nursing services are provided to a neonate who does not require intensive care services.

6. “Critically ill inpatient” means an inpatient whose severity of medical condition requires the nursing services of specially trained registered nurses for:

a. Continuous monitoring and multi-system assessment,

b. Complex and specialized rapid intervention, and

c. Education of the inpatient or inpatient's representative.

7. “Device” has the same meaning as in A.R.S. § 32-1901.

8. “Diet” means food and drink provided to a patient.

9. “Diet manual” means a written compilation of diets.

10. “Dietary services” means providing food and drink to a patient according to an order.

11. “Diversion” means notification to an emergency medical services provider, as defined in A.R.S. § 36-2201, that a hospital is unable to receive a patient from an emergency medical services provider.

12. “Drug formulary” means a written compilation of medication developed according to R9-10-218.

13. “Emergency services” means unscheduled medical services provided in a designated area to an outpatient in an emergency.

14. “Gynecological services” means medical services for the diagnosis, treatment, and management of conditions or diseases of the female reproductive organs or breasts.

15. “Hospital services” means medical services, nursing services, and health-related services provided in a hospital.

16. “Infection control risk assessment” means determining the probability for transmission of communicable diseases.

17. “Inpatient” means an individual who:

a. Is admitted to a hospital as an inpatient according to policies and procedures,

b. Is admitted to a hospital with the expectation that the individual will remain and receive hospital services for 24 consecutive hours or more, or

c. Receives hospital services for 24 consecutive hours or more.

18. “Intensive care services” means hospital services provided to a critically ill inpatient who requires the services of specially trained nursing and other personnel members as specified in policies and procedures.

19. “Medical staff regulations” means standards, approved by the medical staff, that govern the day-to-day conduct of the medical staff members.

20. “Multi-organized service unit” means an inpatient unit in a hospital where more than one organized service may be provided to a patient in the inpatient unit.

21. “Neonate” means an individual:

a. From birth until discharge following birth, or

b. Who is designated as a neonate by hospital criteria.

22. “Nurse anesthetist” means a registered nurse who meets the requirements of A.R.S. § 32-1661 and who has clinical privileges to administer anesthesia.

23. “Nurse executive” means a registered nurse accountable for the direction of nursing services provided in a hospital.

24. “Nursery” means an area in a hospital designated only for neonates.

25. “Nurse supervisor” means a registered nurse accountable for managing nursing services provided in an organized service in a hospital.

26. “Nutrition assessment” means a process for determining a patient's dietary needs using information contained in the patient's medical record.

27. “On duty” means that an individual is at work and performing assigned responsibilities.

28. “Organized service” means specific medical services, such as surgical services or emergency services, provided in an area of a hospital designated for the provision of those medical services.

29. “Outpatient” means an individual who:

a. Is admitted to a hospital with the expectation that the individual will receive hospital services for less than 24 consecutive hours; or

b. Except as provided in subsection (17), receives hospital services for less than 24 consecutive hours.

30. “Pathology” means an examination of human tissue for the purpose of diagnosis or treatment of an illness or disease.

31. “Patient care” means hospital services provided to a patient by a personnel member or a medical staff member.

32. “Pediatric” means pertaining to an individual designated by a hospital as a child based on the hospital's criteria.

33. “Perinatal services” means medical services for the treatment and management of obstetrical patients and neonates.

34. “Post-anesthesia care unit” means a designated area for monitoring a patient following a medical procedure for which anesthesia was administered to the patient.

35. “Private duty staff” means an individual, excluding a personnel member, compensated by a patient or the patient's representative.

36. “Psychiatric services” means the diagnosis, treatment, and management of a mental disorder as defined in A.R.S. § 36-501.

37. “Rehabilitation services” means medical services provided to a patient to restore or to optimize functional capability.

38. “Single group license” means a license that includes authorization to operate health care institutions according to A.R.S. § 36-422(F) or (G).

39. “Social services” means assistance, other than medical services or nursing services, provided by a personnel member to a patient to assist the patient to cope with concerns about the patient’s illness or injury while in the hospital or the anticipated needs of the patient after discharge.

40. “Specialty” means a specific branch of medicine practiced by a licensed individual who has obtained education or qualifications in the specific branch in addition to the education or qualifications required for the individual's license.

41. “Surgical services” means medical services involving a surgical procedure.

42. “Transfusion” means the introduction of blood or blood products from one individual into the body of another individual.

43. “Unit” means a designated area of an organized service.

44. “Vital record” has the same meaning as in A.R.S. § 36-301.

45. “Well-baby bassinet” means a receptacle used for holding a neonate who does not require treatment and whose anticipated discharge is within 96 hours after birth.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Amended by final rulemaking at 14 A.A.R. 4646, effective December 2, 2008 (Supp. 08-4). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-202. Supplemental Application Requirements

A. In addition to the license application requirements in A.R.S. § 36-422 and 9 A.A.C. 10, Article 1, an applicant for:

1. An initial license shall include:

a. On the application the licensed capacity requested for the hospital, including:

i. The number of inpatient beds for each organized service, not including well-baby bassinets;

ii. If applicable, the number of inpatient beds for each multi-organized service unit; and

iii. If applicable, the licensed occupancy for providing observation/stabilization services to:

(1) Individuals who are under 18 years of age, and

(2) Individuals 18 years of age and older; and

b. A list in a format provided by the Department of medical staff specialties and subspecialties; and

2. A renewal license may submit to the Department a copy of an accreditation report if the hospital is accredited and chooses to submit a copy of the accreditation report instead of receiving a compliance inspection by the Department according to A.R.S. § 36-424(C).

B. For a single group license authorized in A.R.S. § 36-422(F), in addition to the requirements in subsection (A), a governing authority applying for an initial or renewal license shall submit the following to the Department in a format provided by the Department, for each satellite facility under the single group license:

1. The name, address, and telephone number;

2. The name of the administrator; and

3. The hours of operation during which the satellite facility provides medical services, nursing services, or health-related services.

C. For a single group license authorized in A.R.S. § 36-422(G), in addition to the requirements in subsection (A), a governing authority applying for an initial or renewal license shall submit the following to the Department in a format provided by the Department for each accredited satellite facility under the single group license:

1. The name, address, and telephone number;

2. The name of the administrator;

3. The hours of operation during which the accredited satellite facility provides medical services, nursing services, or health-related services; and

4. A copy of the accredited satellite facility’s current accreditation report.

D. A governing authority shall:

1. Notify the Department at least 30 calendar days before a satellite facility or an accredited satellite facility on a single group license terminates operations; and

2. Submit an application, according to the requirements in 9 A.A.C. 10, Article 1, at least 60 calendar days but not more than 120 calendar days before a satellite facility or an accredited satellite facility licensed under a single group license anticipates providing medical services, nursing services, or health-related services under a license separate from the single group license.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 14 A.A.R. 4646, effective December 2, 2008 (Supp. 08-4). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-203. Administration

A. A governing authority shall:

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

2. Establish, in writing:

a. A hospital’s scope of services,

b. Qualifications for an administrator,

c. Which organized services are to be provided in the hospital, and

d. The organized services that are to be provided in a multi-organized service unit according to R9-10-228(A);

3. Designate an administrator, in writing, who has the qualifications established in subsection (A)(2)(b);

4. Grant, deny, suspend, or revoke a clinical privilege of a medical staff member or delegate authority to an individual to grant or suspend a clinical privilege for a limited time, according to medical staff by-laws;

5. Adopt a quality management program according to R9-10-204;

6. Review and evaluate the effectiveness of the quality management program at least once every 12 months;

7. Designate an acting administrator, in writing, who has the qualifications established in subsection (A)(2)(b) if the administrator is:

a. Expected not to be present on a hospital’s premises for more than 30 calendar days, or

b. Not present on a hospital’s premises for more than 30 calendar days;

8. Except as provided in subsection (A)(7), notify the Department according to A.R.S. § 36-425(I), if there is a change of administrator and identify the name and qualifications of the new administrator; and

9. For a health care institution under a single group license, ensure that the health care institution complies with the applicable requirements in this Chapter for the class or subclass of the health care institution.

B. An administrator:

1. Is directly accountable to the governing authority of a hospital for the daily operation of the hospital and hospital services and environmental services provided by or at the hospital;

2. Has the authority and responsibility to manage the hospital; and

3. Except as provided in subsection (A)(7), shall designate, in writing, an individual who is present on a hospital’s premises and available and accountable for hospital services and environmental services when the administrator is not present on the hospital’s premises.

C. An administrator shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Cover job descriptions, duties, and qualifications including required skills and knowledge for personnel members, employees, volunteers, and students;

b. Cover orientation and in-service education for personnel members, employees, volunteers, and students;

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

d. Cover cardiopulmonary resuscitation training required in R9-10-206(5) including:

i. The method and content of cardiopulmonary resuscitation training,

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

iii. The time-frame for renewal of cardiopulmonary resuscitation training, and

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

e. Cover use of private duty staff, if applicable;

f. Cover diversion, including:

i. The criteria for initiating diversion;

ii. The categories or levels of personnel or medical staff that may authorize or terminate diversion;

iii. The method for notifying emergency medical services providers of initiation of diversion, the type of diversion, and termination of diversion; and

iv. When the need for diversion will be reevaluated;

g. Include a method to identify a patient to ensure the patient receives hospital services as ordered;

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

i. Cover health care directives;

j. Cover medical records, including electronic medical records;

k. Cover quality management, including incident report and supporting documentation;

l. Cover contracted services;

m. Cover tissue and organ procurement and transplant; and

n. Cover when an individual may visit a patient in a hospital, including visiting a neonate in a nursery, if applicable;

2. Policies and procedures for hospital services are established, documented, and implemented that:

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

b. Cover the provision of hospital services;

c. Cover acuity, including a process for obtaining sufficient nursing personnel to meet the needs of patients;

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

e. Include the age criteria for providing hospital services to pediatric patients;

f. Cover dispensing, administering, and disposing of medication;

g. Cover infection control;

h. Cover restraints that require an order, including the frequency of monitoring and assessing the restraint;

i. Cover seclusion of a patient including:

i. The requirements for an order, and

ii. The frequency of monitoring and assessing a patient in seclusion;

j. Cover telemedicine, if applicable; and

k. Cover environmental services that affect patient care;

3. Policies and procedures are reviewed at least once every 36 months and updated as needed;

4. Policies and procedures are available to personnel members;

5. The licensed capacity in an organized service is not exceeded except for an emergency admission of a patient;

6. A patient is only admitted to an organized service that has exceeded the organized service’s licensed capacity after a medical staff member reviews the medical history of the patient and determines that the patient’s admission is an emergency; and

7. Unless otherwise stated:

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

b. When documentation or information is required by this Chapter to be submitted on behalf of a hospital, the documentation or information is provided to the unit in the Department that is responsible for licensing and monitoring the hospital.

D. An administrator of a special hospital shall ensure that:

1. Medical services are available to an inpatient in an emergency based on the inpatient's medical conditions and the scope of services provided by the special hospital; and

2. A physician or nurse, qualified in cardiopulmonary resuscitation, is on the hospital premises.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Amended by final rulemaking at 12 A.A.R. 4004, effective December 5, 2006 (Supp. 06-4). Amended by final rulemaking at 14 A.A.R. 4646, effective December 2, 2008 (Supp. 08-4). Amended by final rulemaking at 16 A.A.R. 688, effective November 1, 2010 (Supp. 10-2). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-204. Quality Management

A. A governing authority shall ensure that an ongoing quality management program is established that:

1. Complies with the requirements in A.R.S. § 36-445, and

2. Evaluates the quality of hospital services and environmental services related to patient care.

B. An administrator shall ensure that:

1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes:

a. A method to identify, document, and evaluate incidents;

b. A method to collect data to evaluate hospital services and environmental services related to patient care;

c. A method to evaluate the data collected to identify a concern about the delivery of hospital services or environmental services related to patient care;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of hospital services or environmental services related to patient care;

e. A method to identify and document each occurrence of exceeding licensed capacity, as described in R9-10-203(C)(5), and to evaluate the occurrences of exceeding licensed capacity, including the actions taken for resolving occurrences of exceeding licensed capacity; and

f. The frequency of submitting a documented report required in subsection (B)(2) to the governing authority;

2. A documented report is submitted to the governing authority that includes:

a. An identification of each concern about the delivery of hospital services or environmental services related to patient care, and

b. Any changes made or actions taken as a result of the identification of a concern about the delivery of hospital services or environmental services related to patient care;

3. The acuity plan required in R9-10-214(C)(2) is reviewed and evaluated every 12 months and the results are documented and reported to the governing authority;

4. The reports required in subsections (B)(2) and (3) and the supporting documentation for the reports are maintained for 12 months after the date the report is submitted to the governing authority; and

5. Except for information or documentation that is confidential under federal or state law, a report or documentation required in this Section is provided to the Department for review within two hours after the Department’s request.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-205. Contracted Services

An administrator shall ensure that:

1. Contracted services are provided according to the requirements in this Article, and

2. A documented list of current contracted services is maintained that includes a description of the contracted services provided.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-206. Personnel

An administrator shall ensure that:

1. The qualifications, skills, and knowledge required for each type of personnel member:

a. Are based on:

i. The type of physical health services or behavioral health services expected to be provided by the personnel member according to the established job description, and

ii. The acuity of the patients receiving physical health services or behavioral health services from the personnel member according to the established job description; and

b. Include:

i. The specific skills and knowledge necessary for the personnel member to provide the expected physical health services and behavioral health services listed in the established job description,

ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description, and

iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description;

2. A personnel member’s skills and knowledge are verified and documented:

a. Before the personnel member provides physical health services or behavioral health services, and

b. According to policies and procedures;

3. Personnel members are present on a hospital’s premises with the qualifications, skills, and knowledge necessary to:

a. Provide the services in the hospital’s scope of services,

b. Meet the needs of a patient, and

c. Ensure the health and safety of a patient;

4. Orientation occurs within the first 30 calendar days after a personnel member begins providing hospital services and includes:

a. Informing a personnel member about Department rules for licensing and regulating hospitals and where the rules may be obtained,

b. Reviewing the process by which a personnel member may submit a complaint about patient care to a hospital, and

c. Providing the information required by policies and procedures;

5. Policies and procedures designate the categories of personnel providing medical services or nursing services who are:

a. Required to be qualified in cardiopulmonary resuscitation within 30 calendar days after the individual's starting date, and

b. Required to maintain current qualifications in cardiopulmonary resuscitation;

6. A personnel record for a personnel member is established and maintained and includes:

a. The personnel member’s name, date of birth, home address, and contact telephone number;

b. The personnel member's starting date;

c. Verification of a personnel member's certification, license, or education, if necessary for the position held;

d. Documentation of evidence of freedom from infectious tuberculosis required in R9-10-230(A)(5);

e. Verification of current cardiopulmonary resuscitation qualifications, if necessary for the position held; and

f. Orientation documentation;

7. Personnel receive in-service education according to criteria established in policies and procedures;

8. In-service education documentation for each personnel member includes:

a. The subject matter;

b. The date of the in-service education; and

c. The signature, rubber stamp, or electronic signature code of each individual who participated in the in-service education;

9. Personnel records and in-service education documentation are maintained by the hospital for at least two years after the last date the personnel member worked; and

10. Personnel records and in-service education documentation, for a personnel member who has not worked in the hospital during the previous 12 months, are provided to the Department within 72 hours after the Department's request.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-207. Medical Staff

A. A governing authority shall ensure that:

1. The organized medical staff is directly accountable to the governing authority for the quality of care provided by a medical staff member to a patient in a hospital;

2. The medical staff bylaws and medical staff regulations are approved according to the medical staff bylaws and governing authority requirements;

3. A medical staff member complies with medical staff bylaws and medical staff regulations;

4. The medical staff of a general hospital or a special hospital includes at least two physicians who have clinical privileges to admit inpatients to the general hospital or special hospital;

5. The medical staff of a rural general hospital includes at least one physician who has clinical privileges to admit inpatients to the rural general hospital and one additional physician who serves on a committee according to subsection (A)(7)(c);

6. A medical staff member is available to direct patient care;

7. Medical staff bylaws or medical staff regulations are established, documented, and implemented for the process of:

a. Conducting peer review according to A.R.S. Title 36, Chapter 4, Article 5;

b. Appointing members to the medical staff, subject to approval by the governing authority;

c. Establishing committees including identifying the purpose and organization of each committee;

d. Appointing one or more medical staff members to a committee;

e. Obtaining and documenting permission for an autopsy of a patient, performing an autopsy, and notifying, if applicable, the medical practitioner coordinating the patient’s medical services when an autopsy is performed;

f. Requiring that each inpatient has a medical practitioner who coordinates the inpatient’s care;

g. Defining the responsibilities of a medical staff member to provide medical services to the medical staff member's patient;

h. Defining a medical staff member's responsibilities for the transport or transfer of a patient;

i. Specifying requirements for oral, telephone, and electronic orders including which orders require identification of the time of the order;

j. Establishing a time-frame for a medical staff member to complete a patient’s medical records;

k. Establishing criteria for granting, denying, revoking, and suspending clinical privileges;

l. Specifying pre-anesthesia and post-anesthesia responsibilities for medical staff members; and

m. Approving the use of medication and devices under investigation by the U.S. Department of Health and Human Services, Food and Drug Administration including:

i. Establishing criteria for patient selection;

ii. Obtaining informed consent before administering the investigational medication or device; and

iii. Documenting the administration of and, if applicable, the adverse reaction to an investigational medication or device; and

8. The organized medical staff reviews the medical staff bylaws and the medical staff regulations at least once every 36 months and updates the bylaws and regulations as needed.

B. An administrator shall ensure that:

1. A medical staff member provides evidence of freedom from infectious tuberculosis according to the requirements in R9-10-230(A)(5);

2. A record for each medical staff member is established and maintained that includes:

a. A completed application for clinical privileges;

b. The dates and lengths of appointment and reappointment of clinical privileges;

c. The specific clinical privileges granted to the medical staff member, including revision or revocation dates for each clinical privilege; and

d. A verification of current Arizona health care professional active license according to A.R.S. Title 32; and

3. Except for documentation of peer review conducted according to A.R.S. § 36-445, a record under subsection (B)(2) is provided to the Department for review:

a. As soon as possible but not more than two hours after the time of the Department's request if the individual is a current medical staff member; and

b. Within 72 hours after the time of the Department's request if the individual is no longer a current medical staff member.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-208. Admissions

An administrator shall ensure that:

1. A patient is admitted as an inpatient on the order of a medical staff member;

2. An individual, authorized by policies and procedures, is available to accept a patient for admission;

3. Except in an emergency, informed consent is obtained from a patient or the patient's representative before or at the time of admission;

4. The informed consent obtained in subsection (3) or the lack of consent in an emergency is documented in the patient's medical record;

5. A physician or other medical staff member performs a medical history and physical examination on a patient within 30 calendar days before admission or within 48 hours after admission and documents the medical history and physical examination in the patient's medical record within 48 hours after admission; and

6. If a physician or a medical staff member performs a medical history and physical examination on a patient before admission, the physician or the medical staff member enters an interval note into the patient's medical record at the time of admission.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-208 renumbered to R9-10-214; new Section R9-10-208 renumbered from R9-10-210 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-209. Discharge Planning; Discharge

A. For an inpatient, an administrator shall ensure that discharge planning:

1. Identifies the specific needs of the patient after discharge, if applicable;

2. Includes the participation of the patient or the patient's representative;

3. Is completed before discharge occurs;

4. Provides the patient or the patient's representative with written information identifying classes or subclasses of health care institutions and the level of care that the health care institutions provide that may meet the patient's assessed and anticipated needs after discharge, if applicable; and

5. Is documented in the patient's medical record.

B. For an inpatient discharge or a transfer of an inpatient, an administrator shall ensure that:

1. There is a discharge summary that includes:

a. A description of the patient's medical condition and the medical services provided to the patient; and

b. The signature of the medical practitioner coordinating the patient’s medical services;

2. There is a documented discharge order for the patient by a medical practitioner coordinating the patient’s medical services before discharge unless the patient leaves the hospital against a medical staff member's advice; and

3. If the patient is not being transferred:

a. There are documented discharge instructions; and

b. The patient or the patient's representative is provided with a copy of the discharge instructions.

C. Except as provided in subsection (D), an administrator shall ensure that an outpatient is discharged according to policies and procedures.

D. For a discharge of an outpatient receiving emergency services, an administrator shall ensure that:

1. A discharge order is documented by a medical practitioner who provided medical services to the patient before the patient is discharged unless the patient leaves against a medical staff member's advice; and

2. Discharge instructions are documented and provided to the patient or the patient's representative before the patient is discharged unless the patient leaves the hospital against a medical staff member's advice.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-209 renumbered to R9-10-212; new Section R9-10-209 renumbered from R9-10-211 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-210. Transport

A. For a transport of a patient, the administrator of a sending hospital shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Specify the process by which the sending hospital personnel members coordinate the transport and the medical services provided to a patient to protect the health and safety of the patient;

b. Require an assessment of the patient by a registered nurse or a medical staff member before transporting the patient and after the patient's return;

c. Specify the sending hospital's patient medical records that are required to accompany the patient, which shall include the medical records related to the medical services to be provided to the patient at the receiving health care institution;

d. Specify how the sending hospital personnel members communicate patient medical record information that the sending hospital does not provide at the time of transport but is requested by the receiving health care institution; and

e. Specify how a medical staff member explains the risks and benefits of a transport to the patient or the patient's representative based on the:

i. Patient's medical condition, and

ii. Mode of transport; and

2. Documentation in the patient's medical record includes:

a. Consent for transport by the patient or the patient's representative or why consent could not be obtained;

b. The acceptance of the patient by and communication with an individual at the receiving health care institution;

c. The date and the time of the transport to the receiving health care institution;

d. The date and time of the patient's return to the sending hospital, if applicable;

e. The mode of transportation; and

f. The type of personnel member or medical staff member assisting in the transport if an order requires that a patient be assisted during transport.

B. For a transport of a patient to a receiving hospital, the administrator of the receiving hospital shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Specify the process by which the receiving hospital personnel members coordinate the transport and the medical services provided to a patient to protect the health and safety of the patient;

b. Require an assessment of the patient by a registered nurse or a medical staff member upon arrival of the patient and before the patient is returned to the sending hospital unless the receiving facility is a satellite facility, as defined in A.R.S. § 36-422, and does not have a registered nurse or a medical staff member at the satellite facility;

c. Specify the receiving hospital's patient medical records required to accompany the patient when the patient is returned to the sending hospital, if applicable; and

d. Specify how the receiving hospital personnel members communicate patient medical record information to the sending hospital that is not provided at the time of the patient's return; and

2. Documentation in the patient's medical record includes:

a. The date and time the patient arrives at the receiving hospital;

b. The medical services provided to the patient at the receiving hospital;

c. Any adverse reaction or negative outcome the patient experiences at the receiving hospital, if applicable;

d. The date and time the receiving hospital returns the patient to the sending hospital, if applicable;

e. The mode of transportation to return the patient to the sending hospital, if applicable; and

f. The type of personnel member or medical staff member assisting in the transport if an order requires that a patient be assisted during transport.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-210 renumbered to R9-10-208; new Section R9-10-210 renumbered from R9-10-212 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-211. Transfer

For a transfer of a patient, the administrator of a sending hospital shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Specify the process by which the sending hospital personnel members coordinate the transfer and the medical services provided to a patient to protect the health and safety of the patient during the transfer;

b. Require an assessment of the patient by a registered nurse or a medical staff member of the sending hospital before the patient is transferred;

c. Specify how the sending hospital personnel members communicate medical record information that is not provided at the time of the transfer; and

d. Specify how a medical staff member explains the risks and benefits of a transfer to the patient or the patient's representative based on the:

i. Patient's medical condition, and

ii. Mode of transfer;

2. One of the following accompanies the patient during transfer:

a. A copy of the patient's medical record for the current inpatient admission; or

b. All of the following for the current inpatient admission:

i. A medical staff member's summary of medical services provided to the patient,

ii. A care plan containing up-to-date information,

iii. Consultation reports,

iv. Laboratory and radiology reports,

v. A record of medications administered to the patient for the seven calendar days before the date of transfer,

vi. Medical staff member's orders in effect at the time of transfer, and

vii. Any known allergy; and

3. Documentation in the patient's medical record includes:

a. Consent for transfer by the patient or the patient's representative, except in an emergency;

b. The acceptance of the patient by and communication with an individual at the receiving health care institution;

c. The date and the time of the transfer to the receiving health care institution;

d. The mode of transportation; and

e. The type of personnel member or medical staff member assisting in the transfer if an order requires that a patient be assisted during transfer.

Historical Note

Former Section R9-10-211 renumbered as R9-10-311 as an emergency effective February 22, 1979, new Section R9-10-211 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-211 renumbered to R9-10-209; new Section R9-10-211 renumbered from R9-10-213 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-212. Patient Rights

A. An administrator shall ensure that:

1. The requirements in subsection (B) and the patient rights in subsection (C) are conspicuously posted on the premises;

2. At the time of admission, a patient or the patient's representative receives a written copy of the requirements in subsection (B) and the patient rights in subsection (C); and

3. Policies and procedures are established, documented, and implemented that include:

a. How and when a patient or the patient’s representative is informed of patient rights in subsection (C), and

b. Where patient rights are posted as required in subsection (A)(1).

B. An administrator shall ensure that:

1. A patient is treated with dignity, respect, and consideration;

2. A patient is not subjected to:

a. Abuse;

b. Neglect;

c. Exploitation;

d. Coercion;

e. Manipulation;

f. Sexual abuse;

g. Sexual assault;

h. Seclusion;

i. Restraint, if not necessary to prevent imminent harm to self or others;

j. Retaliation for submitting a complaint to the Department or another entity; or

k. Misappropriation of personal and private property by a hospital’s medical staff, personnel members, employees, volunteers, or students; and

3. A patient or the patient's representative:

a. Except in an emergency, either consents to or refuses treatment;

b. May refuse examination or withdraw consent to treatment before treatment is initiated;

c. Is informed of:

i. Except in an emergency, alternatives to a proposed psychotropic medication or surgical procedure and associated risks and possible complications of the proposed psychotropic medication or surgical procedure;

ii. How to obtain a schedule of hospital rates and charges required in A.R.S. § 36-436.01(B);

iii. The patient complaint policies and procedures, including the telephone number of hospital personnel to contact about complaints, and the Department's telephone number if the hospital is unable to resolve the patient's complaint; and

iv. Except as authorized by the Health Insurance Portability and Accountability Act of 1996, proposed involvement of the patient in research, experimentation, or education, if applicable;

d. Except in an emergency, is provided a description of the health care directives policies and procedures:

i. If an inpatient, at the time of admission; or

ii. If an outpatient:

(1) Before any invasive procedure, except phlebotomy for obtaining blood for diagnostic purposes; or

(2) If the hospital services include a planned series of treatments, at the start of each series;

e. Consents to photographs of the patient before a patient is photographed except that a patient may be photographed when admitted to a hospital for identification and administrative purposes; and

f. Except as otherwise permitted by law, provides written consent to the release of the patient’s:

i. Medical records, and

ii. Financial records.

C. A patient has the following rights:

1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;

2. To receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities;

3. To receive privacy in treatment and care for personal needs;

4. To have access to a telephone;

5. To review, upon written request, the patient’s own medical record according to A.R.S. §§ 12-2293, 12-2294, and 12-2294.01;

6. To receive a referral to another health care institution if the hospital is unable to provide physical health services or behavioral health services for the patient;

7. To participate or have the patient's representative participate in the development of, or decisions concerning, treatment;

8. To participate or refuse to participate in research or experimental treatment; and

9. To receive assistance from a family member, representative, or other individual in understanding, protecting, or exercising the patient’s rights.

Historical Note

Former Section R9-10-212 renumbered as R9-10-312 as an emergency effective February 22, 1979, new Section R9-10-212 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-212 renumbered to R9-10-210; new Section R9-10-212 renumbered from R9-10-209 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-213. Medical Records

A. An administrator shall ensure that:

1. A medical record is established and maintained for each patient according to A.R.S. § Title 12, Chapter 13, Article 7.1;

2. An entry in a patient’s medical record is:

a. Recorded only by a personnel member authorized by policies and procedures to make the entry;

b. Dated, legible, and authenticated; and

c. Not changed to make the initial entry illegible;

3. An order is:

a. Dated when the order is entered in the patient’s medical record and includes the time of the order;

b. Authenticated by a medical staff member according to policies and procedures; and

c. If the order is a verbal order, authenticated by the medical staff member entering the order in the patient’s medical record;

4. If a rubber-stamp signature or an electronic signature code is used to authenticate an order, the individual whose signature the stamp or electronic code represents is accountable for the use of the stamp or the electronic code;

5. A patient’s medical record is available to personnel members and medical staff members authorized by policies and procedures to access the medical record;

6. Policies and procedures include the maximum time-frame to retrieve an onsite or off-site patient’s medical record at the request of a medical staff member or authorized personnel member; and

7. A patient’s medical record is protected from loss, damage, or unauthorized use.

B. If a hospital maintains patient’s medical records electronically, an administrator shall ensure that:

1. Safeguards exist to prevent unauthorized access, and

2. The date and time of an entry in a patient’s medical record is recorded by the computer's internal clock.

C. An administrator shall ensure that a hospital's medical record for an inpatient contains:

1. Patient information that includes:

a. The patient's name;

b. The patient's address;

c. The patient's date of birth;

d. The name and contact information of the patient’s representative, if applicable; and

e. Any known allergy including medication allergies or sensitivities;

2. Medication information that includes:

a. A medication ordered for the patient; and

b. A medication administered to the patient including:

i. The date and time of administration;

ii. The name, strength, dosage, amount, and route of administration;

iii. The identification and authentication of the individual administering the medication; and

iv. Any adverse reaction the patient has to the medication;

3. Documentation of general and, if applicable, informed consent for treatment by the patient or the patient's representative except in an emergency;

4. A medical history and results of a physical examination or an interval note;

5. If the patient provides a health care directive, the health care directive signed by the patient;

6. An admitting diagnosis;

7. Names of the admitting medical staff member and medical practitioners coordinating the patient’s care;

8. Orders;

9. Care plans;

10. Documentation of hospital services provided to the patient;

11. Progress notes;

12. Disposition of the patient after discharge;

13. Discharge planning, including discharge instructions required in R9-10-209(B)(3);

14. A discharge summary; and

15. If applicable:

a. A laboratory report,

b. A pathology report,

c. An autopsy report,

d. A radiologic report,

e. A diagnostic imaging report,

f. Documentation of restraint or seclusion, and

g. A consultation report.

D. An administrator shall ensure that a hospital's medical record for an outpatient contains:

1. Patient information that includes:

a. The patient's name;

b. The patient's address;

c. The patient's date of birth;

d. The name and contact information of the patient’s representative, if applicable; and

e. Any known allergy including medication allergies or sensitivities;

2. If necessary for treatment, medication information that includes:

a. A medication ordered for the patient; and

b. A medication administered to the patient including:

i. The date and time of administration;

ii. The name, strength, dosage, amount, and route of administration;

iii. The identification and authentication of the individual administering the medication; and

iv. Any adverse reaction the patient has to the medication;

3. Documentation of general and, if applicable, informed consent for treatment by the patient or the patient's representative except in an emergency;

4. An admitting diagnosis or reason for outpatient medical services;

5. Orders;

6. Documentation of hospital services provided to the patient; and

7. If applicable:

a. A laboratory report,

b. A pathology report,

c. An autopsy report,

d. A radiologic report,

e. A diagnostic imaging report,

f. Documentation of restraint or seclusion, and

g. A consultation report.

E. In addition to the requirements in subsection (D), an administrator shall ensure that the hospital's record of emergency services provided to a patient contains:

1. Documentation of treatment the patient received before arrival at the hospital, if available;

2. The patient's medical history;

3. An assessment, including the name of the individual performing the assessment;

4. The patient's chief complaint;

5. The name of the individual who treated the patient in the emergency room, if applicable; and

6. The disposition of the patient after discharge.

Historical Note

Former Section R9-10-213 renumbered as R9-10-313 as an emergency effective February 23, 1979, new Section R9-10-213 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-213 renumbered to R9-10-211; new Section R9-10-213 renumbered from R9-10-228 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-214. Nursing Services

A. An administrator shall ensure that:

1. Nursing services are provided 24 hours a day, and

2. A nurse executive is appointed who is qualified according to the requirements in policies and procedures.

B. A nurse executive shall designate a registered nurse who is present in the hospital to be accountable for managing the nursing services when the nurse executive is not present in the hospital.

C. A nurse executive shall ensure that:

1. Policies and procedures for nursing services are established, documented, and implemented;

2. An acuity plan is established, documented, and implemented that includes:

a. A method that establishes the types and numbers of nursing personnel that are required for each unit in the hospital;

b. An assessment of a patient's need for nursing services made by a registered nurse providing nursing services directly to the patient; and

c. A policy and procedure stating the steps a hospital will take to:

i. Obtain the necessary nursing personnel to meet patient acuity, and

ii. Make assignments for patient care according to the acuity plan;

3. Registered nurses, including registered nurses providing nursing services directly to a patient, are knowledgeable about the acuity plan and implement the acuity plan established under subsection (C)(2);

4. If licensed capacity in an organized service is exceeded or patients are kept in areas without licensed beds, nursing personnel are assigned according to the specific rules for the organized service in this Chapter;

5. There is a minimum of one registered nurse on duty in a hospital whether or not there is a patient;

6. A general hospital has two registered nurses on duty when there is more than one patient;

7. A special hospital offering emergency services or obstetrical services has two registered nurses on duty when there is more than one patient;

8. A special hospital not offering emergency services or obstetrical services has at least one registered nurse and one other nurse on duty when there is more than one patient;

9. A rural general hospital with more than one patient has one registered nurse and at least one other nursing personnel member on duty. If there is only one registered nurse in the hospital, an additional registered nurse is on-call who is able to be present in the hospital within 15 minutes after being called;

10. If a hospital has a patient in a unit, there is a minimum of one registered nurse in the unit;

11. If a hospital has more than one patient in a unit, there is a minimum of one registered nurse and one additional nursing personnel member in the unit;

12. At least one registered nurse is present and accountable for the nursing services provided to a patient:

a. During the delivery of a neonate,

b. In an operating room, and

c. In a post-anesthesia care unit;

13. Nursing personnel work schedules are planned, reviewed, adjusted, and documented to meet patient needs and emergencies;

14. A registered nurse assesses, plans, directs, and evaluates nursing services provided to a patient;

15. There is a care plan for each inpatient based on the inpatient's need for nursing services; and

16. Nursing personnel document nursing services in a patient's medical record.

Historical Note

Former Section R9-10-214 renumbered as R9-10-314 as an emergency effective February 22, 1979, new Section R9-10-214 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-214 renumbered to R9-10-215; new Section R9-10-214 renumbered from R9-10-208 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-215. Surgical Services

A. An administrator of a general hospital shall ensure that:

1. There is an organized service that provides surgical services under the direction of a medical staff member;

2. There is a designated area for providing surgical services as an organized service;

3. The area of the hospital designated for surgical services is managed by a registered nurse or a physician;

4. Documentation is available in the surgical services area that specifies each medical staff member's clinical privileges to perform surgical procedures in the surgical services area;

5. Postoperative orders are documented in the patient's medical record;

6. There is a chronological log of surgical procedures performed in the surgical services area that contains:

a. The date of the surgical procedure,

b. The patient's name,

c. The type of surgical procedure,

d. The time in and time out of the operating room,

e. The name and title of each individual performing or assisting in the surgical procedure,

f. The type of anesthesia used,

g. An identification of the operating room used, and

h. The disposition of the patient after the surgical procedure;

7. The chronological log required in subsection (A)(6) is maintained in the surgical services area for a minimum of 12 months after the date of the surgical procedure and then maintained by the hospital for an additional 12 months;

8. The medical staff designate in writing the surgical procedures that may be performed in areas other than the surgical services area;

9. The hospital has the medical staff members, personnel members, and equipment to provide the surgical procedures offered in the surgical services area;

10. A patient and the surgical procedure to be performed on the patient are identified before initiating the surgical procedure;

11. Except in an emergency, a medical staff member or a surgeon performs a medical history and physical examination within 30 calendar days before performing a surgical procedure on a patient;

12. Except in an emergency, a medical staff member or a surgeon enters an interval note in the patient's medical record before performing a surgical procedure;

13. Except in an emergency, the following are documented in a patient's medical record before a surgical procedure:

a. A preoperative diagnosis;

b. Each diagnostic test performed in the hospital;

c. A medical history and physical examination as required in subsection (A)(11) and an interval note as required in subsection (A)(12);

d. A consent or refusal for blood or blood products signed by the patient or the patient's representative, if applicable; and

e. Informed consent according to policies and procedures; and

14. Within 24 hours after a surgical procedure on a patient is completed:

a. The surgeon performing the surgery documents in the patient’s medical record the surgical technique, findings, and tissue removed or altered, if applicable; and

b. The individual performing the postoperative follow-up examination completes and documents in the patient’s medical record a postoperative follow-up report.

B. An administrator of a rural general hospital or a special hospital that provides surgical services shall comply with subsection (A).

Historical Note

Former Section R9-10-215 renumbered as R9-10-315 as an emergency effective February 22, 1979, new Section R9-10-215 adopted effective February 23, 1979 (Supp. 79-1). Amended subsection (D) effective August 31, 1988 (Supp. 88-3). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-215 renumbered to R9-10-216; new Section R9-10-215 renumbered from R9-10-214 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-216. Anesthesia Services

An administrator shall ensure that:

1. Anesthesia services provided in conjunction with surgical services performed in the operating room are provided as an organized service under the direction of a medical staff member;

2. Documentation is available in the surgical services area that specifies the medical staff member's clinical privileges to administer anesthesia;

3. Except in an emergency, an anesthesiologist or a nurse anesthetist performs a pre-anesthesia evaluation within 48 hours before anesthesia is administered in conjunction with surgical services;

4. Anesthesia administration is documented in a patient's medical record and includes:

a. A pre-anesthesia evaluation, if applicable;

b. An intra-operative anesthesia record;

c. The postoperative status of the patient upon leaving the operating room; and

d. Post-anesthesia documentation by the individual performing the post-anesthesia evaluation that includes the information required by the medical staff bylaws and medical staff regulations; and

5. A registered nurse or a physician documents resuscitative measures in the patient's medical record.

Historical Note

Adopted as an emergency effective April 2, 1976 (Supp. 76-2). Adopted effective August 25, 1977 (Supp. 77-4). Former Section R9-10-216 renumbered as R9-10-316 as an emergency effective February 22, 1979, new Section R9-10-216 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-216 renumbered to R9-10-217; new Section R9-10-216 renumbered from R9-10-215 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-217. Emergency Services

A. An administrator of a general hospital or a rural general hospital shall ensure that:

1. Emergency services are provided 24 hours a day in a designated area of the hospital;

2. Emergency services are provided as an organized service under the direction of a medical staff member;

3. The scope and extent of emergency services offered are documented;

4. Emergency services are provided to an individual, including a woman in active labor, requesting emergency services;

5. If emergency services cannot be provided at the hospital to meet the needs of a patient in an emergency, measures and procedures are implemented to minimize risk to the patient until the patient is transported or transferred to another hospital;

6. A roster of on-call medical staff members is available in the emergency services area;

7. There is a chronological log of emergency services that includes:

a. The patient's name;

b. The date, time, and mode of arrival; and

c. The disposition of the patient including discharge, transfer, or admission; and

8. The chronological log required in subsection (A)(7) is maintained:

a. In the emergency services area for a minimum of 12 months after the date of the emergency services; and

b. By the hospital for an additional four years.

B. An administrator of a special hospital that provides emergency services shall comply with subsection (A).

C. An administrator of a hospital that provides emergency services, but does not provide perinatal organized services, shall ensure that emergency perinatal services are provided within the hospital's capabilities to meet the needs of a patient and a neonate, including the capability to deliver a neonate and to keep the neonate warm until transfer to a hospital providing perinatal organized services.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-217 renumbered to R9-10-218; new Section R9-10-217 renumbered from R9-10-216 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-218. Pharmaceutical Services

An administrator shall ensure that:

1. Pharmaceutical services are provided under the direction of a pharmacist according to A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23;

2. A copy of the pharmacy license is provided to the Department for review upon the Department's request;

3. A committee, composed of at least one physician, one pharmacist, and other personnel members as determined by policies and procedures is established to:

a. Develop a drug formulary,

b. Update the drug formulary at least every 12 months,

c. Develop medication usage and medication substitution policies and procedures, and

d. Specify which medication and medication classifications are required to be automatically stopped after a specified time period unless the ordering medical staff member specifically orders otherwise;

4. An expired, mislabeled, or unusable medication is disposed of according to policies and procedures;

5. A medication administration error or an adverse reaction is reported to the ordering medical staff member or the medical staff member's designee;

6. A pharmacy medication dispensing error is reported to the pharmacist;

7. In a pharmacist's absence, personnel members designated by policies and procedures have access to a locked area containing a medication;

8. A medication is maintained at temperatures recommended by the manufacturer;

9. A cart used for an emergency:

a. Contains medication, supplies, and equipment as specified in policies and procedures;

b. Is available to a unit; and

c. Is sealed until opened in an emergency;

10. Emergency cart contents and sealing of the emergency cart are verified and documented according to policies and procedures;

11. Policies and procedures specify individuals who may:

a. Order medication, and

b. Administer medication;

12. A medication is administered in compliance with an order;

13. A medication administered to a patient is documented as required in R9-10-213;

14. If pain medication is administered to a patient, documentation in the patient's medical record includes:

a. An assessment of the patient's pain before administering the medication, and

b. The effect of the pain medication administered; and

15. Policies and procedures specify a process for review through the quality management program of:

a. A medication administration error,

b. An adverse reaction to a medication, and

c. A pharmacy medication dispensing error.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-218 renumbered to R9-10-219; new Section R9-10-218 renumbered from R9-10-217 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-219. Clinical Laboratory Services and Pathology Services

An administrator shall ensure that:

1. Clinical laboratory services and pathology services are provided by a hospital through a laboratory that holds a certificate of accreditation or certificate of compliance issued by the United States Department of Health and Human Services under the 1988 amendments to the Clinical Laboratories Improvement Act of 1967;

2. A copy of the certificate of accreditation or compliance in subsection (1) is provided to the Department for review upon the Department's request;

3. A general hospital or a rural general hospital provides clinical laboratory services 24 hours a day within the hospital to meet the needs of a patient in an emergency;

4. A special hospital whose patients require clinical laboratory services:

a. Is able to provide clinical laboratory services when needed by the patients,

b. Obtains specimens for clinical laboratory services without transporting the patients from the special hospital's premises, and

c. Has the examination of the specimens performed by a clinical laboratory on the special hospital's premises or by arrangement with a clinical laboratory not on the premises;

5. A hospital that provides clinical laboratory services 24 hours a day has on duty or on-call laboratory personnel authorized by policies and procedures to perform testing;

6. A hospital that offers surgical services provides pathology services within the hospital or by contracted service to meet the needs of a patient;

7. Clinical laboratory and pathology test results are:

a. Available to the medical staff:

i. Within 24 hours after the test is completed if the test is performed at a laboratory on the hospital premises, or

ii. Within 24 hours after the test result is received if the test is performed at a laboratory outside of the hospital premises; and

b. Documented in a patient's medical record;

8. If a test result is obtained that indicates a patient may have an emergency medical condition, as defined by medical staff, laboratory personnel notify the ordering medical staff member or a registered nurse in the patient's assigned unit;

9. If a clinical laboratory report, a pathology report, or an autopsy report is completed on a patient, a copy of the report is included in the patient's medical record;

10. Policies and procedures are established, documented, and implemented for:

a. Procuring, storing, transfusing, and disposing of blood and blood products;

b. Blood typing, antibody detection, and blood compatibility testing; and

c. Investigating transfusion adverse reactions that specify a process for review through the quality management program;

11. If blood and blood products are provided by contract, the contract includes:

a. The availability of blood and blood products from the contractor, and

b. The process for delivery of blood and blood products from the contractor; and

12. Expired laboratory supplies are discarded according to policies and procedures.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-219 renumbered to R9-10-220; new Section R9-10-219 renumbered from R9-10-218 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-220. Radiology Services and Diagnostic Imaging Services

A. An administrator shall ensure that:

1. Radiology services and diagnostic imaging services are provided in compliance with A.R.S. Title 30, Chapter 4 and 12 A.A.C. 1;

2. A copy of a certificate documenting compliance with subsection (1) is provided to the Department for review upon the Department's request;

3. A general hospital or a rural general hospital provides radiology services 24 hours a day within the hospital to meet the emergency needs of a patient;

4. A hospital that provides surgical services has radiology services and diagnostic imaging services on the hospital's premises to meet the needs of patients;

5. A general hospital or a rural general hospital has a radiologic technologist on duty or on-call; and

6. Except as provided in subsection (A)(4), a special hospital whose patients require radiology services and diagnostic imaging services is able to provide the radiology services and diagnostic imaging services when needed by the patients:

a. On the special hospital's premises, or

b. By arrangement with a radiology and diagnostic imaging facility that is not on the special hospital's premises.

B. An administrator of a hospital that provides radiology services or diagnostic imaging services in the hospital shall ensure that:

1. Radiology services and diagnostic imaging services are provided:

a. Under the direction of a medical staff member; and

b. According to an order that includes:

i. The patient's name,

ii. The name of the ordering individual,

iii. The radiological or diagnostic imaging procedure ordered, and

iv. The reason for the procedure;

2. A medical staff member or radiologist interprets the radiologic or diagnostic image;

3. A radiologic or diagnostic imaging patient report is prepared that includes:

a. The patient's name;

b. The date of the procedure;

c. A medical staff member's or radiologist's interpretation of the image;

d. The type and amount of radiopharmaceutical used, if applicable; and

e. The adverse reaction to the radiopharmaceutical, if any; and

4. A radiologic or diagnostic imaging report is included in the patient's medical record.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-220 renumbered to R9-10-221; new Section R9-10-220 renumbered from R9-10-219 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-221. Intensive Care Services

Except for a special hospital that provides only psychiatric services, an administrator of a hospital that provides intensive care services shall ensure that:

1. Intensive care services are provided as an organized service in a designated area under the direction of a medical staff member;

2. An inpatient admitted for intensive care services is personally visited by a physician at least once every 24 hours;

3. Admission and discharge criteria for intensive care services are established;

4. A personnel member's responsibilities for initiation of medical services in an emergency to a patient in an intensive care unit pending the arrival of a medical staff member are defined and documented in policies and procedures;

5. In addition to the requirements in R9-10-214(C), an intensive care unit is staffed:

a. With a minimum of one registered nurse assigned for every two patients, and

b. According to an acuity plan as required in R9-10-214;

6. Each intensive care unit has a policy and procedure that provides for meeting the needs of the patients;

7. If the medical services of an intensive care patient are reduced to a lesser level of care in the hospital, but the patient is not physically relocated, the nurse to patient ratio is based on the needs of the patient;

8. Private duty staff do not provide hospital services in an intensive care unit;

9. At least one registered nurse assigned to a patient in an intensive care unit is certified in advanced cardiac life support specific to the age of the patient;

10. Resuscitation, emergency, and other equipment are available to meet the needs of a patient including:

a. Ventilatory assistance equipment,

b. Respiratory and cardiac monitoring equipment,

c. Suction equipment,

d. Portable radiologic equipment, and

e. A patient weighing device for patients restricted to a bed; and

11. An intensive care unit has at least one emergency cart that is maintained according to R9-10-218.

Historical Note

Former Section R9-10-221 renumbered as R9-10-317 as an emergency effective February 22, 1979, new Section R9-10-221 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-221 renumbered to R9-10-222; new Section R9-10-221 renumbered from R9-10-220 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-222. Respiratory Care Services

An administrator of a hospital that provides respiratory care services shall ensure that:

1. Respiratory care services are provided under the direction of a medical staff member;

2. Respiratory care services are provided according to an order that includes:

a. The patient's name;

b. The name and signature of the ordering individual;

c. The type, frequency, and, if applicable, duration of treatment;

d. The type and dosage of medication and diluent; and

e. The oxygen concentration or oxygen liter flow and method of administration;

3. Respiratory care services provided to a patient are documented in the patient's medical record and include:

a. The date and time of administration;

b. The type of respiratory care services;

c. The effect of respiratory care services;

d. The adverse reaction to respiratory care services, if any; and

e. The authentication of the individual providing the respiratory care services; and

4. Any area or unit that performs blood gases or clinical laboratory tests complies with the requirements in R9-10-219.

Historical Note

Former Section R9-10-222 renumbered as R9-10-318 as an emergency effective February 22, 1979, new Section R9-10-222 adopted effective February 23, 1979 (Supp. 79-1). Correction, subsection (D)(3) reference to paragraph (E)(2) should read subsection (D)(2). (Supp. 79-6). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-222 renumbered to R9-10-223; new Section R9-10-222 renumbered from R9-10-221 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-223. Perinatal Services

A. An administrator of a hospital that provides perinatal organized services shall ensure that:

1. Perinatal services are provided in a designated area under the direction of a medical staff member;

2. Only medical and surgical procedures approved by the medical staff are performed in the perinatal services unit;

3. The perinatal services unit has the capability to initiate an emergency cesarean delivery within the time-frame established by the medical staff and documented in policies and procedures;

4. Only a patient in need of perinatal services or gynecological services receives perinatal services or gynecological services in the perinatal services unit;

5. A patient receiving gynecological services does not share a room with a patient receiving perinatal services;

6. A chronological log of perinatal services is maintained that includes:

a. The patient's name;

b. The date, time, and mode of the patient's arrival;

c. The disposition of the patient including discharge, transfer, or admission time; and

d. The following information for a delivery of a neonate:

i. The neonate's name or other identifier;

ii. The name of the medical staff member who delivered the neonate;

iii. The delivery time and date; and

iv. Complications of delivery, if any;

7. The chronological log required in subsection (A)(6) is maintained by the hospital in the perinatal services unit for a minimum of 12 months after the date the perinatal services are provided and then maintained by the hospital for an additional 12 months;

8. The perinatal services unit provides fetal monitoring;

9. The perinatal services unit has ultrasound capability;

10. Except in an emergency, a neonate is identified as required by policies and procedures before moving the neonate from a delivery area;

11. Policies and procedures specify:

a. Security measures to prevent neonatal abduction, and

b. How the hospital determines to whom a neonate may be discharged;

12. A neonate is discharged only to an individual who:

a. Is authorized according to subsection (A)(11), and

b. Provides identification;

13. A neonate's medical record identifies the individual to whom the neonate is discharged;

14. A patient or the individual to whom the neonate is discharged receives perinatal education, discharge instructions, and a referral for follow-up care for a neonate in addition to the discharge planning requirements in R9-10-209;

15. Intensive care services for neonates comply with the requirements in R9-10-221;

16. A minimum of one registered nurse is on duty in a nursery when there is a neonate in the nursery except as provided in subsection (A)(17);

17. A nursery occupied only by a neonate, who is placed in the nursery for the convenience of the neonate's mother and does not require treatment as defined in this Article, is staffed by a licensed nurse;

18. Equipment and supplies are available to a nursery, labor-delivery-recovery room, or labor-delivery-recovery-postpartum room to meet the needs of each neonate; and

19. In a nursery, only a neonate's bed or bassinet is used for changing diapers, bathing, or dressing the neonate.

B. An administrator of a hospital that does not provide perinatal organized services shall comply with the requirements in R9-10-217(C).

Historical Note

Former Section R9-10-223 renumbered as R9-10-319 as an emergency effective February 22, 1979, new Section R9-10-223 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-223 renumbered to R9-10-224; new Section R9-10-223 renumbered from R9-10-222 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-224. Pediatric Services

A. An administrator of a hospital that provides pediatric services or organized pediatric services according to the requirements in this Section shall ensure that:

1. Consistent with the health and safety of a pediatric patient, arrangements are made for a parent or guardian of the pediatric patient to stay overnight;

2. Policies and procedures are established, documented, and implemented for:

a. Infection control for shared toys, books, stuffed animals, and other items in a community playroom; and

b. Visitation of a pediatric patient, including age limits if applicable;

3. The hospital only admits a pediatric inpatient if the hospital has the staff, equipment, and supplies available to meet the needs of the pediatric patient based on the pediatric patient’s medical condition and the hospital’s scope of services; and

4. If the hospital provides pediatric intensive care services, the pediatric intensive care services comply with intensive care services requirements in R9-10-221.

B. An administrator of a hospital that provides pediatric organized services shall ensure that pediatric services are provided in a designated area under the direction of a medical staff member.

C. An administrator shall ensure that in a multi-organized service unit or a patient care unit that is providing medical and nursing services to an adult patient and a pediatric patient according to this Section:

1. A pediatric patient is not placed in a patient room with an adult patient, and

2. A medication for a pediatric patient that is stored in the patient care unit is stored separately from a medication for an adult patient.

D. Except as provided in subsections (F) and (G), an administrator of a hospital that does not provide pediatric organized services may admit a pediatric inpatient only in an emergency.

E. A hospital may use a bed in a pediatric organized services patient care unit for an adult patient if an administrator establishes, documents, and implements policies and procedures that:

1. Delineate the specific conditions under which an adult patient is placed in a bed in the pediatric organized services unit, and

2. Except as provided in subsection (H) and (I), ensure that an adult patient is:

a. Not placed in a pediatric organized services patient care unit if a pediatric patient is admitted to and present in the pediatric organized services patient care unit, and

b. Transferred out of the pediatric organized services patient care unit to an appropriate level of care when a pediatric patient is admitted to the pediatric organized services patient care unit.

F. Subsection (G) only applies to a general hospital or rural general hospital that:

1. Does not provide pediatric organized services;

2. Has designated in the general hospital or rural general hospital’s scope of services, inpatient services that are available to a pediatric patient;

3. Has a licensed capacity of less than 100; and

4. Is located in a county with a population of less than 500,000.

G. An administrator of a general hospital or rural general hospital that meets the criteria in subsection (F) shall ensure that:

1. There are pediatric-appropriate equipment and supplies available based on the hospital services designated for pediatric patients in the general hospital or rural general hospital’s scope of services; and

2. Personnel members that are or may be assigned to provide hospital services to a pediatric patient have the appropriate skills and knowledge for providing hospital services to a pediatric patient based on the general hospital or rural general hospital’s scope of services.

H. Subsection (I) only applies to a general hospital or a rural general hospital that:

1. Provides organized pediatric services in a patient care unit;

2. Has designated in the general hospital or rural general hospital’s scope of services, inpatient services that are available to an adult patient in an organized pediatric services patient care unit;

3. Has a licensed capacity of less than 100; and

4. Is located in a county with a population of less than 500,000.

I. An administrator of a general hospital or rural general hospital that meets the criteria in subsection (H) shall comply with the requirements in subsection (E)(1).

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by exempt rulemaking at 18 A.A.R. 1719, effective June 30, 2012 (Supp. 12-2). Section R9-10-224 renumbered to R9-10-225; new Section R9-10-224 renumbered from R9-10-223 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-225. Psychiatric Services

An administrator of a hospital that contains an organized psychiatric services unit or a special hospital licensed to provide psychiatric services shall ensure that in the organized psychiatric unit or special hospital:

1. Psychiatric services are provided under the direction of a medical staff member;

2. An inpatient admitted to the organized psychiatric services unit or special hospital has a principle diagnosis of a mental disorder, a personality disorder, substance abuse, or a significant psychological or behavioral response to an identifiable stressor;

3. Except in an emergency, a patient receives a nursing assessment before treatment for the patient is initiated;

4. An individual whose medical needs cannot be met while the individual is an inpatient in an organized psychiatric services unit or a special hospital is not admitted to or is transferred out of the organized psychiatric services unit or special hospital;

5. Except for a psychotropic drug used as a chemical restraint or administered according to an order from a court of competent jurisdiction, informed consent is obtained from a patient or the patient's representative for a psychotropic drug and documented in the patient’s medical record before the psychotropic drug is administered to the patient;

6. Policies and procedures for the organized psychiatric services unit or special hospital are established, documented, and implemented that:

a. Establish qualifications for medical staff members and personnel members who provide clinical oversight to behavioral health technicians;

b. Establish the process for patient assessment including identification of a patient’s medical conditions and criteria for the on-going monitoring of any identified medical condition;

c. Establish the process for developing and implementing a patient's care plan including:

i. Obtaining the patient's or the patient's representative's participation in the development of the patient's care plan;

ii. Ensuring that the patient is informed of the modality, frequency, and duration of any treatments that are included in the patient's care plan;

iii. Informing the patient that the patient has the right to refuse any treatment;

iv. Updating the patient's care plan and informing the patient of any changes to the patient's care plan; and

v. Documenting the actions in subsection (6)(c)(i) through (6)(c)(iv) in the patient's medical record;

d. Establish the process for warning an identified or identifiable individual, as described in A.R.S. § 36-517.02 (B) through (C), if a patient communicates to a medical staff member or personnel member a threat of imminent serious physical harm or death to the individual and the patient has the apparent intent and ability to carry out the threat;

e. Establish the criteria for determining when an inpatient’s absence is unauthorized, including whether the inpatient:

i. Was admitted under A.R.S. Title 36, Chapter 5, Articles 1, 2, or 3;

ii. Is absent against medical advice; or

iii. Is under the age of 18;

f. Identify each type of restraint and seclusion used in the organized psychiatric services unit or special hospital and include for each type of restraint and seclusion used:

i. The qualifications of a medical staff member or personnel member who can:

(1) Order the restraint or seclusion,

(2) Place a patient in the restraint or seclusion,

(3) Monitor a patient in the restraint or seclusion,

(4) Evaluate a patient’s physical and psychological well-being after being placed in the restraint or seclusion and when released from the restraint or seclusion, or

(5) Renew the order for restraint or seclusion;

ii. On-going training requirements for a medical staff member or personnel member who has direct patient contact while the patient is in a restraint or in seclusion; and

iii. Criteria for monitoring and assessing a patient including:

(1) Frequencies of monitoring and assessment based on a patient's condition, cognitive status, situational factors, and risks associated with the specific restraint or seclusion;

(2) For the renewal of an order for restraint or seclusion, whether an assessment is required before the order is renewed and, if an assessment is required, who may conduct the assessment;

(3) Assessment content, which may include, depending on a patient's condition, the patient's vital signs, respiration, circulation, hydration needs, elimination needs, level of distress and agitation, mental status, cognitive functioning, neurological functioning, and skin integrity;

(4) If a mechanical restraint is used, how often the mechanical restraint is loosened; and

(5) A process for meeting a patient's nutritional needs and elimination needs;

g. Establish the criteria and procedures for renewing an order for restraint or seclusion;

h. Establish procedures for internal review of the use of restraint or seclusion;

i. Establish requirements for notifying the parent or guardian of a patient who is less than 18 years of age and who is restrained or secluded; and

j. Establish medical record and personnel record documentation requirements for restraint and seclusion, if applicable;

7. If time out is used in the organized psychiatric services unit or special hospital, a time out:

a. Takes place in an area that is unlocked, lighted, quiet, and private;

b. Does not take place in the room approved for seclusion by the Department under R9-10-104;

c. Is time-limited and does not exceed two hours per incident or four hours per day;

d. Does not result in a patient's missing a meal if the patient is in time out at mealtime;

e. Includes monitoring of the patient by a medical staff member or personnel member at least once every 15 minutes to ensure the patient's health, safety, and welfare and to determine if the patient is ready to leave time out; and

f. Is documented in the patient's medical record, to include:

i. The date of the time out,

ii. The reason for the time out,

iii. The duration of the time out, and

iv. The action planned and taken to address the reason for the time out;

8. Restraint or seclusion is:

a. Not used as a means of coercion, discipline, convenience, or retaliation;

b. Only used when all of the following conditions are met:

i. Except as provided in subsection (9), after obtaining an order for the restraint or seclusion;

ii. For the management of a patient’s violent or self-destructive behavior;

iii. When less restrictive interventions have been determined to be ineffective; and

iv. To ensure the immediate physical safety of the patient, to prevent imminent harm to the patient or another individual, or to stop physical harm to another individual; and

c. Discontinued at the earliest possible time;

9. If as a result of a patient’s aggressive, violent, or self-destructive behavior, harm to the patient or another individual is imminent or the patient or another individual is being physically harmed, a personnel member:

a. May initiate an emergency application of restraint or seclusion for the patient before obtaining an order for the restraint or seclusion, and

b. Obtains an order for the restraint or seclusion of the patient during the emergency application of the restraint or seclusion;

10. Restraint or seclusion is:

a. Only ordered by a physician or a nurse practitioner, and

b. Not written as a standing order or on an as-needed basis;

11. An order for restraint or seclusion includes:

a. The name of the individual ordering the restraint or seclusion;

b. The date and time that the restraint or seclusion was ordered;

c. The specific restraint or seclusion ordered;

d. If a drug is ordered as a chemical restraint, the drug's name, strength, dosage, and route of administration;

e. The specific criteria for release from restraint or seclusion without an additional order; and

f. The maximum duration authorized for the restraint or seclusion;

12. An order for restraint or seclusion is limited to the duration of the emergency situation and does not exceed:

a. Four continuous hours for a patient who is 18 years of age or older,

b. Two continuous hours for a patient who is between the ages of nine and 17, or

c. One continuous hour for a patient who is younger than nine;

13. If restraint and seclusion are used on a patient simultaneously, the patient receives continuous:

a. Face-to-face monitoring by a medical staff member or personnel member, or

b. Video and audio monitoring by a medical staff member or personnel member who is in close proximity to the patient;

14. If an order for restraint or seclusion of a patient is not provided by a medical practitioner coordinating the patient’s medical services, the medical practitioner is notified as soon as possible;

15. A medical staff member or personnel member does not participate in restraint or seclusion, monitor a patient during restraint or seclusion, or evaluate a patient after restraint or seclusion until the medical staff member or personnel member completes education and training that:

a. Includes:

i. Techniques to identify medical staff member, personnel member, and patient behaviors; events; and environmental factors that may trigger circumstances that require restraint or seclusion;

ii. The use of nonphysical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods;

iii. Techniques for identifying the least restrictive intervention based on an assessment of the patient’s medical or behavioral health condition;

iv. The safe use of restraint and the safe use of seclusion, including training in how to recognize and respond to signs of physical and psychological distress in a patient who is restrained or secluded;

v. Clinical identification of specific behavioral changes that indicate that the restraint or seclusion is no longer necessary;

vi. Monitoring and assessing a patient while the patient is in restraint or seclusion according to policies and procedures; and

vii. Training exercises in which medical staff members and personnel members successfully demonstrate the techniques that the medical staff members and personnel members have learned for managing emergency situations; and

b. Is provided by individuals qualified according to policies and procedures;

16. When a patient is placed in restraint or seclusion:

a. The restraint or seclusion is conducted according to policies and procedures;

b. The restraint or seclusion is proportionate and appropriate to the severity of the patient’s behavior and the patient’s:

i. Chronological and developmental age;

ii. Size;

iii. Gender;

iv. Physical condition;

v. Medical condition;

vi. Psychiatric condition; and

vii. Personal history, including any history of physical or sexual abuse;

c. The physician or nurse practitioner who ordered the restraint or seclusion is available for consultation throughout the duration of the restraint or seclusion;

d. A patient is monitored and assessed according to policies and procedures;

e. A physician or other health professional authorized by policies and procedures assesses the patient within one hour after the patient is placed in the restraint or seclusion and determines:

i. The patient’s current behavior,

ii. The patient's reaction to the restraint or seclusion used,

iii. The patient's medical and behavioral condition, and

iv. Whether to continue or terminate the restraint or seclusion;

f. The patient is given the opportunity:

i. To eat during mealtime, and

ii. To use the toilet, and

g. The restraint or seclusion is discontinued at the earliest possible time, regardless of the length of time identified in the order;

17. If a patient is placed in seclusion, the room used for seclusion:

a. Is approved for use as a seclusion room by the Department under R9-10-104;

b. Is not used as a patient's bedroom or a sleeping area;

c. Allows full view of the patient in all areas of the room;

d. Is free of hazards, such as unprotected light fixtures or electrical outlets;

e. Contains at least 60 square feet of floor space; and

f. Except as provided in subsection (18), contains a non-adjustable bed that:

i. Consists of a mattress on a solid platform that is:

(1) Constructed of a durable, non-hazardous material; and

(2) Raised off of the floor;

ii. Does not have wire springs or a storage drawer; and

iii. Is securely anchored in place;

18. If a non-adjustable bed required in subsection (17)(f) is not in a room used for seclusion:

a. A piece of equipment is available for use in the room used for seclusion that:

i. Is commercially manufactured to safely and humanely restrain a patient’s body;

ii. Provides support to the trunk and head of a patient’s body;

iii. Provides restraint to the trunk of a patient’s body;

iv. Is able to restrict movement of a patient’s arms, legs, trunk, and head;

v. Allows a patient’s body to recline; and

vi. Does not inflict harm on a patient’s body; and

b. Documentation of the manufacturer’s specifications for the piece of equipment in subsection (18)(a) is maintained;

19. A seclusion room may be used for services or activities other than seclusion if:

a. A sign stating the service or activity scheduled or being provided in the room is conspicuously posted outside the room;

b. No permanent equipment other than the bed required in subsection (17)(f) is in the room;

c. Policies and procedures are established, documented, and implemented that:

i. Delineate which services or activities other than seclusion may be provided in the room,

ii. List what types of equipment or supplies may be placed in the room for the delineated services, and

iii. Provide for the prompt removal of equipment and supplies from the room before the room is used for seclusion; and

d. The sign required in subsection (19)(a) and equipment and supplies in the room, other than the bed required in subsection (17)(f), are removed before a patient is placed in seclusion in the room;.

20. A medical staff member or personnel member documents the following information in a patient’s medical record before the end of the shift in which the patient is placed in restraint or seclusion or, if the patient’s restraint or seclusion does not end during the shift in which it began, during the shift in which the patient’s restraint or seclusion ends:

a. The emergency situation that required the patient to be restrained or put in seclusion;

b. The times the patient’s restraint or seclusion actually began and ended;

c. The time of the face-to-face assessment required in subsection (13)(a);

d. The monitoring required in subsection (13)(b) or (16)(d), as applicable;

e. The times the patient was given the opportunity to eat or use the toilet according to subsection (16)(f); and

f. The names of the medical staff members and personnel members with direct patient contact while the patient was in the restraint or seclusion; and

21. If an emergency situation continues beyond the time limit of an order for restraint or seclusion, the order is renewed according to policies and procedures.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-225 renumbered to R9-10-227; new Section R9-10-225 renumbered from R9-10-224 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-226. Behavioral Health Observation/Stabilization Services

An administrator of a hospital that provides behavioral health observation/stabilizations services shall ensure that:

1. Behavioral health observation/stabilization services are provided according to the requirements in R9-10-1012, and

2. Restraint and seclusion are provided according to the requirements for restraint and seclusion in R9-10-225.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-226 renumbered to R9-10-229; new Section R9-10-226 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-227. Rehabilitation Services

An administrator shall ensure that:

1. If rehabilitation services are provided as an organized service, the rehabilitation services are provided under the direction of an individual qualified according to policies and procedures;

2. Rehabilitation services are provided according to an order; and

3. The medical record of a patient receiving rehabilitation services includes:

a. An order for rehabilitation services that includes the name of the ordering individual and a referring diagnosis,

b. A documented care plan that is developed in coordination with the ordering individual and the individual providing the rehabilitation services,

c. The rehabilitation services provided,

d. The patient's response to the rehabilitation services, and

e. The authentication of the individual providing the rehabilitation services.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-227 renumbered to R9-10-231; new Section R9-10-227 renumbered from R9-10-225 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-228. Multi-organized Service Unit

A. A governing authority may designate the following as a multi-organized service unit:

1. An adult unit that provides both intensive care services and medical and nursing services other than intensive care services,

2. A pediatric unit that provides both intensive care services and medical and nursing services other than intensive care services,

3. A unit that provides both perinatal services and intensive care services for obstetrical patients,

4. A unit that provides both intensive care services for neonates and a continuing care nursery, or

5. A unit that provides medical and nursing services to adult and pediatric patients.

B. An administrator shall ensure that:

1. For a patient in a multi-organized service unit, a medical staff member designates in the patient's medical record which organized service is to be provided to the patient;

2. A multi-organized service unit is in compliance with the requirements in this Article that would apply if each organized service were offered as a single organized service unit; and

3. A multi-organized service unit and each bed in the unit are in compliance with physical plant health and safety codes and standards incorporated by reference in A.A.C. R9-1-412 for all organized services provided in the multi-organized service unit.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Amended by final rulemaking at 11 A.A.R. 536, effective March 5, 2005 (Supp. 05-1). Section R9-10-228 renumbered to R9-10-213; new Section R9-10-228 renumbered from R9-10-234 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-229. Social Services

An administrator of a hospital that provides social services shall ensure that:

1. A social worker or a registered nurse designated by the administrator coordinates social services;

2. A medical staff member, nurse, patient, patient's representative, or member of the patient's family may request social services;

3. A personnel member providing social services participates in discharge planning as necessary to meet the needs of a patient;

4. The patient has privacy when communicating with a personnel member providing social services; and

5. Social services provided to a patient are documented in the patient's medical record and the entries are authenticated by the individual providing the social services.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-229 renumbered to R9-10-230; new Section R9-10-229 renumbered from R9-10-226 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-230. Infection Control

A. An administrator shall ensure that:

1. An infection control program that meets the requirements of this Section is established under the direction of an individual qualified according to policies and procedures;

2. An infection control program has a procedure for documenting:

a. The collection and analysis of infection control data,

b. The actions taken relating to infections and communicable diseases, and

c. Reports of communicable diseases to the governing authority and state and county health departments;

3. Infection control documents are maintained for at least two years after the date of the document;

4. Policies and procedures are established, documented, and implemented:

a. To prevent or minimize, identify, report, and investigate infections and communicable diseases that include:

i. Isolating a patient;

ii. Sterilizing equipment and supplies;

iii. Maintaining and storing sterile equipment and supplies;

iv. Use of personal protective equipment such as gowns, masks, or face protection;

v. Disposing of biohazardous medical waste; and

vi. Transporting and processing soiled linens and clothing;

b. That specify communicable diseases, medical conditions, or criteria that prevent an individual, a personnel member, or a medical staff member from:

i. Working in the hospital,

ii. Providing patient care, or

iii. Providing environmental services;

c. That establish criteria for determining whether a medical staff member is at an increased risk of exposure to infectious tuberculosis based on:

i. The level of risk in the area of the hospital premises where the medical staff member practices, and

ii. The work that the medical staff member performs; and

d. That establish the frequency of tuberculosis screening for an individual determined to be at an increased risk of exposure;

5. Tuberculosis screening is performed:

a. As part of a tuberculosis infection control program that complies with the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-care Settings according to R9-10-112; or

b. Using a screening method described in R9-10-112, as follows:

i. For a personnel member, at least once every 12 months or more frequently if the personnel member is determined to be at an increased risk of exposure based on the criteria in subsection (A)(4)(c);

ii. Except as required in subsection (A)(4)(d), for a medical staff member, at least once every two years; and

iii. For a medical staff member at an increased risk of exposure based on the criteria in subsection (A)(4)(c), at the frequency required by policies and procedures, but no less frequently than every two years;

6. Soiled linen and clothing are:

a. Collected in a manner to minimize or prevent contamination,

b. Bagged at the site of use, and

c. Maintained separate from clean linen and clothing and away from food storage, kitchen, or dining areas;

7. A personnel member washes hands or uses a hand disinfection product after each patient contact and after handling soiled linen, soiled clothing, or potentially infectious material;

8. An infection control committee is established according to policies and procedures and consists of:

a. At least one medical staff member,

b. The individual directing the infection control program, and

c. Other personnel identified in policies and procedures; and

9. The infection control committee:

a. Develops a plan for preventing, tracking, and controlling infections;

b. Reviews the type and frequency of infections and develops recommendations for improvement;

c. Meets and provides a quarterly written report for inclusion by the quality management program; and

d. Maintains a record of actions taken and minutes of meetings.

B. An administrator shall comply with communicable disease control and reporting requirements in 9 A.A.C. 6.

Historical Note

Adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-230 renumbered to R9-10-233; new Section R9-10-230 renumbered from R9-10-229 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-231. Dietary Services

An administrator shall ensure that:

1. Dietary services are provided according to 9 A.A.C. 8, Article 1;

2. A copy of the hospital's food establishment license under 9 A.A.C. 8, Article 1, is maintained;

3. For a hospital that contracts with a food establishment, as defined in 9 A.A.C. 8, Article 1, to prepare and deliver food to the hospital, a copy of the contracted food establishment's license under 9 A.A.C. 8, Article 1, is maintained;

4. If a hospital contracts with a food establishment to prepare and deliver food to the hospital, the hospital is able to store, refrigerate, and reheat food to meet the dietary needs of a patient;

5. Dietary services are provided under the direction of an individual qualified to direct the provision of dietary services according to policies and procedures;

6. There are personnel members on duty to meet the dietary needs of patients;

7. Personnel members providing dietary services are qualified to provide dietary services according to policies and procedures;

8. A nutrition assessment of a patient is:

a. Performed according to policies and procedures, and

b. Communicated to the medical practitioner coordinating the patient’s medical services if the nutrition assessment reveals a specific dietary need;

9. A medical staff member documents an order for a diet for each patient in the patient's medical record;

10. A current diet manual approved by a registered dietitian is available to personnel members and medical staff members; and

11. A patient's dietary needs are met 24 hours a day.

Historical Note

Former Section R9-10-231 renumbered as R9-10-320 as an emergency effective February 22, 1979, new Section R9-10-231 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-231 renumbered to R9-10-232; new Section R9-10-231 renumbered from R9-10-227 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-232. Disaster Management

An administrator shall ensure that:

1. A disaster plan is developed and documented that includes:

a. Procedures for protecting the health and safety of patients and other individuals;

b. Assigned personnel responsibilities; and

c. Instructions for the evacuation, transport, or transfer of patients, maintenance of medical records, and arrangements to provide any other hospital services to meet the patients’ needs;

2. A plan exists for back-up power and water supply;

3. A fire drill is performed on each shift at least once every three months;

4. A disaster drill is performed on each shift at least once every 12 months;

5. Documentation of a fire drill required in subsection (3) and a disaster drill required in subsection (4) includes:

a. The date and time of the drill;

b. A critique of the drill; and

c. Recommendations for improvement, if applicable; and

6. Documentation of a fire drill or a disaster drill is maintained by the hospital for 12 months after the date of the drill.

Historical Note

Former Section R9-10-232 renumbered as R9-10-321 as an emergency effective February 22, 1979, new Section R9-10-232 adopted effective February 23, 1979 (Supp. 79-1). Section amended by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section R9-10-232 renumbered to R9-10-234; new Section R9-10-232 renumbered from R9-10-231 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-233. Environmental Standards

An administrator shall ensure that:

1. An individual providing environmental services who has the potential to transmit infectious tuberculosis to patients, as determined by the infection control risk assessment criteria in R9-10-230(A)(4)(c), provides evidence of freedom from infectious tuberculosis as specified in R9-10-112;

2. The hospital premises and equipment are:

a. Cleaned and disinfected according to policies and procedures or manufacturer's instructions to prevent, minimize, and control infection or illness; and

b. Free from a condition or situation that may cause a patient or other individual to suffer physical injury;

3. A pest control program is implemented and documented;

4. The hospital maintains a tobacco smoke-free environment;

5. Biohazardous medical waste is identified, stored, and disposed of according to 18 A.A.C. 13, Article 14 and policies and procedures;

6. Equipment used to provide hospital services is:

a. Maintained in working order;

b. Tested and calibrated according to the manufacturer's recommendations or, if there are no manufacturer's recommendations, as specified in policies and procedures; and

c. Used according to the manufacturer's recommendations; and

7. Documentation of equipment testing, calibration, and repair is maintained for at least 12 months after the date of the testing, calibration, or repair.

Historical Note

Former Section R9-10-233 renumbered as R9-10-322 as an emergency effective February 22, 1979, new Section R9-10-233 adopted effective February 23, 1979 (Supp. 79-1). Section repealed; new Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). Section expired under A.R.S. § 41-1056(E) at 14 A.A.R. 2374, effective February 29, 2008 (Supp. 08-2). New Section R9-10-233 renumbered from R9-10-230 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-234. Physical Plant Standards

A. An administrator shall ensure that:

1. A hospital complies with the applicable physical plant health and safety codes and standards, incorporated by reference in A.A.C. R9-1-412, in effect on the date the hospital submitted architectural plans and specifications for approval to the Department;

2. The licensed hospital premises or any part of the licensed hospital premises is not leased to or used by another person;

3. A unit with inpatient beds is not used as a passageway to another health care institution; and

4. Hospital premises are not licensed as more than one health care institution.

B. An administrator shall:

1. Obtain a fire inspection conducted according to the time-frame established by the local fire department or the State Fire Marshal,

2. Make any repairs or corrections stated on the inspection report, and

3. Maintain documentation of a current fire inspection report.

Historical Note

New Section made by final rulemaking 14 A.A.R. 4646, effective December 2, 2008 (Supp. 08-4). Section R9-10-234 renumbered to R9-10-228; new Section R9-10-234 renumbered from R9-10-232 and amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

ARTICLE 3. BEHAVIORAL HEALTH INPATIENT FACILITIES

Article 3, consisting of Sections R9-10-311 through R9-10-333, repealed at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-301. Definitions

The definitions in A.R.S. § 36-401 and R9-10-101 apply in this Article unless otherwise specified.

Historical Note

New Section R9-10-301 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-302. Supplemental Application Requirements

In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant for a license as a behavioral health inpatient facility shall include on the application whether the applicant is requesting authorization to provide:

1. Inpatient services to individuals under 18 years of age, including the licensed capacity requested;

2. Inpatient services to individuals 18 years of age and older, including the licensed capacity requested;

3. Detoxification services;

4. Court-ordered pre-petition screening;

5. Court-ordered evaluation;

6. Court-ordered treatment;

7. Behavioral health observation/stabilization services including the licensed occupancy requested for providing behavioral health observation/stabilization services to individuals:

a. Under 18 years of age, and

b. 18 years of age and older;

8. Surgical services;

9. Clinical laboratory services;

10. Radiology services;

11. Diagnostic imaging services;

12. Intensive care services; or

13. Perinatal services.

Historical Note

New Section R9-10-302 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-303. Administration

A. A governing authority shall:

1. Consist of one or more individuals responsible for the organization, operation, and administration of a behavioral health inpatient facility;

2. Establish, in writing:

a. A behavioral health inpatient facility’s scope of services, and

b. Qualifications for an administrator;

3. Designate an administrator who has the qualifications established in subsection (A)(2)(b);

4. Adopt a quality management program according to R9-10-304;

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

6. Designate in writing, an acting administrator who has the qualifications established in subsection (A)(2)(b), if the administrator is:

a. Not expected to be present on the behavioral health inpatient facility’s premises for more than 30 calendar days, or

b. Not present on the behavioral health inpatient facility’s premises for more than 30 calendar days; and

7. Except as provided in subsection (A)(6), notify the Department according to § A.R.S. 36-425(I) when there is a change in the administration and identify the name and qualifications of the new administrator.

B. An administrator:

1. Is directly accountable to the governing authority of a behavioral health inpatient facility for the operation of the behavioral health inpatient facility and for the behavioral health services and physical health services provided by or at the behavioral health inpatient facility;

2. Has the authority and responsibility to manage the behavioral health inpatient facility; and

3. Except as provided in subsection (A)(8), designates, in writing, an individual who is available and accountable for services when the administrator is not present on the behavioral health inpatient facility’s premises.

C. An administrator shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Include job descriptions, duties, and qualifications including required skills, knowledge, education, and experience for personnel members, employees, volunteers, and students;

b. Cover orientation and in-service education for personnel members, employees, volunteers, and students;

c. Include how a personnel member may submit a complaint relating to services provided to a patient;

d. Cover cardiopulmonary resuscitation training including:

i. The method and content of cardiopulmonary resuscitation training,

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

iii. The time-frame for renewal of cardiopulmonary resuscitation training, and

iv. The documentation that verifies that the individual has received cardiopulmonary resuscitation training;

e. Cover first aid training;

f. Include a method to identify a patient to ensure the patient receives physical health and behavioral health services as ordered;

g. Cover patient rights including assisting a patient who does not speak English or who has a physical or other disability to become aware of patient rights;

h. Cover specific steps and deadlines for:

i. A patient to file a complaint;

ii. The behavioral health inpatient facility to respond to and resolve a patient’s complaint; and

iii. The behavioral health inpatient facility to obtain documentation of fingerprint clearance, if applicable;

i. Cover health care directives;

j. Cover medical records, including electronic medical records;

k. Cover quality management, including incident report and supporting documentation;

l. Cover contracted services; and

m. Cover when an individual may visit a patient in the behavioral health inpatient facility;

2. Policies and procedures for behavioral health services and physical health services are established, documented, and implemented that:

a. Cover patient screening, admission, assessment, treatment plan, transport, transfer, discharge planning, and discharge;

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

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

d. Cover restraint and seclusion;

e. Cover dispensing, administering, and disposing of medication, including provisions for inventory control and preventing diversion of controlled substances;

f. Cover infection control;

g. Cover telemedicine, if applicable;

h. Cover environmental services that affect patient care;

i. Cover patient outings;

j. Cover whether pets and animals are allowed on the premises, including procedures to ensure that any pets or animals allowed on the premises do not endanger the health or safety of patients or the public;

k. If the behavioral health inpatient facility is involved in research, cover the establishment or use of a Human Subject Review Committee;

l. Cover the process for receiving a fee from a patient and refunding a fee to a patient;

m. Cover the process for obtaining patient preferences for social, recreational, or rehabilitative activities and meals and snacks;

n. Cover the security of a patient's possessions that are allowed on the premises; and

o. Cover smoking and use of tobacco products on the premises;

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

4. Policies and procedures are available to personnel members, 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 Department request; and

b. When documentation or information is required by this Chapter to be submitted on behalf of a behavioral health inpatient facility, the documentation or information is provided to the unit in the Department that is responsible for licensing and monitoring the behavioral health inpatient facility.

D. An administrator shall designate a:

1. Medical director who:

a. Provides direction for physical health services provided by or at the behavioral health inpatient facility, and

b. Is a physician or registered nurse practitioner;

2. Clinical director who:

a. Provides direction for the behavioral health services provided by or at the behavioral health inpatient facility;

b. Is a behavioral health professional; and

c. May be the same individual as the administrator, if the individual meets the qualifications in subsections (A)(2)(b) and (D)(2)(a) and (b); and

3. Registered nurse to provide direction for nursing services provided by or at the behavioral health inpatient facility.

E. An administrator shall provide written notification to the Department:

1. If a patient's death is required to be reported according to A.R.S. § 11-593, within one working day after the patient’s death; and

2. Within two working days after a patient inflicts a self-injury that requires immediate intervention by an emergency medical services provider.

F. If abuse, neglect, or exploitation of a patient is alleged or suspected to have occurred before the patient was admitted or while the patient is not on the premises and not receiving services from a behavioral health inpatient facility’s employee or personnel member, an administrator shall immediately report the alleged or suspected abuse, neglect, or exploitation of the patient as follows.

1. For a patient 18 years of age or older, according to A.R.S. § 46-454; or

2. For a patient under 18 years of age, according to A.R.S. § 13-3620;

G. If abuse, neglect, or exploitation of a patient is alleged or suspected to have occurred on the premises or while the patient is receiving services from a behavioral health inpatient facility’s employee or personnel member, an administrator shall:

1. Take immediate action to stop the alleged or suspected abuse, neglect, or exploitation;

2. Immediately report the alleged or suspected abuse, neglect, or exploitation of the patient:

a. For a patient 18 years of age or older, according to A.R.S. § 46-454; or

b. For a patient 18 years of age, according to A.R.S. § 13-3620;

3. Document the action in subsection (G)(1) and the report in subsection (G)(2) and maintain the documentation for 12 months after the date of the report;

4. Investigate the suspected or alleged abuse, neglect, or exploitation and develop a written report of the investigation within 48 hours after the report required in subsection (G)(2) that includes:

a. Dates, times, and description of the alleged or suspected abuse, neglect, or exploitation;

b. Description of any injury to the patient and any change to the patient's physical, cognitive, functional, or emotional condition;

c. Names of witnesses to the alleged or suspected abuse, neglect, or exploitation; and

d. Actions taken by the administrator to prevent the alleged or suspected abuse, neglect, or exploitation from occurring in the future;

5. Submit a copy of the investigation report required in subsection (G)(4) to the Department within 10 working days after submitting the report in subsection (G)(2); and

6. Maintain a copy of the investigation report required in subsection (G)(4) for 12 months after the date of the investigation report.

H. An administrator shall establish and document the criteria for determining when a resident’s absence is unauthorized, including whether the resident was admitted under A.R.S. Title 36, Chapter 5, Articles 1, 2, or 3, is absent against medical advice, or is under the age of 18.

I. An administrator shall:

1. If a resident’s absence is unauthorized as determined according to the criteria in subsection (H), submit a written report within an hour of determining whether the resident’s absence is unauthorized to:

a. For a resident who is less than 18 years of age, the resident’s parent or legal guardian; and

b. For a resident who is under a court’s jurisdiction, the appropriate court;

2. Maintain a written log of unauthorized absences for two years after the date of a resident’s absence that includes:

a. The name of a resident absent without authorization;

b. Name of the person to whom the report required in subsection (I)(1) was submitted; and

c. Date of report; and

3. Evaluate and take action related to unauthorized absences under the quality management program in R9-10-304.

Historical Note

New Section R9-10-303 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-304. Quality Management

An administrator shall ensure that:

1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes:

a. A method to identify, document, and evaluate incidents;

b. A method to collect data to evaluate services provided to patient;

c. A method to evaluate the data collected to identify a concern about the delivery of services related to patient care;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of services related to patient care; and

e. The frequency of submitting a documented report required in subsection (2) to the governing authority;

2. A documented report is submitted to the governing authority that includes:

a. An identification of each concern about the delivery of services related to patient care, and

b. Any changes made or actions taken as a result of the identification of a concern about the delivery of services related to patient care; and

3. The report required in subsection (2) and the supporting documentation for the report are maintained for 12 months after the date the report is submitted to the governing authority.

Historical Note

New Section R9-10-304 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-305. Contracted Services

An administrator shall ensure that:

1. Contracted services are provided according to the requirements in this Article, and

2. A documented list of current contracted services is maintained that includes a description of the contracted services provided.

Historical Note

New Section R9-10-305 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-306. Personnel

A. An administrator shall ensure that:

1. A personnel member is at least 21 years old,

2. A student is at least 18 years old, and

3. A volunteer is at least 21 years old.

B. An administrator shall ensure that:

1. The qualifications, skills, and knowledge required for each type of personnel member:

a. Are based on:

i. The type of physical health services or behavioral health services expected to be provided by the personnel member according to the established job description, and

ii. The acuity of the patients receiving physical health services or behavioral health services from the personnel member according to the established job description; and

b. Include:

i. The specific skills and knowledge necessary for the personnel member to provide the expected physical health services and behavioral health services listed in the established job description,

ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description, and

iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description;

2. A personnel member’s skills and knowledge are verified and documented:

a. Before the personnel member provides physical health services or behavioral health services, and

b. According to policies and procedures;

3. Personnel members are present on a behavioral health inpatient facility’s premises with the qualifications, skills, and knowledge necessary to:

a. Provide the services in the behavioral health inpatient facility’s scope of services,

b. Meet the needs of a patient, and

c. Ensure the health and safety of a patient.

C. An administrator shall comply with the requirements for behavioral health technicians and behavioral health paraprofessionals in R9-10-114.

D. An administrator shall ensure that an individual who is a baccalaureate social worker, master social worker, associate marriage and family therapist, associate counselor, or associate substance abuse counselor is under direct supervision as defined in A.A.C. R4-6-101.

E. An administrator shall ensure that a personnel member or an employee, volunteer, or student who has direct interaction with a patient, provides evidence of freedom from infectious tuberculosis as specified in R9-10-112.

F. An administrator shall ensure that a personnel record is maintained for each employee, volunteer, and student that contains:

1. The individual’s name, date of birth, home address, and contact telephone number;

2. The individual’s starting date of employment or volunteer service and, if applicable, the ending date; and

3. Documentation of:

a. The individual’s qualifications including skills and knowledge applicable to the employee's job duties;

b. The individual’s education and experience applicable to the employee's job duties;

c. The individual’s completed orientation and in-service education as required by policies and procedures;

d. The individual’s license or certification, if the individual is required to be licensed or certified in this Article or policies and procedures;

e. The individual’s qualifications and on-going training for each type of restraint or seclusion used required in R9-10-316;

f. If the behavioral health residential facility provides serves to children, the individual’s compliance with the fingerprinting requirements in A.R.S. § 36-425.03;

g. If the individual is a behavioral health technician, clinical oversight required in R9-10-114;

h. Cardiopulmonary resuscitation training, if required for the individual according to R9-10-303(C)(1)(d);

i. First aid training, if required for the individual according to this Article or policies and procedures; and

j. Evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (E).

G. An administrator shall ensure that personnel records are maintained:

1. Throughout an individual's period of providing services in or for the behavioral health inpatient facility, and

2. For at least two years after the last date the individual provided services in or for the behavioral health inpatient facility.

H. An administrator shall ensure that:

1. A plan to provide orientation specific to the duties of a personnel member, employees, volunteers, and students is developed, documented, and implemented;

2. A personnel member completes orientation before providing behavioral health services or physical health services;

3. An individual’s orientation is documented, to include:

a. The individual’s name,

b. The date of the orientation, and

c. The subject or topics covered in the orientation;

4. A clinical director develops, documents, and implements a plan to provide in-service education specific to the duties of a personnel member; and

5. A personnel member’s in-service education is documented, to include:

a. The personnel member's name,

b. The date of the training, and

c. The subject or topics covered in the training.

I. An administrator shall ensure that sufficient personnel members are present at the behavioral health inpatient facility to provide general patient supervision and treatment, and sufficient personnel members or employees are present to provide ancillary services to meet the scheduled and unscheduled needs of a patient.

J. An administrator shall ensure that a behavioral health inpatient facility has a daily staffing schedule that:

1. Indicates the date, scheduled work hours, and name of each employee assigned to work, including on-call personnel members;

2. Includes documentation of the employees who work each calendar day and the hours worked by each employee; and

3. Is maintained for at least 12 months after the last date on the daily staffing schedule.

K. An administrator shall ensure that:

1. A physician or registered nurse practitioner is present on the behavioral health inpatient facility’s premises or on-call,

2. A registered nurse is present on the behavioral health inpatient facility’s premises, and

3. A registered nurse who provides direction for the nursing services provided at the behavioral health inpatient facility is present at the behavioral health inpatient facility at least 40 hours every week.

L. An administrator shall ensure that:

1. If a patient requires medical services that the behavioral health inpatient facility is not authorized or not able to provide, a personnel member arranges for the patient to be transported to a hospital or another health care institution where the services can be provided; and

2. The behavioral health inpatient facility has a written agreement with a hospital near the behavioral health inpatient facility’s location to provide medical services for patients who require medical services that the behavioral health inpatient facility is not authorized or able to provide.

Historical Note

New Section R9-10-306 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-307. Admissions; Assessment

Except as provided in R9-10-315(E) and (F), an administrator shall ensure that:

1. A patient is admitted based upon the patient’s presenting behavioral health issue and treatment needs and the behavioral health inpatient facility's ability and authority to provide physical health services, behavioral health services, and ancillary services consistent with the patient's treatment needs;

2. A patient is admitted on the order of a medical practitioner;

3. A medical practitioner, authorized by policies and procedures to accept a patient for admission, is available;

4. Except in an emergency or as provided in subsections (6) and (7), general consent is obtained from an adult patient or the patient's representative before or at the time of admission;

5. The general consent obtained in subsection (4) or the lack of consent in an emergency is documented in the patient's medical record;

6. General consent is not required from a patient receiving a court-ordered treatment;

7. General consent is not required from a patient receiving treatment according to A.R.S. § 36-512;

8. A medical practitioner performs a medical history and physical examination on a patient within 30 calendar days before admission or within 48 hours after admission and documents the medical history and physical examination in the patient's medical record within 48 hours after admission;

9. If a medical practitioner performs a medical history and physical examination on a patient before admission, the medical practitioner enters an interval note into the patient's medical record at the time of admission;

10. Except when a patient needs crisis services, an assessment of a patient is completed before treatment for the patient is initiated;

11. If an assessment is conducted by a:

a. Behavioral health technician, within 24 hours a behavioral health professional reviews and signs the assessment to ensure that the assessment identifies the behavioral health services needed by the patient; or

b. Behavioral health paraprofessional, a behavioral health professional supervises the behavioral health paraprofessional during the completion of the assessment and signs the assessment to ensure that the assessment identifies the behavioral health services needed by the patient;

12. When a patient is admitted, a registered nurse:

a. Assesses a patient’s medical condition and history;

b. Determines whether the:

i. Patient requires immediate physical health services, and

ii. Patient’s behavioral health issue may be related to the patient’s medical condition and history;

c. Documents the patient’s medical condition and history and the determinations required in subsection (12)(b) in the patient’s medical record; and

d. Signs the patient’s medical record;

13. A patient’s assessment:

a. Addresses the patient's:

i. Presenting issue;

ii. Substance abuse history;

iii. Co-occurring disorder;

iv. Legal history, including:

(1) Custody,

(2) Guardianship, and

(3) Pending litigation;

v. Court-ordered evaluation;

vi. Court-ordered treatment;

vii. Criminal justice record;

viii. Family history;

ix. Behavioral health treatment history;

x. Symptoms reported by the patient; and

xi. Referrals needed by the patient, if any; and

b. Includes:

i. Recommendations for further assessment or examination of the patient's needs;

ii. For a patient who:

(1) Is admitted to receive crisis services, the behavioral health services and physical health services that will be provided to the patient; or

(2) Does not need crisis services, the behavioral health services or physical health services that will be provided to the patient until the patient's treatment plan is completed; and

iii. The signature and date signed of the personnel member conducting the assessment;

14. A patient is referred to a medical practitioner if a determination is made that the patient requires immediate physical health services or the patient's behavioral health issue may be related to the patient's medical condition;

15. A request for participation in a patient's assessment is made to the patient or the patient's representative;

16. An opportunity for participation in the patient's assessment is provided to the patient or the patient's representative;

17. The request in subsection (15) and the opportunity in subsection (16) are documented in the patient's medical record;

18. For a patient who is admitted to receive crisis services, the patient’s assessment is documented in the patient’s medical record within 24 hours after admission;

19. Except as provided in subsection (18), a patient's assessment is documented in the patient’s medical record within 48 hours after completing the assessment;

20. A patient's assessment is reviewed and updated when additional information that affects the patient's assessment is identified; and

21. A review and update of a patient's assessment is documented in the medical record within 48 hours after the review is completed.

Historical Note

New Section R9-10-307 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-308. Treatment Plan

A. Except for a patient admitted to receive crisis services or as provided in R9-10-315(G), an administrator shall ensure that a treatment plan is developed and implemented for a patient that is:

1. Based on the assessment and on-going changes to the assessment of the patient;

2. Completed:

a. By a behavioral health professional or by a behavioral health technician under the clinical oversight of a behavioral health professional, and

b. Before the patient receives treatment;

3. Documented in the patient's medical record within 48 hours after the patient first receives treatment;

4. Includes:

a. The patient's presenting issue;

b. The behavioral health services and physical health services to be provided to the patient;

c. The signature of the patient or the patient's representative and date signed, or documentation of the refusal to sign;

d. The date when the patient's treatment plan will be reviewed;

e. If a discharge date has been determined, the treatment needed after discharge; and

f. The signature of the personnel member who developed the treatment plan and the date signed;

5. If the treatment plan was completed by a behavioral health technician, reviewed and signed by a behavioral health professional within 24 hours after the completion of the treatment plan to ensure that the treatment plan meets the patient’s treatment needs;

6. Reviewed and updated on an on-going basis:

a. According to the review date specified in the treatment plan,

b. When a treatment goal is accomplished or changes,

c. When additional information that affects the patient's assessment is identified, and

d. When a patient has a significant change in condition or experiences an event that affects treatment;

B. An administrator shall ensure:

1. A request for participation in developing a patient's treatment plan is made to the patient or the patient's representative;

2. An opportunity for participation in developing the patient's treatment plan is provided to the patient or the patient's representative; and

3. The request in subsection (B)(1) and the opportunity in subsection (B)(2) are documented in the patient's medical record.

C. If a patient who is admitted to receive crisis services remains admitted as a patient after the patient no longer needs crisis services, an administrator shall ensure that a treatment plan for the patient is:

1. Except for subsection (A)(3), completed according to the requirements in subsection (A); and

2. Documented in the patient’s medical record within 24 hours after the patient no longer needs crisis services.

Historical Note

New Section R9-10-308 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-309. Discharge

A. An administrator shall ensure that a discharge plan for a patient is:

1. Developed that:

a. Identifies any specific needs of the patient after discharge;

b. If the discharge date has been determined, includes the discharge date;

c. Is completed before discharge occurs;

d. Includes a description of the level of care that may meet the patient's assessed and anticipated needs after discharge; and

e. Is documented in the patient's medical record within 48 hours after the discharge plan is completed; and

2. Provided to the patient or the patient's representative before the discharge occurs.

B. An administrator shall ensure that:

1. A request for participation in developing a patient's discharge plan is made to the patient or the patient's representative,

2. An opportunity for participation in developing the patient's discharge plan is provided to the patient or the patient's representative, and

3. The request in subsection (B)(1) and the opportunity in subsection (B)(2) are documented in the patient's medical record.

C. An administrator shall ensure that a patient is discharged from a behavioral health inpatient facility:

1. When the patient's treatment goals are achieved, as documented in the patient's treatment plan; or

2. When the patient's treatment needs are not consistent with the services that the behavioral health inpatient facility is authorized or able to provide.

D. An administrator shall ensure that there is a documented discharge order by a medical practitioner before a patient is discharged unless the patient leaves the behavioral health inpatient facility against a medical practitioner's advice.

E. An administrator shall ensure that, at the time of discharge, a patient receives a referral for treatment or ancillary services that the patient may need after discharge, if applicable.

F. If a patient is discharged to any location other than a health care institution, an administrator shall ensure that:

1. Discharge instructions are documented, and

2. The patient or the patient's representative is provided with a copy of the discharge instructions.

G. An administrator shall ensure that a discharge summary:

1. Is entered into the medical record within 10 working days after a patient's discharge; and

2. Includes:

a. The following information completed by a medical practitioner or a behavioral health professional:

i. The patient's presenting issue and other physical health and behavioral health issues identified in the patient's assessment or treatment plan;

ii. A summary of the treatment provided to the patient;

iii. The patient's progress in meeting treatment goals, including treatment goals that were and were not achieved; and

iv. The name, dosage, and frequency of each medication for the patient ordered at the time of the patient's discharge by a medical practitioner at the behavioral health inpatient facility; and

b. A description of the disposition of the patient's possessions, funds, or medications brought to the behavioral health inpatient facility by the patient.

H. An administrator shall ensure that a patient who is dependent upon a prescribed medication is offered detoxification services, opioid treatment, or a written referral to detoxification services or opioid treatment before the patient is discharged from the behavioral health inpatient facility if a medical practitioner for the behavioral health inpatient facility will not be prescribing the medication for the patient at or after discharge.

Historical Note

New Section R9-10-309 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-310. Transport; Transfer

A. Except for a transport of a patient due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transport and the services provided to the patient;

2. According to policies and procedures:

a. An evaluation of the patient is conducted before and after the transport,

b. Medical records are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transport to the patient or the patient’s representative; and

3. Documentation in the patient’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transport;

c. The mode of transportation; and

d. If applicable, the personnel member accompanying the patient during a transport.

B. Except for a transfer of a patient due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transfer and the services provided to the patient;

2. According to policies and procedures:

a. An evaluation of the patient is conducted before the transfer,

b. Medical records including orders that are in effect at the time of the transfer are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transfer to the patient or the patient’s representative; and

3. Documentation in the patient’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transfer;

c. The mode of transportation; and

d. If applicable, a personnel member accompanying the patient during a transfer.

Historical Note

Adopted as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 4, 1979 (Supp. 79-3). Amended effective January 28, 1980 (Supp. 80-1). Repealed effective February 4, 1981 (Supp. 81-1). New Section R9-10-310 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-311. Patient Rights

A. An administrator shall ensure that:

1. The requirements in subsection (B) and the patient rights in subsection (D) are conspicuously posted on the premises;

2. At the time of admission, a patient or the patient's representative receives a written copy of the requirements in subsection (B) and the patient rights in subsection (D); and

3. Policies and procedures are established, documented, and implemented that include:

a. How and when a patient or the patient’s representative is informed of patient rights in subsection (C), and

b. Where patient rights are posted as required in subsection (A)(1).

B. An administrator shall ensure that:

1. A patient is treated with dignity, respect, and consideration;

2. A patient is not subjected to:

a. Abuse;

b. Neglect;

c. Exploitation;

d. Coercion;

e. Manipulation;

f. Sexual abuse;

g. Sexual assault;

h. Seclusion;

i. Restraint, if not necessary to prevent imminent harm to self or others;

j. Retaliation for submitting a complaint to the Department or another entity;

k. Misappropriation of personal and private property by a behavioral health inpatient facility’s personnel members, employees, volunteers, or students;

l. Discharge or transfer, or threat of discharge or transfer, for reasons unrelated to the patient’s treatment needs, except as established in a fee agreement signed by the patient or the patient's representative; or

m. Treatment that involves the denial of:

i. Food,

ii. The opportunity to sleep, or

iii. The opportunity to use the toilet; and

3. Except as provided in subsection (C) is allowed to:

a. Associate with individuals of the patient’s choice, receive visitors, and make telephone calls during the hours established by the behavioral health inpatient facility;

b. Have privacy in correspondence, communication, visitation, financial affairs, and personal hygiene; and

c. Unless restricted by a court order, send and receive uncensored and unopened mail; and

4. A patient or, if the patient is under 18 years of age, the patient's representative:

a. Except in an emergency, either consents to or refuses treatment;

b. May refuse or withdraw consent to treatment before treatment is initiated, unless the treatment is ordered by a court according to A.R.S. Title 36, Chapter 5, is necessary to save the patient’s life or physical health, or is provided according to A.R.S. § 36-512;

c. Except in an emergency, is informed of alternatives to a proposed psychotropic medication or surgical procedure and the associated risks and possible complications of the proposed psychotropic medication or surgical procedure;

d. Is informed of the following:

i. The policy on health care directives; and

ii. The patient complaint process; and

e. Except as otherwise permitted by law, provides written consent to the release of the patient’s:

i. Medical records, and

ii. Financial records.

C. If a medical director or clinical director determines that a patient's treatment requires the behavioral health inpatient facility to restrict the patient's ability to participate in the activities in subsection (B)(2), the medical director or clinical director shall:

1. Document a specific treatment purpose in the patient's medical record that justifies restricting the patient from the activity,

2. Inform the patient of the reason why the activity is being restricted, and

3. Inform the patient of the patient's right to file a complaint and the procedure for filing a complaint.

D. A patient has the following rights:

1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;

2. To receive treatment that:

a. Supports and respects the patient’s individuality, choices, strengths, and abilities;

b. Supports the patient’s personal liberty and only restricts the patient’s personal liberty according to a court order, by the patient’s general consent, or as permitted in this Chapter; and

c. Is provided in the least restrictive environment that meets the patient’s treatment needs;

3. To receive privacy in treatment and care for personal needs, including the right not to be fingerprinted, photographed, or recorded without consent, except:

a. A patient may be photographed when admitted to a behavioral health inpatient facility for identification and administrative purposes;

b. For a patient receiving treatment according to A.R.S. Title 36, Chapter 37;

c. For video recordings used for security purposes that are maintained only on a temporary basis; or

d. As provided in R9-10-316(7);

4. Not to be prevented or impeded from exercising the patient’s civil rights unless the patient has been adjudicated incompetent or a court of competent jurisdiction has found that the patient is unable to exercise a specific right or category of rights;

5. To review, upon written request, the patient’s own medical record according to A.R.S. §§12-2293, 12-2294, and 12-2294.01;

6. To receive a referral to another health care institution if the behavioral health inpatient facility is unable to provide physical health services or behavioral health services for the patient;

7. To participate or have the patient's representative participate in the development of or decisions concerning treatment;

8. To participate or refuse to participate in research or experimental treatment; and

9. To receive assistance from a family member, representative, or other individual in understanding, protecting, or exercising the patient’s rights.

Historical Note

Section R9-10-311, formerly numbered as R9-10-211, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-311 repealed, new Section R9-10-311 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-311 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-312. Medical Records

A. An administrator shall ensure that:

1. A medical record is established and maintained for each patient according to the requirements in A.R.S. Title 12, Chapter 13, Article 7.1;

2. An entry in a patient’s medical record is:

a. Recorded only by a personnel member authorized by policies and procedures to make the entry;

b. Dated, legible, and authenticated; and

c. Not changed to make the initial entry illegible;

3. An order is:

a. Dated when the order is entered in the patient’s medical record and includes the time of the order;

b. Authenticated by a medical practitioner or behavioral health professional according to policies and procedures; and

c. If the order is a verbal order, authenticated by the medical practitioner or behavioral health professional issuing the order;

4. If a rubber-stamp signature or an electronic signature code is used to authenticate an order, the individual whose signature the stamp or electronic code represents is accountable for the use of the stamp or the electronic code;

5. A patient’s medical record is available to personnel members, medical practitioners, and behavioral health professional authorized by policies and procedures to access the patient’s medical record;

6. Information in a patient’s medical record is disclosed to an individual not authorized under subsection (A)(5) only with the written consent of a patient or the patient's representative or as permitted by law; and

7. A patient’s medical record is protected from loss, damage, or unauthorized use.

B. If a behavioral health inpatient facility maintains a patient’s medical records electronically, an administrator shall ensure that:

1. Safeguards exist to prevent unauthorized access, and

2. The date and time of an entry in a medical record is recorded by the computer's internal clock.

C. An administrator shall ensure that a behavioral health inpatient facility’s medical record for a patient contains:

1. Patient information that includes:

a. The patient's name;

b. The patient's address;

c. The patient's date of birth;

d. The name and contact information of the patient’s representative, if applicable; and

e. Any known allergy including medication allergies;

2. Medication information that includes:

a. A medication ordered for the patient; and

b. A medication administered to the patient including:

i. The date and time of administration;

ii. The name, strength, dosage, amount, and route of administration;

iii. The identification and authentication of the individual administering the medication; and

iv. Any adverse reaction the patient has to the medication;

3. If required, documented general and informed consent by the patient or the patient's representative;

4. The patient’s medical history and results of a physical examination or an interval note;

5. If the patient provides a health care directive, the health care directive signed by the patient or the patient's representative;

6. An admitting diagnosis or presenting symptoms;

7. The name of the admitting medical practitioner or behavioral health professional;

8. Orders;

9. Patient assessment;

10. Treatment plans;

11. Documentation of behavioral health services and physical health services provided to the patient;

12. Progress notes;

13. Disposition of the patient after discharge;

14. Discharge plan;

15. Discharge summary; and

16. If applicable:

a. A laboratory report,

b. A radiologic report,

c. A diagnostic report,

d. Documentation of restraint or seclusion, and

e. A consultation report.

Historical Note

Section R9-10-312, formerly numbered as R9-10-212, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-312 repealed, new Section R9-10-312 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-312 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-313. Patient Outings

A. An administrator shall ensure that a behavioral health inpatient facility that uses a vehicle owned or leased by the behavioral health inpatient facility to provide transportation to a patient shall ensure that:

1. The vehicle:

a. Is safe and in good repair,

b. Contains a first aid kit,

c. Contains drinking water sufficient to meet the needs of each patient present in the vehicle, and

d. Contains a working heating and air conditioning system;

2. Documentation of vehicle insurance and a record of maintenance performed or a repair of the vehicle is maintained;

3. A driver of the vehicle:

a. Is 21 years of age or older;

b. Has a valid driver license;

c. Removes the keys from the vehicle and engages the emergency brake before exiting the vehicle or, if the vehicle locks in the park position, places the gear in the park position;

d. Does not leave in the vehicle an unattended:

i. Child;

ii. Patient who may be a threat to the health, safety, or welfare of the patient or another individual; or

iii. Patient who is incapable of independent exit from the vehicle; and

e. Ensures the safe and hazard-free loading and unloading of patients; and

4. Transportation safety is maintained as follows:

a. An individual in the vehicle is sitting in a seat and wearing a working seat belt while the vehicle is in motion, and

b. A seat in the vehicle is securely fastened to the vehicle and provides sufficient space for a patient's body.

B. An administrator shall ensure that an outing is consistent with the age, developmental level, physical ability, medical condition, and treatment needs of each patient participating in the outing.

C. An administrator shall ensure that:

1. At least two personnel members are present on an outing;

2. In addition to the personnel members required in subsection (C)(1), a sufficient number of personnel members are present on an outing to ensure the health and safety of a patient on the outing;

3. Each personnel member on the outing has documentation of current training in cardiopulmonary resuscitation according to R9-10-303(C)(1)(d) and first aid training;

4. Documentation is developed before an outing that includes:

a. The name of each patient participating in the outing;

b. A description of the outing;

c. The date of the outing;

d. The anticipated departure and return times;

e. The name, address, and, if available, telephone number of the outing destination; and

f. If applicable, the license plate number of a vehicle used to provide transportation for the outing;

5. The documentation described in subsection (A)(2) and (C)(4) is updated to include the actual departure and return times and is maintained for at least 12 months after the date of the outing; and

6. Emergency information for a patient participating in the outing is maintained in the vehicle used to provide transportation for the outing and includes:

a. The patient's name;

b. Medication information, including the name, dosage, route of administration, and directions for each medication needed by the patient during the anticipated duration of the outing;

c. The patient's allergies; and

d. The name and telephone number of a designated individual to notify in case of an emergency who is present on the behavioral health inpatient facility’s premises.

Historical Note

Section R9-10-313, formerly numbered as R9-10-213, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-313 repealed, new Section R9-10-313 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-313 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-314. Physical Health Services

An administrator shall ensure that:

1. Medical services are provided under the direction of a physician;

2. Nursing services are provided under the direction of a registered nurse; and

3. If a behavioral health inpatient facility provides:

a. Surgical services as defined in R9-10-215, the behavioral health inpatient facility complies with:

i. The applicable standards for an inpatient surgical services suite and anesthesia services in the physical plant health and safety codes and standards incorporated by reference in A.A.C. R9-1-412, and

ii. The requirements in R9-10-215 and R9-10-216;

b. Clinical laboratory services as defined in R9-10-101, the behavioral health inpatient facility complies with the requirements for clinical laboratory services in R9-10-219;

c. Radiology services or diagnostic imaging services, the behavioral health inpatient facility complies with the requirements in R9-10-220;

d. Intensive care services as defined in R9-10-221, the behavioral health inpatient facility complies with:

i. The applicable standards for inpatient intensive care services in the physical plant health and safety codes and standards incorporated by reference in A.A.C. R9-1-412, and

ii. The requirements in R9-10-221; and

e. Perinatal services as defined in R9-10-223, the behavioral health inpatient facility complies with:

i. The applicable standards for inpatient perinatal services in the physical plant health and safety codes and standards incorporated by reference in A.A.C. R9-1-412, and

ii. The requirements in R9-10-223.

Historical Note

Section R9-10-314, formerly numbered as R9-10-214, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-314 repealed, new Section R9-10-314 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-314 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-315. Behavioral Health Services

A. An administrator shall ensure that:

1. Behavioral health services listed in the behavioral health inpatient facility’s scope of services are provided to meet the needs of a patient;

2. When behavioral health services are:

a. Listed in the behavioral health inpatient facility's scope of services, the behavioral health services are provided on the behavioral health inpatient facility’s premises; and

b. Provided in a setting or activity with more than one patient participating, the patients participating have similar diagnoses, treatment needs, developmental levels, social skills, verbal skills, and personal histories including any history of physical abuse or sexual abuse to ensure that the:

i. Health and safety of a patient is protected, and

ii. Treatment needs of a patient participating in the setting or activity are being met; and

3. A patient does not share any space, participate in any activity or treatment, or verbally or physically interact with any other patient that, based on the other patient's documented diagnosis, treatment needs, developmental levels, social skills, verbal skills, and personal history, may present a threat to the patient.

B. An administrator shall ensure that counseling is:

1. Offered as described in the behavioral health inpatient facility’s scope of services,

2. Provided according to the frequency and number of hours identified in the patient’s treatment plan, and

3. Provided by a behavioral health professional or a behavioral health technician.

C. An administrator shall ensure that each counseling session is documented in the patient’s medical record to include:

1. The date of the counseling session;

2. The amount of time spent in the counseling session;

3. Whether the counseling was individual counseling, family counseling, or group counseling;

4. The treatment goals addressed in the counseling session; and

5. The signature who provided the counseling and the date signed.

D. An administrator that provides pre-petition screening shall ensure pre-petition screening is provided according to the pre-petition screening requirements in A.R.S. Title 36, Chapter 5.

E. An administrator that provides court-ordered evaluation shall ensure that court-ordered evaluation is provided according to the court-evaluation requirements in A.R.S. Title 36, Chapter 5.

F. An administrator is not required to comply with the following provisions in this Chapter for a patient receiving court-ordered evaluation:

1. Admission requirements in R9-10-307,

2. Patient assessment requirements in R9-10-307,

3. Treatment plan requirements in R9-10-308, and

4. Discharge requirements in R9-10-309.

G. An administrator of a behavioral health inpatient facility that provides court-ordered treatment shall ensure that court-ordered treatment is provided according to the court-ordered treatment requirements in A.R.S. Title 36, Chapter 5.

H. An administrator of a behavioral health inpatient facility that provides inpatient services to individuals under 18 years of age:

1. May continue to provide behavioral health services to a patient who is 18 years of age or older:

a. If the patient:

i. Was admitted to the behavioral health inpatient facility before the patient's 18th birthday,

ii. Is not 21 years of age or older, and

iii. Is completing high school or a high school equivalency diploma or participating in a job training program; or

b. Through the last calendar day of the month of the patient's 18th birthday; and

2. Shall ensure that:

a. A patient does not receive the following from other patients at the behavioral health inpatient facility:

i. Threats,

ii. Ridicule,

iii. Verbal harassment,

iv. Punishment, or

v. Abuse;

b. The interior of the behavioral health inpatient facility has furnishings and decorations appropriate to the ages of the patients receiving services at the behavioral health inpatient facility;

c. A patient older than three years of age does not sleep in a crib;

d. Clean and non-hazardous toys, educational materials, and physical activity equipment are available and accessible to patients in a quantity sufficient to meet each patient's needs and are appropriate to each patient's age, developmental level, and treatment needs; and

e. A patient's educational needs are met by establishing and providing an educational component, approved in writing by the Arizona Department of Education.

Historical Note

Section R9-10-315, formerly numbered as R9-10-215, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-315 repealed, new Section R9-10-315 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-315 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-316. Restraint and Seclusion

An administrator shall ensure that:

1. Policies and procedures for providing restraint and seclusion are established, documented, and implemented that:

a. Establish the process for patient assessment including identification of a patient’s medical conditions and criteria for the on-going monitoring of any identified medical condition;

b. Identify each type of restraint and seclusion used and include for each type of restraint and seclusion used:

i. The qualifications of a personnel member who can:

(1) Order the restraint or seclusion,

(2) Place a patient in the restraint or seclusion,

(3) Monitor a patient in the restraint or seclusion,

(4) Evaluate a patient’s physical and psychological well-being after being placed in the restraint or seclusion and when released from the restraint or seclusion, or

(5) Renew the order for restraint or seclusion;

ii. On-going training requirements for a personnel member who has direct patient contact while a patient is in a restraint or seclusion; and

iii. Criteria for monitoring and assessing a patient including:

(1) Frequencies of monitoring and assessment based on a patient’s medical condition and risks associated with the specific restraint or seclusion;

(2) For the renewal of an order for restraint or seclusion, whether an assessment is required before the order is renewed and, if an assessment is required, who may conduct the assessment;

(3) Assessment content, which may include, depending on a patient’s condition, the patient’s vital signs, respiration, circulation, hydration needs, elimination needs, level of distress and agitation, mental status, cognitive functioning, neurological functioning, and skin integrity;

(4) If a mechanical restraint is used, how often the mechanical restraint is loosened; and

(5) A process for meeting a patient’s nutritional needs and elimination needs;

c. Establish the criteria and procedures for renewing an order for restraint or seclusion;

d. Establish procedures for internal review of the use of restraint or seclusion;

e. Establish requirements for notifying the parent or guardian of a patient who is less than 18 years of age and who is restrained or secluded; and

f. Establish patient record and personnel record documentation requirements for restraint and seclusion, if applicable;

2. An order for restraint or seclusion is:

a. Written by a physician or registered nurse practitioner, and

b. Not written as a standing order or an as-needed basis;

3. Restraint or seclusion is:

a. Not used as a means of coercion, discipline, convenience, or retaliation;

b. Only used when all of the following conditions are met:

i. Except as provided in subsection (4), after obtaining an order for the restraint or seclusion;

ii. For the management of a patient’s aggressive, violent, or self-destructive behavior;

iii. When less restrictive interventions have been determined to be ineffective; and

iv. To ensure the immediate physical safety of the patient, to prevent imminent harm to the patient or another individual, or to stop physical harm to another individual; and

c. Discontinued at the earliest possible time;

4. If as a result of a patient’s aggressive, violent, or self-destructive behavior, harm to a patient or another individual is imminent or the patient or another individual is being physically harmed, a personnel member:

a. May initiate an emergency application of restraint or seclusion for the patient before obtaining an order for the restraint or seclusion, and

b. Shall obtain an order for the restraint or seclusion of the patient during the emergency application of the restraint or seclusion;

5. An order for restraint or seclusion includes:

a. The name of the physician or registered nurse practitioner ordering the restraint or seclusion;

b. The date and time that the restraint or seclusion was ordered;

c. The specific restraint or seclusion ordered;

d. If a drug is ordered as a chemical restraint, the drug's name, strength, dosage, and route of administration;

e. The specific criteria for release from restraint or seclusion without an additional order; and

f. The maximum duration authorized for the restraint or seclusion;

6. An order for restraint or seclusion is limited to the duration of the emergency situation and does not exceed:

a. Three continuous hours for a patient who is 18 years of age or older;

b. Two continuous hours for a patient who is between the ages of nine and 17; or

c. One continuous hour for a patient who is younger than nine;

7. If restraint and seclusion are used on a patient simultaneously, the patient receives continuous:

a. Face-to-face monitoring by a medical practitioner or personnel member, or

b. Video and audio monitoring by a medical practitioner or personnel member who is in close proximity to the patient;

8. If an order for restraint or seclusion of a patient is not provided by the patient’s attending physician, the patient’s attending physician is notified as soon as possible;

9. A medical practitioner or personnel member does not participate in restraint or seclusion, assess or monitor a patient during restraint or seclusion, or evaluate a patient after restraint or seclusion and a physician or registered nurse practitioner does not order restraint or seclusion until the medical practitioner or personnel member, completes education and training that:

a. Includes:

i. Techniques to identify medical practitioner, personnel member, and patient behaviors, events, and environmental factors that may trigger circumstances that require restraint or seclusion;

ii. The use of nonphysical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods;

iii. Techniques for identifying the least restrictive intervention based on an assessment of the patient’s medical or behavioral health condition;

iv. The safe use of restraint and the safe use of seclusion, including training in how to recognize and respond to signs of physical and psychological distress in a patient who is restrained or secluded;

v. Clinical identification of specific behavioral changes that indicate that the restraint or seclusion is no longer necessary;

vi. Monitoring and assessing a patient while the patient is in restraint or seclusion according to policies and procedures; and

vii. Except for the medical practitioner, training exercises in which the personnel member successfully demonstrates the techniques that the medical practitioner or personnel member has learned for managing emergency situations; and

b. Is provided by individuals qualified according to policies and procedures;

10. When a patient is placed in restraint or seclusion:

a. The restraint or seclusion is conducted according to policies and procedures;

b. The restraint or seclusion is proportionate and appropriate to the severity of the patient’s behavior and the patient’s:

i. Chronological and developmental age;

ii. Size;

iii. Gender;

iv. Physical condition;

v. Medical condition;

vi. Psychiatric condition; and

vii. Personal history, including any history of physical or sexual abuse;

c. The physician or registered nurse practitioner who ordered the restraint or seclusion is available for consultation throughout the duration of the restraint or seclusion;

d. The patient is monitored and assessed according to policies and procedures;

e. A physician or registered nurse assesses the patient within one hour after the patient is placed in the restraint or seclusion and determines:

i. The patient’s current behavior,

ii. The patient's reaction to the restraint or seclusion used,

iii. The patient's medical and behavioral condition, and

iv. Whether to continue or terminate the restraint or seclusion;

f. The patient is given the opportunity:

i. To eat during mealtime, and

ii. To use the toilet; and

g. The restraint or seclusion is discontinued at the earliest possible time, regardless of the length of time identified in the order;

11. If a patient is placed in seclusion, the room used for seclusion:

a. Is approved for use as a seclusion room by the Department;

b. Is not used as a patient's bedroom or a sleeping area;

c. Allows full view of the patient in all areas of the room;

d. Is free of hazards, such as unprotected light fixtures or electrical outlets;

e. Contains at least 60 square feet of floor space; and

f. Except as provided in subsection (12), contains a non-adjustable bed that:

i. Consists of a mattress on a solid platform that is:

(1) Constructed of a durable, non-hazardous material, and

(2) Raised off of the floor;

ii. Does not have wire springs or a storage drawer; and

iii. Is securely anchored in place;

12. If a non-adjustable bed required in subsection (11)(f) is not in a room used for seclusion:

a. A piece of equipment is available that:

i. Is commercially manufactured to safely and humanely restrain a patient’s body;

ii. Provides support to the trunk and head of a patient’s body;

iii. Provides restraint to the trunk of a patient’s body;

iv. Is able to restrict movement of a patient’s arms, legs, body, and head;

v. Allows a patient’s body to recline; and

vi. Does not inflict harm on a patient’s body; and

b. Documentation of the manufacturer’s specifications for the piece of equipment in subsection (12)(a) is maintained;

13. A seclusion room may be used for services or activities other than seclusion if:

a. A sign stating the service or activity scheduled or being provided in the room is conspicuously posted outside the room;

b. No permanent equipment other than the bed required in subsection (11)(f) is in the room;

c. There are policies and procedures that:

i. Delineate which services or activities other than seclusion may be provided in the room,

ii. List what types of equipment or supplies may be placed in the room for the delineated services, and

iii. Provide for the prompt removal of equipment and supplies from the room before the room is used for seclusion; and

d. The sign required in subsection (13)(a) and equipment and supplies in the room other than the bed required in subsection (11)(f) are removed before a patient is placed in seclusion in the room;

14. A medical practitioner or personnel member documents the following information in a patient’s medical record before the end of the shift in which the patient is placed in restraint or seclusion or, if the patient’s restraint or seclusion does not end during the shift in which it began, during the shift in which the patient’s restraint or seclusion ends:

a. The emergency situation that required the patient to be restrained or put in seclusion;

b. The times the patient’s restraint or seclusion actually began and ended;

c. The time of the assessment required in subsection (10)(e);

d. The monitoring required in subsection (7) or (10)(d), as applicable;

e. The names of the medical practitioners and personnel members with direct patient contact while the patient was in the restraint or seclusion;

f. The times the patient was given the opportunity to eat or use the toilet according to subsection (10)(f); and

g. The patient evaluation required in subsection (16);

15. If an emergency situation continues beyond the time limit of an order for restraint or seclusion, the order is renewed according to policies and procedures that include:

a. The specific criteria for release from restraint or seclusion without an additional order, and

b. The maximum duration authorized for the restraint or seclusion; and

16. A patient is evaluated after restraint or seclusion is no longer being used for the patient.

Historical Note

Section R9-10-316, formerly numbered as R9-10-216, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-316 repealed, new Section R9-10-316 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-316 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-317. Behavioral Health Observation/Stabilization Services

An administrator of a behavioral health inpatient facility that provides behavioral health observation/stabilization services shall comply with the requirements for behavioral health observation/stabilization services in R9-10-1012.

Historical Note

Section R9-10-317, formerly numbered as R9-10-221, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-317 repealed, new Section R9-10-317 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-317 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-318. Detoxification Services

An administrator of a behavioral health inpatient facility licensed to provide detoxification services shall ensure that:

1. Detoxification services are available;

2. Policies and procedures state:

a. Whether the behavioral health inpatient facility provides involuntary, court-ordered alcohol treatment;

b. Whether the behavioral health inpatient facility includes a local alcoholism reception center, as defined in A.R.S. § 36-2021;

c. The types of substances for which the behavioral health inpatient facility provides detoxification services; and

d. The detoxification process or processes used by the behavioral health inpatient facility;

3. A physician with skills and knowledge in providing detoxification services is present at the behavioral health inpatient facility or on-call; and

4. A patient who needs immediate medical services the behavioral health inpatient facility is unable to provide is transferred to a health care institution capable of meeting the patient's immediate needs for medical services.

Historical Note

Section R9-10-318, formerly numbered as R9-10-222, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-318 repealed, new Section R9-10-318 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-318 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-319. Medication Services

A. If a behavioral health inpatient facility provides medication administration or assistance in the self-administration of medication, an administrator shall ensure that policies and procedures:

1. Include:

a. A process for providing information to a patient about medication prescribed for the patient including:

i. The prescribed medication’s anticipated results,

ii. The prescribed medication’s potential adverse reactions,

iii. The prescribed medication’s potential side effects, and

iv. Potential adverse reactions that could result from not taking the medication as prescribed;

b. Procedures for preventing, responding to, and reporting:

i. A medication error,

ii. An adverse response to a medication, or

iii. A medication overdose;

c. Procedures to ensure that a patient’s medication regimen is reviewed by a medical practitioner to ensure the medication regimen and meets the patient’s needs;

d. Procedures for documenting medication services and assistance in the self-administration of medication;

e. Procedures for assisting a patient in obtaining medication; and

f. If applicable, procedures for providing medication administration or assistance in the self-administration of medication off the premises; and

2. Specify a process for review through the quality management program of:

a. A medication administration error, and

b. An adverse reaction to a medication;

B. If a behavioral health inpatient facility provides medication administration, an administrator shall ensure that:

1. Policies and procedures for medication administration:

a. Are reviewed and approved by a medical practitioner;

b. Specify the individuals who may:

i. Order medication, and

ii. Administer medication;

c. Ensure that medication is administered to a patient only as prescribed; and

d. A patient’s refusal to take prescribed medication is documented in the patient’s medical record;

2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law;

3. A medication administered to a patient is:

a. Administered in compliance with an order, and

b. Documented in the patient’s medical record; and

4. If pain medication is administered to a patient, documentation in the patient’s medical record includes:

a. An identification of the patient’s pain before administering the medication, and

b. The effect of the pain medication administered.

C. If a behavioral health inpatient facility provides assistance in the self-administration of medication, an administrator shall ensure that:

1. A patient’s medication is stored by the behavioral health inpatient facility;

2. The following assistance is provided to a patient:

a. A reminder when it is time to take the medication;

b. Opening the medication container for the patient;

c. Observing the patient while the patient removes the medication from the container;

d. Verifying that the medication is taken as ordered by the patient’s medical practitioner by confirming that:

i. The patient taking the medication is the individual stated on the medication container label,

ii. The dosage of the medication is the same as stated on the medication container label, and

iii. The medication is being taken by the patient at the time stated on the medication container label; or

e. Observing the patient while the patient takes the medication;

3. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by a medical practitioner or a registered nurse;

4. Training for a personnel member, other than a medical practitioner or a registered nurse, in the self-administration of medication:

a. Is provided by a medical practitioner or a registered nurse or an individual trained by a medical practitioner or registered nurse; and

b. Includes:

i. A demonstration of the personnel member’s skills and knowledge necessary to provide assistance in the self-administration of medication,

ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

iii. Process for notifying the appropriate entities when an emergency medical intervention is needed;

5. A personnel member, other than a medical practitioner or a registered nurse, completes the training in subsection (C)(4) before the personnel member provides assistance in the self-administration of medication; and

6. Assistance with the self-administration of medication provided to a patient:

a. Is in compliance with an order, and

b. Is documented in the patient’s medical record.

D. An administrator shall ensure that:

1. A current drug reference guide is available for use by personnel members;

2. A current toxicology reference guide is available for use by personnel members; and

3. If pharmaceutical services are provided on the premises:

a. A committee, composed of at least one physician, one pharmacist, and other personnel members as determined by policies and procedures is established to:

i. Develop a drug formulary;

ii. Update the drug formulary at least every 12 months;

iii. Develop medication usage and medication substitution policies and procedures; and

iv. Specify which medication and medication classifications are required to be automatically stopped after a specific time period unless the ordering medical staff member specifically orders otherwise;

b. The pharmaceutical services are provided under the direction of a pharmacist;

c. The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

d. A copy of the pharmacy license is provided to the Department upon request.

E. When medication is stored at a behavioral health inpatient facility, an administrator shall ensure that:

1. There is a separate room, closet, or self-contained unit used for medication storage that includes a lockable door;

2. If medication is stored in a separate room or closet, a locked cabinet or container is used for medication storage;

3. Medication is stored according to the instructions on the medication container; and

4. Policies and procedures are established, documented, and implemented for:

a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication;

b. Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

c. A medication recall and notification of patients who received recalled medication; and

d. Storing, inventorying, and dispensing controlled substances.

F. An administrator shall ensure that a personnel member immediately reports a medication error or a patient’s adverse reaction to a medication to the medical practitioner who ordered the medication and, if applicable, the behavioral health inpatient facility’s clinical director.

Historical Note

Section R9-10-319, formerly numbered as R9-10-223, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-319 repealed, new Section R9-10-319 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-319 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-320. Food Services

A. An administrator shall ensure that:

1. The behavioral health inpatient facility is licensed as a food establishment under 9 A.A.C. 8, Article 1;

2. A copy of the behavioral health inpatient facility’s food establishment license is maintained;

3. If a behavioral health inpatient facility contracts with a food establishment, as defined in 9 A.A.C. 8, Article 1, to prepare and deliver food to the behavioral health inpatient facility:

a. A copy of the contracted food establishment's license under 9 A.A.C. 8, Article 1 is maintained by the behavioral health inpatient facility; and

b. The behavioral health inpatient facility is able to store, refrigerate, and reheat food to meet the dietary needs of a patient;

4. A registered dietitian is employed full-time, part-time, or as a consultant; and

5. If a registered dietitian is not employed full-time, an individual is designated as a director of food services who consults with a registered dietitian as often as necessary to meet the nutritional needs of the patients.

B. A registered dietitian or director of food services shall ensure that:

1. A food menu:

a. Is prepared at least one week in advance,

b. Includes the foods to be served each day,

c. Is conspicuously posted at least one calendar day before the first meal on the food menu will be served,

d. Includes any food substitution no later than the morning of the day of meal service with a food substitution, and

e. Is maintained for at least 60 calendar days after the last day included in the food menu;

2. Meals and snacks provided by the behavioral health inpatient facility are served according to posted menus;

3. Meals for each day are planned using:

a. The applicable meal planning guides in http://www.fns.usda.gov/cnd/Care/ProgramBasics/Meals/ Meal_Pattern.htm; and

b. Preferences for meals and snacks obtained from patients;

4. A patient is provided:

a. A diet that meets the patient's nutritional needs as specified in the patient's assessment plan;

b. Three meals a day with not more than 14 hours between the evening meal and breakfast except as provided in subsection (B)(4)(d);

c. The option to have a daily evening snack identified in subsection (B)(4)(d)(ii) or other snack; and

d. The option to extend the time span between the evening meal and breakfast from 14 hours to 16 hours if:

i. A patient group agrees; and

ii. The patient is offered an evening snack that includes meat, fish, eggs, cheese, or other protein, and a serving from either the fruit and vegetable food group or the bread and cereal food group;

5. A patient requiring assistance to eat is provided with assistance that recognizes the patient's nutritional, physical, and social needs, including the use of adaptive eating equipment or utensils; and

6. Water is available and accessible to patients.

C. An administrator shall ensure that food is obtained, prepared, served, and stored as follows:

1. Food is free from spoilage, filth, or other contamination and is safe for human consumption;

2. Food is protected from potential contamination;

3. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a patient such as cut, chopped, ground, pureed, or thickened;

4. Potentially hazardous food is maintained as follows:

a. Foods requiring refrigeration are maintained at 41° F or below; and

b. Foods requiring cooking are cooked to heat all parts of the food to a temperature of at least 145° F for 15 seconds, except that:

i. Ground beef and ground meats are cooked to heat all parts of the food to at least 155° F;

ii. Poultry, poultry stuffing, stuffed meats and stuffing containing meat are cooked to heat all parts of the food to at least 165° F;

iii. Pork and any food containing pork are cooked to heat all parts of the food to at least 155° F;

iv. Raw shell eggs for immediate consumption are cooked to at least 145° F for 15 seconds and any food containing raw shell eggs is cooked to heat all parts of the food to at least 155° F;

v. Roast beef and beef steak are cooked to an internal temperature of at least 155° F; and

vi. Leftovers are reheated to a temperature of at least 165° F;

5. A refrigerator contains a thermometer, accurate to plus or minus 3° F, placed at the warmest part of the refrigerator;

6. Frozen foods are stored at a temperature of 0° F or below; and

7. Tableware, utensils, equipment, and food-contact surfaces are clean and in good repair.

Historical Note

Section R9-10-320, formerly numbered as R9-10-231, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-320 repealed, new Section R9-10-320 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-320 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-321. Emergency and Safety Standards

A. An administrator shall ensure that a behavioral health inpatient facility has:

1. A fire alarm system installed according to the National Fire Protection Association 72: National Fire Alarm Code, Chapter 3, Section 3-4.1.1(a), incorporated by reference in A.A.C. R9-1-412, and a sprinkler system installed according to the National Fire Protection Association 13 standards incorporated by reference in A.A.C. R9-1-412; or

2. An alternative method to ensure a patient's safety, documented and approved by the local jurisdiction.

B. An administrator shall ensure that:

1. A disaster plan is developed, documented, maintained in a location accessible to personnel members and other employees, and, if necessary, implemented that includes:

a. When, how, and where patients will be relocated;

b. How a patient's medical record will be available to personnel providing services to the patient during a disaster;

c. A plan to ensure each patient's medication will be available to administer to the patient during a disaster; and

d. A plan for obtaining food and water for individuals present in the behavioral health inpatient facility or the behavioral health inpatient facility's relocation site during a disaster;

2. The disaster plan required in subsection (B)(1) is reviewed at least once every 12 months;

3. Documentation of a disaster plan review required in subsection (B)(2) is created, is maintained for at least 12 months after the date of the disaster plan review, and includes:

a. The date and time of the disaster plan review;

b. The name of each personnel member, employee, volunteer, or student participating in the disaster plan review;

c. A critique of the disaster plan review; and

d. If applicable, recommendations for improvement;

4. An evacuation drill for employees is conducted on each shift at least once every three months;

5. An evacuation drill for employees and patients:

a. Is conducted at least once every six months; and

b. Except for a patient whose treatment plan contains documentation that evacuation from the behavioral health inpatient facility would cause harm to the patient, includes all individuals in the behavioral health inpatient facility;

6. Documentation of each evacuation drill is created, is maintained for at least 12 months after the date of the evacuation drill, and includes:

a. The date and time of the evacuation drill;

b. Whether the evacuation drill was for employees only or for both employees and patients;

c. The amount of time taken for all employees and, if applicable, patients to evacuate to a designated area;

d. If applicable:

i. An identification of patients needing assistance for evacuation, and

ii. An identification of patients who were not evacuated;

e. Any problems encountered in conducting the evacuation drill; and

f. Recommendations for improvement, if applicable; and

7. An evacuation path is conspicuously posted on each hallway of each floor of the behavioral health inpatient facility.

C. An administrator shall:

1. Obtain a fire inspection conducted according to the time-frame established by the local fire department or the State Fire Marshal,

2. Make any repairs or corrections stated on the fire inspection report, and

3. Maintain documentation of a current fire inspection.

Historical Note

Section R9-10-321, formerly numbered as R9-10-232, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-321 repealed, new Section R9-10-321 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-321 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-322. Environmental Standards

A. An administrator shall ensure that:

1. The premises and equipment are:

a. Cleaned and, if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness or infection; and

b. Free from a condition or situation that may cause a patient or other individual to suffer physical injury;

2. A pest control program is implemented and documented;

3. Biohazardous medical waste is identified, stored, and disposed of according to 18 A.A.C. 13, Article 14 and policies and procedures;

4. Equipment used at the behavioral health inpatient facility is:

a. Maintained in working order;

b. Tested and calibrated according to the manufacturer's recommendations or, if there are no manufacturer's recommendations, as specified in policies and procedures; and

c. Used according to the manufacturer's recommendations;

5. Documentation of equipment testing, calibration, and repair is maintained for at least 12 months after the date of the testing, calibration, or repair;

6. Garbage and refuse is:

a. In areas used for food storage, food preparation, or food service, stored in covered containers lined with plastic bags;

b. In areas not used for food storage, food preparation, or food service, stored:

i. According to the requirements in subsection (6)(a), or

ii. In a paper-lined container that is cleaned and sanitized as often as necessary to ensure that the container is clean; and

c. Is removed from the premises at least once a week;

7. Heating and cooling systems maintain the behavioral health inpatient facility at a temperature between 70° F and 84° F;

8. Common areas:

a. Are lighted to assure the safety of patients, and

b. Have lighting sufficient to allow personnel members to monitor patient activity;

9. Hot water temperatures are maintained between 95° F and 120° F in the areas of a behavioral health inpatient facility used by patients;

10. The supply of hot and cold water is sufficient to meet the personal hygiene needs of patients and the cleaning and sanitation requirements in this Article;

11. Soiled linen and soiled clothing stored by the behavioral health inpatient facility are maintained separate from clean linen and clothing and stored in closed containers away from food storage, kitchen, and dining areas;

12. Oxygen containers are secured in an upright position;

13. Poisonous or toxic materials stored by the behavioral health inpatient facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to patients;

14. Combustible or flammable liquids and hazardous materials stored by a behavioral health inpatient facility are stored in the original labeled containers or safety containers outside the behavioral health inpatient facility or in an attached garage that is locked and are inaccessible to patients;

15. Pets or animals are:

a. Controlled to prevent endangering the patients and to maintain sanitation;

b. Licensed consistent with local ordinances; and

c. Vaccinated as follows:

i. A dog is vaccinated against rabies and leptospirosis, and

ii. A cat is vaccinated against rabies;

16. If a non-municipal water source is used:

a. The water source is tested at least once every 12 months for total coliform bacteria and fecal coliform or E. coli bacteria;

b. If necessary, corrective action is taken to ensure the water is safe to drink; and

c. Documentation of testing is maintained for two years after the date of the test; and

17. If a non-municipal sewage system is used, the sewage system is in working order and is maintained according to applicable state laws and rules.

B. An administrator shall ensure that:

1. Smoking or the use of tobacco products is not permitted within a behavioral health inpatient facility; and

2. Smoking and the use of tobacco products may be permitted on the premises outside a behavioral health inpatient facility if:

a. Signs designating smoking areas are conspicuously posted, and

b. Smoking is prohibited in areas where combustible materials are stored or in use.

C. If a swimming pool is located on the premises, an administrator shall ensure that:

1. At least one personnel member with cardiopulmonary resuscitation training that meets the requirements in R9-10-303(C)(1)(d) is present in the pool area when a patient is in the pool area, and

2. At least two personnel members are present in the pool area when two or more patients are in the pool area.

Historical Note

Section R9-10-322, formerly numbered as R9-10-233, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-322 repealed, new Section R9-10-322 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-322 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-323. Physical Plant Standards

A. An administrator shall ensure that the premises and equipment are sufficient to accommodate:

1. The services stated in the behavioral health inpatient facility’s scope of services, and

2. An individual accepted as a patient by the behavioral health inpatient facility.

B. An administrator shall ensure that:

1. A behavioral health inpatient facility has a:

a. Waiting area with seating for patients and visitors;

b. Room that provides privacy for a patient to receive treatment or visitors; and

c. Common area and a dining area that:

i. Are not converted, partitioned, or otherwise used as a sleeping area; and

ii. Contain furniture and materials to accommodate the recreational and socialization needs of the patients and other individuals in the behavioral health inpatient facility;

2. A bathroom is available for use by visitors during the behavioral health inpatient facility's hours of operation and:

a. Provides privacy; and

b. Contains:

i. A working sink with running water,

ii. A working toilet that flushes and has a seat,

iii. Toilet tissue,

iv. Soap for hand washing,

v. Paper towels or a mechanical air hand dryer,

vi. Lighting, and

vii. A window that opens or another means of ventilation;

3. For every six patients, there is at least one working toilet that flushes and has a seat and one sink with running water;

4. For every eight patients, there is at least one working bathtub or shower with a slip-resistant surface;

5. A patient bathroom complies with the following:

a. Provides privacy when in use;

b. Contains:

i. A shatterproof mirror, unless the patient's treatment plan requires otherwise;

ii. A window that opens or another means of ventilation; and

iii. Nonporous surfaces for shower enclosures and slip-resistant surfaces in tubs and showers;

c. Has plumbing, piping, ductwork, or other potentially hazardous elements concealed above a ceiling;

d. If the bathroom or shower area has a door, the door swings outward to allow for staff emergency access;

e. If grab bars for the toilet and tub or shower or other assistive devices are identified in the patient's treatment plan, has grab bars or other assistive devices to provide for patient safety;

f. If a grab bar is provided, has the space between the grab bar and the wall filled to prevent a cord being tied around the grab bar;

g. Does not contain a towel bar, a shower curtain rod, or a lever handle that is not a specifically designed anti-ligature lever handle;

h. Has tamper-resistant lighting fixtures, sprinkler heads, and electrical outlets; and

i. For a bathroom with a sprinkler head where a patient is not supervised while the patient is in the bathroom, has a sprinkler head that is recessed or designed to minimize patient access;

6. If a patient bathroom door locks from the inside, an employee has a key and access to the bathroom;

7. Each patient is provided a bedroom for sleeping;

8. A patient bedroom complies with the following:

a. Is not used as a common area;

b. Is not used as a passageway to another bedroom or bathroom unless the bathroom is for the exclusive use of an individual occupying the bedroom;

c. Contains a door that opens into a hallway, common area, or outdoors and, except as provided in subsection (C), another means of egress;

d. Is constructed and furnished to provide unimpeded access to the door;

e. Has window or door covers that provide patient privacy;

f. Has floor to ceiling walls:

g. Is a:

i. Private bedroom that contains at least 60 square feet of floor space, not including the closet; or

ii. Shared bedroom that:

(1) Is shared by no more than four patients;

(2) Contains at least 60 square feet of floor space, not including a closet, for each individual occupying the bedroom; and

(3) Provides at least three feet of floor space between beds;

h. Contains for each patient occupying the bedroom:

i. A bed that is at least 36 inches wide and at least 72 inches long, and consists of at least a frame and mattress and linens; and

ii. Individual storage space for personnel effects and clothing such as shelves, a dresser, or chest of drawers;

i. Has clean linen for each bed including mattress pad, sheets large enough to tuck under the mattress, pillows, pillow cases, bedspread, waterproof mattress covers as needed, and blankets to ensure warmth and comfort for each patient;

j. Has sufficient lighting for a patient occupying the bedroom to read; and

k. If applicable, has a drawer pull that is recessed to eliminate the possibility of use as a tie-off point;

9. In a patient bathroom or a patient bedroom:

a. The ceiling is secured from access or at least 9 feet in height; and

b. A ventilation grille is:

i. Secured and has perforations that are too small to use as a tie-off point, or

ii. Of sufficient height to prevent patient access;

10. For a door located in an area of the behavioral health inpatient facility that is accessible to patients:

a. A door closing device, if used on a patient bedroom door, is mounted on the public side of the door;

b. A door's hinges are designed to minimize points for hanging;

c. Except for a door lever handle that contains specifically designed anti-ligature hardware, a door lever handle points downward when in the latched or unlatched position; and

d. Hardware has tamper-resistant fasteners; and

11. A window located in an area of the behavioral health inpatient facility that is accessible to patients is fabricated with laminated safety glass or protected by polycarbonate, laminate, or safety screens.

C. A bedroom in a behavioral health inpatient facility licensed before October 1, 2013, is not required to have a second means of egress if an administrator ensures that policies and procedures are established, documented, and implemented that provide for the safe evacuation of a patient in the bedroom based on the patient’s physical and mental limitations and the location of the bedroom.

D. If a swimming pool is located on the premises, an administrator shall ensure that:

1. The swimming pool is enclosed by a wall or fence that:

a. Is at least five feet in height as measured on the exterior of the wall or fence;

b. Has no vertical openings greater that four inches across;

c. Has no horizontal openings, except as described in subsection (C)(1)(e);

d. Is not chain-link;

e. Does not have a space between the ground and the bottom fence rail that exceeds four inches in height; and

f. Has a self-closing, self-latching gate that:

i. Opens away from the swimming pool,

ii. Has a latch located at least five feet from the ground, and

iii. Is locked when the swimming pool is not in use; and

2. A life preserver or shepherd’s crook is available and accessible in the pool area.

E. An administrator shall ensure that a spa that is not enclosed by a wall or fence as described in subsection (D)(1) is covered and locked when not in use.

Historical Note

Section R9-10-323, formerly numbered as R9-10-234, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-323 repealed, new Section R9-10-323 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2). New Section R9-10-323 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-324. Repealed

Historical Note

Section R9-10-324, formerly numbered as R9-10-235, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-324 repealed, new Section R9-10-324 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-325. Repealed

Historical Note

Section R9-10-325, formerly numbered as R9-10-236, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-325 repealed, new Section R9-10-325 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-326. Repealed

Historical Note

Section R9-10-326, formerly numbered as R9-10-237, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-326 repealed, new Section R9-10-326 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-327. Repealed

Historical Note

Section R9-10-327, formerly numbered as R9-10-241, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-327 repealed, new Section R9-10-327 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-328. Repealed

Historical Note

Section R9-10-328, formerly numbered as R9-10-242, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-328 repealed, new Section R9-10-328 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-329. Repealed

Historical Note

Section R9-10-329, formerly numbered as R9-10-243, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-329 repealed, new Section R9-10-329 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-330. Repealed

Historical Note

Section R9-10-330, formerly numbered as R9-10-244, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-330 repealed, new Section R9-10-330 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-331. Repealed

Historical Note

Section R9-10-331, formerly numbered as R9-10-245, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-331 repealed, new Section R9-10-331 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-332. Repealed

Historical Note

Section R9-10-332, formerly numbered as R9-10-246, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-332 repealed, new Section R9-10-332 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-333. Repealed

Historical Note

Section R9-10-333, formerly numbered as R9-10-247, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Former Section R9-10-333 repealed, new Section R9-10-333 adopted effective February 4, 1981 (Supp. 81-1). Section repealed by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-334. Repealed

Historical Note

Section R9-10-334, formerly numbered as R9-10-249, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Repealed effective February 4, 1981 (Supp. 81-1).

R9-10-335. Repealed

Historical Note

Section R9-10-335, formerly numbered as R9-10-250, renumbered as an emergency effective February 22, 1979, pursuant to A.R.S. § 41-1003, valid for only 90 days (Supp. 79-1). Adopted effective June 14, 1979 (Supp. 79-3). Repealed effective February 4, 1981 (Supp. 81-1).

ARTICLE 4. NURSING CARE INSTITUTIONS

Article 4, consisting of Sections R9-10-411 through R9-10-438, repealed at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-401. Definitions

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definitions apply in this Article unless otherwise specified:

1. “Administrator” has the meaning in A.R.S. § 36-446.

2. “Behavioral care” means:

a. Assistance with a resident’s psychosocial interactions to manage the resident’s behavior that can be performed by an individual without professional skills that may include direction provided by a behavioral health professional and medication ordered by a medical practitioner or behavioral health professional; or

b. Behavioral health services provided by a behavioral health professional on an intermittent basis to address a resident’s significant psychological or behavioral response to an identifiable stressor or stressors.

3. “Care plan” means a documented description of physical health services and behavioral health services expected to be provided to a resident, based on the resident's comprehensive assessment, that includes measurable objectives and the methods for meeting the objectives.

4. “Direct care” means medical services, nursing services, or social services provided to a resident.

5. “Director of nursing” means an individual who is responsible for the nursing services provided in a nursing care institution.

6. “Full-time” means 40 hours or more every consecutive seven calendar days.

7. “Highest practicable” means a resident's optimal level of functioning and well-being based on the resident's current functional status and potential for improvement as determined by the resident's comprehensive assessment.

8. “Interdisciplinary team” means a group of individuals consisting of a resident's attending physician, a registered nurse responsible for the resident, and other individuals as determined in the resident's comprehensive assessment.

9. “Intermittent” means not on a regular basis.

10. “Medical director” means a physician who is responsible for the coordination of medical services provided to residents in a nursing care institution.

11. “Nursing care institution services” means medical services, nursing services, health-related services, ancillary services, social services, and environmental services provided to a resident.

12. “Ombudsman” means a resident advocate who performs the duties described in A.R.S. § 46-452.02.

13. “Resident” means a patient admitted to a nursing care institution with the expectation that the patient will be present in the nursing care institution for more than 24 hours.

14. “Resident group” means residents or residents' family members who:

a. Plan and participate in resident activities, or

b. Meet to discuss nursing care institution issues and policies.

15. “Resident's representative” means a resident's legal guardian, an individual acting on behalf of a resident with the written consent of the resident, or a surrogate under A.R.S. § 36-3201.

16. “Secured” means the use of a method, device, or structure that:

a. Prevents a resident from leaving an area of the nursing care institution's premises, or

b. Alerts a personnel member of a resident's departure from the nursing care institution.

17. “Social services” means assistance provided to or activities provided for a resident to maintain or improve the resident's physical, mental, and psychosocial capabilities.

18. “Total health condition” means a resident's overall physical and psychosocial well-being as determined by the resident's comprehensive assessment.

19. “Unnecessary drug” means a medication that is not required because:

a. There is no documented indication for a resident’s use of the medication;

b. The medication is excessive or duplicative;

c. The medication is administered before determining whether the resident requires the medication; or

d. The resident has experienced an adverse reaction from the medication, indicating that the medication should be reduced or discontinued.

20. “Ventilator” means a device designed to provide, to a resident who is physically unable to breathe or who is breathing insufficiently, the mechanism of breathing by mechanically moving breathable air into and out of the resident’s lungs.

Historical Note

New Section R9-10-401 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).

R9-10-402. Supplemental Application Requirements

In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant for an initial license as a nursing care institution shall include:

1. On the application whether the nursing care institution:

a. Has:

i. A secured area for a resident with Alzheimer's disease or other dementia, or

ii. An area for a resident on a ventilator;

b. Is requesting authorization to provide to a resident:

i. Behavioral health services,

ii. Clinical laboratory services,

iii. Dialysis services, or

iv. Radiology services and diagnostic imaging services; and

c. Is requesting authorization to operate a nutrition and feeding assistant training program; and

2. If the governing authority is requesting authorization to operate a nutrition and feeding assistant training program, the information in R9-10-115(B)(1)(a), (B)(1)(c), and (B)(2).

Historical Note

New Section R9-10-402 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).

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 administrator 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 management program at least once every 12 months;

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

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

b. Is not on the nursing care institution’s premises 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 nursing care institution and all services provided by or at the nursing care institution;

2. Has the authority and responsibility to administer the nursing care institution;

3. Except as provided in subsection (A)(7), designates an individual, in writing, who is available 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 nutrition assistant training, ensures the nursing care institution complies with the requirements for the operation of a feeding and nutrition assistant training program in R9-10-115.

C. An administrator shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Include job descriptions, duties, and qualifications, including required skills, knowledge, education, and experience, for personnel members, employees, volunteers, and students;

b. Cover orientation and in-service education for personnel members, employees, volunteers, and students;

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

d. 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 cardiopulmonary resuscitation training, and

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

e. Cover first aid training;

f. Include a method to identify a resident to ensure the resident receives physical health services and behavioral health services as ordered;

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

h. Cover specific steps, including applicable deadlines, for:

i. A resident to file a complaint;

ii. The nursing care institution to respond to a resident’s complaint; and

iii. The nursing care institution to obtain documentation of fingerprint clearance, if applicable;

i. Cover health care directives;

j. Cover medical records, including electronic medical records;

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

l. Cover contracted services;

m. Cover resident’s personal accounts;

n. Cover petty cash funds;

o. Cover fees and refund policies;

p. Cover misappropriation of resident property; and

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

2. Policies and procedures for physical health services and behavioral health services are established, documented, and implemented 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 disposing of medication;

e. Cover infection control;

f. Cover restraints that require an order, including the frequency of monitoring and assessing the restraint;

g. Cover seclusion of a resident including:

i. The requirements for an order, and

ii. The frequency of monitoring and assessing a resident in seclusion;

h. Cover telemedicine, if applicable; and

i. Cover environmental services that affect resident care;

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

4. Policies and procedures are available to personnel members, 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 Department 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 responsible for licensing and monitoring the nursing care institution.

D. An administrator shall ensure that medical services, nursing services, health-related services, behavioral health services, or ancillary services provided by a nursing care institution are only provided to a resident.

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

1. Take immediate action to stop the alleged or suspected abuse, neglect, or exploitation;

2. Immediately report the alleged or 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 the action in subsection (F)(1) and the report in subsection (F)(2) and maintain the documentation for at least 12 months after the date of the report;

4. Investigate the alleged or suspected abuse, neglect, or exploitation and develop a written report of the investigation within 48 hours after the report required in subsection (F)(2) that includes:

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

b. A description of any injury to the resident and any change to the resident's physical, cognitive, functional, or emotional condition;

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

d. The actions taken by the administrator to prevent the alleged or suspected abuse, neglect, or exploitation from occurring in the future;

5. Submit a copy of the investigation report required in subsection (F)(4) to the Department within 10 working days after submitting the report in subsection (F)(2); and

6. Maintain a copy of the investigation report required in subsection (F)(4) for at least 12 months after the date of the report.

G. An administrator shall:

1. Allow a resident advocate to assist a resident, the resident's representative, or a resident group with a request or recommendation, and respond in writing to 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 quality 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 Program, 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 Department, 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 according to subsection (C)(1)(m);

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

3. Maintain a complete and separate accounting of each personal account;

4. Obtain written authorization from the resident or the resident'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 representative 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, transfer, or discharge, return all money in the resident's personal 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 subsection (C)(1)(k) 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).

R9-10-404. Quality Management

An administrator shall ensure that:

1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes:

a. A method to identify, document, and evaluate incidents;

b. A method to collect data to evaluate services provided to residents;

c. A method to evaluate the data collected to identify a concern about the delivery of services related to resident care;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of services related to resident care; and

e. The frequency of submitting a documented report required in subsection (2) to the governing authority;

2. A documented report is submitted to the governing authority that includes:

a. An identification of each concern about the delivery of services related to resident care; and

b. Any change made or action taken as a result of the identification of a concern about the delivery of services related to resident care; and

3. The report required in subsection (2) and the supporting documentation for the report are maintained for at least 12 months after the date the report is submitted to the governing authority.

Historical Note

New Section R9-10-404 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-405. Contracted Services

An administrator shall ensure that:

1. Contracted services are provided according to the requirements in this Article, and

2. A documented list of current contracted services is maintained that includes a description of the contracted services provided.

Historical Note

New Section R9-10-405 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-406. Personnel

A. An administrator shall ensure that:

1. A behavioral health technician is at least 21 years old, and

2. A behavioral health paraprofessional is at least 21 years old.

B. An administrator shall ensure that:

1. The qualifications, skills, and knowledge required for each type of personnel member:

a. Are based on:

i. The type of physical health services or behavioral health services expected to be provided by the personnel member according to the established job description, and

ii. The acuity of the residents receiving physical health services or behavioral health services from the personnel member according to the established job description; and

b. Include:

i. The specific skills and knowledge necessary for the personnel member to provide the expected physical health services and behavioral health services listed in the established job description,

ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description, and

iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description;

2. A personnel member’s skills and knowledge are verified and documented:

a. Before the personnel member provides physical health services or behavioral health services, and

b. According to policies and procedures; and

3. Personnel members are present on a nursing care institution’s premises with the qualifications, skills, and knowledge necessary to:

a. Provide the services in the nursing care institution’s scope of services,

b. Meet the needs of a resident, and

c. Ensure the health and safety of a resident.

C. An administrator shall ensure that social services are provided by an individual in compliance with the requirements in A.R.S. Title 32, Chapter 33.

D. An administrator shall ensure that an individual who is a licensed baccalaureate social worker, master social worker, associate marriage and family therapist, associate counselor, or associate substance abuse counselor is under direct supervision as defined in 4 A.A.C. 6, Article 1.

E. An administrator shall ensure that a personnel member or an employee or volunteer who has or is expected to have direct interaction with a resident for more than 8 hours a week provides evidence of freedom from infectious tuberculosis as specified in R9-10-112.

F. An administrator shall ensure that a personnel record is maintained for an employee, a volunteer, and a student that contains:

1. The individual’s name, date of birth, home address, and contact telephone number;

2. The individual’s starting date of employment or volunteer service and, if applicable, the ending date; and

3. Documentation of:

a. The individual’s qualifications including skills and knowledge applicable to the individual's job duties;

b. The individual’s education and experience applicable to the individual's job duties;

c. The individual’s compliance with the requirements in A.R.S. § 36-411;

d. Orientation and in-service education as required by policies and procedures;

e. The individual’s license or certification, if the individual is required to be licensed or certified in this Article or policies and procedures;

f. If the individual is a behavioral health technician, clinical oversight required in R9-10-114;

g. Cardiopulmonary resuscitation training, if required for the individual according to R9-10-403(C)(1)(d);

h. First aid training, if required for the individual according to this Article or policies and procedures;

i. Evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (E); and

j. If the individual is a nutrition and feeding assistant:

i. Completion of the nutrition and feeding assistant training course required in R9-10-115, and

ii. A nurse’s observations required in R9-10-423(C)(6).

G. An administrator shall ensure that personnel records are maintained:

1. Throughout the individual's period of providing services in or for the nursing care institution, and

2. For at least two years after the last date the individual provided services in or for the nursing care institution.

H. An administrator shall ensure that:

1. A plan to provide orientation specific to the duties of a personnel member, an employee, a volunteer, and a student is developed, documented, and implemented;

2. A personnel member completes orientation before providing physical health services or behavioral health services;

3. An individual’s orientation is documented, to include:

a. The individual’s name,

b. The date of the orientation, and

c. The subject or topics covered in the orientation;

4. A director of nursing develops, documents, and implements a plan to provide in-service education specific to the duties of a personnel member;

5. A personnel member’s in-service education is documented, to include:

a. The personnel member's name,

b. The date of the training, and

c. The subject or topics covered in the training; and

6. A work schedule of each personnel member is developed and maintained at the nursing care institution for at least 12 months after the date of the work schedule.

I. An administrator shall designate a qualified individual to provide:

1. Social services, and

2. Recreational activities .

Historical Note

New Section R9-10-406 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).

R9-10-407. Admissions

An administrator shall ensure that:

1. A resident is admitted only on a physician's order;

2. The physician's admitting order includes the nursing care institution services required to meet the immediate needs of a resident such as medication and food services;

3. At the time of a resident's admission, a registered nurse conducts or coordinates an initial assessment on a resident to ensure the resident's immediate needs for nursing care institution services are met;

4. A resident's needs do not exceed the medical services and nursing services available at the nursing care institution as established in the nursing care institution’s scope of services;

5. Before or at the time of admission, a resident or the resident's representative:

a. Signs a written agreement with the nursing care institution that includes rates and charges,

b. Is informed of third-party coverage for rates and charges,

c. Is informed of the nursing care institution's refund policy , and

d. Receives written information concerning the nursing care institution’s policies and procedures related to a resident’s health care directives;

6. Within 30 calendar days before admission or 10 working days after admission, a medical history and physical examination is completed on a resident by:

a. A physician, or

b. A physician assistant or a registered nurse practitioner designated by the attending physician;

7. Except as specified in subsection (8), a resident provides evidence of freedom from infectious tuberculosis as specified in R9-10-112;

8. A resident who transfers from a nursing care institution to another nursing care institution is not required to be rescreened for tuberculosis or provide another written statement by a physician, physician assistant, or registered nurse practitioner as specified in R9-10-112(1) if:

a. Fewer than 12 months have passed since the resident was screened for tuberculosis or since the date of the written statement, and

b. The documentation of freedom from infectious tuberculosis required in subsection (7) accompanies the resident at the time of transfer; and

9. Compliance with the requirements in subsection (6) is documented in the resident's medical records.

Historical Note

New Section R9-10-407 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).

R9-10-408. Discharge

A. An administrator shall ensure that:

1. A resident is transferred or discharged if:

a. The nursing care institution is unable to meet the needs of the resident,

b. The resident's behavior is a threat to the health or safety of the resident or other individuals at the nursing care institution, or

c. The resident's health has improved and the resident no longer requires nursing care institution services; and

2. Documentation of a resident's transfer or discharge includes:

a. The date of the transfer or discharge;

b. The reason for the transfer or discharge;

c. A 30-day written notice except in an emergency;

d. A notation by a physician or the physician's designee if the transfer or discharge is due to any of the reasons listed in subsection (A)(1); and

e. If applicable, actions taken by a personnel member to protect the resident or other individuals if the resident’s behavior is a threat to the health and safety of the resident or other individuals in the nursing care institution.

B. An administrator may transfer or discharge a resident for failure to pay for residency if:

1. The resident or resident's representative receives a 30-day written notice of transfer or discharge, and

2. The 30-day written notice includes an explanation of the resident's right to appeal the transfer or discharge.

C. Except in an emergency, a director of nursing shall ensure that before a resident is discharged:

1. Written follow-up instructions are developed with the resident or the resident's representative that includes:

a. Information necessary to meet the resident's need for medical services and nursing services; and

b. The state long-term care ombudsman's name, address, and telephone number;

2. A copy of the written follow-up instructions is provided to the resident or the resident's representative; and

3. A discharge summary is developed by a personnel member and authenticated by the resident's attending physician or designee and includes:

a. The resident's medical condition at the time of transfer or discharge,

b. The resident's medical and psychosocial history,

c. The date of the transfer or discharge, and

d. The location of the resident after discharge.

Historical Note

New Section R9-10-408 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-409. Transport; Transfer

A. Except for a transport of a resident due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transport and the services provided to the resident;

2. According to policies and procedures:

a. An evaluation of the resident is conducted before and after the transport,

b. Medical records are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transport to the resident or the resident’s representative; and

3. Documentation in the resident’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transport;

c. The mode of transportation; and

d. If applicable, the personnel member accompanying the resident during a transport.

B. Except for a transfer of a resident due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transfer and the services provided to the resident;

2. According to policies and procedures:

a. An evaluation of the resident is conducted before the transfer,

b. Medical records including orders that are in effect at the time of the transfer are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transfer to the resident or the resident’s representative; and

3. Documentation in the resident’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transfer;

c. The mode of transportation; and

d. If applicable, a personnel member accompanying the resident during a transfer.

Historical Note

New Section R9-10-409 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-410. Resident Rights

A. An administrator shall ensure that:

1. The requirements in subsection (B) and the resident rights in subsection (C) are conspicuously posted on the premises;

2. At the time of admission, a resident or the resident’s representative receives a written copy of the requirements in subsection (B) and the resident rights in subsection (C); and

3. Policies and procedures include:

a. How and when a resident or the resident’s representative is informed of resident rights in subsection (C), and

b. Where resident rights are posted as required in subsection (A)(1).

B. An administrator shall ensure that:

1. A resident has privacy in:

a. Treatment,

b. Bathing and toileting,

c. Room accommodations, and

d. A visit or meeting with another resident or an individual;

2. A resident is treated with dignity, respect, and consideration;

3. A resident is not subjected to:

a. Abuse;

b. Neglect;

c. Exploitation;

d. Coercion;

e. Manipulation;

f. Sexual abuse;

g. Sexual assault;

h. Seclusion;

i. Restraint, if not necessary to prevent imminent harm to self or others;

j. Retaliation for submitting a complaint to the Department or another entity; or

k. Misappropriation of personal and private property by a nursing care institution’s personnel members, employees, volunteers, or students; and

4. A resident or the resident’s representative:

a. Except in an emergency, either consents to or refuses treatment;

b. May refuse or withdraw consent to treatment before treatment is initiated;

c. Except in an emergency, is informed of proposed alternatives to psychotropic medication or a surgical procedure and the associated risks and possible complications of the psychotropic medication or surgical procedure;

d. Is informed of the following:

i. The health care institution’s policy on health care directives, and

ii. The resident complaint process;

e. Consents to photographs of the resident before a resident is photographed except that the resident may be photographed when admitted to a nursing care institution for identification and administrative purposes;

f. May manage the resident's financial affairs;

g. May review the nursing care institution's current license survey report and, if applicable, plan of correction in effect;

h. Has access to and may communicate with any individual, organization, or agency;

i. May participate in a resident group;

j. May review the resident's financial records within two working days and medical records within one working day after the resident’s or the resident's representative's request;

k. May obtain a copy of the resident's financial records and medical records within two working days after the resident's request and in compliance with A.R.S. § 12-2295;

l. May select a pharmacy of choice if the pharmacy complies with nursing care institution policies and procedures and does not pose a risk to the resident;

m. Is informed of the method for contacting the resident's attending physician;

n. Is informed of the resident's total health condition;

o. Is provided with a copy of those sections of the resident's medical records that are required for continuity of care free of charge, according to A.R.S. § 12-2295, if the resident is transferred or discharged;

p. Is informed in writing of a change in rates and charges at least 60 calendar days before the effective date of the change; and

q. Except in the event of an emergency, is informed orally or in writing before the nursing care institution makes a change in a resident's room or roommate assignment and notification is documented in the resident's medical records.

C. A resident has the following rights:

1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;

2. To receive treatment that supports and respects the resident’s individuality, choices, strengths, and abilities;

3. To choose activities and schedules consistent with the resident's interests that do not interfere with other residents;

4. To participate in social, religious, political, and community activities that do not interfere with other residents;

5. To retain personal possessions including furnishings and clothing as space permits unless use of the personal possession infringes on the rights or health and safety of other residents;

6. To share a room with the resident's spouse if space is available and the spouse consents;

7. To receive a referral to another health care institution if the nursing care institution is unable to provide physical health services or behavioral health services for the resident;

8. To participate or have the resident’s representative participate in the development of, or decisions concerning, treatment;

9. To participate or refuse to participate in research or experimental treatment; and

10. To receive assistance from a family member, representative, or other individual in understanding, protecting, or exercising the resident’s rights.

Historical Note

New Section R9-10-410 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).

R9-10-411. Medical Records

A. An administrator shall ensure that:

1. A medical record is established and maintained for a resident according to A.R.S. Title 12, Chapter 13, Article 7.1;

2. An entry in a resident’s medical record is:

a. Recorded only by an individual authorized by nursing care institution policies and procedures to make the entry;

b. Dated, legible, and authenticated; and

c. Not changed to make the initial entry illegible;

3. An order is:

a. Dated when the order is entered in the resident’s medical record and includes the time of the order;

b. Authenticated by a medical practitioner or behavioral health professional according to policies and procedures; and

c. If the order is a verbal order, authenticated by the medical practitioner or behavioral health professional issuing the order;

4. If a rubber-stamp signature or an electronic signature code is used to authenticate an order, the individual whose signature the stamp or electronic code represents is accountable for the use of the stamp or the electronic code;

5. A resident’s medical record is available to personnel members, medical practitioners, and behavioral health professionals authorized by nursing care institution policies and procedures;

6. Information in a resident’s medical record is disclosed to an individual not authorized under subsection (A)(5) only with the written consent of the resident or the resident's representative or as permitted by law; and

7. A resident’s medical record is protected from loss, damage, or unauthorized use.

B. If a nursing care institution keeps a resident’s medical records electronically, an administrator shall ensure that:

1. Safeguards exist to prevent unauthorized access, and

2. The date and time of an entry in a resident’s medical record is recorded by the computer's internal clock.

C. An administrator shall ensure that a resident’s medical record contains:

1. Resident information that includes:

a. The resident's name;

b. The resident's date of birth;

c. The name and contact information of the resident’s representative, if applicable; and

d. Any known allergy including medication allergies;

2. The admission date;

3. The admitting diagnosis or presenting symptoms;

4. Documentation of general consent and, if applicable, informed consent;

5. The medical history and physical examination required in R9-10-407(5);

6. A copy of the resident's living will, health care power of attorney, or other health care directive, if applicable;

7. The name and telephone number of the resident's attending physician;

8. Orders;

9. Care plans;

10. Behavioral care plans, if the resident is receiving behavioral care;

11. Documentation of nursing care institution services provided to the resident;

12. Progress notes;

13. The disposition of the resident after discharge;

14. The discharge plan;

15. The discharge summary;

16. Transfer documentation;

17. If applicable:

a. A laboratory report,

b. A radiologic report,

c. A diagnostic report,

d. Documentation of restraint or seclusion, and

e. A consultation report;

18. Documentation of freedom from infectious tuberculosis required in R9-10-407(7);

19. Documentation of a medication administered to the resident that includes:

a. The date and time of administration;

b. The name, strength, dosage, and route of administration;

c. The type of vaccine, if applicable;

d. For a medication administered for pain on a PRN basis:

i. An evaluation of the resident’s pain before administering the medication, and

ii. The effect of the medication administered;

e. For a psychotropic medication administered on a PRN basis:

i. An evaluation of the resident’s behavior before administering the psychotropic medication, and

ii. The effect of the psychotropic medication administered;

f. The identification, signature, and professional designation of the individual administering or observing the self-administration of the medication; and

g. Any adverse reaction a resident has to the medication;

20. If the resident has been assessed for receiving nutrition and feeding assistance, documentation of the assessment and the determination of eligibility; and

21. If applicable, a copy of written notices, including follow-up instructions, provided to the resident or the resident’s representative.

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 R9-10-411 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).

R9-10-412. Nursing Services

A. An administrator shall ensure that:

1. Nursing services are provided 24 hours a day in a nursing care institution;

2. A director of nursing is appointed who:

a. Is a registered nurse,

b. Works full-time at the nursing care institution, and

c. Is responsible for the direction of nursing services;

3. The director of nursing or an individual designated by the administrator participates in the quality management program; and

4. If the daily census of the nursing care institution is less than 60, the director of nursing may provide direct care to residents on a regular basis.

B. A director of nursing shall ensure that:

1. A method is established and documented that identifies the types and numbers of nursing personnel that are necessary to provide nursing services to residents based on the residents’ comprehensive assessments, orders for physical health services and behavioral health services, and care plans and the nursing care institution’s scope of services;

2. Sufficient nursing personnel, as determined by the method in subsection (B)(1), are on the nursing care institution premises to meet the needs of a resident for nursing services;

3. At least one nurse is present and responsible for providing direct care to not more than 64 residents;

4. Documentation of nursing personnel on duty each day is maintained and includes:

a. The date,

b. The number of residents,

c. The name and license or certification title of each nursing personnel member who worked that day, and

d. The actual number of hours each nursing personnel member worked that day;

5. The documentation of nursing personnel required in subsection (B)(4) is maintained for at least 12 months after the date of the documentation;

6. As soon as possible but not more than 24 hours after one of the following events occur, a nurse notifies a resident's attending physician and, if applicable, the resident's representative, if the resident:

a. Is injured,

b. Is involved in an incident that may require medical services, or

c. Has a significant change in condition; and

7. An unnecessary drug is not administered to a resident.

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 R9-10-412 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).

R9-10-413. Medical Services

A. An administrator shall appoint a medical director.

B. A medical director shall ensure that:

1. A resident has an attending physician;

2. An attending physician is available 24 hours a day;

3. An attending physician designates a physician who is available when the attending physician is not available;

4. A physical examination is performed on a resident at least once every 12 months after the date of admission by an individual listed in R9-10-407(5);

5. As required in A.R.S. § 36-406, vaccinations for influenza and pneumonia are available to each resident at least once every 12 months unless:

a. The attending physician provides documentation that the vaccination is medically contraindicated;

b. The resident or the resident's representative refuses the vaccination or vaccinations and documentation is maintained in the resident's medical records that the resident or the resident's representative has been informed of the risks and benefits of a vaccination refused; or

c. The resident or the resident's representative provides documentation that the resident received a pneumonia vaccination within the last five years or the current recommendation from the U.S. Department of Health and Human Services, Center for Disease Control and Prevention; and

6. If the any of the following services are not provided by the nursing care institution and needed by a resident, the resident is assisted in obtaining, at the resident's expense:

a. Vision services;

b. Hearing services;

c. Dental services;

d. Clinical laboratory services from a laboratory that holds a certificate of accreditation or certificate of compliance issued by the United States Department of Health and Human Services under the 1988 amendments to the Clinical Laboratories Improvement Act of 1967;

e. Psychosocial services;

f. Physical therapy;

g. Speech therapy;

h. Occupational therapy;

i. Behavioral health services; and

j. Services for an individual who has a developmental disability, as defined in A.R.S. Title 36, Chapter 5.1, Article 1.

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 R9-10-413 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-414. Comprehensive Assessment; Care Plan

A. A director of nursing shall ensure that:

1. A comprehensive assessment of a resident:

a. Is conducted or coordinated by a registered nurse in collaboration with an interdisciplinary team;

b. Is completed for the resident within 14 calendar days after the resident’s admission to a nursing care institution;

c. Is updated:

i. No later than 12 months after the date of the resident’s last comprehensive assessment, and

ii. When the resident experiences a significant change;

d. Includes the following information for the resident:

i. Identifying information;

ii. An evaluation of the resident’s hearing, speech, and vision;

iii. An evaluation of the resident’s ability to understand and recall information;

iv. An evaluation of the resident’s mental status;

v. Whether the resident’s mental status or behaviors:

(1) Put the resident at risk for physical illness or injury,

(2) Significantly interfere with the resident’s care,

(3) Significantly interfere with the resident’s ability to participate in activities or social interactions,

(4) Put other residents or personnel members at significant risk for physical injury,

(5) Intrude on another resident’s privacy, or

(6) Significantly disrupt care for another resident;

vi. Preferences for customary routine and activities;

vii. An evaluation of the resident’s ability to perform activities of daily living;

viii. Need for a mobility device;

ix. An evaluation of the resident’s ability to control the resident’s bladder and bowels;

x. Any diagnosis that impacts nursing care institution services that the resident may require;

xi. Any medical conditions that impact the resident’s functional status, quality of life, or need for nursing care institution services;

xii. An evaluation of the resident’s ability to maintain adequate nutrition and hydration;

xiii. An evaluation of the resident’s oral and dental status;

xiv. An evaluation of the condition of the resident’s skin;

xv. Identification of any medication or treatment administered to the resident during a seven-day calendar period that includes the time the comprehensive assessment was conducted;

xvi. Identification of any treatment or medication ordered for the resident;

xvii. Whether any restraints have been used for the resident during a seven-day calendar period that includes the time the comprehensive assessment was conducted;

xviii. A description of the resident or resident’s representative’s participation in the comprehensive assessment;

xix. The name and title of the interdisciplinary team members who participated in the resident’s comprehensive assessment;

xx. Potential for rehabilitation; and

xxi. Potential for discharge; and

e. Is signed and dated by:

i. The registered nurse who conducts or coordinates the comprehensive assessment or review; and

ii. If a behavioral health professional is required to review according to subsection (A)(2), the behavioral health professional who reviewed the comprehensive assessment or review;

2. If any of the conditions in (A)(1)(d)(v) are answered in the affirmative during the comprehensive assessment or review, a behavioral health professional reviews a resident’s comprehensive assessment or review and care plan to ensure that the resident’s needs for behavioral health services are being met;

3. A new comprehensive assessment is not required for a resident who is hospitalized and readmitted to a nursing care institution unless a physician, an individual designated by the physician, or a registered nurse determines the resident has a significant change in condition; and

4. A resident's comprehensive assessment is reviewed by a registered nurse at least once every three months after the date of the current comprehensive assessment and if there is a significant change in the resident's condition.

B. An administrator shall ensure that a care plan for a resident:

1. Is developed, documented, and implemented for the resident within seven calendar days after completing the resident’s comprehensive assessment required in subsection (A)(1);

2. Is reviewed and revised based on any change to the resident’s comprehensive assessment; and

3. Ensures that a resident is provided nursing care institution services that:

a. Address any medical condition or behavioral health issue identified in the resident’s comprehensive assessment, and

b. Assist the resident in maintaining the resident's highest practicable well-being according to the resident's comprehensive assessment.

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 R9-10-414 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 3334, effective October 1, 2013 (Supp. 13-4).

R9-10-415. Behavioral Health Services

Except for behavioral care, if a nursing care institution provides behavioral health services, an administrator shall ensure that:

1. The behavioral health services are provided:

a. Under the direction of a behavioral health professional; and

b. In compliance with the requirements:

i. For behavioral health paraprofessionals and behavioral health technicians, in R9-10-114; and

ii. For an assessment, in R9-10-1011(B);

2. Except for a psychotropic drug used as a chemical restraint or administered according to an order from a court of competent jurisdiction, informed consent is obtained from a resident or the resident's representative for a psychotropic drug and documented in the resident’s medical record before the psychotropic drug is administered to the resident; and

3. If the nursing care institution provides assistance in the self-administration of medication to a resident receiving behavioral health services:

a. The resident’s interdisciplinary team determines that the resident is capable of self-administration and the attending physician documents authorization for medication self-administration in the resident's medical records;

b. A resident’s medication is stored by the nursing care institution;

c. The following assistance is provided to a resident:

i. Reminding the resident when it is time to take the medication;

ii. Opening the medication container for the resident;

iii. Observing the resident while the resident removes the medication from the container;

iv. Verifying that the medication is taken as ordered by the resident’s medical practitioner by confirming that:

(1) The resident taking the medication is the individual stated on the medication container label,

(2) The dosage of the medication is the same as stated on the medication container label, and

(3) The medication is being taken by the resident at the time stated on the medication container label; or

v. Observing the resident while the resident takes the medication;

d. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by a medical practitioner or a registered nurse;

e. Training for a personnel member, other than a medical practitioner, nurse, or medication assistant, in the self-administration of medication:

i. Is provided by a medical practitioner or nurse or an individual trained by a medical practitioner or nurse; and

ii. Includes:

(1) A demonstration of the personnel member’s skills and knowledge necessary to provide assistance in the self-administration of medication,

(2) Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

(3) The process for notifying the appropriate entities when an emergency medical intervention is needed;

f. A personnel member, other than a medical practitioner, nurse, or medication assistant, completes the training in subsection (3)(e) before the personnel member provides assistance in the self-administration of medication; and

g. Assistance in the self-administration of medication provided to a resident:

i. Is in compliance with an order, and

ii. Is documented in the resident’s medical record.

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 R9-10-415 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).

R9-10-416. Clinical Laboratory Services

If clinical laboratory services are provided on the premises of a nursing care institution, an administrator shall ensure that:

1. Clinical laboratory services and pathology services are provided through a laboratory that holds a certificate of accreditation, certificate of compliance, or certificate of waiver issued by the United States Department of Health and Human Services under the 1988 amendments to the Clinical Laboratories Improvement Act of 1967;

2. A copy of the certificate of accreditation, certificate of compliance, or certificate of waiver in subsection (1) is provided to the Department for review upon the Department's request;

3. The nursing care institution:

a. Is able to provide the clinical laboratory services delineated in the nursing care institution’s scope of services when needed by the residents,

b. Obtains specimens for the clinical laboratory services delineated in the nursing care institution’s scope of services without transporting the residents from the nursing care institution’s premises, and

c. Has the examination of the specimens performed by a clinical laboratory;

4. Clinical laboratory and pathology test results are:

a. Available to the ordering physician:

i. Within 24 hours after the test is complete with results if the test is performed at a laboratory on the nursing care institution’s premises, or

ii. Within 24 hours after the test result is received if the test is performed at a laboratory outside of the nursing care institution’s premises; and

b. Documented in a resident's medical record;

5. If a test result is obtained that indicates a resident may have an emergency medical condition, as defined in the nursing care institution’s policies and procedures, personnel notify:

a. The ordering physician,

b. A registered nurse in the resident's assigned unit,

c. The nursing care institution’s administrator, or

d. The director of nursing;

6. If a clinical laboratory report is completed on a resident, a copy of the report is included in the resident's medical record;

7. If the nursing care institution provides blood or blood products, policies and procedures are established, documented, and implemented for:

a. Procuring, storing, transfusing, and disposing of blood or blood products;

b. Blood typing, antibody detection, and blood compatibility testing; and

c. Investigating transfusion adverse reactions that specify a process for review through the quality management program; and

8. Expired laboratory supplies are discarded according to policies and procedures.

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 R9-10-416 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).

R9-10-417. Dialysis Services

If dialysis services are provided on the premises of the nursing care institution, an administrator shall ensure that the dialysis services are provided in compliance with the requirements in R9-10-1018.

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 R9-10-417 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-418. Radiology Services and Diagnostic Imaging Services

If radiology services or diagnostic imaging services are provided on the premises of a nursing care institution, an administrator shall ensure that:

1. Radiology services and diagnostic imaging services are provided in compliance with A.R.S. Title 30, Chapter 4 and 12 A.A.C. 1;

2. A copy of a certificate documenting compliance with subsection (1) is maintained by the nursing care institution;

3. When needed by a resident, radiology services and diagnostic imaging services delineated in the nursing care institution’s scope of services are provided on the nursing care institution's premises;

4. Radiology services and diagnostic imaging services are provided:

a. Under the direction of a physician; and

b. According to an order that includes:

i. The resident's name,

ii. The name of the ordering individual,

iii. The radiological or diagnostic imaging procedure ordered, and

iv. The reason for the procedure;

5. A medical director, attending physician, or radiologist interprets the radiologic or diagnostic image;

6. A radiologic or diagnostic imaging report is prepared that includes:

a. The resident's name;

b. The date of the procedure;

c. A medical director, attending physician, or radiologist's interpretation of the image;

d. The type and amount of radiopharmaceutical used, if applicable; and

e. The resident’s adverse reaction to the radiopharmaceutical, if any; and

7. A radiologic or diagnostic imaging report is included in the resident's medical record.

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 R9-10-418 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).

R9-10-419. Respiratory Care Services

If respiratory care services are provided on the premises of a nursing care institution, an administrator shall ensure that:

1. Respiratory care services are provided under the direction of a medical director or attending physician;

2. Respiratory care services are provided according to an order that includes:

a. The resident's name;

b. The name and signature of the ordering individual;

c. The type, frequency, and, if applicable, duration of treatment;

d. The type and dosage of medication and diluent; and

e. The oxygen concentration or oxygen liter flow and method of administration;

3. Respiratory care services provided to a resident are documented in the resident's medical record and include:

a. The date and time of administration;

b. The type of respiratory care services provided;

c. The effect of the respiratory care services;

d. The resident’s adverse reaction to the respiratory care services, if any; and

e. The authentication of the individual providing the respiratory care services; and

4. Any area or unit that performs blood gases or clinical laboratory tests complies with the requirements in R9-10-416.

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 R9-10-419 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).

R9-10-420. Rehabilitation Services

If rehabilitation services are provided on the premises of a nursing care institution, an administrator shall ensure that:

1. Rehabilitation services are provided:

a. Under the direction of an individual qualified according to policies and procedures,

b. By an individual licensed to provide the rehabilitation services, and

c. According to an order; and

2. The medical record of a resident receiving rehabilitation services includes:

a. An order for rehabilitation services that includes the name of the ordering individual and a referring diagnosis,

b. A documented care plan that is developed in coordination with the ordering individual and the individual providing the rehabilitation services,

c. The rehabilitation services provided,

d. The resident's response to the rehabilitation services, and

e. The authentication of the individual providing the rehabilitation services.

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 R9-10-420 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-421. Medication Services

A. If a nursing care institution provides medication administration, an administrator shall ensure that policies and procedures:

1. Include:

a. A process for providing information to a resident about medication prescribed for the resident including:

i. The prescribed medication’s anticipated results,

ii. The prescribed medication’s potential adverse reactions,

iii. The prescribed medication’s potential side effects, and

iv. Potential adverse reactions that could result from not taking the medication as prescribed;

b. Procedures for preventing, responding to, and reporting:

i. A medication error,

ii. An adverse response to a medication, or

iii. A medication overdose;

c. Procedures to ensure that a pharmacist reviews a resident's medications at least every three months and provides documentation to the resident's attending physician and the director of nursing indicating potential medication problems such as incompatible or duplicative medications;

d. Procedures for documenting medication services and assistance in the self-administration of medication; and

e. Procedures for assisting a resident in obtaining medication; and

2. Specify a process for review through the quality management program of:

a. A medication administration error, and

b. An adverse reaction to a medication.

B. If a nursing care institution provides medication administration, an administrator shall ensure that:

1. Policies and procedures for medication administration:

a. Are reviewed and approved by the director of nursing;

b. Specify the individuals who may:

i. Order medication, and

ii. Administer medication;

c. Ensure that medication is administered to a resident only as prescribed; and

d. Cover the documentation of a resident’s refusal to take prescribed medication in the resident’s medical record;

2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law;

3. A medication administered to a resident:

a. Is administered in compliance with an order, and

b. Is documented in the resident’s medical record; and

4. If a psychotropic medication is administered to a resident, the psychotropic medication:

a. Is only administered to a resident for a diagnosed medical condition; and

b. Unless clinically contraindicated or otherwise ordered by an attending physician or the attending physician's designee, is gradually reduced in dosage while the resident is simultaneously provided with interventions such as behavior and environment modification in an effort to discontinue the psychotropic medication unless a dose reduction is attempted and the resident displays behavior justifying the need for the psychotropic medication, and the attending physician documents the necessity for the continued use and dosage.

C. An administrator shall ensure that:

1. A current drug reference guide is available for use by personnel members; and

2. If pharmaceutical services are provided:

a. The pharmaceutical services are provided under the direction of a pharmacist;

b. The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

c. A copy of the pharmacy license is provided to the Department upon request.

D. When medication is stored at a nursing care institution, an administrator shall ensure that:

1. There is a separate room, closet, or self-contained unit used for medication storage that includes a lockable door;

2. If medication is stored in a room or closet, a locked cabinet is used for medication storage;

3. Medication is stored according to the instructions on the medication container; and

4. Policies and procedures are established, documented, and implemented for:

a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication;

b. Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

c. A medication recall and notification of residents who received recalled medication; and

d. Storing, inventorying, and dispensing controlled substances.

E. An administrator shall ensure that a personnel member immediately reports a medication error or a resident’s adverse reaction to a medication to the medical practitioner who ordered the medication and the nursing care institution’s director of nursing.

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 R9-10-421 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).

R9-10-422. Infection Control

A. An administrator shall ensure that:

1. An infection control program is established, under the direction of an individual qualified according to policies and procedures, to prevent the development and transmission of infections and communicable diseases including:

a. A method to identify and document infections occurring at the nursing care institution;

b. Analysis of the types, causes, and spread of infections and communicable diseases at the nursing care institution;

c. The development of corrective measures to minimize or prevent the spread of infections and communicable diseases at the nursing care institution; and

d. Documentation of infection control activities including:

i. The collection and analysis of infection control data,

ii. The actions taken related to infections and communicable diseases, and

iii. Reports of communicable diseases to the governing authority and state and county health departments;

2. Infection control documentation is maintained for at least two years after the date of the documentation;

3. Policies and procedures are established, documented, and implemented that cover:

a. Compliance with the requirements in 9 A.A.C. 6 for reporting and control measures for communicable diseases and infestations;

b. Handling and disposal of biohazardous medical waste;

c. Sterilization, disinfection, and storage of medical equipment and supplies;

d. Use of personal protective equipment such as aprons, gloves, gowns, masks, or face protection when applicable;

e. Cleaning of an individual's hands when the individual's hands are visibly soiled and before and after providing a service to a resident;

f. Training of personnel members, employees, and volunteers in infection control practices; and

g. Work restrictions for a personnel member with a communicable disease or infected skin lesion;

4. Biohazardous medical waste is identified, stored, and disposed of according to 18 A.A.C. 13, Article 14 and policies and procedures;

5. Soiled linen and clothing are:

a. Collected in a manner to minimize or prevent contamination;

b. Bagged at the site of use; and

c. Maintained separate from clean linen and clothing and away from food storage, kitchen, or dining areas; and

6. A personnel member, an employee, or a volunteer washes hands or use a hand disinfection product after a resident contact and after handling soiled linen, soiled clothing, or potentially infectious material.

B. An administrator shall comply with contagious disease reporting requirements in A.R.S. § 36-621 and communicable disease reporting requirements in 9 A.A.C. 6, Article 2.

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 R9-10-422 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-423. Food Services

A. An administrator shall ensure that:

1. The nursing care institution is licensed as a food establishment under 9 A.A.C. 8, Article 1;

2. A copy of the nursing care institution’s food establishment license is maintained;

3. If a nursing care institution contracts with a food establishment, as defined in 9 A.A.C. 8, Article 1, to prepare and deliver food to the nursing care institution:

a. A copy of the contracted food establishment's license under 9 A.A.C. 8, Article 1 is maintained by the nursing care institution; and

b. The nursing care institution is able to store, refrigerate, and reheat food to meet the dietary needs of a resident;

4. A registered dietitian:

a. Reviews a food menu before the food menu is used to ensure that a resident’s nutritional needs are being met,

b. Documents the review of a food menu, and

c. Is available for consultation regarding a resident’s nutritional needs; and

5. If a registered dietitian is not employed full-time, an individual is designated as a director of food services who consults with a registered dietitian as often as necessary to ensure that the nutritional needs of a resident are met.

B. A registered dietitian or director of food services shall ensure that:

1. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a resident such as cut, chopped, ground, pureed, or thickened;

2. A food menu:

a. Is prepared at least one week in advance,

b. Includes the foods to be served on each day,

c. Is conspicuously posted at least one day before the first meal on the food menu will be served,

d. Includes any food substitution no later than the morning of the day of meal service with a food substitution, and

e. Is maintained for at least 60 calendar days after the last day included in the food menu;

3. Meals for each day are planned and served using the applicable meal planning guides in http://www.fns.usda.gov/cnd/Care/ProgramBasics/Meals/Meal_Pattern.htm;

4. A resident is provided:

a. A diet that meets the resident's nutritional needs as specified in the resident's comprehensive assessment and care plan;

b. Three meals a day with not more than 14 hours between the evening meal and breakfast except as provided in subsection (B)(4)(d);

c. The option to have a daily evening snack identified in subsection (B)(4)(d)(ii) or other snack; and

d. The option to extend the time span between the evening meal and breakfast from 14 hours to 16 hours if:

i. A resident group agrees; and

ii. The resident is offered an evening snack that includes meat, fish, eggs, cheese, or other protein, and a serving from either the fruit and vegetable food group or the bread and cereal food group;

5. A resident is provided with food substitutions of similar nutritional value if:

a. The resident refuses to eat the food served, or

b. The resident requests a substitution;

6. Recommendations and preferences are requested from a resident or the resident's representative for meal planning;

7. A resident requiring assistance to eat is provided with assistance that recognizes the resident's nutritional, physical, and social needs, including the use of adaptive eating equipment or utensils;

8. Tableware, utensils, equipment, and food-contact surfaces are clean and in good repair;

9. A resident eats meals in a dining area unless the resident chooses to eat in the resident's room or is confined to the resident's room for medical reasons documented in the resident’s medical records; and

10. Water is available and accessible to residents.

C. If a nursing care institution has nutrition and feeding assistants, an administrator shall ensure that:

1. A nutrition and feeding assistant:

a. Is at least 16 years of age;

b. If applicable, complies with the fingerprint clearance card requirements in A.R.S. § 36-411;

c. Completes a nutrition and feeding assistant training course within 12 months before initially providing nutrition and feeding assistance;

d. Provides nutrition and feeding assistance where nursing personnel are present;

e. Immediately reports an emergency to a nurse or, if a nurse is not present in the common area, to nursing personnel; and

f. If the nutrition and feeding assistant observes a change in a resident’s physical condition or behavior, reports the change to a nurse or, if a nurse is not present in the common area, to nursing personnel;

2. A resident is not eligible to receive nutrition and feeding assistance from a nutrition and feeding assistant if the resident:

a. Has difficulty swallowing,

b. Has had recurrent lung aspirations,

c. Requires enteral feedings,

d. Requires parenteral feedings, or

e. Has any other eating or drinking difficulty that may cause the resident’s health or safety to be compromised if the resident receives nutrition and feeding assistance from a nutrition and feeding assistant;

3. Only an eligible resident receives nutrition and feeding assistance from a nutrition and feeding assistant;

4. A nurse determines if a resident is eligible to receive nutrition and feeding assistance from a nutrition and feeding assistant, based on:

a. The resident’s comprehensive assessment,

b. The resident’s care plan, and

c. An assessment conducted by the nurse when making the determination;

5. A method is implemented that identifies eligible residents that ensures only eligible residents receive nutrition and feeding assistance from a nutrition and feeding assistant;

6. When a nutrition and feeding assistant initially provides nutrition and feeding assistance and at least once every three months, a nurse observes the nutrition and feeding assistant while the nutrition and feeding assistant is providing nutrition and feeding assistance to ensure that the nutrition and feeding assistant is providing nutrition and feeding assistance appropriately;

7. A nurse documents the nurse’s observations required in subsection (C)(6); and

8. A nutrition and feeding assistant is provided additional training:

a. According to policies and procedures, and

b. If a nurse identifies a need for additional training based on the nurse’s observation in subsection (C)(6).

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 R9-10-423 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).

R9-10-424. Emergency and Safety Standards

A. An administrator shall ensure that:

1. A disaster plan is developed, documented, maintained in a location accessible to personnel members and other employees, and, if necessary, implemented that includes:

a. When, how, and where residents will be relocated, including:

i. Instructions for the evacuation, transport, or transfer of residents;

ii. Assigned responsibilities for each employee and personnel member; and

iii. A plan for continuing to provide services to meet a resident’s needs;

b. How a resident's medical record will be available to individuals providing services to the resident during a disaster;

c. A plan for back-up power and water supply;

d. A plan to ensure a resident's medications will be available to administer to the resident during a disaster;

e. A plan to ensure a resident is provided nursing services and other services required by the resident during a disaster; and

f. A plan for obtaining food and water for individuals present in the nursing care institution or the nursing care institution's relocation site during a disaster;

2. The disaster plan required in subsection (A)(1) is reviewed at least once every 12 months;

3. Documentation of a disaster plan review required in subsection (A)(2) is created, is maintained for at least 12 months after the date of the disaster plan review, and includes:

a. The date and time of the disaster plan review;

b. The name of each personnel member, employee, or volunteer participating in the disaster plan review;

c. A critique of the disaster plan review; and

d. If applicable, recommendations for improvement;

4. A fire drill for employees is conducted on each shift at least once every three months;

5. A disaster drill for employees and residents is conducted at least once every six months ;

6. Documentation of each drill is created, is maintained for at least 12 months after the date of the drill, and includes:

a. The date and time of the drill;

b. Whether the drill was for employees only or for both employees and residents;

c. If applicable:

i. The amount of time taken for employees and residents to evacuate,

ii. An identification of residents needing assistance for evacuation, and

iii. An identification of residents who were not evacuated;

d. Any problems encountered in conducting the drill; and

e. Recommendations for improvement, if applicable; and

7. An evacuation path is conspicuously posted on each hallway of each floor of the nursing care institution.

B. An administrator shall ensure that, if applicable, a sign is placed at the entrance to a room or area indicating that oxygen is in use.

C. An administrator shall:

1. Obtain a fire inspection conducted according to the time-frame established by the local fire department or the State Fire Marshal,

2. Make any repairs or corrections stated on the fire inspection report, and

3. Maintain documentation of a current fire inspection.

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 R9-10-424 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).

R9-10-425. Environmental Standards

A. An administrator shall ensure that:

1. A nursing care institution's premises and equipment are:

a. Cleaned and disinfected according to policies and procedures or manufacturer's instructions to prevent, minimize, and control illness and infection; and

b. Free from a condition or situation that may cause a resident or an individual to suffer physical injury;

2. A pest control program is implemented and documented;

3. Equipment used to provide direct care is:

a. Maintained in working order;

b. Tested and calibrated according to the manufacturer's recommendations or, if there are no manufacturer's recommendations, as specified in policies and procedures; and

c. Used according to the manufacturer's recommendations;

4. Documentation of equipment testing, calibration, and repair is maintained for at least 12 months after the date of the testing, calibration, or repair;

5. Garbage and refuse are:

a. In areas used for food storage, food preparation, or food service, stored in a covered container lined with a plastic bag;

b. In areas not used for food storage, food preparation, or food service, stored:

i. According to the requirements in subsection (5)(a), or

ii. In a paper-lined or plastic-lined container that is cleaned and sanitized as often as necessary to ensure that the container is clean; and

c. Removed from the premises at least once a week;

6. Heating and cooling systems maintain the nursing care institution at a temperature between 70° F and 84° F ;

7. Common areas:

a. Are lighted to assure the safety of residents, and

b. Have lighting sufficient to allow personnel members to monitor resident activity;

8. The supply of hot and cold water is sufficient to meet the personal hygiene needs of residents and the cleaning and sanitation requirements in this Article;

9. Linens are clean before use, without holes and stains, and not in need of repair;

10. Oxygen containers are secured in an upright position;

11. Poisonous or toxic materials stored by the nursing care institution are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and inaccessible to residents;

12. Combustible or flammable liquids stored by the nursing care institution are stored in the original labeled containers or safety containers in a locked area outside the nursing care institution and inaccessible to residents;

13. If pets or animals are allowed in the nursing care institution, pets or animals are:

a. Controlled to prevent endangering the residents and to maintain sanitation;

b. Licensed consistent with local ordinances; and

c. Vaccinated as follows:

i. A dog is vaccinated against rabies ; and

ii. A cat is vaccinated against rabies;

14. If a water source that is not regulated under 18 A.A.C. 4 by the Arizona Department of Environmental Quality is used:

a. The water source is tested at least once every 12 months for total coliform bacteria and fecal coliform or E. coli bacteria;

b. If necessary, corrective action is taken to ensure the water is safe to drink; and

c. Documentation of testing is retained for at least 12 months after the date of the test; and

15. If a non-municipal sewage system is used, the sewage system is in working order and is maintained according to all applicable state laws and rules.

B. An administrator shall ensure that:

1. Smoking or the use of tobacco products is not permitted within a nursing care institution, and

2. Smoking and the use of tobacco products may be permitted outside a nursing care institution if:

a. Signs designating smoking areas are conspicuously posted, and

b. Smoking is prohibited in areas where combustible materials are stored or in use.

C. If a swimming pool is located on the premises, an administrator shall ensure that:

1. At least one personnel member with cardiopulmonary resuscitation training that meets the requirements in R9-10-403(C)(1)(d) is present in the pool area when a resident is in the pool area, and

2. At least two personnel members are present in the pool area when two or more residents are in the pool area.

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 R9-10-425 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).

R9-10-426. Physical Plant Standards

A. An administrator shall ensure that:

1. A nursing care institution complies with:

a. The applicable physical plant health and safety codes and standards, incorporated by reference in A.A.C. R9-1-412, in effect on the date the nursing care institution submitted architectural plans and specifications to the Department for approval; and

b. The requirements for Existing Health Care Occupancies in National Fire Protection Association 101, Life Safety Code, incorporated by reference in A.A.C. R9-1-412;

2. The premises and equipment are sufficient to accommodate:

a. The services stated in the nursing care institution’s scope of services; and

b. An individual accepted as a resident by the nursing care institution;

3. A nursing care institution is ventilated by windows or mechanical ventilation, or a combination of both;

4. The corridors are equipped with handrails on each side that are firmly attached to the walls and are not in need of repair;

5. No more than two individuals reside in a resident room unless:

a. The nursing care institution was operating before October 31, 1982, and

b. The resident room has not undergone a modification as defined in 9 A.A.C. 10, Article 1;

6. A resident has a separate bed, a nurse call system, and furniture to meet the resident's needs in a resident room or suite of rooms;

7. A resident room has:

a. A window to the outside with window coverings for controlling light and visual privacy, and the location of the window permits a resident to see outside from a sitting position;

b. A closet with clothing racks and shelves accessible to the resident; and

c. If the resident room contains more than one bed, a curtain or similar type of separation between the beds for privacy; and

8. A resident room or a suite of rooms:

a. Is accessible without passing through another resident's room; and

b. Does not open into any area where food is prepared, served, or stored.

B. If a swimming pool is located on the premises, an administrator shall ensure that:

1. The swimming pool is enclosed by a wall or fence that:

a. Is at least five feet in height as measured on the exterior of the wall or fence;

b. Has no vertical openings greater that four inches across;

c. Has no horizontal openings, except as described in subsection (B)(1)(e);

d. Is not chain-link;

e. Does not have a space between the ground and the bottom fence rail that exceeds four inches in height; and

f. Has a self-closing, self-latching gate that:

i. Opens away from the swimming pool,

ii. Has a latch located at least five feet from the ground, and

iii. Is locked when the swimming pool is not in use; and

2. A life preserver or shepherd’s crook is available and accessible in the pool area.

C. An administrator shall ensure that a spa that is not enclosed by a wall or fence as described in subsection (B)(1) is covered and locked when not in use.

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 R9-10-426 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

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 nursing care institution achieves a score of 90 to 100 points;

2. A quality rating of “B” is issued if the nursing care institution achieves a score of 80 to 89 points;

3. A quality rating of “C” is issued if the nursing care institution achieves a score of 70 to 79 points; and

4. A quality rating of “D” is issued if the nursing care institution 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 implementing 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 resident'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 implementing 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 concerning, treatment including the right to refuse treatment and to formulate a health care directive.

3. Administration:

a. 10 points: The nursing care institution has no repeat deficiencies that resulted in actual harm or immediate jeopardy to residents that were cited during the last survey or other survey or complaint investigation conducted between the last survey and the current survey.

b. 5 points: The nursing care institution is implementing a system to prevent abuse of a resident and misappropriation of resident property, investigate each allegation of abuse of a resident and misappropriation of resident's property, and report each allegation of abuse of a resident and misappropriation of resident's property to the Department and as required by A.R.S. § 46-454.

c. 5 points: The nursing care institution is implementing a quality management program that addresses nursing care institution services provided to residents, resident complaints, and resident concerns, and documents actions taken for response, resolution, or correction of issues about nursing care institution services provided to residents, resident complaints, and resident concerns.

d. 1 point: The nursing care institution is implementing a system to provide social services and 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 implementing a system to ensure that records documenting freedom from infectious pulmonary tuberculosis are maintained for each personnel member, volunteer, and resident.

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

g. 1 point: The nursing care institution is implementing a system to ensure a personnel member 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 written disaster plan that includes procedures for protecting the health and safety of residents.

d. 1 point: The nursing care institution ensures orientation 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 implementing a system to prevent and control infection.

g. 1 point: An employee washes hands after each direct resident contact or where hand washing is indicated to prevent the spread of infection.

5. Food Services:

a. 1 point: The nursing care institution complies with 9 A.A.C. 8, Article 1, for food preparation, storage, and handling as evidenced by a current food establishment license.

b. 3 points: The nursing care institution provides each resident with food that meets the resident's needs as specified in the resident's comprehensive assessment and care plan.

c. 2 points: The nursing care institution obtains input from each resident or the resident's representative and implements recommendations for meal planning and food choices consistent with the resident's dietary needs.

d. 2 points: The nursing care institution provides assistance to a resident who needs help in eating so that the resident’s nutritional, physical, and social needs are met.

e. 1 point: The nursing care institution prepares menus at least one week in advance, conspicuously posts each menu, and adheres to each planned menu unless an uncontrollable situation such as food spoilage or non-delivery of a specified food requires substitution.

f. 1 point: The nursing care institution provides food substitution of similar nutritive value for residents who refuse the food served or who request a substitution.

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 compliance 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 Department 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).

R9-10-428. Repealed

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).

R9-10-429. Repealed

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).

R9-10-430. Repealed

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).

R9-10-431. Repealed

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).

R9-10-432. Repealed

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).

R9-10-433. Repealed

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).

R9-10-434. Repealed

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).

R9-10-435. Repealed

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).

R9-10-436. Repealed

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).

R9-10-437. Repealed

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).

R9-10-438. Repealed

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).

R9-10-439. Repealed

Historical Note

Adopted effective January 28, 1980 (Supp. 80-1). Repealed effective October 30, 1989 (Supp. 89-4).

ARTICLE 5. RECOVERY CARE CENTERS

R9-10-501. Definitions

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definition applies in this Article unless otherwise specified:

“Recovery care services” has the same meaning as in A.R.S. § 36-448.51.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Emergency expired. Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-502. Administration

A. A governing authority shall:

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

2. Establish in writing:

a. A recovery care center’s scope of services, and

b. Qualifications for an administrator;

3. Designate as administrator, in writing, who has the qualifications established in subsection (A)(2)(b);

4. Grant, deny, suspend, or revoke the clinical privileges of a medical staff member according to medical staff bylaws;

5. Adopt a quality management program according to R9-10-503;

6. Review and evaluate the effectiveness of the quality management program at least once every 12 months;

7. Designate an acting administrator, in writing, who has the qualifications established in subsection (A)(2)(b) if the administrator is:

a. Expected not to be present on a recovery care center’s premises for more than 30 calendar days; or

b. Not present on a recovery care center’s premises for more than 30 calendar days; and

8. Except as provided in subsection (A)(7), notify the Department according to § A.R.S. 36-425(I) when there is a change in the administrator and provide the name and qualifications of the new administrator.

B. An administrator:

1. Is directly accountable to the governing authority of a recovery care center for the daily operation of the recovery care center and for services provided by or at the recovery care center;

2. Has the authority and responsibility to manage a recovery care center; and

3. Except as provided in subsection (A)(8), shall designate, in writing, an individual who is on a recovery care center’s premises and is available and accountable for recovery care services when the administrator is not present on the recovery care center premises.

C. An administrator shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

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

b. Cover orientation and recovery care center education for personnel members, employees, volunteers, and students;

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

d. Cover cardiopulmonary resuscitation training required in R9-10-505(5) including:

i. The method and content of cardiopulmonary resuscitation training,

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

iii. The time-frame for renewal of cardiopulmonary resuscitation training, and

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

e. Cover first aid training;

f. Include a method to identify a patient to ensure the patient receives services as ordered;

g. Cover patient rights including assisting a patient who does not speak English or who has a disability to become aware of patient rights;

h. Cover specific steps and deadlines for:

i. A patient to file a complaint, and

ii. The recovery care center to respond to and resolve a patient’s complaint;

i. Cover health care directives;

j. Cover medical records, including electronic medical records;

k. Cover a quality management program, including incident report and supporting documentation;

l. Cover contracted services;

m. Cover tissue and organ procurement and transplant; and

n. Cover when an individual may visit a patient in a recovery care center;

2. Policies and procedures for recovery care services are established, documented, and implemented that:

a. Cover patient screening, admission, transfer, discharge planning, and discharge;

b. Cover the provision of recovery care services;

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

d. Cover dispensing, administering, and disposing of medications;

e. Cover infection control; and

f. Cover environmental services that affect patient care;

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

4. Policies and procedures are available to personnel members, 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 Department request; and

b. When documentation or information is required by this Chapter to be submitted on behalf of a recovery care center, the documentation or information is provided to the unit in the Department that is responsible for licensing and monitoring the recovery care center.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; Section amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-503. Quality Management

An administrator shall ensure that:

1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes:

a. A method to identify, document, and evaluate incidents;

b. A method to collect data to evaluate services provided to patients;

c. A method to evaluate the data collected to identify a concern about the delivery of services related to patient care;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of services related to patient care; and

e. The frequency of submitting a documented report required in subsection (2) to the governing authority;

2. A documented report is submitted to the governing authority that includes:

a. An identification of each concern about the delivery of services related to patient care; and

b. Any change made or action taken as a result of the identification of a concern about the delivery of services related to patient care; and

3. The report required in subsection (2) and the supporting documentation for the report are maintained for 12 months after the date the report is submitted to the governing authority.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-504. Contracted Services

An administrator shall ensure that:

1. Contracted services are provided according to the requirements in this Article, and

2. A documented list of current contracted services is maintained that includes a description of the contracted services provided.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 198, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-505. Personnel

A. An administrator shall ensure that:

1. The qualifications, skills, and knowledge required for each type of personnel member:

a. Are based on:

i. The type of physical health services or behavioral health services expected to be provided by the personnel member according to the established job description, and

ii. The acuity of the patients receiving physical health services or behavioral health services from the personnel member according to the established job description; and

b. Include:

i. The specific skills and knowledge necessary for the personnel member to provide the expected physical health services and behavioral health services listed in the established job description,

ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description, and

iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description;

2. A personnel member’s skills and knowledge are verified and documented:

a. Before the personnel member provides physical health services or behavioral health services, and

b. According to policies and procedures; and

3. Personnel members are present on a recovery care center’s premises with the qualifications, skills, and knowledge necessary to:

a. Provide the services in the recovery care center’s scope of services,

b. Meet the needs of a patient, and

c. Ensure the health and safety of a patient.

B. An administrator shall ensure that an individual who is a baccalaureate social worker, master social worker, associate marriage and family therapist, associate counselor, or associate substance abuse counselor is under direct supervision as defined in 4 A.A.C. 6, Article 1.

C. An administrator shall ensure that a personnel member, or an employee or a volunteer who has direct interaction with a patient, provides evidence of freedom from infectious tuberculosis as specified in R9-10-112.

D. An administrator shall ensure that a personnel record is maintained for each employee, volunteer, and student that contains:

1. The individual’s name, date of birth, home address, and contact telephone number;

2. The individual’s starting date of employment or volunteer service and, if applicable, the ending date; and

3. Documentation of:

a. The individual’s qualifications including skills and knowledge applicable to the employee's job duties;

b. The individual’s education and experience applicable to the employee's job duties;

c. The individual’s completed orientation and in-service education as required by policies and procedures;

d. The individual’s license of certification, if the individual is required to be licensed or certified in this Article or policies and procedures;

e. The individual’s compliance with the requirements in A.R.S. § 36-411;

f. Cardiopulmonary resuscitation training, if required for the individual according to R9-10-502(C)(1)(d);

g. First aid training, if the individual is required to have according to this Article and policies and procedures; and

h. Evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (C).

E. An administrator shall ensure that personnel records are maintained:

1. Throughout the individual's period of providing services in or for the recovery care center, and

2. For at least two years after the last date the individual provided services in or for the recovery care center.

F. An administrator shall ensure that:

1. A plan to provide orientation specific to the duties of a personnel member, employee, volunteer, and student is developed, documented, and implemented;

2. A personnel member completes orientation before providing behavioral health services or physical health services;

3. An individual’s orientation is documented, to include:

a. The individual’s name,

b. The date of the orientation, and

c. The subject or topics covered in the orientation;

4. A director of nursing develops, documents, and implements a plan to provide in-service education specific to the duties of a personnel member;

5. A personnel member’s in-service education is documented, to include:

a. The personnel member's name,

b. The date of the training, and

c. The subject or topics covered in the training; and

6. A work schedule of each personnel member is developed and maintained at the recovery care center for 12 months from the date of the work schedule.

G. An administrator shall ensure that a nursing personnel member:

1. Is 18 years of age or older;

2. Is certified in cardiopulmonary resuscitation within the first month of employment;

3. Maintains current certification in cardiopulmonary resuscitation; and

4. Attends additional orientation that includes patient care and infection control policies and procedures.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-506. Medical Staff

A. A governing authority shall require that:

1. The organized medical staff is directly accountable to the governing authority for the quality of care provided by a medical staff member to a patient in a recovery care center;

2. The medical staff bylaws and medical staff regulations are approved according to the medical staff bylaws and governing authority requirements;

3. A medical staff member complies with medical staff bylaws and medical staff regulations;

4. The medical staff includes at least two physicians who have clinical privileges to admit patients to the recovery care center;

5. A medical staff member is available to direct patient care;

6. Medical staff bylaws or medical staff regulations are established, documented, and implemented for the process of:

a. Conducting peer review according to A.R.S. Title 36, Chapter 4, Article 5;

b. Appointing members to the medical staff, subject to approval by the governing authority;

c. Establishing committees including identifying the purpose and organization of each committee;

d. Appointing one or more medical staff members to a committee;

e. Requiring that each patient has a medical staff member who coordinates the patient’s care;

f. Defining the responsibilities of a medical staff member to provide medical services to the medical staff member's patient;

g. Defining a medical staff member's responsibilities for the transfer of a patient;

h. Specifying requirements for oral, telephone, and electronic orders including which orders require identification of the time of the order;

i. Establishing a time-frame for a medical staff member to complete patient medical records; and

j. Establishing criteria for granting, denying, revoking, and suspending clinical privileges; and

7. The organized medical staff reviews the medical staff bylaws and the medical staff regulations at least once every 36 months and updates the bylaws and regulations as needed.

B. An administrator shall ensure that:

1. A medical staff member provides evidence of freedom from infectious tuberculosis as specified in R9-10-112;

2. A record for each medical staff member is established and maintained that includes:

a. A completed application for clinical privileges,

b. The dates and lengths of appointment and reappointment of clinical privileges,

c. The specific clinical privileges granted to the medical staff member including revision or revocation dates for each clinical privilege, and

d. A verification of current Arizona health care professional active license according to A.R.S. Title 32; and

3. Except for documentation of peer review conducted according to A.R.S. § 36-445, a record under subsection (B)(2) is provided to the Department for review:

a. For a current medical staff member, within 2 hours after the Department’s request, or

b. Within 72 hours after the time of the Department's request if the individual is no longer a current medical staff member.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-507. Admissions

A. An administrator shall ensure that a physician only admits patients to the recovery care center who require recovery care services as defined in A.R.S. § 36-448.51.

B. An administrator shall ensure that the following documents are in a patient's medical record at the time the patient is admitted to the recovery care center:

1. A medical history and physical examination performed or approved by a member of the recovery care center’s medical staff within 30 calendar days before the patient’s admission to the recovery care center,

2. A discharge summary from the referring health care institution or physician,

3. Physician orders, and

4. Documentation concerning health care directives.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-508. Discharge

A. For a patient, an administrator shall ensure that discharge planning:

1. Identifies the specific needs of the patient after discharge, if applicable;

2. Includes the participation of the patient or the patient's representative;

3. Is completed before discharge occurs;

4. Provides the patient or the patient's representative with written information identifying classes or subclasses of health care institutions and the level of care that the health care institutions provide that may meet the patient's assessed and anticipated needs after discharge, if applicable; and

5. Is documented in the patient's medical record.

B. For a patient discharge or a transfer of the patient, an administrator shall ensure that:

1. There is a discharge summary that includes:

a. A description of the patient's medical condition and the medical services provided to the patient, and

b. The signature of the medical practitioner coordinating the patient’s medical services;

2. There is a documented discharge order for the patient by a medical practitioner coordinating the patient’s medical services before discharge unless the patient leaves the recovery care center against a medical staff member's advice;

3. There are documented discharge instructions; and

4. The patient or the patient's representative is provided with a copy of the discharge instructions.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-509. Transfer

Except for a transfer of a patient due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transfer and the services provided to the patient;

2. According to policies and procedures:

a. An evaluation of the patient is conducted before the transfer,

b. Medical records including orders that are in effect at the time of the transfer are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transfer to the patient or the patient’s representative; and

3. Documentation in the patient’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transfer;

c. The mode of transportation; and

d. If applicable, a personnel member accompanying the patient during a transfer.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-510. Patient Rights

A. An administrator shall ensure:

1. The requirements in subsection (B) and the patient rights in subsection (C) are conspicuously posted on the premises;

2. At the time of admission, a patient or the patient's representative receives a written copy of the requirements in subsection (B) and the patient rights in subsection (C); and

3. There are policies and procedures that include:

a. How and when a patient or the patient’s representative is informed of patient rights in subsection (C), and

b. Where patient rights are posted as required in subsection (A)(1).

B. An administrator shall ensure that:

1. A patient is treated with dignity, respect, and consideration;

2. A patient is not subjected to:

a. Abuse;

b. Neglect;

c. Exploitation;

d. Coercion;

e. Manipulation;

f. Sexual abuse;

g. Sexual assault;

h. Seclusion;

i. Restraint, if not necessary to prevent imminent harm to self or others;

j. Retaliation for submitting a complaint to the Department or another entity; or

k. Misappropriation of personal and private property by a recovery care center’s medical staff, personnel members, employees, volunteers, or students; and

3. A patient or the patient's representative:

a. Except in an emergency, either consents to or refuses treatment;

b. May refuse or withdraw consent to treatment before treatment is initiated;

c. Except in an emergency, is informed of proposed treatment alternatives to the treatment, associated risks, and possible complications;

d. Is informed of the following:

i. The recovery care center’s policy on health care directives, and

ii. The patient complaint process;

e. Consents to photographs of the patient before a patient is photographed except that a patient may be photographed when admitted to a recovery care center for identification and administrative purposes; and

f. Except as otherwise permitted by law, provides written consent to the release of the patient’s:

i. Medical records, and

ii. Financial records.

C. A patient has the following rights:

1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;

2. To receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities;

3. To receive privacy in treatment and care for personal needs;

4. Has access to a telephone;

5. Is advised of the recovery care center’s policy regarding health care directives;

6. May associate and communicate privately with individuals of the patient's choice;

7. To review, upon written request, the patient’s own medical record according to A.R.S. §§ 12-2293, 12-2294, and 12-2294.01;

8. To receive a referral to another health care institution if the health care institution is unable to provide physical health services or behavioral health services for the patient;

9. To participate or have the patient's representative participate in the development of, or decisions concerning treatment;

10. To participate or refuse to participate in research or experimental treatment; and

11. To receive assistance from a family member, representative, or other individual in understanding, protecting, or exercising the patient’s rights.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-511. Medical Records

A. An administrator shall ensure that:

1. A patient’s medical record is established and maintained for each patient according to A.R.S. Title 12, Chapter 13, Article 7.1;

2. An entry in a patient’s medical record is:

a. Recorded only by an individual authorized by policies and procedures to make entry;

b. Dated, legible, and authenticated; and

c. Not changed to make the initial entry illegible;

3. An order is:

a. Dated when the order is entered in the patient’s medical record and includes the time of the order;

b. Authenticated by a medical staff according to policies and procedures; and

c. If the order is a verbal order, authenticated by the medical staff issuing the order;

4. If a rubber-stamp signature or an electronic signature code is used to authenticate an order, the individual whose signature the stamp or electronic code represents is accountable for the use of the stamp or the electronic code;

5. A patient’s medical record is available to personnel member and medical staff authorized by policies and procedures;

6. Information in a patient’s medical record is disclosed to an individual not authorized under subsection (A)(5) only with the written consent of a patient or the patient's representative or as permitted by law;

7. Policies and procedures that include the maximum time-frame to retrieve an onsite or off-site patient’s medical record at the request of a medical staff or authorized personnel member; and

8. A patient’s medical record is protected from loss, damage or unauthorized use.

B. If a recovery care center keeps patient’s medical records electronically, an administrator shall ensure that:

1. Safeguards exist to prevent unauthorized access, and

2. The date and time of an entry in a patient’s medical record is recorded by the computer's internal clock.

C. An administrator shall ensure that a recovery care center medical record for a patient contains:

1. Patient information that includes:

a. The patient's name;

b. The patient’s address;

c. The patient's date of birth;

d. The name and contact information of the patient’s representative, if applicable; and

e. Any known allergies;

2. The admission date;

3. The admitting diagnosis;

4. Documentation of general consent, and if applicable, informed consent;

5. The medical history and physical examination required in R9-10-407(5);

6. A copy of the patient’s health care directive, if applicable;

7. The name and telephone number of the patient's physician;

8. Orders;

9. Nursing assessment;

10. Treatment plans;

11. Progress notes;

12. Documentation of recovery care center services provided to a patient;

13. Disposition of the patient after discharge;

14. Discharge plan;

15. Discharge summary;

16. Transfer documentation from referring health care institution or physician;

17. If applicable:

a. A laboratory reports,

b. A radiologic reports,

c. A diagnostic reports,

d. Documentation of restraint or seclusion, and

e. A consultation report; and

18. Documentation of a medication administered to the patient that includes:

a. The date and time of administration;

b. The name, strength, dosage, and route of administration;

c. For a medication administered for pain:

i. An assessment of the patient’s pain before administering the medication, and

ii. The effect of the medication administered;

d. For a psychotropic medication:

i. An assessment of the patient’s behavior before administering the psychotropic medication, and

ii. The effect of the psychotropic medication administered;

e. The signature of the individual administering or observing the patient self-administer the medication; and

f. Any adverse reaction a patient has to the medication.

D. An administrator shall ensure that a patient’s medical record is completed within 30 calendar days after the patient’s discharge.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-512. Nursing Services

A. An administrator shall appoint a registered nurse as the director of nursing who has the authority and responsibility to manage nursing services at a recovery care center.

B. A director of nursing shall:

1. Ensure that policies and procedures are developed, documented, and implemented that cover nursing assessments;

2. Designate, in writing, a registered nurse to manage nursing services when the director of nursing is not present on a recovery care center’s premises;

3. Ensure that a recovery care center is staffed with nursing personnel according to the number of patients and their health care needs;

4. Ensure that a patient receives medical services, nursing services, and health-related services based on the patient’s nursing assessment and the physician's orders; and

5. Ensure that medications are administered by a nurse licensed according to A.R.S. Title 32, Chapter 15 or as otherwise provided by law.

C. An administrator shall ensure that a registered nurse completes a nursing assessment of each patient, which addresses patient care needs, when the patient is admitted to the recovery care center.

D. An administrator shall ensure that a licensed nurse provides a patient with written discharge instructions, based on the patient's health care needs and physician's instructions, before the patient is discharged from the recovery care center.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-513. Medication Services

A. An administrator shall ensure that a recovery care center has policies and procedures in medication administration that:

1. Include:

a. A process for providing information to a patient about medication prescribed for the patient including:

i. The prescribed medication’s anticipated results,

ii. The prescribed medication’s potential adverse reactions,

iii. The prescribed medication’s potential side effects, and

iv. Potential adverse reactions that could result from not taking the medication as prescribed;

b. Procedures for preventing, responding to, and reporting:

i. A medication error,

ii. An adverse response to a medication, or

iii. A medication overdose; and

c. Procedures to ensure that a patient’s medication regimen is reviewed by a medical practitioner and meets the patient’s needs; and

2. Specify a process for review through the quality management program of:

a. A medication administration error, and

b. An adverse reaction to a medication.

B. An administrator shall ensure that:

1. Policies and procedures for medication administration:

a. Are reviewed and approved by a medical practitioner;

b. Specify the individuals who may:

i. Order medication, and

ii. Administer medication;

c. Ensure that medication is administered to a patient only as prescribed; and

d. A patient’s refusal to take prescribed medication is documented in the patient’s medical record;

2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law;

3. A medication administered to a patient:

a. Is administered in compliance with an order, and

b. Is documented in the patient’s medical record; and

4. If pain medication is administered to a patient, documentation in the patient’s medical record includes:

a. An identification of the patient’s pain before administering the medication, and

b. The effect of the pain medication administered.

C. An administrator shall ensure that:

1. A current drug reference guide is available for use by personnel members;

2. A current toxicology reference guide is available for use by personnel members; and

3. If pharmaceutical services are provided on the premises:

a. A committee, composed of at least on physician, one pharmacist, and other personnel members as determined by policies and procedures, is established to:

i. Develop a drug formulary,

ii. Update the drug formulary at least every 12 months,

iii. Develop medication usage and medication substitution policies and procedures, and

iv. Specify which medication and medication classifications are required to be automatically stopped after a specific time period unless the ordering medical staff member specifically orders otherwise;

b. The pharmaceutical services are provided under the direction of a pharmacist;

c. The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

d. A copy of the pharmacy license is provided to the Department upon request.

D. When medication is stored at a recovery care center, an administrator shall ensure that:

1. There is a separate room, closet, or self-contained unit used for medication storage that includes a lockable door;

2. If medication is stored in a room or closet, a locked cabinet or self-contained unit is used for medication storage;

3. Medication is stored according to the instructions on the medication container; and

4. Policies and procedures are established, documented, and implemented for:

a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication;

b. Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

c. A medication recall and notification of patients who received recalled medication; and

d. Storing, inventorying, and dispensing controlled substances.

E. An administrator shall ensure that a personnel member immediately reports a medication error or a patient’s adverse reaction to a medication to the medical practitioner who ordered the medication and, if applicable, the recovery care center’s director of nursing.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-514. Ancillary Services

An administrator shall ensure that:

1. Laboratory services are provided on the premises, or are available through contract, with a laboratory that holds a certificate of accreditation or certificate of compliance issued by the U.S. Department of Health and Human Services under the 1988 amendments to the Clinical Laboratories Improvement Act of 1967; and

2. Pharmaceutical services are provided on the premises, or are available through contract, by a pharmacy licensed according to A.R.S. Title 32, Chapter 18.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-515. Food Services

A. An administrator shall ensure that:

1. The recovery care center is licensed as a food establishment under 9 A.A.C. 8, Article 1;

2. A copy of the recovery care center’s food establishment license is maintained; and

3. If a recovery care center contracts with a food establishment, as defined in 9 A.A.C. 8, Article 1, to prepare and deliver food to the recovery care center:

a. A copy of the contracted food establishment's license under 9 A.A.C. 8, Article 1 is maintained by the recovery care center; and

b. The recovery care center is able to store, refrigerate, and reheat food to meet the dietary needs of a patient.

B. An administrator shall:

1. Designate a food service manager who is responsible for food service in the recovery care center; and

2. Ensure that a current therapeutic diet reference manual is available to the food service manager.

C. A food service manager shall ensure that:

1. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a patient such as cut, chopped, ground, pureed, or thickened;

2. A food menu:

a. Is prepared at least one week in advance,

b. Includes the foods to be served each day,

c. Is conspicuously posted at least one day before the first meal on the food menu will be served,

d. Includes any food substitution no later than the morning of the day of meal service with a food substitution, and

e. Is maintained for at least 60 calendar days after the last day included in the food menu;

3. Meals and snacks provided by the recovery care center are served according to posted menus;

4. Meals for each day are planned using the applicable meal planning guides in http://www.fns.usda.gov/cnd/Care/ProgramBasics/Meals/Meal_Pattern.htm;

5. A patient is provided:

a. A diet that meets the patient's nutritional needs and, if applicable, the orders of the patient’s physician;

b. Three meals a day with not more than 14 hours between the evening meal and breakfast except as provided in subsection (C)(4)(d);

c. The option to have a daily evening snack identified in subsection (C)(4)(d)(ii) or other snack; and

d. The option to extend the time span between the evening meal and breakfast from 14 hours to 16 hours if:

i. A patient agrees; and

ii. The patient is offered an evening snack that includes meat, fish, eggs, cheese, or other protein, and a serving from either the fruit and vegetable food group or the bread and cereal food group;

6. A patient requiring assistance to eat is provided with assistance that recognizes the patient's nutritional, physical, and social needs, including the use of adaptive eating equipment or utensils; and

7. Water is available and accessible to a patient.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed effective April 4, 1994 (Supp. 94-2). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-516. Emergency and Safety Standards

A. An administrator shall ensure that policies and procedures for providing emergency treatment are established, documented, and implemented that protect the health and safety of patients and include:

1. Basic life support procedures, including the administration of oxygen and cardiopulmonary resuscitation; and

2. Transfer arrangements for patients who require care not provided by the recovery care center.

B. An administrator shall ensure that emergency treatment is provided to a patient admitted to the recovery care center according to policies and procedures.

C. An administrator shall ensure that:

1. A disaster plan is developed, documented, maintained, and, if necessary, implemented that includes:

a. When, how, and where patients will be relocated, including:

i. Instructions for the evacuation or transfer of patients,

ii. Assigned responsibilities for each personnel member, and

iii. A plan for providing continuing services to meet patient’s needs;

b. How each patient's medical record will be available to personnel providing services to the patient during a disaster;

c. A plan to ensure each patient's medication will be available to administer to the patient during a disaster; and

d. A plan for obtaining food and water for individuals present in the recovery care center or the recovery care center's relocation site during a disaster;

2. The disaster plan required in subsection (C)(1) is reviewed at least once every 12 months;

3. Documentation of a disaster plan review required in subsection (C)(2) is created, is maintained for at least 12 months after the date of the disaster plan review, and includes:

a. The date and time of the disaster plan review;

b. The name of each personnel member, employee, or volunteer participating in the disaster plan review;

c. A critique of the disaster plan review; and

d. If applicable, recommendations for improvement;

4. An evacuation drill for employees is conducted on each shift at least once every three months;

5. Documentation of an evacuation drill is created, is maintained for at least 12 months after the date of the evacuation drill, and includes:

a. The date and time of the drill;

b. The amount of time taken for employees to evacuate the recovery care center;

c. A list of the individuals who took part in the drill;

d. A critique of the drill, including any problems encountered in conducting the drill; and

e. Recommendations for improvement, if applicable; and

6. An evacuation path is conspicuously posted on each hallway of each floor of the recovery care center.

D. An administrator shall:

1. Obtain a fire inspection conducted according to the time-frame established by the local fire department or the State Fire Marshal,

2. Make any repairs or corrections stated on the inspection report, and

3. Maintain documentation of a current fire inspection.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed effective April 4, 1994 (Supp. 94-2). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-517. Environmental Standards

A. An administrator shall ensure the recovery care center’s infection control policies and procedures include:

1. Development and implementation of a written plan for preventing, detecting, reporting, and controlling communicable diseases and infection;

2. Handling and disposal of biohazardous medical waste; and

3. Sterilization, disinfection, and storage of medical equipment and supplies.

B. An administrator shall ensure that:

1. A recovery care center's premises and equipment are:

a. Cleaned and disinfected according to policies and procedures or manufacturer's instructions to prevent, minimize, and control illness or infection; and

b. Free from a condition or situation that may cause a patient or an individual to suffer physical injury;

2. A pest control program is implemented and documented;

3. Equipment used to provide direct care is:

a. Maintained in working order;

b. Tested and calibrated according to the manufacturer's recommendations or, if there are no manufacturer's recommendations, as specified in policies and procedures; and

c. Used according to the manufacturer's recommendations;

4. Documentation of equipment testing, calibration, and repair is maintained for at least 12 months after the date of the testing, calibration, or repair;

5. Biohazardous medical waste is identified, stored, and disposed of according to 18 A.A.C. 13, Article 14 and policies and procedures;

6. Soiled linen and clothing are:

a. Collected in a manner to minimize or prevent contamination;

b. Bagged at the site of use; and

c. Maintained separate from clean linen and clothing and away from food storage, kitchen, or dining areas;

7. Garbage and refuse are:

a. Stored in covered containers lined with plastic bags, and

b. Removed from the premises at least once a week;

8. Heating and cooling systems maintain the recovery care center at a temperature between 70° F and 84° F;

9. Common areas:

a. Are lighted to assure the safety of patients, and

b. Have lighting sufficient to allow personnel members to monitor patient activity;

10. The supply of hot and cold water is sufficient to meet the personal hygiene needs of patients and the cleaning and sanitation requirements in this Article;

11. Oxygen containers are secured in an upright position;

12. Poisonous or toxic materials stored by the recovery care center are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to patients;

13. Combustible or flammable liquids and hazardous materials stored by the recovery care center are stored in the original labeled containers or safety containers in a locked area outside the recovery care center and are inaccessible to patients;

14. If pets or animals are allowed in the recovery care center, pets or animals are:

a. Controlled to prevent endangering the patients and to maintain sanitation;

b. Licensed consistent with local ordinances; and

c. Vaccinated as follows:

i. A dog is vaccinated against rabies and leptospirosis, and

ii. A cat is vaccinated against rabies;

15. If a non-municipal water source is used:

a. The water source is tested at least once every 12 months for total coliform bacteria and fecal coliform or E. coli bacteria;

b. If necessary, corrective action is taken to ensure the water is safe to drink; and

c. Documentation of testing is retained for two years after the date of the test; and

16. If a non-municipal sewage system is used, the sewage system is in working order and is maintained according to applicable state laws and rules.

C. An administrator shall ensure that:

1. Smoking or the use of tobacco products is not permitted within a recovery care center; and

2. Smoking and the use of tobacco products may be permitted outside a recovery care center if:

a. Signs designating smoking areas are conspicuously posted, and

b. Smoking is prohibited in areas where combustible materials are stored or in use.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted effective October 30, 1989 (Supp. 89-4). Section repealed effective April 4, 1994 (Supp. 94-2). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-518. Physical Plant Standards

A. An administrator shall ensure that a recovery care center complies with the applicable physical plant health and safety codes and standards, incorporated by reference in A.A.C. R9-1-412, in effect on the date the recovery care center submitted architectural plans and specifications to the Department for approval.

B. An administrator shall ensure that the premises and equipment are sufficient to accommodate:

1. The services stated in the recovery care center’s scope of services; and

2. An individual accepted as a patient by the recovery care center.

C. An administrator shall ensure that the recovery care center does not allow more than two beds per room.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted effective October 30, 1989 (Supp. 89-4). Section repealed effective April 4, 1994 (Supp. 94-2). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Article was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

ARTICLE 6. HOSPICES

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-601. Definitions

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definitions apply in this Article unless otherwise specified:

1. “Medical social services” means activities that assist a patient or the patient’s family to cope with concerns about the patient’s illness, finances, or personal issues and may include problem-solving, interventions, and identification of resources to address the patient’s or the patient’s family’s concerns.

2. “Palliative care” means medical services or nursing services provided to a patient that is not curative and is designed for pain control or symptom management.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-602. Supplemental Application Requirements

In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant for a license as a hospice service facility or hospice inpatient facility shall include on the application:

1. For an application as a hospice service agency:

a. The hours of operation for the hospice's administrative office, and

b. The geographic region to be served by the hospice service agency; and

2. For an application as a hospice inpatient facility, the requested licensed capacity.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-603. Administration

A. A governing authority shall:

1. Consist of one or more individuals responsible for the organization, operation, and administration of the hospice;

2. Establish, in writing:

a. A hospice’s scope of services, and

b. Qualifications for an administrator;

3. Designate an administrator, in writing, who has the qualifications established in subsection (A)(2)(b);

4. Adopt a quality management plan that complies with R9-10-604;

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

6. Designate an acting administrator, in writing, who has the qualifications establish in subsection (A)(2)(b), if the administrator is:

a. Expected not to be present:

i. At a hospice service agency’s administrative office for more than 30 calendar days; or

ii. On a hospice inpatient facility’s premises for more than 30 calendar days; or

b. Not present:

i. At a hospice service agency’s administrative office for more than 30 calendar days; or

ii. On a hospice inpatient facility’s premises for more than 30 calendar days; and

7. Except as provided in subsection (A)(6), notify the Department according to § A.R.S. 36-425(I) when there is a change in the administrator and provide the name and qualifications of the new administrator.

B. An administrator is:

1. Directly accountable to the governing authority of a hospice for the daily operation of the hospice and services provided by or through the hospice;

2. Have the authority and responsibility to manage the hospice;

3. Except as provided in subsection (A)(6), shall designate, in writing, an individual who is responsible for services provided by the:

a. Hospice service agency when the administrator is not present at the hospice service agency’s administrative office, or

b. Inpatient hospice facility when the administrator is not on inpatient hospice facility’s premises; and

4. Designate a personnel member to provide direction for volunteers.

C. An administrator shall:

1. Establish, document, and implement policies and procedures that:

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

b. Cover orientation and in-service education for personnel members, employees, volunteers, and students;

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

d. Include a method to identify a patient to ensure the patient receives hospice services as ordered;

e. Cover patient rights including assisting a patient who does not speak English or who has a disability to become aware of patient rights;

f. Cover specific steps and deadlines for:

i. A patient to file a complaint, and

ii. The hospice service agency to respond to and resolve a patient’s complaint;

g. Cover health care directives;

h. Cover medical records, including electronic medical records;

i. Cover a quality management program, including incident report and supporting documentation; and

j. Cover contracted services;

2. Policies and procedures for hospice services are established, documented, and implemented that:

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

b. Cover the provision of hospice services;

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

d. Cover dispensing, administering, and disposing of medication;

e. Cover infection control; and

f. Cover telemedicine, if applicable;

3. For a hospice inpatient facility, establish, document, and implement policies and procedures that:

a. Cover visitation of a patient, including:

i. Allowing visitation by individuals 24 hours a day, and

ii. Allowing a visitor to bring a pet to visit the patient;

b. Cover the use and display of a patient’s personal belongings; and

c. Cover environmental services that affect patient care;

4. Policies and procedures are reviewed at least once every two years and updated as needed;

5. Policies and procedures are available to personnel members, employees, volunteers, and students; and

6. Unless otherwise stated:

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

b. When documentation or information is required by this Chapter to be submitted on behalf of a hospice, the documentation or information is provided to the unit in the Department that is responsible for licensing and monitoring the hospice.

D. An administrator shall ensure that the following are conspicuously posted:

1. The current Department-issued license;

2. The current telephone number of the Department; and

3. The location at which the following are available for review:

a. A copy of the most recent Department inspection report;

b. A list of the services provided by the hospice;

c. A written copy of rates and charges, as required in A.R.S. § 36-436.03; and

d. A list of patient rights.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-604. Quality Management

An administrator shall ensure that:

1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes:

a. A method to identify, document, and evaluate incidents;

b. A method to collect data to evaluate services provided to patients;

c. A method to evaluate the data collected to identify a concern about the delivery of services related to patient care;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of services related to patient care; and

e. The frequency of submitting a documented report required in subsection (2) to the governing authority;

2. A documented report is submitted to the governing authority that includes:

a. An identification of each concern about the delivery of services related to patient care; and

b. Any change made or action taken as a result of the identification of a concern about the delivery of services related to patient care; and

3. The report required in subsection (2) and the supporting documentation for the report are maintained for 12 months after the date the report is submitted to the governing authority.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-605. Contracted Services

An administrator shall ensure that:

1. Contracted services are provided according to the requirements in this Article, and

2. A documented list of current contracted services is maintained that includes a description of the contracted services provided.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-606. Personnel

A. An administrator shall ensure that:

1. The qualifications, skills, and knowledge required for each type of personnel member:

a. Are based on:

i. The type of physical health services or behavioral health services expected to be provided by the personnel member according to the established job description, and

ii. The acuity of the patients receiving physical health services or behavioral health services from the personnel member according to the established job description; and

b. Include:

i. The specific skills and knowledge necessary for the personnel member to provide the expected physical health services and behavioral health services listed in the established job description,

ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description, and

iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected physical health services or behavioral health services listed in the established job description;

2. A personnel member’s skills and knowledge are verified and documented:

a. Before the personnel member provides physical health services or behavioral health services, and

b. According to policies and procedures;

3. Personnel members are present on a hospice’s premises with the qualifications, skills, and knowledge necessary to:

a. Provide the services in the hospice’s scope of services,

b. Meet the needs of a patient, and

c. Ensure the health and safety of a patient;

4. Orientation occurs within the first week of providing hospice services and includes:

a. Informing personnel about Department rules for licensing and regulating hospices and where the rules may be obtained,

b. Reviewing the process by which a personnel member may submit a complaint about patient care to a hospice, and

c. Providing the information required by hospice policies and procedures;

5. Personnel receive in-service education according to criteria established in hospice policies and procedures;

6. In-service education documentation for a personnel member includes:

a. The subject matter;

b. The date of the in-service education; and

c. The signature, rubber stamp, or electronic signature code of each individual who participated in the in-service education; and

7. A personnel member, or an employee or a volunteer who has direct interaction with a patient, provides evidence of freedom from infectious tuberculosis as specified in R9-10-112.

B. An administrator shall ensure that a personnel record for each personnel member, employee, volunteer, or student:

1. The individual’s name, date of birth, home address, and contact telephone number;

2. The individual’s starting date of employment or volunteer service and, if applicable, the ending date;

3. Documentation of:

a. The individual’s qualifications including skills and knowledge applicable to the individual's job duties;

b. The individual’s education and experience applicable to the individual's job duties;

c. The individual’s completed orientation and in-service education as required by policies and procedures;

d. The individual’s license or certification, if the individual is required to be licensed or certified in this Article or policies and procedures; and

e. Evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (A)(7);

4. Is maintained:

a. Throughout the individual's period of providing services in or for the hospice, and

b. For at least two years after the last date the individual provided services in or for the hospice; and

5. For an individual who has not worked in the hospice during the previous 12 months, is provided to the Department within 72 hours after the Department's request.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-607. Admissions

A. Before admitting an individual as a patient, an administrator shall obtain:

1. The name of the individual's physician;

2. Documentation that the individual has a diagnosis by a physician that indicates that the individual has a specific, progressive, normally irreversible disease that is likely to cause the individual's death in six months or less; and

3. Documentation from the individual or the individual's representative acknowledging that:

a. Hospice service includes palliative care and supportive care and is not curative, and

b. The individual or individual's representative has received:

i. A list of services to be provided by the hospice, and

ii. A list of patient rights.

B. At the time of admission, a physician or registered nurse shall:

1. Assess a patient's medical, social, nutritional, and psychological needs; and

2. As applicable, obtain informed consent or general consent.

C. Before or at the time of admission, a social worker shall assess the social and psychological needs of a patient’s family, if applicable.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-608. Transfer

Except for a transfer of a patient due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transfer and the services provided to the patient;

2. According to policies and procedures:

a. An evaluation of the patient is conducted before the transfer,

b. Medical records including orders that are in effect at the time of the transfer are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transfer to the patient or the patient’s representative; and

3. Documentation in the patient’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transfer;

c. The mode of transportation; and

d. If applicable, a personnel member accompanying the patient during a transfer.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-609. Patient Rights

A. An administrator shall ensure that:

1. The requirements in subsection (B) and the patient rights in subsection (C) are conspicuously posted on the premises;

2. At the time of admission, a patient or the patient's representative receives a written copy of the requirements in subsection (B) and the patient rights in subsection (C); and

3. There are policies and procedures that include:

a. How and when a patient or the patient’s representative is informed of patient rights in subsection (C), and

b. Where patient rights are posted as required in subsection (A)(1).

B. An administrator shall ensure that:

1. A patient is treated with dignity, respect, and consideration;

2. A patient is not subjected to:

a. Abuse;

b. Neglect;

c. Exploitation;

d. Coercion;

e. Manipulation;

f. Sexual abuse;

g. Sexual assault;

h. Seclusion;

i. Restraint, if not necessary to prevent imminent harm to self or others;

j. Retaliation for submitting a complaint to the Department or another entity; or

k. Misappropriation of personal and private property by a hospice’s personnel members, employees, volunteers, or students; and

3. A patient or the patient's representative:

a. Except in an emergency, either consents to or refuses treatment;

b. May refuse or withdraw consent to treatment before treatment is initiated;

c. Except in an emergency, is informed of proposed treatment alternatives to the treatment, associated risks, and possible complications;

d. Consents to photographs of the patient before a patient is photographed except that a patient may be photographed when admitted to a hospice for identification and administrative purposes;

e. Except as otherwise permitted by law, provides written consent to the release of the patient’s:

i. Medical records, and

ii. Financial records;

f. Is informed of:

i. The components of hospice service provided by the hospice;

ii. The rates and charges for the components of hospice service before the components are initiated and before a change in rates, charges, or services;

iii. The hospice’s policy on health care directives; and

iv. The patient complaint process; and

g. Is informed that a written copy of rates and charges, as required in A.R.S. § 36-436.03, may be requested.

C. A patient has the following rights:

1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;

2. To receive treatment that supports and respects the patient’s individuality, choices, strengths, and abilities;

3. To receive privacy in treatment and care for personal needs;

4. To review, upon written request, the patient’s own medical record according to A.R.S. §§ 12-2293, 12-2294, and 12-2294.01;

5. To receive a referral to another health care institution if the hospice inpatient facility is unable to provide physical health services or behavioral health services for the patient;

6. To participate or have the patient's representative participate in the development of, or decisions concerning treatment;

7. To participate or refuse to participate in research or experimental treatment; and

8. To receive assistance from a family member, representative, or other individual in understanding, protecting, or exercising the patient’s rights.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-610. Medical Records

A. An administrator shall ensure that:

1. A patient’s medical record is established and maintained for each patient according to A.R.S. Title 12, Chapter 13, Article 7.1;

2. An entry in a patient’s medical record is:

a. Recorded only by a personnel member authorized by policies and procedures to make the entry;

b. Dated, legible, and authenticated; and

c. Not changed to make the initial entry illegible;

3. An order is:

a. Dated when the order is entered in the patient’s medical record and includes the time of the order;

b. Authenticated by a medical practitioner or behavioral health professional according to policies and procedures; and

c. If the order is a verbal order, authenticated by the medical practitioner issuing the order;

4. If a rubber-stamp signature or an electronic signature code is used to authenticate an order, the individual whose signature the stamp or electronic code represents is accountable for the use of the stamp or the electronic code;

5. A patient’s medical record is available to a personnel member, medical practitioner, or behavioral health professional authorized by policies and procedures to access the patient’s medical record;

6. Information in a patient’s medical record is disclosed to an individual not authorized under subsection (A)(5) only with the written consent of a patient or the patient's representative or as permitted by law; and

7. A patient’s medical record is protected from loss, damage or unauthorized use.

B. If a hospice keeps a patient’s medical records electronically, an administrator shall ensure that:

1. Safeguards exist to prevent unauthorized access, and

2. The date and time of an entry in a patient’s medical record is recorded by the computer's internal clock.

C. An administrator shall ensure that a patient’s medical record contains:

1. Patient information that includes:

a. The patient's name;

b. The patient’s address;

c. The patient’s telephone number;

d. The patient's date of birth;

e. The name and contact information of the patient’s representative, if applicable; and

f. Any known allergy;

2. Admission date and date that the patient stopped receiving services from the hospice;

3. Name and telephone number of the patient's physician;

4. Admitting diagnosis;

5. Documentation of general consent, and if applicable informed consent, for treatment by the patient or the patient's representative except in an emergency;

6. Documentation of medical history;

7. Copy of the patient's living will, health care power of attorney, or other health care directive, if applicable;

8. Orders;

9. Assessment required in R9-10-607;

10. Care plans;

11. Progress notes for each patient contact including:

a. The date of the patient contact,

b. The services provided,

c. A description of the patient’s condition, and

d. Instructions given to the patient or patient’s representative;

12. Documentation of hospice services provided to a patient;

13. Documentation of restraint or seclusion, if applicable;

14. Documentation of coordination of patient care;

15. Documentation of contacts with the patient’s physician by a personnel member;

16. Discharge summary, if applicable;

17. If applicable, transfer documentation from a sending health care institution; and

18. Documentation of a medication administered to the patient that includes:

a. The date and time of administration;

b. The name, strength, dosage, and route of administration;

c. For a medication administered for pain when initially administered or when administered PRN:

i. An assessment of the patient’s pain before administering the medication, and

ii. The effect of the medication administered;

d. For a psychotropic medication when initially administered or when administered PRN:

i. An assessment of the patient’s behavior before administering the psychotropic medication, and

ii. The effect of the psychotropic medication administered;

e. The identification, signature, and professional designation of the individual administering or observing the self-administration of the medication; and

f. Any adverse reaction a patient has to the medication.

Historical Note

New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

R9-10-611. Care Plan

A. An administrator shall ensure that a care plan is developed for each patient:

1. Based on the:

a. Assessment of the:

i. Patient; and

ii. Patient’s family, if applicable;

b. Hospice service agency’s or inpatient hospice facility’s scope of service;

2. With participation from a:

a. Physician,

b. Registered nurse, and

c. Social worker; and

3. That includes:

a. The patient’s diagnosis;

b. The patient’s health care directives;

c. The patient’s cognitive awareness of self, location, and time;

d. The patient’s functional abilities and limitations;

e. Goals for pain control and symptom management;

f. The type, duration, and frequency of services to be provided to the patient and, if applicable, the patient’s family;

g. Treatments the patient is receiving from a health care institution or health care professional other than the hospice, if applicable;

h. Medications ordered for the patient;

i. Any known allergies;

j. Nutritional requirements and preferences; and

k. Specific measures to improve the patient’s safety and protect the patient against injury.

B. An administrator shall ensure that:

1. A request for participation in a patient’s care plan is made to the patient or patient’s representative;

2. An opportunity for participation in the patient’s care plan is provided to the patient, patient’s representative, or patient’s family; and

3. Documentation of the request in subsection (B)(1) and the opportunity in subsection (B)(2) is in the patient’s medical record.

C. An administrator shall ensure that:

1. Hospice service is provided to a patient and, if applicable, the patient’s family according to the patient’s care plan;

2. A patient’s care plan is reviewed and updated:

a. Whenever there is a change in the patient’s condition that indicates a need for a change in the type, duration, or frequency of the services being provided:

b. If the patient’s physician orders a change in the care plan; and

c. At least every 30 calendar days; and

3. A patient’s physician authenticates the care plan with a signature within 14 calendar days after the care plan is initially developed and whenever the care plan is reviewed or updated.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-611 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-612. Hospice Services

A. An administrator shall ensure that the following are included in the hospice service provided by the hospice:

1. Medical services;

2. Nursing services;

3. Nutritional services, including menu planning and the designation of the kind and amount of food appropriate for a patient;

4. Medical social services, provided as follows:

a. For medical social services under the practice of social work as defined in A.R.S. § 32-3251, by a clinical social worker, licensed according to A.R.S. § 32-3293, or a licensed baccalaureate social worker according to A.R.S. § 32-3291; and

b. For other medical social services, by an individual with a master’s or higher degree in social work who has at least one year of social work experience in a health care setting or by a licensed baccalaureate social worker, according to A.R.S. § 32-3291;

5. Bereavement counseling for a patient’s family for at least one year after the death of a patient; and

6. Spiritual counseling services, consistent with a patient's customs, religious preferences, cultural background, and ethnicity.

B. In addition to the services specified in subsection (A), an administrator of a hospice service agency shall ensure that the following are included in the hospice service provided by the hospice:

1. Home health aide services;

2. Respite care services; and

3. Supportive services, as defined in A.R.S. § 36-151.

C. An administrator shall ensure that the medical director provides direction for medical services provided by or through the hospice.

D. A medical director shall ensure that:

1. A patient’s need for medical services is met, according to the patient’s care plan and a hospice’s scope of services; and

2. If a patient is receiving medical services not provided by or through the hospice, hospice services are coordinated with the physician providing medical services to the patient.

E. A director of nursing shall ensure that:

1. A registered nurse or practical nurse provides nursing services according to the hospice’s policies and procedures;

2. A sufficient number of nurses are available to provide the nursing services identified in each patient's care plan;

3. The care plan for a patient is implemented;

4. A personnel member is only assigned to provide services the personnel member can competently perform;

5. A registered nurse:

a. Assigns tasks in writing to a home health aide who is providing home health aide service to a patient,

b. Provides direction for the home health aide services provided to a patient, and

c. Verifies the competency of the home health aide in performing assigned tasks;

6. A registered dietitian or a personnel member under the direction of a registered dietitian plans menus for a patient;

7. A patient’s condition and the services provided to the patient are documented in the patient’s medical record after each patient contact;

8. A patient's physician is immediately informed of a change in the patient's condition that requires medical services; and

9. The implementation of a patient’s care plan is coordinated among the personnel members providing hospice service to the patient.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-612 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-613. Medication Services

A. If a hospice provides medication administration or assistance in the self-administration of medication, an administrator shall ensure that policies and procedures:

1. Include:

a. A process for providing information to a patient about medication prescribed for the patient including:

i. The prescribed medication’s anticipated results,

ii. The prescribed medication’s potential adverse reactions,

iii. The prescribed medication’s potential side effects, and

iv. Potential adverse reactions that could result from not taking the medication as prescribed;

b. Procedures for preventing, responding to, and reporting:

i. A medication error,

ii. An adverse response to a medication, or

iii. A medication overdose;

c. Procedures to ensure that a patient’s medication regimen is reviewed by a medical practitioner and meets the patient’s needs;

d. Procedures for documenting medication services and assistance in the self-administration of medication;

e. Procedures for assisting a patient in obtaining medication; and

f. If applicable, procedures for providing medication administration or assistance in the self-administration of medication off the premises; and

2. Specify a process for review through the quality management program of:

a. A medication administration error, and

b. An adverse reaction to a medication.

B. If a hospice provides medication administration, an administrator shall ensure that:

1. Policies and procedures for medication administration:

a. Are reviewed and approved by a medical practitioner;

b. Specify the individuals who may:

i. Order medication, and

ii. Administer medication;

c. Ensure that medication is administered to a patient only as prescribed; and

d. A patient’s refusal to take prescribed medication is documented in the patient’s medical record;

2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law;

3. A medication administered to a patient:

a. Is administered in compliance with an order, and

b. Is documented in the patient’s medical record; and

4. If pain medication is administered to a patient, documentation in the patient’s medical record includes:

a. An identification of the patient’s pain before administering the medication, and

b. The effect of the pain medication administered.

C. If a hospice provides assistance in the self-administration of medication, an administrator shall ensure that:

1. A patient’s medication is stored by the hospice;

2. The following assistance is provided to a patient:

a. A reminder when it is time to take the medication;

b. Opening the medication container for the patient;

c. Observing the patient while the patient removes the medication from the container;

d. Verifying that the medication is taken as ordered by the patient’s medical practitioner by confirming that:

i. The patient taking the medication is the individual stated on the medication container label,

ii. The dosage of the medication is the same as stated on the medication container label, and

iii. The medication is being taken by the patient at the time stated on the medication container label; or

e. Observing the patient while the patient takes the medication;

3. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by a medical practitioner, a pharmacist, or a registered nurse;

4. Training for a personnel member, other than a medical practitioner or a registered nurse, in the self-administration of medication:

a. Is provided by a medical practitioner or a registered nurse or an individual trained by a medical practitioner or registered nurse;

b. Includes:

i. A demonstration of the personnel member’s skills and knowledge necessary to provide assistance in the self-administration of medication,

ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

iii. Process for notifying the appropriate entities when an emergency medical intervention is needed;

5. A personnel member, other than a medical practitioner or a registered nurse, completes the training in subsection (C)(4) before the personnel member provides assistance in the self-administration of medication; and

6. Assistance with the self-administration of medication provided to a patient:

a. Is in compliance with an order, and

b. Is documented in the patient’s medical record.

D. An administrator shall ensure that:

1. A current drug reference guide is available for use by personnel members;

2. A current toxicology reference guide is available for use by personnel members;

3. If pharmaceutical services are provided on the premises:

a. A committee, composed of at least on physician, one pharmacist, and other personnel members as determined by the hospice’s policies and procedures is established to:

i. Develop a drug formulary,

ii. Update the drug formulary at least every 12 months,

iii. Develop medication usage and medication substitution policies and procedures, and

iv. Specify which medication and medication classifications are required to be automatically stopped after a specific time period unless the ordering medical staff member specifically orders otherwise;

b. The pharmaceutical services are provided under the direction of a pharmacist;

c. The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

d. A copy of the pharmacy license is provided to the Department upon request.

E. When medication is stored at a hospice inpatient facility, an administrator shall ensure that:

1. There is a separate room, closet, or self-contained unit used for medication storage that includes a lockable door;

2. If a room or closet is used to store medication, a locked cabinet or self-contained unit is used for medication storage;

3. Medication is stored according to the instructions on the medication container; and

4. Policies and procedures are established, documented, and implemented for:

a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication;

b. Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

c. A medication recall and notification of patients who received recalled medication; and

d. Storing, inventorying, and dispensing controlled substances.

F. An administrator shall ensure that a personnel member immediately reports a medication error or a patient’s adverse reaction to a medication to the medical practitioner who ordered the medication and, if applicable, the hospice’s director of nursing.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-613 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-614. Infection Control

A. An administrator shall ensure that:

1. An infection control program is established, under the direction of an individual qualified according to the hospice’s policies and procedures, to prevent the development and transmission of infections and communicable diseases including:

a. A method to identify and document infections;

b. Analysis of the types, causes, and spread of infections and communicable diseases;

c. The development of corrective measures to minimize or prevent the spread of infections and communicable diseases; and

d. Documenting infection control activities including:

i. The collection and analysis of infection control data,

ii. The actions taken relating to infections and communicable diseases, and

iii. Reports of communicable diseases to the governing authority and state and county health departments;

2. Infection control documents are maintained for at least two years after the date of the documents;

3. Policies and procedures are established, documented, and implemented that cover:

a. Compliance with the requirements in 9 A.A.C. 6 for reporting and control measures for communicable diseases and infestations;

b. Handling and disposal of biohazardous medical waste;

c. Sterilization and disinfection of medical equipment and supplies;

d. Use of personal protective equipment such as aprons, gloves, gowns, masks, or face protection when applicable;

e. Cleaning of an individual's hands when the individual's hands are visibly soiled and before and after providing a service to a patient;

f. Training of personnel members in infection control practices; and

g. Work restrictions for a personnel member with a communicable disease or infected skin lesion;

4. Biohazardous medical waste is identified, stored, and disposed of according to 18 A.A.C. 13, Article 14 and policies and procedures; and

5. A personnel member washes hands or use a hand disinfection product after each patient contact and after handling soiled linen, soiled clothing, or potentially infectious material.

B. An administrator shall comply with contagious disease reporting requirements in A.R.S. § 36-621 and communicable disease reporting requirements in 9 A.A.C. 6, Article 2.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-614 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-615. Food Services for a Hospice Inpatient Facility

A. An administrator of a hospice inpatient facility shall ensure that:

1. A food menu:

a. Is prepared at least one week in advance,

b. Includes the foods to be served each day,

c. Is conspicuously posted at least one day before the first meal on the food menu will be served,

d. Includes any food substitution no later than the morning of the day of meal service with a food substitution, and

e. Is maintained for at least 60 calendar days after the last day included in the food menu;

2 Meals and snacks provided by the hospice inpatient facility are served according to posted menus;

3. Meals for each day are planned using:

a. The applicable meal planning guides in http://www.fns.usda.gov/cnd/Care/ProgramBasics/Meals/ Meal_Pattern.htm; and

b. Preferences for meals and snacks obtained from patients;

4. A patient requiring assistance to eat is provided with assistance that recognizes the patient's nutritional, physical, and social needs, including the use of adaptive eating equipment or utensils; and

5. Water is available and accessible to patients at all times, unless otherwise stated in a patient's care plan.

B. An administrator of a hospice inpatient facility shall ensure that food is obtained, prepared, served, and stored as follows:

1. Food is free from spoilage, filth, or other contamination and is safe for human consumption;

2. Food is protected from potential contamination;

3. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a patient, such as cut, chopped, ground, pureed, or thickened;

4. Potentially hazardous food is maintained as follows:

a. Foods requiring refrigeration are maintained at 41° F or below;

b. Foods requiring cooking are cooked to heat all parts of the food to a temperature of at least 145° F for 15 seconds, except that:

i. Ground beef and ground meats are cooked to heat all parts of the food to at least 155° F;

ii. Poultry, poultry stuffing, stuffed meats and stuffing containing meat are cooked to heat all parts of the food to at least 165° F;

iii. Pork and any food containing pork are cooked to heat all parts of the food to at least 155° F;

iv. Raw shell eggs for immediate consumption are cooked to at least 145° F for 15 seconds and any food containing raw shell eggs is cooked to heat all parts of the food to at least 155 °F;

v. Roast beef and beef steak are cooked to an internal temperature of at least 155° F; and

vi. Leftovers are reheated to a temperature of at least 165° F;

5. A refrigerator contains a thermometer, accurate to plus or minus 3° F, at the warmest part of the refrigerator;

6. Frozen foods are stored at a temperature of 0° F or below; and

7. Tableware, utensils, equipment, and food-contact surfaces are clean and in good repair.

C. An administrator shall ensure that:

1. For a hospice inpatient facility with a licensed capacity of more than 20 beds, the hospice inpatient facility:

a. Is licensed as a food establishment under 9 A.A.C. 8, Article 1, and

b. Maintains a copy of the hospice inpatient facility’s food establishment license;

2. If the hospice inpatient facility contracts with food establishment, as defined in 9 A.A.C. 8, Article 1, to prepare and deliver food to the hospice inpatient facility a copy of the contracted food establishment's license under 9 A.A.C. 8, Article 1 is maintained by the hospice inpatient facility; and

3. Food is stored, refrigerated, and reheated to meet the dietary needs of a patient.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-615 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-616. Emergency and Safety Standards for a Hospice Inpatient Facility

A. An administrator of a hospice inpatient facility shall ensure that:

1. A disaster plan is developed, documented, maintained in a location accessible to personnel members and other employees, and, if necessary, implemented that includes:

a. When, how, and where patients will be relocated, including:

i. Instructions for the evacuation, transport, or transfer of patients,

ii. Assigned responsibilities for each personnel member, and

iii. A plan for providing continuing services to meet patient’s needs;

b. How each patient's medical record will be available to personnel providing services to the patient during a disaster;

c. A plan to ensure each patient's medication will be available to administer to the patient during a disaster; and

d. A plan for obtaining food and water for individuals present in the hospice inpatient facility or the hospice inpatient facility's relocation site during a disaster;

2. The disaster plan required in subsection (A)(1) is reviewed at least once every 12 months;

3. An evacuation drill for employees is conducted on each shift at least once every three months;

4. Documentation of each evacuation drill is created, is maintained for at least 12 months after the date of the evacuation drill, and includes:

a. The date and time of the evacuation drill;

b. The amount of time taken for employees to evacuate the hospice inpatient facility;

c. Any problems encountered in conducting the evacuation drill; and

d. Recommendations for improvement, if applicable; and

5. An evacuation path is conspicuously posted on each hallway of each floor of the hospice inpatient facility.

B. An administrator shall:

1. Obtain a fire inspection conducted according to the time-frame established by the local fire department or the State Fire Marshal,

2. Make any repairs or corrections stated on the fire inspection report, and

3. Maintain documentation of a current fire inspection.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-616 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-617. Environmental Standards for a Hospice Inpatient Facility

A. An administrator of a hospice inpatient facility shall ensure that:

1. Policies and procedures are established, documented, and implemented that cover:

a. Transport, storage, and cleaning of soiled linens and clothing;

b. Housekeeping procedures that ensure a clean environment; and

c. Isolation of a patient who may spread an infection;

2. The premises and equipment are:

a. Cleaned and disinfected according to policies and procedures or manufacturer's instructions to prevent, minimize, and control illness or infection; and

b. Free from a condition or situation that may cause a patient or other individual to suffer physical injury or illness;

3. A pest control program is implemented and documented;

4. Equipment used at the hospice inpatient facility is:

a. Maintained in working order;

b. Tested and calibrated according to the manufacturer’s recommendations or, if there are no manufacturer’s recommendations, as specified in the hospice inpatient facility’s policies and procedures; and

c. Used according to the manufacturer’s recommendations;

5. Documentation of equipment testing, calibration, and repair is maintained for at least 12 months after the date of the testing, calibration, or repair;

6. Garbage and refuse are:

a. Stored in covered containers lined with plastic bags, and

b. Removed from the premises at least once a week;

7. Soiled linen and clothing are:

a. Collected in a manner to minimize or prevent contamination;

b. Bagged at the site of use; and

c. Maintained separate from clean linen and clothing and away from food storage, kitchen, or dining areas;

8. Heating and cooling systems maintain the hospice inpatient facility at a temperature between 70° F and 84° F at all times;

9. Common areas:

a. Are lighted to assure the safety of patients, and

b. Have lighting sufficient to allow personnel members to monitor patient activity;

10. The supply of hot and cold water is sufficient to meet the personal hygiene needs of patients and the cleaning and sanitation requirements in this Article;

11. Oxygen containers are secured in an upright position;

12. Poisonous or toxic materials stored in the hospice inpatient facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and inaccessible to patients;

13. Except for medical supplies needed by a patient, combustible or flammable liquids and hazardous materials are stored outside the hospice inpatient facility in the original labeled containers or safety containers in a storage area that is locked and inaccessible to patients;

14. If pets or animals are allowed in the hospice inpatient facility, pets or animals are:

a. Controlled to prevent endangering the patients and to maintain sanitation;

b. Licensed consistent with local ordinances; and

c. Vaccinated as follows:

i. A dog is vaccinated against rabies and leptospirosis; and

ii. A cat is vaccinated against rabies;

15. If a non-municipal water source is used:

a. The water source is tested at least once every 12 months for total coliform bacteria and fecal coli form or E. coli bacteria and corrective action is taken to ensure the water is safe to drink, and

b. Documentation of testing is retained for two years after the date of the test; and

16. If a non-municipal sewage system is used, the sewage system is in working order and is maintained according to all applicable state laws and rules.

B. An administrator of a hospice inpatient facility shall ensure that a patient is allowed to use and display personal belongings.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-617 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-618. Physical Plant Standards for a Hospice Inpatient Facility

A. An administrator shall ensure that a hospice inpatient facility complies with applicable requirements for Health Care Occupancies in National Fire Protection Association 101, Life Safety Code, incorporated by reference in A.A.C. R9-1-412.

B. An administrator of a hospice inpatient facility shall ensure that the premises and equipment are sufficient to accommodate:

1. The services stated in the hospice inpatient facility’s scope of services, and

2. An individual accepted as a patient by the hospice inpatient facility.

C. An administrator of a hospice inpatient facility shall ensure that a patient’s sleeping area:

1. Is shared by no more than four patients;

2. Measures at least 80 square feet of floor space per patient, not including a closet;

3. Has walls from floor to ceiling;

4. Contains a door that opens into a hallway, common area, or outdoors;

5. Is at or above ground level;

6. Is vented to the outside of the hospice inpatient facility;

7. Has a working thermometer for measuring the temperature in the sleeping area;

8. For each patient, has a:

a. Bed,

b. Bedside table,

c. Bedside chair,

d. Reading light,

e. Privacy screen or curtain, and

f. Closet or drawer space;

9. Is equipped with a bell, intercom, or other mechanical means for a patient to alert a personnel member;

10. Is no farther than 20 feet from a room containing a toilet and a sink;

11. Is not used as a passageway to another sleeping area, a toilet room, or a bathing room;

12. Contains one of the following to provide sunlight:

a. A window to the outside of the hospice inpatient facility, or

b. A transparent or translucent door to the outside of the hospice inpatient facility; and

13. Has coverings for windows and for transparent or translucent doors that provide patient privacy.

D. An administrator of a hospice inpatient facility shall ensure that there is:

1. For every six patients, a toilet room that contains:

a. At least one working toilet that flushes;

b. At least one working sink with running water;

c. Soap for hand washing;

d. Paper towels or a mechanical air hand dryer;

e. Grab bars attached to a wall that an individual may hold onto to assist the individual in becoming or remaining erect;

f. A mirror;

g. Lighting;

h. Space for a personnel member to assist a patient;

i. A bell, intercom, or other mechanical means for a patient to alert a personnel member; and

j. An operable window to the outside of the hospice inpatient facility or other means of ventilation;

2. For every 12 patients, at least one working bathtub or shower accessible to a wheeled shower chair, with a slip-resistant surface, located in a toilet room or in a separate bathing room;

3. For a patient occupying a sleeping area with one or more other patients, a separate room in which the patient can meet privately with family members;

4. Space in a lockable closet, drawer, or cabinet for a patient to store the patient's private or valuable items;

5. A room other than a sleeping area that can be used for social activities;

6. Sleeping accommodations for family members;

7. A designated toilet room, other than a patient toilet room, for personnel and visitors that:

a. Provides privacy; and

b. Contains:

i. A working sink with running water,

ii. A working toilet that flushes and has a seat,

iii. Toilet tissue,

iv. Soap for hand washing,

v. Paper towels or a mechanical air hand dryer,

vi. Lighting, and

vii. A window that opens or another means of ventilation;

8. If the hospice inpatient facility has a kitchen with a stove or oven, a mechanism to vent the stove or oven to the outside of the hospice inpatient facility; and

9. Space designated for administrative responsibilities that is separate from sleeping areas, toilet rooms, bathing rooms, and drug storage areas.

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-618 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-619. Repealed

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-619 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-620. Repealed

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-620 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-621. Repealed

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Correction, subsection (H), after “... 105° F” added “nor more than 110° F” as certified effective November 6, 1978 (Supp. 87-2). Section R9-10-621 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-622. Repealed

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-622 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-623. Repealed

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-623 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Editor’s Note: The following Section was repealed under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on the repealing of these rules.

R9-10-624. Repealed

Historical Note

Adopted effective November 6, 1978 (Supp. 78-6). Section R9-10-624 repealed effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4).

Editor’s Note: The following Article was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

ARTICLE 7. BEHAVIORAL HEALTH RESIDENTIAL FACILITIES

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-701. Definitions

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definitions apply in this Article unless otherwise specified:

1. “Emergency safety response” means physically holding a resident to manage the resident’s sudden, intense, or out-of-control behavior to prevent harm to the resident or another individual.

2. “Resident” means a patient admitted to a behavioral health residential facility:

a. With the expectation that the patient will be present in the behavioral health residential facility for more than 24 hours; or

b. For respite services.

3. “Resident’s representative” means:

a. The resident’s legal guardian;

b. If the resident is under 18 years of age and not an emancipated minor, the resident’s parent;

c. If the resident is 18 years of age or older or an emancipated minor, an individual acting on behalf of the resident with the written consent of the resident or the resident’s legal guardian; or

d. A surrogate as defined in A.R.S. § 36-3201.

4. “Treatment plan” means a description of the specific services that a behavioral health residential facility plans to provide to a resident.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted without changes effective October 30, 1989 (Supp. 89-4). Section R9-10-701 repealed, new Section R9-10-701 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-702. Supplemental Application Requirements

In addition to the license application requirements in A.R.S. § 36-422 and R9-10-105, an applicant shall include on the application:

1. For the licensed capacity for a behavioral health residential facility:

a. The requested licensed capacity for providing behavioral health services to individuals under 18 years of age, and

b. The requested licensed capacity for providing behavioral health residential services to individuals 18 years of age and older;

2. For the licensed capacity for an outdoor behavioral health care program:

a. The requested licensed capacity for providing the outdoor behavioral health care program to individuals 12 to 17 years of age, and

b. The requested licensed capacity for providing the outdoor behavioral health care program to individuals 18 to 24 years of age;

3. Whether the applicant is requesting authorization to provide:

a. Residential services to individuals 18 years of age or older whose behavioral health issue limits the individuals’ ability to function independently, or

b. Personal care services;

4. For a behavioral health residential facility providing respite services, the requested number of individuals the behavioral health residential facility plans to admit for respite services who do not stay overnight in the behavioral health residential facility; and

5. For an outdoor behavioral health care program, a copy of the outdoor behavioral health care program’s accreditation report.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-702 repealed, new Section R9-10-702 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-703. Administration

A. A governing authority shall:

1. Consist of one or more individuals accountable for the organization, operation, and administration of a behavioral health residential facility;

2. Establish in writing:

a. A behavioral health residential facility’s scope of services, and

b. Qualifications for an administrator;

3. Designate an administrator, in writing, who has the qualifications established in subsection (A)(2)(b);

4. Adopt a quality management program according to R9-10-704;

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

6. Designate an acting administrator, in writing, who has the qualifications established in subsection (A)(2)(b), if the administrator is:

a. Not expected to be present on a behavioral health residential facility’s premises for more than 30 calendar days, or

b. Not present on a behavioral health residential facility’s premises for more than 30 calendar days; and

7. Except as provided in subsection (A)(6), notify the Department according to § A.R.S. 36-425(I) when there is a change in the administrator.

B. An administrator:

1. Is directly accountable to the governing authority for the operation of a behavioral health residential facility and services provided by or at the behavioral health residential facility;

2. Has the authority and responsibility to manage the behavioral health residential facility; and

3. Except as provided in subsection (A)(7), designates, in writing, an individual who is on the behavioral health residential facility’s premises and is available and accountable for the services provided by the behavioral health residential facility when the administrator is not present on the behavioral health residential facility’s premises.

C. An administrator shall ensure that:

1. Policies and procedures are established, documented, and implemented that:

a. Include job descriptions, duties, and qualifications, including required skills, knowledge, education, and experience for personnel members, employees, volunteers, and students;

b. Cover orientation and in-service education for personnel members, employees, volunteers, and students;

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

d. Cover cardiopulmonary resuscitation training including:

i. The method and content of cardiopulmonary resuscitation training which includes a demonstration of the individual’s ability to perform cardiopulmonary resuscitation,

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

iii. The time-frame for renewal of cardiopulmonary resuscitation training, and

iv. The documentation that verifies that the individual has received cardiopulmonary resuscitation training;

e. Include a method to identify a resident to ensure the resident receives physical health services and behavioral health services as ordered;

f. Cover first aid training;

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

h. Cover specific steps and deadlines for:

i. A resident to file a complaint;

ii. The behavioral health residential facility to respond to and resolve a resident complaint; and

iii. The behavioral health residential facility to obtain documentation of fingerprint clearance, if applicable;

i. Cover medical records, including electronic medical records;

j. Cover a quality management program, including incident report and supporting documentation;

k. Cover contracted services; and

l. Cover when an individual may visit a resident in a behavioral health residential facility;

2. Policies and procedures for behavioral health residential facility services and physical health services are established, documented, and implemented that:

a. Cover resident screening, admission, assessment, treatment plan, transport, transfer, discharge plan, and discharge;

b. Cover resident outings;

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

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

e. Cover administering medication, assistance in the self-administration of medication, and disposing of medication, including provisions for inventory control and preventing diversion of controlled substances;

f. Cover respite services;

g. Cover services provided by an outdoor behavioral health care program, if applicable;

h. Cover infection control;

i. Cover resident time out;

j. Cover environmental services that affect resident care;

k. Cover whether pets and other animals are allowed on the premises, including procedures to ensure that any pets or other animals allowed on the premises do not endanger the health or safety of residents or the public;

l. If animals are used as part of a therapeutic program, cover:

i. Inoculation/vaccination requirements, and

ii. Methods to minimize risks to resident’s health and safety;

m. Cover the process for receiving and refunding a fee;

n. Cover the process for obtaining resident preferences for social, recreational, or rehabilitative activities and meals and snacks;

o. Cover the security of a resident’s possessions that are allowed on the premises;

p. Cover smoking and the use of tobacco products on the premises; and

q. Cover how the behavioral health residential facility will respond to a resident’s sudden, intense, or out-of-control behavior to prevent harm to the resident or another individual;

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

4. Policies and procedures are available to personnel members, 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 Department request; and

b. When documentation or information is required by this Chapter to be submitted on behalf of a behavioral health residential facility, the documentation or information is provided to the unit in the Department that is responsible for licensing and monitoring the behavioral health residential facility.

D. If an applicant requests or a behavioral health residential facility has a licensed capacity of 10 or more residents, an administrator shall designate a clinical director who:

1. Provides direction for behavioral health services provided at the behavioral health residential facility, and

2. Is a behavioral health professional.

E. Except for respite services, an administrator shall ensure that medical services, nursing services, health-related services, or ancillary services provided by a behavioral health residential facility are only provided to a resident who is expected to be present in the behavioral health residential facility for more than 24 hours.

F. An administrator shall provide written notification to the Department:

1. If a 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. Within two working days after a resident inflicts a self-injury or has an accident that requires immediate intervention by an emergency medical services provider.

G. If abuse, neglect, or exploitation of a resident is alleged or suspected to have occurred before the resident was admitted or while the resident is not on the premises and not receiving services from a behavioral health residential facility’s employee or personnel member, an administrator shall immediately 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;

H. If abuse, neglect, or exploitation of a resident is alleged or suspected to have occurred on the premises or while the resident is receiving services from a behavioral health residential facility’s employee or personnel member, an administrator shall:

1. Take immediate action to stop the alleged or suspected abuse, neglect, or exploitation;

2. Immediately report the alleged or suspected abuse, neglect, or exploitation of the resident:

a. For a resident 18 years of age or older, according to A.R.S. § 46-454; or

b. For a resident 18 years of age, according to A.R.S. § 13-3620;

3. Document the action in subsection (H)(1) and the report in subsection (H)(2) and maintain the documentation for 12 months after the date of the report;

4. Investigate the alleged or suspected abuse, neglect, or exploitation and develop a written report of the investigation within 48 hours after the report required in (H)(2) that includes:

a. Dates, times, and description of the alleged or suspected abuse, neglect, or exploitation;

b. Description of any injury to the resident and any change to the resident’s physical, cognitive, functional, or emotional condition;

c. Names of witnesses to the alleged or suspected abuse, neglect, or exploitation; and

d. Actions taken by the administrator to prevent the alleged or suspected abuse, neglect, or exploitation from occurring in the future;

5. Submit a copy of the investigation report required in subsection (H)(4) to the Department within 10 working days after submitting the report in subsection (H)(2); and

6. Maintain a copy of the investigation report required in subsection (H)(4) for 12 months after the date of the investigation report.

I. An administrator shall:

1. Establish and document requirements regarding residents, personnel members, employees, and other individuals entering and exiting the premises;

2. Establish and document guidelines for meeting the needs of an individual residing at a behavioral health residential facility with a resident, such as a child accompanying a parent in treatment, if applicable;

3. If children under the age of 12, who are not admitted to a behavioral health residential facility, are residing at the behavioral health residential facility and being cared for by employees or personnel members, ensure that:

a. An employee or personnel member caring for children has current cardiopulmonary resuscitation and first aid training specific to the age of children being cared for, and

b. The staff-to-children ratios in A.A.C. R9-5-404(A) are maintained based on the age of the youngest child in the group;

4. Establish and document the process for responding to a resident’s need for immediate and unscheduled behavioral health services or physical health services;

5. Establish and document the criteria for determining when a resident’s absence is unauthorized, including whether the resident was admitted under A.R.S. Title 36, Chapter 5, Articles 1, 2, or 3, is absent against medical advice, or is under the age of 18;

6. If a resident’s absence is unauthorized as determined according to the criteria in subsection (I)(5), submit a written report within an hour of the determination to:

a. For a resident who is less than 18 years of age, the resident’s parent or legal guardian; and

b. For a resident who is under a court’s jurisdiction, the appropriate court;

7. Maintain a written log of unauthorized absences for 2 years after the date of a resident’s absence that includes:

a. The name of a resident absent without authorization;

b. Name of person to whom the report required in subsection (I)(6) was submitted; and

c. Date of report; and

8. Evaluate and take action related to unauthorized absences under the quality management program in R9-10-704.

J. An administrator shall ensure that the following information or documents are conspicuously posted on the premises and are available upon request to a personnel member, employee, resident, or a resident’s representative:

1. The resident rights listed in R9-10-711,

2. The behavioral health residential facility’s current license,

3. The location at which inspection reports required in R9-10-720(C) are available for review or can be made available for review, and

4. The calendar days and times when a resident may accept visitors or make telephone calls.

K. An administrator shall ensure that:

1. Labor performed by a resident for the behavioral health residential facility is consistent with A.R.S. § 36-510;

2. A resident who is a child is only released to the child’s custodial parent, guardian, or custodian or as authorized in writing by the child’s custodial parent, guardian, or custodian;

3. The administrator obtains documentation of the identity of the parent, guardian, custodian, or family member authorized to act on behalf of a resident who is a child; and

4. A resident, who is an incapacitated person according to A.R.S. § 14-5101 or who is gravely disabled, is assisted in obtaining a resident’s representative to act on the resident’s behalf.

L. An administrator shall:

1. If the administrator determines that a resident is incapable of handling the resident’s financial affairs:

a. Notify the resident’s representative or contacts a public fiduciary or a trust officer to take responsibility of the resident’s financial affairs, and

b. Maintain documentation of the notification required in subsection (L)(1)(a) in the resident’s medical record for 12 months after the date of the notification; and

2. If a resident refuses medical services or nursing services:

a. Notify the resident’s primary care provider or other medical practitioner, and

b. Maintain documentation of the notification required in subsection (L)(2)(a) in the resident’s medical record for at least 12 months after the date of notification.

M. If an administrator manages a resident’s money through a personal funds account, the administrator shall ensure:

1. Policies and procedure are established, developed, and implemented for:

a. Using resident’s funds in a personal funds account,

b. Protecting resident’s funds in a personal funds account,

c. Investigating a complaint about the use of resident’s funds in a personal funds account and ensuring that the complaint is investigated by an individual who does not manage the personal funds account,

d. Processing each deposit into and withdrawal from a personal funds account, and

e. Maintaining a record for each deposit into and withdrawal from a personal funds account; and

2. The personal funds account is only initiated after receiving a written request that:

a. Is provided:

i. Voluntarily by the resident,

ii. By the resident’s representative, or

iii. By a court of competent jurisdiction;

b. May be withdrawn at any time; and

c. Is maintained in the resident’s record.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-703 repealed, new Section R9-10-703 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-704. Quality Management

An administrator shall ensure that:

1. A plan is established, documented, and implemented for an ongoing quality management program that, at a minimum, includes:

a. A method to identify, document, and evaluate incidents;

b. A method to collect data to evaluate services provided to residents;

c. A method to evaluate the data collected to identify a concern about the delivery of services related to resident care;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of services related to resident care; and

e. The frequency of submitting a documented report required in subsection (2) to the governing authority;

2. A documented report is submitted to the governing authority that includes:

a. An identification of each concern about the delivery of services related to resident care, and

b. Any change made or action taken as a result of the identification of a concern about the delivery of services related to resident care; and

3. The report required in subsection (2) and the supporting documentation for the report are maintained for at least 12 months after the date the report is submitted to the governing authority.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-704 repealed, new Section R9-10-704 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-705. Contracted Services

An administrator shall ensure that:

1. Contracted services are provided according to the requirements in this Article, and

2. A documented list of current contracted services is maintained that includes a description of the contracted services provided.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-705 repealed, new Section R9-10-705 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-706. Personnel

A. An administrator shall ensure that:

1. A personnel member is at least 21 years old,

2. An employee is at least 18 years old,

3. A student is at least 18 years old, and

4. A volunteer is at least 21 years old.

B. An administrator shall ensure that:

1. The qualifications, skills, and knowledge required for each type of personnel member:

a. Are based on:

i. The type of behavioral health services or physical health services expected to be provided by the personnel member according to the established job description, and

ii. The acuity of the residents receiving behavioral health services or physical health services from the personnel member according to the established job description; and

b. Include:

i. The specific skills and knowledge necessary for the personnel member to provide the expected behavioral health services or physical health services listed in the established job description,

ii. The type and duration of education that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected behavioral health services or physical health services listed in the established job description, and

iii. The type and duration of experience that may allow the personnel member to acquire the specific skills and knowledge for the personnel member to provide the expected behavioral health services or physical health services listed in the established job description;

2. A personnel member’s skills and knowledge are verified and documented:

a. Before the personnel member provides physical health services or behavioral health services, and

b. According to policies and procedures; and

3. The behavioral health residential facility has personnel members with the qualifications, experience, skills, and knowledge necessary to:

a. Provide the behavioral health services, physical health services, and ancillary services in the behavioral health residential facility’s scope of services;

b. Meet the needs of a resident; and

c. Ensure the health and safety of a resident.

C. For a behavioral health paraprofessional and a behavioral health technician, an administrator shall comply with the requirements in R9-10-114.

D. An administrator shall ensure that:

1. A written plan is developed and implemented to provide orientation specific to the duties of the personnel member, employee, volunteer, or student;

2. A personnel member completes orientation before providing services related to resident care;

3. An individual’s orientation is documented, to include:

a. The individual’s name,

b. The date of the orientation, and

c. The subject or topics covered in the orientation;

4. A written plan is developed and implemented to provide personnel member in-service education specific to the duties of the personnel member; and

5. A personnel member’s in-service education is documented, to include:

a. The personnel member’s name,

b. The date of the training, and

c. The subject or topics covered in the training.

E. An administrator shall ensure that a personnel member or an employee, volunteer, or student who has direct interaction with a resident, provides evidence of freedom from infectious tuberculosis as specified in R9-10-112.

F. An administrator shall ensure that a personnel member or employee record is maintained for each that contains:

1. The individual’s name, date of birth, home address, and contact telephone number;

2. The individual’s starting date of employment or volunteer service and, if applicable, the ending date; and

3. Documentation of:

a. The individual’s qualifications, including skills and knowledge applicable to the individual’s job duties;

b. The individual’s education and experience applicable to the individual’s job duties;

c. The individual’s completed orientation and in-service education as required by policies and procedures;

d. The individual’s license or certification, if the individual is required to be licensed or certified in this Article or policies and procedures;

e. If the behavioral health residential facility provides services to children, the individual’s compliance with the fingerprinting requirements in A.R.S. § 36-425.03;

f. If the individual is a behavioral health technician, clinical oversight required in R9-10-114;

g. Cardiopulmonary resuscitation training, if required for the individual according to R9-10-703(C)(1)(d);

h. First aid training, if required for the individual according to this Article or policies and procedures; and

i. Evidence of freedom from infectious tuberculosis, if required for the individual according to subsection (E).

G. An administrator shall ensure that personnel records are maintained:

1. Throughout an individual's period of providing services in or for the behavioral health residential facility; and

2. For at least two years after the last date the individual provided services in or for the behavioral health residential facility.

H. An administrator shall ensure that the following personnel members have first-aid and cardiopulmonary resuscitation training certification specific to the populations served by the behavioral health residential facility:

1. At least one personnel member who is present at the behavioral health residential facility during hours of behavioral health residential facility operation, and

2. Each personnel member participating in an outing.

I. An administrator shall ensure that:

1. At least one personnel member is present and awake at the behavioral health residential facility when a resident is on the premises;

2. In addition to the personnel member in subsection (I)(1), at least one personnel member is on-call and available to come to the behavioral health residential facility if needed;

3. The behavioral health residential facility has sufficient personnel members to provide general resident supervision and treatment and sufficient personnel members or employees to provide ancillary services to meet the scheduled and unscheduled needs of each resident;

4. There is a daily staffing schedule that:

a. Indicates the date, scheduled work hours, and name of each employee assigned to work, including on-call personnel members;

b. Includes documentation of the employees who work each calendar day and the hours worked by each employee;

c. Is maintained for 12 months after the last date on the documentation; and

d. Is provided to the Department for review within two hours of the Department’s request;

5. A behavioral health professional is present at the behavioral health residential facility or on-call;

6. A registered nurse is present at the behavioral health residential facility or on-call; and

7. If a resident requires services that the behavioral health residential facility is not licensed or able to provide, a personnel member arranges for the resident to be transported to a hospital or another health care institution where the services can be provided.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-706 repealed, new Section R9-10-706 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Amended by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-707. Admission; Assessment

A. An administrator shall ensure that:

1. A resident is admitted based upon the resident’s presenting behavioral health issue and treatment needs and the behavioral health residential facility’s scope of services;

2. A behavioral health professional, authorized by policies and procedures to accept a resident for admission, is available;

3. General consent is obtained from:

a. An adult resident or the resident’s representative before or at the time of admission, or

b. A resident’s representative, if the resident is not an adult;

4. The general consent obtained in subsection (A)(3) is documented in the resident’s medical record;

5. Except as provided in subsection (E)(1)(a), a medical practitioner performs a medical history and physical examination or a registered nurse performs a nursing assessment on a resident within 30 calendar days before admission or within seven calendar days after admission and documents the medical history and physical examination or nursing assessment in the resident’s medical record within seven calendar days after admission;

6. If a medical practitioner performs a medical history and physical examination or a nurse performs a nursing assessment on a resident before admission, the medical practitioner enters an interval note into or a nurse enters a progress note in the resident’s medical record at the time of admission;

7. Except as provided in subsection (A)(8), an assessment for a resident is completed before treatment for the resident is initiated;

8. If an assessment that complies with the requirements in this Section is received from a behavioral health provider other than the behavioral health residential facility or if the behavioral health residential facility has a medical record for the resident that contains an assessment that was completed within 12 months before the date of the resident’s current admission:

a. The resident’s assessment information is reviewed and updated if additional information that affects the resident’s assessment is identified, and

b. The review and update of the resident’s assessment information is documented in the resident’s medical record within 48 hours after the review is completed;

9. An assessment:

a. Documents a resident’s:

i. Presenting issue;

ii. Substance abuse history;

iii. Co-occurring disorder;

iv. Medical condition and history;

v. Legal history, including:

(1) Custody,

(2) Guardianship, and

(3) Pending litigation;

vi. Criminal justice record;

vii. Family history;

viii. Behavioral health treatment history;

ix. Symptoms reported by the resident; and

x. Referrals needed by the resident, if any;

b. Includes:

i. Recommendations for further assessment or examination of the resident’s needs,

ii. The physical health services or ancillary services that will be provided to the resident until the resident’s treatment plan is completed, and

iii. The signature and date signed of the personnel member conducting the assessment; and

c. Is documented in resident’s medical record; and

10. A resident is referred to a medical practitioner if a determination is made that the resident requires immediate physical health services or the resident’s behavioral health issue may be related to the resident’s medical condition.

B. An administrator shall ensure that:

1. A request for participation in a resident’s assessment is made to the resident or the resident’s representative,

2. An opportunity for participation in the resident’s assessment is provided to the resident or the resident’s representative, and

3. Documentation of the request in subsection (B)(1) and the opportunity in subsection (B)(2) is in the resident’s medical record.

C. An administrator shall ensure that a resident’s assessment information is documented in the medical record within 48 hours after completing the assessment.

D. An administrator shall ensure that:

1. A resident’s assessment information is reviewed and updated when additional information that affects the resident’s assessment is identified, and

2. A resident’s assessment information is completed and documented in the resident’s medical record within 48 hours after completing the resident’s assessment.

E. If a behavioral health residential facility provides respite services, an administrator shall ensure that:

1. Upon admission of a resident for respite services:

a. A medical history and physical examination of the resident:

i. Is performed; or

ii. Dated within the previous 12 months, is available in the resident’s medical record from a previous admission to the behavioral health residential facility;

b. A treatment plan that meets the requirements in R9-10-708:

i. Is developed; or

ii. Dated within the previous 12 months, is available in the resident’s medical record from a previous admission to the behavioral health residential facility; and

c. If a treatment plan, dated within the previous 12 months, is available, the treatment plan is reviewed, updated, and documented in the resident’s medical record;

2. The common area required in R9-10-722(B)(1)(b) provides at least 25 square feet for each resident including residents who do not stay overnight; and

3. In addition to the requirements in R9-10-722(B)(3), toilets and hand washing sinks are available to residents, including residents who do not stay overnight, as follows:

a. There is at least one working toilet that flushes and one sink with running water for every 10 residents;

b. There are at least two working toilets that flush and two sinks with running water if there are 11 to 25 residents; and

c. There is at least one additional working toilet that flushes and one additional sink with running water for each additional 20 residents.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-707 repealed, new Section R9-10-707 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-708. Treatment Plan

A. An administrator shall ensure that a treatment plan is developed and implemented for each resident that is:

1. Based on the assessment and on-going changes to the assessment of the resident;

2. Completed:

a. By a behavioral health professional or a behavioral health technician under the clinical oversight of a behavioral health professional, and

b. Before the resident receives physical health services or behavioral health services or within 48 hours after the assessment is completed;

3. Documented in the resident’s medical record within 48 hours after the resident first receives physical health services or behavioral health services;

4. Includes:

a. The resident’s presenting issue;

b. The physical health services or behavioral health services to be provided to the resident;

c. The signature of the resident or the resident’s representative, and date signed, or documentation of the refusal to sign;

d. The date when the resident’s treatment plan will be reviewed;

e. If a discharge date has been determined, the treatment needed after discharge; and

f. The signature of the personnel member who developed the treatment plan and the date signed;

5. If the treatment plan was completed by a behavioral health technician, reviewed and signed by a behavioral health professional within 24 hours after the completion of the treatment plan to ensure that the treatment plan is complete and accurate and meets the resident’s treatment needs; and

6. Is reviewed and updated on an on-going basis:

a. According to the review date specified in the treatment plan,

b. When a treatment goal is accomplished or changed,

c. When additional information that affects the resident’s assessment is identified, and

d. When a resident has a significant change in condition or experiences an event that affects treatment.

B. An administrator shall ensure that:

1. A request for participation in developing a resident’s treatment plan is made to the resident or the resident’s representative,

2. An opportunity for participation in developing the resident’s treatment plan is provided to the resident or the resident’s representative, and

3. Documentation of the request in subsection (B)(1) and the opportunity in subsection (B)(2) is in the resident’s medical record.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-708 repealed, new Section R9-10-708 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-709. Discharge

A. An administrator shall ensure that a discharge plan for a resident is:

1. Developed that:

a. Identifies any specific needs of the resident after discharge,

b. Is completed before discharge occurs,

c. Includes a description of the level of care that may meet the resident’s assessed and anticipated needs after discharge;

2. Documented in the resident’s medical record within 48 hours after the discharge plan is completed; and

3. Provided to the resident or the resident’s representative before the discharge occurs.

B. An administrator shall ensure that:

1. A request for participation in developing a resident’s discharge plan is made to the resident or the resident’s representative,

2. An opportunity for participation in developing the resident’s discharge plan is provided to the resident or the resident’s representative, and

3. Documentation of the request in subsection (B)(1) and the opportunity in subsection (B)(2) is in the resident’s medical record.

C. An administrator shall ensure that a resident is discharged from a behavioral health residential facility:

1. When the resident’s treatment goals are achieved, as documented in the resident’s treatment plan; or

2. When the resident’s treatment needs are not consistent with the services that the behavioral health residential facility is authorized or able to provide.

D. An administrator shall ensure that there is a documented discharge order by a medical practitioner before a resident is discharged unless the resident leaves the behavioral health residential facility against a medical practitioner’s advice.

E. An administrator shall ensure that at the time of discharge a resident receives a referral for treatment or ancillary services that the resident may need after discharge, if applicable.

F. If a resident is discharged to any location other than a health care institution, an administrator shall ensure that:

1. Discharge instructions are documented, and

2. The resident or the resident’s representative is provided with a copy of the discharge instructions.

G. An administrator shall ensure that a discharge summary for a resident:

1. Is entered into the resident’s medical record within 10 working days after a resident’s discharge; and

2. Includes:

a. The following information completed by a medical practitioner or a behavioral health professional:

i. The resident’s presenting issue and other physical health and behavioral health issues identified in the resident’s treatment plan;

ii. A summary of the treatment provided to the resident;

iii. The resident’s progress in meeting treatment goals, including treatment goals that were and were not achieved; and

iv. The name, dosage, and frequency of each medication ordered for the resident by a medical practitioner at the behavioral health residential facility at the time of the resident’s discharge; and

b. A description of the disposition of the resident’s possessions, funds, or medications brought to the behavioral health residential facility by the resident.

H. An administrator shall ensure that a resident who is dependent upon a prescribed medication is offered detoxification services, opioid treatment, or a written referral to detoxification services or opioid treatment, before the resident is discharged from the behavioral health residential facility if a medical practitioner for the behavioral health residential facility will not be prescribing the medication for the resident at or after discharge.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section R9-10-709 repealed, new Section R9-10-709 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed and a new Article adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-710. Transport; Transfer

A. Except for a transport of a resident due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transport and the services provided to the resident;

2. According to policies and procedures:

a. An evaluation of the resident is conducted before and after the transport,

b. Medical records are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transport to the resident or the resident’s representative; and

3. Documentation in the resident’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transport;

c. The mode of transportation; and

d. If applicable, the personnel member accompanying the resident during a transport.

B. Except for a transfer of a resident due to an emergency, an administrator shall ensure that:

1. A personnel member coordinates the transfer and the services provided to the resident;

2. According to policies and procedures:

a. An evaluation of the resident is conducted before the transfer,

b. Medical records including orders that are in effect at the time of the transfer are provided to a receiving health care institution, and

c. A personnel member explains risks and benefits of the transfer to the resident or the resident’s representative; and

3. Documentation in the resident’s medical record includes:

a. Communication with an individual at a receiving health care institution;

b. The date and time of the transfer;

c. The mode of transportation; and

d. If applicable, a personnel member accompanying the resident during a transfer.

Historical Note

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted effective October 30, 1989 (Supp. 89-4). Section R9-10-710 repealed, new Section R9-10-710 adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-711. Resident Rights

A. An administrator shall ensure that:

1. The requirements in subsection (B) and the resident rights in subsection (E) are conspicuously posted on the premises;

2. At the time of admission, a resident or the resident 's representative receives a written copy of the requirements in subsection (B) and the resident rights in subsection (E); and

3. Policies and procedures include:

a. How and when a resident or the resident’s representative is informed of the resident rights in subsection (E), and

b. Where resident rights are posted as required in subsection (A)(1).

B. An administrator shall ensure that:

1. A resident is treated with dignity, respect, and consideration;

2. A resident is not subjected to:

a. Abuse;

b. Neglect;

c. Exploitation;

d. Coercion;

e. Manipulation;

f. Sexual abuse;

g. Sexual assault;

h. Seclusion;

i. Restraint, if not necessary to prevent imminent harm to self or others;

j. Retaliation for submitting a complaint to the Department or another entity;

k. Misappropriation of personal and private property by a behavioral health residential facility’s personnel members, employees, volunteers, or students;

l. Discharge or transfer, or threat of discharge or transfer, for reasons unrelated to the resident’s treatment needs, except as established in a fee agreement signed by the resident or the resident 's representative; or

m. Treatment that involves the denial of:

i. Food,

ii. The opportunity to sleep, or

iii. The opportunity to use the toilet;

3. Except as provided in subsection (C) or (D), and unless restricted by the resident’s representative, is allowed to:

a. Associate with individuals of the resident’s choice, receive visitors, and make telephone calls during the hours established by the behavioral health residential facility;

b. Have privacy in correspondence, communication, visitation, financial affairs, and personal hygiene; and

c. Unless restricted by a court order, send and receive uncensored and unopened mail; and

4. A resident or the resident's representative:

a. Except in an emergency, either consents to or refuses treatment;

b. May refuse or withdraw consent to treatment before treatment is initiated, unless the treatment is ordered by a court according to A.R.S. Title 36, Chapter 5, is necessary to save the resident’s life or physical health, or is provided according to A.R.S. § 36-512;

c. Except in an emergency, is informed of proposed treatment alternatives to the treatment, associated risks, and possible complications;

d. Is informed of the following:

i. The behavioral health residential facility’s policy on health care directives, and

ii. The resident complaint process; and

e. Except as otherwise permitted by law, provides written consent to the release of the resident’s:

i. Medical records, and

ii. Financial records.

C. For a behavioral health residential facility with licensed capacity of less than 10 residents, if a behavioral health professional determines that a resident’s treatment requires the behavioral health residential facility to restrict the resident’s ability to participate in the activities in subsection (B)(3), the behavioral health professional shall:

1. Document a specific treatment purpose in the resident’s medical record that justifies restricting the resident from the activity,

2. Inform the resident or resident’s representative of the reason why the activity is being restricted, and

3. Inform the resident or resident’s representative of the resident’s right to file a complaint and the procedure for filing a complaint.

D. For a behavioral health residential facility with a licensed capacity of 10 or more residents, if a clinical director determines that a resident’s treatment requires the behavioral health residential facility to restrict the resident’s ability to participate in the activities in subsection (B)(3), the clinical director shall comply with the requirements in subsection (C)(1) through (3).

E. A resident has the following rights:

1. Not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis;

2. To receive treatment that:

a. Supports and respects the resident’s individuality, choices, strengths, and abilities;

b. Supports the resident’s personal liberty and only restricts the resident’s personal liberty according to a court order, by the resident’s or resident’s representative’s general consent, or as permitted in this Chapter; and

c. Is provided in the least restrictive environment that meets the resident’s treatment needs;

3. To receive privacy in treatment and care for personal needs, including the right not to be fingerprinted, photographed, or recorded without consent, except:

a. A resident may be photographed when admitted to a behavioral health residential facility for identification and administrative purposes;

b. For a resident receiving treatment according to A.R.S. Title 36, Chapter 37; or

c. For video recordings used for security purposes that are maintained only on a temporary basis;

4. Not to be prevented or impeded from exercising the resident’s civil rights unless the resident has been adjudicated incompetent or a court of competent jurisdiction has found that the resident is unable to exercise a specific right or category of rights;

5. To review, upon written request, the resident’s own medical record according to A.R.S. §§12-2293, 12-2294, and 12-2294.01;

6. To be provided locked storage space for the resident’s belongings while the resident receives treatment;

7. To have opportunities for social contact and daily social, recreational, or rehabilitative activities;

8. To be informed of the requirements necessary for the resident’s discharge or transfer to a less restrictive physical environment;

9. To receive a referral to another health care institution if the behavioral health residential facility is unable to provide physical health services or behavioral health services for the resident;

10. To participate or have the resident's representative participate in the development of or decisions concerning treatment;

11. To participate or refuse to participate in research or experimental treatment; and

12. To receive assistance from a family member, representative, or other individual in understanding, protecting, or exercising the resident’s rights.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-712. Medical Records

A. An administrator shall ensure that:

1. A medical record is established and maintained for each resident according to A.R.S. Title 12, Chapter 13, Article 7.1;

2. An entry in a resident’s medical record is:

a. Recorded only by a personnel member authorized by policies and procedures to make the entry;

b. Dated, legible, and authenticated; and

c. Not changed to make the initial entry illegible;

3. An order is:

a. Dated when the order is entered in the resident’s medical record and includes the time of the order;

b. Authenticated by a medical practitioner or behavioral health professional according to policies and procedures; and

c. If the order is a verbal order, authenticated by the medical practitioner or behavioral health professional issuing the order;

4. If a rubber-stamp signature or an electronic signature code is used to authenticate an order, the individual whose signature the stamp or electronic code represents is accountable for the use of the stamp or the electronic code;

5. A resident’s medical record is available to personnel members, medical practitioners, and behavioral health professionals authorized by policies and procedures;

6. Information in a resident’s medical record is disclosed to an individual not authorized under subsection (A)(5) only with the written consent of a resident or the resident’s representative, or as permitted by law;

7. Policies and procedures include the maximum time-frame to retrieve a resident’s medical record at the request of a medical practitioner, behavioral health professional, or authorized personnel member; and

8. A resident’s medical record is protected from loss, damage, or unauthorized use.

B. If a behavioral health residential facility maintains a resident’s medical records electronically, an administrator shall ensure that:

1. Safeguards exist to prevent unauthorized access, and

2. The date and time of an entry in a resident’s medical record is recorded by the computer’s internal clock.

C. An administrator shall ensure that a resident’s medical record contains:

1. Resident information that includes:

a. The resident’s name;

b. The resident’s address;

c. The resident’s date of birth;

d. The name and contact information of the resident’s representative, if applicable; and

e. Any known allergies, including medication;

2. The name of the admitting medical practitioner or behavioral health professional;

3. An admitting diagnosis or presenting behavioral health issues;

4. Documentation of general consent, and if applicable informed consent, for treatment by the resident or the resident’s representative except in an emergency;

5. Documentation of medical history and results of a physical examination;

6. A copy of resident’s health care directive, if applicable;

7. Orders;

8. Assessment;

9. Treatment plans;

10. Interval note;

11. Progress notes;

12. Documentation of behavioral health services and physical health services provided to the resident;

13. Disposition of the resident after discharge;

14. Discharge plan;

15. A discharge summary, if applicable;

16. If applicable:

a. Laboratory reports,

b. Radiologic reports,

c. Diagnostic reports, and

d. Consultation reports; and

17. Documentation of a medication administered to the resident that includes:

a. The date and time of administration;

b. The name, strength, dosage, and route of administration;

c. For a medication administered for pain when initially administered or PRN:

i. An assessment of the resident’s pain before administering the medication, and

ii. The effect of the medication administered;

d. For a psychotropic medication when initially administered or PRN:

i. An assessment of the resident’s behavior before administering the psychotropic medication, and

ii. The effect of the psychotropic medication administered;

e. The identification, signature, and professional designation of the individual administering or observing the self-administration of the medication; and

f. Any adverse reaction a resident has to the medication.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-713. Resident Outings

A. An administrator shall ensure that:

1. A vehicle owned or leased by a behavioral health residential facility to transport a resident:

a. Is safe and in good repair,

b. Contains a first aid kit,

c. Contains drinking water sufficient to meet the needs of each resident present in the vehicle, and

d. Contains a working heating and air conditioning system;

2. Documentation of current vehicle insurance for a vehicle owned or leased by the behavioral health residential facility is maintained;

3. A driver of a vehicle:

a. Is 21 years of age or older;

b. Has a valid driver license;

c. Does not wear headphones or operate any hand-held wireless communication devices or hand-held electronic entertainment devices while operating the vehicle;

d. Removes the keys from the vehicle and engages the emergency brake before exiting the vehicle or, if the vehicle locks in the park position, places the gear in the park position;

e. Does not leave in the vehicle an unattended:

i. Child,

ii. Resident who may be a threat to the health or safety of the resident or another individual, or

iii. Resident who is incapable of independent exit from the vehicle; and

f. Ensures the safe and hazard-free loading and unloading of residents; and

4. Transportation safety is maintained as follows:

a. Each individual in the vehicle is sitting in a seat and wearing a working seat belt while the vehicle is in motion, and

b. Each seat in the vehicle is securely fastened to the vehicle and provides sufficient space for a resident’s body.

B. An administrator shall ensure that:

1. An outing is consistent with the age, developmental level, physical ability, medical condition, and treatment needs of each resident participating in the outing;

2. At least two personnel members are present on an outing;

3. In addition to the personnel members required in subsection (B)(2), a sufficient number of personnel members are present to ensure each resident’s health and safety on the outing;

4. Documentation is developed before an outing that includes:

a. The name of each resident participating in the outing;

b. A description of the outing;

c. The date of the outing;

d. The anticipated departure and return times;

e. The name, address, and, if available, telephone number of the outing destination; and

f. If applicable, the license plate number of each vehicle used to transport a resident;

5. The documentation described in subsection (B)(4) is updated to include the actual departure and return times and is maintained for at least 12 months after the date of the outing; and

6. Emergency information for each resident participating in the outing is maintained by a personnel member participating in the outing or in the vehicle used to transport the resident on the outing and includes:

a. The resident’s name;

b. Medication information, including the name, dosage, route of administration, and directions for each medication needed by the resident during the anticipated duration of the outing;

c. The resident’s allergies; and

d. The name and telephone number of the individual to notify at the behavioral health residential facility in case of medical emergency or other emergency.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-714. Resident Time Out

An administrator shall ensure that a time out:

1. Is provided to a resident who voluntary decides to go in a time out;

2. Takes place in an area that is unlocked, lighted, quiet, and private;

3. Is time limited and does not exceed the amount of time as determined by the resident;

4. Does not result in a resident missing a meal if the resident is in time out at mealtime;

5. Includes monitoring of the resident by a personnel member at least once every 15 minutes to ensure the resident’s health and safety and to discuss with the resident if the resident is ready to leave time out; and

6. Is documented in the resident’s medical record, to include:

a. The date of the time out,

b. The reason for the time out,

c. The duration of the time out, and

d. The action planned and taken by the administrator to prevent the use of time out in the future.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-715. Physical Health Services

An administrator of a behavioral health residential facility that provides personal care services shall ensure that:

1. Personnel members who provide personal care services have documentation of completion of a caregiver training program that complies with A.A.C. R4-33-702(A)(5); and

2. Residents receive personal care services according to the requirements in R9-10-813(A), (C), (D), and (E).

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-716. Behavioral Health Services

A. An administrator shall ensure that:

1. If a behavioral health residential facility is licensed to provide behavioral health services to individuals whose behavioral health issue limits the individuals’ ability to function independently, a resident admitted to the behavioral health residential facility with limited ability to function independently, in addition to behavioral health services and personnel care services as indicated in the resident’s treatment plan, receives continuous protective oversight;

2. A resident admitted to the behavioral health residential facility who needs behavioral health services to maintain or enhance the resident’s ability to function independently, in addition to receiving behavioral health services, and, if indicated in the resident’s treatment plan, personal care services, is provided an opportunity to participate in activities designed to maintain or enhance the resident’s ability to function independently while caring for the resident’s health, safety, or personal hygiene or performing homemaking functions;

3. Behavioral health services are provided to meet the needs of a resident and consistent with a behavioral health residential facility’s scope of services;

4. Behavioral health services:

a. Listed in the behavioral health residential facility’s scope of services are provided on the premises; and

b. When in a setting or activity with more than one resident participating, are provided to residents having similar diagnoses, treatment needs, developmental levels, social skills, verbal skills, and personal histories, including any history of physical or sexual abuse, to ensure that the:

i. Health and safety of each resident is protected, and

ii. Treatment needs of each resident participating are being met; and

5. A resident does not:

a. Use or have access to any materials, furnishings, or equipment or participate in any activity or treatment that may present a threat to the resident’s health or safety based on the resident’s documented diagnosis, treatment needs, developmental levels, social skills, verbal skills, or personal history; or

b. Share any space, participate in any activity or treatment, or verbally or physically interact with any other resident that may present a threat to the resident’s health or safety based on the other resident’s documented diagnosis, treatment needs, developmental levels, social skills, verbal skills, and personal history.

B. An administrator shall ensure that counseling is:

1. Offered as described in the behavioral health residential facility’s scope of services,

2. Provided according to the frequency and number of hours identified in the resident’s treatment plan, and

3. Provided by a behavioral health professional or a behavioral health technician.

C. An administrator shall ensure that:

1. A personnel member providing counseling that addresses a specific type of behavioral health issue has the skills and knowledge necessary to provide the counseling that addresses the specific type of behavioral health issue; and

2. Each counseling session is documented in a resident’s medical record to include:

a. The date of the counseling session;

b. The amount of time spent in the counseling session;

c. Whether the counseling was individual counseling, family counseling, or group counseling;

d. The treatment goals addressed in the counseling session; and

e. The signature of the personnel member who provided the counseling and the date signed.

D. An administrator of a behavioral health residential facility that provides behavioral health residential services to individuals under 18 years of age:

1. May continue to provide behavioral health services to a resident who is 18 years of age:

a. If the resident:

i. Was admitted to the behavioral health residential facility before the resident’s 18th birthday;

ii. Is not 21 years of age or older; and

iii. Is:

(1) Attending classes or completing coursework to obtain a high school or a high school equivalency diploma, or

(2) Participating in a job training program; or

b. Through the last calendar day of the month of the resident’s 18th birthday; and

2. Shall ensure that:

a. A resident does not receive the following from other residents at the behavioral health residential facility:

i. Threats,

ii. Ridicule,

iii. Verbal harassment,

iv. Punishment, or

v. Abuse;

b. The interior of the behavioral health residential facility has furnishings and decorations appropriate to the ages of the resident receiving services at the behavioral health residential facility;

c. A resident older than three years of age does not sleep in a crib;

d. Clean and non-hazardous toys, educational materials, and physical activity equipment are available and accessible to residents on the premises in a quantity sufficient to meet each resident’s needs and are appropriate to each resident’s age, developmental level, and treatment needs; and

e. A resident’s educational needs are met, including providing or arranging for transportation:

i. By establishing and providing an educational component, approved in writing by the Arizona Department of Education; or

ii. As arranged and documented by the administrator through the local school district.

E. An administrator shall ensure that an emergency safety response is:

1. Only used:

a. By a personnel member trained to use an emergency safety response,

b. For the management of a resident’s violent or self-destructive behavior, and

c. When less restrictive interventions have been determined to be ineffective;

2. Discontinued at the earliest possible time, but no longer than five minutes after the emergency safety response is initiated; and

3. Documented as follows:

a. Within 24 hours after an emergency safety response is used for a resident, the following information is entered into the resident medical record:

i. The date and time the emergency safety response was used;

ii. The name of each personnel member who used an emergency safety response;

iii. The specific emergency safety response used;

iv. Personnel member or resident behavior, event, or environmental factor that caused the need for the emergency safety response; and

v. Any injury that resulted from the emergency safety response;

b. Within 10 working days after an emergency safety response is used for a resident, the administrator or clinical director reviews the information in subsection (E)(3)(a); and

c. After the review required in subsection (E)(3)(b), the following information is entered into the resident’s medical record:

i. Actions taken or planned actions to prevent the need for the use of an emergency safety response for the resident,

ii. A determination of whether the resident is appropriately placed at the behavioral health residential facility, and

iii. Whether the resident’s treatment plan was reviewed or needs to be reviewed and amended to ensure that the resident’s treatment plan is meeting the resident’s treatment needs.

F. An administrator shall ensure that:

1. A personnel member whose job description includes the ability to use an emergency safety response:

a. Completes training in crisis intervention that includes:

i. Techniques to identify personnel member and resident behaviors, events, and environmental factors that may trigger the need for the use of an emergency safety response;

ii. The use of nonphysical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods; and

iii. The safe use of an emergency safety response including the ability to recognize and respond to signs of physical distress in a client who is receiving an emergency safety response; and

b. Completes training required in subsection (F)(1)(a):

i. Before providing behavioral health services, and

ii. At least once every 12 months after the date the personnel member completed the initial training;

2. Documentation of the completed training in subsection (F)(1)(a) includes:

a. The name and credentials of the individual providing the training,

b. Date of the training, and

c. Verification of a personnel member’s ability to use the training; and

3. The materials used to provide the completed training in crisis intervention, including handbooks, electronic presentations, and skills verification worksheets, are maintained for 12 months after each personnel member who received training using the materials no longer provides services at the behavioral health residential facility.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-717. Outdoor Behavioral Health Care Programs

A. An administrator of a behavioral health residential facility providing an outdoor behavioral health care program shall ensure that:

1. Behavioral health services are provided to a resident participating in the outdoor behavioral health care program consistent with the age, developmental level, physical ability, medical condition, and treatment needs of the resident;

2. Continuous protective oversight is provided to a resident;

3. Transportation is provided to a resident from the behavioral health residential facility’s administration office for the outdoor behavioral health care program to the location where the outdoor behavioral health care program is provided and from the location where the outdoor behavioral health care program is provided to the behavioral health residential facility’s administration office for the outdoor behavioral health care program; and

4. Communication is available between the outdoor behavioral health care program personnel and:

a. A behavioral health professional,

b. A registered nurse,

c. An emergency medical response team, and

d. The behavioral health residential facility’s administration office for the outdoor behavioral health care program.

B. An administrator of a behavioral health residential facility providing an outdoor behavioral health care program shall ensure that:

1. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a resident such as cut, chopped, ground, pureed, or thickened;

2. A food menu is prepared based on the number of calendar days scheduled for the behavioral health care program;

3. Meals and snacks provided are served according to menus;

4. Meals for each day are planned using the applicable meal planning guides in http://www.fns.usda.gov/cnd/Care/ ProgramBasics/Meals/Meal_Pattern.htm;

5. A resident is provided:

a. A diet that meets the resident’s nutritional needs as specified in the resident’s assessment or treatment plan;

b. Three meals a day with not more than 14 hours between the evening meal and breakfast, except as provided in subsection (B)(5)(d);

c. The option to have a daily evening snack or other snack; and

d. The option to extend the time span between the evening meal and breakfast from 14 hours to 16 hours if the resident agrees;

6. Water is available and accessible to residents unless otherwise stated in a resident’s treatment plan;

7. Food is free from spoilage, filth, or other contamination and is safe for human consumption;

8. Food is protected from potential contamination; and

9. Food being maintained in coolers containing ice is not in direct contact with ice or water if water may enter the food because of the nature of the food’s packaging, wrapping, or container or the positioning of the food in the ice or water.

C. An administrator of a behavioral health residential facility providing an outdoor behavioral health care program shall ensure that:

1. The location and equipment, if applicable, used by the outdoor behavioral health care program are sufficient to accommodate the activities, treatment, and ancillary services required by the residents participating in the behavioral health care program;

2. The location and equipment are maintained in a condition that allows the location and equipment to be used for the original purpose of the location and equipment;

3. Garbage and refuse are:

a. Stored in plastic bags in covered containers, and

b. Removed from the location used by the outdoor behavioral health care program at least once a week;

4. Common areas:

a. Are lighted when in use to assure the safety of residents, and

b. Have sufficient lighting to allow personnel members to monitor resident activity;

5. The supply of hot and cold water is sufficient to meet the personal hygiene needs of residents and the cleaning and sanitation requirements in this Article;

6. Soiled clothing is stored in closed containers away from food storage, medications, and eating area;

7. Poisonous or toxic materials are maintained in labeled containers, secured, and separate from food preparation and storage, eating areas, and medications and inaccessible to residents;

8. Combustible or flammable liquids and hazardous materials are stored in the original labeled containers or safety containers, secured, and inaccessible to residents;

9. If a non-municipal water source is used:

a. The water source is tested at least once every 12 months for total coliform bacteria and fecal coli form or E. coli bacteria and corrective action is taken to ensure the water is safe to drink, and

b. Documentation of testing is retained for two years after the date of the test; and

10. Smoking or the use of tobacco products may be permitted away from the residents.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-718. Medication Services

A. If a behavioral health residential facility provides medication administration or assistance in the self-administration of medication, an administrator shall ensure that policies and procedures:

1. Include:

a. A process for providing information to a resident about medication prescribed for the resident including:

i. The prescribed medication’s anticipated results,

ii. The prescribed medication’s potential adverse reactions,

iii. The prescribed medication’s potential side effects, and

iv. Potential adverse reactions that could result from not taking the medication as prescribed;

b. Procedures for preventing, responding to, and reporting:

i. A medication error,

ii. An adverse response to a medication, or

iii. A medication overdose;

c. Procedures to ensure that a resident’s medication regimen is reviewed by a medical practitioner and meets the resident’s needs;

d. Procedures for documenting medication services and assistance in the self-administration of medication;

e. Procedures for assisting a resident in obtaining medication; and

f. If applicable, procedures for providing medication administration or assistance in the self-administration of medication off the premises; and

2. Specify a process for review through the quality management program of:

a. A medication administration error, and

b. An adverse reaction to a medication.

B. If a behavioral health residential facility provides medication administration, an administrator shall ensure that:

1. Policies and procedures for medication administration:

a. Are reviewed and approved by a medical practitioner;

b. Specify the individuals who may:

i. Order medication, and

ii. Administer medication;

c. Ensure that medication is administered to a resident only as prescribed; and

d. A resident’s refusal to take prescribed medication is documented in the resident’s medical record;

2. Verbal orders for medication services are taken by a nurse, unless otherwise provided by law;

3. A medication administered to a resident:

a. Is administered in compliance with an order, and

b. Is documented in the resident’s medical record;

4. If pain medication is administered to a resident, documentation in the resident’s medical record includes:

a. An identification of the resident’s pain before administering the pain medication, and

b. The effect of the pain medication administered; and

5. If a psychotropic medication is administered to a resident, documentation in the resident’s medical record includes:

a. An identification of the resident’s behavior before administering the psychotropic medication, and

b. The effect of the psychotropic medication administered.

C. If behavioral health residential facility provides assistance in the self-administration of medication, an administrator shall ensure that:

1. A resident’s medication is stored by the behavioral health residential facility;

2. The following assistance is provided to a resident:

a. A reminder when it is time to take the medication;

b. Opening the medication container for the resident;

c. Observing the resident while the resident removes the medication from the container;

d. Verifying that the medication is taken as ordered by the resident’s medical practitioner by confirming that:

i. The resident taking the medication is the individual stated on the medication container label,

ii. The dosage of the medication is the same as stated on the medication container label, and

iii. The medication is being taken by the resident at the time stated on the medication container label; or

e. Observing the resident while the resident takes the medication;

3. Policies and procedures for assistance in the self-administration of medication are reviewed and approved by a medical practitioner or a registered nurse;

4. Training for a personnel member, other than a medical practitioner or a registered nurse, in the self-administration of medication:

a. Is provided by a medical practitioner or a registered nurse or an individual trained by a medical practitioner or registered nurse; and

b. Includes:

i. A demonstration of the personnel member’s skills and knowledge necessary to provide assistance in the self-administration of medication,

ii. Identification of medication errors and medical emergencies related to medication that require emergency medical intervention, and

iii. Process for notifying the appropriate entities when an emergency medical intervention is needed;

5. A personnel member, other than a medical practitioner or a registered nurse, completes the training in subsection (C)(4) before the personnel member provides assistance in the self-administration of medication; and

6. Assistance with the self-administration of medication provided to a resident:

a. Is in compliance with an order, and

b. Is documented in the resident’s medical record.

D. An administrator shall ensure that:

1. A current drug reference guide is available for use by personnel members;

2. A current toxicology reference guide is available for use by personnel members; and

3. If pharmaceutical services are provided on the premises:

a. A committee, composed of at least on physician, one pharmacist, and other personnel members as determined by policies and procedures is established to:

i. Develop a drug formulary;

ii. Update the drug formulary at least every 12 months;

iii. Develop medication usage and medication substitution policies and procedures; and

iv. Specify which medication and medication classifications are required to be automatically stopped after a specific time period unless the ordering medical staff member specifically orders otherwise;

b. The pharmaceutical services are provided under the direction of a pharmacist;

c. The pharmaceutical services comply with A.R.S. Title 36, Chapter 27; A.R.S. Title 32, Chapter 18; and 4 A.A.C. 23; and

d. A copy of the pharmacy license is provided to the Department upon request.

E. When medication is stored at a behavioral health residential facility, an administrator shall ensure that:

1. There is a separate room, closet, or self-contained unit used for medication storage that includes a lockable door;

2. If medication is stored in a separate room or closet, a locked cabinet is used for medication storage;

3. Medication is stored according to the instructions on the medication container; and

4. Policies and procedures are established, documented, and implemented for:

a. Receiving, storing, inventorying, tracking, dispensing, and discarding medication including expired medication;

b. Discarding or returning prepackaged and sample medication to the manufacturer if the manufacturer requests the discard or return of the medication;

c. A medication recall and notification of residents who received recalled medication; and

d. Storing, inventorying, and dispensing controlled substances.

F. An administrator shall ensure that a personnel member immediately reports a medication error or a resident’s adverse reaction to a medication to the medical practitioner who ordered the medication and, if applicable, the behavioral health residential facility’s clinical director.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-719. Food Services

A. Except for an outdoor behavioral health care program provided by a behavioral health residential facility, an administrator shall ensure that:

1. For a behavioral health residential facility that has more than 10 residents:

a. The behavioral health residential facility is licensed as a food establishment under 9 A.A.C. 8, Article 1; and

b. A copy of the behavioral health residential facility’s food establishment license is maintained;

2. If a behavioral health residential facility contracts with food establishment, as defined in 9 A.A.C. 8, Article 1, to prepare and deliver food to the behavioral health residential facility, a copy of the food establishment's license under 9 A.A.C. 8, Article 1 is maintained by the behavioral health residential facility;

3. Food is stored, refrigerated, and reheated to meet the dietary needs of a resident;

4. A registered dietitian is employed full-time, part-time, or as a consultant; and

5. If a registered dietitian is not employed full-time, an individual is designated as a director of food services who consults with a registered dietitian as often as necessary to meet the nutritional needs of the residents.

B. Except for an outdoor behavioral health care program provided by a behavioral health residential facility, a registered dietitian or director of food services shall ensure that:

1. Food is prepared:

a. Using methods that conserve nutritional value, flavor, and appearance; and

b. In a form to meet the needs of a resident such as cut, chopped, ground, pureed, or thickened;

2. A food menu:

a. Is prepared at least one week in advance,

b. Includes the foods to be served each day,

c. Is conspicuously posted at least one calendar day before the first meal on the food menu will be served,

d. Includes any food substitution no later than the morning of the day of meal service with a food substitution, and

e. Is maintained for at least 60 calendar days after the last calendar day included in the food menu;

3. Meals and snacks provided by the behavioral health residential facility are served according to posted menus;

4. Meals for each day are planned using the applicable meal planning guides in http://www.fns.usda.gov/cnd/Care/ ProgramBasics/Meals/Meal_Pattern.htm;

5. A resident is provided:

a. A diet that meets the resident’s nutritional needs as specified in the resident’s assessment or treatment plan;

b. Three meals a day with not more than 14 hours between the evening meal and breakfast except as provided in subsection (B)(5)(d);

c. The option to have a daily evening snack identified in subsection (B)(5)(d)(ii) or other snack; and

d. The option to extend the time span between the evening meal and breakfast from 14 hours to 16 hours if:

i. The resident agrees; and

ii. The resident is offered an evening snack that includes meat, fish, eggs, cheese, or other protein, and a serving from either the fruit and vegetable food group or the bread and cereal food group;

6. A resident requiring assistance to eat is provided with assistance that recognizes the resident’s nutritional, physical, and social needs, including the use of adaptive eating equipment or utensils; and

7. Water is available and accessible to residents unless otherwise stated in a resident’s treatment plan.

C. Except for an outdoor behavioral health care program provided by a behavioral health residential facility, an administrator shall ensure that food is obtained, prepared, served, and stored as follows:

1. Food is free from spoilage, filth, or other contamination and is safe for human consumption;

2. Food is protected from potential contamination;

3. Potentially hazardous food is maintained as follows:

a. Foods requiring refrigeration are maintained at 41° F or below; and

b. Foods requiring cooking are cooked to heat all parts of the food to a temperature of at least 145° F for 15 seconds, except that:

i. Ground beef and ground meats are cooked to heat all parts of the food to at least 155° F;

ii. Poultry, poultry stuffing, stuffed meats and stuffing containing meat are cooked to heat all parts of the food to at least 165° F;

iii. Pork and any food containing pork are cooked to heat all parts of the food to at least 155° F;

iv. Raw shell eggs for immediate consumption are cooked to at least 145° F for 15 seconds and any food containing raw shell eggs is cooked to heat all parts of the food to at least 155 °F;

v. Roast beef and beef steak are cooked to an internal temperature of at least 155° F; and

vi. Leftovers are reheated to a temperature of at least 165° F;

4. A refrigerator contains a thermometer, accurate to plus or minus 3° F, placed at the warmest part of the refrigerator;

5. Frozen foods are stored at a temperature of 0° F or below; and

6. Tableware, utensils, equipment, and food-contact surfaces are clean and in good repair.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-720. Emergency and Safety Standards

A. Except for an outdoor behavioral health care program provided by a behavioral health residential facility, an administrator shall ensure that a behavioral health residential facility has:

1. A fire alarm system installed according to the National Fire Protection Association 72: National Fire Alarm Code, Chapter 3, Section 3-4.1.1(a), incorporated by reference in A.A.C. R9-1-412, and a sprinkler system installed according to the National Fire Protection Association 13 standards incorporated by reference in A.A.C. R9-1-412; or

2. An alternative method to ensure resident's safety that is documented and approved by the local jurisdiction.

B. Except for an outdoor behavioral health care program provided by a behavioral health residential facility, an administrator shall ensure that:

1. An evacuation drill for employees and residents on the premises is conducted at least once every three months on each shift;

2. Documentation of each evacuation drill is created, is maintained for 12 months after the date of the evacuation drill, and includes:

a. The date and time of the evacuation drill;

b. The amount of time taken for all employees and residents to evacuate the behavioral health residential facility;

c. Names of employees participating in the evacuation drill;

d. An identification of residents needing assistance for evacuation;

e. Any problems encountered in conducting the evacuation drill; and

f. Recommendations for improvement, if applicable;

3. A written evacuation plan is developed and maintained in a location accessible to personnel members and other employees;

4. An evacuation path is conspicuously posted on each hallway of each floor of the behavioral health residential facility; and

5. A written disaster plan is developed, documented, maintained in a location accessible to personnel members and other employees, and, if necessary, implemented that includes:

a. When, how, and where residents will be relocated;

b. How each resident’s medical record will be available to personnel providing services to the resident during a disaster;

c. A plan to ensure each resident's medication will be available to administer to the resident during a disaster; and

d. A plan for obtaining food and water for individuals present in the behavioral health residential facility, under the care and supervision of personnel members, or in the behavioral health residential facility's relocation site during a disaster.

C. An administrator shall:

1. Obtain a fire inspection conducted according to the time-frame established by the local fire department or the State Fire Marshal,

2. Make any repairs or corrections stated on the fire inspection report, and

3. Maintain documentation of a current fire inspection.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-721. Environmental Standards

A. Except for an outdoor behavioral health care program provided by a behavioral health residential facility, an administrator shall ensure that:

1. The premises and equipment are:

a. Maintained in a condition that allows the premises and equipment to be used for the original purpose of the premises and equipment;

b. Cleaned and, if applicable, disinfected according to policies and procedures designed to prevent, minimize, and control illness or infection; and

c. Free from a condition or situation that may cause a resident or other individual to suffer physical injury;

2. A pest control program is implemented and documented;

3. Biohazardous medical waste is identified, stored, and disposed of according to 18 A.A.C. 13, Article 14 and policies and procedures;

4. Equipment is:

a. Tested and calibrated according to the manufacturer's recommendations or, if there are no manufacturer's recommendations, as specified in policies and procedures; and

b. Used according to the manufacturer's recommendations;

5. Documentation of equipment testing, calibration, and repair is maintained for at least 12 months after the date of the testing, calibration, or repair;

6. Garbage and refuse are:

a. Stored in covered containers lined with plastic bags, and

b. Removed from the premises at least once a week;

7. Heating and cooling systems maintain the behavioral health residential facility at a temperature between 70° F and 84° F;

8. A space heater is not used;

9. Common areas:

a. Are lighted to assure the safety of residents, and

b. Have lighting sufficient to allow personnel members to monitor resident activity;

10. Hot water temperatures are maintained between 95° F and 120° F in the areas of the behavioral health residential facility used by residents;

11. The supply of hot and cold water is sufficient to meet the personal hygiene needs of residents and the cleaning and sanitation requirements in this Article;

12. Soiled linen and soiled clothing stored by the behavioral health residential facility are maintained separate from clean linen and clothing and stored in closed containers away from food storage, kitchen, and dining areas;

13. Oxygen containers are secured in an upright position;

14. Poisonous or toxic materials stored by the behavioral health residential facility are maintained in labeled containers in a locked area separate from food preparation and storage, dining areas, and medications and are inaccessible to residents;

15. Combustible or flammable liquids and hazardous materials stored by a behavioral health residential facility are stored in the original labeled containers or safety containers in a storage area outside the behavioral health residential facility or in an attached garage that is locked and inaccessible to residents;

16. Pets or animals are:

a. Controlled to prevent endangering the residents and to maintain sanitation;

b. Licensed consistent with local ordinances; and

c. Vaccinated as follows:

i. A dog is vaccinated against rabies; and

ii. A cat is vaccinated against rabies;

17. If a non-municipal water source is used:

a. The water source is tested at least once every 12 months for total coliform bacteria and fecal coliform or E. coli bacteria and corrective action is taken to ensure the water is safe to drink;

b. If necessary, corrective action is taken to ensure the water is safe to drink; and

c. Documentation of testing is retained for 24 months after the date of the test; and

18. If a non-municipal sewage system is used, the sewage system is in working order and is maintained according to all applicable state laws and rules.

B. An administrator shall ensure that:

1. Smoking or the use of tobacco products is not permitted within a behavioral health residential facility; and

2. Smoking and the use of tobacco products may be permitted on the premises outside a behavioral health residential facility if:

a. Signs designating smoking areas are conspicuously posted, and

b. Smoking is prohibited in areas where combustible materials are stored or in use.

C. If a swimming pool is located on the premises, an administrator shall ensure that:

1. On each day that a resident uses the swimming pool, an employee:

a. Tests the swimming pool’s water quality at least once for compliance with one of the following chemical disinfection standards:

i. A free chlorine residual between 1.0 and 3.0 ppm as measured by the N, N-Diethyl-p-phenylenediamine test;

ii. A free bromine residual between 2.0 and 4.0 ppm as measured by the N, N-Diethyl-p-phenylenediamine test; or

iii. An oxidation-reduction potential equal to or greater than 650 millivolts; and

b. Records the results of the water quality tests in a log that includes each testing date and test result;

2. Documentation of the water quality test is maintained for at least 12 months after the date of the test;

3. A swimming pool is not used by a resident if a water quality test shows that the swimming pool water does not comply with subsection (C)(1)(a);

4. At least one personnel member with cardiopulmonary resuscitation training that meets the requirements in R9-10-703(C)(1)(d), is present in the pool area when a resident is in the pool area; and

5. At least two personnel members are present in the pool area if two or more residents are in the pool area.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-722. Physical Plant Standards

A. Except for a behavioral health outdoor program, an administrator shall ensure that the premises and equipment are sufficient to accommodate:

1. The services in the behavioral health residential facility’s scope of services, and

2. An individual accepted as a resident by the behavioral health residential facility.

B. An administrator shall ensure that:

1. A behavioral health residential facility has a:

a. Room that provides privacy for a resident to receive treatment or visitors; and

b. Common area and a dining area that:

i. Are not converted, partitioned, or otherwise used as a sleeping area; and

ii. Contain furniture and materials to accommodate the recreational and socialization needs of the residents and other individuals in the behavioral health residential facility;

2. A bathroom is available for use by visitors during the behavioral health residential facility's hours of operation that:

a. Provides privacy; and

b. Contains:

i. A working sink with running water,

ii. A working toilet that flushes and has a seat,

iii. Toilet tissue,

iv. Soap for hand washing,

v. Paper towels or a mechanical air hand dryer,

vi. Lighting, and

vii. A window that opens or another means of ventilation;

3. For every six residents who stay overnight at the behavioral health residential facility, there is at least one working toilet that flushes and one sink with running water;

4. For every eight residents who stay overnight at the behavioral health residential facility, there is at least one working bathtub or shower;

5. A resident bathroom provides privacy when in use and contains:

a. A shatter-proof mirror, unless the resident’s treatment plan requires otherwise;

b. A window that opens or another means of ventilation; and

c. Nonporous surfaces for shower enclosures and slip-resistant surfaces in tubs and showers;

6. If a resident bathroom door locks from the inside, an employee has a key and access to the bathroom;

7. Each resident is provided a bedroom for sleeping; and

8. A resident bedroom complies with the following:

a. Is not used as a common area;

b. Is not used as a passageway to another bedroom or bathroom unless the bathroom is for the exclusive use of an individual occupying the bedroom;

c. Contains a door that opens into a hallway, common area, or outdoors;

d. Is constructed and furnished to provide unimpeded access to the door;

e. Has window or door covers that provide resident privacy;

f. Has floor to ceiling walls;

g. Is a:

i. Private bedroom that contains at least 60 square feet of floor space, not including the closet; or

ii. Shared bedroom that:

(1) Is shared by no more than eight residents;

(2) Except as provided in subsection (C), contains at least 60 square feet of floor space, not including a closet, for each individual occupying the shared bedroom; and

(3) Provides at least three feet of floor space between beds or bunk beds;

h. Contains for each resident occupying the bedroom:

i. A bed that is at least 36 inches wide and at least 72 inches long, and consists of at least a frame and mattress and linens; and

ii. Individual storage space for personal effects and clothing such as shelves, a dresser, or chest of drawers;

i. Has clean linen for each bed including mattress pad, sheets large enough to tuck under the mattress, pillows, pillow cases, bedspread, waterproof mattress covers as needed, and blankets to ensure warmth and comfort for each resident;

j. Has sufficient lighting for a resident occupying the bedroom to read; and

k. Has a clothing rod or hook in the bedroom designed to minimize the opportunity for a resident to cause self-injury.

C. A behavioral health residential facility that was licensed as a Level 4 transitional agency before October 1, 2013 may continue to use a shared bedroom that provides at least 40 square feet of floor space, not including a closet, for each individual occupying the shared bedroom. If there is a modification to the shared bedroom, the behavioral health residential facility shall comply with the requirement in subsection (B)(8)(g).

D. If a swimming pool is located on the premises, an administrator shall ensure that:

1. The swimming pool is equipped with the following:

a. An operational water circulation system that clarifies and disinfects the swimming pool water continuously and that includes at least:

i. A removable strainer,

ii. Two swimming pool inlets located on opposite sides of the swimming pool, and

iii. A drain located at the swimming pool’s lowest point and covered by a grating that cannot be removed without using tools; and

b. An operational vacuum cleaning system;

2. The swimming pool is enclosed by a wall or fence that:

a. Is at least five feet in height as measured on the exterior of the wall or fence;

b. Has no vertical openings greater that four inches across;

c. Has no horizontal openings, except as described in subsection (D)(2)(e);

d. Is not chain-link;

e. Does not have a space between the ground and the bottom fence rail that exceeds four inches in height; and

f. Has a self-closing, self-latching gate that:

i. Opens away from the swimming pool,

ii. Has a latch located at least five feet from the ground, and

iii. Is locked when the swimming pool is not in use; and

3. A life preserver or shepherd’s crook is available and accessible in the pool area.

E. An administrator shall ensure that a spa that is not enclosed by a wall or fence as described in subsection (D)(2) is covered and locked when not in use.

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Section repealed; new Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under exempt rulemaking (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-723. Repealed

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Repealed by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

Editor’s Note: The following Section was repealed under exempt rulemaking (Supp. 13-2).

Editor’s Note: The following Section was adopted under an exemption from the provisions of the Administrative Procedure Act which means these rules were not reviewed by the Governor’s Regulatory Review Council; the Department did not submit notice of proposed rulemaking to the Secretary of State for publication in the Arizona Administrative Register; and the Department was not required to hold public hearings on these rules (Supp. 98-4).

R9-10-724. Repealed

Historical Note

Adopted effective November 1, 1998, under an exemption from the provisions of the Administrative Procedure Act pursuant to Laws 1998, Ch. 178, § 17; filed with the Office of the Secretary of State October 2, 1998 (Supp. 98-4). Repealed by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2).

ARTICLE 8. ASSISTED LIVING FACILITIES

R9-10-801. Definitions

In addition to the definitions in A.R.S. § 36-401 and R9-10-101, the following definitions apply in this Article, unless the context otherwise requires:

1. “Accept” or “acceptance” means:

a. An individual begins living in a