TITLE 9. HEALTH SERVICES

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3).

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. Adult day health care facility,

5. Adult foster care,

6. Assisted living center,

7. Assisted living home,

8. Home health agency,

9. Hospice,

10. Hospice inpatient facility,

11. Nursing care institution,

12. Home health agency,

13. Abortion clinic,

14. Recovery care center,

15. Outpatient surgical center, or

16. Outpatient treatment center.

B. A health care institution shall comply with the requirements in R9-10-115 if:

1. There are no specific rules in 9 A.A.C. 10 or 9 A.A.C. 20 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).

R9-10-103. Licensure Exceptions

A. Except for R9-10-122, this Article does not apply to a behavioral health service agency regulated under 9 A.A.C. 20.

B. 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.

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

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

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

a. Adjacent to the licensed health care institution; or

b. Not adjacent to the licensed health care institution but is connected to the licensed health care institution by an all-weather enclosure and that is:

i. Owned by the health care institution, or

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

3. A mobile clinic operated by a licensed health care institution.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3).

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 R9-1-412, an applicant shall submit to the Department an application packet including:

1. An application form 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. The requested licensed capacity 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 and the requested licensed capacity 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 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; and

f. If providing or planning to provide medical services, which require compliance with specific physical plant codes and standards incorporated by reference in R9-1-412, the number of rooms or inpatient beds designated for providing the medical 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 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 form complies with applicable codes and standards incorporated by reference in 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 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 on a form 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 on a form 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 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 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 R9-10-122.

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).

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

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

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

e. 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;

f. 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;

g. The name and address of the governing authority;

h. 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 licensure is requested; and

i. Signature required in A.R.S. § 36-422(B) that is notarized;

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, one of the following:

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

b. If 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 R9-1-412:

i. Documentation from the local jurisdiction of compliance with all applicable local building codes and zoning ordinances;

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

iii. 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 premises, and, if applicable, each swimming pool on the health care premises; and

iv. 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; and

6. The applicable application fee required by R9-10-122.

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).

R9-10-106. Reserved

R9-10-107. Renewal License

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

1. A renewal application on a form 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; and

ii. Class or subclass;

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 licensure is requested; and

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

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 licensure fees required by R9-10-122.

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 or 9 A.A.C. 20 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 inspection of the health care institution as part of the substantive review for a renewal license.

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, if a licensee is in substantial compliance with the applicable statutes and this Chapter, and the licensee agrees to implement a plan acceptable to the Department to eliminate any deficiencies;

2. Two years, if a licensee has no deficiencies at the time of the Department's licensure inspection; or

3. The duration of the accreditation period, 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 accreditation report.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3).

R9-10-108. Time-frames

A. The overall time-frame for each type of approval granted by the Department is listed in Table 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. 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(E):

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 days from 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 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 R9-10-122 to the Department within 60 days of 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 days of 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 R9-10-122.

6. An applicant may file a written notice of appeal with the Department within 30 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 business day to be the time-frame's last day.

Table 1

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).

R9-10-109. Changes Affecting a License

A. A licensee shall ensure that the Department is notified in writing at least 30 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. 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 R9-1-412 shall submit an application for approval of architectural plans and specifications for a modification of the health care institution.

C. A governing authority shall submit a 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, or health-related services on the premises; or

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

D. 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) if:

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

E. A licensee of a health care institution that is not required to comply with the physical plant codes and standards incorporated by reference in 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 a 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.

F. The Department shall approve or deny a request for a change or modification in this Section according to R9-10-108.

G. A licensee shall not implement a change or modification described in this Section until an amended license or a new 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).

R9-10-110. Enforcement Actions

A. If the Department determines that an applicant or licensee is not in substantial compliance with applicable laws and rules, 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 R9-10-111 and A.R.S. § 36-427,

6. Deny a license under 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 threat to the health, safety, and welfare of patients in the health care institution based on:

1. Repeated violations of statutes or rules,

2. Pattern of non-compliance,

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).

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

The Department may deny, revoke, or suspend a license to operate a health care institution if an applicant, a licensee, or a person with a business interest of 10% or more in the health care institution:

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, endangering the health and safety of patients.

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).

R9-10-112. 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 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. "Dialyzer" means a blood filter used in hemodialysis to remove wastes and excess fluid from a patient's blood.

10. "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.

11. "Direct supervision" means a nurse or a physician is physically present within sight or hearing of the patient and readily available to provide care to a patient.

12. "Electrolytes" means compounds, such as sodium, potassium, and calcium that break apart into electrically charged particles when dissolved in water.

13. "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.

14. "Fistula" means a vascular access created by a surgical connection between an artery and vein.

15. "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.

16. "Germicide-negative test" means a determination that a chemical used to kill microorganisms is not present.

17. "Germicide-positive test" means a determination that a chemical used to kill microorganisms is present.

18. "Graft" means a vascular access created by a surgical connection between an artery and vein using a synthetic tube.

19. "Hemodialysis" means a process for removing wastes and excess fluids from a patient's blood by passing the blood through a dialyzer.

20. "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.

21. "Hemodialysis technician" has the same meaning as in A.R.S. § 36-423.

22. "Hemodialysis technician trainee" means an individual who is working in a health care institution after March 31, 2003 to assist in providing hemodialysis and who is not certified as a hemodialysis technician according to A.R.S. § 36-423(A).

23. "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.

24. "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.

25. "Medical records" has the same meaning as in A.R.S. § 12-2291.

26. "Nephrologist" means a physician who specializes in the structure, function, and diseases of the kidney.

27. "Not established" means not approved for use by the patient's nephrologist.

28. "Patient" means an individual who receives hemodialysis.

29. "pH test" means a determination of the acidity of a dialysate.

30. "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.

31. "Respond" means to mute, shut off, reset, or troubleshoot an alarm.

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

33. "Vascular access" means the point created on a patient's body where blood lines are connected for hemodialysis.

34. "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 after passing all didactic, skills and competency examinations; 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 hemodialyisis; or

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

E. An inexperienced hemodialysis technician trainee may perform, under direct supervision, any of the hemodialysis tasks listed in subsection (D) after the inexperienced hemodialysis technician trainee has passed the didactic, skills and competency examination applicable to the hemodialysis task.

F. 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.

G. 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.

H. 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.

I. The effective date of this Section is April 1, 2003.

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).

R9-10-113. Repealed

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).

R9-10-114. Repealed

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).

R9-10-115. Unclassified Health Care Institutions

Implementation of the provisions of R9-10-114(B) shall be at the sole discretion of the Director or the Director's representative. Health care institutions not otherwise classified or subclassified in R9-10-114(A) shall include but need not be limited to the following:

1. Be adequately equipped and staffed by qualified personnel to meet the needs and assure the safety of persons attending the facility and conform to all applicable statutory requirements for the provision of health care.

2. Establish and maintain a record of each inpatient and outpatient documenting the assessment of the patient's health needs and all health care service the patient receives.

3. Maintain all parts of the facility, including its premises and equipment, neat, clean, free of insects, rodents, litter and rubbish. Policies and procedures shall be established and implemented for cleaning, sanitizing or sterilizing equipment and supplies.

4. Cause the facility's physical plant and equipment to be periodically inspected and, where appropriate, tested, calibrated, serviced or repaired to assure that they are functioning properly and reliably. Records shall be maintained to assure that appropriate inspections and maintenance of equipment is periodically accomplished by an appropriately qualified person.

5. Comply with applicable regulations adopted pursuant to A.R.S. § 36-136(G) for the control of communicable disease and maintenance of proper sanitation.

6. Comply with applicable fire and building codes.

7. Adopt policies and procedures that delineate the scope of services offered, hours of operation, admission and discharge criteria and type of staff provided.

8. Obtain certificates of need and/or permits, if applicable.

Historical Note

Adopted effective February 4, 1981 (Supp. 81-1).

R9-10-116. Repealed

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).

R9-10-117. Repealed

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).

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. 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 $50.00.

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 license fee as follows:

1. For a facility with no licensed capacity, $100.00;

2. For a facility with a licensed capacity of one to 59 beds, $100.00, plus the licensed capacity times $25.00;

3. For a facility with a licensed capacity of 60 to 99 beds, $200.00, plus the licensed capacity times $25.00;

4. For a facility with a licensed capacity of 100 to 149 beds, $300.00, plus the licensed capacity times $25.00; or

5. For a facility with a licensed capacity of 150 beds or more, $500.00, plus the licensed capacity times $25.00.

D. A person who has paid a health care institution license fee for a facility and submits a behavioral health service agency application for the same facility shall submit an application fee but is not required to submit an additional license fee.

E. 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.

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

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).

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 A.A.C. Title 9, Chapter 10, Article 1, the following definitions apply in this Article:

1. "Accredited" has the same meaning as in A.R.S. § 36-422(I).

2. "Activities of daily living" means bathing, dressing, grooming, eating, ambulating, and toileting.

3. "Acuity" means a patient's need for hospital services based on the patient's medical condition.

4. "Acuity plan" means a method for establishing nursing personnel requirements by unit based on a patient's acuity.

5. "Administrator" means a chief administrative officer, or an individual who has been designated by the governing authority to act on its behalf in the onsite direction of the hospital.

6. "Admission" or "admitted" means documented acceptance by a hospital of an individual as an inpatient on the order of a medical staff member.

7. "Adult" means an individual the hospital designates as an adult based on the hospital's criteria.

8. "Adverse reaction" means an unexpected outcome that threatens the health and safety of a patient as a result of medical services provided to the patient.

9. "Anesthesiologist" means a physician granted clinical privileges to administer anesthesia.

10. "Assessment" means an analysis of a patient's current medical condition and need for hospital services.

11. "Attending physician" means a physician with clinical privileges who is accountable for the management of medical services delivered to a patient.

12. "Attending physician's designee" means a physician, physician assistant, registered nurse practitioner, or medical staff member who has clinical privileges and is authorized by medical staff bylaws to act on behalf of the attending physician.

13. "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 already appears on the document or in the medical record;

c. A rubber-stamp signature; or

d. An electronic signature code.

14. "Available" means:

a. For an individual, the ability to be contacted by any means possible such as by telephone or pager;

b. For equipment and supplies, retrievable at a hospital; and

c. For a document, retrievable at a hospital or accessible according to the time-frames in the applicable rules in this Article.

15. "Biohazardous medical waste" has the same meaning as in A.A.C. R18-13-1401.

16. "Biologicals" mean medicinal compounds prepared from living organisms and their products such as serums, vaccines, antigens, and antitoxins.

17. "Care plan" means a documented guide for providing nursing services and rehabilitative services to a patient that includes measurable objectives and the methods for meeting the objectives.

18. "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.

19. "Clinical privilege" means authorization to a medical staff member to provide medical services granted by a governing authority or according to medical staff bylaws.

20. "Communicable disease" has the same meaning as in A.A.C. R9-6-101.

21. "Consultation" means an evaluation of a patient requested by a medical staff member.

22. "Contracted services" means hospital services provided according to a written agreement between a hospital and the person providing the hospital services.

23. "Controlled substance" has the same meaning as in A.R.S. § 36-2501.

24. "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 patient or patient's representative.

25. "Current" means up-to-date and extending to the present time.

26. "Device" has the same meaning as in A.R.S. § 32-1901.

27. "Diet" means food and drink provided to a patient.

28. "Diet manual" means a written compilation of diets.

29. "Dietary services" means providing food and drink to a patient according to an order.

30. "Disaster" means an unexpected adverse occurrence that affects a hospital's ability to provide hospital services.

31. "Discharge" means a hospital's termination of hospital services to an inpatient or an outpatient.

32. "Discharge instructions" means written information relevant to a patient's medical condition provided by a hospital to the patient at the time of discharge.

33. "Discharge planning" means a process of establishing goals and objectives for an inpatient in preparation for the inpatient's discharge.

34. "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.

35. "Documentation" or "documented" means information in written, photographic, electronic, or other permanent form.

36. "Drill" means a response to a planned, simulated event.

37. "Drug" has the same meaning as in A.R.S. § 32-1901.

38. "Drug formulary" means a written compilation of medication developed according to R9-10-217.

39. "Electronic" has the same meaning as in A.R.S. § 44-7002.

40. "Electronic signature" has the same meaning as in A.R.S. § 44-7002.

41. "Emergency" means an immediate threat to the life or health of a patient.

42. "Emergency services" means unscheduled medical services provided in a designated area to an outpatient in an emergency.

43. "Environmental services" means activities such as housekeeping, laundry, and facility and equipment maintenance.

44. "Exploitation" has the same meaning as in A.R.S. § 46-451.

45. "General hospital" means a subclass of hospital that provides surgical services and emergency services.

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

47. "Health care directive" has the same meaning as in A.R.S. § 36-3201.

48. "Hospital" means a class of health care institution that provides, through an organized medical staff, inpatient beds, medical services, and continuous nursing services for the diagnosis and treatment of patients.

49. "Hospital premises" means a hospital's licensed space excluding, if applicable, space in an accredited outpatient facility under the hospital's single group license, or space leased by the hospital to another entity according to the lease terms.

50. "Hospital services" means medical services, nursing services, and other health-related services provided in a hospital.

51. "Incident" means an unexpected occurrence that harms or has the potential to harm a patient while the patient is on a hospital's premises.

52. "Infection control risk assessment" means determining the risk for transmission of communicable diseases.

53. "Informed consent" means advising a patient of a proposed medical procedure, alternatives to the medical procedure, associated risks, and possible complications, and obtaining authorization of the patient or the patient's representative for the procedure.

54. "Inpatient" means an individual who:

a. Is admitted to a hospital; or

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

55. "Inservice education" means organized instruction or information related to hospital services provided to a personnel member or a medical staff member.

56. "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 hospital policies and procedures.

57. "Interval note" means documentation updating a patient's medical condition after a medical history and physical examination are performed.

58. "License" means documented authorization:

a. Issued by the Department to operate a health care institution; or

b. Issued to an individual to practice a profession in this state.

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

60. "Medical condition" means the state of a patient's physical or mental health, including the patient's illness, injury, or disease.

61. "Medical history" means a part of a patient's medical record consisting of an account of the patient's health, including past and present illnesses or diseases.

62. "Medical record" has the same meaning as in A.R.S. § 12-2291.

63. "Medical staff member" means a physician or other licensed individual who has clinical privileges in a hospital.

64. "Medical staff bylaws" means standards, approved by the medical staff and governing authority, that provides the framework for the organization, responsibilities and self-governance of the medical staff.

65. "Medical staff regulations" means standards, approved by the medical staff, that govern the day-to-day conduct of the medical staff members.

66. "Medication" has the same meaning as drug.

67. "Monitor" or "monitoring" means observing a patient's medical condition.

68. "Neonate" means an individual:

a. From birth until discharge following birth; or

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

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

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

71. "Nurse executive" means a registered nurse accountable for the direction of nursing services provided in a hospital.

72. "Nursery" means an area in a hospital designated only for neonates.

73. "Nurse supervisor" means a registered nurse accountable for managing nursing services provided in an organized service in a hospital.

74. "Nursing personnel" means an individual authorized by hospital policies and procedures to provide nursing services to a patient.

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

76. "On call" means a time during which an individual is available and required to come to a hospital when requested by the hospital.

77. "Order" means an instruction to provide medical services, as authorized by the governing authority, to a patient by:

a. A medical staff member,

b. An individual licensed under A.R.S. Title 32 or authorized by a hospital within the scope of the individual's license, or

c. A physician who is not a medical staff member.

78. "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.

79. "Orientation" means the initial instruction and information provided to an individual starting work in a hospital.

80. "Outpatient" means an individual who:

a. Is not admitted to a hospital; or

b. Receives hospital services for less than 24 consecutive hours.

81. "Pathology" means an examination of human tissue for the purpose of diagnosis or treatment of an illness or disease.

82. "Patient" means an individual receiving hospital services.

83. "Patient care" means hospital services provided to a patient by a personnel member or a medical staff member.

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

85. "Pediatric" means pertaining to an individual designated by a hospital as a child based on the hospital's criteria.

86. "Perinatal services" means medical services for the treatment and management of obstetrical patients and neonates.

87. "Person" has the same meaning as in A.R.S. § 1-215 and includes governmental agencies.

88. "Personnel member" means:

a. A volunteer, or

b. An individual, except for a medical staff member or private duty staff, who provides hospital services for compensation, including an individual who is compensated by an employment agency.

89. "Pharmacist" has the same meaning as in A.R.S. § 32-1901.

90. "Physical examination" means to observe, test, or inspect an individual's body to evaluate health or determine cause of illness or disease.

91. "Postanesthesia care unit" means a designated area for monitoring a patient following a medical procedure for which anesthesia was administered to the patient.

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

93. "Psychiatric services" means the diagnosis, treatment, and management of mental illness.

94. "Quality management program" means activities designed and implemented by a hospital to improve the delivery of hospital services.

95. "Registered dietitian" means an individual approved to work as a dietitian by the American Dietetic Association's Commission on Dietetic Registration.

96. "Rehabilitation services" means medical services provided to a patient to restore or to optimize functional capability.

97. "Registered nurse" has the same meaning as in A.R.S. § 32-1601.

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

99. "Restraint" means any chemical or physical method of restricting a patient's freedom of movement, physical activity, or access to the patient's own body.

100. "Require" means to carry out an obligation imposed by this Article.

101. "Risk" means potential for an adverse outcome.

102. "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, and that elects to be licensed as a rural general hospital rather than a general hospital.

103. "Satellite facility" has the same meaning as in A.R.S. § 36-422(I).

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

105. "Shift" means the beginning and ending time of a work period established by hospital policies and procedures.

106. "Single group license" means a license that includes authorization to operate health care institutions according to A.R.S. § 36-422(F) and (G).

107. "Social services" means assistance, other than medical services, provided by a personnel member to a patient to meet the needs of the patient while in the hospital or the anticipated needs of the patient after discharge.

108. "Social worker" means an individual who has at least a baccalaureate degree in social work from a program accredited by the Council on Social Work Education or who is certified according to A.R.S. Title 32, Chapter 33.

109. "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.

110. "Specialty" means a specific area of medicine practiced by a licensed individual who has obtained education or qualifications in the specific area in addition to the education or qualifications required for the individual's license.

111. "Student" means an individual attending an educational institution and working under supervision in a hospital through an arrangement between the hospital and the educational institution.

112. "Surgical services" means medical services involving the excision or incision of a patient's body for the:

a. Correction of a deformity or a defect;

b. Repair of an injury; or

c. Diagnosis, amelioration, or cure of disease.

113. "Telemedicine" has the same meaning as in A.R.S. § 36-3601.

114. "Transfer" means a hospital 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 hospital.

115. "Transfusion" means the introduction of blood or blood products from one individual into the body of another individual.

116. "Transport" means a hospital sending a patient to another health care institution for outpatient medical services with the intent of returning the patient to the sending hospital.

117. "Treatment" means a procedure or method to cure, improve, or palliate a medical condition.

118. "Unit" means a designated area of an organized service.

119. "Verification" means:

a. A documented telephone call including the information obtained, the date, and the name of the documenting individual;

b. A documented observation including the information observed, the date, and the name of the documenting individual; or

c. A documented confirmation of a fact including the date and the name of the documenting individual.

120. "Vital records" has the same meaning as in A.R.S. § 36-301.

121. "Vital statistics" has the same meaning as in A.R.S. § 36-301.

122. "Volunteer" means an individual, except a student, authorized by a hospital to work in the hospital who does not receive compensation.

123. "Well-baby bassinet" means a receptacle used for holding a neonate who does not require treatment and whose anticipated discharge is within 96 hours of 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).

R9-10-202. Application Requirements

A. In addition to the license application requirements in A.R.S. § 36-422 and A.A.C. Title 9, Chapter 10, Article 1, a governing authority applying for an initial or renewal license shall submit the following to the Department:

1. For a hospital license:

a. A statement on a form provided by the Department of the licensed capacity requested for the hospital, including the number of inpatient beds for each organized service, not including well-baby bassinets.

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

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

2. For a single group license authorized in A.R.S. § 36-422(F) or (G):

a. The items listed in subsection (A)(1); and

b. A form provided by the Department that includes:

i. The name, address, and telephone number of each accredited facility under the single group license;

ii. The name of the administrator for each accredited facility; and

iii. The specific times each accredited facility provides medical services.

B. An administrator shall:

1. Notify the Department when there is a change in administrator according to A.R.S. § 36-425(E);

2. Notify the Department at least 30 days before an accredited facility on a single group license terminates operations; and

3. Submit an application, according to the requirements in A.A.C. Title 9, Chapter 10, Article 1, at least 60 days but not more than 120 days before an accredited facility licensed under a single group license anticipates providing medical 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).

R9-10-203. Administration

A. A governing authority shall:

1. Consist of one or more individuals accountable for the organization, operation, and administration of a hospital;

2. Determine which organized services are to be provided in the hospital;

3. Appoint an administrator in writing who:

a. Has a baccalaureate degree or a post-baccalaureate degree in a health care-related field;

b. Has at least three years of experience in health care administration; or

c. On December 5, 2006, was currently employed as an administrator in a licensed hospital;

4. Approve hospital policies and procedures or designate an individual to approve hospital policies and procedures;

5. Approve medical staff bylaws and medical staff regulations;

6. Approve contracted services or designate an individual to approve contracted services;

7. 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 bylaws;

8. Adopt a quality management program according to R9-10-204;

9. Review and evaluate the effectiveness of the quality management program at least once every 12 months;

10. Appoint an acting administrator if the administrator is expected to be absent for more than 30 days;

11. Except if subsection (A)(10) applies, notify the Department in writing within five working days if there is a change of administrator and identify the name and qualifications of the new administrator;

12. For a health care institution under a single group license, comply with the applicable requirements in A.A.C. Title 9, Chapter 10 and Chapter 20 for the class or subclass of the health care institution; and

13. Comply with federal and state laws, rules, and local ordinances governing operations of a health care institution.

B. An administrator shall:

1. Be directly accountable to the governing authority for all hospital services and environmental services provided by a hospital;

2. Have the authority and responsibility to manage the hospital;

3. Act as a liaison between the governing authority and personnel; and

4. Designate, in writing, an individual who is available and accountable for hospital services and environmental services when the administrator is not available;

C. An administrator shall require that:

1. Hospital policies and procedures are established, documented, and implemented that:

a. Include personnel job descriptions, duties, and qualifications;

b. Cover orientation and inservice education for personnel, volunteers, and students;

c. Include duties of volunteers and students;

d. Include how a personnel member may submit a complaint relating to patient care;

e. Cover cardiopulmonary resuscitation training required in R9-10-206(6) 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 personnel have received cardiopulmonary resuscitation training;

f. Cover use of private duty staff, if applicable;

g. 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;

h. Include a method to identify a patient to ensure the patient receives medical services as ordered;

i. Cover patient rights;

j. Cover health care directives;

k. Cover medical records, including electronic medical records;

l. Cover quality management, including incident documentation;

m. Cover tissue and organ procurement and transplant; and

n. Cover hospital visitation, including visitations to a nursery, if applicable;

2. Hospital policies and procedures for hospital services are established, documented, and implemented that:

a. Cover patient admission, transport, transfer, discharge planning, and discharge;

b. Cover acuity, including a process for obtaining sufficient nursing personnel to meet the needs of patients at all times;

c. Include when informed consent is required;

d. Include the age criteria for providing hospital services to pediatric patients;

e. Cover dispensing, administering, and disposing of medication and biologicals;

f. Cover infection control;

g. Cover restraints that require an order, including the frequency of monitoring and assessing the restraint;

h. Cover seclusion of a patient including:

i. The requirements for an order, and

ii. The frequency of monitoring and assessing a patient in seclusion;

i. Cover telemedicine, if applicable; and

j. Cover environmental services that affect patient care;

3. Hospital policies and procedures are reviewed at least once every 36 months and updated as needed;

4. Hospital policies and procedures are available to personnel and medical staff;

5. Licensed capacity in an organized service is not exceeded except for an emergency admission of a patient. If the licensed capacity of an organized service is exceeded:

a. A medical staff member reviews the medical history of a patient scheduled to be admitted to the organized service to determine whether the admission is an emergency; and

b. A patient is not admitted to the organized service except in an emergency;

6. A patient is free from:

a. The intentional infliction of physical, mental, or emotional pain unrelated to the patient's medical condition;

b. Exploitation;

c. Seclusion or restraint if not medically indicated or necessary to prevent harm to self or others;

d. Sexual abuse according to A.R.S. § 13-1404;

e. Sexual assault according to A.R.S. § 13-1406; and

f. A pattern of failure to provide hospital services without the informed consent of the patient or the patient's representative that results or may result in risk to the health and safety of the patient as determined by:

i. The number of incidents;

ii. How the incidents are related to each other;

iii. When the incidents occurred; and

iv. The amount of time between the incidents.

D. An administrator of a special hospital shall require that:

1. Medical services are available to an inpatient in an emergency based on the inpatient's medical conditions and the type of medical services provided by the special hospital; and

2. A physician or a nurse, qualified in cardiopulmonary resuscitation, is on the hospital premises at all times.

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).

R9-10-204. Quality Management

A. A governing authority shall require 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, including contracted services.

B. An administrator shall require 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;

d. A method to make changes or take action as a result of the identification of a concern about the delivery of hospital services;

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; and

b. Any changes made or actions taken as a result of the identification of a concern about the delivery of hospital services;

3. The acuity plan required in R9-10-208(C)(2) is reviewed and evaluated every 12 months and the results are documented and reported to the governing authority; and

4. The reports required in subsections (B)(2) and (3) and the supporting documentation for the reports are:

a. Maintained on the hospital premises for 12 months from the date the report is submitted to the governing authority; and

b. Except for information or documents that are confidential under federal or state law, provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the 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).

R9-10-205. Contracted Services

An administrator shall require that:

1. Contracted services are provided according to the requirements in this Article;

2. A contract includes the responsibilities of each contractor;

3. A documented list of current contracted services is maintained at the hospital that includes a description of the contracted services provided; and

4. A contract and the list of contracted services required in subsection (3) is provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the request.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 2785, effective October 1, 2002 (Supp. 02-2).

R9-10-206. Personnel

An administrator shall require that:

1. Personnel are available to meet the needs of a patient based on the acuity plan required in R9-10-208(C)(2);

2. A personnel member who provides medical services or nursing services demonstrates competency and proficiency according to criteria established in hospital policies and procedures for each type of unit and each type of patient to which the personnel member is assigned;

3. Before the initial date of providing hospital services or volunteer service, a personnel member submits one of the following as evidence of freedom from infectious pulmonary tuberculosis according to the requirements in R9-10-229(A)(4):

a. A report of a negative Mantoux skin test;

b. If the individual has had a positive Mantoux skin test for tuberculosis, a physician's written statement that the individual is free from infectious pulmonary tuberculosis; or

c. A report of a negative chest x-ray;

4. Orientation occurs within the first 30 days of providing hospital services or volunteer service and includes:

a. Informing personnel 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 hospital policies and procedures;

5. Hospital 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 days of the individual's starting date; and

b. Required to maintain current qualifications in cardiopulmonary resuscitation;

6. Documentation of current qualifications in cardiopulmonary resuscitation is maintained at the hospital;

7. A personnel record for each personnel member is maintained electronically or in writing or a combination of both and includes:

a. Verification by the personnel member of receipt of the position job description for the position held by the personnel member;

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. Verification of current cardiopulmonary resuscitation qualifications, if necessary for the position held; and

e. Orientation documentation;

8. Personnel receive inservice education according to criteria established in hospital policies and procedures;

9. Inservice education documentation for each personnel member includes:

a. The subject matter;

b. The date of the inservice education; and

c. The signature, rubber stamp, or electronic signature code of each individual who participated in the inservice education;

10. Personnel records and inservice education documentation are maintained by the hospital for at least two years after the last date the personnel member worked; and

11. Personnel records and inservice education documentation are provided upon request to the Department for review:

a. For a current personnel member, as soon as possible but not more than four hours from the time of the Department's request; and

b. For a personnel member who is not currently working in the hospital, within 24 hours of 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).

R9-10-207. 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 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 patients 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 patients 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, performing an autopsy, and notifying the attending physician when an autopsy is performed;

f. Requiring that each inpatient has an attending physician;

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 patient medical records;

k. Establishing criteria for granting 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;

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 require that:

1. By October 1, 2003, a medical staff member submits one of the following as evidence of freedom from infectious pulmonary tuberculosis according to the requirements in R9-10-229(A)(4):

a. A report of a negative Mantoux skin test;

b. If the individual has had a positive Mantoux skin test for tuberculosis, a physician's written statement that the individual is free from infectious pulmonary tuberculosis; or

c. A report of a negative chest x-ray;

2. A record for each medical staff member is established and maintained electronically or in writing or a combination of both 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;

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 four hours from the time of the Department's request if the individual is a current medical staff member; and

b. Within 72 hours from 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).

R9-10-208. Nursing Services

A. An administrator shall:

1. Require that nursing services are provided 24 hours a day; and

2. Appoint a nurse executive who is qualified according to the requirements specified in the hospital's 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 require 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 obtain the nursing personnel necessary to meet patient acuity;

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 at all times whether or not there is a patient;

6. A general hospital has two registered nurses on duty at all times when there is more than one patient;

7. A special hospital that is licensed to provide behavioral health services complies with the staffing requirements in A.A.C. Title 9, Chapters 10 and 20;

8. A special hospital offering emergency services or obstetrical services has two registered nurses on duty at all times when there is more than one patient;

9. A special hospital not offering emergency services or obstetrical services has at least one registered nurse and one other nurse on duty at all times when there is more than one patient;

10. A rural general hospital with more than one patient has one registered nurse and at least one other nursing personnel on duty at all times. 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 of being called;

11. If a hospital has a patient in a unit, there is a minimum of one registered nurse in the unit at all times;

12. If a hospital has more than one patient in a unit, there is a minimum of one registered nurse and one additional nursing personnel in the unit at all times;

13. 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 postanesthesia care unit;

14. Nursing personnel work schedules are planned, reviewed, adjusted, and documented to meet patient needs and emergencies;

15. A registered nurse assesses, plans, directs, and evaluates nursing services provided to a patient;

16. There is a care plan for each inpatient based on the inpatient's need for nursing services; and

17. Nursing personnel document nursing services in a patient's medical record.

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).

R9-10-209. Patient Rights

A. An administrator shall require that:

1. A patient:

a. Is treated with consideration, respect, and dignity, and receives privacy in treatment and activities of daily living; and

b. Has access to a telephone;

2. A patient or the patient's representative:

a. Either consents to or refuses treatment, if capable of doing so;

b. May refuse examination, or withdraw consent for treatment before treatment is initiated;

c. May submit grievances without retaliation;

d. Is informed of:

i. Proposed medical procedures, alternatives to the medical procedures, associated risks, and possible complications;

ii. How to obtain a schedule of hospital rates and charges required in A.R.S. § 36-436.01(B);

iii. The hospital's patient grievance policies and procedures, including the telephone number of hospital personnel to contact about grievances, and the Department's telephone number if the hospital is unable to resolve the patient's grievance; 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;

3. A patient or the patient's representative is provided a description of the hospital's health care directives policies and procedures:

a. If an inpatient, at the time of admission; or

b. If an outpatient:

i. Before any invasive procedure, except phlebotomy for obtaining blood for diagnostic purposes; or

ii. If the hospital services include a planned series of treatments, at the start of each series;

4. There are hospital policies and procedures that include:

a. How and when a patient or the patient's representative is informed of patient rights in subsections (1) and (2); and

b. Where patient rights are posted in the hospital;

5. A patient or the patient's representative receives a written statement of patient's rights; and

6. Medical record information is disclosed only with the written consent of a patient or the patient's representative or as permitted by law.

B. The requirements in subsections (A)(2)(a), (A)(2)(d)(i), (A)(3), and (A)(4) do not apply in an emergency.

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).

R9-10-210. Admission

An administrator shall require that:

1. A patient is admitted on the order of a medical staff member;

2. An individual, authorized by hospital policies and procedures, is available at all times 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 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 of admission;

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).

R9-10-211. Discharge Planning; Discharge

A. For an inpatient, an administrator shall require 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, an administrator shall require 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 patient's attending physician or the attending physician's designee;

2. There is a documented discharge order by an attending physician or the attending physician's designee before discharge unless the patient leaves the hospital against a medical staff member's advice; and

3. If the patient is discharged to any location other than a health care institution:

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 require that an outpatient is discharged according to hospital policies and procedures.

D. For a discharge of an outpatient receiving emergency services, an administrator shall require:

1. A discharge order is documented by an attending physician or the attending physician's designee 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.

E. A patient transferred to another hospital is exempt from the requirements in this Section. An administrator shall require that a transfer of a patient to another hospital complies with the requirements in R9-10-213.

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).

R9-10-212. Transport

A. For a transport of a patient, the administrator of a sending hospital shall require that:

1. Hospital policies and procedures:

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; and

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 professional 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 require that:

1. Hospital policies and procedures:

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 hospital 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 professional assisting in the transport if an order requires that a patient be assisted during transport.

C. A sending hospital and a receiving hospital that are licensed at separate locations and have the same Medicare number issued by the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services are exempt from subsections (A)(1)(d), (B)(1)(c), and (B)(1)(d).

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).

R9-10-213. Transfer

A. For a transfer of a patient, the administrator of a sending hospital shall require that:

1. Hospital policies and procedures:

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 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 professional assisting in the transfer if an order requires that a patient be assisted during transfer.

B. A sending hospital and a receiving hospital that are licensed at separate locations and have the same Medicare number issued by the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services are exempt from subsections (A)(1)(c), (A)(2) and (A)(3)(a).

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).

R9-10-214. Surgical Services

A. An administrator of a general hospital shall require 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 from 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 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 hospital policies and procedures; and

14. Within 24 hours after a surgical procedure is completed:

a. The surgeon performing the surgery documents the surgical technique, findings, and tissue removed or altered, if applicable; and

b. The individual performing the postoperative follow-up examination completes 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 R9-10-214 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).

R9-10-215. Anesthesia Services

An administrator shall require 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

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).

R9-10-216. Emergency Services

A. An administrator of a general hospital or a rural general hospital shall require 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 from 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 require 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 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).

R9-10-217. Pharmaceutical Services

An administrator shall require 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 A.A.C. Title 4, Chapter 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 hospital 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, medication categories, and biologicals 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 or biological is disposed of according to hospital 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 hospital policies and procedures have access to a locked area containing a medication or biological;

8. A medication or biological is maintained at temperatures recommended by the manufacturer;

9. A cart used for an emergency:

a. Contains medication, supplies, and equipment as specified in hospital 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 hospital policies and procedures;

11. There are hospital policies and procedures that specify individuals who may:

a. Order medication and biologicals; and

b. Administer medication and biologicals;

12. A medication or biological is administered in compliance with an order;

13. A medication or a biological administered to a patient is documented as required in R9-10-228;

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. Hospital 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).

R9-10-218. Clinical Laboratory Services and Pathology Services

An administrator shall require 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 at all times laboratory personnel authorized by hospital policies and procedures to perform testing;

6. A hospital that offers surgical services shall provide pathology services within the hospital or by contract 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. There are hospital policies and procedures 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 hospital 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).

R9-10-219. Radiology Services and Diagnostic Imaging Services

A. An administrator shall require that:

1. Radiology services and diagnostic imaging services are provided in compliance with A.R.S. Title 30, Chapter 4 and A.A.C. Title 12, Chapter 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 at all times; 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 and diagnostic imaging services in the hospital shall require 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 patient 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).

R9-10-220. Intensive Care Services

A. A general hospital or special hospital may provide intensive care services. A rural general hospital shall not provide intensive care services.

B. An administrator of a hospital that provides intensive care services shall require that:

1. Intensive care services are provided as an organized service in a designated area under the direction of a medical staff member;

2. A patient 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 hospital policies and procedures;

5. In addition to the requirements in R9-10-208(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 R9-10-208;

6. Each intensive care unit has a policy and procedure that provides for meeting the needs of the patients at all times;

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 qualified in advanced cardiopulmonary resuscitation specific to the age of the patient;

10. Resuscitation, emergency, and other equipment are available at all times 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 R9-10-217.

C. A special hospital providing only psychiatric services and licensed according to A.R.S. Title 36, Chapters 4 and 5, is not subject to the requirements in this Section.

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).

R9-10-221. Respiratory Care Services

An administrator of a hospital that provides respiratory care services shall require 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 R9-10-218.

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).

R9-10-222. Perinatal Services

A. An administrator of a hospital that provides perinatal organized services shall require 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 hospital 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 from 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 hospital policies and procedures before moving the neonate from a delivery area;

11. There are hospital policies and procedures that 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 is:

a. 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 R9-10-211;

15. Intensive care services for neonates comply with the requirements in R9-10-220;

16. A minimum of one registered nurse is on duty in a nursery at all times 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 R9-10-216(C).

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).

R9-10-223. Pediatric Services

A. An administrator of a hospital that provides pediatric organized services shall require that:

1. Pediatric services are provided in a designated area under the direction of a medical staff member;

2. Consistent with the health and safety of a pediatric patient, arrangements are made for a parent or a guardian of a pediatric patient to stay overnight; and

3. There are hospital policies and procedures 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.

B. An administrator of a hospital that provides pediatric intensive care services shall require that the pediatric intensive care services comply with intensive care services requirements in R9-10-220.

C. An administrator of a hospital that does not provide pediatric organized services may admit a pediatric patient only in an emergency and shall require that:

1. The pediatric patient is not placed in a patient room with an adult patient; and

2. Consistent with the health and safety of a pediatric patient, arrangements are made for a parent or a guardian of a pediatric patient to stay overnight.

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).

R9-10-224. Psychiatric Services

An administrator of a hospital that provides psychiatric organized services shall require that the hospital is in compliance with A.R.S. Title 36, Chapters 4 and 5, A.A.C. Title 9, Chapter 20, and this Chapter.

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).

R9-10-225. Rehabilitation Services

An administrator shall require 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 hospital 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).

R9-10-226. Social Services

An administrator of a hospital that provides social services shall require 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 a 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).

R9-10-227. Dietary Services

An administrator shall require that:

1. Dietary services are provided according to A.A.C. Title 9, Chapter 8, Article 1;

2. A copy of the hospital's food establishment license under A.A.C. Title 9, Chapter 8, Article 1, is provided to the Department for review upon the Department's request;

3. For a hospital that contracts with a food establishment to prepare and deliver food to the hospital, a copy of the contracted food establishment's license under A.A.C. Title 9, Chapter 8, Article 1, is:

a. Maintained on the hospital premises, and

b. Provided to the Department for review upon the Department's request;

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 hospital policies and procedures;

6. There are personnel members on duty to meet the dietary needs of all patients;

7. Personnel members providing dietary services are qualified to provide dietary services according to hospital policies and procedures;

8. A nutrition assessment of a patient is:

a. Performed according to hospital policies and procedures; and

b. Communicated to the attending physician or the attending physician's designee 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

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).

R9-10-228. Medical Records

A. An administrator shall require that:

1. A medical record is established and maintained for each patient;

2. An entry in a medical record is:

a. Recorded only by a personnel member authorized by hospital 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 medical record and includes the time of the order if required by medical staff bylaws;

b. Authenticated by a medical staff member or the organized medical staff according to medical staff bylaws or hospital policies and procedures; and

c. Authenticated by the individual entering the order in the medical record if the order is an oral or telephone 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 medical record is available to personnel members and medical staff members authorized by hospital policies and procedures to access the medical record;

6. Information in a medical record is disclosed to an individual not authorized under subsection (5) only with the written consent of a patient or the patient's representative or as permitted by law;

7. A medical record is maintained under the direction of an individual:

a. Who is qualified to maintain the medical record according to hospital policies and procedures, or

b. Who consults with an individual qualified according to hospital policies and procedures;

8. There are hospital policies and procedures that include:

a. The length of time a medical record is maintained on the hospital premises; and

b. The maximum time-frame to retrieve an onsite or off-site medical record at the request of a medical staff member or authorized personnel member;

9. A medical record of a patient is provided to the Department:

a. As soon as possible but not more than four hours from the time of the Department's request if the patient was discharged within 12 months from the date of the Department's request, or

b. Within 24 hours from the time of the Department's request if the patient was discharged more than 12 months from the date of the Department's request;

10. A medical record is:

a. Protected from loss, damage, or unauthorized use; and

b. According to A.R.S. § 12-2297;

11. Vital records and vital statistics are maintained for at least 10 years according to A.R.S. § 36-343; and

12. If a hospital discontinues hospital services, the Department is notified in writing, not less than 30 days before hospital services are discontinued, of the location where the medical records are stored.

B. If a hospital maintains medical records electronically, an administrator shall require that:

1. There are safeguards 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 require 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. A designated patient representative, if applicable; and

e. Any known allergy including medication or biological allergies or sensitivities;

2. Medication information that includes:

a. The patient's weight;

b. A medication or biological ordered for the patient; and

c. A medication or biological 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 or biological; and

iv. Any adverse reaction the patient has to the medication or biological;

3. Documented 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 attending physician;

8. All orders;

9. All care plans;

10. A record of hospital services provided to the patient;

11. Notes by medical staff members, nursing or other personnel members;

12. Disposition of the patient after discharge;

13. Discharge instructions required in R9-10-211(B)(3);

14. A discharge summary; and

15. If applicable:

a. A laboratory report required in R9-10-218;

b. A radiologic report required in R9-10-219;

c. A diagnostic report;

d. Documentation of restraint; and

e. A consultation report;

D. An administrator shall require 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. A designated patient representative, if applicable; and

e. If necessary for treatment, any known allergy including medication or biological allergies or sensitivities;

2. If necessary for treatment, medication information that includes:

a. The patient's weight;

b. A medication or biological ordered for the patient; and

c. A medication or biological 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 or biological; and

iv. Any adverse reaction the patient has to the medication or biological;

3. Documented informed consent by the patient or the patient's representative, except in an emergency;

4. A diagnosis or reason for outpatient medical services;

5. All orders;

6. A record of hospital services provided to the patient; and

7. If applicable:

a. A laboratory report required in R9-10-218;

b. A radiologic report required in R9-10-219;

c. A diagnostic report;

d. Documentation of restraint; and

e. A consultation report;

E. In addition to the requirements in subsection (D), an administrator shall require that the hospital's record of emergency services provided to a patient contains:

1. A record 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

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).

R9-10-229. Infection Control

A. An administrator shall require that:

1. An infection control program that meets the requirements of this Section is established under the direction of an individual qualified according to hospital policies and procedures;

2. There are hospital policies and procedures:

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. Disposing of biohazardous medical waste; and

v. 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 pulmonary 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;

3. An infection control program includes an infection control risk assessment that is reviewed and updated at least every 12 months;

4. A tuberculosis screening is performed as follows:

a. For a personnel member, at least once every 12 months or more frequently if determined by an infection control risk assessment;

b. Except as required in subsection (A)(4)(c), for a medical staff member, at least once every 24 months; and

c. For a medical staff member at an increased risk of exposure based on the criteria in subsection (A)(2)(c), at the frequency required by the hospital's policies and procedures, but no less frequently than every 24 months;

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;

6. 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;

7. 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;

8. Infection control documents are maintained in the hospital for two years and are provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the request;

9. An infection control committee is established according to hospital policies and procedures that consists of:

a. At least one medical staff member;

b. The individual directing the infection control program; and

c. Other personnel identified in hospital policies and procedures; and

10. 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 reporting requirements in A.A.C. Title 9, Chapter 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).

R9-10-230. Environmental Services

An administrator shall require that:

1. An individual providing environmental services who has the potential to transmit pulmonary tuberculosis to patients as determined by the infection control risk assessment shall comply with the requirements in R9-10-206(3);

2. The hospital premises and equipment are:

a. Cleaned according to policies and procedures designed to prevent or control illness or infection; 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 used to control insects and rodents;

4. The hospital maintains a tobacco smoke-free environment;

5. Biohazardous waste and hazardous waste are identified, stored, used, and disposed of according to A.A.C. Title 18, Chapter 13, Article 14 and hospital 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 hospital policies and procedures; and

c. Used according to the manufacturer's recommendations;

7. Documentation of equipment testing, calibration, and repair is maintained on the hospital premises for one year from the date of the testing, calibration, or repair and provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the request.

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).

R9-10-231. Disaster Management

An administrator shall require 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 from the date of the drill and provided to the Department for review as soon as possible after a Department request but not more than four hours from the time of the request.

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).

R9-10-232. Physical Plant Standards

A. An administrator shall require that:

1. A hospital complies with the physical plant health and safety codes and standards that are incorporated by reference in A.A.C. R9-1-412 at the time the hospital is licensed;

2. Architectural plans and specifications for construction, modification, or change in licensed capacity or inpatient beds are submitted to the Department for approval;

3. Construction, a modification, or a change in inpatient beds complies with the requirements of this Article and the physical plant health and safety codes and standards incorporated by reference in A.A.C. R9-1-412 at the time the construction, modification, or change in licensed capacity or inpatient beds is approved by the Department;

4. The licensed hospital premises or any part of the licensed hospital premises is not leased to or used by another person;

5. A unit with inpatient beds is not used as a passageway to another health care institution; and

6. Hospital premises are not licensed as more than one health care institution except as provided in A.R.S. Title 36, Chapters 4 and 5, and 9 A.A.C. 20.

B. An administrator shall provide to the Department for review as soon as possible but not more than four hours from the time of the Department's request, documentation of a current fire inspection conducted by a local jurisdiction.

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).

R9-10-233. Expired

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).

ARTICLE 3. REPEALED

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. Reserved

R9-10-302. Reserved

R9-10-303. Reserved

R9-10-304. Reserved

R9-10-305. Reserved

R9-10-306. Reserved

R9-10-307. Reserved

R9-10-308. Reserved

R9-10-309. Reserved

R9-10-310. Repealed

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).

R9-10-311. Repealed

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).

R9-10-312. Repealed

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).

R9-10-313. Repealed

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).

R9-10-314. Repealed

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).

R9-10-315. Repealed

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).

R9-10-316. Repealed

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).

R9-10-317. Repealed

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).

R9-10-318. Repealed

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).

R9-10-319. Repealed

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).

R9-10-320. Repealed

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).

R9-10-321. Repealed

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).

R9-10-322. Repealed

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).

R9-10-323. Repealed

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).

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. REPEALED

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. Reserved

R9-10-402. Reserved

R9-10-403. Reserved

R9-10-404. Reserved

R9-10-405. Reserved

R9-10-406. Reserved

R9-10-407. Reserved

R9-10-408. Reserved

R9-10-409. Reserved

R9-10-410. Reserved

R9-10-411. 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).

R9-10-412. 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).

R9-10-413. 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).

R9-10-414. 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).

R9-10-415. 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).

R9-10-416. 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).

R9-10-417. 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).

R9-10-418. 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).

R9-10-419. 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).

R9-10-420. 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).

R9-10-421. 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).

R9-10-422. 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).

R9-10-423. 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).

R9-10-424. 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).

R9-10-425. 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).

R9-10-426. 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).

R9-10-427. 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).

R9-10-428. 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. ADULT DAY HEALTH CARE FACILITIES

R9-10-501. Definitions

In this Article, unless the context otherwise requires:

1. "Abuse" means the same as defined in A.R.S. § 46-451(A)(1).

2. "Activities of daily living" means ambulating, bathing, toileting, shaving, brushing teeth, combing hair, dressing, and eating.

3. "Advance directives" means a living will, prehospital medical care directive, or a health care power of attorney.

4. "Caregiver" means an adult who provides functionally impaired adults with supervision and assistance in the preparation of meals, housework, and personal grooming.

5. "Care Plan" means a written program of action for each participant's care based upon an assessment of that person's physical, nutritional, psychosocial, economic, environmental strengths and needs and implemented pursuant to established short- and long-term goals.

6. "Communicable disease" means the same as defined in A.R.S. § 36-661(4).

7. "Licensed nurse" means a nurse licensed pursuant to A.R.S. Title 32, Chapter 15.

8. "Medical provider" means a physician licensed pursuant to A.R.S. Title 32, Chapters 13 and 17, a physician's assistant licensed pursuant to A.R.S. Title 32, Chapter 25, or a nurse practitioner licensed pursuant to A.R.S. Title 32, Chapter 15.

9. "Medication" means a drug, prescription or nonprescription, administered to or self-administered by a participant to maintain health or to prevent or treat an illness or disease.

10. "Participant" means a person enrolled in an adult day health care facility.

11. "Participant's representative" means a person acting on behalf of a participant, under the written consent of the participant or the participant's legal guardian.

12. "Personal living skills training" means teaching a participant techniques in order to maintain or improve the participant's independence in performing activities of daily living.

13. "Personnel" means all staff, including employees and volunteers, who perform services for an adult day health care facility and have direct or indirect contact with the participants at the facility.

14. "Physical restraint" means confinement in a locked room or the use of any article, device, or garment which interferes with freedom of movement that cannot be easily removed by the participant and is used to control the participant's mobility.

15. "Significant change in condition" means a life-threatening or clinical complication.

16. "Volunteer" means a person who provides services at an adult day health care facility without compensation.

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).

R9-10-502. Administration

A. The governing authority shall consist of one or more persons responsible for organizing and managing the facility, establishing policies and procedures, establishing facility rules, and ensuring compliance with state laws, rules, and local ordinances.

B. The governing authority shall appoint an administrator who shall have the authority and responsibility to operate the facility. The Administrator shall:

1. Be 21 years of age or older;

2. Remain on the premises, or ensure that a designee is present, whenever participants are present in the facility; and

3. Designate, in writing, a staff person who is 21 years of age or older to act as administrator when the administrator is absent.

C. The administrator shall be responsible for:

1. Managing adult day health services;

2. Staffing and conducting employee orientation;

3. In-service training;

4. Recordkeeping;

5. Supervising and evaluating staff performance;

6. Ensuring that participants receive services which are offered by the facility and specified in the participants' care plan;

7. Ensuring that a monthly calendar of planned activities is posted and that materials, supplies, and equipment are provided for the activities which are clean, safe, and in working condition;

8. Assisting in the formation of a participants' council pursuant to R9-10-506 and maintaining communication with the council;

9. Ensuring that facility rules are followed and assisting participants in exercising their rights pursuant to R9-10-505;

10. Ensuring that all participants in the facility annually provide the same type of evidence of being free from pulmonary tuberculosis as required of personnel in R9-10-503(A); and

11. Maintaining the following documents and references in the facility;

a. Operating licenses and permits,

b. Schedules of rates and charges,

c. Policies and procedures,

d. Monthly activity calendars for the preceding 90 days,

e. Menus for the preceding 60 days,

f. Incident reports,

g. Current fire and sanitation reports,

h. Records of fire and disaster drills,

i. Orientation and in-service program records,

j. Personnel records, and

k. Participant records.

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).

R9-10-503. Personnel

A. Personnel, prior to being employed and annually thereafter, shall submit one of the following as evidence of freedom from pulmonary tuberculosis:

1. A report of a negative Mantoux skin test taken within six months of submitting the report; or

2. A written statement from a medical provider stating that, upon an evaluation of a positive Mantoux skin test taken within six months of submitting the medical provider's statement or a history of a positive Mantoux skin test, the individual was found to be free from tuberculosis.

B. All personnel shall meet the following requirements:

1. Be 18 years of age or older.

2. Not be a participant of the facility as defined in R9-10-501(10).

3. Within the first week of employment, attend orientation that includes:

a. Policies and procedures, including personnel procedures;

b. Participant rights and facility rules;

c. Protection of participant privacy and confidentiality;

d. Basic infection control techniques, including hand washing and prevention of communicable diseases; and

e. Fire, safety, and emergency procedures.

4. Attend 10 hours of in-service training per year which may include time spent in orientation.

C. Personnel providing direct care to participants shall attend four or more hours of orientation, in addition to complying with subsection (B)(3), before providing care to participants. The orientation shall include:

1. Communication skills,

2. Assistance with the activities of daily living,

3. Personal living skills training, and

4. Special needs of the elderly and functionally impaired.

D. The administrator shall maintain personnel records which include:

1. Application for employment,

2. Verification of training and certification,

3. Initial proof of freedom from tuberculosis and annual verification statement thereafter, and

4. Orientation and in-service training records that include:

a. Class content,

b. Instructor's name, and

c. Signatures and job titles of those who attend.

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).

R9-10-504. Staffing

A. The administrator shall ensure that staffing provides:

1. Adult day health services,

2. Nutritional services,

3. Activities program,

4. Social services,

5. Housekeeping services, and

6. Safety program.

B. The administrator shall ensure that two staff members are on duty at all times when two or more participants are in the facility. One staff member, certified in cardiopulmonary resuscitation and first-aid training, shall be on duty at all times.

C. A registered nurse shall supervise health care needs of participants.

D. A licensed nurse shall be on duty daily to perform the following functions:

1. Administer medications and treatments,

2. Monitor participant's health status, and

3. Conduct initial health assessments.

E. Each facility which is operated by a nursing care institution shall not share staff with the nursing care institution during the course of a day.

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).

R9-10-505. Participant Rights

A. The administrator shall establish and implement a written policy regarding participant rights and facility rules.

B. The administrator shall give each participant or participant's representative a list of participant rights and a copy of facility rules at the time of enrollment. The receipt of the documents shall be acknowledged in writing.

C. The administrator shall post the participant rights and facility rules in a conspicuous area.

D. The administrator and staff shall ensure that language barriers or physical handicaps do not prevent each participant or participant's representative from becoming aware of participant rights.

E. A participant shall have the following rights:

1. To be treated with consideration, respect, and full recognition of the dignity and individuality of each participant;

2. To be free from the following:

a. Medical, psychological, physical, and chemical abuse;

b. Physical restraints; and

c. Use of psychoactive drugs administered for the purposes of discipline or convenience and not required to treat the participant's medical symptoms;

3. To refuse treatment or withdraw consent for treatment;

4. To participate in the development of and receive the services specified in the care plan.

5. To have medical and financial records kept in confidence. The release of such records shall be by written consent of the participant or participant's representative, except as otherwise required or permitted by law;

6. To inspect the participant's own records at a time agreed upon by the participant and the facility;

7. To be informed of the following:

a. Rates and charges for the use of the facilities, and

b. The process for contacting the local office of adult protective services;

8. To communicate, associate, and meet privately with persons of the participant's choice;

9. To have access to a telephone, to make and receive calls, and to send and receive correspondence without interception or interference by the facility;

10. To arrive and depart from the facility freely, consistent with the participant's care plan and personal safety; and

11. To exercise other civil rights and religious liberties, including the right to make personal decisions and to submit grievances without retaliation.

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).

R9-10-506. Participants' Council

A. The participants' council shall:

1. Be composed of participants who are willing to serve on the council and take part in scheduled meetings,

2. Develop guidelines that govern the council's activities,

3. Meet quarterly and record minutes of the meeting, and

4. Provide written input to the facility staff on planned activities and facility policies.

B. The participants' council may invite facility staff or the administrator to attend their meetings.

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).

R9-10-507. Enrollment

A. Prior to enrollment, and annually thereafter, the administrator shall ensure that each participant provides to the facility the same type of evidence of being free from pulmonary tuberculosis as required of personnel in R9-10-503(A).

B. The administrator shall enroll a participant in the facility upon written agreement between the participant or the participant's representative and the facility. The agreement shall include:

1. Enrollment requirements,

2. Statement of the customary services that the facility provides,

3. Statement of services that are available at an additional cost.

4. Statement of all fees and charges,

5. Procedures for termination of an enrollment agreement,

6. Copy of participant rights and facility rules,

7. Persons to be notified in the event of an emergency, and

8. Copy of facility procedure on advanced directives.

C. The administrator shall give one copy of the enrollment agreement to the participant or participant's representative and keep the original in the participant's record.

D. The administrator shall ensure that each participant enrolled in the facility shall have a signed written medical assessment completed by the participant's medical provider within 60 days prior to enrollment. The assessment shall include:

1. Information that addresses the participant's health and mental status and cognitive impairments;

2. Physical, mental, and emotional problems including medications, treatments, special dietary needs, and allergies; and

3. Evidence of freedom from communicable diseases.

E. At the time of enrollment, the participant or participant's representative, in consultation with the administrator, shall determine if the participant is capable of signing in and out of the facility. This determination shall be documented in the participant's record.

F. The administrator shall ensure that a comprehensive written assessment of the participant is completed by the participant's 10th visit or within 30 calendar days of enrollment, whichever comes first. The assessment shall include the participant's:

1. Physical health,

2. Mental and emotional status,

3. Social history,

4. Medical provider orders,

5. Adult day health services to be provided, and

6. Emergency information that includes the following:

a. Name and telephone number of participant's medical provider;

b. Hospital choice;

c. Participant's representative, family member, or care giver; and

d. Any advance 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).

R9-10-508. Discharge

A. The administrator may terminate an enrollment agreement after giving the participant or participant's representative a five-day written notice for any of the following reasons:

1. Evidence of repeated failure to abide by the facility's rules,

2. Documented proof of failure to pay,

3. Behavior which is dangerous to self or which interferes with the physical or psychological well-being of other residents, or

4. Participant's service requirements exceed those services for which the facility is licensed to provide.

B. The administrator shall ensure that a discharge plan is included in the care plan when the discharge is anticipated and shall include recommendations for continuing care and referrals to community service agencies.

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).

R9-10-509. Adult Day Health Services

A. The staff shall be responsible for the supervision of the participants except for the periods of the day the participant signs out or is signed out according to the facility's policies and procedures.

B. Staff shall provide assistance with activities of daily living and supervision of personal hygiene in accordance with the participant's care plan. Where bathing is required in the care plan, only trained staff shall provide the assistance in bathing.

C. Staff shall provide planned therapeutic individual and group activities in accordance with the participant's care plan. The activities shall include:

1. Physical activities,

2. Group discussion,

3. Personal living skills training,

4. Reality orientation,

5. Activity daily living skills,

6. Participants' council meetings, and

7. Leisure time.

D. The administrator shall ensure that each participant's health status is monitored by a licensed nurse as follows:

1. Observe changes in a participant's mental and physical condition, including monthly monitoring of participant's vital signs and nutritional status;

2. Document changes in the participant's record; and

3. Report changes to each participant's medical provider or representative.

E. The administrator shall ensure that medications are ordered, administered, stored, and destroyed as follows:

1. The participant's medical provider shall order, in writing, all medications and treatments. The orders shall include the name of the medication or treatment, method of administration, dosage, and frequency.

2. A licensed nurse, medical provider, or an individual as provided by law shall administer medications which cannot be self-administered.

3. A licensed nurse, family member, or an individual as provided by law may prepare patient medication organizers one month in advance for self-administration by participants.

4. Staff may remind and supervise a participant who is functionally capable in the self-administration of medication according to the order of the medical provider and instruction of the pharmacist as indicated on the label of the individual container of medication. Supervision may include:

a. Opening a bottle cap for a participant,

b. Reading the medication label to the participant,

c. Checking the self-administration dosage against the label of the container and reassuring the participant that the dosage is correct, and

d. Observing the participant while the medication is taken.

5. Medications shall be stored as follows:

a. A locked, secured area shall be provided which may be used for storage of medicines and solutions. This area shall be locked when not in use.

b. All medications, with the exception of patient medication organizers, shall be stored in their original labeled containers.

c. Medications requiring refrigeration shall be kept in a separate locked container within the refrigerator.

d. Medications for external use shall be stored separately from medications for internal use.

6. All expired or discontinued medications, including those of deceased participants, shall be disposed of according to the facility's policies and procedures.

7. An updated drug reference source shall be available for use by staff.

F. The administrator shall ensure that injuries from an accident or incident that affect the participant's health status are reported, investigated, and documented as follows:

1. Participant's medical provider and representative shall be notified immediately of the injuries.

2. Injuries shall be reported to Adult Protective Services pursuant to A.R.S. § 46-454, when applicable.

3. A written accident or incident report shall be prepared on the day of occurrence or when any injury of unknown origin is detected. The report shall include:

a. Name of the participant,

b. Date and time of the accident or incident,

c. Type of accident or incident,

d. Injury sustained,

e. Names of witnesses, and

f. Action taken by the facility.

4. The accident or incident shall be investigated within 24 hours and any corrective action documented on the report form which shall be retained by the facility for one year.

G. The administrator shall designate a food service supervisor who shall be responsible for nutrition services that provide for the following:

1. The menu pattern for each meal shall consist of:

a. Two servings of whole grain or enriched cereals and bread. A serving size is one slice of bread, 1/2 to 1 cup of cereal or 1/2 cup enriched grain products.

b. One serving of vegetables. A serving size is 1/2 (4 ounces) to 1 cup (8 ounces) of all juices and vegetables.

c. One serving of fruits. A serving size is 1/2 (4 ounces) to 1 cup (8 ounces) of all juices and fruits.

d. One serving of milk, yogurt, or cheese. A serving size is 1 cup of milk or yogurt, 1 1/2 ounces of cheese, or 3/4 cup (6 ounces) of cottage cheese. Cheese is considered both a dairy product and a protein and can be counted as one or the other but not both.

e. One serving of protein: meat, fish, poultry, cheese, egg, peanut butter, peas, beans, lentils, or equivalent. One serving size is 2 to 3 ounces of lean meat without bone, 1 cup dry beans or legumes, 4 tablespoons or peanut butter, or two eggs.

2. Two snacks a day shall be offered to participants. Snacks shall consist of a serving of each of two of the food groups listed in subsection (E)(1).

3. Meals, including therapeutic meals, shall be served in accordance with preplanned menus that are prepared one week in advance and posted in an area accessible to participants.

4. Substitutes of equal nutritional value and complementary to the remainder of the meal may be made as long as substitutes are recorded on the menus.

5. If a participant requires a therapeutic diet, the administrator shall ensure that the diet shall be prescribed in writing by the participant's medical provider.

6. An updated therapeutic diet reference manual shall be available for use by staff, if the facility provides therapeutic diets.

7. Self-help devices that include plate guards, rocking forks, and assistive hand devices shall be available to participants who need them.

8. Onsite or catered food preparation, storage, and handling shall comply with applicable food and drink regulations of 9 A.A.C. 8, Article 1.

H. The administrator shall ensure that social services as specified in the participant's care plan are provided to each participant. The services shall include the following:

1. Counseling of an individual or group basis according to the needs of the participant and the person's family, and

2. Referral to therapeutic counseling services, if such services are not available at the facility.

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).

R9-10-510. Care Plan

A. An interdisciplinary team shall develop a care plan within seven days after the completion of the comprehensive assessment prepared in accordance with R9-10-507(F). The team shall be comprised of:

1. The participant or participant's representative,

2. Representatives of staff, and

3. Service providers.

B. The interdisciplinary team shall base the care plan on the participant's comprehensive assessment. The care plan shall include:

1. Medical or health problems, including physical, mental, and emotional disabilities or impairments;

2. Adult day health services to be provided;

3. Goals and objectives of care that are time limited and measurable;

4. Interventions required to achieve objectives, including recommendations for therapy and referrals to other service providers;

5. Any advance directives; and

6. Discharge plan pursuant to R9-10-508(B).

C. The interdisciplinary team shall review and update a participant's care plan every six months or earlier when there is a significant change in the participant's condition.

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).

R9-10-511. Participant Records

A. The administrator shall ensure that up-to-date participant records are available to the participant or participant's representative upon 48 hours' written notice to the facility, excluding weekends and holidays.

B. Records for each participant shall include the following:

1. Full name, date of birth, social security number, and address;

2. Names, addresses, telephone numbers of participant's representative, medical provider, and other medical and nonmedical providers involved in the care of the participant;

3. Enrollment agreement;

4. Emergency information;

5. Written acknowledgment of the receipt of copies of participant rights and facility rules;

6. Signed medical provider's assessment;

7. Medical provider's orders;

8. Evidence of freedom from tuberculosis;

9. Comprehensive assessment;

10. Records of medical care and medications provided by the facility;

11. Vital signs and nutritional status;

12. Care plan;

13. Documentation of any significant changes in participant behavior or condition, including injuries and accidents, and notification of the participant's medical provider and participant's representative;

14. Signed authorization if medical information is released;

15. Determination of participant's capability of signing in or out of the facility; and

16. Discharge date, if applicable.

C. Records shall be legibly recorded in ink. Each entry shall be dated and signed. Records shall be protected at all times from possible loss, damage, or unauthorized use.

D. Records shall be retained for three years.

E. If the facility ceases operation, copies of records shall be available upon the request of the participant or participant's representative for three years from the date of closure.

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).

R9-10-512. Physical Plant Requirements

A. Existing facilities licensed prior to the adoption of these rules shall conform to the requirements of A.A.C. R9-1-412(B), Life Safety Code, Chapter 11, "Existing Educational Occupancies."

B. Facilities licensed after the effective date of these rules shall conform to the requirements applicable to educational occupancies in the codes adopted by reference in A.A.C. R9-1-412, excluding A.A.C. R9-1-412(B), Life Safety Code, Chapter 11, "Existing Educational Occupancies."

C. The facility shall have space to accommodate adult day health services including:

1. Individual and group activities;

2. Special therapies, if provided;

3. Storage areas for program and operating supplies; and

4. A quiet rest area for participants.

D. If the facility is operated by a nursing care institution, the facility shall be physically and functionally separate from the nursing care institution.

E. If any portion of a building is used for purposes other than adult day health care, that portion of the building which participants regularly occupy shall be used only for adult day health care purposes during operational hours.

F. There shall be 40 square feet or more of indoor activity space for each participant. Floor space of bathrooms, halls, storage areas, kitchens, wall thicknesses, and rooms designated for staff use shall be excluded when computing the minimum activity space.

G. An outside activity space shall be provided which:

1. Is accessible to the building without crossing thorough fares,

2. Is free from hazards,

3. Has a hard-surfaced section for wheelchairs, and

4. Has an available shaded area.

H. The facility temperature shall be maintained at a range from 68° to 82° F.

I. All stairs used by participants shall:

1. Be edge-marked with high contrast color,

2. Be slip resistant, and

3. Have a tactile warning at the top of the stair run.

J. Each facility shall have bathrooms with one toilet and a sink for each 10 participants. Bathrooms shall also have toilet and bathroom fixtures, towel bars, towel and soap dispensers, and mirrors accessible and usable for all participants.

K. If bathing facilities are provided, all tub and shower floors shall have slip-resistant surfaces.

L. Dining areas shall be furnished with dining tables and chairs and large enough to accommodate all participants.

M. There shall be a physical separation of dining facilities from food preparation areas.

N. There shall be food preparation, storage, and handling areas in facilities serving food. These areas shall not be used as a passageway by participants.

O. All flooring shall be slip-resistant.

P. All swimming pools shall, unless otherwise required in A.R.S. § 36-1681:

1. Be enclosed by a five-foot solid wall or a five-foot fence with openings not exceeding six inches, and

2. Have one or more self-closing and self-latching gates which shall be locked when the pool is not in use.

Q. Swimming pools which are used by participants shall:

1. Conform to the minimum requirements for semipublic pools as set forth in state and local rules for design, construction, and operation of public and semipublic swimming pools;

2. Have posted pool safety rules; and

3. Be supervised when 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 with changes effective October 30, 1989 (Supp. 89-4). Section repealed, new Section adopted effective April 4, 1994 (Supp. 94-2).

R9-10-513. Environmental Standards

A. The facility shall be maintained free from offensive odors, hazards, insects, rodents, and accumulations of dirt, garbage, and other refuse.

B. Combustible liquids, hazardous materials, and house and garden insecticides shall be safely stored in their original labeled containers, outside of the facility, in a locked area inaccessible to participants.

C. All windows and doors opening to the outside shall be screened if they are kept open at any time for ventilation or other purposes.

D. The use of a common drinking utensil is prohibited. When paper cups are used, clean single-use cups are required.

E. If laundry facilities are provided on the premises, soiled and clean laundry areas shall be separately maintained.

F. There shall be no pets allowed in treatment, food storage, food preparation, and dining areas.

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).

R9-10-514. Safety Standards

A. The administrator shall develop a written plan of operation with procedures to be followed in the event of fire, disaster, or threat to participant's safety. The plan shall include:

1. Telephone numbers for contacting local emergency medical, fire, and other service agencies;

2. The route to be used when evacuating participants; and

3. Designation of the specific places to which participants will be evacuated.

B. The administrator shall ensure that each participant receives orientation to the facility's exits within two visits of the person's enrollment. This orientation shall be documented in the participant's record.

C. A current floor plan shall be posted in a central location on each floor and shall include an emergency exit plan.

D. A fire evacuation drill shall be conducted once every three months.

E. A disaster drill shall be conducted once every six months. Disaster drills may include the involvement of participants.

F. Records of fire and evacuation drills shall be retained for one year and include the date, time, length of time for full evacuation, and a critique of the drill.

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).

R9-10-515. Repealed

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).

R9-10-516. Repealed

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).

R9-10-517. Repealed

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).

R9-10-518. Repealed

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).

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. REPEALED

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.

R9-10-611. Repealed

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).

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. Repealed

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).

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. Repealed

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).

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. Repealed

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).

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. Repealed

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).

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. Repealed

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).

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. Repealed

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).

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. Repealed

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).

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. ASSISTED LIVING 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

The following definitions apply in this Article unless otherwise specified:

1. "Abuse" means the intentional infliction of physical harm; injury caused by negligent acts or omissions; unreasonable confinement; sexual abuse or sexual assault; or a pattern of ridiculing or demeaning a resident, making derogatory remarks, verbally harassing, or threatening to inflict physical harm on a resident.

2. "Accept" or "acceptance" means:

a. An individual begins living in and receiving services at an assisted living facility; or

b. An individual begins receiving adult day health care services or respite care services from an assisted living facility.

3. "Accident" means an unexpected occurrence that causes harm to a resident.

4. "Activities of daily living" means bathing, dressing, grooming, eating, mobility, transfer, and toileting.

5. "Adult day health care services" means a program that provides planned care supervision and activities, personal care, personal living skills training, meals and health monitoring in a group setting during a portion of a continuous twenty-four hour period. Adult day health services may also include preventive, therapeutic and restorative health related services that do not include behavioral health services.

6. "Adult foster care" means a residential setting which provides room and board and adult foster care services for at least one and no more than four adults who are participants in the Arizona long-term care system pursuant to Chapter 29, Article 2 of this title and in which the sponsor or the manager resides with the residents and integrates the residents who are receiving adult foster care into that person's family.

7. "Applicant" means an individual, firm, partnership, association, or corporation that has submitted an application for:

a. An assisted living facility license;

b. Department approval of an exemption in R9-10-702; or

c. Department approval of an assisted living training program.

8. "Assessment" means a written analysis of a resident's abilities; preferences; and need for supervisory care services, personal care services, or directed care services.

9. "Assistance" means the help or aid necessary to complete a function or a task.

10. "Assistant caregiver" means an individual who assists in providing supervisory care services, personal care services, or directed care services under the direct supervision of a manager or caregiver.

11. "Assisted living center" or "center" means an assisted living facility that provides resident rooms or residential units to eleven or more residents.

12. "Assisted living facility" means a residential care institution, including adult foster care, that provides or contracts to provide supervisory care services, personal care services or directed care services on a continuing basis.

13. "Assisted living home" or "home" means an assisted living facility that provides resident rooms to ten or fewer residents.

14. "Bathing" means washing, rinsing, and drying all parts of an individual's body.

15. "Bedbound" means confined to a bed or chair because of an inability to ambulate even with assistance.

16. "Bedroom" or "room" means a portion of a facility that is wall-enclosed with a door where a resident sleeps and maintains personal items.

17. "Behavioral health residential services" means a therapeutic regimen of screening, evaluation, treatment, or rehabilitation provided on a 24-hour basis to individuals suffering from mental disorders, emotional conditions, or the effects of substance abuse.

18. "Board of Examiners" means the Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers.

19. "Caregiver" means an individual who provides supervisory care services, personal care services, or directed care services to residents.

20. "Charge" means a one-time payment or a payment that is not incurred in fixed, regular intervals.

21. "Chemical restraint" means any medication that is administered for purposes of discipline or convenience and is not required to treat a resident's medical symptoms.

22. "Clean" means free of dirt or debris by such methods as washing with soap and water, vacuuming, wiping, dusting, or sweeping.

23. "Common areas" means portions of a facility or facility grounds accessible to residents.

24. "Communicable disease" means the same as defined in A.A.C. R9-6-101.

25. "Conspicuously posted" means placed at a location within a facility that is accessible and visible to residents and the public.

26. "Continuous" means available at all times without cessation, break, or interruption.

27. "CPR" means cardiopulmonary resuscitation.

28. "Current" means up-to-date, extending to the present time.

29. "Day" means calendar day.

30. "Department" means the department of health services.

31. "Deposit" means monies or property given to a licensee to assure payment or performance.

32. "D.E.S." means the Arizona Department of Economic Security.

33. "Directed care services" means programs and services, including personal care services, provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions.

34. "Direction" means authoritative policy or procedural guidance for the accomplishment of a function or activity.

35. "Direct self-care" means a resident is able to recognize danger, summon assistance, express need, and make basic care decisions.

36. "Direct supervision" means the physical presence of a manager or caregiver providing direction to an assistant caregiver or volunteer in a facility or during an activity outside the facility.

37. "Documentation" means written supportive information.

38. "Door" means a movable hard-surfaced barrier for opening or closing an entranceway that swings on hinges or slides in groves and is capable of being closed for privacy and fire safety.

39. "Dressing" means choosing, putting on, securing fasteners, and removing clothing, footwear, artificial limbs, braces, and other appliances including those appropriate for current weather conditions.

40. "Eating" means putting food and fluids into the digestive system.

41. "Employee" means a licensee, manager, caregiver, or assistant caregiver who provides or assists in the provision of supervisory care services, personal care services, or directed care services to residents.

42. "Exploitation" means the illegal use of a resident's resources for another's profit or advantage according to A.R.S. Title 46, Chapter 4, or A.R.S. Title 13, Chapter 18, 19, 20, or 21.

43. "Facility" or "facilities" means buildings used by a health care institution for providing any types of services as defined in this chapter.

44. "Facility grounds" means the outdoor area, adjacent to the facility, designated by an applicant or licensee for use by residents.

45. "Fees" means payments in fixed, regular intervals.

46. "Food" means any raw, cooked or processed edible substance, ice, beverage or ingredient used or intended for use or for sale, in whole or in part, for human consumption.

47. "Food services" means the storage, preparation, serving, and cleaning up of food intended for consumption in an assisted living facility.

48. "General supervision" means guidance of a resident by an employee as required by the needs of the resident including the following: being aware of a resident's general whereabouts, monitoring the activities of the resident while on the premises to ensure the health, safety, and welfare of the resident; reminding the resident to carry out activities of daily living; and reminding the resident of activities or appointments.

49. "Grooming" means combing or brushing hair, washing face and hands, shaving, caring for nails, oral hygiene including denture care, and menstrual care.

50. "Guardian" means an individual appointed by a court according to A.R.S. Title 14, Chapter 5, Article 3.

51. "Hazard" means a condition or situation where a resident may suffer physical injury.

52. "Health care directive" means the same as defined in A.R.S. § 36-3201.

53. "Health care institution" means every place, institution, building or agency, whether organized for profit or not, which provides facilities with medical services, nursing services, health screening services, other health-related services, supervisory care services, personal care services, directed care services and includes home health agencies as defined in section 36-151 and hospice service agencies.

54. "Health-related experience" means work in a health care institution, the professional fields of nursing, social work, gerontology, or other closely-related field, or providing health or health-related services to one or more adults.

55. "Health-related services" means services, other than medical, pertaining to general supervision, protective, preventive and personal care services, supervisory care services or directed care services.

56. "Home health agency" means an agency or organization, or a subdivision of such an agency or organization, which meets all of the following requirements.

a. Is primarily engaged in providing skilled nursing services and other therapeutic services.

b. Has policies, established by a group of professional personnel, associated with the agency or organization, including one or more physicians and one or more registered professional nurses, to govern the services referred to in subdivision (a), which it provides, and provides for supervision of such services by a physician or registered professional nurse.

c. Maintains clinical records on all patients.

57. "Hospice service agency" means an agency or organization, or a subdivision of that agency or organization, which is engaged in providing hospice services at the place of residence of its clients.

58. "Hour" means 60 minutes.

59. "Incident" means an occurrence or event that has the potential to cause harm to a resident.

60. "Independent" means able to complete a function or task without assistance.

61. "Intermittent" means periodically scheduled and predictable.

62. "Internal facility requirements" means guidelines and standards developed by a licensee that govern a resident's use and occupancy of an assisted living facility.

63. "Key" means a mechanical device used for holding or locking.

64. "Laundry service" means the process of cleaning linens and clothing.

65. "Learning objective" means the specific and measurable behavior, knowledge, or skill an individual demonstrates.

66. "Licensee" means the individual, firm or partnership, association, or corporation licensed by the Department to operate an assisted living facility.

67. "Manager" means an individual designated by the licensee to act on the licensee's behalf in the onsite management of the assisted living facility.

68. "Medical practitioner" means any physician, dentist, podiatrist, or other individual licensed and authorized by law to use and prescribe drugs and devices for the treatment of sick and injured human beings, or for the diagnosis or prevention of sickness in human beings in this state or any state, territory, or district of the United States.

69. "Medication" means a prescription medication as defined in A.R.S. § 32-1901 or a nonprescription drug as defined in A.R.S. § 32-1901 used to maintain health or to prevent or treat an illness, injury, or disease.

70. "Medication administration" or "administration of medication" means the application of a medication to its ultimate destination on the body of a resident.

71. "Medication organizer" means a container that is designed to hold doses of medication and is divided according to date or time increments.

72. "Mobility" means the ability to move within a residential environment.

73. "Neglect" means a pattern of conduct, without a resident's or the resident's informed consent as defined in A.R.S. § 46-451, resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health.

74. "Nurse" means an individual licensed and in good standing as a registered nurse or a practical nurse as prescribed in A.R.S. Title 32, Chapter 15.

75. "Nurse practitioner" means an individual licensed as a registered nurse practitioner as prescribed in A.R.S. Title 32, Chapter 15.

76. "Nursing services" means those services pertaining to the curative, restorative and preventive aspects of nursing care that are performed at the direction of a physician by or under the supervision of a registered nurse licensed in this state.

77. "Personal care services" means assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes the coordination or provision of intermittent nursing services and the administration of medications and treatments by a nurse who is licensed pursuant to Title 32, Chapter 15 or as otherwise provided by law.

78. "Personnel" means employees, support staff, and volunteers.

79. "Pharmacist" means an individual licensed as prescribed in A.R.S. Title 32, Chapter 18.

80. "Physical restraint" means the confinement of a resident or the use of any article, device, or garment that cannot be removed by a resident, used to restrict movement, and control the resident's behavior.

81. "Physician" means an individual licensed as prescribed in A.R.S. Title 32, Chapter 13 or Chapter 17.

82. "Physician assistant" means an individual licensed as prescribed in A.R.S. Title 32, Chapter 25.

83. "Poisonous or toxic materials" means chemicals such as insecticides, rodenticides, hazardous cleaning agents, and caustic acids.

84. "Potentially hazardous foods" means the same as defined in A.A.C. R9-8-112.

85. "Premises" means a facility, the facility's grounds and each building or grounds on contiguous property used for administering and operating an assisted living facility.

86. "Primary care provider" means a physician, a physician's assistant, or a nurse practitioner who directs a resident's medical care.

87. "Private duty nurse" means a nurse who provides nursing services to a resident that are arranged, paid for, and overseen by the resident, the representative, or the resident's relatives.

88. "PRN" means pro re nata or medication given as needed.

89. "RN" means a registered nurse licensed as prescribed in A.R.S. Title 32, Chapter 15.

90. "Regular basis" means at recurring, fixed, or uniform intervals.

91. "Relative" means a child, parent, sibling, spouse, grandparent, grandchild, uncle, aunt, niece, nephew, or any individual of the same affiliation through marriage or adoption.

92. "Representative" means a resident's guardian or an individual designated in writing by a resident or by the resident's guardian to aid a resident or act on the resident's behalf.

93. "Residency agreement" means a document signed by a resident or the representative and a licensee or the licensee's designee, detailing the terms of residency as agreed upon by the resident or the representative and the licensee.

94. "Resident" means an individual who is not a relative of the licensee and who:

a. Lives in an assisted living facility and receives supervisory care services, personal care services or directed care services; or

b. Receives adult day health care services, or respite care services from an assisted living facility.

95. "Residential unit" or "unit" means a private apartment, unless otherwise requested by a resident, that includes a living and sleeping space, kitchen area, private bathroom, and storage area.

96. "Respite care services" means services provided by a licensed health care institution to persons otherwise cared for in foster homes and in private homes to provide an interval of rest or relief of not more than thirty days to operators of foster homes or to family members.

97. "Secure" means to control, or alert employees of, the egress of a resident from the facility or facility grounds through the use of a method, device, or structure that ensures resident safety.

98. "Service plan" means a written description of a resident's need for supervisory care services, personal care services, or directed care services and the specific services to be provided to the resident.

99. "Short term" means 14 days or less.

100. "Significant change" means an observable deterioration or improvement in a resident's physical, cognitive, behavioral, or functional condition.

101. "Supervisory care services" means general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assistance in the self-administration of prescribed medications.

102. "Supervision" means direct overseeing and inspection of the act of accomplishing a function or activity.

103. "Support staff" means any individual who receives compensation from a licensee, but who does not provide supervisory care services, personal care services, or directed care services at an assisted living facility.

104. "Swimming pool" means a contained body of water that is 18 inches or more in depth at any point and wider than eight feet at any point and intended for swimming.

105. "Termination of residency" or "terminate residency" means a resident is no longer receiving services from an assisted living facility.

106. "Therapeutic diet" means foods prescribed by a physician or an individual authorized by law to prescribe foods.

107. "Toileting" means the discharge and disposal of body waste from bowel or bladder.

108. "Training program" means an individual or an organization that has received written approval from the Department to provide training to assisted living facility personnel and to verify that individuals demonstrate specific skills and knowledge in a level of training.

109. "Transfer" means the movement of an individual's body from a surface to another surface.

110. "Treatment" means a specific procedure used for the prevention, cure, or the improvement of a disease, injury, or illness.

111. "Volunteer" means an individual who provides supervisory care services, personal care services, or directed care services to a resident on a regular basis under the direct supervision of a manager or caregiver at all times but does not receive compensation.

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).

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. Licensing Classifications

A. The Department shall sub-classify an assisted living facility according to facility size as follows:

1. An assisted living facility providing services to 10 or fewer residents is an assisted living home;

2. An assisted living facility providing services to 11 or more residents is an assisted living center; or

3. An assisted living facility that meets the definition of adult foster care in A.R.S. § 36-401 is an adult foster care.

B. An adult foster care shall comply with the requirements for an assisted living home except as provided by statute and this Article.

C. The Department shall license an assisted living facility to provide one of the following levels of service:

1. Supervisory care services,

2. Personal care services, or

3. Directed care services.

D. To change an assisted living facility's sub-classification, a licensee shall submit an application for licensure as required by A.R.S. §§ 36-421 and 36-422.

E. To change the level of service an assisted living facility is licensed to provide, a licensee shall submit to the Department a written request for a change in level of service and documentation of the assisted living facility's compliance with requirements in this Article for the requested level of service.

1. Within 60 days from the date of receipt of the request, the Department shall review the requested change and send written notice to the licensee. The Department may conduct an onsite review of the assisted living facility to determine compliance.

a. If an assisted living facility does not comply with this Article and the requirements for the requested level of service, the Department shall provide the licensee with written notice stating the requirements necessary for compliance with this Article and the requirements for the requested level of service.

b. When the assisted living facility complies with the requirements of this Article and the requirements for the requested level of service, the Department shall send the licensee an amended license that incorporates the requested level of service but retains the expiration date of the current license.

2. A licensee shall not provide services at the requested level of service until an amended license is issued.

F. The Department may grant an exception from the requirements in R9-10-716(C)(1)(a), R9-10-720(A)(1), R9-10-720(C)(1)(c), or R9-10-720(C)(2)(c) if a licensee or applicant can demonstrate that an alternate method is available to ensure the residents' health, safety, and welfare.

1. The Department shall not grant an exception:

a. From local building codes, local ordinances, local fire codes, or local zoning requirements;

b. To a licensee operating on a provisional license; or

c. If the Department determines that an exception will not protect the health, safety, or welfare of a resident.

2. An applicant or licensee shall submit a written request for an exception on a Department-provided form that includes:

a. The applicant's or licensee's name;

b. The name, address, and license number if applicable, of the assisted living facility;

c. The specific rule the applicant or licensee is requesting an exception from;

d. The reason or reasons an applicant is not able to comply with the rule; and

e. An alternative method that ensures that the health, safety, and welfare of residents is protected by the exception.

3. The Department shall evaluate a request for an exception as follows:

a. Review the written request;

b. Verify submitted documentation;

c. If the requested exception involves a physical plant requirement, inspect the assisted living facility; and

d. If applicable, discuss the exception with the assisted living facility's manager or manager's designee, residents or representatives, or any individual the Department determines is necessary to evaluate the request.

G. The Department shall approve or deny an exception as follows:

1. The overall time-frame described in A.R.S. § 41-1072(2), is 90 days.

2. The administrative completeness review described in A.R.S. § 41-1072(1) is 60 days and begins on the date the Department receives a request.

a. If any of the documents is missing or if information on the documents is deficient, the Department shall provide to the applicant a written notice of incompleteness that states each deficiency and the information or documents needed to complete the request. The 60 day time-frame for the Department to finish the administrative completeness review is suspended from the date the Department provides the notice of incompleteness to the applicant until the date the Department receives the required information or missing document.

b. If all of the documents are submitted and the information on the documents is complete, the Department shall provide a written notice of administrative completeness to the applicant.

c. If the documents or information are not submitted within 120 days from the date of notice of incompleteness, the Department shall consider the request withdrawn.

d. If the Department grants an exception during the time provided to assess administrative completeness, the Department shall not provide a separate written notice of administrative completeness.

3. The substantive review time-frame described in A.R.S. § 41-1072(3) is 30 days and begins on the date the Department provides written notice of administrative completeness to the applicant.

a. If the applicant does not meet the requirements of this Article the Department shall provide a written request for additional information to the applicant. The 30 day time-frame for the Department to finish the substantive review is suspended from the date the Department provides the written request to the applicant until the Department receives the additional information.

b. The applicant shall submit to the Department the information or documents identified in the written request for additional information within 30 days of the receipt of the written request.

c. The Department shall provide the applicant with a written notice of denial if:

i. The applicant does not submit the additional information within the time-frame in subsection (D)(3)(b); or

ii. Upon receipt of the additional information from the applicant, the Department determines that the applicant does not meet the requirements of this Article.

d. An applicant may appeal the Department's determination according to A.R.S. Title 41, Chapter 6.

4. If an applicant meets the requirements of this Article, the Department shall provide a written notice of Department approval to the applicant.

5. The Department shall withdraw an exception if:

a. A licensee is operating on a provisional license;

b. A licensee does not comply with the conditions of the exception as approved by the Department; or

c. The Department determines that the health, safety, or welfare of residents is not protected by the exception.

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).

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 licensee is responsible for the organization and management of an assisted living facility. A licensee shall:

1. Ensure compliance with federal and state laws, rules, and local ordinances;

2. Designate an onsite manager who has the authority and responsibility to operate the assisted living facility. The manager and the licensee may be the same individual;

3. Permit an individual to manage no more than two health care institutions that may be located not more than 40 miles apart;

4. Designate another manager when the manager is absent from the premises for more than 30 consecutive days;

5. Notify the Department, in writing, of the following:

a. A change of ownership no later than 30 days before the effective date of the change;

b. A change in the name of the assisted living facility no later than 30 days before the effective date of the change;

c. A termination of operation no later than 30 days before the termination; and

d. The location and arrangements for the maintenance of resident records no later than 30 days before the assisted living facility ceases operation;

6. Not act as a representative, agent, surrogate, health care power of attorney, power of attorney, guardian, or conservator of a resident who is not a relative and ensure that assisted living facility employees, support staff, or relatives of employees or support staff do not act as a representative, agent, surrogate, health care power of attorney, power of attorney, guardian, or conservator of a resident who is not a relative;

7. Ensure that a manager and each manager's designee is able to read, write, understand, and communicate in English;

8. Except when a resident's service needs change as documented in the resident's service plan as required in R9-10-711(A)(7), ensure that a resident receives at least 30 days written notice before any increase in a fee or charge;

9. Ensure that an official of the following agencies is allowed immediate access to an assisted living facility:

a. The Department,

b. A county health department,

c. Adult Protective Services,

d. The D.E.S. Long-Term Care Ombudsman, or

e. A county or municipal fire department; and

10. Ensure that the following individuals have immediate access to a resident:

a. The representative,

b. The resident's case manager, or

c. An individual assigned by a court of law to provide services to the resident.

B. A licensee shall ensure that a manager of an assisted living facility:

1. Develops and implements written policies and procedures for the day-to-day operation of the assisted living facility including:

a. Depositing and refunding deposits, fees, and charges;

b. Resolving resident grievances;

c. Terminating residency;

d. Obtaining information on resident preferences for:

i. Social, recreational, or rehabilitative activities; and

ii. Food;

e. Assisting residents with medication as required in R9-10-713, R9-10-722(D), and R9-10-723(E), as applicable;

f. Protecting and releasing resident records and maintaining confidentiality of resident records;

g. Ensuring the facility and facility grounds are safe and free from hazards based upon the physical, cognitive, and functional condition of the residents;

h. Ensuring resident safety in an assisted living facility with a swimming pool, spa, or other contained body of water on the premises, if applicable; and

i. Ensuring the safety of residents and other individuals and pet and animal sanitation, if pets or animals are maintained on the premises;

2. Conspicuously posts the following:

a. Resident rights;

b. Current phone numbers of the Arizona Department of Health Services' Office of Assisted Living Licensure, D.E.S. Adult Protective Services, 911 or other local emergency response number, the D.E.S. Long-Term Care Ombudsman, the Arizona Center for Disability Law, and the Governor's Office for Americans with Disabilities;

c. Internal facility requirements; and

d. Each document, schedule, or calendar required by state law and this Article;

3. Ensures that each resident and each individual living in the facility provides documentation of freedom from pulmonary tuberculosis at least once every 12 months as required in R9-10-706(A)(1);

4. Designates, in writing, one or more individuals who are 21 years of age or older, who meet the qualifications for a caregiver in R9-10-706(C)(2) and (3) as the manager's designee. A manager's designee is physically present at the facility and in charge of the assisted living facility operations when the manager is not physically present at the facility;

5. Hires and directs employees and support staff as necessary to ensure compliance with this Article;

6. Ensures each assistant caregiver is under the direct supervision of a manager or caregiver at all times;

7. Ensures that an assistant caregiver, who is 16 or 17 years old, or a volunteer does not provide assistance to a resident for:

a. Bathing,

b. Toileting,

c. Transfer,

d. Self-administration of medication,

e. Medication administration, or

f. Nursing services;

8. Ensures that a manager or caregiver does not provide direct supervision to more than two assistant caregivers at any time;

9. Ensures compliance with fingerprinting requirements contained in A.R.S. § 36-411;

10. Notifies a representative, or contacts a public fiduciary or a trust officer to take responsibility of a resident's financial affairs if the resident is incapable of handling financial affairs;

11. Notifies a resident's primary care provider or other medical practitioner if a resident or the representative refuses medical or nursing services, and maintains documentation of the notification in the resident's record for no less than 12 months from the date of notification;

12. When there is an accident, incident, or injury that effects the resident's health and safety:

a. Immediately notifies the representative, and if applicable:

i. The primary care provider;

ii. An emergency response team;

iii. The resident's case manager;

iv. The resident's emergency contact; and

b. Documents the following:

i. Date and time of the accident, incident, or injury;

ii. Description of the accident, incident, or injury;

iii. Names of individuals who observed the accident, incident, or injury;

iv. Action taken by employees, support staff, or volunteers;

v. Individuals notified by employees, support staff, or volunteers; and

vi. Action taken to prevent the accident, incident, or injury from occurring in the future;

13. Ensures each resident is assisted in exercising the resident's rights listed in R9-10-710;

14. Maintains documentation on the premises of licensing and vaccination of pets or animals, if applicable, as required by R9-10-718(12); and

15. Ensures the health and safety of a resident is maintained during relocation of a resident and that the resident's records are relocated with the resident;

C. A manager may, upon written authorization by a resident or the representative, administer a personal funds account, not to exceed $500 each month for the resident. The resident or the representative may revoke, in writing, this authorization at any time. If a manager administers a resident's personal funds account, the manager shall:

1. Maintain a separate record for each resident's personal funds account including all receipts and expenditures;

2. Maintain the resident's personal funds account separate from any account of the assisted living facility; and

3. Provide a copy of a resident's personal funds account record to the resident or representative at least once every three months.

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).

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. Abuse, Neglect, and Exploitation Prevention and Reporting

A. A manager, employee, or volunteer shall immediately report or cause a report to be made to Adult Protective Services or local law enforcement of suspected or alleged abuse, neglect, or exploitation as required by A.R.S. § 46-454.

B. A licensee shall:

1. Notify the Department of suspected or alleged abuse, neglect, or exploitation within 24 hours of receiving the allegation;

2. Document the initial report and maintain documentation of the report on the premises for 12 months from the date of the report;

3. Report suspected or alleged abuse, neglect, or exploitation to Adult Protective Services or to a local law enforcement agency as prescribed in A.R.S. § 46-454; and

4. Investigate suspected or alleged abuse, neglect, or exploitation and develop a written report within 14 days of the initial report of the suspected or alleged abuse, neglect, or exploitation. The licensee shall send the written report to the Department, Adult Protective Services, and any local law enforcement agency previously notified and maintain a copy of the written report on the premises for 12 months from the date of the report. A written report shall contain the following:

a. Dates, times, and description of the suspected or alleged abuse, neglect, or exploitation; description of any injury to the resident; change in the resident's physical, cognitive, functional, or emotional condition; actions taken by the licensee; individuals and agencies notified by the licensee; names of witnesses to the suspected or alleged abuse, neglect, or exploitation; and

b. Action taken by the licensee to prevent the suspected or alleged abuse, neglect, or exploitation from occurring in the future.

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).

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. Limitations on Level of Services

A licensee shall ensure that an assisted living facility does not accept or retain a resident who requires:

1. Physical restraints,

2. Chemical restraints,

3. Behavioral health residential services,

4. Services that the assisted living facility is not licensed to provide; or

5. Services that the assisted living facility is not able to provide.

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).

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 Qualifications and Records

A. A licensee shall ensure that:

1. At the starting date of employment or service and every 12 months from the starting date of employment or service, each support staff and volunteer who interacts with a resident on a regular basis and each employee submits one of the following as evidence of being free from pulmonary tuberculosis:

a. A report of a negative Mantoux skin test administered within six months of submitting the report; or

b. A written physician's statement dated within six months of submitting the statement, indicating freedom from pulmonary tuberculosis, if the individual has had a positive skin test for tuberculosis;

2. Each manager and caregiver:

a. Obtains first aid training specific to adults;

b. Obtains CPR training specific to adults which includes a demonstration of the individual's ability to perform CPR; and

c. Maintains current training in first aid and CPR.

B. A licensee shall ensure that a manager, at the starting date of employment as a manager, meets all of the following:

1. Is 21 years of age or older;

2. Is certified by the Board of Examiners as an assisted living facility manager as required in A.R.S. Title 36, Chapter 4, Article 6 or meets one of the following:

a. Is certified by the Board of Examiners as an adult care home manager before the effective date of this Article and maintains current certification by the Board of Examiners; or

b. Is exempt from certification under A.R.S. § 36-446.04;

3. Provides verification of completion of training from a training program as stated in R9-10-724(B) that states the individual has completed manager training or provides one of the following:

a. Documentation of adult care home manager training from a Board of Examiners approved training program before the effective date of this Article;

b. A license issued to the individual by the Board of Examiners as an administrator of a nursing care institution;

c. Documentation of sponsorship of an adult foster care on the effective date of this Article; or

d. Documentation of employment as a manager of an unclassified residential care institution, supportive residential living center, or supervisory care home on the effective date of this Article;

4. Provides verification of completion of training from a training program as stated in R9-10-724(B) that states the individual is trained in the level of service the assisted living facility is licensed to provide or documentation of one of the following:

a. For supervisory care services, employment of the individual as a manager or caregiver of a supervisory care home on the effective date of this Article;

b. For supervisory care services or personal care services, employment of the individual as a manager or caregiver of a supportive residential living center on the effective date of this Article;

c. For supervisory care services, personal care services, or directed care services, one of the following:

i. Documentation of training as a manager or caregiver from a Board of Examiners approved training program before the effective date of this Article;

ii. A nursing care institution license issued by the Board of Examiners;

iii. A nurse's license issued to the individual under A.R.S. Title 32, Chapter 15;

iv. Documentation of employment as a manager or caregiver of an unclassified residential care institution on the effective date of this Article;

v. Documentation of sponsorship of or employment as a caregiver in an adult foster care home on the effective date of this Article; or

vi. A certificate as a nursing assistant in good standing under A.R.S. Title 32, Chapter 15 and employment as a caregiver in an adult care home on the effective date of this Article; and

5. Has a minimum of 12 months of health-related experience.

C. A licensee shall ensure that a caregiver, at the starting date of employment as a caregiver, meets all of the following:

1. Is 18 years of age or older;

2. Meets the training requirements in subsection (B)(4); and

3. Has a minimum of three months of health-related experience; and

D. A licensee shall ensure that an assistant caregiver, at the starting date of employment as an assistant caregiver, is 16 years of age or older.

E. A licensee shall ensure that a file is maintained on the premises for each employee containing the following:

1. The employee's name, date of birth, home address, and telephone number;

2. Documentation of:

a. Freedom from pulmonary tuberculosis as required in subsection (A)(1);

b. Compliance with fingerprinting requirements in R9-10-703(B)(9);

c. Current training in CPR and first aid as required in subsection (A)(2);

d. Employee qualifications required in subsections (B), (C), or (D);

e. Employee orientation required in R9-10-707(A); and

f. Ongoing training required in R9-10-707(B), R9-10-722(B), and R9-10-723(C), as applicable;

3. An employee's starting date of employment and ending date, if applicable; and

4. For each employee hired after the effective date of this Article, at least two personal and two professional or work-related references, if the employee has previous work experience, and documentation of the licensee's good faith effort to contact each reference.

F. A licensee shall ensure a file is maintained on the premises for each volunteer and support staff who has contact on a regular basis with residents that contains:

1. The individual's name, home address, and telephone number; and

2. Documentation of freedom from pulmonary tuberculosis as required in subsection (A)(1).

G. A licensee shall ensure that all records required by this Section are maintained throughout the individual's period of employment or service and for at least 12 months from the individual's last date of employment or service.

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).

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. Employee Orientation and Ongoing Training

A. A licensee shall ensure that a new employee completes orientation within 10 days from the starting date of employment that includes:

1. Orientation to the characteristics and needs of the assisted living facility's residents;

2. The assisted living facility's philosophy and goals;

3. Promotion of resident dignity, independence, self-determination, privacy, choice, and resident rights;

4. The significance and location of resident service plans, and how to read and implement a service plan;

5. Internal facility requirements and the assisted living facility's policies and procedures;

6. Confidentiality of resident records and resident information;

7. Infection control;

8. Food preparation, service, and storage, if applicable;

9. Abuse, neglect, and exploitation prevention and reporting requirements;

10. Accident, incident, and injury reporting; and

11. Fire, safety, and emergency procedures.

B. A licensee shall ensure that each manager and caregiver completes a minimum of six hours of ongoing training every 12 months from the starting date of employment, or for a manager or caregiver hired before the effective date of this Article, every 12 months from the effective date of this Article.

1. The training shall include:

a. Promoting resident dignity, independence, self-determination, privacy, choice, and resident rights;

b. Fire, safety, and emergency procedures;

c. Infection control;

d. Assistance in self-administration of medications; and

e. Abuse, neglect, and exploitation prevention and reporting requirements;

2. Orientation for new employees, hours used in obtaining and maintaining current CPR and first aid, and hours used in obtaining initial training from a training program may count toward ongoing training for the first 12 months after the employee's starting date of employment.

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).

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. Personnel Requirements

A. A licensee shall ensure there are sufficient personnel to provide the following unless Arizona Long-Term Care System contracts, as provided by A.R.S. Title 36, Chapter 29, Article 2, permit otherwise:

1. Supervisory care services, personal care services, or directed care services, consistent with the level of service the assisted living facility is licensed to provide;

2. Services established in each resident's service plan;

3. Services to meet the needs of each resident including scheduled and unscheduled needs, general supervision, and the ability to intervene in a crisis 24 hours a day;

4. Food services;

5. Environmental services required in R9-10-718;

6. Evacuations of residents during emergencies; and

7. Ongoing social, recreational, or rehabilitative activities.

B. A licensee shall ensure that a personnel schedule:

1. Indicates the date, scheduled work hours, and name of each employee assigned;

2. Reflects actual work hours; and

3. Is maintained on the premises for at least 12 months from the last date on the schedule.

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).

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. Residency Agreements

A. The following requirements apply to a resident accepted into an assisted living facility after the effective date of this Article and to a resident who is not an enrolled member of the Arizona Long-Term Care System as provided by A.R.S. Title 36, Chapter 29, Article 2.

B. A licensee shall ensure that there is a written agreement signed by the licensee and any individual submitting a deposit or other pre-payment of fees before the licensee receives a deposit or other pre-payment of fees.

C. A licensee shall ensure that:

1. Each resident has a residency agreement that includes the:

a. Terms of occupancy, including resident responsibilities and obligations;

b. Services to be provided to the resident;

c. The amount and purpose of any fee, charge, and deposit, including any fee or charge for any days a resident is absent from the assisted living facility;

d. Services that are available at an additional fee or charge;

e. Assisted living facility's policy for refunding fees, charges, or deposits;

f. Assisted living facility's responsibility to provide at least 30 days written notice before the effective date of any change in a fee or charge. A licensee is not required to provide 30 day written notice of increase to a resident whose service needs change, as documented in the resident's service plan;

g. Assisted living facility's policy and procedure for termination of residency; and

h. Assisted living facility's grievance procedure;

2. A residency agreement is signed and dated by the manager or the manager's designee and the resident or the representative within five days after the resident's acceptance into the assisted living facility;

3. A copy of the residency agreement is given to the resident or the representative; and

4. A residency agreement that has been signed, as stated in subsection (C)(2), is maintained on the premises throughout the resident's residency at the assisted living facility.

D. If a licensee receives a deposit or pre-payment of fees from a resident or a representative, the licensee shall ensure that:

1. Except for a Life Care Contract regulated under A.R.S. Title 20, Chapter 8, a deposit does not exceed the amount of one month's fees;

2. A deposit is maintained in a bank account separate from the assisted living facility's operating expenses;

3. A deposit or portion of a deposit is not used for any purpose other than as stated in the resident's residency agreement; and

4. Only the following are deducted from the deposit:

a. Damages to property caused by the resident, excluding normal wear and tear;

b. A fee or charge incurred by the resident; or

c. The resident's documented non-compliance with the residency agreement.

E. A licensee or resident may terminate residency as follows:

1. A licensee may terminate residency of a resident without notice if:

a. The resident exhibits behavior that is an immediate threat to the health and safety of the resident or other individuals in the assisted living facility;

b. The resident's urgent medical or health needs require immediate transfer to another health care institution; or

c. The resident's care and service needs exceed the services the assisted living facility is licensed to provide;

2. A licensee may terminate residency of a resident after providing 14 days written notice to the resident or the representative for one of the following reasons:

a. Documentation of failure to pay fees or charges;

b. Documentation of the resident's non-compliance with the residency agreement or internal facility requirements;

3. Except as provided by subsections (E)(1) and (2), a licensee shall not terminate residency of a resident without providing the resident or the representative 30 days written notice;

4. A resident or the representative may terminate residency of a resident without notice due to the following, as substantiated by a governmental agency:

a. Neglect;

b. Abuse;

c. Exploitation; or

d. Conditions of imminent danger to life, health, or safety; and

5. A resident or the representative may terminate residency of a resident after providing 14 days written notice to the licensee for documentation of the licensee's failure to comply with the resident's service plan or residency agreement.

F. A licensee shall ensure that a written notice of termination of residency includes:

1. The reason for the termination of residency;

2. The effective date of the termination of residency;

3. The resident's right to grieve the termination of residency;

4. The assisted living facility's grievance procedure; and

5. The assisted living facility's refund policy.

G. A licensee shall provide the following to a resident or a representative upon issuing a written notice of termination of residency:

1. A copy of the resident's service plan;

2. Documentation that the resident is free from pulmonary tuberculosis; and

3. The phone numbers and addresses of the local area agency on aging and D.E.S. Long-Term Care Ombudsman.

H. A licensee shall not request or retain fees as follows:

1. If a resident dies or if a resident or representative terminates residency as permitted in subsection (E)(4), a licensee shall not request or retain fees after the date of the resident's death or termination of residency;

2. If termination of residency occurs as permitted in subsection (E)(1), (2), or (5), a licensee shall not request or retain fees for more than 14 days from the date the written notice was received by the assisted living facility; and

3. For reasons other than identified in subsections (H)(1) and (2), the licensee shall not request or retain fees for more than 30 days after termination of residency.

I. Within 30 days after the date of termination of residency, a licensee shall provide to the resident, the representative, or the individual to be contacted in the event of a significant change in the resident's condition:

1. A written statement that includes:

a. The disposition of the resident's personal property;

b. An accounting of all fees, personal funds, or deposits owed to the resident; and

c. An accounting of any deduction from fees or deposits; and

2. All fees or deposits required by this Section and personal funds.

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).

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. Resident Rights

A. A licensee shall ensure that a resident or representative is provided the following at the time the resident is accepted into an assisted living facility:

1. A list of current resident rights;

2. A copy of current internal facility requirements; and

3. Current phone numbers of:

a. The Arizona Department of Health Services' Office of Assisted Living Licensure;

b. D.E.S. Adult Protective Services;

c. 911 or other local emergency response;

d. The D.E.S. Long-Term Care Ombudsman;

e. The Arizona Center for Disability Law;

f. The Governor's Office for Americans with Disabilities; and

g. An entity that provides information on health care directives.

B. A licensee shall ensure that a resident or the representative acknowledges, in writing, receipt of the items in subsection (A).

C. A licensee shall ensure that language barriers or physical disabilities do not prevent a resident or representative from becoming aware of internal facility requirements and the resident rights.

D. A licensee shall ensure that a resident has the following rights:

1. To live in an environment that promotes and supports each resident's dignity, individuality, independence, self-determination, privacy, and choice;

2. To be treated with consideration and respect;

3. To be free from abuse, neglect, exploitation, and physical restraints and chemical restraints;

4. To privacy in correspondence, communications, visitation, financial and personal affairs, hygiene, and health-related services;

5. To receive visitors and make private phone calls;

6. To participate or allow the representative or other individual to participate in the development of a written service plan;

7. To receive the services specified in the service plan, and to review and re-negotiate the service plan at any time;

8. To refuse services, unless such services are court ordered or the health, safety, or welfare of other individuals is endangered by the refusal of services;

9. To maintain and use personal possessions, unless such use infringes upon the health, safety, or welfare of other individuals;

10. To have access to common areas in the facility;

11. To request to relocate or refuse to relocate within the facility based upon the resident's needs, desires, and availability of such options;

12. To have financial and other records kept in confidence. The release of records shall be by written consent of the resident or the representative, except as otherwise provided by law;

13. To review the resident's own records during normal business hours or at a time agreed upon by the resident and the manager;

14. To review a copy of this Article during normal business hours or at a time agreed upon by the resident and the manager;

15. To review the assisted living facility's most recent survey conducted by the Arizona Department of Health Services, and any plan of correction in effect during normal business hours or at a time agreed upon by the resident and the manager;

16. To be informed, in writing, of any change to a fee or charge at least 30 days before the change, unless the resident's service needs change, as documented in the resident's service plan as required in R9-10-711(A)(7);

17. To submit grievances to employees, outside agencies, and other individuals without constraint or retaliation;

18. To exercise free choice in selecting activities, schedules, and daily routines;

19. To exercise free choice in selecting a primary care provider, pharmacy, or other service provider and assume responsibility for any additional costs incurred as a result of such choices;

20. To perform or refuse to perform work for the assisted living facility;

21. To participate or refuse to participate in social, recreational, rehabilitative, religious, political, or community activities; and

22. To be free from discrimination in regard to race, color, national origin, sex, sexual orientation, and religion and to be assured the same civil and human rights accorded to other individuals.

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).

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. Requirements for Service Plans and Health-Related Services

A. A licensee shall ensure that a resident has a written service plan that:

1. Is initiated the day a resident is accepted into the assisted living facility;

2. Is completed no later than 14 days after the resident's date of acceptance;

3. Is developed with assistance and review from:

a. The resident or representative;

b. The manager or manager's designee;

c. A nurse, if the resident is receiving nursing services, medication administration, or is unable to direct self-care;

d. The resident's case manager, if applicable;

e. Any individual requested by the resident or the representative; and

f. If applicable and necessary, any of the following: caregivers, assistant caregivers, the resident's primary care provider, or other medical practitioner;

4. Is based on an assessment conducted with resident interaction and by the individuals in subsection (A)(3);

5. Includes the following:

a. The level of service the resident is receiving;

b. The amount, type, and frequency of health-related services needed by the resident; and

c. Each individual responsible for the provisions of the service plan;

6. Is signed and dated by:

a. The resident or the representative;

b. The manager or the manager's designee;

c. The nurse, if a nurse assisted in the preparation or review of the plan; and

d. The case manager, if a case manager assisted in the preparation or review of the plan; and

7. Is updated according to the requirements in subsection (A)(3) through (6):

a. No later than 14 days after a significant change in the resident's physical, cognitive, or functional condition; and

b. As follows:

i. At least once every 12 months for a resident receiving supervisory care services;

ii. At least once every six months for a resident receiving personal care services; and

iii. At least once every three months for a resident receiving directed care services.

B. A licensee shall ensure that a resident is provided the following, consistent with the level of service the assisted living facility is licensed to provide:

1. Supervisory care services, personal care services, or directed care services specified in the resident's service plan;

2. Supervisory care services, personal care services, or directed care services to meet a resident's scheduled and unscheduled needs;

3. General supervision to ensure crisis intervention during an emergency, accident, incident, illness, or significant change in the resident's physical, functional, or cognitive condition;

4. Supervisory care services, personal care services, or directed care services that promote a resident's independence, dignity, choice, self determination, and the resident's highest physical, cognitive, and functional capability;

5. Assistance in utilizing community resources, as applicable;

6. Encouragement and assistance to preserve outside support systems; and

7. Social interaction to maintain identity and self-worth.

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).

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. Activity Programs

A. A licensee shall ensure that daily social, recreational, or rehabilitative activities are provided as follows:

1. Activities are planned according to residents' preferences, needs, and abilities;

2. A calendar of activities:

a. Is prepared at least one week in advance from the date the activity is provided;

b. Is conspicuously posted;

c. Reflects all substitutions in activities provided; and

d. Is maintained on the premises for 12 months after the last scheduled activity; and

3. Equipment and supplies are available and accessible to accommodate each resident who chooses to participate in an activity.

B. A licensee shall ensure that daily newspapers, current magazines, and a variety of reading materials are available and accessible to a resident at an assisted living 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).

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. Medications

A. A licensee shall ensure that a resident's service plan states whether the resident:

1. Requires no assistance in the self-administration of medication or medication administration;

2. Needs assistance in the self-administration of medication which includes one or more of the following:

a. Storing a resident's medication;

b. Reminding a resident that it is time to take a medication;

c. Reading the medication label to a resident to:

i. Confirm the medication is being taken by the individual it is prescribed for;

ii. Check the dosage against the label on the container and reassure the resident that the dosage is correct; and

iii. Confirm the resident is taking the medication as directed;

d. Opening the medication container for a resident;

e. Pouring or placing a specified dosage into a container or into the resident's hand; or

f. Observing the resident while the medication is taken; or

3. Needs medication administration.

B. A licensee shall ensure that:

1. An assisted living facility's medication policies and procedures are approved by a physician, pharmacist, or RN and address:

a. Obtaining and refilling medication;

b. Storing and controlling of medication;

c. Disposing of medication;

d. Assisting in the self-administration of medication and medication administration, as applicable; and

e. Recording of medication assistance provided to residents and maintenance of medication records;

2. A drug reference guide, no older than two years from the copyright date, is available and accessible for use by employees;

3. Medication stored by the licensee is stored or controlled as follows:

a. Medication is stored in a locked container, cabinet, or area that is inaccessible to residents;

b. Medication is not left unattended by an employee;

c. Medication is stored in the original labeled container, except for medication organizers, and according to instructions on the medication label;

d. A bathroom or laundry room is not used for medication storage; and

e. All expired or discontinued medication, including those of deceased residents, are disposed of according to the assisted living facility's medication policies and procedures;

4. Medication stored by a resident in the resident's room or unit is stored and controlled as follows:

a. Medication is kept in a locked container or cabinet or a resident locks the entrance to the room or unit when the resident is not in the room or unit and an employee has a key and access to the resident's room or unit and medication storage container or cabinet; or

b. As stated in the resident's service plan;

5. Except for medication organizers, resident medication is not pre-poured. Medication organizers may be prepared up to four weeks in advance by the following individuals:

a. A resident or the representative;

b. A resident's relatives;

c. A nurse; or

d. As otherwise provided by law; and

6. A separate medication record is maintained for each resident receiving assistance in self-administration of medication or medication administration that includes:

a. Name of resident;

b. Name of medication, dosage, directions, and route of administration;

c. Date and time medication is scheduled to be administered;

d. Date and time of actual assistance in self-administration of medication or medication administration; and

e. Signature or initials of the employee providing assistance in self-administration of medication or medication administration.

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).

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 Records

A. A licensee shall maintain a resident's record that contains:

1. The resident's name and social security number;

2. The date of resident's acceptance into the assisted living facility, source of referral to the assisted living facility, and last address of resident;

3. The names, addresses, and telephone numbers of the following:

a. The representative, if applicable;

b. The resident's primary care provider;

c. The resident's case manager, if applicable;

d. Each medical practitioner providing health-related services or medical services to the resident; and

e. An individual or relative to be contacted in the event of emergency, significant change in the resident's condition, or termination of residency;

4. The residency agreement and any amendments;

5. The documentation of the receipt of internal facility requirements, resident rights, and community phone numbers as required in R9-10-710(B);

6. The documentation of orientation to the evacuation plan as required in R9-10-717(B);

7. The service plan, its amendments and updates;

8. A health care directive, if applicable;

9. Documentation of freedom from pulmonary tuberculosis as required in R9-10-703(B)(3);

10. Any orders from a primary care provider or medical practitioner as required in R9-10-722 or R9-10-723;

11. The medication records as required in R9-10-713(B)(6);

12. Accident, incident, or injury reports as required in R9-10-703(B)(12);

13. Written authorizations for residency or continued residency as required by R9-10-722(A)(3) and (4) and R9-10-723(B)(1) and (3);

14. Documentation of any change in a resident's behavior, physical, cognitive, or functional condition and action taken by employees to address the resident's changing needs;

15. A written notice of termination of residency, if applicable;

16. The address and phone number of the resident's new place of residence, if applicable;

17. Documentation of relocation assistance provided to the resident, if applicable; and

18. Documentation of the disposition of the resident's personal property and monies owed to the resident as required in R9-10-709(I)(1), if applicable.

B. A licensee shall ensure that a resident's record is:

1. Confidential and only released with written permission from the resident or the representative, or as otherwise provided by law;

2. Maintained at the facility;

3. Legibly recorded in ink or electronically recorded;

4. Retained for three years from the date of termination of residency; and

5. Available for review by the resident or the representative during normal business hours or at a time agreed upon by the resident and the manager.

C. A licensee shall ensure that a resident's financial records are maintained separate from a resident's record and are only accessible to individuals designated by the licensee.

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).

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. Food Services

A. A licensee shall ensure that:

1. Three meals a day, served with not more than a 14 hour span between the evening meal and morning meal, and one snack a day is available to residents, unless otherwise prescribed by a therapeutic diet;

2. Meals and snacks meet each resident's nutritional needs based upon the resident's age and health needs;

3. Menus are:

a. Based on:

i. Resident food preferences, eating habits, customs, health conditions, appetites, and religious, cultural, and ethnic backgrounds; and

ii. The Food Guide Pyramid, USDA, Center for Nutrition Policy and Promotion, Home and Garden Bulletin Number 252, Revised October 1996, incorporated by reference and on file with the Department and the Office of the Secretary of State. This incorporation by reference contains no future additions or amendments;

b. Prepared at least one week before the date the food is served;

c. Dated and conspicuously posted; and

d. Maintained on the premises for at least 60 days from the date on the menu;

4. Meals and snacks provided by the assisted living facility are served according to preplanned menus. Substitutions to the pre-planned menu are stated on the menu;

5. Meals and snacks on each posted menu contain a variety of foods from each food group in the Food Guide Pyramid;

6. A three-day supply of perishable and a three-day supply of non-perishable foods is maintained on the premises; and

7. Water is available and accessible to residents at all times.

B. If the assisted living facility offers therapeutic diets, a licensee shall ensure that:

1. A therapeutic diet manual, no older than five years from the copyright date, is available and accessible for use by employees; and

2. The therapeutic diet is provided to a resident according to a written order from the resident's physician or as otherwise provided by law.

C. A licensee 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. Except for food from a garden or orchard, food is obtained only from sources that comply with all laws relating to food and food labeling. A licensee shall ensure that any canned food is commercially canned;

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 140° F, except that:

i. Ground beef, poultry, poultry stuffing, stuffed meats and stuffing containing meat are cooked to heat all parts of the food to at least 165° F;

ii. Pork and any food containing pork are cooked to heat all parts of the food to at least 155° F;

iii. Rare roast beef is cooked to an internal temperature of at least 140° F and rare beef steak is cooked to a temperature of at least 130° F unless otherwise requested by a resident; and

iv. Leftovers are reheated to a temperature of 165° F;

5. A refrigerator contains a thermometer, accurate to plus or minus 3° F at the warmest part of the refrigerator;

6. Raw fruits and raw vegetables are rinsed with water before being cooked or served;

7. Food is stored in covered containers, a minimum of six inches above the floor, and protected from splash and other contamination;

8. Frozen foods are stored at a temperature of 0° F or below;

9. Food service is not provided by an individual infected with a communicable disease that may be transmitted by food handling or in which there is a likelihood of the individual contaminating food or food-contact surfaces or transmitting disease to other individuals;

10. Before starting work, after smoking, using the toilet, and as often as necessary to remove soil and contamination, individuals providing food services wash their hands and exposed portions of their arms with soap and warm water; and

11. Table