[Rev. 9/23/2024 10:26:39 AM]

[NAC-449 Revised Date: 8-24]

CHAPTER 449 - MEDICAL FACILITIES AND OTHER RELATED ENTITIES

GENERAL PROVISIONS

449.002        Definitions.

449.0022      “Administrator” defined.

449.0024      “Affiliated facility” defined.

449.0026      “Agent” defined.

449.0028      “Bureau” defined.

449.0029      “Centers for Medicare and Medicaid Services” defined.

449.00295    “Central Repository” defined.

449.003        “Deficiency” defined.

449.00305    “Division” defined.

449.0031      “Division of Welfare and Supportive Services” defined.

449.0032      “Emergency” defined.

449.0033      “Employment agency to provide nonmedical services” defined.

449.0034      “Facility” defined.

449.0042      “Holiday” defined.

449.0043      “Home for individual residential care” defined.

449.0044      “Immediate and serious threat” and “immediate jeopardy” defined.

449.0046      “Incident” defined.

449.0048      “License” defined.

449.0049      “Licensed dietitian” defined.

449.005        “Licensee” defined.

449.0052      “Medicaid” defined.

449.0054      “Medicare” defined.

449.0056      “Party” defined.

449.0058      “Person” defined.

449.006        “Recipient” defined.

449.0061      “Referral agency” defined.

449.0062      “Resident” defined.

449.0064      “Residential facility” defined.

449.0066      “Sanction” defined.

449.0068      “Services” defined.

449.007        “Survey” defined.

449.0072      “Treatment” defined.

449.008        Computation of time.

449.0085      Licensee prohibited from employing or contracting with unlicensed person to provide certain nutrition services.

449.009        Control by Division over medical records of medical facility or facility for dependent upon suspension of license or cessation of operation: Authorized actions to remove, store and protect records; facilities to pay cost of maintenance of records; notice before destruction of records.

449.010        Severability.

449.0105      Adoption of certain publications by reference; revision of publication after adoption.

449.0106      Adoption by reference of certain publications relating to personal protective equipment and prevention of infection; revision of publication after adoption.

449.01065    Requirements relating to personal protective equipment; exception for nursing pool.

449.0107      Posting of star rating by medical facility or facility for the dependent; exception.

449.0108      Notification of Division concerning accreditation of medical facility; administrative penalty.

449.0109      Program and policy for control of infection; designation and training of person responsible for infection control.

GENERAL REQUIREMENTS FOR LICENSURE

449.011        Application for license.

449.0112      Investigation; prelicensure or precertification survey; inspection for fire safety; exceptions.

449.01125    Duties of Division if Central Repository unable to complete investigation of applicant; grounds for denial or revocation of license or delay of action concerning application.

449.0113      Duties of administrator or licensee if Central Repository unable to complete investigation of employee or independent contractor; grounds for termination; actions to ensure patient safety.

449.0114      Display of license; compliance with law; transfer of real property; change in administrator, ownership, location, services or maximum number of clients.

449.0115      Review of building plans for new construction or remodeling by certain applicants: Required documents; payment of fees and costs.

449.01153    Approval of building plans for construction or remodeling of certain facilities: Period of validity.

449.01156    On-site advisory inspection of facility: Written request; action by Division; fee.

449.0116      Renewal of license: Application; validity of existing license pending decision on application; inspection of facility; untimely filing or failure to file application.

449.0118      Denial, suspension or revocation of license: Grounds.

449.0119      Denial, suspension or revocation of license or endorsement: Appeals.

CULTURAL COMPETENCY AND PREVENTION OF DISCRIMINATION

449.011901     Definitions.

449.011903  “Cultural competency training” defined.

449.011906  “Department” defined.

449.011909  “Director” defined.

449.011911  “Facility” defined.

449.011913     Types of prohibited discrimination.

449.011916     Policies and procedures for transfer, discharge and provision of services.

449.011919     Posting of notice relating to filing of complaints.

449.011921     Requirements for posting certain required information: Contents; size; placement.

449.011923     Provision to patient or resident of information concerning complaints.

449.011926     Policy on handling of complaints; log of complaints.

449.011929     Written permission required for presence of certain persons during physical examination where patient is unclothed.

449.011931     Cultural competency training for agent or employee who provides care to patient or resident.

449.011933     Submission of course or program for cultural competency training.

449.011936     Materials for course or program for cultural competency training.

449.011939     Approval or denial of course or program for cultural competency training; means for delivery of course or program.

449.011941     Assignment of course number to course or programs for cultural competency training.

449.011943     Policies concerning preferred names and pronouns; adaptation of records to reflect gender identities or expressions; method to obtain medically relevant information from patients or residents.

449.011946     Provision of certain statements, notices and information in appropriate languages and with reasonable accommodations.

449.011949     Designation of representative to ensure compliance.

449.011951     Facility to make certain documentation available to Division or Department.

FEES

449.012        Definitions.

449.01205    “Agency to provide personal care services in the home” defined.

449.0121      “Ambulatory surgical center” defined.

449.01215    “Branch office” defined.

449.01219    “Community triage center” defined.

449.01225    “Facility for hospice care” defined.

449.01227    “Facility for refractive surgery” defined.

449.01228    “Facility for transitional living for released offenders” defined.

449.01229    “Facility for treatment with narcotics” defined.

449.0123      “Home health agency” defined.

449.01235    “Home office” defined.

449.0124      “Hospice care” defined.

449.01245    “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” defined.

449.0125      “Medication unit” defined.

449.01252    “Mobile unit” defined.

449.01255    “Nursing pool” defined.

449.01257    “Psychiatric residential treatment facility” defined.

449.01259    “Recovery center” defined.

449.0126      “Rural clinic” defined.

449.01265    “Rural hospital” defined.

449.013        License and renewal fees to operate ambulatory surgical center or home office of home health agency, branch office of home health agency, rural clinic, free standing birthing center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, facility for refractive surgery, mobile unit, agency to provide personal care services in home, facility for the care of adults during day, community health worker pool and employment agency to provide nonmedical services; fee to support system for reporting of information on cancer and other neoplasms; expiration of application for license.

449.016        License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facility, residential facility for groups, facility for treatment of alcohol or other substance use disorders, facility for hospice care, home for individual residential care, facility for modified medical detoxification, community triage center, facility for treatment of irreversible renal disease, halfway house for persons recovering from alcohol or other substance use disorders, facility for transitional living for released offenders, psychiatric residential treatment facility and recovery center; expiration of application for license; fee to support system for reporting of information on cancer and other neoplasms; refund of certain fees.

449.0164      Fees for renewal of licenses for certain facilities: Payment in two equal installments.

449.0168      Fees for modification of certain licenses.

449.01685    Division authorized to charge and collect fee from licensee to recover costs of investigating complaint if complaint is substantiated.

449.0169      Department of Corrections to pay fee to Division for certain services.

PROVISION OF HOSPICE CARE

General Provisions

449.017        Definitions.

449.0171      “Bereavement services” defined.

449.0172      “Facility for hospice care” defined.

449.0173      “Governing body” defined.

449.0175      “Hospice care” defined.

449.0176      “Medical director” defined.

449.01765    “Palliative services” defined.

449.0177      “Patient” defined.

449.0178      “Terminally ill” defined.

Licensing

449.0181      Compliance with regulations required for license to operate facility for hospice care.

449.0183      Report of change in ownership, address or staff of program of hospice care.

Administration

449.0184      Governing body required; duties of governing body and administrator.

Medical Services

449.0185      Requirements for program of hospice care.

449.0186      Requirements for plan of care.

449.0187      Requirements for operation of facility for hospice care.

449.01875    New construction or remodeling: Submission and approval of building plans; prerequisites for approval of facility for licensure.

449.0188      Continuity of service to patients required.

FACILITIES FOR THE TREATMENT OF ALCOHOL OR OTHER SUBSTANCE USE DISORDERS

General Provisions

449.019        Definitions.

449.022        “Administrator” defined.

449.025        “Alcohol or other substance use disorder treatment” defined.

449.030        “Case management services” defined.

449.031        “Client” defined.

449.034        “Detoxification” defined.

449.043        “Facility” defined.

449.044        “Facility for modified medical detoxification” defined.

449.046        “Governing body” defined.

449.060        “Medically managed intensive detoxification program” defined.

449.064        “Overall program” defined.

449.068        “Qualified social worker” defined.

449.069        “Residential program” defined.

449.072        “Social model detoxification program” defined.

Licensing

449.079        Denial, revocation or suspension of license if facility not certified by Division; appeal.

449.081        New construction or remodeling: Submission and approval of building plans; prerequisites to approval of licensing.

Administration and Personnel

449.085        Governing body; bylaws.

449.088        Policies and procedures.

449.091        Transfer of client to another facility.

449.094        Money of clients.

449.098        Preparations for disasters; reporting of fire or disaster.

449.102        Inventory and return of client’s belongings.

449.105        Insurance.

449.108        General requirements for programs.

449.111        Administrator: Duties.

449.114        Employees: General requirements.

449.117        Employees: Proof of compliance with provisions concerning tuberculosis.

Social Model Detoxification Programs

449.121        Certain facilities authorized to offer program.

449.1214      General requirements.

449.1218      Program of ongoing quality improvement.

Operation of Facility

449.123        General sanitary requirements.

449.126        Laundry requirements.

449.129        Design, construction, equipment and maintenance.

449.132        Accommodations for clients.

449.135        Safety from fire.

449.141        Health services.

449.144        Medication.

449.147        Dietary services.

449.150        Records of clients.

FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION

449.15311    Definitions.

449.15313    “Administrator” defined.

449.15315    “Client” defined.

449.15317    “Facility” defined.

449.15319    “Overall program” defined.

449.15321    “Program” defined.

449.15323    Proof of certification required; revocation of license.

449.15325    Governing body; bylaws and policies.

449.15327    Policies and procedures for services and operation of facility.

449.15329    Transfer of client.

449.15331    Handling of money of client.

449.15333    Inventory of belongings of client.

449.15335    Liability insurance.

449.15337    Program: Requirements; review.

449.15339    Responsibilities and duties of administrator.

449.15341    Policies and procedures concerning employees.

449.15343    Nursing services.

449.15345    Health services.

449.15347    Pharmaceutical services.

449.15349    Medication and biologicals.

449.15351    Dietary services.

449.15353    Records of clients.

449.15355    Safety and sanitation; temperature.

449.15357    Laundry requirements.

449.15359    New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure.

449.15361    Design, construction, equipment and maintenance.

449.15363    Accommodations for clients.

449.15365    Safety from fire.

449.15367    Preparations for disasters; reporting of fire or disaster.

FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS

General Provisions

449.154        Definitions.

449.15415    “DEA” defined.

449.1542      “Facility for treatment with narcotics” defined.

449.1543      “Medical director” defined.

449.15435    “Medication unit” defined.

449.15438    “SAMHSA” defined.

449.1544      Division is state authority for certain federal regulations.

Licensing

449.15445    License and federal certification required to operate facility or unit.

449.1545      Filing requirements; recommendation for certification.

449.15455    Investigation and prelicensure survey.

449.1547      Suspension, revocation or cancellation of license; provisional license; denial of application.

Operation

449.1548      General operational requirements.

449.15485    Continuing review of operations; investigation of complaints.

HALFWAY HOUSES FOR PERSONS RECOVERING FROM ALCOHOL OR OTHER SUBSTANCE USE DISORDERS

449.1549      Definitions.

449.154901  “Administrator” defined.

449.154903  “Client” defined.

449.154905  “Facility” defined.

449.15491    Administrator: Qualifications.

449.154911     Administrator: General duties.

449.154913     General operational guidelines.

449.154915     Policies and procedures: Establishment; maintenance of manual.

449.154917     Limitation on admissions.

449.154919     Health and sanitation.

449.154921     Laundry facilities.

449.154923     Kitchens; storage of food.

449.154925     Bedrooms; bedding.

449.154927     Use of certain areas as bedroom prohibited.

449.154929     Bathrooms and toilet facilities; toilet articles.

449.154931     Accommodations for residents with restricted mobility.

449.154933     First aid.

449.154935     Medication.

449.154937     Telephones; listing of facility’s telephone number.

449.154939     Notification to Bureau under certain circumstances.

449.154941     Rights of clients.

449.154943     Client files: Maintenance; contents; confidentiality.

449.154945     Safety from fire.

FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS

General Provisions

449.154951     Definitions.

449.154953  “Administrator” defined.

449.154955  “Facility” defined.

449.154957  “Resident” defined.

449.154959  “Supportive services” defined.

Administration

449.154961     Administrator: Qualifications.

449.154963     Administrator: General duties.

449.154965     Operation of facility.

449.154967     Policies and procedures.

449.154969     Preparations for disasters and other emergencies.

Operation

449.154971     Limitation on number of admissions.

449.154973     Prerequisites to provision of particular services.

449.154975     Sanitation, safety and comfort.

449.154977     Laundry facilities.

449.154979     Kitchens; preparation and storage of food.

449.154981     Bedrooms and bedding.

449.154983     Use of certain areas as bedroom prohibited.

449.154985     Bathrooms and toilet facilities; toiletries.

449.154987     First aid.

449.154989     Medication.

449.154991     Telephones; listing of facility’s telephone number.

449.154993     Notification of occurrence of certain incidents.

449.154995     Rights of residents.

449.154997     Files for residents.

449.154999     Safety from fire.

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

449.15511    Definitions.

449.15513    “Caregiver” defined.

449.15515    “Director” defined.

449.15517    “Home” defined.

449.15519    “Protective supervision” defined.

449.15521    Director: Qualifications.

449.15523    Director: Duties.

449.15525    Requirements for safety and sanitation of facility.

449.15527    Agreement between operator of home and resident concerning rates; maintenance of records of residents.

449.15529    On-site survey of home by Bureau.

RESIDENTIAL FACILITIES FOR GROUPS

General Provisions

449.156        Definitions.

449.1565      “Administer” defined.

449.157        “Administrator” defined.

449.1575      “Board” defined.

449.1585      “Caregiver” defined.

449.1591      “Category 1 resident” defined.

449.1595      “Category 2 resident” defined.

449.1597      “Dietary supplement” defined.

449.1599      “Discharge” defined.

449.160        “Division” defined.

449.161        “Grade” defined.

449.164        “Hospice care” defined.

449.169        “Medical professional” defined.

449.170        “Placard” defined.

449.172        “Residential facility” defined.

449.173        “Residential facility which provides care to persons with Alzheimer’s disease” defined.

449.175        “Severity and scope score” defined.

449.176        “Staff of a facility” defined.

449.178        “Transfer” defined.

Licensing

449.179        Submission and approval of plan for new construction or remodeling; inspection; evidence of compliance.

449.180        Requirements for purchasing licensed facility.

449.190        License: Contents; validity; transferability; issuance of more than one type.

449.191        Denial, suspension or revocation of endorsement: Grounds.

449.1915      Suspension or revocation of license and endorsement if residential facility has been assigned grade of D on two or more consecutive surveys or resurveys, or both.

Administration and Personnel

449.194        Responsibilities of administrator.

449.196        Qualifications and training of caregivers.

449.197        Medical services may be provided only by medical professional.

449.1985      Performance of certain tasks by caregiver.

449.199        Staffing requirements; limitation on number of residents; written schedule for each shift; direct supervision of certain employees.

449.200        Personnel files.

449.202        Rights of staff members during investigation of facility; duties of investigator.

General Operational Requirements

449.204        System of financial accounting; insurance.

449.205        Advertising and promotional materials.

449.208        Restrictions on conducting other businesses or providing other services on premises.

449.209        Health and sanitation.

449.211        Automatic sprinkler systems.

449.213        Laundry and linen services.

449.216        Common areas; dining rooms.

449.217        Kitchens; storage of food; adequate supplies of food; permits; inspections.

449.2175      Service of food; seating; menus; special diets; nutritional requirements; dietary consultants.

449.218        Bedrooms: Floor space; windows and doors; privacy; storage space; bedding; personal furnishings; lighting.

449.220        Bedroom doors.

449.221        Use of certain areas in facility as bedroom prohibited.

449.222        Bathrooms and toilet facilities; toilet articles.

449.224        Housing for staff members.

449.226        Safety requirements for residents with restricted mobility or poor eyesight; water hazards; auditory systems for bathrooms and bedrooms; access by vehicles.

449.227        Accommodations for residents with restricted mobility.

449.229        Requirements and precautions regarding safety from fire.

449.231        First aid and cardiopulmonary resuscitation.

449.232        Telephones; emergency telephone numbers for each resident; listing of facility’s telephone number.

449.241        Limitations on use of volunteers; requirements concerning residents who volunteer to assist staff or perform other duties.

449.258        Written policies for facility; policy on visiting hours; residents’ mail; compliance with policies.

449.259        Supervision and treatment of residents generally.

449.260        Activities for residents.

449.262        Provision of dental, optical and hearing care and social services; report of suspected abuse, neglect, isolation or exploitation; restrictions on use of restraints, confinement or sedatives.

449.267        Money and property of residents.

449.268        Rights of residents; procedure for filing grievance, complaint or report of incident; investigation and response.

Admitting, Transferring and Discharging Residents

449.2702      Written policy on admissions; eligibility for residency.

449.2704      Disclosure of information concerning rates and payment for services.

449.2706      Transfer of resident whose condition deteriorates.

449.2707      Transfer of resident: Effective date.

449.2708      Discharge of resident; notice of discharge; issuance of notice to quit to resident for improper or harmful behavior.

Restrictions on Admitting or Retaining Residents With Certain Medical Needs or Conditions

449.271        Residents requiring gastrostomy care or suffering from staphylococcus infection or other serious infection or medical condition.

449.2712      Residents requiring use of oxygen.

449.2714      Residents requiring use of intermittent positive pressure breathing equipment.

449.2716      Residents having colostomy or ileostomy.

449.2718      Residents requiring manual removal of fecal impactions or use of enemas or suppositories.

449.272        Residents requiring use of indwelling catheter.

449.2722      Residents having unmanageable condition of bowel or bladder incontinence; residents having manageable condition of bowel or bladder incontinence.

449.2724      Residents having contractures.

449.2726      Residents having diabetes.

449.2728      Residents requiring regular intramuscular, subcutaneous or intradermal injections.

449.2732      Residents requiring protective supervision.

449.2734      Residents having tracheostomy or open wound requiring treatment by medical professional; residents having pressure or stasis ulcers.

449.2736      Procedure to exempt certain residents from restrictions.

449.2738      Review of medical condition of resident; relocation or transfer of resident having certain medical needs or conditions.

Medical Services, Medical Records and Other Records Concerning Residents

449.274        Medical care of resident after illness, injury or accident; periodic physical examination of resident; rejection of medical care by resident; written records.

449.2742      Administration of medication: Responsibilities of administrator, caregivers and employees of facility.

449.2744      Administration of medication: Maintenance and contents of logs and records.

449.2746      Administration of medication: Restrictions concerning medication taken as needed by resident; written records.

449.2748      Medication: Storage; duties upon discharge, transfer and return of resident.

449.2749      Maintenance and contents of separate file for each resident; confidentiality of information.

Special Types of Services and Facilities

449.275        Residential facility which provides residents with hospice care: Responsibilities of staff; retention of resident with special medical needs.

449.2751      Residential facility which provides assisted living services: Application for endorsement; general requirements.

449.2754      Residential facility which provides care to persons with Alzheimer’s disease: Application for endorsement; general requirements.

449.2756      Residential facility which provides care to persons with Alzheimer’s disease: Standards for safety; personnel required; training for employees.

449.2758      Residential facility which provides care for elderly persons or persons with disabilities: Training for caregivers.

449.2762      Residential facility which offers or provides care for adults with intellectual disabilities or adults with developmental disabilities: Application for endorsement; training for caregivers.

449.2764      Residential facility which offers or provides care for persons with mental illnesses: Application for endorsement; training for employees.

449.2766      Residential facility which offers or provides care for persons with chronic illnesses and debilitating diseases: Application for endorsement; training for employees.

449.2768      Residential facility which provides care to persons with dementia: Training for employees.

Deficiencies

449.27702    Determination of severity and scope of deficiency; assignment of grade.

449.27704    Placard: Issuance and display; failure to comply.

449.27706    Resurvey: Application and fee; failure to comply.

BUSINESSES THAT PROVIDE REFERRALS TO GROUP HOUSING ARRANGEMENTS

449.27811    Definitions.

449.27813    “Client” defined.

449.27817    “Financial assessment” defined.

449.27818    “Group housing arrangement” defined.

449.27819    “Needs assessment” defined.

449.27823    License not required by certain persons to make referrals; application for licensure; referral through licensed referral agency.

449.27827    Requirements for employees.

449.27829    Responsibilities of referral agency.

449.27831    Contract for services; fees; maintenance of client records.

HOSPITALS

General Provisions

449.279        Definitions.

449.286        “Governing body” defined.

449.287        “Hospital” defined.

449.289        “Inpatient” defined.

449.297        “Outpatient” defined.

449.298        “Outpatient department” defined.

449.299        “Patient” defined.

449.300        “Restraint” defined.

Licensing and Administration

449.307        Applicability of license; coverage against certain liabilities.

449.310        Limitation on number of patients; annual on-site inspection not required under certain circumstances.

449.312        Change in ownership, use or construction; correction of deficiencies.

449.313        Responsibilities and duties of governing body; bylaws; appointment and duties of chief executive officer; protocol for organ donations; annual operating budget.

449.314        Quality of care; scope of services.

449.3152      Quality improvement program.

449.3154      Construction, remodeling, maintenance and change of use: General requirements; prerequisites to approval of licensure.

449.3156      Compliance with certain guidelines for design and construction; correction of deficiencies.

Policies and Procedures for Operation of Hospital

449.316        Physical environment: Safety and well-being of patients; plan for emergency preparedness; safety management.

449.317        Risk management.

449.318        Accreditation by national accrediting organization required; exceptions; submission of proof of accreditation to Division.

449.319        Requirements for personal needs of patients.

449.321        Requirement to be primarily engaged in providing certain services; determination of whether requirement is met; exemption for certain hospitals.

449.322        Housekeeping and laundry services.

449.325        Prevention, control and investigation of infections and communicable diseases.

449.327        Preparation, sterilization, storage and distribution of sterile supplies and medical and surgical equipment.

449.329        Admission of patients.

449.331        Provision of emergency services and medical care; transfer agreements with long-term care facilities; attestation of compliance.

449.332        Discharge planning.

449.337        Dietary services: General requirements.

449.338        Dietary services: Provision for needs of patients; facilities; standards; permits; records.

449.3385      Dietary services: Personnel.

449.339        Dietary services: Nutritional status of patients.

449.3395      Dietary services: Sanitary conditions; supplies.

449.340        Pharmaceutical services.

449.343        Orders for medication and biologicals.

449.344        Administration of medication; security.

449.346        Rehabilitative services.

449.349        Emergency services.

449.352        Social services.

449.358        Medical staff.

449.361        Nursing services.

449.3622      Appropriate care of patients.

449.3624      Assessment of patients.

449.3626      Rights of patients.

449.3628      Protection of patients; use of physical restraints.

449.363        Personnel policies concerning employment, licensing and certification; training of employees who provide care to victims of sexual assault or attempted sexual assault.

449.364        Obstetrical services: Administration; staffing and equipment.

449.3645      Obstetrical services: Labor rooms; delivery rooms; utility rooms; area for cleaning instruments.

449.365        Obstetrical services: Required services.

449.3655      Obstetrical services: Transfer or discharge of patient.

449.367        Obstetrical services: Nurseries.

449.370        Outpatient services.

449.371        Intensive care services.

449.373        Laboratory services; pathology services; blood and blood products.

449.3735      Transfusions of blood.

449.374        Nuclear medicine services.

449.375        Records for nuclear medicine services; authorization.

449.376        Radiological services.

449.377        Radiological therapeutic services.

449.379        Medical records.

449.382        Medical library.

449.385        Surgical services.

449.388        Anesthesia services.

449.389        Respiratory care services.

449.391        Dental services.

449.394        Psychiatric services.

INTERMEDIARY SERVICE ORGANIZATIONS

General Provisions

449.395        Definitions.

449.39501    “Certificate” defined.

449.39502    “Client” defined.

449.39503    “Intermediary service organization” defined.

449.39504    “Managing employer” defined.

449.39505    “Other responsible person” defined.

449.39506    “Personal assistance” defined.

449.39507    “Personal assistant” defined.

449.39508    “Guardian” interpreted.

Certification

449.3951      Form of application; written verification for submission of fingerprints.

449.39511    Application for certificate and renewal: Fees.

449.39512    Application for certificate and renewal: Proof of insurance coverage.

449.39513    Applicability of certificate; specification of primary location; records.

449.39514    Issuance of provisional certificate.

Authorized Activities and General Requirements for Operation

449.39515    Operation of intermediary service organization and agency to provide personal care services in the home.

449.39516    Duties and responsibilities.

449.39517    Personal assistants: Qualifications; maintenance and availability of personnel files.

449.39518    Personal assistants: Results of reports on criminal history.

449.395185     Personal assistants: Performance of certain tasks.

449.39519    Client to serve as managing employer and provide training to personal assistant; reporting of training to organization.

449.3952      Additional training to be provided by intermediary service organization.

449.39521    Visits and telephone interviews with clients.

449.39522    Written statement of services provided to clients.

449.39523    Discussion of services provided to clients.

449.39524    Rights of person with a disability receiving services.

Administrative Review and Hearings

449.39525    Request for administrative review of complaint.

449.39526    Scheduling of administrative review.

449.39527    Conduct of administrative review.

449.39528    Issuance of written decision following administrative review.

449.39529    Request for hearing.

449.395295     Hearings: Scheduling; notice.

449.3953      Hearings: Representation; evidence; rights of parties.

449.39531    Resolution of complaint.

449.39532    Final decision of hearing officer; request for judicial review.

449.39533    Record of hearing.

449.39534    Provision of transcript of oral proceedings of hearing.

Administrative Sanctions

449.39535    Definitions.

449.39536    “Ban on enrollment” defined.

449.39537    “Cluster” defined.

449.39538    “Compliance” defined.

449.39539    “De minimis violation” defined.

449.3954      “Major violation” defined.

449.39541    “Plan of correction” defined.

449.39542    “Resurvey” defined.

449.39543    “Severity and scope score” defined.

449.39544    “Subsequent violation” defined.

449.39545    Imposition of sanctions generally.

449.39546    Minimum sanction to be imposed.

449.39547    Available sanctions.

449.39548    Duration of sanctions.

449.39549    Notice of sanction; appointment of temporary manager; ban on enrollment or suspension of certificate authorized in certain circumstances.

449.3955      Imposition of one or more sanctions; reporting of violations; presumption of de minimis violation.

449.39551    Severity and scope of violations to be considered in determining sanctions to be imposed.

449.39552    Scope of violations: Survey of organization; sampling of clients; use of scope relating to one client authorized.

449.39553    Scope of violations: Use of scope; basis for assessment.

449.39554    Scope of violations: Criteria for evaluation.

449.39555    Severity of violations: Use of severity scale; basis for assessment; criteria for evaluation.

449.39556    Subsequent violation on resurvey: Rebuttable presumption; imposition of sanction.

449.39557    Determination of sanctions: Initial assessment.

449.39558    Determination of sanctions: Secondary factors to be considered.

449.39559    Determination of sanctions: Basis for selection; restrictions upon service and monetary penalties presumed to be most effective.

449.3956      Plan of correction: Development by intermediary service organization; authority of Division when plan is not acceptable; effect of failure to submit plan.

449.39561    Monetary penalties: Determination of initial penalty; daily penalties; maximum total penalties.

COMMUNITY HEALTH WORKER POOLS

449.39565    Definitions.

449.39567    “Client” defined.

449.39569    “Continuing education” defined.

449.39571    “Representative of the client” defined.

449.39573    “Service plan” defined.

449.39575    “Services of a community health worker” defined.

449.39577    Location to which license applies; name of administrator to appear on license; liability coverage.

449.39579    Qualifications and duties of administrator; access to records in absence of administrator.

449.39581    Written policies and procedures.

449.39583    Qualifications of community health worker.

449.39585    Personnel files for community health workers.

449.39587    Training and evaluation of community health workers.

449.39589    Rights of clients: Duties of administrator; provision of written description to clients.

449.39591    Initial screening of client.

AGENCIES TO PROVIDE PERSONAL CARE SERVICES IN THE HOME

General Provisions

449.396        Definitions.

449.3961      “Activities of daily living” defined.

449.3962      “Agency” defined.

449.3963      “Attendant” defined.

449.3964      “Client” defined.

449.3965      “Personal care services” defined.

449.3966      “Representative of the client” defined.

449.3967      “Service plan” defined.

449.3968      “Work station” defined.

Licensing

449.3972      Location to which license applies; agency to retain proof of liability coverage and compliance with certain statutory provisions.

Administration and Personnel

449.3973      Qualifications and duties of administrator; appointment of designee to act in administrator’s absence.

449.39735    Training of employees: Provision or arranging for provision of training; costs; payment of salary or hourly wage; exceptions; documentation.

449.3974      Maintenance of policies and procedures concerning qualifications, responsibilities and conditions of employment for staff members.

449.3975      Attendants: Qualifications; annual training.

449.3976      Attendants: Maintenance of personnel file; evaluation of competency.

449.3977      Attendants: Required knowledge and training.

449.39775    Attendants: Performance of certain tasks.

449.3978      Attendants: Prohibition on provision of certain types of services to clients.

Provision of Services

449.3979      Provision of written disclosure statement to client upon acceptance for services by agency.

449.398        Rights of clients: Duties of administrator; provision of written description to clients.

449.3981      Initial screening of client and development or acceptance of service plan; requirements before providing personal care to client.

449.3982      Supervisory home visits or telephone calls required to ensure quality of care provided; documentation of evaluation.

FACILITIES FOR CARE OF ADULTS DURING THE DAY

General Provisions

449.4061      Definitions.

Licensing

449.4063      Design, construction, equipment and maintenance of facility: General requirements; prerequisites to approval for licensure.

449.4065      Consultation with representative of Division; notice of nonconformity.

449.4067      Operation in combination with other medical facility or facility for the dependent.

449.4069      Insurance.

Operation of Facility

449.407        Advertising and promotional materials.

449.4071      Policies and procedures; accounting.

449.4072      Director and employees: Qualifications and duties; physical and mental health; personnel files.

449.40723    Supervision of clients; volunteers.

449.40725    Orientation and training of employees and volunteers.

449.4073      Files concerning employees.

449.4074      Requirements of facility; health and sanitation; medications; exits.

449.4075      Preparations for fires and other emergencies; reporting of fire or disaster.

449.4076      First aid.

449.4077      Policy for admissions; retention of signed copy.

449.4078      Requirements for admission; designation of physician.

449.4079      Required services.

449.408        Housekeeping and maintenance.

449.4081      Administration of medication; notification of accidents, injuries or illnesses; treatment with dignity; use of restraints or sedatives.

449.40815    Performance of certain tasks by employee.

449.4082      Service of food; dietary consultants.

449.40833    Summary of client’s care; referrals.

449.40835    Records.

Medical and Ancillary Services

449.4084      Contract for provision by another person.

449.4085      Provision by facility authorized.

449.4086      Evaluation of programs and policies.

449.4087      Written assessments of clients.

449.4088      Plan of care; periodic assessment.

449.4089      Menus.

PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES

General Provisions

449.410        Definitions.

449.4105      “Administrator” defined.

449.411        “Psychiatric residential treatment facility” defined.

449.4115      “Resident” defined.

Licensing

449.414        License required to operate facility.

449.4145      Application for accreditation required; recognition as accrediting organization by Board; failure of facility to attain or maintain accreditation.

449.416        Prelicensure investigation and site inspection.

449.417        Issuance of license.

449.419        Personnel: Written policies required; evidence of licensure or certification and tuberculosis testing required.

449.420        Compliance with state, federal and local laws, regulations and ordinances; failure to comply is ground for suspension or revocation of license.

449.421        Suspension, revocation or cancellation of license; provisional license.

Administration and Operation

449.423        Written scope of services; policies and procedures; responsibilities and duties of administrator.

449.424        Quality improvement program.

449.426        Construction and maintenance of facility; plan for emergency preparedness; safety from fire and other disasters.

449.427        Limitation on number of residents.

449.428        Access of residents to their belongings; accommodations, equipment and supplies for residents; lighting and temperature levels.

449.429        Housekeeping services; cleaning and laundry requirements.

449.430        Prevention, control and investigation of infections and communicable diseases.

449.432        Administration of medication; security.

449.4325      Orders for medication and biologicals.

449.433        Reporting of problems concerning administration of drug to resident and misuses and losses of controlled substances; information concerning drugs must be available to professional members of staff.

449.435        Dietary services: General requirements.

449.436        Dietary services: Facilities; standards; permits.

449.438        Dietary services: Sanitary conditions required; supplies.

449.439        Dietary services: Therapeutic diets.

449.441        Dietary services: Personnel.

Provision of Services

449.442        Policies and procedures for protection of rights of residents; duties of employee or independent contractor who believes resident has been abused or neglected.

449.445        Policies and procedures for admission of residents; provision of certain information to resident or person legally responsible for resident.

449.447        Records of residents.

449.448        Assessment and appropriate care of residents.

449.4495      Discharge planning.

FACILITIES FOR REFRACTIVE SURGERY

449.450        “Facility” defined.

449.4504      Administrator: Appointment; duties; qualifications.

449.4505      Administrator of facility that performs intraocular lens implants: Duties.

449.4506      Staffing requirements; personnel files.

449.4508      Maintenance of patient records.

449.451        Written policies and procedures.

449.4512      Program of quality improvement.

449.4514      Rights of patients; informed consent.

449.4516      Equipment and supplies.

449.4518      Liability for use of leased equipment.

449.4522      Sanitation and hygiene; space and storage.

449.4524      Medical care of patients.

449.4526      Application for indemnification for certain damages; claims against surety bond or substitute thereof.

FACILITIES FOR TREATMENT OF IRREVERSIBLE RENAL DISEASE

General Provisions

449.501        Definitions.

449.502        “Advanced practice registered nurse” defined.

449.504        “Charge nurse” defined.

449.5045      “Competency” defined.

449.505        “Dialysis” defined.

449.5053      “Dialysis technician” defined.

449.5055      “Direct supervision” defined.

449.5065      “End-stage renal disease” defined.

449.507        “Facility” defined.

449.508        “Hemodialysis” defined.

449.510        “Immediate supervision” defined.

449.511        “Intermediate level disinfection” defined.

449.513        “Licensed practical nurse” defined.

449.516        “Product water” defined.

449.517        “Supervision” defined.

449.519        “Training” defined.

Construction; Health and Safety

449.520        New construction or remodeling: Notification; increase in number of stations for which facility is licensed.

449.5205      New construction or remodeling: Submission of plans and specifications; minor changes; inspection.

449.522        Construction, space and design; physical environment; restrictions for treatment of patients with hepatitis B.

449.5225      Safety and comfort of patients during construction; imposition of more stringent design and space requirements.

449.523        Safety requirements.

449.5235      Maintenance and repair of equipment.

449.525        Water treatment system: General requirements.

449.5255      Water treatment system: Chemical testing of product water; records.

449.526        Water treatment system: Microbiological testing of product water.

449.5265      Reuse of hemodialyzer; transport of used dialyzer.

449.528        Adoption of more stringent requirements for treatment of water and reuse of hemodialyzers.

449.5285      Sanitation: Precautions regarding blood and bodily fluids.

449.529        Sanitation: Control of infections; nonsmoking policy.

449.5295      Sanitation: Provision of sanitary environment; walls, floors and ceilings; blood spills.

449.531        Sanitation: Disinfection of dialysis machines; culturing dialysate; cleaning of machines and equipment; handling of waste.

449.5315      Hepatitis B: Vaccinations for certain staff members; postvaccination screening; adoption of related provisions.

449.532        Hepatitis B: Vaccinations for certain patients.

449.5325      Hepatitis B surface antigen: Screening of patients; additional serologic screening.

449.534        Hepatitis B surface antigen: Treatment of patients who test positive.

449.5345      Tuberculosis: Screening of staff and patients.

Provision of Services

449.540        Program of quality assurance; recordation of accidents and incidents; reporting of certain events.

449.5405      Rights of patients.

449.541        Interdisciplinary teams; plans for care of patients.

449.5415      Preparations for emergencies and disasters.

449.543        Pharmaceutical services.

449.5435      Nursing services; physicians and other staff.

449.544        Nutrition services.

449.5445      Social services.

449.546        Patient care: Advanced practice registered nurses and physician assistants; medical emergencies.

449.5465      Patient care: Licensed practical nurses and dialysis technicians.

449.547        Self-dialysis: Provision of training and certain services.

449.5475      Continuous ambulatory peritoneal dialysis.

449.549        Continuous cycling peritoneal dialysis.

449.5495      Patient services by contract; laboratory.

Administration and Personnel

449.550        Governing body.

449.5505      Medical director.

449.552        Physicians.

449.5525      Orientation program for new employees; continuing education.

449.553        Medical staff: Generally.

449.5535      Nurses.

449.555        Dietitians.

449.5555      Social workers.

449.556        Staff responsible for operating water treatment system.

449.5565      Staff that repairs or maintains equipment used to provide care to patients.

Clinical Records

449.558        Preparation and maintenance.

449.5585      Additional requirements.

449.559        Medical history and physical examination.

449.5595      Transient patients.

449.561        Discharge or transfer of patients; removal of records.

449.5615      Cessation of operation of facility.

Dialysis Technicians

449.570        General qualifications; identification to be worn during training; provision of care; requirements to act as preceptor.

449.5705      Qualification of technician determined to be qualified before July 1, 2001.

449.571        Program of training: Curriculum; duties of instructor; written examinations.

449.5715      Program of training: Qualifications of instructors.

449.573        Program of training: Certain persons authorized to provide instruction and serve as preceptor.

449.5735      Program of training: Required hours.

449.574        Committee to review program of training.

449.5745      Written list concerning knowledge and skills.

449.576        Peritoneal dialysis: Additional activities required.

449.5765      Cannulation or administration of normal saline or heparin: Additional activities required.

449.577        Cannulation or administration of normal saline, heparin or lidocaine: Verification and documentation of competency required.

449.5775      Documentation of successful completion of program of training; employment by another facility.

449.579        Patient care: Technicians must demonstrate certain knowledge and competency.

449.5795      Prohibited acts.

PROVISION OF CERTAIN SPECIAL SERVICES

Open-Heart Surgery

449.612        Definitions.

449.612011  “Approval” defined.

449.612012  “Approved hospital” defined.

449.612014  “Cardiac surgery” defined.

449.612017  “Open-heart surgery” defined.

449.61202    Prerequisites to initial provision of service.

449.61204    Form and contents of application for approval to provide service.

449.61206    Notification of applicant upon review of application; site inspection required.

449.61208    Composition and duties of site inspection team.

449.6121      Hospital to pay costs of inspection.

449.61212    Approval or denial of application; period of validity of approval; cessation of performance of surgeries.

449.61214    Amount of surgery required following approval.

449.61216    Provision of patient with preoperative instruction.

449.61218    Surgical team: Composition; privileges and qualifications of members; participation of qualified nurses.

449.6122      Qualifications of anesthesiologist.

449.61222    Qualifications of nurse in charge of service.

449.61224    Perfusion team: Use required; qualifications; approval of members by surgeon of record.

449.61226    Operating rooms: General requirements.

449.61228    Operating rooms: Equipment and staff.

449.6123      Intensive care facility: General requirements.

449.61232    Intensive care facility: Staff.

449.61234    Intensive care facility: Equipment and supplies.

449.61236    Orientation and continuing education of personnel.

449.61238    Maintenance of blood bank.

449.6124      Maintenance of cardiac catheterization laboratory.

449.61242    Maintenance of medical laboratory.

449.61244    Maintenance of facilities to perform contrast studies and equipment to review films of operations.

449.61246    Maintenance of registry to record results for each patient.

449.61248    Maintenance of program to follow recovery of patient.

449.6125      Annual review and inspection of hospital.

449.61252    Annual inspection of hospital: Assessment of rate of mortality.

449.61254    Further review or on-site inspection for failure to comply with provisions or for excessive rate of mortality; notice; plan for compliance.

449.61256    Denial, suspension or revocation of approval: Grounds; hearing.

Transplantation of Organs

449.6126      Definitions.

449.61262    Application for approval to provide services.

449.61264    Evaluation of application for approval.

449.61266    Duties of hospital providing services.

449.61268    Revocation of approval.

449.6127      Notice of intent to deny application or revoke approval; hearing.

INDEPENDENT CENTERS FOR EMERGENCY MEDICAL CARE

Licensing

449.61302    Limitations on issuance of license.

449.61306    Denial of application for license or renewal of license.

449.61308    Compliance with regulations; ground for suspension or revocation of license.

Administration and Personnel

449.6132      Requirement of governing body; adoption of written rules.

449.61322    Exception to requirements of governing body.

449.61324    Standards of care; policy for authentication.

449.61326    Program to review quality of care; contents of program.

449.61328    Integration into local emergency medical system.

449.6133      Appointment and responsibilities of administrator.

449.61332    Employment and duties of medical director.

449.61334    Standards and procedures for selection, treatment and retention of medical staff and members of allied health professions.

449.61336    Rules for organization of medical staff.

449.61338    Employment and duties of chief nurse; size of on-duty nursing staff; limitation on scope of practice by person who is not registered nurse; oversight of nursing staff.

Facilities

449.6135      Design, construction, equipment and maintenance: General requirements; prerequisites to approval for licensure.

449.61352    Contents of center: Emergency entrance; reception and waiting areas; treatment and examination rooms; space for storage and maintenance of medical records and supplies.

449.61354    Contents of treatment rooms; accessibility to person in wheelchair.

Medical Services and Medical Records

449.6137      Requirement for minimum level of care in certain situations.

449.61372    Criteria for denial of care, transfer or discharge of patient; compliance with state and federal laws.

449.61374    Laboratory services and reports; procedures for storage and administration of tissue specimens, blood and blood products; agreements with outside blood banks; review of blood transfusions and reactions.

449.61376    Program for control of infection.

449.61378    Radiological services: Availability; interpretation and reporting of films; storage and retention.

449.6138      Distribution and administration of drugs and controlled substances.

449.61382    Medical records: Maintenance; access; authorized release; completion after discharge.

449.61384    Contents of medical records.

FREESTANDING BIRTHING CENTERS

449.61387    Definitions.

449.613875  “Birth assistant” defined.

449.61388    “Certified nurse-midwife” defined.

449.613885  “Clinical provider” defined.

449.61389    Proof and maintenance of accreditation; maintenance of documents relating to issuance or renewal of accreditation; specification of capacity in application for license.

449.613895     Design, construction, equipment and maintenance.

449.6139      Submission of plans for new construction or remodeling; prerequisites to approval of facility for licensure; exception.

449.613905     Supply of oxygen; policies and procedures for administration and storage of oxygen.

449.61391    Policies and procedures for control of infection: Manufacturer’s guidelines; training and evaluation of employees; notification to employees upon revision; supply of personal protective equipment.

449.613915     Compliance with certain laws, regulations, codes and ordinances; participation in National Healthcare Safety Network; provision of records to Division.

449.61392    Adoption of publication by reference; revision of publication after adoption; compliance with adopted standards.

449.613925     Qualifications of clinical provider; director to maintain personnel file and ensure licensure, certification or registration of employees; staff requirements for delivery and care.

449.61393    Birth assistants: Qualifications.

449.613935     Birth assistants: Supervision; delegation of tasks; personnel files; prohibited tasks.

449.61394    Program of supervised training: Supervision; instruction; policies and procedures.

449.613945     Establishment of criteria and protocols concerning pregnancy; requirements for birth at birthing center; exception.

449.61395    Information to be provided to patient; access of patient to medical record; adoption of procedure for complaint.

449.613953     Exclusions from term “surgery.”

449.613956     Duties of director relating to drugs and laboratory testing supplies; use of prescribed drug by patient.

449.61396    Death of patient; notification of Division; provision of counseling.

INTERMEDIATE CARE FACILITIES

General Provisions

449.614        Definitions.

449.617        “Administrator” defined.

449.623        “Facility” defined.

449.629        “Intermediate care facility as a distinct part of a health and care facility furnishing more than one level of care” defined.

449.632        “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” defined.

449.635        “Licensee” defined.

449.638        “Long-term care facility” defined.

449.644        “Mixed facility” defined.

449.647        “New facility” defined.

449.650        “Nursing home” defined.

449.653        “Patient in an intermediate care facility I” defined.

449.656        “Patient in an intermediate care facility II” defined.

449.657        “Person with a developmental disability” defined.

449.658        “Person with an intellectual disability” defined.

449.659        “Resident” defined.

Licensing

449.668        Provisional licenses.

Administration and Personnel

449.671        Financing; liability insurance.

449.674        Administrator: Qualifications.

449.677        Employees: General requirements.

449.680        Maintenance of evidence of screenings for communicable diseases.

449.681        Employees of facility which provides care to persons with dementia: Continuing education.

Construction and Operation: Generally

449.685        Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.

449.692        Sanitary requirements.

449.695        Laundry requirements.

449.698        Fire inspections; hazardous conditions; operation of other business.

449.701        Preparations for emergencies; reporting of fire or disaster.

449.704        Written policies and procedures for facility; admission agreements; transfer agreements.

449.707        Money of residents.

449.710        Inventory of residents’ belongings.

449.713        Program requirements.

449.716        Dietary services.

449.719        Health services.

449.722        Pharmaceutical services.

449.725        Records.

449.728        Supervision by physician; volunteers; advertising.

Construction and Operation: Facilities for Persons With an Intellectual Disability or Persons With a Developmental Disability

449.732        Definitions.

449.7322      “Facility” defined.

449.7324      “New facility” defined.

449.7326      Standards for construction, remodeling or change in use of facility; fire alarms; emergency radio system; submission and approval of building plans.

449.7328      Elevators.

449.733        Electrical systems.

449.7332      Mechanical systems.

449.7334      Doors, windows, ceilings, walls and floors.

449.7336      Entrances and lobbies; miscellaneous space.

449.7338      Dining and storage space.

449.7342      Facilities for employees and volunteers.

449.7344      Areas for engineering and maintenance.

449.7346      Janitors’ closets.

449.7348      Linen service.

449.735        Area for medical records.

449.7352      Nursing units.

449.7354      Service areas.

449.7356      Processing of waste.

449.736        Personnel.

449.737        Plan of care.

449.740        Corporal punishment; restraints.

449.743        Records.

COMMUNITY TRIAGE CENTERS

449.74311    Definitions.

449.74313    “Administrator” defined.

449.74315    “Facility” defined.

449.74317    “Governing body” defined.

449.74321    “Patient” defined.

449.74322    “Person with mental illness” defined.

449.74323    “Program” defined.

449.74325    “Psychologist” defined.

449.74327    Governing body; bylaws and policies.

449.74329    Policies and procedures for services and operation of facility.

449.74331    Transfer of patient.

449.74333    Handling of money of patient.

449.74335    Inventory of belongings of patient.

449.74337    Liability insurance.

449.74339    General requirements for programs and services.

449.74341    Responsibilities and duties of administrator.

449.74343    Policies and procedures concerning employees.

449.74345    Nursing services.

449.74347    Health services.

449.74349    Mental health services.

449.74351    Pharmaceutical services.

449.74353    Medication and biologicals.

449.74355    Records of patients.

449.74357    Laundry requirements.

449.74359    Dietary services.

449.74361    New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure.

449.74363    Design, construction, equipment and maintenance of facility.

449.74365    Entrances, lobbies and offices; storage space.

449.74367    Patients’ rooms; toilet and bathing facilities.

449.74369    Service areas; miscellaneous requirements.

449.74371    Safety and sanitation.

449.74373    Preparations for disasters; reporting of fire or disaster.

FACILITIES FOR SKILLED NURSING

General Provisions

449.744        “Facility for skilled nursing” defined.

Licensing and Administration of Facility

449.74411    Applicability of license; limitation on number of patients; coverage against certain liabilities.

449.74413    Change in ownership, use or construction of facility.

449.74415    Responsibilities of governing body.

449.74417    Administrator of facility.

449.74419    Committee for quality assurance.

449.74421    Procedures for emergency or disaster.

Admission, Transfer and Discharge of Patient

449.74423    Certain conditions for admission prohibited.

449.74425    Admission of patient with mental illness or an intellectual disability.

449.74427    Agreement with hospital for transfer of patients.

449.74429    Transfer or discharge of patient.

449.74431    Summary of discharge.

Assessment of Patients and Plan of Care

449.74433    Comprehensive assessment of needs of patient.

449.74435    Quarterly assessment of patient.

449.74437    Conduct of assessments.

449.74439    Comprehensive plan of care.

Medical Records

449.74441    Maintenance.

449.74443    Inspection.

Rights of Patients

449.74445    Generally.

449.74447    Communications with other persons; examination of records by advocate.

449.74449    Notice to patients of rights, services and charges.

449.74451    Charges to be consistent with notice of charges.

449.74453    Notice to patients of programs available for assistance in payment of services.

449.74457    Policies and procedures for advance directives by patient; information to be furnished regarding physicians.

449.74459    Examination by patient of survey of facility and plan of correction.

449.74461    Finances of patient: System for maintenance and accounting.

449.74463    Finances of patient: Authorization to withhold money.

449.74465    Sending and receiving mail.

449.74467    Performance of services for facility by patient.

Quality of Care

449.74469    Standards of care.

449.74471    Administration of drugs.

449.74473    Program for control of infections.

449.74475    Vision and hearing.

449.74477    Pressure sores.

449.74479    Urinary problems.

449.74481    Range of motion.

449.74483    Mental or psychosocial behavior.

449.74485    Nasogastric tubes.

449.74487    Nutritional health; hydration.

449.74489    Physical or chemical restraint of patients.

449.74491    Prohibition of certain practices regarding patients; investigation of certain violations and injuries to patients; unfit employees.

449.74493    Notification of changes or condition of patient.

449.74495    Development of program of activities.

449.74497    Daily activities of patient.

449.74499    Participation in activities.

Staff and Attending Physicians

449.74511    Personnel policies; personnel records.

449.74513    Medical director.

449.74515    Physicians.

449.74517    Nursing staff.

449.74519    Nursing assistants and nursing assistant trainees.

449.74521    Other health care professionals.

449.74522    Employees of facility which provides care to persons with dementia.

Provision of Services

449.74523    Social services.

449.74525    Dietary services.

449.74527    Specialized rehabilitative services.

449.74529    Dental services.

449.74531    Pharmaceutical services.

449.74533    Laboratory services.

449.74535    Radiological and other diagnostic services.

449.74537    Special services.

Physical Environment

449.74539    General requirements.

449.74543    Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.

449.74549    Patients’ rooms.

NURSING POOLS

General Provisions

449.747        Definitions.

Licensing

449.7471      License required.

449.7473      Location to which license applies; persons named in license; restrictions on use of license.

449.7474      Duties of licensee or applicant for license.

Administration and Personnel

449.7475      Administrator: Qualifications and duties.

449.7476      Director of professional services: Qualifications and duties.

449.7477      Personnel policies: Maintenance and availability.

449.7478      Requirements for contracts to provide nursing services.

449.7479      Referral of patients when services not available; provision of services; bonding of staff.

449.748        Duties of registered nurse; provision of nursing care by practical nurse or nursing assistant.

449.7481      Annual evaluation of nursing pool by licensee.

HOME HEALTH AGENCIES

General Provisions

449.749        Definitions.

449.750        Adoption of publication by reference; revision of publication after adoption.

Licensing and Inspection

449.752        License required.

449.758        Applicability of license; coverage against certain liabilities.

449.761        Periodic inspections.

449.767        Action to enjoin operation without license.

449.768        Applicant or licensee to maintain home office in Nevada.

Administration and Personnel

449.782        Personnel policies.

449.788        Licensure, registration or certification of certain personnel.

449.793        Periodic review of patient and clinical records by appointed committee; minutes of meetings.

449.7935      Compliance with certain federal requirements; exception; provision of data to Division; application of certain provisions to physician assistants and advanced practice registered nurses.

Medical Services and Medical Records

449.794        Clinical records: Maintenance.

449.797        Clinical records; contents.

449.800        Orders of a physician, physician assistant or advanced practice registered nurse.

COMMUNITY-BASED LIVING ARRANGEMENT SERVICES

General Provisions

449.801        Definitions.

449.802        “Certificate” defined.

449.804        “Community-based living arrangement services” or “services” defined.

449.805        “Facility” defined.

449.807        “Individual support team” defined.

449.808        “Individualized plan” defined.

449.810        “Mental illness” defined.

449.811        “Provider” defined.

449.813        “Provisional license” defined.

449.814        “Quality assurance review” defined.

449.816        “Resident” defined.

Issuance and Renewal of Provisional Licenses and Licenses

449.817        Provisional license or license required to provide services; exception.

449.818        Contents of application for provisional license; fee; bond.

449.819        Review of application for provisional license; actions upon determination that application is incomplete.

449.820        Training required of applicant for provisional license; inspection of facility; issuance and validity of provisional license.

449.822        Grounds for denial of application for provisional license; notice of denial.

449.823        Quality assurance review; extension or revocation of provisional license; issuance of license.

449.825        Renewal of license; fee.

Operation of Provider

449.826        Duties of provider.

449.828        Policies and procedures of governmental or organizational provider.

449.829        Initial and periodic investigations of employee, independent contractor or adult present during provision of services; termination of employment, contract or authority to be present for conviction of certain crimes; period in which to correct information regarding conviction.

449.831        Required certifications and courses for employee or independent contractor who provides services.

449.832        Arrangements for services from specially trained persons; determination of need for such services.

449.834        Financial plan; financial records; financial report.

449.835        Assessment of need for services; maintenance of findings of assessment; establishment of individual support team and permanent individualized plan; acceptance of person before assessment in urgent situation.

449.837        Contract for provision of services.

449.8385      Training for providers and employees; exception.

449.840        Record regarding recipient of services: Contents; maintenance; availability for review by recipient or guardian.

449.841        Record regarding recipient of services: Retention; availability for review by representatives of Department of Health and Human Services.

449.8415      Logs and records of medication; administration of over-the-counter medications and dietary supplements.

449.843        Rights of recipient of services.

449.844        Facilities: Ownership or lease by operator; limitation on number of residents; compliance with certain state and local requirements.

449.846        Facilities: Occupancy, size, furnishings and use of bedrooms; use of certain rooms or bedrooms prohibited.

449.847        Facilities: Common areas; dining areas; kitchens; storage of food.

449.849        Facilities: Maintenance of premises.

449.850        Facilities: Fire safety.

449.852        Facilities: Policy concerning visitation; presence of minor child of provider or employee prohibited; visitation by child of resident.

Quality Assurance Reviews and Discipline

449.853        Quality assurance review; report and correction of violation.

449.855        Authorized actions of Division upon determination of deficiencies; plans of correction; grounds for sanctions; authorized sanctions.

449.856        Grounds for revocation of provisional license or license.

449.858        Notice of intent to revoke provisional license or license.

449.859        Immediate termination of provision of services.

449.861        Appeal.

EMPLOYMENT AGENCIES TO PROVIDE NONMEDICAL SERVICES

449.870        Definitions.

449.871        “Attendant” defined.

449.873        “Client” defined.

449.874        “Employment agency” defined.

449.876        “Nonmedical services” defined.

449.877        Designation of primary place of business on license; operation of multiple work stations; licensee’s name to appear on face of license; liability coverage required.

449.879        Qualifications and duties of administrator.

449.880        Qualifications of attendant; required training.

449.882        Duties of employment agency.

CARA PLANS OF CARE

449.939        Definitions.

449.941        “CARA Plan of Care” defined.

449.942        “Infant” defined.

449.944        “Medical facility” defined.

449.945        “Provider of health care” defined.

449.947        Establishment and contents of plan; use of form; provision of copy to parent or guardian and Division.

449.948        Duties of Division; confidentiality and protection of plans and related information.

FINANCIAL REPORTING

449.951        Definitions.

449.953        Annual fee for insurers: Amount; notice; administrative fine for failure to pay.

449.957        Hospitals to file certain reports; certification; exception; extension.

449.960        Hospitals to submit quarterly financial and utilization report; certification; extension.

449.962        Facility for intermediate care or facility for skilled nursing to submit quarterly financial and utilization report; certification; extension.

449.9625      Institution to submit quarterly financial and utilization report; certification; extension; exception.

449.963        Information concerning treated patients: Submission; limitation on disclosure.

449.966        Notice of insufficiency of submitted information.

449.969        Administrative fine for failing to meet deadlines.

MOBILE UNITS

449.970        Definitions.

449.9701      “Independent facility” defined.

449.97012    “Mobile unit” defined.

449.97014    “Parent facility” defined.

449.97016    “Service site” defined.

449.97018    “Staging area” defined.

449.9702      Applicability of provisions.

449.97022    Licensure.

449.97024    Application for licensure.

449.97026    Design, construction, equipment, maintenance and parking.

449.97028    Staging areas; disposal of biohazards and waste.

449.9703      Compliance with certain statutes and regulations.

449.97032    Compliance with regulations relating to evaluation of quality of services.

449.97034    Written policies for operation of unit; agreement with hospital or medical facility for transfer of patients during emergencies.

449.97036    Rights of patients.

449.97038    Maintenance of schedule and records; supplies and equipment; diagnostic radiological services; laboratory services.

449.9704      Occupancy; fire safety; exits; use and maintenance of equipment; telecommunications device.

449.97042    Restrictions on operation; office of independent facility; operation pursuant to contract.

SURGICAL CENTERS FOR AMBULATORY PATIENTS

General Provisions

449.971        Definitions.

449.9715      “Allied health profession” defined.

449.972        “Ambulatory surgical center” defined.

449.9721      “Biohazardous waste” defined.

449.9722      “Biologic indicator test” defined.

449.9724      “Cleaning” defined.

449.9725      “Division” defined.

449.973        “Governing body” defined.

449.9731      “High-level disinfection” defined.

449.9732      “Implantable device” defined.

449.9733      “Invasive procedure” defined.

449.9735      “Licensee” defined.

449.9736      “Low-level disinfection” defined.

449.9738      “Multidose vial” defined.

449.974        “Patient” defined.

449.9741      “Physician” defined.

449.9742      “Registered nurse” defined.

449.97422    “Reprocess” defined.

449.97426    “Single-dose vial” defined.

449.97428    “Sterilization” defined.

449.9743      “Surgery” defined.

Licensing

449.9745      Center required to provide proof of national accreditation; submission of reports to Division; application by accrediting organization for recognition by State Board of Health.

449.9755      Investigation of applicant and inspection of facility.

449.978        Effect of expiration of license.

449.9785      Conformance with regulations required.

Administration

449.979        Governing body required.

449.9795      Duties of governing body.

449.980        Responsibilities of governing body.

449.9801      Procedures for granting privileges to members of medical staff.

449.9805      Establishment of policy for authentication.

449.981        Appointment and responsibilities of administrator.

449.9811      Program for review of surgical procedures and patient outcomes.

449.9812      Program for quality assurance.

449.9813      Committee for quality assurance.

449.9815      Maintenance.

449.982        Sanitation and housekeeping.

449.983        Protection from fire and other disasters.

449.9832      Establishment of policies for provision of services and care by persons under contract with or who are otherwise not employed by center.

449.9835      Exemption from requirements for governing body and administrator.

449.9837      Restrictions on operation of ambulatory surgical center; maintenance of records.

449.9843      Compliance with certain standards, laws, ordinances and codes; submission and approval of building plans; prerequisites to approval of center for licensure.

449.9844      Class designations: Authorized procedures; operating room dimensions.

Program for the Prevention and Control of Infections and Communicable Diseases

449.98451    Adoption of guidelines by governing body for establishment of program.

449.98452    General requirements of program.

449.98453    Program required to include policies and procedures for prevention of exposure to blood-borne and other potentially infectious pathogens.

449.98454    Program required to include policies and procedures for single-dose vials and multidose vials.

449.98455    Sterilization and disinfection of surgical instruments, items and equipment; training required for employees and contractors responsible for sterilization or disinfection.

449.98456    Center required to designate employee or enter into contract for overseeing and managing program; qualifications and duties of employee or contractor.

449.98457    Mandatory training and evaluation of employees and other persons.

Personnel

449.9855      Policies and requirements for personnel.

449.9865      Medical staff.

449.988        Nursing staff.

449.9883      Requirements for employment of certain persons to engage in practice of surgical technology; documentation.

Medical Records, Services and Facilities

449.9885      Medical records: Maintenance.

449.989        Medical records: Contents.

449.990        Medication and treatment.

449.9902      Emergency equipment and supplies.

449.9905      Pharmacist employed by or contracted with center; records, storage and administration of drugs; center required to obtain license to operate pharmacy.

449.991        Laboratory services.

449.992        Pathological services.

449.9925      Blood and derivatives of blood: Procurement, storage, transfusion and administration; policies and procedures; reporting of adverse reaction.

449.993        Diagnostic radiological services.

449.9935      Operating and recovery rooms; endoscopy suite; revision of certain standards adopted by reference.

449.9937      Extended recovery units.

449.994        Records required before surgery; report of surgery.

449.9945      Administration and record of anesthesia.

449.9947      Register of surgeries performed in operating rooms.

449.9955      Informing patient of rights, services and cost.

449.996        Transfer of patients.

449.9965      Prohibited locations for construction of center.

449.997        Conversion of hazardous building into center prohibited.

RECOVERY CENTERS

General Provisions

449.99702    “Recovery center” defined.

Licensing and Inspection

449.99704    License required to operate.

449.99706    Requirements to operate.

449.99708    Prelicensure investigation and inspection.

449.9971      Issuance and expiration of license.

449.99712    Suspension, revocation or cancellation of license; provisional license.

Administration

449.99714    Governing body; quality improvement and risk management programs; review of programs.

449.99716    Appointment, qualifications and responsibilities of administrator.

Construction and Operation

449.99718    Design, construction, equipment and maintenance.

449.9972      General requirements.

449.99722    Patients’ rooms.

449.99724    Limitation on number of patients; insurance.

449.99726    Preparations for emergencies; reporting of fire or disaster.

449.99728    Administration of prescription medications.

449.9973      Control of infections.

449.99732    Meals; hydration; sanitation.

Admission, Care, Transfer and Discharge of Patients

449.99734    Responsibilities for admission and care of patient.

449.99736    Assessment of needs of patient.

449.99738    Plan of care; compliance with professional standards.

449.9974      Provision of service or treatment.

449.99742    Summary of discharge.

449.99744    Agreement with hospital for transfer of patients.

Records of Patients

449.99746    Contents, maintenance and confidentiality of medical records.

449.99748    Inspection of records relating to patient.

Personnel and Staffing

449.99749    Personnel policies and records.

449.99752    Staffing.

449.99754    Employment of health care professionals.

Medical Services

449.99756    Specialized rehabilitative services.

449.99758    Pharmaceutical services; labeling and storage of drugs and biologicals; licensure of pharmacy; chart order signed by prescribing practitioner.

449.9976      Laboratory services.

449.99762    Radiological and other diagnostic services.

RECEIVERS

449.9981      List of interested and qualified persons.

449.99811    Experience.

449.99812    Authority.

449.99813    Compensation and payment of bond.

449.99814    Operation of facility.

ADMINISTRATIVE SANCTIONS

General Provisions

449.9982      Definitions.

449.99821    “Ban on admissions” defined.

449.99822    “Cluster” defined.

449.99823    “Compliance” and “substantially correct the deficiency” defined.

449.99824    “Costs” defined.

449.99825    “De minimis deficiency” defined.

449.998253  “Division of Health Care Financing and Policy” defined.

449.998255  “Facility” defined.

449.99826    “Immediate family” defined.

449.99827    “Initial deficiency” defined.

449.99828    “Major deficiency” defined.

449.99829    “Medicaid facility” defined.

449.9983      “Medicare facility” defined.

449.99832    “Monitor” defined.

449.99833    “New admission” defined.

449.99834    “Particular kinds of care, treatment or services” defined.

449.99835    “Plan of correction” defined.

449.99836    “Provider agreement” defined.

449.99837    “Repeated deficiency” defined.

449.99838    “Resurvey” defined.

449.99839    “Severity and scope score” defined.

449.9984      “Subsequent deficiency” defined.

449.99841    “Temporary management” defined.

449.99843    Purposes of administrative sanctions.

449.99844    Interpretation of provisions in accordance with federal standards.

Imposition: Generally

449.9985      Authority of Division and Bureau.

449.99851    Requirement for imposition; optional imposition.

449.99852    Requirement for imposition; multiple sanctions.

449.99853    Imposition of one or more sanctions; criteria for imposition of particular sanction.

449.99854    Imposition in lieu of or in addition to recommendation to terminate provider agreement; duration of sanctions.

449.99855    Imposition in emergencies: Authority; notice.

449.99856    Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis deficiency; confidentiality.

449.99857    Classifications of severity and scope of deficiencies: Use.

449.99858    Scope of violations: Evaluation of representative sample of recipients; size of sample.

449.99859    Scope of deficiencies: Use of scope scale; basis for assessment.

449.9986      Scope of deficiencies: Criteria for evaluation.

449.99861    Severity of deficiencies: Use of severity scale; basis for assessment; criteria for evaluation.

449.99862    Presumption when same deficiency found on resurvey; imposition of sanction for subsequent deficiency.

449.99863    Available sanctions.

449.99864    Determination of appropriate sanction: Procedure.

449.99865    Determination of appropriate sanction: Initial assessment.

449.99866    Determination of appropriate sanction: Consideration of secondary factors.

449.99867    Determination of appropriate sanction: Basis for selection; presumption.

Plan of Abatement

449.99868    Notification of immediate and serious threat to health and safety; submission and contents of plan.

Plan of Correction

449.9987      Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan; confidentiality.

Limitation on Occupancy of Residential Facility

449.99875    Purpose and scope of limitation; imposition in addition to partial ban on admissions.

449.99876    Criteria for imposition.

449.99877    Duration and termination of limitation.

449.99878    Notice of limitation: General requirements; effect of noncompliance.

Ban on Admissions

449.9988      Purpose and scope of ban.

449.99881    Criteria for imposition.

449.99882    Duration and termination of ban.

449.99883    Notice of ban: General requirements; effect of noncompliance.

Monitoring of Facility

449.99885    Authority of Bureau.

Monetary Penalties

449.99895    Imposition by Bureau; purpose; applicable criteria.

449.99896    Criteria for imposition; imposition of initial and daily penalties.

449.99897    Imposition of initial penalty pending hearing or appeal; stay of payment of penalties pending appeal.

449.99898    Procedure for imposition; interest on total penalty assessed.

449.99899    Determination of amount of penalties.

449.998995     Use of initial monetary penalty to correct deficiency.

449.999        Limitation on principal amount of total daily penalty.

449.99901    Daily penalty: Computation according to number of recipients.

449.99902    Increase in penalty for repeated deficiencies or false compliance.

449.99903    Presumption regarding deficiencies identified on resurvey.

449.99904    Reduction of penalty.

449.99905    Daily penalty: Effective beginning date.

449.99906    Daily penalty: Date and period of computation; notice to facility.

449.99907    Termination of daily penalties; failure of Medicaid facility to remove immediate and serious threat after appointment of temporary management.

449.99908    Time for payment of penalties.

449.99909    Assessment of interest on unpaid balance of penalty.

449.9991      Recovery of costs for collection of penalty.

449.99911    Failure to pay penalty: Suspension of license of facility.

449.99912    Disposition of money collected.

Temporary Management

449.99915    Appointment of temporary manager when there is immediate and serious threat: Notice; effect of failure to accept manager and to remove threat.

449.99916    Appointment of temporary manager when there is no immediate and serious threat: Notice.

449.99917    Temporary manager: Qualifications.

449.99918    Temporary manager: Authority.

449.99919    Effect of failure to agree to appointment of or to relinquish authority to temporary manager.

449.9992      Events requiring termination of management; initiation of judicial proceedings.

449.99921    Payment of costs and expenses.

Closure of Facility and Transfer of Residents

449.99925    Authority of Bureau.

449.99926    Requirements for notification.

449.99927    Appointment of temporary manager.

449.99928    Bureau to supervise or appoint temporary manager to supervise transfer; imposition of other appropriate sanctions.

449.99929    Determination of appropriate placement of residents.

449.9993      Rights of appeal for transferred residents.

Facilities Participating in Medicaid

449.99935    Authorized recommendations in addition to available sanctions.

449.99936    Withholding of monetary penalties from payments owed to facility.

449.99937    Denial of payments for new admissions generally.

449.99938    Denial of payments for new admissions who have certain specified diagnoses or special care needs.

449.99939    Suspension of payments for services furnished to Medicaid recipient on or after date of deficiency.

OUTPATIENT FACILITIES: PERMIT FOR SERVICES OF GENERAL ANESTHESIA, CONSCIOUS SEDATION AND DEEP SEDATION

General Provisions

449.9994      Definitions.

449.99941    “Bureau” defined.

449.999413  “Division” defined.

449.999415  “Inspection” defined.

449.999417  “Outpatient facility” defined.

449.999419  “Treatment” defined.

Permitting

449.99942    Application; general requirements; proof of national accreditation; fee; period for validity; application required for each location.

449.999421     Inspection by Division of applicant and outpatient facility; prerequisite of satisfactory fire inspection.

449.999422     Term of permit; circumstances under which permit deemed invalid.

449.999423     Renewal of permit: Application; additional inspection by Division authorized; fees; untimely filing or failure to file application.

449.999424     Outpatient facility required to provide proof of national accreditation; submission of reports to Division; application by accrediting organization for recognition by State Board of Health; maintenance of list by Division of approved accrediting organizations.

449.999425     Display of permit; maintenance of outpatient facility in compliance with law; notification of transfer of real property; notification of change of ownership, location or services provided.

449.999426     Additional grounds for denial, suspension or revocation of permit.

Program for the Prevention and Control of Infections and Communicable Diseases

449.99943    Definitions.

449.999431  “Biologic indicator test” defined.

449.999432  “Cleaning” defined.

449.999433  “High-level disinfection” defined.

449.999434  “Implantable device” defined.

449.999435  “Invasive procedure” defined.

449.999436  “Low-level disinfection” defined.

449.999437  “Multidose vial” defined.

449.999438  “Reprocess” defined.

449.999439  “Single-dose vial” defined.

449.99944    “Sterilization” defined.

449.999441     Adoption of guidelines by holder of permit for establishment of program.

449.999442     General requirements of program.

449.999443     Program required to include policies and procedures for prevention of exposure to blood-borne and other potentially infectious pathogens.

449.999444     Program required to include policies and procedures for single-dose vials and multidose vials.

449.999445     Sterilization and disinfection of surgical instruments, items and equipment; training required for employees and contractors responsible for sterilization or disinfection.

449.999446     Outpatient facility required to designate employee or enter into contract for overseeing and managing program; qualifications and duties of employee or contractor.

449.999447     Mandatory training and evaluation of employees and other persons.

449.999448     Establishment of additional policies and guidelines by holder of permit to ensure health and safety of patients; professional standards of practice; requirement of tuberculosis test for employees and persons under contract with outpatient facility.

Administrative Sanctions

449.99945    Definitions.

449.999451  “Cluster” defined.

449.999452  “De minimis deficiency” defined.

449.999453  “Deficiency” defined.

449.999454  “Immediate and serious threat” and “immediate jeopardy” defined.

449.999455  “Incident” defined.

449.999456  “Initial deficiency” defined.

449.999457  “Severity and scope score” defined.

449.999458     Purpose of sanctions.

449.999459     Grounds for denial, suspension or revocation of permit.

449.99946    Appeal of denial, suspension or revocation of permit or other sanction.

449.999461     Imposition of sanctions: Authority of Division and Bureau.

449.999462     Imposition of sanctions: Requirement for imposition; optional imposition; multiple sanctions; use of severity and scope factors for particular sanction.

449.999463     Imposition of sanctions in emergencies: Notice; authority; exception to notice requirement.

449.999464     Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis deficiency.

449.999465     Scope of violations: Evaluation of representative sample of recipients; sample size.

449.999466     Scope of deficiencies: Use of scope scale; basis for assessment.

449.999467     Scope of deficiencies: Criteria for evaluation.

449.999468     Severity of deficiencies: Use of severity scale; basis for assessment; criteria for evaluation.

449.999469     Presumption when same deficiency found on subsequent inspection; imposition of sanction for subsequent deficiency.

449.99947    Available sanctions.

449.999471     Determination of appropriate sanction: Procedure.

449.999472     Determination of appropriate sanction: Initial assessment.

449.999473     Determination of appropriate sanction: Consideration of secondary factors.

449.999474     Determination of appropriate sanction: Basis for selection; presumption for monetary penalties.

449.999475     Plan of correction: Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan.

449.999476     Monetary penalties: Criteria for imposition; imposition of initial and daily penalties; exception for de minimis deficiency.

449.999477     Monetary penalties: Imposition of initial penalty pending hearing or appeal; stay of payment of penalties pending appeal.

449.999478     Monetary penalties: Procedure for imposition; interest on total penalty assessed.

449.999479     Monetary penalties: Determination of amount of penalties.

449.99948    Monetary penalties: Increase in penalty for repeated deficiencies or falsely alleged compliance.

449.999481     Monetary penalties: Presumption regarding deficiencies identified on subsequent inspection.

449.999482     Monetary penalties: Reduction of penalty.

449.999483     Monetary penalties: Effective beginning date.

449.999484     Monetary penalties: Date and period of computation; notice to outpatient facility.

449.999485     Monetary penalties: Termination of daily penalties.

449.999486     Monetary penalties: Time for payment.

449.999487     Recovery of expenses incurred by Bureau or Division for implementing and enforcing administrative penalties, bringing actions for enforcement and collecting monetary penalties.

449.999488     Failure to pay monetary penalty: Suspension of permit.

449.999489     Disposition of money collected.

STAR RATINGS OF CERTAIN HEALTH CARE FACILITIES

449.99984    Definitions.

449.999842  “Deficiency” defined.

449.999844  “Facility” defined.

449.999845  “Unit” defined.

449.999846     Criteria for assignment of ratings; issuance of placard with rating.

449.999848     Follow-up inspections and appeals.

 

REVISER’S NOTE.

      Ch. 444, Stats. 2021, which removed provisions from NRS relating to licensing and regulation of peer support recovery organizations, contains the following provision not included in NRS:

      “Sec. 34.5.  Any regulations adopted by the State Board of Health pursuant to NRS 449.0302 governing peer support recovery organizations [NAC 449.15488 to 449.154894, inclusive] are void. The Legislative Counsel shall remove those regulations from the Nevada Administrative Code as soon as practicable after January 1, 2022.”

 

GENERAL PROVISIONS

      NAC 449.002  Definitions. (NRS 439.200, 449.03005, 449.0302)  As used in NAC 449.002 to 449.99939, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.0022 to 449.0072, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99 & R132-99, 11-29-99; R051-02, 7-24-2002; R179-09, 7-22-2010; R090-12, 12-20-2012; R120-16, 9-21-2017; R133-15, 12-19-17; R109-18, 1-30-2019)

      NAC 449.0022  “Administrator” defined. (NRS 449.0302)  “Administrator” means the person responsible for the day-to-day management of a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0024  “Affiliated facility” defined. (NRS 449.0302)  “Affiliated facility” means a facility that owns, directly or indirectly, an equity interest of 5 percent or more in the capital, the stock, the profits or the assets of another facility or is, as a subcontractor, agent or otherwise, responsible for the management or control of that facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0026  “Agent” defined. (NRS 449.0302)  “Agent” means a person having actual or apparent authority to act on behalf of a licensee.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0028  “Bureau” defined. (NRS 449.0302)  “Bureau” means the Bureau of Health Care Quality and Compliance of the Division.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R179-09, 7-22-2010)

      NAC 449.0029  “Centers for Medicare and Medicaid Services” defined. (NRS 449.0302)  “Centers for Medicare and Medicaid Services” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

     (Added to NAC by Bd. of Health by R051-02, eff. 7-24-2002)

      NAC 449.00295  “Central Repository” defined. (NRS 449.0302)  “Central Repository” means the Central Repository for Nevada Records of Criminal History.

     (Added to NAC by Bd. of Health by R111-12, eff. 3-28-2014)

      NAC 449.003  “Deficiency” defined. (NRS 449.0302)

     1.  “Deficiency” means noncompliance with any federal or state statute or of the rules or regulations of the Division or the Centers for Medicare and Medicaid Services or conditions and standards of or requirements for participation in the Medicare or Medicaid program pertaining to a facility.

     2.  The term includes an incident concerning a facility where there are no extenuating circumstances or where the facility has made an inappropriate response to a complaint, including the failure to:

     (a) Prevent an incident from occurring, if the incident could have been avoided;

     (b) Identify an incident;

     (c) Take action to correct an incident before the identification of the incident by the Bureau; or

     (d) Implement a contingency plan if permanent action to correct an incident has not been undertaken.

     3.  In determining whether an incident is a deficiency, the right of the recipient to refuse treatment, where applicable, shall be deemed an extenuating circumstance.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)

      NAC 449.00305  “Division” defined. (NRS 449.0302)  “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R094-06 & R098-06, 7-14-2006)—(Substituted in revision for NAC 449.0038)

      NAC 449.0031  “Division of Welfare and Supportive Services” defined. (NRS 449.0302)  “Division of Welfare and Supportive Services” means the Division of Welfare and Supportive Services of the Department of Health and Human Services.

     (Added to NAC by Bd. of Health, eff. 8-1-91)—(Substituted in revision for NAC 449.0074)

      NAC 449.0032  “Emergency” defined. (NRS 449.0302)  “Emergency” means a major deficiency that places one or more recipients in immediate jeopardy. The term includes, without limitation, any fire, flood, contagious infection, loss of utilities or inappropriate transfer of residents.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0033  “Employment agency to provide nonmedical services” defined. (NRS 439.200, 449.03005)

     “Employment agency to provide nonmedical services” means an employment agency that contracts with persons to provide “nonmedical services related to personal care to elderly persons or persons with disabilities,” as that term is defined in NRS 449.01517.

     (Added to NAC by Bd. of Health by R109-18, eff. 1-30-2019)

      NAC 449.0034  “Facility” defined. (NRS 449.0302)  Except as otherwise defined in NAC 449.011911, “facility” means a medical facility, facility for the dependent, an employment agency that contracts with persons in this State to provide certain nonmedical services described in subsection 1 of NRS 449.03005, a facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed or a referral agency.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R131-99 & R132-99, 11-29-99; R016-20, 11-2-2020)

      NAC 449.0042  “Holiday” defined. (NRS 449.0302)  “Holiday” means a day on which the offices of State Government are closed.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0043  “Home for individual residential care” defined. (NRS 449.0302)  “Home for individual residential care” has the meaning ascribed to it in NRS 449.0105.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.0044  “Immediate and serious threat” and “immediate jeopardy” defined. (NRS 449.0302)  “Immediate and serious threat” or “immediate jeopardy” means a situation in which corrective action within 48 hours is necessary because the failure by a facility to comply with a requirement for licensure, certification or participation in Medicare or Medicaid has caused, or if uncorrected is likely to cause, serious injury or harm, or even death, to a recipient.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0046  “Incident” defined. (NRS 449.0302)  “Incident” means an action, practice or situation that appears to be inconsistent with a federal or state statute, rule or regulation of the Division or the Centers for Medicare and Medicaid Services or conditions and standards of or requirement for participation in Medicare or Medicaid.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)

      NAC 449.0048  “License” defined. (NRS 449.0302)  “License” means all or part of any permit, certificate, approval, registration, charter or similar grant of permission to operate issued to a facility by the Division.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0049  “Licensed dietitian” defined. (NRS 449.0302)  “Licensed dietitian” has the meaning ascribed to it in NRS 640E.040.

     (Added to NAC by Bd. of Health by R090-12, eff. 12-20-2012)

      NAC 449.005  “Licensee” defined. (NRS 449.0302)  “Licensee” means any person, corporation, partnership, voluntary association or other public or private entity, including any governmental body, licensed to operate a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0052  “Medicaid” defined. (NRS 449.0302)  “Medicaid” means the program established pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0054  “Medicare” defined. (NRS 449.0302)  “Medicare” means the program of health insurance for aged and disabled persons established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395 et seq.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0056  “Party” defined. (NRS 449.0302)  “Party” means each person or agency as defined in NRS 233B.035.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0058  “Person” defined. (NRS 449.0302)  “Person” means a natural person, trust, estate, partnership, corporation, professional association, governmental body or any other entity, public or private.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.006  “Recipient” defined. (NRS 449.0302)  “Recipient” means a person receiving care, services or treatment from a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0061  “Referral agency” defined. (NRS 449.0302, 449.0305)  “Referral agency” means a business that provides referrals to residential facilities for groups which is subject to regulation pursuant to NRS 449.0305, including, without limitation, any business entity that engages in the process of referring clients for compensation to residential facilities for groups.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.0062  “Resident” defined. (NRS 449.0302)  “Resident” means a person who resides in a residential facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0064  “Residential facility” defined. (NRS 449.0302)  “Residential facility” means a facility operated 24 hours per day in which one or more persons receiving care, treatment or services ordinarily remain for 24 hours a day.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0066  “Sanction” defined. (NRS 449.0302)  “Sanction” means a corrective measure or penalty that is imposed by the Bureau upon a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0068  “Services” defined. (NRS 449.0302)  “Services” means medical or personal care, including necessary preparation of food, laundry and housekeeping in the case of a residential facility and items such as medical diagnosis and treatment, drugs and biologicals, supplies, appliances, equipment, medical-social services and use of a facility.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.007  “Survey” defined. (NRS 449.0302)

     1.  “Survey” means a regularly scheduled inspection of a facility conducted by employees of the Bureau to verify the facility’s compliance with the regulations of the Division, the Centers for Medicare and Medicaid Services, eligibility for participation in the Medicare or Medicaid programs and eligibility for licensure.

     2.  The term includes a follow-up inspection to recertify a facility or evaluate compliance with a plan of correction or an inspection made in response to a complaint.

     (Added to NAC by Bd. of Health, eff. 8-1-91; A by R051-02, 7-24-2002)

      NAC 449.0072  “Treatment” defined. (NRS 449.0302)  “Treatment” means any medication, drug, test or procedure conducted or administered to diagnose or remedy a physical or mental illness or condition.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.008  Computation of time. (NRS 449.0302)  For the purposes of any computation of time required by NAC 449.002 to 449.99939, inclusive:

     1.  Any prescribed period of more than 5 days includes Saturdays, Sundays and holidays.

     2.  Any prescribed period of 5 days or less does not include Saturdays, Sundays or holidays.

     3.  If the date on which any action required to be performed falls on a Saturday, Sunday or holiday, the time is extended until the next day that is not a Saturday, Sunday or holiday.

     4.  The day of any act or event or on which notice is received is not included in the computation.

     (Added to NAC by Bd. of Health, eff. 8-1-91)

      NAC 449.0085  Licensee prohibited from employing or contracting with unlicensed person to provide certain nutrition services. (NRS 449.0302)  A licensee shall not employ or contract with a person to provide medical nutrition therapy or nutrition services unless the person is licensed pursuant to chapter 640E of NRS or exempt from such licensure.

     (Added to NAC by Bd. of Health by R090-12, eff. 12-20-2012)

      NAC 449.009  Control by Division over medical records of medical facility or facility for dependent upon suspension of license or cessation of operation: Authorized actions to remove, store and protect records; facilities to pay cost of maintenance of records; notice before destruction of records. (NRS 449.171)

     1.  If the Division takes control of the medical records of a medical facility or a facility for the dependent pursuant to NRS 449.171, the Division:

     (a) May remove any or all of the medical records and store them in a manner that ensures the safety of the medical records.

     (b) May contract with a person or governmental entity to ensure the safety of the medical records.

     (c) Shall determine the costs for maintaining the medical records and require the medical facility or facility for the dependent, as applicable, to pay those costs. The costs must be assessed beginning on the date on which the Division obtains control of the medical records and ending on the date on which the medical records are destroyed or returned to the facility pursuant to subsection 3. The medical facility or facility for the dependent, as applicable, shall pay the costs within 30 days after receipt of notice of the amount owed.

     2.  If the Division contracts with a person or governmental entity pursuant to paragraph (b) of subsection 1, the Division shall ensure that the person or governmental entity complies with the provisions of subsection 2 of NRS 449.171.

     3.  The Division may:

     (a) Unless a longer period is required by federal law, destroy a medical record upon expiration of the period of retention required by NRS 629.051; or

     (b) Return a medical record to the medical facility or facility for the dependent, as applicable, if the license of the facility is reinstated or the facility restores its operation.

     4.  If the Division determines that a medical record in the control of the Division will be destroyed in accordance with subsection 3, the Division shall, for a period of not less than 30 days, post on an Internet website maintained by the Division and in other locations as determined by the Division a notice informing the patients of the medical facility or facility for the dependent, as applicable, how to obtain a medical record before it is destroyed.

     5.  If a medical facility or facility for the dependent fails to pay the amount owed pursuant to paragraph (c) of subsection 1, the Division may suspend or revoke the license of the medical facility or facility for the dependent pursuant to NAC 449.0118.

     (Added to NAC by Bd. of Health by R114-10, eff. 12-20-2012)

      NAC 449.010  Severability. (NRS 449.0302)  If any of the provisions of NAC 449.002 to 449.99939, inclusive, or any application thereof to any person, thing or circumstance is held invalid, it is intended that such invalidity not affect the remaining provisions, or their application, that can be given effect without the invalid provision or application.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 17, eff. 3-27-76]

      NAC 449.0105  Adoption of certain publications by reference; revision of publication after adoption. (NRS 439.200, 449.0302)

     1.  The State Board of Health hereby adopts by reference:

     (a) NFPA 101: Life Safety Code, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the code may be obtained from the National Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at the Internet address http://www.nfpa.org or by telephone at (800) 344-3555, for the price of $151.50.

     (b) NFPA 99: Health Care Facilities Code, in the form most recently published by the National Fire Protection Association, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the standard may be obtained from the National Fire Protection Association at 11 Tracy Drive, Avon, Massachusetts 02322, at the Internet address http://www.nfpa.org or by telephone at (800) 344-3555, for the price of $111.00.

     (c) Guidelines for Design and Construction of Hospitals, in the form most recently published by the Facility Guidelines Institute, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the guidelines may be obtained from the Facility Guidelines Institute at the Internet address https://shop.fgiguidelines.org or by telephone at (800) 798-9296, for the price of $235.

     (d) Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, in the form most recently published by the Facility Guidelines Institute, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the guidelines may be obtained from the Facility Guidelines Institute at the Internet address https://shop.fgiguidelines.org or by telephone at (800) 798-9296, for the price of $235.

     (e) Guidelines for Design and Construction of Outpatient Facilities, in the form most recently published by the Facility Guidelines Institute, unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 2. A copy of the guidelines may be obtained from the Facility Guidelines Institute at the Internet address https://shop.fgiguidelines.org or by telephone at (800) 798-9296, for the price of $235.

     2.  The State Board of Health will review each revision of the publications adopted by reference pursuant to subsection 1 to ensure its suitability for this State. If the Board determines that a revision is not suitable for this State, the Board will hold a public hearing to review its determination within 12 months after the date of the publication of the revision and give notice of that hearing. If, after the hearing, the Board does not revise its determination, the Board will give notice within 30 days after the hearing that the revision is not suitable for this State. If the Board does not give such notice, the revision becomes part of the publication adopted by reference pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R066-04, R067-04, R068-04, R069-04, R073-04, R076-04 & R077-04, eff. 8-4-2004; A by R121-16, 9-21-2017; R122-16, 9-21-2017; R048-22, 12-29-2022)

      NAC 449.0106  Adoption by reference of certain publications relating to personal protective equipment and prevention of infection; revision of publication after adoption. (NRS 439.200, 439.0302)

     1.  The following publications are hereby adopted by reference:

     (a) “Part II.E.: Personal Protective Equipment (PPE) for Healthcare Personnel” of 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, as updated in May 2022, published by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services and available at no cost on the Internet at http://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf, or, if that Internet website ceases to exist, from the Division.

     (b) “Optimizing Personal Protective Equipment (PPE) Supplies,” available at no cost on the Internet website of the Centers for Disease Control and Prevention of the United States Department of Health and Human Services at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html, or, if that Internet website ceases to exist, from the Division.

     (c) “Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic,” available at no cost on the Internet website of the Centers for Disease Control and Prevention of the United States Department of Health and Human Services at http://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html, or, if that Internet website ceases to exist, from the Division.

     2.  If any publication adopted by reference in subsection 1 is revised, the Division shall review the revision to determine its suitability for this State. If the Division determines that the revision is not suitable for this State, the Division shall hold a public hearing to review its determination and give notice of that hearing within 90 days after the date of the publication of the revision. If, after the hearing, the Division does not revise its determination, the Division shall give notice that the revision is not suitable for this State within 90 days after the hearing. If the Division does not give such notice, the revision becomes part of the publication adopted by reference pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R048-22, eff. 12-29-2022)

      NAC 449.01065  Requirements relating to personal protective equipment; exception for nursing pool. (NRS 439.200, 439.0302)

     1.  A medical facility, facility for the dependent or other facility required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed shall ensure that each person on the premises of the facility uses personal protective equipment in accordance with the publications adopted by reference in NAC 449.0106. The facility shall maintain:

     (a) Not less than a 30-day supply of personal protective equipment at all times; or

     (b) If the facility is unable to comply with the requirements of paragraph (a) due to a shortage in personal protective equipment, documentation of attempts by and the inability of the facility to obtain personal protective equipment.

     2.  Except as otherwise provided in subsection 3, a medical facility, facility for the dependent or other facility required by the regulations adopted by the Board pursuant to NRS 449.0303 to be licensed shall:

     (a) Enter into a contract with a supplier of personal protective equipment which ensures that the facility has a supply of personal protective equipment sufficient to comply with the requirements of subsection 1; and

     (b) Track the amount of personal protective equipment that the facility has available, the rate at which personal protective equipment is used in the facility and orders for personal protective equipment in a manner sufficient to ensure compliance with the requirements of subsection 1.

     3.  The requirements of subsection 2 do not apply to a nursing pool that receives sufficient personal protective equipment from its clients to meet the requirements of subsection 1. Such a nursing pool shall maintain documentation demonstrating that it meets the requirements of this subsection.

     (Added to NAC by Bd. of Health by R048-22, eff. 12-29-2022)

      NAC 449.0107  Posting of star rating by medical facility or facility for the dependent; exception. (NRS 439.200, 449.0302, 449.1825)

     1.  Information posted by a medical facility or facility for the dependent to satisfy the requirements of subsection 2 of NRS 449.1825 must, in addition to meeting the requirements of that subsection:

     (a) Be posted on a sign that is not less than 8.5 inches in height and 11 inches in width, with margins not greater than 1 inch on any side;

     (b) Be written using a single typeface in not less than 20-point type; and

     (c) State the name of the facility and identify the star rating assigned by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services as the “Centers for Medicare and Medicaid Services Star Rating.”

     2.  The requirements of subsection 2 of NRS 449.1825 apply to each entrance to a building where activity is conducted for which a license as a medical facility or facility for the dependent is required.

     3.  A medical facility or facility for the dependent is not required to post a star rating assigned by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services pursuant to subsection 2 of NRS 449.1825 if the facility did not receive such a rating, including, without limitation, if the facility received an asterisk instead of a star rating.

     (Added to NAC by Bd. of Health by R109-18, eff. 1-30-2019)

      NAC 449.0108  Notification of Division concerning accreditation of medical facility; administrative penalty. (NRS 439.200, 449.0302, 449.165)

     1.  If a medical facility receives notice from a national accrediting organization that the national accrediting organization has accredited the medical facility, the medical facility shall submit to the Division in the manner prescribed by the Division a copy of the notice not later than 7 calendar days after receiving the notice.

     2.  If a medical facility loses the accreditation of a national accrediting organization, the medical facility shall notify the Division not later than 7 calendar days after receiving notice of the loss of accreditation.

     3.  The Division may impose an administrative penalty in an amount not to exceed $1,000 for a failure to comply with the requirements of this section. The Bureau shall not impose any administrative sanction pursuant to NAC 449.9982 to 449.99939, inclusive, for such a deficiency.

     4.  As used in this section, “national accrediting organization” has the meaning ascribed to it in 42 C.F.R. § 488.1.

     (Added to NAC by Bd. of Health by R048-22, eff. 12-29-2022)

      NAC 449.0109  Program and policy for control of infection; designation and training of person responsible for infection control. (NRS 439.200, 449.0302)

     1.  A facility for the dependent shall:

     (a) Develop and carry out an infection control program to prevent and control infections within the facility;

     (b) Review the infection control program, including, without limitation, the infection control policy adopted pursuant to subsection 2, at least annually to ensure that the program meets current evidence-based standards for infection control plans and the safety needs of residents, staff and visitors; and

     (c) Develop and carry out a comprehensive plan for emergency preparedness.

     2.  To carry out the infection control program developed pursuant to paragraph (a) of subsection 1, the facility shall adopt an infection control policy. The policy must include, without limitation, current infection control guidelines developed by a nationally recognized infection control organization that are appropriate for the scope of service of the facility. Such nationally recognized organizations include, without limitation, the Association for Professionals in Infection Control and Epidemiology, Inc., the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the World Health Organization or the Society for Healthcare Epidemiology of America, or a successor in interest to any of those organizations.

     3.  The program to prevent and control infections within the facility for the dependent developed pursuant to paragraph (a) of subsection 1 must provide for the designation of:

     (a) A primary person who is responsible for infection control; and

     (b) A secondary person who is responsible for infection control when the primary person is absent to ensure that someone is responsible for infection control at all times.

     4.  The persons designated pursuant to subsection 3 as responsible for infection control shall complete not less than 15 hours of training concerning the control and prevention of infections provided by the Association for Professionals in Infection Control and Epidemiology, Inc., the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, the World Health Organization or the Society for Healthcare Epidemiology of America, or a successor in interest to any of those organizations, not later than 3 months after being designated and annually thereafter.

     5.  Training completed pursuant to subsection 4 may be in any format, including, without limitation, an online course provided for compensation or free of charge. A certificate of completion for the training must be maintained in the personnel file of each person designated pursuant to subsection 3 for 3 years immediately following the completion of the training.

     6.  The plan for emergency preparedness developed pursuant to paragraph (c) of subsection 1 must address internal and external emergencies and local and widespread emergencies. Such emergencies must include, without limitation, emerging infectious diseases.

     (Added to NAC by Bd. of Health by R048-22, eff. 12-29-2022)

GENERAL REQUIREMENTS FOR LICENSURE

      NAC 449.011  Application for license. (NRS 439.200, 449.0302, 449.040)  An application for a license that is filed with the Division pursuant to NRS 449.040:

     1.  Must be complete and include proof of the identity of the applicant that is acceptable to the Division.

     2.  In accordance with NRS 449.050, must be accompanied by the appropriate application fee specified in NAC 449.002 to 449.99939, inclusive.

     3.  In establishing that the applicant is of reputable and responsible character as required by NRS 449.040, must include personal references and information concerning the applicant’s financial status and business activities and associations in and out of this State during the immediately preceding 3-year period. If the applicant is a firm, association, organization, partnership, business trust, corporation or company, such references and information must be provided with respect to the members thereof and the person in charge of the facility or program for which application is made.

     4.  In addition to the information required by NRS 449.040 and any other information specifically required for a particular license, must include:

     (a) Full, complete and accurate information regarding the ownership of the facility or program and all changes to that ownership that occur while the application is pending. The information must include the name of:

          (1) Each natural person who is an owner of the facility or program;

          (2) Each person who has a direct or indirect ownership interest in the facility or program of 10 percent or more and who is the owner, in whole or in part, of any mortgage, deed of trust, note or other obligation secured in whole or in part by the facility or program or any of the property or assets of the facility or program;

          (3) If the applicant is a corporation, each officer and director; and

          (4) If the applicant is a partnership, each partner.

     (b) The address of the applicant’s principal office.

     (c) Evidence satisfactory to the Division that the facility or program meets all applicable federal, state and local laws and complies with all safety, health, building and fire codes. If there are any differences between the state and local codes, the more restrictive standards apply.

     (d) If required by NRS 439A.100, a copy of a letter of approval issued by the Director of the Department of Health and Human Services.

     (e) A copy of the certificate of occupancy, a copy of the applicant’s business license and a copy of any special use permits obtained in connection with the operation of the facility or program.

     (f) A copy of any property lease or rental agreements concerning the facility or program.

     (g) If the applicant is a corporation, a copy of its bylaws and articles of incorporation.

     5.  If the application is for a facility for the care of adults during the day, must include the maximum number of clients allowed to occupy the facility at one time.

     6.  If the application is for an ambulatory surgical center, must identify the class designation for the ambulatory surgical center designated pursuant to NAC 449.9844. As used in this subsection, “ambulatory surgical center” has the meaning ascribed to it in NAC 449.972.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R078-12, 12-20-2012; R022-14, 6-26-2015; R048-22, 12-29-2022)

      NAC 449.0112  Investigation; prelicensure or precertification survey; inspection for fire safety; exceptions. (NRS 439.200, 449.0302)

     1.  Upon receipt of a properly completed application, proof of the identity of the applicant that is acceptable to the Division and the appropriate fee, the Division shall conduct an investigation concerning the premises, facilities, qualifications of personnel, methods of operation and policies of the applicant and perform a prelicensure survey or precertification survey, as applicable, of:

     (a) The applicant; and

     (b) The facility, program plan and management plan, as appropriate.

     2.  Except as otherwise provided in this subsection, before issuing a license or certificate, as applicable, the Division must receive a satisfactory report of inspection of the facility from the State Fire Marshal or the local fire department. The Division is not required to receive such a report before issuing a license or certificate, as applicable, to:

     (a) A provider of community-based living arrangement services;

     (b) An agency to provide personal care services in the home;

     (c) An intermediary service organization;

     (d) An agency to provide nursing in the home;

     (e) A nursing pool;

     (f) A business described in NRS 449.0305;

     (g) An employment agency described in NRS 449.03005; or

     (h) A program of hospice care.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R078-12, 12-20-2012; R048-22, 12-29-2022)

      NAC 449.01125  Duties of Division if Central Repository unable to complete investigation of applicant; grounds for denial or revocation of license or delay of action concerning application. (NRS 449.0302)

     1.  If the Central Repository notifies the Division that it is unable to complete an investigation pursuant to NRS 449.122 because:

     (a) Additional information is required, the Division shall send a notice to the applicant or licensee directing the applicant or licensee to provide the Division and the Central Repository with the information or proof that the information cannot be obtained within 30 days after the date on which the notice was sent by the Division.

     (b) Criminal charges against the applicant or licensee are pending, the Division shall notify the applicant or licensee that he or she is required to:

          (1) Notify the Division of the date of each court proceeding relating to the charges; and

          (2) Provide the Central Repository with any information relating to the final disposition of the charges as soon as the information is available.

     2.  The Division may deny an application for a license of an applicant or revoke the license of a licensee who fails to comply with the provisions of this section.

     3.  The Division may delay taking any action concerning an application until the Central Repository completes its investigation.

     (Added to NAC by Bd. of Health by R111-12, eff. 3-28-2014)

      NAC 449.0113  Duties of administrator or licensee if Central Repository unable to complete investigation of employee or independent contractor; grounds for termination; actions to ensure patient safety. (NRS 449.0302)

     1.  If the Central Repository notifies the administrator of, or the person licensed to operate, a facility, hospital, agency, program or home that it is unable to complete an investigation pursuant to NRS 449.123 because:

     (a) Additional information is required, the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall, within 10 working days after receiving the notice from the Central Repository, send a notice to the employee, employee of a temporary employment service or independent contractor directing the employee, employee of a temporary employment service or independent contractor to provide the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home and the Central Repository with the information or proof that the information cannot be obtained within 30 days after the date on which the notice was sent by the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home.

     (b) Criminal charges against the employee, employee of a temporary employment service or independent contractor are pending, the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall notify the employee, employee of a temporary employment service or independent contractor that he or she is required to:

          (1) Notify the administrator of, or the person licensed to operate, the facility, hospital, agency, program or home of the date of each court proceeding relating to the charges; and

          (2) Provide the Central Repository with any information relating to the final disposition of the charges as soon as the information is available.

     2.  The administrator of, or the person licensed to operate, the facility, hospital, agency, program or home shall terminate the employment of an employee or the contract with an independent contractor or notify the temporary employment service that its employee is prohibited from providing services for the facility, hospital, agency, program or home upon determining that the employee, employee of a temporary employment service or independent contractor has willfully failed to comply with the provisions of this section.

     3.  Pending the completion of an investigation of an employee, employee of a temporary employment service or independent contractor of a facility, hospital, agency, program or home for which the Central Repository has provided notice pursuant to subsection 1 that it is unable to complete the investigation for a reason stated in subsection 1, and during any period in which an employee, employee of a temporary employment service or independent contractor has to correct information provided by the Central Repository pursuant to NRS 449.125, the administrator of, or the person licensed to operate, a facility, hospital, agency, program or home shall take actions to ensure the safety of its patients, residents or clients, including:

     (a) Prohibiting the employee, employee of a temporary employment service or independent contractor from working at the facility, hospital, agency, program or home by placing the employee, employee of a temporary employment service or independent contractor on leave;

     (b) Requiring the employee, employee of a temporary employment service or independent contractor to be under the direct supervision and observation of an employee of the facility, hospital, agency, program or home while caring for any patient, client or resident of the facility, hospital, agency, program or home;

     (c) Conducting an investigation into the circumstances of the record of criminal history to determine and carry out any measures that the facility, hospital, agency, program or home identifies as necessary to ensure the safety of its patients, residents or clients if the employee, employee of a temporary employment service or independent contractor cares for patients, residents or clients; or

     (d) Taking any combination of the actions set forth in paragraph (a), (b) or (c).

     4.  As used in this section, “facility, hospital, agency, program or home” has the meaning ascribed to it in NRS 449.119 and includes an intermediary service organization for the purpose of carrying out this section and NAC 449.01125.

     (Added to NAC by Bd. of Health by R111-12, eff. 3-28-2014)

      NAC 449.0114  Display of license; compliance with law; transfer of real property; change in administrator, ownership, location, services or maximum number of clients. (NRS 449.0302, 449.050)

     1.  Upon receipt of a license, the licensee shall display the license at a conspicuous location within the facility.

     2.  During the term of the license, the licensee shall continuously maintain the facility in conformance with the provisions of NAC 449.002 to 449.99939, inclusive, and chapter 449 of NRS.

     3.  If there is a transfer of the real property on which the facility is located, but no change in the operator of the facility, the licensee shall, within 10 days, notify the Division of the transfer in writing and provide the Division with a copy of any lease agreement relating to the transfer.

     4.  If there is a change in the administrator of the facility, the licensee shall notify the Division of the change within 10 days. The notification must provide evidence that the new administrator is currently licensed pursuant to chapter 654 of NRS and the regulations adopted pursuant thereto. If the licensee fails to notify the Division and submit an application for a new license within 10 days after the change, the licensee shall pay to the Division a fee in an amount equal to 150 percent of the fee required for a new application set forth in subsection 1 of NAC 449.0168.

     5.  A licensee shall notify the Division immediately of any change in:

     (a) The ownership of the facility;

     (b) The location of the facility;

     (c) The services provided at the facility; and

     (d) If the facility is a facility for the care of adults during the day, the maximum number of clients allowed to occupy the facility at one time.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R122-05, 11-17-2005; R022-14, 6-26-2015)

      NAC 449.0115  Review of building plans for new construction or remodeling by certain applicants: Required documents; payment of fees and costs. (NRS 439.150, 439.200, 449.0302)

     1.  An applicant for a license or the renewal of a license to operate a medical facility or facility for the dependent who wishes or is required to have building plans for new construction or remodeling reviewed by the Division must:

     (a) Submit to the Division or have on file a current application for a license or renewal of a license;

     (b) Pay to the Division any fees required for the issuance or renewal of a license pursuant to NAC 449.013 or 449.016; and

     (c) Submit two complete sets of building plans for new construction or remodeling prepared by a registered architect, registered residential designer or licensed general contractor to the entity designated to review such plans by the Division.

     2.  All costs incurred for the review of building plans and any changes or revisions made to the plans must be borne by the applicant and paid directly to the designee of the Division conducting the review of the plans.

     3.  The costs required to be paid pursuant to subsection 2 are not refundable and are in addition to the fees charged for the issuance or renewal of the license pursuant to NAC 449.013 or 449.016.

     (Added to NAC by Bd. of Health, eff. 11-1-95; A by R035-97, 10-30-97; R129-99, 11-29-99, eff. 1-1-2000; R076-01, 10-18-2001; R067-04, R070-04 & R072-04, 8-4-2004; R076-04, 8-5-2004; R122-05, 11-17-2005; R051-06, 7-14-2006)

      NAC 449.01153  Approval of building plans for construction or remodeling of certain facilities: Period of validity. (NRS 449.0302)  If the Division approves building plans for the construction or remodeling of a facility for modified medical detoxification, a facility for skilled nursing, a facility for the care of adults during the day, a facility for the treatment of persons with alcohol or other substance use disorders, a hospital, a mobile unit, a residential facility for groups or a surgical center for ambulatory patients, the approval is valid for 42 months after it is issued, unless there has been:

     1.  A modification of the building plans;

     2.  A change in the ownership of the facility; or

     3.  A change in the intended use of the facility.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)

      NAC 449.01156  On-site advisory inspection of facility: Written request; action by Division; fee. (NRS 439.150, 439.200, 449.0302)

     1.  A licensee or an applicant for the issuance or renewal of a license whose building plans for the construction of a facility have been reviewed pursuant to NAC 449.0115 may submit a written request to the Division for an on-site advisory inspection to be conducted by the Division after at least 80 percent of the construction of the facility is completed. The written request must include, without limitation, the anticipated date on which 80 percent of the construction of the facility will be completed.

     2.  If the Division receives a request submitted pursuant to subsection 1, the Division shall determine its ability to grant the request and shall issue a notice of that determination to the licensee or applicant who submitted the request.

     3.  If the Division grants a request submitted pursuant to subsection 1, the licensee or applicant who submitted the request shall, before the Division conducts the on-site inspection, submit to the Division a fee of:

     (a) Five hundred dollars, if the project is valued at not more than $500,000;

     (b) One thousand dollars, if the project is valued at more than $500,000 but not more than $1,000,000; or

     (c) Two thousand dollars, if the project is valued at more than $1,000,000.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004)

      NAC 449.0116  Renewal of license: Application; validity of existing license pending decision on application; inspection of facility; untimely filing or failure to file application. (NRS 439.150, 439.200, 449.0302, 449.050, 449.089)

     1.  Except as otherwise provided in subsection 2, a licensee who wishes to renew his or her license must submit a complete application for renewal to the Division on or before November 15 of the calendar year in which the license expires. The existing license shall be deemed valid until the submitted application for renewal is evaluated and a final determination is made by the Division concerning whether to renew the license. The Division may require an inspection of the facility to ensure that it meets the requirements of NAC 449.002 to 449.99939, inclusive, before deciding whether to renew a license.

     2.  A licensee who, without good cause, files an application for the renewal of his or her license after the date set forth in subsection 1 but on or before December 31 of the calendar year in which the license expires and who wishes to renew the license must pay:

     (a) The fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate; and

     (b) An additional charge equal to one-half the amount of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate.

     3.  A licensee who fails to file an application for the renewal of his or her license before the license expires is not eligible to renew the license and, if he or she wishes to be licensed, must submit an application for a new license.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R065-04, 8-4-2004)

      NAC 449.0118  Denial, suspension or revocation of license: Grounds. (NRS 449.0302)  In addition to the grounds set forth in NRS 449.160 and any other grounds specifically applicable to a particular license, the Division may deny an application for a license or may suspend or revoke a license upon any of the following grounds:

     1.  The failure or refusal of an applicant or licensee to comply with any of the provisions of chapter 449 of NRS or the regulations adopted by the State Board of Health.

     2.  The failure or refusal of an applicant or licensee to comply with a reasonable order from the Division to remove a resident from a facility or program.

     3.  Operating a facility or program without a license, if a license is required before operating.

     4.  Accepting for care, at any given time, more residents than the number specified in the license.

     5.  The failure or refusal of a licensee to return an adequate plan of correction to the Division within 10 days after the receipt by the licensee of a statement of deficiencies.

     6.  The failure or refusal to cooperate fully with an investigation or inspection by the Bureau.

     7.  Misappropriation of the property of a resident of a facility.

     8.  Abuse, neglect or exploitation of an infirm person, a person with an intellectual disability or a person with a disability, or of a person who is 60 years of age or older.

     9.  The failure of a medical facility or facility for the dependent to pay the costs for the maintenance of the medical records of the facility required pursuant to paragraph (c) of subsection 1 of NAC 449.009.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R114-10, 12-20-2012)

      NAC 449.0119  Denial, suspension or revocation of license or endorsement: Appeals. (NRS 449.0302, 449.170)  An applicant or licensee who is aggrieved by an action of the Division relating to the denial, suspension or revocation of a license or an endorsement may appeal pursuant to the procedures set forth in NAC 439.300 to 439.395, inclusive.

     (Added to NAC by Bd. of Health by R044-97, eff. 10-30-97; A by R119-10, 1-13-2011)

CULTURAL COMPETENCY AND PREVENTION OF DISCRIMINATION

      NAC 449.011901  Definitions. (NRS 449.0302)  As used in NAC 449.011901 to 449.011951, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.011903 to 449.011911, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011903  “Cultural competency training” defined. (NRS 449.0302)  “Cultural competency training” means the training required by NAC 449.011931.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011906  “Department” defined. (NRS 449.0302)  “Department” means the Department of Health and Human Services.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011909  “Director” defined. (NRS 449.0302)  “Director” means the Director of the Department.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011911  “Facility” defined. (NRS 449.0302)  “Facility” means a medical facility, facility for the dependent or facility which is otherwise required by regulations adopted by the Board pursuant to NRS 449.0303 to be licensed.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011913  Types of prohibited discrimination. (NRS 449.0302, 449.101)  Pursuant to paragraph (e) of subsection 1 of NRS 449.0302 and paragraph (a) of subsection 2 of NRS 449.101, the specific types of prohibited discrimination include, without limitation:

     1.  Discrimination that results in a person not being treated with dignity and which is based wholly or partially on the actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or human immunodeficiency virus status of the patient or resident or any person with whom the patient or resident associates.

     2.  Indirect discrimination that may or may not be intentional and which results in the application of policies that are applied uniformly and in a nondiscriminatory manner by the facility.

     3.  Discrimination which is based wholly or partially on the person associating with other persons who:

     (a) Are actually or perceived to be of a different race, color, religion, national origin, ancestry, age, gender, sexual orientation, gender identity or expression or human immunodeficiency virus status of the person; or

     (b) Actually or are perceived to have a physical or mental disability.

     4.  Harassment or bullying of any kind of a person because of his or her actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or human immunodeficiency virus status.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011916  Policies and procedures for transfer, discharge and provision of services. (NRS 449.0302)  A facility shall adopt and maintain policies and procedures for the transfer and discharge of, and the provision of services to, patients or residents in the facility which do not discriminate against a patient or resident based on the source of payment for the services provided.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011919  Posting of notice relating to filing of complaints. (NRS 449.0302)  In addition to the statement prescribed by paragraph (b) of subsection 2 of NRS 449.101, a facility shall post prominently in the facility and include on any Internet website to market the facility:

     1.  Notice that a patient or resident who has experienced prohibited discrimination may file a complaint with the Division; and

     2.  The contact information for the Division.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011921  Requirements for posting certain required information: Contents; size; placement. (NRS 449.0302)

     1.  The statement required to be posted pursuant to paragraph (b) of subsection 2 of NRS 449.101 and the notice and information required to be posted pursuant to subsection 3 of NRS 449.101 or NAC 449.011919, as applicable, must:

     (a) State the name of the facility; and

     (b) When posted in the facility:

          (1) Be not less than 8.5 inches in height and 11 inches in width, with margins not greater than 0.5 inches on any side; and

          (2) Be written using a single typeface in not less than 22-point type.

     2.  When posting prominently the statement required to be posted pursuant to paragraph (b) of subsection 2 of NRS 449.101 and the notice and information required to be posted pursuant to subsection 3 of NRS 449.101 or NAC 449.011919, as applicable, the facility shall post the statement or notice and information in each:

     (a) Public entrance of the facility;

     (b) Waiting room of the facility; and

     (c) Public dining room of the facility.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011923  Provision to patient or resident of information concerning complaints. (NRS 449.0302)

     1.  Upon admission of a patient or resident, the facility shall:

     (a) Provide the patient or resident with a written copy of the statement required pursuant to paragraph (b) of subsection 2 of NRS 449.101 and the notice and information required pursuant to subsection 3 of NRS 449.101 or NAC 449.011919, as applicable.

     (b) Provide the patient or resident with a written notice that a patient or resident who has experienced prohibited discrimination may file a complaint with the facility. The written notice provided by the facility must include, without limitation:

          (1) The contact information for the Division;

          (2) A clear statement that such a complaint with the facility:

               (I) May be filed in addition to the complaint that may be filed with the Division pursuant to subsection 3 of NRS 449.101 or NAC 449.011919, as applicable; and

               (II) Is not required to be filed for the patient or resident to file a complaint with the Division pursuant to subsection 3 of NRS 449.101 or 449.011919, as applicable; and

          (3) The procedure that the facility uses to address such complaints with the facility and the timeframe for how long it will take the facility to address such complaints with the facility.

     2.  As used in this section, “prohibited discrimination” means the discrimination described in NAC 449.011913 and in subsection 1 of NRS 449.101.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011926  Policy on handling of complaints; log of complaints. (NRS 449.0302)  A facility shall:

     1.  Develop and adopt a written policy on how a complaint with the facility that is filed pursuant to paragraph (b) of subsection 1 of NAC 449.011923 is documented, investigated and resolved; and

     2.  Maintain a log that lists:

     (a) All complaints with the facility that are filed pursuant to paragraph (b) of subsection 1 of NAC 449.011923;

     (b) The actions taken by the facility to investigate and resolve the complaint; and

     (c) If no action was taken, an explanation as to why no action was taken.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011929  Written permission required for presence of certain persons during physical examination where patient is unclothed. (NRS 449.0302)  To provide express permission pursuant to subsection 2 of NRS 449.102, a patient or resident or the authorized representative of the patient or resident must provide permission in writing.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011931  Cultural competency training for agent or employee who provides care to patient or resident. (NRS 449.0302, 449.103)

     1.  Pursuant to subsection 1 of NRS 449.103, within 30 business days after the course or program is assigned a course number by the Division pursuant to NAC 449.011941 or within 30 business days of any agent or employee being contracted or hired, whichever is later, and at least once each year thereafter, a facility shall conduct training relating specifically to cultural competency for any agent or employee of the facility who provides care to a patient or resident of the facility so that the agent or employee may:

     (a) More effectively treat patients or care for residents, as applicable; and

     (b) Better understand patients or residents who have different cultural backgrounds, including, without limitation, patients or residents who fall within one or more of the categories in paragraphs (a) to (f), inclusive, of subsection 1 of NRS 449.103.

     2.  The facility shall provide the training required by subsection 1 through a course or program that is approved by the Director of the Department or his or her designee pursuant to NAC 449.011939 and is assigned a course number by the Division pursuant to NAC 449.011941.

     3.  The facility shall keep documentation in the personnel file of any agent or employee of the facility of the completion of the cultural competency training required pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011933  Submission of course or program for cultural competency training. (NRS 449.0302, 449.103)

     1.  Within 90 days after a facility is licensed to operate, the facility must submit to the Department on a form prescribed by the Department the course or program which the facility will use to provide cultural competency training. The facility may:

     (a) Develop or operate the course or program; or

     (b) Contract with a third party to develop and operate the course or program.

     2.  The course or program submitted by the facility pursuant to subsection 1 must address patients or residents who have different cultural backgrounds from that of the agent or employee of the facility, including, without limitation, patients or residents who fall within one or more of the categories in paragraphs (a) to (f), inclusive, of subsection 1 of NRS 449.103.

     3.  When a facility submits a course or program pursuant to subsection 1, the facility must also provide to the Department the following information for the instructor of the course or program:

     (a) The application of the instructor who will teach the course or program;

     (b) Three letters of recommendation for the instructor, including, without limitation, at least one letter of recommendation in which the recommender has knowledge of the methods the instructor uses in teaching a cultural competency course or program; and

     (c) The resume of the instructor of the course or program that includes, without limitation, the education, training and experience the instructor has in providing cultural competency training.

     4.  Except as otherwise provided in subsection 5, when a facility submits a course or program pursuant to subsection 1, the facility must also provide to the Department:

     (a) The syllabus of the course or program;

     (b) The following information:

          (1) The name of the facility;

          (2) The address of the facility;

          (3) The electronic mail address of the facility;

          (4) The license number of the facility; and

          (5) The name and contact information of a person who represents the facility and who can discuss the course or program submitted by the facility pursuant to subsection 1;

     (c) If the facility contracts with a third party who develops and operates the course or program, the following information:

          (1) The name of the third party;

          (2) The address of the third party;

          (3) The electronic mail address of the third party; and

          (4) The name and contact information of a person who represents the third party and who can discuss the course or program submitted by the facility pursuant to subsection 1;

     (d) Evidence that the subjects covered by the course or program include, without limitation, the course materials required by NAC 449.011936;

     (e) A sample sign-in sheet for the course or program that contains:

          (1) The dates of the course or program; and

          (2) A place for a participant of the course or program to print and sign his or her name;

     (f) A sample evaluation form that a participant of the course or program may complete at the end of the course or program which evaluates:

          (1) The content of the course or program;

          (2) The instructor of the course or program; and

          (3) The manner in which the course or program is presented to the participant; and

     (g) A sample document that a participant of the course or program may complete at the end of the course or program in which the participant can perform a self-evaluation.

     5.  A facility may submit a course or program pursuant to subsection 1 without submitting the information required in subsection 4 if the course or program:

     (a) Is provided by:

          (1) A nationally recognized organization, as determined by the Director of the Department;

          (2) A federal, state or local government agency; or

          (3) A university or college that is accredited in the District of Columbia or any state or territory of the United States; and

     (b) Provides proof of completion upon the participant of the course or program completing the course or program that the Director or his or her designee determines to be satisfactory.

     6.  When a facility submits pursuant to subsection 1 a course or program that is described in subsection 5, the facility must also provide to the Department:

     (a) The name of the course or program;

     (b) The name of the organization, agency, university or college providing the course or program;

     (c) If the course or program is provided online, the URL of the course or program;

     (d) If the course or program is provided through a training system, access to the training system;

     (e) If the course or program is not provided online or through a training system, the syllabus of the course or program;

     (f) The following information:

          (1) The name of the facility;

          (2) The address of the facility;

          (3) The electronic mail address of the facility;

          (4) The license number of the facility; and

          (5) The name and contact information of a person who represents the facility and who can discuss the course or program submitted by the facility pursuant to subsection 1; and

     (g) Any other information the Department requests to assist the Director or his or her designee in determining whether or not to approve the course or program pursuant to NAC 449.011939.

     7.  As used in this section, “URL” means the Uniform Resource Locator associated with an Internet website.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011936  Materials for course or program for cultural competency training. (NRS 449.0302, 449.103)

     1.  A course or program subject to the requirements of subsection 4 of NAC 449.011933 must include, without limitation, the following course materials:

     (a) An overview of cultural competency;

     (b) An overview of implicit bias and indirect discrimination;

     (c) The common assumptions and myths concerning stereotypes and examples of such assumptions and myths;

     (d) An overview of social determinants of health;

     (e) An overview of best practices when interacting with persons who fall within one or more of the categories in paragraphs (a) to (f), inclusive, of subsection 1 of NRS 449.103;

     (f) An overview of gender, race and ethnicity;

     (g) An overview of religion;

     (h) An overview of sexual orientation and gender identities or expressions;

     (i) An overview of mental and physical disabilities;

     (j) Examples of barriers to providing care;

     (k) Examples of language and behaviors that are discriminatory; and

     (l) Examples of a welcoming and safe environment.

     2.  The course materials included in a course or program, including, without limitation, the course materials required by subsection 1, must include, without limitation:

     (a) Evidence-based, peer-reviewed sources;

     (b) Source materials that are used in universities or colleges that are accredited in the District of Columbia or any state or territory of the United States;

     (c) Source materials that are from nationally recognized organizations, as determined by the Director of the Department;

     (d) Source materials that are published or used by federal, state or local government agencies; or

     (e) Other source materials that are deemed appropriate by the Department.

     3.  The Department must:

     (a) Publish a copy of the requirements set forth in subsections 1 and 2 on its Internet website; and

     (b) Provide a copy of the requirements set forth in subsections 1 and 2 to a facility upon request by the facility.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011939  Approval or denial of course or program for cultural competency training; means for delivery of course or program. (NRS 449.0302, 449.103)

     1.  The Department shall review the course or program information submitted pursuant to NAC 449.011933 and, if applicable, NAC 449.011936 within 60 days after receipt. During this review process, the Department may have the course or program reviewed by a person who is an expert on cultural competency or a committee of persons who are experts on cultural competency.

     2.  If the information that is provided to the Department meets the requirements set forth in NAC 449.011933 and 449.011936, if applicable, the Director or his or her designee may approve the course or program. If the information that is provided to the Department does not meet the requirements set forth in NAC 449.011933 and 449.011936, if applicable, the Director or his or her designee shall not approve the course or program.

     3.  Within 5 business days after completing the review of the information pursuant to subsection 1, the Director or his or her designee shall:

     (a) Notify the facility that submitted the information whether the course or program is approved or not approved pursuant to subsection 2; and

     (b) If the Director or his or her designee does not approve the course or program, inform the facility of any additional information that the facility needs to submit for the course or program to be approved.

     4.  The facility shall submit the additional information that the facility needs to submit pursuant to paragraph (b) of subsection 3 within 45 days after being notified that the course or program is not approved pursuant to paragraph (a) of subsection 3. Upon receiving the additional information, the Director or his or her designee may approve the course or program. If the additional information is not received or fails to include all of the information that the Director or his or her designee informed the facility that it needed to submit, the Director or his or her designee shall not approve the course or program.

     5.  Any course or program approved pursuant to this section may be provided:

     (a) Online;

     (b) Through a training system; or

     (c) In person.

     6.  If the Director or his or her designee approves the course or program, the Director or his or her designee shall notify the Division of the approval of the course or program not later than 7 business days after such approval.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011941  Assignment of course number to course or programs for cultural competency training. (NRS 449.0302, 449.103)

     1.  Not later than 7 business days after receiving the notice of approval of the course or program pursuant to subsection 6 of NAC 449.011939, the Division shall assign a course number to the approved course or program.

     2.  Not later than 7 business days after assigning the course number pursuant to subsection 1, the Division shall notify the facility whose course or program is approved pursuant to NAC 449.011939 of the course number assigned pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011943  Policies concerning preferred names and pronouns; adaptation of records to reflect gender identities or expressions; method to obtain medically relevant information from patients or residents. (NRS 449.0302, 449.104)

     1.  A facility shall:

     (a) Develop policies to ensure that a patient or resident is addressed by his or her preferred name and pronoun and in accordance with his or her gender identity or expression; and

     (b) Adapt electronic records and any paper records the facility has to reflect the gender identities or expressions of patients or residents with diverse gender identities or expressions, including, without limitation:

          (1) If the facility is a medical facility, adapting health records to meet the medical needs of patients or residents with diverse sexual orientations and gender identities or expressions, including, without limitation, integrating information concerning sexual orientation and gender identity or expression into electronic systems for maintaining health records; and

          (2) If the facility is a facility for the dependent or other residential facility, adapting electronic records and any paper records the facility has to include the preferred name and pronoun and gender identity or expression of a resident.

     2.  If a patient or resident chooses to provide the following information, the health records adapted pursuant to subparagraph (1) of paragraph (b) of subsection 1 must include, without limitation:

     (a) The preferred name and pronoun of the patient or resident;

     (b) The gender identity or expression of the patient or resident;

     (c) The gender identity or expression of the patient or resident that was assigned at the birth of the patient or resident;

     (d) The sexual orientation of the patient or resident; and

     (e) If the gender identity or expression of the patient or resident is different than the gender identity or expression of the patient or resident that was assigned at the birth of the patient or resident:

          (1) A history of the gender transition and current anatomy of the patient or resident; and

          (2) An organ inventory for the patient or resident which includes, without limitation, the organs:

               (I) Present or expected to be present at the birth of the patient or resident;

               (II) Hormonally enhanced or developed in the patient or resident; and

               (III) Surgically removed, enhanced, altered or constructed in the patient or resident.

     3.  A medical facility that has adapted health records pursuant to subparagraph (1) of paragraph (b) of subsection 1 shall develop a method to lead patients or residents through a series of questions to help obtain thorough and medically relevant information regarding the patients or residents to accurately reflect the diverse gender identities or expressions of patients or residents with diverse gender identities or expression to be used in providing care to the patient or resident, including, without limitation, when interacting with insurance providers. A patient or resident may decline to answer any such questions.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011946  Provision of certain statements, notices and information in appropriate languages and with reasonable accommodations. (NRS 449.0302)

     1.  Except as otherwise provided in subsection 2, the statements, notices and information required by NAC 449.011901 to 449.011951, inclusive, and NRS 449.101 to 449.104, inclusive, must be in English and, as appropriate for a facility, in any other language the Department determines is appropriate based on the demographic characteristics of this State. In addition to the notices and information provided in English and any other language the Department determines is appropriate based on the demographic characteristics of this State, a facility may provide the statements, notices and information in any other language the facility may desire.

     2.  A facility must make reasonable accommodations in providing the statements, notices and information described in subsection 1 for patients or residents who:

     (a) Are unable to read;

     (b) Are blind or visually impaired;

     (c) Have communication impairments; or

     (d) Do not read or speak English or any other language in which the statements, notices and information are written pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011949  Designation of representative to ensure compliance. (NRS 449.0302)  A facility shall designate a representative of the facility who shall be responsible for ensuring that the facility is in compliance with NAC 449.011901 to 449.011951, inclusive, and NRS 449.101 to 449.104, inclusive.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

      NAC 449.011951  Facility to make certain documentation available to Division or Department. (NRS 449.0302)  Upon request from the Division or Department, a facility shall make available to the Division or Department documentation for the Division or Department to determine if the facility is complying with NAC 449.011901 to 449.011951, inclusive, and NRS 449.101 to 449.104, inclusive. If the Division or Department obtains personally identifiable information of a patient or resident through such a request, the Division or Department shall maintain the confidentiality of such information.

     (Added to NAC by Bd. of Health by R016-20, eff. 11-2-2020)

FEES

      NAC 449.012  Definitions. (NRS 439.150, 439.200, 449.0302, 449.0303, 449.050)  As used in NAC 449.012 to 449.0169, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.01205 to 449.01265, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R229-97, 4-15-98; R052-02 & R063-02, 7-24-2002; R065-04, 8-4-2004; R051-06 & R095-06, 7-14-2006; R182-07, 1-30-2008; R046-14, 10-24-2014; R121-16, 9-21-2017; R048-22, 12-29-2022)

      NAC 449.01205  “Agency to provide personal care services in the home” defined. (NRS 449.0302)  “Agency to provide personal care services in the home” has the meaning ascribed to it in NRS 449.0021.

     (Added to NAC by Bd. of Health by R182-07, eff. 1-30-2008)

      NAC 449.0121  “Ambulatory surgical center” defined. (NRS 449.0302)  “Ambulatory surgical center” has the meaning ascribed to it in NAC 449.972.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01215  “Branch office” defined. (NRS 449.0302)  “Branch office” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01219  “Community triage center” defined. (NRS 449.0302)  “Community triage center” has the meaning ascribed to it in NRS 449.0031.

     (Added to NAC by Bd. of Health by R051-06, eff. 7-14-2006)

      NAC 449.01225  “Facility for hospice care” defined. (NRS 449.0302)  “Facility for hospice care” has the meaning ascribed to it in NAC 449.0172.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R123-99, 11-29-99)

      NAC 449.01227  “Facility for refractive surgery” defined. (NRS 449.0302)  “Facility for refractive surgery” has the meaning ascribed to it in NRS 449.00387.

     (Added to NAC by Bd. of Health by R052-02, eff. 7-24-2002; A by R042-06, 7-14-2006)

      NAC 449.01228  “Facility for transitional living for released offenders” defined. (NRS 449.0302)  “Facility for transitional living for released offenders” has the meaning ascribed to it in NRS 449.0055.

     (Added to NAC by Bd. of Health by R095-06, eff. 7-14-2006)

      NAC 449.01229  “Facility for treatment with narcotics” defined. (NRS 449.0302, 449.0303)  “Facility for treatment with narcotics” has the meaning ascribed to it in NAC 449.1542.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)—(Substituted in revision for NAC 449.0122)

      NAC 449.0123  “Home health agency” defined. (NRS 449.0302)  “Home health agency” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01235  “Home office” defined. (NRS 449.0302)  “Home office” has the meaning ascribed to it in NAC 449.749.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0124  “Hospice care” defined. (NRS 449.0302)  “Hospice care” has the meaning ascribed to it in NAC 449.0175.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01245  “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” defined. (NRS 449.0302)  “Intermediate care facility for persons with an intellectual disability or persons with a developmental disability” has the meaning ascribed to it in NAC 449.632.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.0125  “Medication unit” defined. (NRS 449.0302, 449.0303)  “Medication unit” has the meaning ascribed to it in NAC 449.15435.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.01252  “Mobile unit” defined. (NRS 449.0302)  “Mobile unit” has the meaning ascribed to it in NRS 449.01515.

     (Added to NAC by Bd. of Health by R063-02, eff. 7-24-2002)

      NAC 449.01255  “Nursing pool” defined. (NRS 449.0302)  “Nursing pool” has the meaning ascribed to it in NRS 449.0153.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01257  “Psychiatric residential treatment facility” defined. (NRS 439.150, 449.0302, 449.050)  “Psychiatric residential treatment facility” has the meaning ascribed to it in NAC 449.411.

     (Added to NAC by Bd. of Health by R046-14, eff. 10-24-2014)

      NAC 449.01259  “Recovery center” defined. (NRS 439.200, 449.0302, 449.0303)  “Recovery center” has the meaning ascribed to it in NAC 449.99702.

     (Added to NAC by Bd. of Health by R121-16, eff. 9-21-2017)

      NAC 449.0126  “Rural clinic” defined. (NRS 449.0302)  “Rural clinic” has the meaning ascribed to it in NRS 449.0175.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.01265  “Rural hospital” defined. (NRS 449.0302)  “Rural hospital” has the meaning ascribed to it in NRS 449.0177.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97)

      NAC 449.013  License and renewal fees to operate ambulatory surgical center or home office of home health agency, branch office of home health agency, rural clinic, free standing birthing center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, facility for refractive surgery, mobile unit, agency to provide personal care services in home, facility for the care of adults during day, community health worker pool and employment agency to provide nonmedical services; fee to support system for reporting of information on cancer and other neoplasms; expiration of application for license. (NRS 439.150, 439.200, 449.03005, 449.0302, 449.0303, 449.0305, 449.050, 457.240)

     1.  Except as otherwise provided in NAC 449.0168, an applicant for a license to operate any of the following facilities, programs of hospice care or agencies must pay to the Division of Public and Behavioral Health the following nonrefundable fees:

     2.  An applicant for the renewal of such a license must pay to the Division of Public and Behavioral Health the following nonrefundable fees:

     3.  Upon the issuance or renewal of a license to operate an ambulatory surgical center, program of hospice care, agency to provide personal care services in the home or rural clinic, the licensee shall pay to the Division a nonrefundable fee equal to 6 percent of the renewal fee set forth in subsection 2. The Division shall use the fees collected pursuant to this subsection during the immediately following fiscal year to support the system for the reporting of information on cancer and other neoplasms.

     4.  An application for a license is valid for 1 year after the date on which the application is submitted. If an applicant does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations adopted pursuant thereto within 1 year after the date on which the applicant submits his or her application, the applicant must submit a new application and pay the required fee to be considered for licensure.

     [Bd. of Health, Health Facility Fees Art. 1, eff. 1-20-77]—(NAC A 7-22-87; 1-31-90; 9-1-93; 11-1-95; 10-3-96; R035-97 & R044-97, 10-30-97; R229-97, 4-15-98; R105-98, 9-23-98; R132-99, 11-29-99; R123-01, 12-17-2001, eff. 1-1-2002; R052-02 & R063-02, 7-24-2002; R050-02, 10-22-2002; R074-03, 10-22-2003; R065-04, 8-4-2004; R042-06 & R095-06, 7-14-2006; R182-07, 1-30-2008; R060-10, 1-13-2011; R022-14, 6-26-2015; R120-16, 9-21-2017; R133-15, 12-19-17; R109-18, 1-30-2019; R062-21, 9-28-2022; R010-22 & R048-22, 12-29-2022)

      NAC 449.016  License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facility, residential facility for groups, facility for treatment of alcohol or other substance use disorders, facility for hospice care, home for individual residential care, facility for modified medical detoxification, community triage center, facility for treatment of irreversible renal disease, halfway house for persons recovering from alcohol or other substance use disorders, facility for transitional living for released offenders, psychiatric residential treatment facility and recovery center; expiration of application for license; fee to support system for reporting of information on cancer and other neoplasms; refund of certain fees. (NRS 439.150, 439.200, 449.0302, 449.050, 457.240)

     1.  Except as otherwise provided in NAC 449.0168, an applicant for a license to operate any of the following facilities must pay to the Division the following nonrefundable fees:

 

     2.  An applicant for the renewal of such a license must pay to the Division the following nonrefundable fees:

     3.  An applicant for a license or for the renewal of a license for a residential facility for groups shall pay a fee of $35 for each bed in the facility if the facility is paid less than $1,000 per month for services provided to each bed in the facility.

     4.  An application for a license is valid for 1 year after the date on which the application is submitted. If an applicant does not meet the requirements for licensure imposed by chapter 449 of NRS or the regulations adopted pursuant thereto within 1 year after the date on which he or she submits his or her application, the applicant must submit a new application and pay the required fee to be considered for licensure.

     5.  Upon the issuance or renewal of a license to operate a facility for the treatment of irreversible renal disease, facility for hospice care, hospital, facility for intermediate care or facility for skilled nursing, the licensee shall pay to the Division a nonrefundable fee equal to 6 percent of the renewal fee set forth in subsection 2. The Division shall use the fees collected pursuant to this subsection during the immediately following fiscal year to support the system for the reporting of information on cancer and other neoplasms.

     6.  Pursuant to NRS 449.050, if an application for a license to operate a facility for transitional living for released offenders or the renewal of such a license is denied, any amount of a fee paid pursuant to paragraph (n) of subsection 1 or paragraph (n) of subsection 2 that exceeds the expenses and costs incurred by the Division must be refunded to the applicant.

     [Bd. of Health, Health Facility Fees Art. 2, eff. 1-20-77]—(NAC A 7-22-87; 8-31-89; 9-1-93; 11-1-95; R035-97 & R044-97, 10-30-97; R105-98, 9-23-98; R123-99 & R131-99, 11-29-99; R129-99, 11-29-99, eff. 1-1-2000; R110-01, 11-21-2001; R050-02, 10-22-2002; R074-03, 10-22-2003; R065-04, 8-4-2004; R051-06, 7-14-2006; R060-10, 1-13-2011; R046-14, 10-24-2014; R121-16, 9-21-2017; R010-22, 12-29-2022)

      NAC 449.0164  Fees for renewal of licenses for certain facilities: Payment in two equal installments. (NRS 439.150, 439.200, 449.0302, 449.050)  An applicant for the renewal of a license for a residential facility for groups, a halfway house for persons recovering from alcohol or other substance use disorders, a home for individual residential care or a facility for transitional living for released offenders may pay the fee required for the renewal of his or her license in two equal installments if:

     1.  On or before November 1 of the calendar year in which the license expires, the applicant submits a complete application for the renewal of the license which includes, without limitation:

     (a) The first installment payment which is equal to one-half the amount of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate;

     (b) An additional fee of $100 for the administrative costs of billing and collecting such payments; and

     (c) A signed payment agreement and a confession of judgment for the total amount of the second installment payment which may be filed with a court of competent jurisdiction if the applicant fails to make the second installment payment in accordance with the agreement;

     2.  On or before April 15 of the calendar year for which the license is renewed, he or she submits the second installment payment for the remainder of the fee required for the renewal of the license pursuant to NAC 449.013 or 449.016, as appropriate; and

     3.  The applicant has not failed to make a payment in accordance with any other similar agreement.

     (Added to NAC by Bd. of Health by R065-04, eff. 8-4-2004; A by R095-06, 7-14-2006)

      NAC 449.0168  Fees for modification of certain licenses. (NRS 439.150, 439.200, 449.0302, 449.0305, 449.050)

     1.  Except as otherwise provided in subsection 2, a holder of a license to operate a medical facility, facility for the dependent, program of hospice care or referral agency who wishes or is required pursuant to NAC 449.190, 449.307, 449.7473 or 449.758 to modify his or her license to reflect:

     (a) A change in the name of the facility, program or agency;

     (b) A change of the administrator of the facility, program or agency;

     (c) A change in the number of beds in the facility;

     (d) A change in the type of facility licensed or the addition of another type of facility to be licensed;

     (e) A change in the category of residents who may reside at the facility;

     (f) A change in the designation of a staging area for a mobile unit or, if the mobile unit is operated by an independent facility, a change in the address of the independent facility; or

     (g) A change in any of the services provided by an agency to provide nursing in the home,

Ê must submit an application for a new license to the Division and pay to the Division a fee of $250.

     2.  An applicant who applies for a license pursuant to paragraph (c) of subsection 1 because of an increase in the number of beds in the facility must pay to the Division:

     (a) A fee of $250; and

     (b) A fee for each additional bed as follows:

     3.  If the address of the home office of a home health agency has not changed, a holder of a license to operate a branch office of the home health agency who wishes or is required pursuant to NAC 449.758 to modify his or her license to reflect a change in the address of the branch office of the home health agency must:

     (a) Submit an application for a new license to the Division; and

     (b) Pay to the Division a fee of $250.

     4.  A fee paid pursuant to this section is nonrefundable.

     5.  As used in this section:

     (a) “Administrator” means the person who is responsible for the daily management of a medical facility, facility for the dependent or program of hospice care.

     (b) “Independent facility” has the meaning ascribed to it in NAC 449.9701.

     (c) “Staging area” has the meaning ascribed to it in NAC 449.97018.

     (Added to NAC by Bd. of Health by R035-97, eff. 10-30-97; A by R053-99, 9-27-99; R132-99, 11-29-99; R110-01, 11-21-2001; R063-02, 7-24-2002; R050-02, 10-22-2002; R074-03, 10-22-2003; R123-05, 11-17-2005; R060-10, 1-13-2011; R048-22, 12-29-2022)

      NAC 449.01685  Division authorized to charge and collect fee from licensee to recover costs of investigating complaint if complaint is substantiated. (NRS 439.150, 439.200, 449.0302)

     1.  The Division may charge and collect a fee from any licensee who is involved in a complaint submitted to the Division to recover the costs of investigating the complaint after the investigation is completed and the complaint is substantiated. The fee will be based upon the hourly rate established for each surveyor of health facilities as determined by the budget of the Division.

     2.  As used in this section, “substantiated” means supported or established by evidence or proof.

     (Added to NAC by Bd. of Health by R155-10, eff. 12-16-2010; A by R048-22, 12-29-2022)

      NAC 449.0169  Department of Corrections to pay fee to Division for certain services. (NRS 449.0302)

     1.  To the extent that money is appropriated for this purpose, each institution of the Department of Corrections shall pay a fee of $3,266 each year to the Division for the purpose of enabling the Division to carry out its duties set forth in NRS 209.382, 444.330 and 446.885.

     2.  As used in this section, “institution” has the meaning ascribed to it in NRS 209.071.

     (Added to NAC by Bd. of Health by R060-10, 1-13-2011, eff. 7-1-2011)

PROVISION OF HOSPICE CARE

General Provisions

      NAC 449.017  Definitions. (NRS 439.200, 449.0302)  As used in NAC 449.017 to 449.0188, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.0171 to 449.0178, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06, 7-14-2006; R048-22, 12-29-2022)

      NAC 449.0171  “Bereavement services” defined. (NRS 449.0302)  “Bereavement services” means social and emotional support offered to the family of a patient in a program of hospice care for at least 1 year following the death of the patient.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0172  “Facility for hospice care” defined. (NRS 449.0302)  “Facility for hospice care” has the meaning ascribed to it in NRS 449.0033.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)

      NAC 449.0173  “Governing body” defined. (NRS 449.0302)  “Governing body” means the person or group of persons responsible for carrying out and monitoring the administration of a program of hospice care or for the operation of a facility for hospice care.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)

      NAC 449.0175  “Hospice care” defined. (NRS 449.0302)  “Hospice care” has the meaning ascribed to it in NRS 449.0115.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0176  “Medical director” defined. (NRS 449.0302)  “Medical director” means the physician who is responsible for acting as a medical resource to an interdisciplinary team which provides hospice care.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.01765  “Palliative services” defined. (NRS 449.0302)  “Palliative services” has the meaning ascribed to it in NRS 449.0156.

     (Added to NAC by Bd. of Health by R041-06, eff. 7-14-2006)

      NAC 449.0177  “Patient” defined. (NRS 449.0302)  “Patient” means a person who is terminally ill and who is receiving hospice care.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0178  “Terminally ill” defined. (NRS 449.0302)  “Terminally ill” has the meaning ascribed to it in NRS 449.0195.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06, 7-14-2006)

Licensing

      NAC 449.0181  Compliance with regulations required for license to operate facility for hospice care. (NRS 449.0302)  The Division shall not issue a license to operate a facility for hospice care unless the program of hospice care which it provides complies with the requirements of NAC 449.017 to 449.0188, inclusive.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99)

      NAC 449.0183  Report of change in ownership, address or staff of program of hospice care. (NRS 449.0302)  An applicant for a license to administer a program of hospice care or a person licensed to administer such a program shall immediately advise the Division of any change in:

     1.  The ownership of the program;

     2.  The address of the principal office of the program; or

     3.  The membership of the staff which prevents the program from providing adequate hospice care to each patient.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

Administration

      NAC 449.0184  Governing body required; duties of governing body and administrator. (NRS 449.0302)  Every facility which provides a program of hospice care must have a governing body which shall:

     1.  Appoint an administrator of the program of hospice care. The administrator shall be available on a daily basis for consultation with members of the interdisciplinary team of the program of hospice care.

     2.  Ensure that all services provided by the program of hospice care are consistent with accepted standards of practice for the care of the patients.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

Medical Services

      NAC 449.0185  Requirements for program of hospice care. (NRS 449.0302)  A program of hospice care must comply with the following requirements:

     1.  A qualified person must be available when required to evaluate the dietary patterns of each patient and plan diets to meet the individual nutritional needs of each patient.

     2.  Each patient must be advised regarding the availability of pastoral care.

     3.  Bereavement services must be available to each member of a patient’s family after the patient dies to provide appropriate counseling.

     4.  Nursing care must be provided by a registered nurse or under the supervision of a registered nurse.

     5.  A social worker must provide social services to each patient in the program under the direction of the interdisciplinary team.

     6.  The services of:

     (a) A physical therapist;

     (b) An occupational therapist; and

     (c) A speech-language pathologist,

Ê must be provided when such services are prescribed for a patient by his or her physician.

     7.  Home health aide and homemaker services must be available to each patient and provided at intervals which meet the needs of each patient. A registered nurse must:

     (a) Supervise the persons providing such services; and

     (b) Prepare written instructions for the persons providing such services which identify the duties they are to perform.

     8.  Arrangements must be made to provide any medical supplies and appliances which are required by a patient, including any drug or biological needed for palliative services.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R041-06, 7-14-2006)

      NAC 449.0186  Requirements for plan of care. (NRS 449.0302)

     1.  The medical director of a program of hospice care shall cause a written plan of care to be established for each patient in the program. Any person who furnishes care for the patient shall adhere to the plan.

     2.  A plan of care must:

     (a) Be established by the physician of the patient or by the medical director of the program of hospice care, and the interdisciplinary team which provides the hospice care;

     (b) Include an assessment of the needs of the patient and identify the services required by the patient, which must include the management of discomfort and relief of symptoms of the patient;

     (c) State the scope and frequency of each service to be provided to the patient and members of his or her family; and

     (d) Be reviewed and updated at intervals that are specified in the plan by the person who established the plan. The review must be documented in writing.

     (Added to NAC by Bd. of Health, eff. 7-20-90)

      NAC 449.0187  Requirements for operation of facility for hospice care. (NRS 439.200, 449.0302)  A facility for hospice care must comply with the following requirements:

     1.  A program of hospice care must be provided for each inpatient pursuant to a written plan of care established pursuant to NAC 449.0186.

     2.  Nursing services must be provided 24 hours per day in accordance with the plan of care for each patient.

     3.  Medication must be dispensed to each patient according to the instructions of the patient’s physician or the medical director.

     4.  Treatment must be administered to a patient pursuant to the instructions of the physician of the patient or the plan of care for the patient.

     5.  Each patient must be maintained in a clean and well-groomed manner.

     6.  Each patient must be protected from accidents, injuries and infections.

     7.  At least one registered nurse must be on duty for each work shift, providing direct care to patients.

     8.  A written plan of the procedures to be followed during a local disaster, a widespread disaster or a disaster which occurs within the facility for hospice care must be adopted. The plan must:

     (a) Provide procedures designed to protect each patient and to care for any casualty which may arise from such a disaster;

     (b) Be reviewed and the procedures set forth therein rehearsed by all members of the staff at least once in each quarter of the year; and

     (c) Be approved by the Division.

     9.  A private room with an adjoining bath must be provided for each patient.

     10.  An anteroom, a room adjoining the room of each patient or a private area must be provided and furnished with a bed and chairs for use by the members of the patient’s family.

     11.  A facility for hospice care must comply with the provisions of 42 C.F.R. § 418.110(d).

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R123-99, 11-29-99; R048-22, 12-29-2022)

      NAC 449.01875  New construction or remodeling: Submission and approval of building plans; prerequisites for approval of facility for licensure. (NRS 439.200, 439.0302)

     1.  Except as otherwise provided in subsection 2, before any construction of a new facility for hospice care or remodeling of an existing facility for hospice care commences, the facility must submit two complete sets of the building plans for the construction or remodeling, as applicable, to:

     (a) The entity designated by the Division to review such plans in the manner prescribed by NAC 449.0115, regardless of whether the facility is applying for a license or the renewal of a license. The review by that entity is only advisory, and approval by that entity does not constitute the approval of the construction or remodeling by the Bureau.

     (b) The Division. The facility shall not commence the construction or remodeling, as applicable, until the plans have been approved by the Division.

     2.  The provisions of subsection 1 do not apply to the remodeling of an existing facility for hospice care if the remodeling is limited to refurbishing an area within the facility including, without limitation, painting the area, replacing flooring in the area, repairing windows in the area or replacing window and wall coverings in the area.

     3.  The Division shall not issue a license to operate a newly constructed facility for hospice care until the Bureau has approved the construction. The Bureau shall not approve the construction without conducting a survey at the site of the facility. Such a survey must occur after the construction has been completed.

     (Added to NAC by Bd. of Health by R048-22, eff. 12-29-2022)

      NAC 449.0188  Continuity of service to patients required. (NRS 449.0302)  A person licensed to administer a program of hospice care or to operate a facility for hospice care shall maintain the continuity of service provided to each patient pursuant to NAC 449.017 to 449.0188, inclusive, during the term of his or her license.

     (Added to NAC by Bd. of Health, eff. 7-20-90; A by R044-97, 10-30-97; R123-99, 11-29-99)

FACILITIES FOR THE TREATMENT OF ALCOHOL OR OTHER SUBSTANCE USE DISORDERS

General Provisions

      NAC 449.019  Definitions. (NRS 449.0302)  As used in NAC 449.019 to 449.150, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.022 to 449.072, inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Bd. of Health by R077-01, 10-18-2001; R016-20, 11-2-2020)

      NAC 449.022  “Administrator” defined. (NRS 449.0302)  “Administrator” means the person who is appointed by the governing body of a facility who has primary responsibility for the operations of the overall program of the facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.4, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.025  “Alcohol or other substance use disorder treatment” defined. (NRS 449.0302)  “Alcohol or other substance use disorder treatment” means a program concerned with substance use disorder treatment directed towards achieving the mental and physical restoration of persons with alcohol or other substance use disorders.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.9, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.030  “Case management services” defined. (NRS 449.0302)  “Case management services” means a multistep process by which clients may receive assistance in accessing services, including, without limitation, services concerning health, mental health, education, vocation, employment, legal issues, child care, housing and aftercare for recovery from alcohol or other substance use disorders.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.031  “Client” defined. (NRS 449.0302)  “Client” means a resident or patient of a facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.8, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.034  “Detoxification” defined. (NRS 449.0302)  “Detoxification” means the process of eliminating the toxic effects of alcohol and drugs from the body.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.1.3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.043  “Facility” defined. (NRS 449.0302)  “Facility” means a facility for the treatment of alcohol or other substance use disorders as defined in NRS 449.00455.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.1, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.044  “Facility for modified medical detoxification” defined. (NRS 449.0302)  “Facility for modified medical detoxification” has the meaning ascribed to it in NRS 449.00385.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.046  “Governing body” defined. (NRS 449.0302)  “Governing body” means a body that has the ultimate authority for the administration of the overall program at a facility pursuant to NAC 449.085.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.060  “Medically managed intensive detoxification program” defined. (NRS 449.0302)  “Medically managed intensive detoxification program” means a program which provides 24-hour medical monitoring of treatment and detoxification services in a licensed hospital pursuant to NAC 449.279 to 449.394, inclusive, and which has life support systems in place.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.064  “Overall program” defined. (NRS 449.0302)  “Overall program” means all aspects of alcohol or other substance use disorder treatment, including general fiscal management, fund-raising projects and the general long-term goals of a facility which are defined in writing.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.10, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.068  “Qualified social worker” defined. (NRS 449.0302)  “Qualified social worker” means a person who is licensed by the Board of Examiners for Social Workers to practice as a social worker.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 1 § 1.11, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)—(Substituted in revision for NAC 449.073)

      NAC 449.069  “Residential program” defined. (NRS 449.0302)  “Residential program” means a treatment program for alcohol or other substance use disorders which takes place in a 24-hour residential setting and which encompasses organized services staffed by designated treatment personnel who provide a planned regimen of client care.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.072  “Social model detoxification program” defined. (NRS 449.0302)  “Social model detoxification program” means a treatment program that concentrates on providing psychosocial services and nonmedical detoxification.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

Licensing

      NAC 449.079  Denial, revocation or suspension of license if facility not certified by Division; appeal. (NRS 449.0302)

     1.  If a facility is not certified by the Division pursuant to paragraph (d) of subsection 1 of NRS 458.025, the Division shall deny an application for a license or suspend or revoke the license of the facility.

     2.  An applicant or licensee who wishes to appeal an action of the Division relating to the denial, suspension or revocation of a license may appeal the action pursuant to the procedures set forth in NAC 439.300 to 439.395, inclusive.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 2 §§ 2.7-2.12, eff. 3-27-76; A and renumbered as §§ 2.7-2.11, 12-27-77]—(NAC A by R035-97 & R044-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.081  New construction or remodeling: Submission and approval of building plans; prerequisites to approval of licensing. (NRS 449.0302)

     1.  Building plans for new construction or remodeling must be submitted to the entity designated to review such plans by the Division pursuant to the provisions of NAC 449.0115. Before the construction or remodeling may begin, the plans for the construction or remodeling must be approved by the Division.

     2.  The Division shall not approve the licensing of a facility until all construction has been completed and a survey is conducted at the site.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 16, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R076-01 & R077-01, 10-18-2001; R073-04, 8-4-2004)

Administration and Personnel

      NAC 449.085  Governing body; bylaws. (NRS 449.0302)

     1.  Every facility must have a governing body which has the ultimate authority for the administration of the overall program.

     2.  The governing body shall adopt written bylaws and policies that define the powers and duties of the governing body, its committees, the administrator and any advisory group.

     3.  The bylaws and policies must:

     (a) Identify the overall goals.

     (b) Include an organizational chart.

     (c) Define the major lines of authority and areas of responsibility within the treatment program.

     (d) Define the membership of the governing body, the types of membership, the method of selection or appointment of members, offices or committees and their terms of office.

     (e) Define the frequency of meetings of the governing body and attendance requirements.

     4.  The duties of the governing body include, but are not limited to, the following items:

     (a) Appointment of a qualified administrator with authority and responsibilities appropriate to the requirements of the program;

     (b) Adoption, review and revision of the governing body’s bylaws and policies;

     (c) Adoption of controls designed to achieve and maintain maximum standards of service; and

     (d) Review and approval of an annual budget to carry out the objectives of the program.

     5.  New facilities must show sufficient resources to operate for 120 days.

     6.  The governing body shall retain the ultimate responsibility for the overall program and its objectives.

     7.  The governing body shall meet at least semiannually. Minutes must be kept of the meetings, including the date of the meeting, those in attendance, topics discussed, decisions made and actions taken, target dates for the implementation of recommendations and all program reports.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R044-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.088  Policies and procedures. (NRS 449.0302)

     1.  A facility must have written policies and procedures available to members of the staff, clients and the public which govern the operation of the facility and services provided by the facility.

     2.  The policies must:

     (a) Ensure that only those persons are accepted as clients whose needs can be met by the facility directly or in cooperation with community resources or other providers of treatment with which it is affiliated.

     (b) Ensure that a client whose physical or mental condition has changed to such an extent that the client can no longer be adequately served by the facility will be transferred promptly to an appropriate facility.

     (c) Set forth the rights of clients and members of the staff and provide for the registration and disposition of complaints without threat of discharge or reprisal against any employee or client.

     (d) Ensure that the admission agreement between the administrator and the client does not permit the administrator or his or her designee a power of attorney.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.091  Transfer of client to another facility. (NRS 449.0302)

     1.  Except in the case of an emergency, the transfer of a client to another facility must not be effected until the client, attending physician, if any, and responsible agency are notified in advance.

     2.  If a client is transferred to another facility, information required for appropriate continuation of care must be released to the receiving facility in compliance with the standards set forth in 42 C.F.R. Part 2, which are hereby adopted by reference. A copy of the standards may be obtained from the Division, free of charge, upon request.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.094  Money of clients. (NRS 449.0302)

     1.  If a facility handles a client’s money, a written ledger account of all deposits, disbursements or other transactions must be maintained. A record must be made available to the client at least quarterly.

     2.  A client’s money must be given to the client within 24 hours of his or her exit from the facility.

     3.  Large sums of money must be maintained in a financial institution in the community where the facility is located in a separate trustee account apart from the facility’s operational accounts and must be clearly designated.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.098  Preparations for disasters; reporting of fire or disaster. (NRS 449.0302)

     1.  Each facility shall develop a written plan for disasters which outlines procedures for members of the staff and clients to follow in case of fire or another emergency and which provides for meeting the needs of clients if the facility must be evacuated or is destroyed.

     2.  A simple floor plan showing the routes for evacuating must be posted in prominent locations on each floor of each facility.

     3.  Each facility shall conduct a disaster drill at least annually, and a written record of each drill must be retained in the facility for not less than 12 months after the drill is conducted.

     4.  The facility shall notify the Bureau of the occurrence of a fire or disaster in the facility within 24 hours after the facility becomes aware of the fire or disaster.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004)

      NAC 449.102  Inventory and return of client’s belongings. (NRS 449.0302)  If a facility holds or stores a client’s belongings, there must be an inventory of the belongings on admission, made a part of the client’s record, and updated as needed. These belongings must be returned to the client upon his or her exit.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001)

      NAC 449.105  Insurance. (NRS 449.0302)  Liability insurance in a sufficient amount to protect clients, members of the staff, volunteers, and visitors, must be maintained. A certificate of insurance must be furnished to the Division. The certificate must include provision for 30 days notice to the Division of cancellation or the nonrenewal of the policies.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 3, eff. 3-27-76; A 3-30-77]

      NAC 449.108  General requirements for programs. (NRS 449.0302)

     1.  A residential program must be certified by the Division pursuant to NAC 458.108 and must comply with any applicable regulations adopted pursuant to paragraph (d) of subsection 1 of NRS 458.025.

     2.  At the time of admission into a residential program, there must be documentation indicating that the client has been informed of:

     (a) The general nature and goal of the program;

     (b) The rules governing client conduct and the infractions that can lead to disciplinary action or discharge from the program;

     (c) The treatment costs, if any, to be borne by the client;

     (d) The client’s rights and responsibilities; and

     (e) Confidentiality laws, rules and regulations.

     3.  The program must be periodically evaluated to ensure compliance with any applicable regulations adopted pursuant to paragraph (d) of subsection 1 of NRS 458.025.

     4.  The facility must provide access to medical, dental, psychological and rehabilitative services to meet the needs of all its clients, to the extent possible, with assistance from available community resources.

     5.  If a facility provides services through outside sources, written arrangements must be made ensuring that the services are supplied directly by, or under the supervision of, qualified persons.

     6.  The facility must provide case management services as needed by the client either directly or by written agreement with a qualified social worker, a registered nurse or a counselor certified or licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors.

     7.  A plan for case management services must be recorded in the client’s record and must be periodically evaluated in conjunction with the client’s treatment plan.

     8.  Each facility shall review the program at least annually. Areas reviewed must include, but need not be limited to, appropriateness of admissions, lengths of stay, discharge planning, use of services, and utilization of the components of the program and outside services. Written reports of the reviews must be evaluated by the governing body, administrator and such committees as they designate. Documentation of the evaluation process must be maintained at the facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 4, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004; R098-06, 7-14-2006)

      NAC 449.111  Administrator: Duties. (NRS 449.0302)

     1.  The administrator is responsible to the governing body for the operation of the facility in accordance with established policy.

     2.  The administrator shall:

     (a) Organize the administrative functions of the program, delegate duties and establish a formal means of accountability on the part of subordinates.

     (b) Ensure that a written manual defining program policies and procedures is prepared, regularly revised and updated. The manual must:

          (1) Contain all of the required written policies, procedures, definitions, lists and other documentation required by NAC 449.019 to 449.150, inclusive.

          (2) Be available to members of the staff at all times at designated and convenient locations.

     (c) Appoint a person of majority age to act for him or her during any absence.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 5, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R016-20, 11-2-2020)

      NAC 449.114  Employees: General requirements. (NRS 449.0302)

     1.  A facility must have on duty, all hours of each day, members of the staff sufficient in number and qualifications to carry out policies, responsibilities and program continuity.

     2.  Each member of the counseling staff must be:

     (a) A registered intern;

     (b) Certified or licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors; or

     (c) A licensed mental health professional who has experience with alcohol and drug counseling.

     3.  The administrator or his or her appointee must be present and responsible for the operations of the facility during normal hours.

     4.  A facility must have written policies and procedures for the recruitment, selection, promotion and termination of members of the staff.

     5.  The facility must have written policies and procedures covering wages and salaries, working hours, employee benefits, vacation and sick leave, rules of conduct, and training and the development of the staff.

     6.  The facility must provide an orientation session to new employees. Documentation of the sessions must be maintained in the employee’s personnel record.

     7.  There must be written policies and procedures governing disciplinary actions which clearly define the mechanism for suspension or dismissal of members of the staff as well as the procedures for appeal.

     8.  Written job descriptions must be maintained for all positions. A description must include:

     (a) The title of the job;

     (b) The tasks and responsibilities of the job;

     (c) The skills, education and experience necessary for the job;

     (d) The relationship of the job to other jobs within the program; and

     (e) The working conditions, location, shift, materials and equipment to be used on the job.

Ê The job description must accurately reflect the actual job situation and must be reviewed annually or whenever a change in the job or qualifications occurs. Job descriptions must be available on request to all members of the staff.

     9.  A personnel record must be maintained for each employee. The record must contain:

     (a) The employment application;

     (b) Letters of recommendation;

     (c) Reference investigation records;

     (d) Verification of training, experience and, if applicable, certification;

     (e) Documentation of attendance at the orientation session for new employees;

     (f) Job performance evaluations;

     (g) Incident reports; and

     (h) Disciplinary actions taken.

     10.  Personnel records must be maintained in a secure manner and must be available only to those persons authorized in written policies and procedures. An employee must have access to his or her own records upon request.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 6, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R098-06, 7-14-2006)

      NAC 449.117  Employees: Proof of compliance with provisions concerning tuberculosis. (NRS 449.0302)  All persons employed in a facility must have documentation showing that they are in compliance with any applicable provisions of chapter 441A of NAC concerning tuberculosis.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 12, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

Social Model Detoxification Programs

      NAC 449.121  Certain facilities authorized to offer program. (NRS 449.0302)  A social model detoxification program may be offered to clients in:

     1.  Residential programs that offer detoxification services;

     2.  A licensed facility for modified medical detoxification pursuant to NAC 449.15311 to 449.15367, inclusive; or

     3.  A medically managed intensive detoxification program.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001; A by R016-20, 11-2-2020)

      NAC 449.1214  General requirements. (NRS 449.0302)

     1.  A facility that offers a social model detoxification program:

     (a) Must have a physician, nurse practitioner, registered nurse or physician assistant conduct a physical assessment and a review of the general medical and drug history of a client within 24 hours after the client is admitted to the facility to ensure that a social model detoxification program is appropriate for the client.

     (b) Must not provide detoxification services for clients who exhibit life-threatening symptoms of withdrawal from alcohol and drugs.

     (c) Must develop and implement policies and procedures that protect the safety and health of clients. The facility must have these policies and procedures reviewed annually by a licensed physician who is familiar with the symptoms of withdrawal from alcohol and drugs.

     (d) Must ensure that the observation of a client during his or her treatment in the social model detoxification program is reflected in the records of the client as deemed necessary by the policies and procedures of that facility.

     2.  The staff of a facility that offers a social model detoxification program must complete at least 6 hours of additional education in the detoxification of persons with alcohol and other substance use disorders, as approved by the program of ongoing quality improvement pursuant to NAC 449.1218, every 2 years. Such education must include instruction in:

     (a) Acute withdrawal symptoms from alcohol and drugs; and

     (b) First-aid procedures for clients with seizures.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

      NAC 449.1218  Program of ongoing quality improvement. (NRS 449.0302)

     1.  A social model detoxification program must have a program of ongoing quality improvement designed to:

     (a) Monitor and evaluate, objectively and systematically, the quality and appropriateness of client care;

     (b) Pursue opportunities to improve client care; and

     (c) Resolve identified problems.

     2.  The program of ongoing quality improvement must:

     (a) Establish written policies and procedures to describe and document the monitoring and evaluation activities of the program of ongoing quality improvement.

     (b) Include the participation of a medical professional who is not required to be a member of the staff. For the purposes of this paragraph, “medical professional” means a licensed physician, nurse practitioner, physician assistant or registered nurse who is familiar with clients suffering from acute withdrawal symptoms from alcohol and drugs.

     (c) In addition to the participation of a medical professional pursuant to paragraph (b), include the participation of the administrator and two staff members of the social model detoxification program.

     (d) Approve the 6 hours of additional education required pursuant to NAC 449.1214 to ensure that the additional education is appropriate.

     3.  The findings of the program of ongoing quality improvement, including any conclusions, recommendations, actions taken and the results of the actions taken, must be documented. All documentation must be reported to the governing body and must be reflected in the minutes annually.

     (Added to NAC by Bd. of Health by R077-01, eff. 10-18-2001)

Operation of Facility

      NAC 449.123  General sanitary requirements. (NRS 449.0302)

     1.  Each facility must meet all state and local environmental health standards.

     2.  A facility which provides dietary services must have food service equipment of appropriate quality and type for the type of food service program used by the facility. The equipment must comply with all applicable provisions in chapter 446 of NAC.

     3.  All environmental health inspection reports must be on file in the facility. Any deficiencies must be corrected within 90 days and documented in the file.

     4.  Premises and equipment must be maintained in a sanitary condition:

     (a) The facility must have the necessary cleaning and maintenance equipment with sufficient storage areas and appropriate procedures to maintain a clean and orderly establishment.

     (b) Janitorial supplies, including aerosols, must be stored in areas separate from clean linen, food and other supplies.

     (c) The storage of dirty linen must be separate from the storage of clean linen, food and other supplies.

     5.  The facility shall establish a policy that prohibits clients from sharing items for personal use, such as combs, toothbrushes, towels or bar soap.

     6.  Restrooms or lavatories for the staff must be provided with soap dispensers and individual disposable towels.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 11, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.126  Laundry requirements. (NRS 449.0302)

     1.  A facility must maintain:

     (a) A laundry with equipment which is adequate for the sanitary washing and finishing of linen and other washable goods; or

     (b) A written agreement with a commercial establishment to provide laundry services for the facility.

     2.  The laundry must be situated in an area which is separate from any area where food is stored, prepared or served. The laundry must be well-lighted, ventilated, adequate in size to house the equipment and maintained in a sanitary manner. The equipment must be kept in good repair.

     3.  Soiled linen must be collected and transported to the laundry in washable or disposable covered containers in a sanitary manner.

     4.  Clean linen to be dried, ironed, folded, transferred or distributed must be handled in a sanitary manner, specified in writing.

     5.  Closets for storing linen and laundry supplies must be provided and must not be used for any other purpose.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 11, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.129  Design, construction, equipment and maintenance. (NRS 449.0302)

     1.  A facility must be designed, constructed, equipped and maintained in a manner that protects the health and safety of the clients and personnel of the facility and members of the general public.

     2.  Each facility must comply with all currently adopted life safety, fire, Division, local building and zoning codes. If there is a difference between state and local codes, the more stringent standards apply.

     3.  Facilities housing 17 or more clients must meet the requirements of the chapter entitled “New Hotels and Dormitories,” of the edition of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105. Those facilities housing not more than 16 clients must meet the requirements of the chapter entitled “Lodging or Rooming Houses,” of the edition of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105.

     4.  A facility is deemed to be in compliance with the provisions of this section if:

     (a) The facility is licensed by May 30, 2001, and:

          (1) The use of the physical space in the facility is not changed; and

          (2) There are no deficiencies in the construction of the facility that are likely to cause serious injury, harm or impairment to the health and welfare of the public; or

     (b) Before May 30, 2001, the facility has submitted building plans to the entity designated to review such plans by the Division pursuant to the provisions of NAC 449.0115 and:

          (1) The Division determines that the plans comply with standards for construction in effect before May 30, 2001;

          (2) Construction of the facility is begun before February 1, 2002;

          (3) The facility is constructed in accordance with those standards; and

          (4) There are no deficiencies in the construction of the facility that are likely to cause serious injury, harm or impairment to the health and welfare of the public.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001; R073-04, 8-4-2004; R098-06, 7-14-2006)

      NAC 449.132  Accommodations for clients. (NRS 449.0302)

     1.  No room or space in a facility may be occupied for sleeping, living or dining which is accessible only by a ladder, by folding stairs or through a trapdoor.

     2.  If a basement is used for living and dining, at least one exit must be provided directly to the outside at ground level. No facility may:

     (a) Be situated more than one story below the ground.

     (b) Use any basement or space in a basement for sleeping.

     3.  Each room of a facility used by clients for sleeping must:

     (a) Be furnished with a bed, clean linen and blankets; and

     (b) Not be less than 50 square feet per bed.

     4.  Toilet and bathing facilities must be provided to clients in a manner that ensures their privacy during use and in an adequate number to meet the needs of the clients.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001)

      NAC 449.135  Safety from fire. (NRS 449.0302)

     1.  Portable fire extinguishers must be installed throughout each facility at the direction of the fire authority having jurisdiction. Each portable fire extinguisher available at a facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.

     2.  Any facility with a kitchen range with an upper surface of more than 15 square feet must provide the range with an exhaust hood having an automatic fire protection system in accordance with the chapter titled “Standards for Ventilation Control and Fire Protection of Commercial Cooking Operations,” of the edition of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105.

     3.  A portable room-heating device may be used at a facility if the device:

     (a) Is located at least 2 feet from any combustible material;

     (b) Is plugged directly into a wall socket;

     (c) Turns off automatically if it is tipped over; and

     (d) Has no exposed heating elements.

     4.  Receptacles or outlets serviced by extension cords are prohibited.

     5.  Rooms in which smoking is allowed by direction of the facility or the fire authority must be provided with plainly visible “Smoking Area” signs.

     6.  A facility must conduct fire drills at least monthly and a written record of each drill conducted must be retained in the facility for not less than 12 months after the drill is conducted.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities part Art. 13, eff. 3-27-76]—(NAC A by R035-97, 10-30-97; R077-01, 10-18-2001; R073-04, 8-4-2004)

      NAC 449.141  Health services. (NRS 449.0302)

     1.  Facilities must provide access to health services which ensure that each client receives treatment, prescribed medication, adequate diets and other health services consistent with the program administered by the facility.

     2.  Facilities must implement policies and procedures designed to ensure the early detection of complications or conditions considered to be common among persons with substance use disorders. These policies and procedures must be developed in conjunction with and approved by a licensed physician.

     3.  Before a client’s admission to a program or facility, a general medical and drug history must be taken by a designated member of the staff who is certified or licensed by the Board of Examiners for Alcohol, Drug and Gambling Counselors or who is a licensed mental health professional who has experience with alcohol and drug counseling. Current medical information must be provided on a form that has been approved by a physician. The history must include, but is not limited to:

     (a) Drugs used in the past;

     (b) Drugs used recently;

     (c) Drugs of preference;

     (d) Frequently used drugs;

     (e) Drugs used in combination;

     (f) Dosages used;

     (g) Date of first usage;

     (h) Incidents of overdose, withdrawal or adverse drug reactions; and

     (i) Previous history of treatment.

     4.  A program may accept medical history and physical examination results from referral sources which were conducted not more than 30 days before admission in lieu of personally taking a general medical and drug history as required pursuant to subsection 3.

     5.  Each facility must be able to provide directly, or through written arrangements, laboratory tests as requested by a physician or federal regulations.

     6.  Facilities must implement written policies and procedures that are reviewed by a licensed physician defining the appropriate action to be taken when a medical emergency arises.

     7.  There must be one staff person in the facility who is capable of providing cardiopulmonary resuscitation at all times. Staff members providing cardiopulmonary resuscitation must be qualified by the American Red Cross or another recognized agency.

     8.  Clients of residential programs must undergo a tuberculin skin test that meets the requirements specified in chapter 441A of NAC.

     9.  Each facility shall maintain and have readily available first-aid supplies. Staff members shall have evidence that they have received training on the use of first-aid supplies.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 7, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001; R098-06, 7-14-2006)

      NAC 449.144  Medication. (NRS 449.0302)

     1.  In programs that permit the self-administration of medication, there must be written policies and procedures governing this activity. The policies must require that:

     (a) The decisions to permit self-administration be based on individual needs.

     (b) The reasons for the permission be clearly documented in the client’s case record.

     (c) All medications that are to be self-administered be packaged in a manner complying with the Poison Prevention Packaging Act of 1970, 15 U.S.C. §§ 1471 et seq., and all current regulations stemming from that act.

     (d) The self-administration of prescription medication be observed by a staff member who has been oriented to the program’s policies and procedures on self-administration of prescription medication.

     (e) The self-administration of prescription medication be permitted only when the medication is clearly labeled.

     (f) There be documentation in the client’s record of the name of the medication, dose, route of administration, time and name of the person observing the self-administration or the licensed staff member who administered the medication.

     (g) Clients who receive medication for self-administration be given instructions concerning the safe storage and usage of the drugs and the appropriate emergency procedures to be followed if adverse reactions occur.

     2.  Any unusual reaction to a medication by a client must be documented in the client’s record and reported to the appropriate physician as outlined in the policies of the facility.

     3.  Facilities must provide a locked storage area for prescription medication that is to be self-administered by clients. Such medication must be made available to clients at appropriate times and may be dispensed only from a licensed pharmacy in accordance with all applicable provisions of NRS and NAC.

     4.  Members of the staff may not administer any medication unless licensed to do so.

     5.  All medication must be maintained in locked storage. Controlled substances must be maintained in a locked box within the locked storage. Medications requiring refrigeration must be kept in a locked box inside the refrigerator separated from food and other items. Disinfectants and medication for external use must be stored separately from medications for internal use and from medications that can be injected. All potent, poisonous or caustic drugs must be plainly labeled, stored and made accessible only to authorized persons. All medication storage must be maintained in accordance with the security requirements of federal, state and local laws.

     6.  Narcotic treatment facilities may issue methadone “takeouts” to a client in a facility without listing the strength of the drug if the label shows:

     (a) The client’s name or other identifying code; and

     (b) The 24-hour emergency telephone number for the narcotic treatment facility.

     7.  Medication prescribed for a client must not be allowed to be in the possession of another client.

     8.  Any unused prescription medication left behind at a facility by a client must be destroyed by the administrator or his or her designee in the presence of a witness, and a notation indicating that the medication was destroyed must be made on the client’s record. At the time a client is discharged or leaves the facility, medications that are currently being self-administered must be sent, in the original container, with the client or a responsible agent of the client.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 9, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

      NAC 449.147  Dietary services. (NRS 449.0302)

     1.  Facilities must serve at least three meals or their equivalent daily, at regular times, with not more than 14 hours between a substantial evening meal and breakfast. A second serving must be provided for those clients who desire one.

     2.  Menus must be planned and followed to meet the nutritional needs of the clients in accordance with the recommended dietary allowances of the Food and Nutrition Board of the Institute of Medicine of the National Academies.

     3.  Therapeutic menus must be planned by a licensed dietitian or must be reviewed and approved by the client’s attending or staff physician.

     4.  Menus must be in writing, planned in advance, dated and posted, and kept on file for 90 days. Any substitution must be noted on the written menus so that the menu on file reflects what was actually served.

     5.  Adequate facilities and equipment for the preparation, serving, refrigeration and storage of food in a sanitary manner must be provided.

     6.  A facility with more than 10 clients must:

     (a) Comply with all applicable provisions of chapter 446 of NRS and the regulations adopted pursuant thereto;

     (b) Obtain the necessary permits from the Division;

     (c) Maintain a report of each inspection concerning the sanitation of the facility for at least 1 year after the date of the inspection; and

     (d) Maintain a report of each corrective action taken to address a deficiency noted in a report described in paragraph (c) for at least 1 year after the date of the corrective action.

     7.  Clients needing special equipment, implements or utensils to assist them while eating must have such items provided.

     8.  If a facility operates on the cottage plan, provision must be made for food service that assures hot, palatable meals.

     9.  A licensed dietitian must be used as a consultant on planning meals and serving food. Consultation each month is required.

     10.  All facilities that contract with food management companies must comply with the applicable regulations of the Division as provided in chapter 446 of NAC.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 8, eff. 3-27-76; A 3-30-77]—(NAC A by R077-01, 10-18-2001; R073-04, 8-4-2004; R155-10, 12-16-2010; R090-12, 12-20-2012)

      NAC 449.150  Records of clients. (NRS 449.0302)

     1.  Each facility must maintain an organized system for clients’ records.

     2.  Clients’ records must be available to members of the staff who have authority to review such records.

     3.  Clients’ records must be available to representatives of the Division.

     4.  Clients’ records must contain:

     (a) Identification information;

     (b) Past medical and social history;

     (c) Copies of initial and periodic examinations;

     (d) Evaluations and progress notes; and

     (e) A review and any revisions of each plan of treatment.

     5.  There must be an overall plan of treatment stated in quantifiable terms which outlines goals to be accomplished through individually designed activities, therapies and treatments.

     6.  The plan of treatment must state what service or person is responsible for treatment or services to the client.

     7.  Entries must be made describing treatments and services rendered, medications administered, including those that are self-administered, and any symptoms or other indications of illness or injury, including the date, time and action taken regarding each incident.

     8.  Records must be adequately safeguarded against destruction, loss or unauthorized use.

     9.  Records must be retained for at least 5 years following a client’s discharge.

     10.  A discharge plan, as determined by a case management services assessment of the client, must be documented for each client discharged from the facility. The discharge plan must be formulated upon a client’s admission to the facility.

     [Bd. of Health, Alcohol and Drug Abuse Treatment Facilities Art. 10, eff. 3-27-76]—(NAC A by R077-01, 10-18-2001)

FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION

      NAC 449.15311  Definitions. (NRS 449.0302)  As used in NAC 449.15311 to 449.15367, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.15313 to 449.15321, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R016-20, 11-2-2020)

      NAC 449.15313  “Administrator” defined. (NRS 449.0302)  “Administrator” means the person who is appointed by the governing body of a facility who has primary responsibility for the overall operations of the program of the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15315  “Client” defined. (NRS 449.0302)  “Client” means a resident or patient of a facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15317  “Facility” defined. (NRS 449.0302)  “Facility” means a facility for modified medical detoxification as defined in NRS 449.00385.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15319  “Overall program” defined. (NRS 449.0302)  “Overall program” means tasks that are commonly undertaken by a board of directors, including, without limitation, general fiscal management, fund-raising projects and establishing the general long-term goals of a facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15321  “Program” defined. (NRS 449.0302)  “Program” means the program established pursuant to NAC 449.15337.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15323  Proof of certification required; revocation of license. (NRS 449.0302)

     1.  As a condition of the issuance of a license to a facility, the facility shall provide proof that it is certified by the Division.

     2.  If the Division revokes or does not renew the certification of a facility, the Division shall revoke the license of the facility subject to the appeals procedure set forth in NAC 439.300 to 439.395, inclusive.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15325  Governing body; bylaws and policies. (NRS 449.0302)

     1.  Each facility shall have a governing body that has the ultimate authority for the administration of the overall program of the facility.

     2.  The governing body shall adopt written bylaws and policies that define the powers and duties of the governing body, its committees, the administrator and any advisory group.

     3.  The bylaws and policies must:

     (a) Identify the overall goals of the facility;

     (b) Include, without limitation, an organizational chart of the facility;

     (c) Define the major lines of authority and areas of responsibility within the program of treatment provided by the facility;

     (d) Define the membership of the governing body, the types of membership, the method of selection or appointment of members, offices or committees and their terms of office; and

     (e) Define the frequency of meetings of the governing body and attendance requirements.

     4.  The governing body shall:

     (a) Appoint a qualified administrator of the facility with authority and responsibilities appropriate to the requirements of the program;

     (b) Establish policies governing the responsibilities, authority and duties of the administrator that are designed to enable the administrator to perform the administrative and treatment functions of the facility;

     (c) Appoint a medical director of the facility who is responsible for the medical services provided at the facility;

     (d) Determine, in accordance with state law, which categories of practitioners are eligible to be appointed to the medical staff of the facility;

     (e) Appoint members to the medical staff of the facility who are accountable to the governing body for the quality of medical care provided to clients of the facility, taking into consideration any recommendations of the existing members of the medical staff;

     (f) Review and revise the bylaws and policies of the governing body;

     (g) Adopt controls designed to achieve and maintain maximum standards of service; and

     (h) Review and approve an annual budget to carry out the objectives of the program.

     5.  The governing body shall retain the ultimate responsibility for the overall program and its objectives.

     6.  The governing body shall meet at least semiannually. Minutes must be kept of the meetings, including, without limitation, the date of each meeting, those in attendance, topics discussed, decisions made and actions taken, and all program reports.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15327  Policies and procedures for services and operation of facility. (NRS 449.0302)

     1.  Each facility shall have written policies and procedures available to members of the staff, clients and the public that govern the operation of the facility and services provided by the facility.

     2.  The policies must:

     (a) Ensure that only those persons are accepted as clients whose needs can be met by the facility directly or in cooperation with community resources or other providers of treatment with which it is affiliated or has contacts.

     (b) Ensure that a client whose physical or mental condition has changed to such an extent that the client can no longer be adequately served by the facility will be transferred promptly to an appropriate facility. Written transfer agreements or other written provisions with such other facilities must be maintained by the facility.

     (c) Set forth the rights of clients and members of the staff and provide for the registration and disposition of complaints without threat of discharge or reprisal against any employee or client.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15329  Transfer of client. (NRS 449.0302)

     1.  Except in the case of an emergency, the transfer of a client must not be effected until the client, attending physician of the client, if any, and responsible agency are consulted in advance.

     2.  Except as otherwise provided in subsection 3, if a client is transferred to a hospital or other medical facility, a summary of discharge containing a plan for continuation of care must be prepared and forwarded to the receiving facility if the client or his or her guardian consents to release such information to the receiving facility.

     3.  If a client is transferred to a hospital or other medical facility as a result of a medical emergency, information required for appropriate continuation of care must be released to the receiving facility in compliance with the standards set forth in 42 C.F.R. Part 2.

     4.  The admission agreement must not allow the licensee or his or her designee to be given power of attorney.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15331  Handling of money of client. (NRS 449.0302)

     1.  If a facility handles the money of a client, a written ledger account of all deposits, disbursements or other transactions must be maintained. A record must be made available to the client at least quarterly.

     2.  The money of a client must be given to the client within 24 hours after his or her exit from the facility.

     3.  Large sums of money must be maintained in a financial institution in the community where the facility is located in a separate trustee account apart from the operational accounts of the facility and must be clearly designated.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15333  Inventory of belongings of client. (NRS 449.0302)  If a facility holds or stores the belongings of a client, there must be an inventory of the belongings on admission, made a part of the record of the client and updated as needed. These belongings must be returned to the client upon his or her exit.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15335  Liability insurance. (NRS 449.0302)  Liability insurance in a sufficient amount to protect clients, members of the staff, volunteers and visitors, must be maintained by each facility. A certificate of insurance must be furnished to the Division. The certificate must include, without limitation, provision for 30 days’ notice to the Division of cancellation or the nonrenewal of a policy of insurance.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15337  Program: Requirements; review. (NRS 449.0302)

     1.  Each facility shall have a written program outlining short-term and long-term objectives and goals. These goals must be realistic, attainable, and clearly and operationally defined.

     2.  Each component of the program must develop objectives that complement the goals of the program.

     3.  The Division shall:

     (a) Periodically evaluate the program;

     (b) Prepare a report of the evaluation; and

     (c) Distribute the report to the persons who manage the program and make the report available to the members of the staff of the facility and the Bureau of Licensure and Certification of the Division.

     4.  The facility shall provide for the medical, dental and psychological services needed to fulfill the goals of the program and meet the needs of all its clients to the extent that is possible, with assistance from available community resources.

     5.  If a facility provides services through outside sources, formal, written arrangements must be made ensuring that the services are supplied directly by, or under the supervision of, qualified persons.

     6.  Each facility shall provide case management services as needed by a client through a social worker or a registered nurse or by written agreement with a social worker or a registered nurse.

     7.  A plan for case management must be recorded in the records of a client and must be periodically evaluated in conjunction with the treatment plan of the client.

     8.  Each facility shall review its general program at least annually. Areas reviewed must include, without limitation, appropriateness of admissions, lengths of stay, discharge planning, use of services and utilization of the components of the program and outside services. Written reports of the reviews must be evaluated by the governing body, administrator and such committees as they designate. Documentation of the evaluation process must be maintained at the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15339  Responsibilities and duties of administrator. (NRS 449.0302)

     1.  The administrator of a facility is responsible to the governing body of the facility for the operation of the facility in accordance with the policies and procedures of the facility.

     2.  The administrator shall:

     (a) Organize the administrative functions of the program, delegate duties and establish a formal means of accountability on the part of subordinates.

     (b) Ensure that a written manual defining the policies and procedures of the program is prepared, regularly revised and updated. The manual must:

          (1) Contain all policies and procedures of the facility, including, without limitation, definitions and other documentation required by NAC 449.15311 to 449.15367, inclusive; and

          (2) Be available to members of the staff of the facility at all times at designated and convenient locations.

     (c) Appoint a person who has attained the age of majority to act for him or her during any extended absence.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R016-20, 11-2-2020)

      NAC 449.15341  Policies and procedures concerning employees. (NRS 449.0302)

     1.  Each facility shall have on duty, all hours of each day, members of the staff sufficient in number and qualifications to carry out policies, responsibilities and program continuity.

     2.  All members of the counseling staff of a facility shall be authorized by state law to provide counseling for alcohol and other substance use disorders.

     3.  The administrator or his or her appointee shall be present and responsible for the operations of the facility during normal hours.

     4.  Each facility shall have written policies and procedures for the recruitment, selection, promotion and termination of members of the staff.

     5.  Each facility shall have written policies and procedures concerning wages and salaries, working hours, employee benefits, vacation and sick leave, rules of conduct, and training and development of the staff.

     6.  Each facility shall provide an orientation session to new employees. Documentation of the session must be maintained in the personnel file of the employee.

     7.  Each facility shall have written policies and procedures governing disciplinary actions that clearly define the mechanism for the suspension or dismissal of members of the staff as well as the procedures for appeal.

     8.  Each facility shall maintain a written job description for each position at the facility. The job description must accurately reflect the actual job situation and must be reviewed annually or whenever a change in the responsibilities of the job or qualifications occurs. Job descriptions must be available on request to all members of the staff. A job description must include, without limitation:

     (a) The title of the job;

     (b) The tasks and responsibilities of the job;

     (c) The skills, education and experience necessary for the job;

     (d) The relationship of the job to other jobs within the program; and

     (e) The working conditions, location and shift of the job, and the materials and equipment to be used on the job.

     9.  Each facility shall maintain a personnel record for each employee of the facility. The record must include, without limitation:

     (a) The employment application;

     (b) Letters of recommendation;

     (c) Records from any investigation of the employee;

     (d) Verification of training, experience and certification;

     (e) Job performance evaluations;

     (f) Incident reports; and

     (g) Disciplinary actions taken.

     10.  Each facility shall maintain personnel records in a secure manner and make them available only to those persons authorized to receive personnel records in the written policies and procedures of the facility. An employee must have access to his or her own file upon request.

     11.  Each person employed in a facility shall have a preemployment physical examination or certification of a 3-year health record from a physician, and be tested for tuberculosis as required in chapter 441A of NAC.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15343  Nursing services. (NRS 449.0302)

     1.  Each facility shall have an organized plan for nursing service that provides nursing services 24 hours per day. The nursing services must be provided or supervised by a registered nurse in compliance with state law, including, without limitation, chapter 632 of NRS and chapter 632 of NAC.

     2.  The nursing service shall have a sufficient number of registered nurses, licensed practical nurses and other personnel to provide nursing care to all clients as needed.

     3.  The facility shall ensure that the nursing staff develops and keeps current a plan for nursing care for each client.

     4.  The administrator shall appoint a chief administrative nurse to direct the nursing service. The chief administrative nurse must:

     (a) Be a registered nurse;

     (b) Be knowledgeable, skilled and competent in clinical practice and the management of nurses;

     (c) Be authorized by state law to provide counseling for alcohol and other substance use disorders; and

     (d) Comply with the provisions of chapter 632 of NRS and chapter 632 of NAC and follow professional standards established for organized nursing services.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15345  Health services. (NRS 449.0302)

     1.  Each facility shall provide health services which ensure that each client receives treatment, prescribed medication, adequate diets and other health services consistent with the program administered by the facility.

     2.  There must be policies and procedures designed to ensure the early detection of complications or conditions considered to be common among persons with alcohol or other substance use disorders. The policies and procedures must be developed with assistance from and approved by the medical director of the facility.

     3.  Before a client is admitted to a facility, a general medical and drug history of the client must be taken by a physician or designated member of the nursing staff of the facility. The history must include, without limitation:

     (a) Drugs used in the past;

     (b) Drugs used recently;

     (c) Drugs of preference;

     (d) Frequently used drugs;

     (e) Drugs used in combination;

     (f) Dosages used;

     (g) Date of first usage;

     (h) Incidents of overdose, withdrawal or adverse drugs reactions; and

     (i) Previous history of treatment.

     4.  Except as otherwise provided in this subsection, a physical examination and review of the medical and drug history of a client must be conducted by a physician, registered nurse or physician assistant within 48 hours after the client is admitted to a facility. If the assessment performed by a physician or a member of the nursing staff before a client is admitted to the facility concludes that a physical examination of the client should be completed within less than 48 hours after the client is admitted to the facility to ensure that the needs of the client are met, the physical examination must be conducted within the time recommended in the assessment.

     5.  Each facility must be able to provide directly, or through written arrangements, laboratory tests as requested by a physician or federal regulations.

     6.  Referral to an outside health resource must be made only if the resource is able to accept the client. Any records that accompany the client must be either expurgated of any sensitive material or be available only to persons authorized to receive the information under the direction of the physician or administrator. Except where an emergency that threatens a life exists and except as otherwise provided in NAC 449.15329, no information may be released without the prior consent of the client or his or her guardian.

     7.  Each facility shall have written policies and procedures defining the appropriate action to be taken when a medical emergency arises. The policies and procedures must be reviewed and approved by the medical director of the facility.

     8.  Each member of the staff of a facility must be qualified by the American Red Cross or another similar nationally recognized agency to administer cardiopulmonary resuscitation.

     9.  Each client of a facility shall, within 5 days after admission, undergo a Mantoux tuberculin skin test. If the client has no documented history of a two-step Mantoux tuberculin skin test and has not had a single Mantoux tuberculin skin test within the 12 months preceding admission to the facility, the client shall undergo a two-step Mantoux tuberculin skin test.

     10.  First-aid supplies must be maintained and readily available at each facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15347  Pharmaceutical services. (NRS 449.0302)

     1.  Each facility shall have a pharmacy directed by a registered pharmacist or a drug room supervised by no less than a currently licensed professional nurse. The pharmacy or drug room must be administered in accordance with all applicable state and federal laws. The facility shall have a full-time, part-time or consulting pharmacist who is responsible for developing, supervising and coordinating all of the activities of the pharmacy service.

     2.  Each facility shall have and implement policies and procedures that minimize errors in the administration of drugs. The medical director of the facility and the pharmacist who is responsible for the pharmacy service shall approve the policies and procedures.

     3.  Drugs and biologicals must be controlled and distributed in accordance with applicable standards of practice and state and federal laws.

     4.  When a pharmacist is not available at the facility, drugs and biologicals may be removed from the pharmacy or drug area only by a member of the staff who is authorized to remove such substances by the policies and procedures of the facility, which must be established in accordance with state and federal laws.

     5.  Errors in administering a drug, adverse reactions by a client to a drug and incompatibilities between a drug and a client must be immediately reported to the attending physician of the client.

     6.  Misuses and losses of controlled substances must be reported to the pharmacist who is responsible for the pharmacy service, the administrator and the chief administrative nurse of the facility, in accordance with all applicable state and federal laws.

     7.  Information relating to drug interactions and information on drug therapy, side effects, toxicology, dosage indications for use and routes of administration must be available to the professional members of the staff of the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15349  Medication and biologicals. (NRS 449.0302)

     1.  Except as otherwise provided in subsection 2, an order for medication or biologicals for a client must be in writing and signed by the practitioner, or other appropriate professional person authorized by state or federal law to order the medication or biological, who is responsible for the care of the patient.

     2.  When a telephone or verbal order is used to order medications or biologicals, the order must be:

     (a) Accepted only by a person who is authorized by the policies and procedures of the facility, which must be consistent with state law, to accept such an order; and

     (b) Signed or initialed by the prescribing practitioner in accordance with the policies and procedures of the facility.

     3.  Each order for a medication or biological must include, without limitation, the name of the medication or biological, and the dosage, time or frequency of administration and route of administration of the medication or biological.

     4.  Only a member of the staff of the facility who is authorized by state law to administer medication or biologicals may administer medication or biologicals at the facility.

     5.  Each facility shall have a system to monitor and improve the process of administering medication and biologicals.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15351  Dietary services. (NRS 449.0302)

     1.  Facilities shall serve at least three meals or their equivalent daily, at regular times, with not more than 14 hours between a substantial evening meal and breakfast. A second serving must be provided for those clients who desire one.

     2.  Menus must be planned and followed to meet the nutritional needs of the clients in accordance with the recommended dietary allowances recommended by the Food and Nutrition Board of the Institute of Medicine of the National Academies.

     3.  Therapeutic menus must be planned by a licensed dietitian or must be reviewed and approved by the attending physician of the client or a staff physician.

     4.  Menus must be in writing, planned in advance, dated and posted, and kept on file at the facility for at least 90 days. Any substitution must be noted on the written menu so that the menu on file reflects what was actually served.

     5.  Adequate facilities and equipment for the preparation, serving, refrigeration and storage of food in a sanitary manner must be provided.

     6.  A facility with more than 10 clients shall:

     (a) Comply with all applicable provisions of chapter 446 of NRS and the regulations adopted pursuant thereto;

     (b) Obtain the necessary permits from the Division;

     (c) Maintain a report of each inspection concerning the sanitation of the facility for at least 1 year after the date of the inspection; and

     (d) Maintain a report of each corrective action taken to address a deficiency noted in a report described in paragraph (c) for at least 1 year after the date of the corrective action.

     7.  Clients needing special equipment, implements or utensils to assist them while eating must have such items provided.

     8.  If a facility operates on the cottage plan, provision must be made for food service that ensures hot, palatable meals.

     9.  A licensed dietitian must be used as a consultant on planning meals and serving food. At least 4 hours of consultation each month is required.

     10.  A facility that contracts with a food management company shall comply with all applicable regulations of the State Board of Health.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004; R155-10, 12-16-2010; R090-12, 12-20-2012)

      NAC 449.15353  Records of clients. (NRS 449.0302)

     1.  Each facility shall maintain an organized system for the records of clients.

     2.  The records of a client must be available to professional members of the staff of the facility who are directly involved with the client.

     3.  The records of clients must be available to representatives of the Division.

     4.  The records of clients must include, without limitation:

     (a) Identification information;

     (b) Past medical and social history;

     (c) Copies of initial and periodic examinations;

     (d) Evaluations and progress notes; and

     (e) Assessments and goals of the plan of treatment of each client.

     5.  The plan of treatment must state what service or person is responsible for providing treatment or services to the client.

     6.  Entries must be made describing treatments and services rendered, medications administered, and any symptoms or other indications of illness or injury, including, without limitation, the date, time and action taken regarding each incident.

     7.  Records must be adequately safeguarded against destruction, loss or unauthorized use.

     8.  Records must be retained for at least 5 years after the discharge of a client from a facility.

     9.  A discharge plan, as determined by a case management assessment of the client, must be documented for each client discharged from the facility.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15355  Safety and sanitation; temperature. (NRS 449.0302)

     1.  The premises and equipment of each facility must be maintained in a safe, functional and sanitary condition. Each facility shall have the necessary cleaning and maintenance equipment with sufficient storage areas and appropriate procedures to maintain a clean and orderly establishment. Janitorial supplies, including, without limitation, aerosols, must be stored in areas separate from clean linen, food and other supplies. The storage of dirty linen must be separate from the storage of clean linen, food and other supplies.

     2.  Items for personal use, including, without limitation, combs, toothbrushes, towels and bar soap, must not be shared by clients.

     3.  Restrooms or lavatories for the staff of a facility must be provided with soap dispensers and individual, disposable towels.

     4.  Each facility shall ensure that the environment of the facility is free of hazards that may cause accidents.

     5.  Each facility shall maintain an effective program to control pests and rodents in order to ensure that the facility is free from pests and rodents.

     6.  Each facility shall provide safe and comfortable levels of temperature in the facility. The temperature of the facility must be maintained at a level that is not less than 71 degrees Fahrenheit and not more than 81 degrees Fahrenheit.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15357  Laundry requirements. (NRS 449.0302)

     1.  Each facility shall have the proper equipment for the sanitary washing and finishing of linen and other washable goods or shall maintain a written agreement with a commercial establishment to provide laundry services.

     2.  The laundry area of a facility must be situated in an area of the facility that is separate and apart from any room where food is stored, prepared or served. The laundry area must be well-lighted, ventilated, adequate in size to house equipment, maintained in a sanitary manner and kept in good repair.

     3.  Soiled linen must be collected and transported to the laundry in washable or disposable containers in a sanitary manner. Soiled linen must not be transported through areas of the facility used for preparing or serving food.

     4.  Clean linen to be dried, ironed, folded, transferred or distributed must be handled in a sanitary manner in accordance with a written plan maintained by the facility.

     5.  Closets for storing linen and laundry supplies must be provided and must not be used for any other purpose.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15359  New construction or remodeling: Submission and approval of building plans; prerequisites to approval of facility for licensure. (NRS 449.0302)

     1.  Except as otherwise provided in subsection 4, before any new construction of a facility or any remodeling of an existing facility is begun:

     (a) The facility must submit a copy of the building plans for the new construction or remodeling to the entity designated to review such plans by the Division pursuant to the provisions of NAC 449.0115. The entity’s review of those plans is advisory only and does not constitute approval for licensure of the facility.

     (b) The building plans must be approved by the Division.

     2.  The Bureau shall not approve a facility for licensure until all construction is completed and a survey is conducted at the site of the facility.

     3.  The Division shall not issue a license to operate a facility until the Bureau has approved the construction of the facility.

     4.  The provisions of subsection 1 do not apply to plans for remodeling a facility if the remodeling is limited to refurbishing an area within the facility, including, without limitation, painting in the area, replacing flooring in the area, repairing windows in the area or replacing window and wall coverings in the area.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R076-01, 10-18-2001; R069-04, 8-4-2004)

      NAC 449.15361  Design, construction, equipment and maintenance. (NRS 449.0302)

     1.  Each facility must be designed, constructed, equipped and maintained in a manner that protects the health and safety of the clients and personnel of the facility and members of the general public.

     2.  Each facility shall comply with all applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without limitation, zoning ordinances; and

     (c) Environmental, life safety, fire, health and local building codes,

Ê related to the construction and maintenance of the facility. If there is a difference between state and local requirements, the more stringent requirements apply.

     3.  Each facility shall comply with the provisions of NFPA 101: Life Safety Code, as adopted by reference pursuant to NAC 449.0105. Facilities housing 17 or more clients shall meet the requirements of the chapter entitled “Hotel and Dormitories,” of the edition of NFPA 101: Life Safety Code adopted by reference pursuant to NAC 449.0105. Those facilities housing not more than 16 clients shall meet the requirements of the chapter entitled “Lodging or Rooming Houses,” of the edition of NFPA 101: Life Safety Code adopted by reference pursuant to NAC 449.0105.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15363  Accommodations for clients. (NRS 449.0302)

     1.  No room or space of a facility may be occupied for sleeping, living or dining that is accessible only by a ladder, by folding stairs or through a trapdoor.

     2.  If a basement of a facility is used for living and dining, at least one exit must be provided directly to the outside at ground level. No facility may:

     (a) Be situated more than one story below the ground; and

     (b) Use any basement or space in a basement for sleeping.

     3.  Each room of a facility used by clients for sleeping must:

     (a) Be provided and furnished with a bed, clean linen and blankets;

     (b) Not be less than 60 square feet per bed; and

     (c) Not be used for sleeping by more than four clients.

     4.  Toilet facilities and bathing facilities must be provided to clients in a manner that ensures their privacy while bathing and in an adequate number to meet the needs of the clients.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000)

      NAC 449.15365  Safety from fire. (NRS 449.0302)

     1.  Devices for the detection of combustion other than heat detectors must be installed on the ceiling of each story of a facility, in front of doors to stairways in a facility, and at not more than 30 feet apart in the corridors of all floors of a facility, including, without limitation, the center. Smoke detectors must also be installed in the center of any lounge or recreational area of a facility. The smoke detectors may be single station units with an integral alarm.

     2.  Portable fire extinguishers must be installed throughout each facility at the direction of the fire authority having jurisdiction. Each portable fire extinguisher available at a facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.

     3.  A portable room-heating device may be used if the device:

     (a) Is located 2 feet or more from any combustible material;

     (b) Is plugged directly into a wall socket;

     (c) Turns off automatically if tipped over; and

     (d) Has no exposed heating elements.

     4.  Receptacles or outlets serviced by extension cords are prohibited in facilities.

     5.  Rooms in which smoking is allowed by direction of the facility or the fire authority must be provided with plainly visible “Smoking Area” signs.

     6.  Each facility shall conduct fire drills at least monthly, and a written record of each drill conducted must be retained in the facility for not less than 12 months after the drill is conducted.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)

      NAC 449.15367  Preparations for disasters; reporting of fire or disaster. (NRS 449.0302)

     1.  Each facility shall develop a written plan for disasters that outlines procedures for members of the staff and clients to follow in case of fire or another emergency and provides for meeting the needs of clients if the facility must be evacuated or is destroyed.

     2.  A simple floor plan showing the routes for evacuating must be posted in prominent locations on each floor of the facility.

     3.  The facility shall notify the Bureau of the occurrence of a fire or disaster in the facility within 24 hours after the facility becomes aware of the fire or disaster.

     4.  Each facility shall conduct a disaster drill at least annually and retain a written record of the drill in the facility for not less than 12 months after the drill is conducted.

     5.  Each facility shall adopt procedures to ensure that water is available to the essential areas of the facility if there is an interruption in the facility’s normal supply of water.

     (Added to NAC by Bd. of Health by R129-99, 11-29-99, eff. 1-1-2000; A by R069-04, 8-4-2004)

FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS

General Provisions

      NAC 449.154  Definitions. (NRS 449.0302, 449.0303)  As used in NAC 449.154 to 449.15485, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.15415 to 449.15438, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

      NAC 449.15415  “DEA” defined. (NRS 449.0302, 449.0303)  “DEA” means the Drug Enforcement Administration of the United States Department of Justice.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.1542  “Facility for treatment with narcotics” defined. (NRS 449.0302, 449.0303)  “Facility for treatment with narcotics” means any person or any public or private facility that provides a narcotic treatment program described in 42 C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

      NAC 449.1543  “Medical director” defined. (NRS 449.0302, 449.0303)  “Medical director” means a physician who is licensed to practice medicine in this State and who is responsible for the administration of all medical services at a facility for treatment with narcotics or a medication unit and for ensuring that the facility or the medication unit complies with all applicable federal, state and local laws and regulations.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.15435  “Medication unit” defined. (NRS 449.0302, 449.0303)  “Medication unit” means any person or any public or private facility that:

     1.  Is established as part of or operates in conjunction with a facility for treatment with narcotics but is separated geographically from the facility for treatment with narcotics; and

     2.  Is limited to:

     (a) Administering or dispensing narcotics; and

     (b) Collecting specimens in accordance with chapter 652 of NRS for drug testing or analysis relating to treatment with narcotics.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98)

      NAC 449.15438  “SAMHSA” defined. (NRS 449.0302, 449.0303)  “SAMHSA” means the Substance Abuse and Mental Health Services Administration of the United States Department of Health and Human Services.

     (Added to NAC by Bd. of Health by R053-02, eff. 7-24-2002)

      NAC 449.1544  Division is state authority for certain federal regulations. (NRS 449.0302, 449.0303)  The Division is the state authority for the purposes of 42 C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

Licensing

      NAC 449.15445  License and federal certification required to operate facility or unit. (NRS 449.0302, 449.0303)

     1.  A person or a public or private facility shall not operate or provide the services of a facility for treatment with narcotics or represent that it operates or provides the services of a facility for treatment with narcotics, unless the person or the public or private facility is:

     (a) Licensed by the Division pursuant to NAC 449.154 to 449.15485, inclusive, to operate the facility for treatment with narcotics; and

     (b) Certified by the SAMHSA pursuant to 42 C.F.R. Part 8 to operate the facility for treatment with narcotics.

     2.  A person or a public or private facility shall not operate or provide the services of a medication unit or represent that it operates or provides the services of a medication unit, unless the person or the public or private facility is:

     (a) Licensed by the Division pursuant to NAC 449.154 to 449.15485, inclusive, to operate the medication unit and the facility for treatment with narcotics that is associated with the medication unit; and

     (b) Certified by the SAMHSA pursuant to 42 C.F.R. Part 8 to operate the medication unit and the facility for treatment with narcotics that is associated with the medication unit.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

      NAC 449.1545  Filing requirements; recommendation for certification. (NRS 449.0302, 449.0303)

     1.  If a person or a public or private facility wants to operate a facility for treatment with narcotics or a medication unit, the person or the public or private facility must:

     (a) File with the SAMHSA an application for certification pursuant to 42 C.F.R. Part 8;

     (b) File with the Bureau an application for a license pursuant to NAC 449.011 and include with the application:

          (1) If there is an accreditation body that has been approved pursuant to 42 C.F.R. § 8.3, proof that the applicant has applied for accreditation from such accreditation body; and

          (2) Any other information requested by the Bureau; and

     (c) Demonstrate that the proposed facility for treatment with narcotics or the proposed medication unit is able to comply with the requirements set forth in NAC 449.1548.

     2.  A person or a public or private facility must file an application for a license for each facility for treatment with narcotics that it wants to operate, whether or not the person or the public or private facility is already licensed to operate one or more other facilities for treatment with narcotics.

     3.  A person or a public or private facility must file an application for a license for each medication unit that it wants to operate, whether or not the person or the public or private facility is already licensed to operate one or more other medication units.

     4.  The Division may make a recommendation to the SAMHSA that an applicant for certification of a facility for treatment with narcotics or a medication unit be certified, if the applicant has:

     (a) Satisfied all the requirements for licensure by the Division pursuant to NAC 449.154 to 449.15485, inclusive;

     (b) Submitted all items required pursuant to NAC 449.011; and

     (c) Provided satisfactory evidence to the Division that the facility is in substantial compliance with the requirements of 42 C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

      NAC 449.15455  Investigation and prelicensure survey. (NRS 449.0302, 449.0303)

     1.  If an application for a license is filed pursuant to NAC 449.1545, the Bureau shall conduct pursuant to NAC 449.0112:

     (a) An investigation; and

     (b) A prelicensure survey.

     2.  The investigation and any prelicensure survey conducted by the Bureau must include, but are not limited to, an evaluation of whether the proposed facility for treatment with narcotics or the proposed medication unit is able to comply with the requirements set forth in NAC 449.1548.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

      NAC 449.1547  Suspension, revocation or cancellation of license; provisional license; denial of application. (NRS 449.0302, 449.0303)

     1.  The Division may suspend or revoke a license issued pursuant to NAC 449.154 to 449.15485, inclusive, or cancel such a license and issue a provisional license based upon any grounds for such action set forth in NAC 449.002 to 449.99939, inclusive, or chapter 449 of NRS.

     2.  The Division shall deny an application for a license pursuant to NAC 449.1545 if the SAMHSA denies an application for certification pursuant to 42 C.F.R. Part 8.

     3.  The Division shall suspend or revoke a license issued pursuant to NAC 449.154 to 449.15485, inclusive, if the facility for treatment with narcotics or the medication unit operates without certification from the SAMHSA pursuant to 42 C.F.R. Part 8.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

Operation

      NAC 449.1548  General operational requirements. (NRS 449.0302, 449.0303)  In addition to all other requirements set forth in NAC 449.154 to 449.15485, inclusive, each facility for treatment with narcotics and each medication unit shall:

     1.  Have a medical director who has a valid and current license to practice medicine in this State;

     2.  Employ, contract with or allow a person to act as an alcohol and drug counselor only if the person is certified by the Board of Examiners for Alcohol, Drug and Gambling Counselors to be such a counselor;

     3.  Obtain and maintain with the State Board of Pharmacy a valid and current registration relating to the use of narcotics;

     4.  Be in full compliance with all applicable provisions of 42 C.F.R. Part 8, all other applicable federal laws and regulations and all other requirements of the SAMHSA and the DEA;

     5.  Be in full compliance with all applicable provisions of chapters 449 and 453 of NRS and in substantial compliance with all applicable provisions of NAC 449.002 to 449.99939, inclusive, and chapter 453 of NAC;

     6.  Maintain records and documentation of treatment pursuant to NRS 453.690;

     7.  Provide the Division and the State Board of Pharmacy with access to all records and documentation relating to the purchase, distribution and use of narcotics;

     8.  Comply with the rules of confidentiality and privilege set forth in NRS 453.720;

     9.  Develop and maintain a system to ensure that prospective and existing clients are not receiving narcotics from any other facility for treatment with narcotics or any other medication unit; and

     10.  Comply with all applicable local laws and regulations, including, but not limited to, zoning laws and regulations.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002; R098-06, 7-14-2006)

      NAC 449.15485  Continuing review of operations; investigation of complaints. (NRS 449.0302, 449.0303)

     1.  The operation of a facility for treatment with narcotics or a medication unit is subject to continuing review by the Division.

     2.  The Division shall investigate all complaints against a facility for treatment with narcotics or a medication unit directly or in conjunction with other federal, state or local governmental agencies, including, but not limited to, the SAMHSA, the DEA, the State Board of Pharmacy or the Division.

     (Added to NAC by Bd. of Health by R229-97, eff. 4-15-98; A by R053-02, 7-24-2002)

HALFWAY HOUSES FOR PERSONS RECOVERING FROM ALCOHOL OR OTHER SUBSTANCE USE DISORDERS

      NAC 449.1549  Definitions. (NRS 449.0302)  As used in NAC 449.1549 to 449.154945, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.154901, 449.154903 and 449.154905 have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154901  “Administrator” defined. (NRS 449.0302)  “Administrator” means a person:

     1.  Whose name appears on a license issued by the Bureau as administrator of record for a facility; and

     2.  Who is legally responsible for the management of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154903  “Client” defined. (NRS 449.0302)  “Client” means a person who is admitted to a facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154905  “Facility” defined. (NRS 449.0302)  “Facility” means a halfway house for persons recovering from alcohol or other substance use disorders as defined in NRS 449.008.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.15491  Administrator: Qualifications. (NRS 449.0302)  An administrator must:

     1.  Be at least 21 years of age;

     2.  Have the tests and obtain the certifications required by NAC 441A.375 for a person employed in a facility for the dependent; and

     3.  Maintain evidence that he or she satisfies the requirements of this section in a file that is maintained on the premises of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154911  Administrator: General duties. (NRS 449.0302)  An administrator shall:

     1.  Post the license issued by the Bureau in a conspicuous place within the facility.

     2.  Organize and manage the facility.

     3.  Establish policies, procedures and rules for the operation of the facility, including, without limitation, the policies and procedures required to be established by NAC 449.154915.

     4.  Ensure that the records of the facility are maintained in accordance with the requirements of the policies, procedures and rules for the operation of the facility established pursuant to subsection 3.

     5.  Ensure that the facility complies with any applicable state statutes and regulations and local ordinances.

     6.  Ensure that the clients of the facility are afforded the opportunity to exercise their individual rights in a manner consistent with the rules of the facility.

     7.  Ensure that the facility is maintained in a safe and clean condition.

     8.  Review and approve changes in the policies and procedures established pursuant to subsection 3 at least annually. This review must be signed and dated.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154913  General operational guidelines. (NRS 449.0302)  An administrator shall ensure that:

     1.  Alcohol or drugs are not allowed on the premises of the facility;

     2.  The policies, procedures and rules established pursuant to NAC 449.154911 are carried out;

     3.  Each client complies with those policies, procedures and rules;

     4.  The facility provides an environment that will facilitate the reintegration of the clients of the facility into the community; and

     5.  The operation of the facility is not compromised by a client who violates the policies, procedures or rules of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154915  Policies and procedures: Establishment; maintenance of manual. (NRS 449.0302)

     1.  An administrator shall establish written policies and procedures concerning:

     (a) The manner in which records of clients will be maintained and protected against unauthorized use;

     (b) The disclosure of confidential information about clients;

     (c) The criteria the facility will use to determine whether to:

          (1) Admit a client to the facility; and

          (2) Discharge a client from the facility;

     (d) The discharge of a client for a violation of the rules of the facility;

     (e) The discharge of a client for the use of alcohol or drugs;

     (f) The rights and responsibilities of a client; and

     (g) The evacuation of clients in case of fire or other emergency as required by NAC 449.154945.

     2.  The administrator shall maintain a manual of policies, procedures and rules of the facility that includes the policies and procedures established pursuant to subsection 1. The manual must be available on the premises of the facility at all times.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154917  Limitation on admissions. (NRS 449.0302)  An administrator shall ensure that the facility does not admit more clients to the facility than the number of beds for which it is licensed.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154919  Health and sanitation. (NRS 449.0302)

     1.  An administrator shall ensure that the facility:

     (a) Has a safe and sufficient supply of water, adequate drainage and an adequate system for the disposal of sewage; and

     (b) Complies with all local ordinances and state and federal laws and regulations relating to zoning, sanitation, safety and accessibility to persons with disabilities.

     2.  A container used to store garbage outside of a facility must be kept reasonably clean and must be covered in such a manner that rodents are unable to get inside the container. At least once each week, the container must be emptied and the contents of the container must be removed from the premises of the facility.

     3.  To the extent practicable, the premises of the facility must be kept free from:

     (a) Offensive odors;

     (b) Hazards, including obstacles that impede the free movement of clients within and outside the facility;

     (c) Insects and rodents; and

     (d) Accumulations of dirt, garbage and other refuse.

     4.  The administrator shall ensure that the premises of the facility are clean and that the interior, exterior and landscaping of the facility are well maintained.

     5.  All windows that are capable of being opened in the facility and all doors that are left open to provide ventilation for the facility must be screened to prevent the entry of insects.

     6.  The administrator shall ensure that electrical lighting is maintained in the facility as necessary to ensure the comfort and safety of the clients of the facility.

     7.  The temperature in the facility must be maintained at a level that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154921  Laundry facilities. (NRS 449.0302)

     1.  An administrator shall ensure that laundry facilities are provided in the facility commensurate with the number of clients in the facility. At least one washer and at least one dryer must be provided in the facility.

     2.  The laundry area in a facility must be maintained in a sanitary manner. All the equipment in the laundry area must be maintained in good working condition. All dryers must be ventilated to the outside of the building.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154923  Kitchens; storage of food. (NRS 449.0302)

     1.  The kitchen in a facility and the equipment in the kitchen must be clean and must allow for the sanitary preparation of food. The equipment must be in good working condition.

     2.  Perishable food must be refrigerated at a temperature of 40 degrees Fahrenheit or less. Frozen food must be kept at a temperature of 0 degrees Fahrenheit or less.

     3.  Food must not be stored in any area in which cleaning or pest control products are stored.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154925  Bedrooms; bedding. (NRS 449.0302)

     1.  A bedroom in a facility that is used by more than one client must have at least 45 square feet of floor space for each client who resides in the bedroom. A bedroom that is occupied by only one client must have at least 80 square feet of floor space.

     2.  The arrangement of the beds and other furniture in the bedroom must accommodate the clients occupying the bedroom in comfort and safety.

     3.  A bed with a comfortable and clean mattress must be provided for each client. The bed must be made with two clean sheets, a blanket, a pillow and a bedspread. Linens must be changed at least once each week and more often if the linens become dirty.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154927  Use of certain areas as bedroom prohibited. (NRS 449.0302)  A hall, stairway, unfinished attic, garage, storage area or shed or other similar area of a facility must not be used as a bedroom. Any other room must not be used as a bedroom if it is used for any other purpose.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154929  Bathrooms and toilet facilities; toilet articles. (NRS 449.0302)

     1.  All bathrooms and toilet facilities in the facility must be sufficiently lighted.

     2.  Each client must have his or her own towels and washcloths. Paper towels may be used for hand towels. The towels and washcloths must be changed as often as is necessary to maintain cleanliness, but in no event less often than once each week. A soap dispenser that provides liquid or granular soap may be used instead of individual bars of soap.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154931  Accommodations for residents with restricted mobility. (NRS 449.0302)  A facility that has a client who uses a wheelchair or a walker must:

     1.  Have hallways, doorways and exits wide enough to accommodate a wheelchair or walker; and

     2.  Have ramps at all primary exits.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154933  First aid. (NRS 449.0302)

     1.  A first-aid kit must be available at the facility. The first-aid kit must include, without limitation:

     (a) A germicide safe for use by humans;

     (b) Sterile gauze pads;

     (c) Adhesive bandages, rolls of gauze and adhesive tape;

     (d) Disposable gloves;

     (e) A shield or mask to be used by a person who is administering cardiopulmonary resuscitation; and

     (f) A thermometer or other device that may be used to determine the bodily temperature of a person.

     2.  Except for first aid in an emergency, no treatment or medication may be administered to a client.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154935  Medication. (NRS 449.0302)

     1.  Except as otherwise provided in NAC 449.154933, an administrator or another client shall not administer or assist in the administration of medication to a client.

     2.  Medication for self-administration may be kept at the facility. That medication must:

     (a) Be disposed of immediately when it expires or when a physician orders the medication to be discontinued;

     (b) Be stored and controlled in a manner that protects the medication from unauthorized use; and

     (c) Not be used by more than one of the clients.

     3.  The provisions of paragraph (a) of subsection 2 do not apply to over-the-counter medication.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154937  Telephones; listing of facility’s telephone number. (NRS 449.0302)  An administrator shall ensure that:

     1.  The facility has at least one telephone that is in good working condition in the facility; and

     2.  The telephone number of the facility is listed in the telephone directory.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154939  Notification to Bureau under certain circumstances. (NRS 449.0302)  An administrator shall notify the Bureau within 24 hours after the occurrence of an incident that:

     1.  Involved significant harm to a client of the facility if the client of the facility required medical treatment as a result of the incident;

     2.  May cause imminent danger to the health or safety of a client of the facility; or

     3.  May jeopardize the integrity of the operation of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154941  Rights of clients. (NRS 449.0302)  An administrator shall ensure that:

     1.  A client of the facility is not abused, neglected or exploited by another client of the facility or any person who is visiting the facility;

     2.  A client is not prohibited from speaking to any person who advocates for the rights of the clients of the facility;

     3.  Each client is treated with respect and dignity;

     4.  The facility provides a safe and comfortable environment;

     5.  A client is not prohibited from interacting socially in a manner that is consistent with the rules of the facility;

     6.  To the extent practicable and in a manner that is consistent with the rules of the facility, each client is allowed to make his or her own decisions; and

     7.  The telephone number of the local office of the Bureau and the name and telephone number of the administrator is conspicuously posted on the premises of the facility.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154943  Client files: Maintenance; contents; confidentiality. (NRS 449.0302)

     1.  An administrator shall ensure that the facility maintains a separate file for each client of the facility and retains the file for at least 5 years after the client permanently leaves the facility. The file must be kept locked in a location that is protected against unauthorized use. Each file must contain the information obtained by the facility that is related to the client, including, without limitation:

     (a) The full name, address, date of birth and social security number of the client;

     (b) The address and telephone number of the client’s physician and any next of kin or guardian of the client;

     (c) A statement of the allergies of the client, if any, and any special diet or medication he or she requires;

     (d) Evidence of compliance with the provisions of NAC 441A.380;

     (e) A list of the rules of the facility that is signed by the client; and

     (f) The name and telephone number of the vendors and medical professionals that provide services for the client.

     2.  Except as otherwise provided in this subsection, the file of the client must be kept confidential. The file of a client must be made available upon request at any time to an employee of the Bureau who is acting in his or her capacity as an employee of the Bureau.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

      NAC 449.154945  Safety from fire. (NRS 449.0302)

     1.  An administrator shall ensure that the facility complies with the regulations adopted by the State Fire Marshal pursuant to chapter 477 of NRS and any local ordinances relating to safety from fire. The facility must be approved for occupancy by the State Fire Marshal.

     2.  The administrator shall ensure that the facility has a plan for the evacuation of clients in case of fire or other emergency. The plan must be:

     (a) Understood by all clients;

     (b) Posted in a common area of the facility; and

     (c) Discussed with each client at the time of his or her admission.

     3.  At least one portable fire extinguisher must be available at the facility. Any portable fire extinguishers available at the facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.

     4.  The administrator shall ensure that a written policy on smoking is developed and carried out by the facility. The policy must be:

     (a) Developed with the purpose of preventing a fire caused by smoking in the facility; and

     (b) Posted in a common area of the facility.

     5.  Smoke detectors installed in a facility must be maintained in proper operating condition at all times and must be tested monthly. The results of the tests conducted pursuant to this subsection must be recorded and maintained at the facility.

     6.  If a fire sprinkler system is installed in a facility, the system must be maintained in proper operating condition at all times and must be inspected in accordance with the provisions of NAC 477.460.

     (Added to NAC by Bd. of Health by R123-01, 12-17-2001, eff. 1-1-2002)

FACILITIES FOR TRANSITIONAL LIVING FOR RELEASED OFFENDERS

General Provisions

      NAC 449.154951  Definitions. (NRS 449.0302)  As used in NAC 449.154951 to 449.154999, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.154953 to 449.154959, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154953  “Administrator” defined. (NRS 449.0302)  “Administrator” means a person:

     1.  Whose name appears on a license issued by the Bureau as administrator of record for a facility; and

     2.  Who is legally responsible for the management of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154955  “Facility” defined. (NRS 449.0302)  “Facility” means a facility for transitional living for released offenders as defined in NRS 449.0055.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154957  “Resident” defined. (NRS 449.0302)  “Resident” means a person who:

     1.  Is a person who has been released from prison as that term is defined in subsection 2 of NRS 449.0055; and

     2.  Is admitted to a facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154959  “Supportive services” defined. (NRS 449.0302)

     1.  “Supportive services” mean services provided by a facility, directly or indirectly through arrangements with other providers, which are intended to assist a resident with reintegration into the community.

     2.  Those services may include, without limitation:

     (a) Referrals and the provision of information concerning:

          (1) Health care, including mental health care;

          (2) Access to housing, benefits or employment;

          (3) Resume writing; and

          (4) Required counseling for sex offenders.

     (b) Training concerning:

          (1) Life skills;

          (2) Resume writing; and

          (3) Any other topic pursuant to the policies of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

Administration

      NAC 449.154961  Administrator: Qualifications. (NRS 449.0302)  An administrator must:

     1.  Be at least 21 years of age;

     2.  Have the physical examination or certification required by paragraph (a) of subsection 3 of NAC 441A.375 for a person employed in a facility for the dependent; and

     3.  Maintain evidence that he or she satisfies the requirements of this section in a file that is maintained on the premises of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154963  Administrator: General duties. (NRS 449.0302)  An administrator shall:

     1.  Post the license issued by the Bureau in a conspicuous place within the facility.

     2.  Organize and manage the facility.

     3.  Establish policies, procedures and rules for the operation of the facility, including, without limitation, the policies and procedures required to be established by NAC 449.154967.

     4.  Ensure that the records of the facility are maintained in accordance with the requirements of the policies, procedures and rules for the operation of the facility established pursuant to subsection 3.

     5.  Ensure that the facility complies with any applicable state statutes and regulations and local ordinances.

     6.  Ensure that the residents of the facility are afforded the opportunity to exercise their individual rights in a manner consistent with the rules of the facility.

     7.  Ensure that the facility is maintained in a safe and clean condition.

     8.  Review and approve changes in the policies and procedures established pursuant to subsection 3 at least annually. This review must be signed and dated.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154965  Operation of facility. (NRS 449.0302)  An administrator shall ensure that:

     1.  Alcohol or drugs are not allowed on the premises of the facility;

     2.  The policies, procedures and rules established pursuant to NAC 449.154963 are carried out;

     3.  Each resident complies with those policies, procedures and rules;

     4.  The facility provides an environment that will facilitate the reintegration of the residents of the facility into the community; and

     5.  The operation of the facility is not compromised by a resident who violates the policies, procedures or rules of the facility.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154967  Policies and procedures. (NRS 449.0302)

     1.  An administrator shall establish written policies and procedures concerning:

     (a) The manner in which records of residents will be maintained and protected against unauthorized use;

     (b) The disclosure of confidential information about residents;

     (c) The criteria the facility will use to determine whether to:

          (1) Admit a resident to the facility; and

          (2) Discharge a resident from the facility;

     (d) The discharge of a resident for a violation of the rules of the facility;

     (e) The discharge of a resident for the use of alcohol or drugs;

     (f) The rights and responsibilities of a resident; and

     (g) The evacuation of residents in case of fire or other emergency as required by NAC 449.154999.

     2.  The administrator shall maintain a manual of policies, procedures and rules of the facility that includes, without limitation, the policies and procedures established pursuant to subsection 1. The manual must be available on the premises of the facility at all times.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154969  Preparations for disasters and other emergencies. (NRS 449.0302)

     1.  An administrator shall develop a written plan for disasters that outlines procedures for members of the staff of the facility and residents of the facility to follow in case of a disaster or other emergency. The plan must include, without limitation, provisions outlining procedures to be followed with regard to:

     (a) Workplace threats and violence, bomb threats, and the possession of firearms or explosives by a resident;

     (b) Medical emergencies;

     (c) Natural disasters typical of the particular geographic area in which the facility is located; and

     (d) Other disasters, including, without limitation, a power failure, an interruption in the normal supply of water to the facility and threats by terrorists.

     2.  The plan must include, without limitation, provisions concerning the provision of temporary shelter and other services for residents of the facility who are required to evacuate the facility because of a disaster.

     3.  The provisions of the plan must be communicated to each member of the staff of the facility and each resident of the facility.

     4.  Each facility shall conduct a drill for evacuation of the facility at least once each quarter and shall ensure that each shift of the staff of the facility participates in such a drill at least annually.

     5.  Each facility shall retain a written record of each drill conducted pursuant to subsection 4 on file at the facility for not less than 12 months after the drill is conducted. The administrator shall make such records available for inspection by the Division upon request.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

Operation

      NAC 449.154971  Limitation on number of admissions. (NRS 449.0302)  An administrator shall ensure that the facility does not admit more residents to the facility than the number of beds for which it is licensed.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154973  Prerequisites to provision of particular services. (NRS 449.0302)

     1.  In addition to satisfying the requirements of NAC 449.011, an applicant for a license to operate a facility must include with his or her application a statement indicating whether he or she will be operating a facility:

     (a) That only provides a housing and living environment;

     (b) That provides or arranges for the provision of supportive services for residents of the facility to assist the residents with reintegration into the community, in addition to providing a housing and living environment; or

     (c) That provides or arranges for the provision of alcohol and other substance use disorder programs, in addition to providing a housing and living environment and providing or arranging for the provision of other supportive services.

     2.  If the applicant wishes to operate a facility described in paragraph (c) of subsection 1, the applicant must:

     (a) Obtain certification of its program pursuant to paragraph (d) of subsection 1 of NRS 458.025 and include evidence of that certification with his or her application; and

     (b) Satisfy the requirements set forth in NAC 449.019 to 449.150, inclusive, for a facility for the treatment of alcohol or other substance use disorders.

     3.  If the applicant wishes to operate a facility described in paragraph (b) or (c) of subsection 1 which has residents who are under the supervision of a parole officer, the applicant must:

     (a) Obtain the approval of the Division of Parole and Probation of the Department of Public Safety; and

     (b) Include evidence of that approval with his or her application.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006; A by R016-20, 11-2-2020)

      NAC 449.154975  Sanitation, safety and comfort. (NRS 449.0302)

     1.  An administrator shall ensure that the facility:

     (a) Has a safe and sufficient supply of water, adequate drainage and an adequate system for the disposal of sewage; and

     (b) Complies with all local ordinances and state and federal laws and regulations relating to zoning, sanitation, safety and accessibility to persons with disabilities.

     2.  A container used to store garbage outside of a facility must be kept reasonably clean and must be covered in such a manner that rodents are unable to get inside the container. At least once each week, the container must be emptied and the contents of the container must be removed from the premises of the facility.

     3.  To the extent practicable, the premises of the facility must be kept free from:

     (a) Offensive odors;

     (b) Hazards, including obstacles that impede the free movement of residents within and outside the facility;

     (c) Insects and rodents; and

     (d) Accumulations of dirt, garbage and other refuse.

     4.  The administrator shall ensure that the premises of the facility are clean and that the interior, exterior and landscaping of the facility are well maintained.

     5.  All windows that are capable of being opened in the facility and all doors that are left open to provide ventilation for the facility must be screened to prevent the entry of insects.

     6.  The administrator shall ensure that electrical lighting is maintained in the facility as necessary to ensure the comfort and safety of the residents of the facility.

     7.  The temperature in the facility must be maintained at a level that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit.

     8.  The administrator shall ensure that any pest control work performed at the facility is performed by a person licensed to engage in pest control pursuant to chapter 555 of NRS.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154977  Laundry facilities. (NRS 449.0302)

     1.  An administrator shall ensure that laundry facilities are provided in the facility commensurate with the number of residents in the facility. At least one washer and at least one dryer must be provided in the facility.

     2.  The laundry area in a facility must be maintained in a sanitary manner. All the equipment in the laundry area must be maintained in good working condition. All dryers must be ventilated to the outside of the building.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154979  Kitchens; preparation and storage of food. (NRS 449.0302)

     1.  The kitchen in a facility and the equipment in the kitchen must be clean and must allow for the sanitary preparation of food. The equipment must be in good working condition.

     2.  Perishable food must be refrigerated at a temperature of 40 degrees Fahrenheit or less. Frozen food must be kept at a temperature of 0 degrees Fahrenheit or less.

     3.  Food must not be stored in any area in which cleaning or pest control products are stored.

     4.  A facility with more than 10 residents must:

     (a) Comply with applicable provisions of chapter 446 of NRS and the regulations adopted pursuant thereto; and

     (b) Obtain the necessary permits from the Division.

     5.  The equipment used for cooking and storing food in a facility with more than 10 residents must be inspected and approved by the Division and the state and local fire safety authorities.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006; A by R155-10, 12-16-2010)

      NAC 449.154981  Bedrooms and bedding. (NRS 449.0302)

     1.  A bedroom in a facility that is used by more than one resident must have at least 50 square feet of floor space for each resident who resides in the bedroom. A bedroom that is occupied by only one resident must have at least 80 square feet of floor space.

     2.  The arrangement of the beds and other furniture in the bedroom must accommodate the residents occupying the bedroom in comfort and safety.

     3.  A bed with a comfortable and clean mattress must be provided for each resident. The bed must be made with a mattress cover, two clean sheets, a blanket, a pillow and a bedspread. Linens must be changed at least once each week and more often if the linens become dirty.

     4.  Each mattress used in a facility must comply with the provisions of NRS 444.010 to 444.040, inclusive, and the regulations adopted pursuant thereto.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154983  Use of certain areas as bedroom prohibited. (NRS 449.0302)  A hall, stairway, unfinished attic, garage, storage area or shed or other similar area of a facility must not be used as a bedroom. Any other room must not be used as a bedroom if it is used for any other purpose.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154985  Bathrooms and toilet facilities; toiletries. (NRS 449.0302)

     1.  All bathrooms and toilet facilities in the facility must be sufficiently lighted.

     2.  Each facility must have:

     (a) A flush toilet and lavatory for each four residents; and

     (b) A tub or shower for each six residents.

     3.  Each resident must have his or her own towels and washcloths. Paper towels may be used for hand towels. The towels and washcloths must be changed as often as is necessary to maintain cleanliness, but in no event less often than once each week. A soap dispenser that provides liquid or granular soap may be used instead of individual bars of soap.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154987  First aid. (NRS 449.0302)

     1.  A first-aid kit must be available at the facility. The first-aid kit must include, without limitation:

     (a) A germicide safe for use by humans;

     (b) Sterile gauze pads;

     (c) Adhesive bandages, rolls of gauze and adhesive tape;

     (d) Disposable gloves;

     (e) A shield or mask to be used by a person who is administering cardiopulmonary resuscitation; and

     (f) A thermometer or other device that may be used to determine the bodily temperature of a person.

     2.  Except for first aid in an emergency, no treatment or medication may be administered to a resident.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154989  Medication. (NRS 449.0302)

     1.  Medication for self-administration may be kept at the facility. That medication must:

     (a) Except as otherwise provided in subsection 3, be disposed of immediately when it expires or when a physician orders the medication to be discontinued;

     (b) Be stored and controlled in a manner that protects the medication from unauthorized use; and

     (c) Not be used by more than one of the residents.

     2.  Medication kept at the facility must be controlled and distributed in a manner that is consistent with applicable state and federal law.

     3.  The provisions of paragraph (a) of subsection 1 do not apply to over-the-counter medication.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154991  Telephones; listing of facility’s telephone number. (NRS 449.0302)  An administrator shall ensure that:

     1.  The facility has at least one telephone that is in good working condition in the facility; and

     2.  The telephone number of the facility is listed in the telephone directory.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154993  Notification of occurrence of certain incidents. (NRS 449.0302)

     1.  An administrator shall notify the Bureau within 24 hours after the occurrence of an incident that:

     (a) Involved significant harm to a resident of the facility if the resident of the facility required medical treatment as a result of the incident;

     (b) May cause imminent danger to the health or safety of a resident of the facility; or

     (c) May jeopardize the integrity of the operation of the facility.

     2.  The administrator shall report to the Division of Public and Behavioral Health any fire or other disaster that takes place in the facility within 24 hours after the fire or other disaster occurs.

     3.  The administrator shall notify the Division of Parole and Probation of the Department of Public Safety of the occurrence of any of the incidents described in this section.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154995  Rights of residents. (NRS 449.0302)  An administrator shall ensure that:

     1.  A resident of the facility is not abused, neglected or exploited by another resident of the facility or any person who is visiting the facility;

     2.  A resident is not prohibited from speaking to any person who advocates for the rights of the residents of the facility;

     3.  Each resident is treated with respect and dignity;

     4.  The facility provides a safe and comfortable environment;

     5.  A resident is not prohibited from interacting socially in a manner that is consistent with the rules of the facility;

     6.  To the extent practicable and in a manner that is consistent with the rules of the facility, each resident is allowed to make his or her own decisions;

     7.  The telephone number of the local office of the Bureau and the name and telephone number of the administrator is conspicuously posted on the premises of the facility; and

     8.  Each resident of the facility is allowed to exercise his or her right to vote.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154997  Files for residents. (NRS 449.0302)

     1.  An administrator shall ensure that the facility maintains a separate file for each resident of the facility and retains the file for at least 5 years after the resident permanently leaves the facility. The file must be kept locked in a location that is protected against unauthorized use. Each file must contain the information obtained by the facility that is related to the resident, including, without limitation:

     (a) The full name, address and date of birth of the resident;

     (b) The address and telephone number of any next of kin or guardian of the resident;

     (c) Evidence of compliance with the provisions of NAC 441A.380;

     (d) A list of the rules of the facility that is signed by the resident; and

     (e) The name and telephone number of the parole officer of the resident, if any.

     2.  Except as otherwise provided in this subsection, the file of the resident must be kept confidential. The file of a resident must be made available upon request at any time to an employee of the Bureau who is acting in his or her capacity as an employee of the Bureau.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

      NAC 449.154999  Safety from fire. (NRS 449.0302)

     1.  An administrator shall ensure that the facility complies with the regulations adopted by the State Fire Marshal pursuant to chapter 477 of NRS and any local ordinances relating to safety from fire.

     2.  A facility with more than 16 beds must be equipped with a sufficient number of sprinklers to cover the entire area of the facility.

     3.  The administrator shall ensure that the facility has a plan for the evacuation of residents in case of fire or other emergency. The plan must be:

     (a) Understood by all residents;

     (b) Posted in a common area of the facility; and

     (c) Discussed with each resident at the time of his or her admission.

     4.  At least one portable fire extinguisher must be available at the facility. Any portable fire extinguishers available at the facility must be inspected, recharged and tagged at least once each year by a person certified by the State Fire Marshal to conduct such inspections.

     5.  The administrator shall ensure that a written policy on smoking is developed and carried out by the facility. The policy must be:

     (a) Developed with the purpose of preventing a fire caused by smoking in the facility; and

     (b) Posted in a common area of the facility.

     6.  Smoke detectors installed in a facility must be maintained in proper operating condition at all times and must be tested monthly. The results of the tests conducted pursuant to this subsection must be recorded and maintained at the facility.

     7.  If an automatic fire sprinkler system is installed in a facility, the system must be inspected:

     (a) Not less than once each calendar quarter by a person who understands the manner in which the system operates and the manner in which the system must be maintained; and

     (b) Not less than once each calendar year by a person who is licensed to inspect such a system pursuant to the provisions of chapter 477 of NAC.

     (Added to NAC by Bd. of Health by R094-06, eff. 7-14-2006)

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

      NAC 449.15511  Definitions. (NRS 449.0302)  As used in NAC 449.15511 to 449.15529, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.15513 to 449.15519, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15513  “Caregiver” defined. (NRS 449.0302)  “Caregiver” means a person who provides care, assistance and protective supervision to a resident of a home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15515  “Director” defined. (NRS 449.0302)  “Director” means a person:

     1.  Whose name appears on a license issued by the Bureau as the director of record for a home; and

     2.  Who is legally responsible for the care of the residents and the daily operation of the home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15517  “Home” defined. (NRS 449.0302)  “Home” means a home for individual residential care.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15519  “Protective supervision” defined. (NRS 449.0302)  “Protective supervision” means supervision that protects the residents of a home from potential danger to their physical and mental well-being.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15521  Director: Qualifications. (NRS 449.0302)  The director of a home must:

     1.  Be at least 21 years of age and have a high school diploma or its equivalent. A person who proposes to act as the director of a home must provide the Bureau with evidence that he or she satisfies the requirements of this subsection.

     2.  Possess the appropriate knowledge, skills and abilities to meet the needs of the residents of the home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15523  Director: Duties. (NRS 449.0302)  The director of a home shall:

     1.  Post the license to operate the home in a conspicuous place within the home.

     2.  Ensure that the needs of each resident of the home are assessed upon admission of the resident to the home, and that the assessment is updated as the needs of the resident change. Such an assessment must include:

     (a) Documentation of the abilities of the resident to function independently; and

     (b) A complete list of the matters for which the resident requires assistance.

     3.  Ensure that the residents of the home:

     (a) Are treated with dignity and respect and are not abused, neglected or exploited; and

     (b) Receive:

          (1) The personal care they require;

          (2) A balanced daily diet that meets their nutritional needs;

          (3) Protective supervision and adequate services to maintain and enhance their physical, mental and emotional well-being; and

          (4) The names of, and the telephone numbers for the registration of complaints with, the Bureau and the Aging and Disability Services Division of the Department of Health and Human Services.

     4.  Ensure that a caregiver, who is capable of meeting the needs of the residents and has been trained in first aid and cardiopulmonary resuscitation, is on the premises of the home at all times when a resident is present.

     5.  Ensure that appropriate sanitary procedures are carried out for the handling, cleaning and storage of linens and personal laundry in the home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15525  Requirements for safety and sanitation of facility. (NRS 449.0302)

     1.  The interior and exterior of a home must be clean and free of hazards and offensive odors.

     2.  A home must contain:

     (a) Appropriate and well-maintained furnishings;

     (b) At least one functional, portable fire extinguisher;

     (c) A first-aid kit;

     (d) Equipment that is sufficiently clean and adequate for the preparation, service and storage of food; and

     (e) Adequate areas and equipment to carry out appropriate sanitary procedures for the handling, cleaning and storage of linens and personal laundry.

     3.  The temperature of a home must be maintained at levels that are comfortable and safe. Portable heaters are prohibited in a home.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15527  Agreement between operator of home and resident concerning rates; maintenance of records of residents. (NRS 449.0302)  The operator of a home shall:

     1.  Enter into a written agreement with each resident of the home that sets forth the basic rate for the services of the home and the charges for any optional services.

     2.  Maintain a separate, organized file for each resident of the home and retain the file for 5 years after the resident permanently leaves the home. Each file must include:

     (a) The full name, address, date of birth and social security number of the resident;

     (b) The address and telephone number of the resident’s physician and a person who is responsible for the resident;

     (c) A copy of the results of a general physical examination of the resident conducted by his or her physician; and

     (d) A current copy of the assessment of the needs of the resident conducted pursuant to NAC 449.15523.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

      NAC 449.15529  On-site survey of home by Bureau. (NRS 449.0302)  The Bureau shall conduct:

     1.  An initial on-site survey of a home:

     (a) After the Bureau receives a completed application for a license to operate the home and the fee required pursuant to NAC 449.016; and

     (b) Before the issuance of a license to operate the home.

     2.  Additional on-site surveys of a home not less than once every 3 years after conducting the survey of the home pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R131-99, eff. 11-29-99)

RESIDENTIAL FACILITIES FOR GROUPS

General Provisions

      NAC 449.156  Definitions. (NRS 439.200, 449.0302, 449.0304)  As used in NAC 449.156 to 449.27706, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.1565 to 449.178, inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Bd. of Health, 3-6-86; R003-97, 10-30-97; R204-99, 2-10-2000; R071-04, 8-4-2004; R122-05, 11-17-2005; R097-06, 7-14-2006; R109-18, 1-30-2019)

      NAC 449.1565  “Administer” defined. (NRS 449.0302)  “Administer” means the direct application of a drug or medicine referred to in NRS 454.181 to 454.371, inclusive, by injection, inhalation, ingestion or any other means, to the body of a resident of a residential facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.157  “Administrator” defined. (NRS 449.0302)  “Administrator” means a person:

     1.  Who is licensed by the Board of Examiners for Long-Term Care Administrators pursuant to chapter 654 of NRS;

     2.  Whose name appears on a license issued by the Bureau as administrator of record for a residential facility; and

     3.  Who is legally responsible for the care of residents and the daily operation of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1575  “Board” defined. (NRS 449.0302)  “Board” means the State Board of Health.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1585  “Caregiver” defined. (NRS 449.0302)  “Caregiver” means an employee of a residential facility who provides care, assistance or protective supervision to a resident of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1591  “Category 1 resident” defined. (NRS 449.0302)  “Category 1 resident” means:

     1.  In a residential facility with not more than 10 residents, a resident who, without the assistance of any other person, is physically and mentally capable of moving himself or herself from the room in which the resident sleeps to outside the facility in 4 minutes or less; or

     2.  In a residential facility with more than 10 residents, a resident who, without the assistance of any other person, is physically and mentally capable of moving himself or herself from the room in which the resident sleeps to the other side of a smoke or fire barrier or outside the facility, whichever is nearest, in 4 minutes or less.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1595  “Category 2 resident” defined. (NRS 449.0302)  “Category 2 resident” means:

     1.  In a residential facility with not more than 10 residents, a resident who, without the assistance of any other person, is not physically or mentally capable of moving himself or herself from the room in which the resident sleeps to outside the facility in 4 minutes or less.

     2.  In a residential facility with more than 10 residents, a resident who, without the assistance of any other person, is not physically or mentally capable of moving himself or herself from the room in which the resident sleeps to the other side of a smoke or fire barrier or outside the facility, whichever is nearest, in 4 minutes or less.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.1597  “Dietary supplement” defined. (NRS 449.0302)  “Dietary supplement” has the meaning ascribed to it in 21 U.S.C. 321(ff) as that section existed on August 17, 1999.

     (Added to NAC by Bd. of Health by R204-99, eff. 2-10-2000)

      NAC 449.1599  “Discharge” defined. (NRS 449.0302)  “Discharge” means the release of a resident from a residential facility which does not involve a transfer.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

      NAC 449.160  “Division” defined. (NRS 449.0302)  “Division” means the Division of Public and Behavioral Health of the Department of Health and Human Services.

     (Added to NAC by Bd. of Health, eff. 3-6-86)

      NAC 449.161  “Grade” defined. (NRS 449.0302)  “Grade” means a letter that is assigned to a residential facility by the Bureau based on the severity and scope scores of the facility as determined by the Bureau.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.164  “Hospice care” defined. (NRS 449.0302)  “Hospice care” has the meaning ascribed to it in NRS 449.0115.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.169  “Medical professional” defined. (NRS 449.0302)  “Medical professional” means a physician or a physician assistant, nurse practitioner, registered nurse, physical therapist, occupational therapist, speech-language pathologist or practitioner of respiratory care who is trained and licensed to perform medical procedures and care prescribed by a physician.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.170  “Placard” defined. (NRS 449.0302)  “Placard” means a certificate issued to a residential facility by the Bureau that includes the grade assigned to the facility by the Bureau.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.172  “Residential facility” defined. (NRS 449.0302)  “Residential facility” means a residential facility for groups as defined in NRS 449.017.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.173  “Residential facility which provides care to persons with Alzheimer’s disease” defined. (NRS 449.0302)  “Residential facility which provides care to persons with Alzheimer’s disease” means a residential facility that provides care and protective supervision for persons with Alzheimer’s disease or a related disease, including, without limitation, senile dementia, organic brain syndrome or other cognitive impairment.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.175  “Severity and scope score” defined. (NRS 449.0302)  “Severity and scope score” has the meaning ascribed to it in NAC 449.99839.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.176  “Staff of a facility” defined. (NRS 449.0302)  “Staff of a facility” means the administrator, caregivers and other employees of a residential facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.178  “Transfer” defined. (NRS 449.0302)  “Transfer” means the movement of a resident from a residential facility to another facility for inpatient or residential care.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

Licensing

      NAC 449.179  Submission and approval of plan for new construction or remodeling; inspection; evidence of compliance. (NRS 449.0302)

     1.  Except for a residential facility with less than 11 beds, before a residential facility is constructed or an existing facility is remodeled, the facility must:

     (a) Submit the plan for construction or remodeling to the entity designated to review such plans by the Division pursuant to the provisions of NAC 449.0115;

     (b) Notify the Bureau of a tentative date for the completion of the construction or remodeling; and

     (c) Obtain approval of the plan from the Division.

     2.  The plan for construction or remodeling must include a description of the materials that will be used to complete the project.

     3.  Before issuing a license to operate a residential facility, the Bureau shall inspect the facility to ensure that it complies with:

     (a) The provisions of NAC 449.156 to 449.27706, inclusive; and

     (b) The applicable zoning ordinances and regulations.

     4.  An applicant for a license to operate a residential facility must submit to the Bureau with his or her application evidence that the applicant and the facility are in compliance with the provisions of NRS 449.001 to 449.240, inclusive, and NAC 449.156 to 449.27706, inclusive.

     5.  The Bureau shall not perform the inspection required pursuant to subsection 3 until the applicant has submitted to the Bureau the application required pursuant to NRS 449.040, the fee required pursuant to NAC 449.016 and the evidence required pursuant to subsection 4.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R076-01, 10-18-2001; R071-04, 8-4-2004; R118-05, 11-17-2005)

      NAC 449.180  Requirements for purchasing licensed facility. (NRS 449.0302)  If an applicant for a license to operate a residential facility desires to purchase a currently licensed facility, the facility must comply with all current state and local requirements relating to health and safety.

     [Bd. of Health, Group Care Facilities Appendix §§ 1, 1.1 & 2-2.7, eff. 10-13-77]—(NAC A 3-6-86; R003-97, 10-30-97)

      NAC 449.190  License: Contents; validity; transferability; issuance of more than one type. (NRS 449.0302)

     1.  A license to operate a residential facility must include:

     (a) The name of the administrator of the facility;

     (b) The name and address of the facility;

     (c) The type of facility;

     (d) The maximum number of residents authorized to reside at the facility; and

     (e) The category of residents who may reside at the facility.

     2.  The license becomes invalid if the facility is moved to a location other than the location stated on the license. The license may not be transferred to another owner.

     3.  A residential facility may be licensed as more than one type of residential facility if the facility provides evidence satisfactory to the Bureau that it complies with the requirements for each type of facility and can demonstrate that the residents will be protected and receive necessary care and services.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.191  Denial, suspension or revocation of endorsement: Grounds. (NRS 449.0302, 449.165)  In addition to the grounds set forth in NRS 449.160 and NAC 449.1915, the Division may deny an application for an endorsement made pursuant to NAC 449.2751 to 449.2768, inclusive, on a license to operate a residential facility or may suspend or revoke an existing endorsement based upon any of the following grounds:

     1.  The failure or refusal of an applicant or licensee to comply with any of the provisions of chapter 449 of NRS or the regulations adopted by the Board.

     2.  The failure or refusal of an applicant or licensee to comply with a reasonable order from the Division to remove a resident from a facility.

     3.  Providing services at the facility without an endorsement, if an endorsement is required before providing those types of services.

     4.  Accepting for care, at any given time, more residents than the number specified in the license.

     5.  The failure or refusal of a licensee to return an adequate plan of correction to the Division within 10 days after the receipt by the licensee of a statement of deficiencies.

     6.  The failure or refusal to cooperate fully with an investigation or inspection by the Bureau.

     7.  Misappropriation of the property of a resident of a facility.

     8.  Abuse, neglect or exploitation of a person who is infirm, a person with an intellectual disability, a person with a disability or a person who is 60 years of age or older.

     9.  The residential facility has demonstrated an inability to care for residents adequately, as demonstrated by a history of deficiencies affecting the health or safety of residents or employees.

     10.  The license has been revoked or suspended due to a failure to comply with the provisions of NAC 449.002 to 449.99939, inclusive, or chapter 449 of NRS and was subsequently reinstated within the immediately preceding year.

     (Added to NAC by Bd. of Health by R119-10, eff. 1-13-2011)

      NAC 449.1915  Suspension or revocation of license and endorsement if residential facility has been assigned grade of D on two or more consecutive surveys or resurveys, or both. (NRS 449.0302, 449.165)  In addition to the grounds set forth in NRS 449.160 and NAC 449.0118, 449.191, 449.2751 and 449.27706, the Division may suspend or revoke a license to operate a residential facility, including any endorsement on the license, if the residential facility has been assigned, pursuant to NAC 449.27702, a grade of D on two or more consecutive surveys or resurveys, or both.

     (Added to NAC by Bd. of Health by R119-10, eff. 1-13-2011)

Administration and Personnel

      NAC 449.194  Responsibilities of administrator. (NRS 449.0302)  The administrator of a residential facility shall:

     1.  Provide oversight and direction for the members of the staff of the facility as necessary to ensure that residents receive needed services and protective supervision and that the facility is in compliance with the requirements of NAC 449.156 to 449.27706, inclusive, and chapter 449 of NRS.

     2.  Designate one or more employees to be in charge of the facility during those times when the administrator is absent. Except as otherwise provided in this subsection, employees designated to be in charge of the facility when the administrator is absent must have access to all areas of and records kept at the facility. Confidential information may be removed from the files to which the employees in charge of the facility have access if the confidential information is maintained by the administrator. The administrator or an employee who is designated to be in charge of the facility pursuant to this subsection shall be present at the facility at all times. The name of the employee in charge of the facility pursuant to this subsection must be posted in a public place within the facility during all times that the employee is in charge.

     3.  Maintain in the facility, and make available upon request, a copy of the provisions of NAC 449.156 to 449.27706, inclusive, and the report of the latest investigation of the facility conducted by the Bureau pursuant to NRS 449.0307.

     4.  Ensure that the records of the facility are complete and accurate.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.196  Qualifications and training of caregivers. (NRS 449.0302)

     1.  A caregiver of a residential facility must:

     (a) Be at least 18 years of age;

     (b) Be responsible and mature and have the personal qualities which will enable him or her to understand the problems of elderly persons and persons with disabilities;

     (c) Understand the provisions of NAC 449.156 to 449.27706, inclusive, and sign a statement that he or she has read those provisions;

     (d) Demonstrate the ability to read, write, speak and understand the English language;

     (e) Possess the appropriate knowledge, skills and abilities to meet the needs of the residents of the facility; and

     (f) Receive annually not less than 8 hours of training related to providing for the needs of the residents of a residential facility.

     2.  If a resident of a residential facility uses prosthetic devices or dental, vision or hearing aids, the caregivers employed by the facility must be knowledgeable of the use of those devices.

     3.  If a caregiver assists a resident of a residential facility in the administration of any medication, including, without limitation, an over-the-counter medication or dietary supplement, the caregiver must:

     (a) Before assisting a resident in the administration of a medication, receive the training required pursuant to paragraph (e) of subsection 6 of NRS 449.0302, which must include at least 16 hours of training in the management of medication consisting of not less than 12 hours of classroom training and not less than 4 hours of practical training, and obtain a certificate acknowledging the completion of such training;

     (b) Receive annually at least 8 hours of training in the management of medication and provide the residential facility with satisfactory evidence of the content of the training and his or her attendance at the training;

     (c) Complete the training program developed by the administrator of the residential facility pursuant to paragraph (e) of subsection 1 of NAC 449.2742; and

     (d) Annually pass an examination relating to the management of medication approved by the Bureau.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R118-05, 11-17-2005; R119-10, 1-13-2011)

      NAC 449.197  Medical services may be provided only by medical professional. (NRS 439.200, 449.0302, 449.0304)  Except as otherwise provided in NAC 449.1985, a member of the staff of a residential facility shall not provide medical services to a resident of the facility unless the member of the staff is a medical professional.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R109-18, 1-30-2019)

      NAC 449.1985  Performance of certain tasks by caregiver. (NRS 439.200, 449.0302, 449.0304)

     1.  A caregiver of a residential facility may perform a task described in NRS 449.0304 if the caregiver:

     (a) Before performing the task, annually thereafter and when any device used for performing the task is changed:

          (1) Has received training concerning the task that meets the requirements of subsections 5 and 6; and

          (2) Has demonstrated an understanding of the manner in which the task must be performed;

     (b) Follows the manufacturer’s instructions when operating any device used for performing the task;

     (c) Performs the task in conformance with the Clinical Laboratory Improvement Amendments of 1988, Public Law 100-578, 42 U.S.C. § 263a, if applicable, and any other applicable federal law or regulation; and

     (d) If the resident has diabetes, complies with the requirements of subsection 3 and NAC 449.2726.

     2.  If a person with diabetes who is a resident does not have the physical or mental capacity to perform a blood glucose test on himself or herself and a caregiver of the residential facility performs a blood glucose test on the resident, the Clinical Laboratory Improvement Amendments of 1988, Public Law 100-578, 42 U.S.C. § 263a, shall be deemed to be applicable for the purposes of paragraph (c) of subsection 1.

     3.  If a caregiver conducts a blood glucose test, the caregiver must ensure that the device for monitoring blood glucose is not used on more than one person.

     4.  A caregiver may weigh a resident of a residential facility only if:

     (a) The caregiver has received training on the manner in which to weigh a person that meets the requirements of subsections 5 and 6; and

     (b) The resident has consented to being weighed by the caregiver.

     5.  The training described in this section must be provided by:

     (a) A physician, physician assistant or licensed nurse;

     (b) For the training described in paragraph (b) or (c) of subsection 1 of NRS 449.0304, a registered pharmacist; or

     (c) An employee of the residential facility who has:

          (1) Received training pursuant to paragraph (a) of subsection 1 or paragraph (a) of subsection 4, as applicable, from a physician, a physician assistant, a licensed nurse or, if applicable, a registered pharmacist;

          (2) At least 1 year of experience performing the task for which he or she is providing training; and

          (3) Demonstrated competency in performing the task for which he or she is providing training.

     6.  Any training described in this section must include, without limitation:

     (a) Instruction concerning how to accurately perform the task for which the caregiver is being trained in conformance with nationally recognized infection control guidelines which may include, without limitation, guidelines published by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services;

     (b) Instruction concerning how to accurately interpret the information obtained from performing the task; and

     (c) A description of any action, including, without limitation, notifying a physician, that must be taken based on such information.

     (Added to NAC by Bd. of Health by R109-18, eff. 1-30-2019)

      NAC 449.199  Staffing requirements; limitation on number of residents; written schedule for each shift; direct supervision of certain employees. (NRS 449.0302)

     1.  The administrator of a residential facility shall ensure that a sufficient number of caregivers are present at the facility to conduct activities and provide care and protective supervision for the residents. There must be at least one caregiver on the premises of the facility if one or more residents are present at the facility.

     2.  Except as otherwise provided in NAC 449.2756, the administrator of a residential facility which has more than 20 residents shall ensure that at least one employee is awake and on duty at the facility at all times. An additional employee must be available to provide care within 10 minutes after being informed that his or her services are needed.

     3.  A residential facility must not accept residents in excess of the number of residents specified on the license issued to the owner of the facility.

     4.  The administrator of a residential facility shall maintain monthly a written schedule that includes the number and type of members of the staff of the facility assigned for each shift. The schedule must be amended if any changes are made to the schedule. The schedule must be retained for at least 6 months after the schedule expires.

     5.  An employee of a residential facility who is less than 18 years of age must be under the direct supervision of an employee who is 18 years of age or older.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.200  Personnel files. (NRS 449.0302)

     1.  Except as otherwise provided in subsection 2, a separate personnel file must be kept for each member of the staff of a facility and must include:

     (a) The name, address, telephone number and social security number of the employee;

     (b) The date on which the employee began his or her employment at the residential facility;

     (c) Records relating to the training received by the employee;

     (d) The health certificates required pursuant to chapter 441A of NAC for the employee;

     (e) Evidence that the references supplied by the employee were checked by the residential facility; and

     (f) Evidence of compliance with NRS 449.122 to 449.125, inclusive.

     2.  The personnel file for a caregiver of a residential facility must include, in addition to the information required pursuant to subsection 1:

     (a) A certificate stating that the caregiver is currently certified to perform first aid and cardiopulmonary resuscitation; and

     (b) Proof that the caregiver is 18 years of age or older.

     3.  The administrator may keep the personnel files for the facility in a locked cabinet and may, except as otherwise provided in this subsection, restrict access to this cabinet by other employees of the facility. Copies of the documents which are evidence that an employee has been certified to perform first aid and cardiopulmonary resuscitation and that the employee has been tested for tuberculosis must be available for review at all times. The administrator shall make the personnel files available for inspection by the Bureau within 72 hours after the Bureau requests to review the files.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.202  Rights of staff members during investigation of facility; duties of investigator. (NRS 449.0302)

     1.  Upon the request of the administrator of a residential facility or any other member of the staff of the facility, a person who is conducting an investigation of the facility pursuant to NRS 449.0307 shall:

     (a) Identify himself or herself and provide the name and telephone number of his or her supervisor; and

     (b) Inform the administrator or other member of the staff of the facility of the reason for the investigation.

     2.  The person who is conducting the investigation shall:

     (a) Treat the members of the staff of the facility in a professional and respectful manner;

     (b) Conduct an unbiased investigation; and

     (c) Provide to the administrator of the facility an accurate report of the findings of the investigation, including a description of each deficiency found and a citation to the section of NAC 449.002 to 449.99939, inclusive, or chapter 449 of NRS which has been violated.

     3.  After the investigation has been completed, the person conducting the investigation shall, upon the request of a member of the staff of the facility:

     (a) Provide the member of the staff of the facility with the opportunity to:

          (1) Ask questions concerning the findings of the investigation; and

          (2) Review with the person who conducted the investigation the provisions of NAC 449.002 to 449.99939, inclusive, and chapter 449 of NRS that the investigator believes were violated; and

     (b) Provide to the member of the staff of the facility the details of any complaints received by the Division concerning the facility, other than details that may reveal the identity of the person who submitted the complaint.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

General Operational Requirements

      NAC 449.204  System of financial accounting; insurance. (NRS 449.0302)

     1.  A residential facility shall:

     (a) Maintain a recognized system of financial accounting; and

     (b) Maintain a contract of insurance for protection against liability to third persons in amounts appropriate for the protection of residents, employees, volunteers and visitors to the facility.

     2.  A certificate of insurance must be furnished to the Division as evidence that the contract required by subsection 1 is in force, and a license must not be issued until that certificate is furnished. Each contract of insurance must contain an endorsement providing for a notice of 30 days to the Bureau before the effective date of a cancellation or nonrenewal of the policy.

     [Bd. of Health, Group Care Facilities §§ 5.1-5.4, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.205  Advertising and promotional materials. (NRS 449.0302)  Advertising and promotional materials for a residential facility must be accurate and not misrepresent accommodations, services or programs offered by the facility.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97, 10-30-97)

      NAC 449.208  Restrictions on conducting other businesses or providing other services on premises. (NRS 449.0302)  No other business may be conducted or other services may be provided on the premises of a residential facility if the business or services would interfere with the operation of the facility or the care provided to the residents of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.209  Health and sanitation. (NRS 449.0302)

     1.  A residential facility must:

     (a) Have a safe and sufficient supply of water, adequate drainage and an adequate system for the disposal of sewage; and

     (b) Comply with all local ordinances and state and federal laws and regulations relating to zoning, sanitation, accessibility to persons with disabilities and safety.

     2.  Containers used to store garbage outside of the facility must be kept reasonably clean and must be covered in such a manner that rodents are unable to get inside the containers. At least once each week, the containers must be emptied and the contents of the containers must be removed from the premises of the facility.

     3.  Containers used to store garbage in the kitchen and laundry room of the facility must be covered with a lid unless the containers are kept in an enclosed cupboard that is clean and prevents infestation by rodents or insects. Containers used to store garbage in bedrooms and bathrooms are not required to be covered unless they are used for food, bodily waste or medical waste.

     4.  To the extent practicable, the premises of the facility must be kept free from:

     (a) Offensive odors;

     (b) Hazards, including obstacles that impede the free movement of residents within and outside the facility;

     (c) Insects and rodents; and

     (d) Accumulations of dirt, garbage and other refuse.

     5.  The administrator of a residential facility shall ensure that the premises are clean and that the interior, exterior and landscaping of the facility are well maintained.

     6.  All windows that are capable of being opened in the facility and all doors that are left open to provide ventilation for the facility must be screened to prevent the entry of insects.

     7.  The facility must maintain electrical lighting as necessary to ensure the comfort and safety of the residents of the facility.

     8.  The temperature in the facility must be maintained at a level that is not less than 68 degrees Fahrenheit and not more than 82 degrees Fahrenheit.

     9.  If the door of a bathroom opens into any room in which food or utensils for eating are handled or stored, the door must close automatically.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99)

      NAC 449.211  Automatic sprinkler systems. (NRS 449.0302)

     1.  After January 14, 1997, the Division shall withhold the issuance of an initial license to operate a residential facility that does not have an automatic sprinkler system which complies with the provisions of chapter 477 of NRS and any local ordinances relating to the installation of automatic sprinkler systems.

     2.  Except as otherwise provided in subsection 3, a residential facility with less than seven residents that is issued a license on or before January 14, 1997, shall install an automatic sprinkler system that complies with the provisions of chapter 477 of NRS and any local ordinances relating to the installation of automatic sprinkler systems if:

     (a) The ownership of the facility is transferred to a new owner;

     (b) The number of beds in the facility is increased;

     (c) The facility is currently authorized to admit or retain category 1 residents only and wishes to apply for authorization to admit or retain category 2 residents; or

     (d) The facility is not currently authorized to admit or retain residents who suffer from Alzheimer’s disease or other related dementia and the facility wishes to apply for authorization to admit or retain such residents.

     3.  A residential facility with less than seven residents that was issued its initial license on or before January 14, 1997, may not admit or retain a category 2 resident, unless an automatic sprinkler system that complies with the provisions of chapter 477 of NRS and any local ordinances relating to the installation of automatic sprinkler systems is installed in the facility. Not more than one resident who is confined to a wheelchair or who is required to use a walker may be admitted to such a facility at any time unless such an automatic sprinkler system is installed in the facility.

     4.  An automatic sprinkler system that has been installed in a residential facility must be inspected:

     (a) Not less than once each calendar quarter by a person who understands the manner in which the system operates and the manner in which it should be maintained; and

     (b) Not less than once each calendar year by a person who is licensed to inspect such a system pursuant to the provisions of chapter 477 of NAC.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.213  Laundry and linen services. (NRS 449.0302)

     1.  A residential facility shall:

     (a) Provide laundry and linen services on the premises of the facility; or

     (b) Contract with a commercial laundry for the provision of those services.

     2.  A residential facility that provides its own laundry and linen services shall have accommodations which are adequate for the proper and sanitary washing and finishing of linen and other washable goods.

     3.  The laundry room in a residential facility must be situated in an area which is separate from an area where food is stored, prepared or served. The laundry must be adequate in size for the needs of the facility and maintained in a sanitary manner. The laundry room must contain at least one washer and at least one dryer. All the equipment must be kept in good repair. All dryers must be ventilated to outside the building. If a washer or dryer is located outside the residential facility, the washer or dryer must be in a room or enclosure.

     4.  Clothes, bedding, linens and any other materials laundered pursuant to subsection 1 must be made clean by the laundering process. If a residential facility provides its own laundry and linen services, the residential facility shall:

     (a) Make appropriate use of detergents, soaps, heat or chemicals; and

     (b) Take precautions to ensure that no resident, member of the staff of the facility or other person in the facility is harmed by exposure to the detergents, soaps, heat or chemicals used in the laundering process.

     [Bd. of Health, Group Care Facilities § 14.8, eff. 12-18-75; A 5-7-82; §§ 14.8.1-14.10.2, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.216  Common areas; dining rooms. (NRS 449.0302)

     1.  A residential facility must have at least one centrally located common area in which residents may socialize and participate in recreational activities. A common area may include, without limitation, a living room, dining room, enclosed porch or solarium.

     2.  The common areas must be large enough to accommodate those to be served without overcrowding the areas. A minimum area of 15 square feet of total common area space per person must be provided.

     3.  All common areas must be furnished and equipped with comfortable furniture.

     4.  The dining room must be of sufficient size to accommodate all the residents comfortably. A minimum area of 10 square feet per person must be provided.

     5.  The dining room must be conveniently located near the kitchen to ensure the rapid and efficient serving of food.

     [Bd. of Health, Group Care Facilities §§ 15.1-15.2.3, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97)

      NAC 449.217  Kitchens; storage of food; adequate supplies of food; permits; inspections. (NRS 449.0302)

     1.  The equipment in a kitchen of a residential facility and the size of the kitchen must be adequate for the number of residents in the facility. The kitchen and the equipment must be clean and must allow for the sanitary preparation of food. The equipment must be in good working condition.

     2.  Perishable foods must be refrigerated at a temperature of 40 degrees Fahrenheit or less. Frozen foods must be kept at a temperature of 0 degrees Fahrenheit or less.

     3.  Sufficient storage must be available for all food and equipment used for cooking and storing food. Food that is stored must be appropriately packaged.

     4.  The administrator of a residential facility shall ensure that there is at least a 2-day supply of fresh food and at least a 1-week supply of canned food in the facility at all times.

     5.  Pesticides and other toxic substances must not be stored in any area in which food, kitchen equipment, utensils or paper products are stored. Soaps, detergents, cleaning compounds and similar substances must not be stored in any area in which food is stored.

     6.  A residential facility with more than 10 residents shall:

     (a) Comply with the standards prescribed in chapter 446 of NAC; and

     (b) Obtain the necessary permits from the Division.

     7.  The equipment used for cooking and storing food and for washing dishes in a residential facility with more than 10 residents must be inspected and approved by the Division and the state and local fire safety authorities.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R155-10, 12-16-2010)

      NAC 449.2175  Service of food; seating; menus; special diets; nutritional requirements; dietary consultants. (NRS 449.0302)

     1.  A residential facility shall have adequate facilities and equipment for the preparation, service and storage of food.

     2.  Tables and chairs must be of proper height and of sufficient number to provide seating for the number of residents authorized for the facility. They must be sturdy and have easily washable surfaces. Chairs must be constructed so that they do not overturn easily.

     3.  Menus must be in writing, planned a week in advance, dated, posted and kept on file for 90 days.

     4.  A resident who has been placed on a special diet by a physician or licensed dietitian must be provided a meal that complies with the diet. The administrator of the facility shall ensure that records of any modifications to the menu to accommodate for special diets prescribed by a physician or licensed dietitian are kept on file for at least 90 days.

     5.  Any substitution for an item on the menu must be documented and kept on file with the menu for at least 90 days after the substitution occurs. A substitution must be posted in a conspicuous place during the serving of the meal.

     6.  Each meal must provide a reasonable portion of the daily dietary allowances recommended by the Food and Nutrition Board of the Institute of Medicine of the National Academies.

     7.  Meals must be nutritious, served in an appropriate manner, suitable for the residents and prepared with regard for individual preferences and religious requirements. At least three meals a day must be served at regular intervals. The times at which meals will be served must be posted. Not more than 14 hours may elapse between the meal in the evening and breakfast the next day. Snacks must be made available between meals for the residents who are not prohibited by their physicians from eating between meals.

     8.  A resident must be served meals in his or her bedroom for not more than 14 consecutive days if the resident is temporarily unable to eat in the dining room because of an injury or illness. The facility may serve meals to other residents in their rooms upon request. If a meal is served to a resident in his or her room because the resident is unable to eat in the dining room, the facility shall maintain a record of the times and reasons for serving meals to the resident in his or her room.

     9.  A residential facility with more than 10 residents shall employ or otherwise obtain the services of a person to serve as a consultant for the planning and serving of meals who:

     (a) Is a licensed dietitian; or

     (b) Is a graduate from an accredited college with a major in food and nutrition and has 2 years of supervisory experience in a medical facility or facility for the dependent or has participated in a course of training for a supervisor of the service of food.

     10.  The person providing services pursuant to subsection 9 shall provide those services not less than once each calendar quarter. The administrator of the facility shall keep a written record of the consultations on file at the facility. The consultations must include:

     (a) The development and review of weekly menus;

     (b) Training for the employees who work in the kitchen;

     (c) Advice regarding compliance with the nutritional program of the facility; and

     (d) Any observations of the person providing the services regarding the preparation and service of meals in the facility to ensure that the facility is in compliance with the nutritional program of the facility.

     [Bd. of Health, Group Care Facilities §§ 12.1-12.8.1, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004; R090-12, 12-20-2012)

      NAC 449.218  Bedrooms: Floor space; windows and doors; privacy; storage space; bedding; personal furnishings; lighting. (NRS 439.200, 449.0302)

     1.  A bedroom in a residential facility that is shared by two or three residents must have at least 60 square feet of floor space for each resident who resides in the bedroom. A resident may not share a bedroom with more than two other residents. A bedroom that is occupied by only one resident must have at least 80 square feet of floor space.

     2.  Each bedroom in a residential facility must have one or more windows to the outside that can be opened from the inside of the room without the use of tools or a door to the outside which is at least 36 inches wide and can be opened from the inside.

     3.  The combined size of the panes of glass of the windows in a bedroom in a facility that was issued a license on or after January 14, 1997, must equal not less than 8 percent of the floor space in the room.

     4.  The arrangement of the beds and other furniture in the bedroom must provide privacy for and promote the safety of the residents occupying the bedroom. Adjustable curtains, shades, blinds or similar devices must be provided for visual privacy.

     5.  Each resident must be provided:

     (a) At least 10 square feet of space for storage in a bedroom for each bed in the bedroom; and

     (b) At least 24 inches of space in a permanent or portable closet for hanging garments.

     6.  A separate bed with a comfortable and clean mattress must be made available for each resident. The bed must be at least 36 inches wide. Two clean sheets, a blanket, a pillow and a bedspread must be available for each bed. Linens must be changed at least once each week and more often if the linens become dirty. Additional bedding, including protective mattress covers, must be provided if necessary.

     7.  Upon the request of a resident, a residential facility may authorize the resident to use personal furniture and furnishings that comply with the requirements of subsection 6 if their use does not jeopardize the health and safety of any of the residents of the facility.

     8.  There must be a light outside the entrance to each bedroom to provide a resident with adequate lighting to reach safely a switch for turning on a light fixture inside the bedroom. Upon the request of a resident, bedside lighting must be provided.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R119-10, 1-13-2011; R048-22, 12-29-2022)

      NAC 449.220  Bedroom doors. (NRS 449.0302)

     1.  A bedroom door in a residential facility which is equipped with a lock must open with a single motion from the inside unless the lock provides security for the facility and can be operated without a key or any special knowledge.

     2.  A bedroom door must not be equipped with a deadbolt lock or chain stop unless the door opens directly to the outside of the facility. The doors of a bedroom and the doors of the closets in the bedroom may be equipped with locks for use by residents if:

     (a) The doors may be unlocked with a single motion from inside the bedroom or closet without the use of a key; and

     (b) The doors of the bedroom may be unlocked from outside the room and the keys are readily available at all times.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.221  Use of certain areas in facility as bedroom prohibited. (NRS 449.0302)  A hall, stairway, unfinished attic, garage, storage area or shed or other similar area of a residential facility must not be used as a bedroom. Any other room must not be used as a bedroom if it:

     1.  Can only be reached by passing through a bedroom occupied by another resident; or

     2.  Is used for any other purpose.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.222  Bathrooms and toilet facilities; toilet articles. (NRS 449.0302)

     1.  Each residential facility with less than seven residents that was issued an initial license before January 14, 1997, must have bathroom facilities in sufficient number to accommodate the residents, the members of the staff of the facility and other persons at the facility.

     2.  Each residential facility that is issued an initial license on or after January 14, 1997, must have:

     (a) A flush toilet and lavatory for each four residents; and

     (b) A tub or shower for each six residents.

     3.  The bottoms of tubs and showers must have surfaces that inhibit falling and slipping. Cabinets that are attached to the floor or grab bars must be adjacent to the tubs, toilets and showers.

     4.  All bathrooms and toilet facilities must be located convenient to sleeping, recreational and living areas. A bathroom must have a window that can be opened or a vent to outside the facility.

     5.  Provision must be made for privacy in all bathrooms and toilet facilities in rooms intended for use by more than one person.

     6.  Bathroom doors that are equipped with locks must open with a single motion from the inside without the use of a key. If a key is required to open a lock from outside the bathroom, the key must be readily available at all times.

     7.  Each resident must have his or her own toilet articles and must be provided with toilet paper, individual towels and washcloths. Paper towels may be used for hand towels. The towels and washcloths must be changed as often as is necessary to maintain cleanliness, but in no event less often than once each week. A soap dispenser may be used instead of individual bars of soap.

     8.  All bathrooms and toilet facilities must be sufficiently lighted, and night-lights must be provided in hallways that lead from the bedrooms to the bathrooms and toilet facilities.

     [Bd. of Health, Group Care Facilities §§ 15.4-15.4.6 & 15.6, eff. 12-18-75; § 15.5, eff. 12-18-75; A 5-7-82]—(NAC A by R003-97, 10-30-97)

      NAC 449.224  Housing for staff members. (NRS 449.0302)

     1.  Bedrooms must be provided for any members of the staff of a residential facility and their families who live at a residential facility. The bedrooms must comply with the provisions of subsections 2 to 8, inclusive, of NAC 449.218 and the provisions of NAC 449.220 and 449.221.

     2.  Members of the staff of the facility and their families who live at the facility shall be deemed residents of the facility for the purposes of determining the number of toilets, lavatories and tubs or showers the facility is required to have pursuant to NAC 449.222. All toilets, lavatories and tubs or showers used by the members of the staff of the facility or their families must comply with the provisions of NAC 449.222.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.226  Safety requirements for residents with restricted mobility or poor eyesight; water hazards; auditory systems for bathrooms and bedrooms; access by vehicles. (NRS 449.0302)

     1.  A resident of a residential facility who uses a wheelchair or a walker must not be required to use a bedroom on a floor other than the first floor of the facility that is entirely above the level of the ground, unless the facility is designed and equipped in such a manner that the resident can move between floors without assistance.

     2.  Stairways, inclines, ramps, open porches and other areas that are potentially hazardous for residents who have poor eyesight must be adequately lighted.

     3.  If a residential facility with a resident who is mentally or physically disabled has a fishpond, pool, hot tub, jacuzzi or other body of water on the premises of the facility, the body of water must be fenced, covered or blocked in some other manner at all times when it is not being used by a resident.

     4.  In a residential facility with more than 10 residents:

     (a) Each resident must be provided with, or the bedroom and bathroom of each resident must be equipped with, an auditory system that is monitored by a member of the staff of the facility.

     (b) An auditory system must be available for use in the bathroom of each resident of the facility if the facility was issued its initial license on or after January 14, 1997, so that a resident needing assistance can alert a member of the staff of the facility of that fact from the toilet and the shower.

     (c) A bathroom that is located in a common area of the facility must be equipped with an auditory system that is monitored by a member of the staff of the facility.

     5.  Residential facilities must be easily accessible by vehicle in the case of an emergency.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99)

      NAC 449.227  Accommodations for residents with restricted mobility. (NRS 449.0302)  A residential facility with a resident who uses a wheelchair or a walker shall:

     1.  Have hallways, doorways and exits wide enough to accommodate a wheelchair or walker;

     2.  Have ramps to accommodate access to areas used by residents; and

     3.  Provide assistance to such a resident at all steps located inside the facility on the first floor that is entirely above grade.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.229  Requirements and precautions regarding safety from fire. (NRS 449.0302)

     1.  The administrator of a residential facility shall ensure that the facility complies with the regulations adopted by the State Fire Marshal pursuant to chapter 477 of NRS and all local ordinances relating to safety from fire. The facility must be approved for residency by the State Fire Marshal.

     2.  The Bureau shall notify the State Fire Marshal or the appropriate local government, as applicable, if, during an inspection of a residential facility, the Bureau knows of or suspects the presence of a violation of a regulation of the State Fire Marshal or a local ordinance relating to safety from fire.

     3.  An exit door in a residential facility must not be equipped with a lock that requires a key to open it from the inside unless approved by the State Fire Marshal or his or her designee.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.231  First aid and cardiopulmonary resuscitation. (NRS 449.0302)

     1.  Within 30 days after an administrator or caregiver of a residential facility is employed at the facility, the administrator or caregiver must be trained in first aid and cardiopulmonary resuscitation. The advanced certificate in first aid and adult cardiopulmonary resuscitation issued by the American Red Cross or an equivalent certification will be accepted as proof of that training.

     2.  A first-aid kit must be available at the facility. The first-aid kit must include, without limitation:

     (a) A germicide safe for use by humans;

     (b) Sterile gauze pads;

     (c) Adhesive bandages, rolls of gauze and adhesive tape;

     (d) Disposable gloves;

     (e) A shield or mask to be used by a person who is administering cardiopulmonary resuscitation; and

     (f) A thermometer or other device that may be used to determine the bodily temperature of a person.

     3.  Except for first aid in an emergency, no treatment or medication may be administered to a resident without the approval of a physician.

     [Bd. of Health, Group Care Facilities §§ 16.9-16.12.3, eff. 12-18-75; § 16.13, eff. 5-7-82]—(NAC A 3-6-86; R003-97, 10-30-97)

      NAC 449.232  Telephones; emergency telephone numbers for each resident; listing of facility’s telephone number. (NRS 449.0302)

     1.  Each residential facility shall have a telephone that the residents may use to make local calls.

     2.  A list of telephone numbers to be called in case of an emergency for each resident must be located near the telephone. The list must include the telephone number of the resident’s physician and the telephone number of a friend of the resident or one of the members of the resident’s family.

     3.  The telephone number of the facility must be listed in the telephone directory under the name of the facility.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.241  Limitations on use of volunteers; requirements concerning residents who volunteer to assist staff or perform other duties. (NRS 449.0302)

     1.  Volunteers may be used to supplement the services and programs of a residential facility, but may not be used to replace members of the staff of the facility.

     2.  A resident may volunteer to help the employees of the facility in a manner that does not create an unsafe condition for the resident, other residents or the members of the staff of the facility.

     3.  A resident must not be required to perform duties normally performed by the staff of the facility. If a resident volunteers to perform such duties, the administrator of the facility shall ensure that the resident’s records include a statement that the resident has volunteered to perform those duties.

     4.  A resident who is performing duties pursuant to this section must not be allowed access to confidential files.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97, 10-30-97)

      NAC 449.258  Written policies for facility; policy on visiting hours; residents’ mail; compliance with policies. (NRS 449.0302)

     1.  Written policies for a residential facility that comply with the provisions of NAC 449.156 to 449.27706, inclusive, must be developed.

     2.  A policy on visiting hours must be established to promote contact by the residents with persons who are not residents of the facility. The policy regarding visits must be flexible to ensure that every resident has the opportunity to retain and strengthen ties with family and friends.

     3.  Assurances must be provided that incoming and outgoing mail for a resident will not be interfered with in any way, unless written permission is obtained from the resident or his or her representative. Permission obtained from the resident or the representative may specifically state the type of mail that may be interfered with by the members of the staff of the facility. Permission granted by a resident or the representative pursuant to this subsection may be revoked by the resident at any time.

     4.  The employees of the facility shall comply with the policies developed pursuant to this section.

     [Bd. of Health, Group Care Facilities §§ 11.1-11.7.1, eff. 12-18-75]—(NAC A by R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.259  Supervision and treatment of residents generally. (NRS 449.0302)

     1.  A residential facility shall:

     (a) Provide each resident with protective supervision as necessary;

     (b) Inform all caregivers of the required supervision;

     (c) Provide each resident with the opportunity to attend the religious service of his or her choice and participate in personal and private pastoral counseling;

     (d) Permit a resident to rest in his or her room at any time;

     (e) Permit a resident to enter or leave the facility at any time if the resident:

          (1) Is physically and mentally capable of leaving the facility; and

          (2) The resident complies with the rules established by the administrator of the facility for leaving the facility;

     (f) Provide laundry services for each resident unless a resident elects in writing to make other arrangements;

     (g) Ensure that each resident’s clothes are clean, comfortable and presentable; and

     (h) Inform each resident or his or her representative of the actions that the resident should take to protect the resident’s valuables.

     2.  The administrator of a residential facility may require a resident who leaves the facility to inform a member of the staff of the facility upon his or her departure and return.

     3.  The employees of a residential facility shall:

     (a) Treat each resident in a kind and considerate manner; and

     (b) Respect each resident’s independence and ability to make decisions on his or her own, whenever possible.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.260  Activities for residents. (NRS 449.0302)

     1.  The caregivers employed by a residential facility shall:

     (a) Ensure that the residents are afforded an opportunity to enjoy their privacy, participate in physical activities, relax and associate with other residents;

     (b) Provide group activities that provide mental and physical stimulation and develop creative skills and interests;

     (c) Plan recreational opportunities that are suited to the interests and capacities of the residents;

     (d) Provide each resident with a written program of activities;

     (e) Provide for the residents at least 10 hours each week of scheduled activities that are suited to their interests and capacities;

     (f) Encourage the residents to participate in the activities scheduled pursuant to paragraph (e); and

     (g) Post, in a common area of the facility, a calendar of activities for each month that notifies residents of the major activities that will occur in the facility. The calendar must be:

          (1) Prepared at least 1 month in advance; and

          (2) Kept on file at the facility for not less than 6 months after it expires.

     2.  The administrator of a residential facility with at least 20 residents shall appoint a member of the staff of the facility who will be responsible for the organization, conduct and evaluation of activities for the residents. The person so appointed shall ensure that the activities are suited to the interests and capacities of the residents.

     3.  The administrator of a residential facility with 50 or more residents shall, in addition to appointing a member of the staff of the facility pursuant to subsection 2, appoint such other members of the staff as the administrator deems necessary to assist the person who is responsible for conducting the activities.

     4.  A residential facility shall have areas of sufficient size to conduct indoor and outdoor activities, including, without limitation:

     (a) A common area that complies with the provisions of NAC 449.216; and

     (b) An outdoor activity area that is easily accessible for the residents and is safe from vehicular traffic.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.262  Provision of dental, optical and hearing care and social services; report of suspected abuse, neglect, isolation or exploitation; restrictions on use of restraints, confinement or sedatives. (NRS 449.0302)

     1.  The administrator of a residential facility shall ensure that residents are provided with or are assisted in obtaining dental and optical care, treatment for hearing and hearing impairment and social services. The employees of the facility shall maintain a record of the services or assistance provided pursuant to this subsection.

     2.  If an employee of the facility suspects that a resident is being abused, neglected, isolated or exploited, the employee shall report that fact in the manner prescribed in NRS 200.5093.

     3.  The members of the staff of a residential facility shall not:

     (a) Use restraints on any resident;

     (b) Lock a resident in a room inside the facility; or

     (c) Provide sedatives to a resident unless that sedative has been prescribed for that resident by a physician to treat specific symptoms. A caregiver shall make a record of the behavior of a resident who has been prescribed a sedative.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.267  Money and property of residents. (NRS 449.0302)

     1.  An employee of a residential facility shall not handle a resident’s money without first being requested to do so in writing by the resident or his or her representative.

     2.  An accurate record must be kept of all money deposited with the facility for use by the resident, including withdrawals. The record must include:

     (a) A separate accounting of the money held by the facility on behalf of the resident;

     (b) Receipts for expenditures made by the facility on behalf of the resident; and

     (c) A written acknowledgment by the resident for each withdrawal of his or her money.

     3.  Unless a resident otherwise requests in writing, all money in excess of $400 held by the facility on behalf of the resident must be maintained in a financial institution in an account separate from the facility’s operating accounts and must be clearly designated as such.

     4.  Each resident must have access to his or her money held at the facility on his or her behalf during normal business hours on each business day.

     5.  If a member of the staff of a residential facility receives from a resident a request to make a withdrawal of money in such an amount that the member of the staff has reason to believe that the resident is being or has been exploited, the member of the staff shall report the transaction to:

     (a) If the resident is 60 years of age or older:

          (1) The local office of the Aging and Disability Services Division of the Department of Health and Human Services;

          (2) The local law enforcement agency;

          (3) The office for protective services for the county in which the facility is located if that county has such an office; or

          (4) The toll-free telephone service designated by the Aging and Disability Services Division pursuant to NRS 200.5093.

     (b) If the resident is less than 60 years of age:

          (1) The office for protective services for the county in which the facility is located if that county has such an office; or

          (2) The local law enforcement agency if the county in which the facility is located does not have an office for protective services.

     6.  Except as otherwise provided in subsection 7, an operator or employee of a residential facility shall not accept appointment as a guardian or conservator of the estate of any resident, become a substitute payee for any payments made to any resident or accept an appointment as an attorney in fact for any resident.

     7.  If a resident whose only source of income is in the form of monthly checks is legally determined to be unable to manage his or her money and documentary evidence can be produced showing that efforts to obtain a legal guardian have failed, the facility may be the substitute payee on the checks. Records of all checks received, deposited or dispersed by the facility must be maintained in the resident’s file.

     8.  Money that is held by a residential facility on behalf of a resident must be returned to the resident or his or her representative within 30 days after the resident is discharged from the facility.

     9.  An employee of a residential facility shall not borrow money from a resident.

     [Bd. of Health, Group Care Facilities §§ 11.15-11.19.1, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.268  Rights of residents; procedure for filing grievance, complaint or report of incident; investigation and response. (NRS 449.0302)

     1.  The administrator of a residential facility shall ensure that:

     (a) The residents are not abused, neglected or exploited by a member of the staff of the facility, another resident of the facility or any person who is visiting the facility;

     (b) A resident is not prohibited from speaking to any person who advocates for the rights of the residents of the facility;

     (c) The residents are treated with respect and dignity;

     (d) The facility is a safe and comfortable environment;

     (e) Residents are not prohibited from interacting socially;

     (f) Residents are allowed to make their own decisions whenever possible;

     (g) Residents are aware that they may file a complaint or grievance with the administrator and that a resident who files such a complaint receives a response in a timely manner;

     (h) A resident is informed as soon as practicable that the resident is being moved to a new room or that he or she is receiving a new roommate; and

     (i) Residents are afforded the opportunity to initiate an advance directive or power of attorney for health care and that the employees of the facility comply with the wishes contained in such a document.

     2.  The administrator of a residential facility shall provide a procedure to respond immediately to grievances, incidents and complaints. The procedure must include a method for ensuring that the administrator or a person designated by the administrator is notified of the grievance, incident or complaint. The administrator or a person designated by the administrator shall personally investigate the matter. A resident who files a grievance or complaint or reports an incident pursuant to this subsection must be notified of the action taken in response to the grievance, complaint or report or be given a reason why no action needs to be taken.

     3.  The employees of the facility shall comply with the procedures adopted pursuant to subsection 2.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

Admitting, Transferring and Discharging Residents

      NAC 449.2702  Written policy on admissions; eligibility for residency. (NRS 449.0302)

     1.  Each residential facility shall have a written policy on admissions which includes:

     (a) A statement of nondiscrimination regarding admission to the facility and treatment after admission; and

     (b) The requirements for eligibility as a resident of that type of facility.

     2.  A person who wishes to reside in a residential facility with residents that require a higher category of care than the person requires may reside in the facility if he or she is not otherwise prohibited from residing in the facility.

     3.  A person who is admitted to a residential facility must be at least 18 years of age.

     4.  Except as otherwise provided in NAC 449.275 and 449.2754, a residential facility shall not admit or allow to remain in the facility any person who:

     (a) Is bedfast;

     (b) Requires restraint;

     (c) Requires confinement in locked quarters; or

     (d) Requires skilled nursing or other medical supervision on a 24-hour basis.

     5.  A person may not reside in a residential facility if the person’s physician or the Bureau determines that the person does not comply with the requirements for eligibility.

     6.  As used in this section:

     (a) “Bedfast” means a condition in which a person is:

          (1) Incapable of changing his or her position in bed without the assistance of another person; or

          (2) Immobile.

     (b) “Restraint” means:

          (1) A psychopharmacologic drug that is used for discipline or convenience and is not required to treat medical symptoms;

          (2) A manual method for restricting a resident’s freedom of movement or the resident’s normal access to his or her body; or

          (3) A device or material or equipment which is attached to or adjacent to a resident’s body that cannot be removed easily by the resident and restricts the resident’s freedom of movement or the resident’s normal access to his or her body.

     [Bd. of Health, Group Care Facilities § 7.1, eff. 12-18-75; §§ 7.2-7.4.2, eff. 12-18-75; A 5-7-82; §§ 7.5-7.6.4, eff. 12-18-75]—(NAC A 3-6-86; 8-1-91; R003-97, 10-30-97; R073-03, 1-22-2004; R118-05, 11-17-2005)

      NAC 449.2704  Disclosure of information concerning rates and payment for services. (NRS 449.0302)  The administrator of a residential facility shall, upon request, make the following information available in writing:

     1.  The basic rate for the services provided by the facility;

     2.  The schedule for payment;

     3.  The services included in the basic rate;

     4.  The charges for optional services which are not included in the basic rate; and

     5.  The residential facility’s policy on refunds of amounts paid but not used.

     (Added to NAC by Bd. of Health, eff. 3-6-86; A by R003-97, 10-30-97; R052-99, 9-27-99)

      NAC 449.2706  Transfer of resident whose condition deteriorates. (NRS 449.0302)

     1.  If a resident’s condition deteriorates to such an extent that:

     (a) The residential facility is unable to provide the services necessary to treat the resident properly; or

     (b) The resident no longer complies with the requirements for admission to the facility,

Ê the facility shall plan for the transfer of the resident pursuant to NRS 449A.100 and 449A.103 to another facility that is able to provide the services necessary to treat the resident properly.

     2.  A resident, his or her next of kin and the responsible agency, if any, must be consulted and adequate arrangements must be made to meet the resident’s needs through other means before he or she permanently leaves the facility.

     [Bd. of Health, Group Care Facilities §§ 10.1-10.3, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.2707  Transfer of resident: Effective date. (NRS 449.0302)  The transfer of a resident from a residential facility occurs:

     1.  Except as otherwise provided in subsection 2, on the date that the resident is admitted to the facility to which he or she is moved; or

     2.  If the resident is moved to a unit or department of a hospital, other than the emergency department of the hospital, on the date that the resident is accepted at the hospital for care or observation.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

      NAC 449.2708  Discharge of resident; notice of discharge; issuance of notice to quit to resident for improper or harmful behavior. (NRS 449.0302)

     1.  A resident may be discharged from a residential facility without his or her approval if:

     (a) The resident fails to pay his or her bill within 5 days after it is due;

     (b) The resident fails to comply with the rules or policies of the facility; or

     (c) The administrator of the facility or the Bureau determines that the facility is unable to provide the necessary care for the resident.

     2.  Except as otherwise provided in this section, before a resident may be discharged from a residential facility without his or her approval pursuant to this section, the facility must provide the resident, his or her representative and the person who pays the bill on behalf of the resident, if any, with written notice that the resident will be discharged.

     3.  A residential facility shall discharge a resident who is transferred pursuant to NRS 449A.100 and 449A.103 and admitted to another facility for a higher level of care. Written notice pursuant to subsection 2 that the resident will be discharged is not required if the condition of the resident necessitates immediate transfer to receive emergency care.

     4.  If the resident or any of his or her visitors are engaging in behavior which is a threat to the mental or physical health or safety of the resident or other persons in the facility, the facility may issue a notice to quit to the resident. The notice to quit must include:

     (a) The reasons for its issuance, with specific facts relating to the date, time and place of the incidents that posed a threat to the physical or mental health or safety of the resident or other persons in the facility; and

     (b) The names of persons who witnessed the incidents and the circumstances under which the incidents occurred.

Ê If the resident or his or her visitors do not comply with the notice to quit, the resident may be discharged from the facility without his or her approval pursuant to subsection 2.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)

Restrictions on Admitting or Retaining Residents With Certain Medical Needs or Conditions

      NAC 449.271  Residents requiring gastrostomy care or suffering from staphylococcus infection or other serious infection or medical condition. (NRS 439.200, 449.0302)

      1.  Except as otherwise provided in subsection 2 and NAC 449.2736, a person must not be admitted to a residential facility or permitted to remain as a resident of a residential facility if he or she:

     (a) Requires gastrostomy care;

     (b) Suffers from a staphylococcus infection or other serious infection; or

     (c) Suffers from any other serious medical condition that is not described in NAC 449.2712 to 449.2734, inclusive.

     2.  If a governmental entity with jurisdiction, including, without limitation, a local board of health, a local health officer, the Division, the Chief Medical Officer or the Centers for Disease Control and Prevention of the United States Department of Health and Human Services, declares the existence of an epidemic or pandemic, a residential facility located in the area in which the epidemic or pandemic is occurring may permit a resident suffering from a serious infection to remain a resident if the resident does not have symptoms that require a higher level of care than the residential facility is capable of providing.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R048-22, 12-29-2022)

      NAC 449.2712  Residents requiring use of oxygen. (NRS 449.0302)

     1.  A person who requires the use of oxygen must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless he or she:

     (a) Is mentally and physically capable of operating the equipment that provides the oxygen; or

     (b) Is capable of:

          (1) Determining his or her need for oxygen; and

          (2) Administering the oxygen to himself or herself with assistance.

     2.  The caregivers employed by a residential facility with a resident who requires the use of oxygen shall:

     (a) Monitor the ability of the resident to operate the equipment in accordance with the orders of a physician; and

     (b) Ensure that:

          (1) The resident’s physician evaluates periodically the condition of the resident which necessitates his or her use of oxygen;

          (2) Signs which prohibit smoking and notify persons that oxygen is in use are posted in areas of the facility in which oxygen is in use or is being stored;

          (3) Persons do not smoke in those areas where smoking is prohibited;

          (4) All electrical equipment is inspected for defects which may cause sparks;

          (5) All oxygen tanks kept in the facility are secured in a stand or to a wall;

          (6) The equipment used to administer oxygen is in good working condition;

          (7) A portable unit for the administration of oxygen in the event of a power outage is present in the facility at all times when a resident who requires oxygen is present in the facility; and

          (8) The equipment used to administer oxygen is removed from the facility when it is no longer needed by the resident.

     3.  The administrator of a residential facility shall ensure that the caregivers who may be required to administer oxygen have demonstrated the ability to operate properly the equipment used to administer oxygen.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2714  Residents requiring use of intermittent positive pressure breathing equipment. (NRS 449.0302)

     1.  A person who requires the use of intermittent positive pressure breathing equipment must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The resident is mentally and physically capable of operating and disinfecting the equipment and is capable of determining when its use is required; or

     (b) The equipment is operated by a medical professional who has been trained to operate the equipment.

     2.  The caregivers employed by a residential facility with a resident who requires the use of intermittent positive pressure breathing equipment shall:

     (a) Monitor the ability of the resident to operate the equipment in accordance with the orders of a physician; and

     (b) Ensure that:

          (1) The resident’s physician evaluates periodically the condition of the resident which necessitates his or her use of the equipment;

          (2) The equipment is operated by a medical professional trained in the operation of the equipment if the resident requires assistance;

          (3) The equipment is in good working condition; and

          (4) The equipment is removed from the facility when it is no longer needed by the resident.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2716  Residents having colostomy or ileostomy. (NRS 449.0302)

     1.  A person who has a colostomy or ileostomy must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The resident is mentally and physically capable of properly caring for his or her colostomy or ileostomy, with or without assistance, and the resident’s physician has stated in writing that the colostomy or ileostomy is completely healed; or

     (b) The care for the colostomy or ileostomy is provided by a medical professional who is trained to provide that care.

     2.  The caregivers employed by a residential facility with a resident who has a colostomy or ileostomy shall ensure that:

     (a) All bags used by the resident are discarded appropriately; and

     (b) Privacy is afforded to the resident when care for the colostomy or ileostomy is being provided.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2718  Residents requiring manual removal of fecal impactions or use of enemas or suppositories. (NRS 449.0302)

     1.  A person who requires the manual removal of fecal impactions or the use of enemas or suppositories must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The resident is able to provide the care for himself or herself; or

     (b) The care is administered according to the written instructions of a physician by a medical professional who has been trained to provide that care.

     2.  The caregivers employed by a residential facility with a resident who requires the manual removal of fecal impactions or the use of enemas or suppositories shall ensure that privacy is afforded to the resident when that care is being provided.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R204-99, 2-10-2000)

      NAC 449.272  Residents requiring use of indwelling catheter. (NRS 449.0302)

     1.  A person who requires the use of an indwelling catheter must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The resident is physically and mentally capable of caring for all aspects of the condition, with or without the assistance of a caregiver;

     (b) Irrigation of the catheter is performed in accordance with the physician’s orders by a medical professional who has been trained to provide that care; and

     (c) The catheter is inserted and removed only in accordance with the orders of a physician by a medical professional who has been trained to insert and remove a catheter.

     2.  The caregivers employed by a residential facility with a resident who requires the use of an indwelling catheter shall ensure that:

     (a) The bag and tubing of the catheter are changed by:

          (1) The resident, with or without the assistance of a caregiver; or

          (2) A medical professional who has been trained to provide that care;

     (b) Waste from the use of the catheter is disposed of properly;

     (c) Privacy is afforded to the resident while care is being provided; and

     (d) The bag of the catheter is emptied by a caregiver who has received instruction in the handling of such waste and the signs and symptoms of urinary tract infections and dehydration.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2722  Residents having unmanageable condition of bowel or bladder incontinence; residents having manageable condition of bowel or bladder incontinence. (NRS 449.0302)

     1.  A person who has an unmanageable condition of bowel or bladder incontinence must not be admitted to a residential facility or permitted to remain as a resident of a residential facility.

     2.  A person who has a manageable condition of bowel or bladder incontinence must not be admitted to a residential facility or permitted to remain as a resident of a residential facility unless the condition can be managed by:

     (a) The resident without the assistance of any other person;

     (b) Requiring the resident to participate in a structured bowel or bladder retraining program to assist the resident in restoring a normal pattern of continence;

     (c) A program which includes scheduled toileting at regular intervals; or

     (d) Requiring the resident to use products that keep him or her clean and dry at all times.

     3.  The caregivers employed by a residential facility with a resident who has a manageable condition of bowel or bladder incontinence shall ensure that:

     (a) If the resident can benefit from scheduled toileting, he or she is assisted or reminded to go to the bathroom at regular intervals;

     (b) The resident is checked during those periods when he or she is known to be incontinent, including during the night;

     (c) The resident is kept clean and dry;

     (d) Retraining programs are designed by a medical professional with training and experience in the care of persons with bowel or bladder dysfunction;

     (e) The retraining programs established for a resident are followed; and

     (f) Privacy is afforded to the resident when care is being provided.

     4.  The caregivers employed by the facility shall not:

     (a) Withhold fluids from a resident to control incontinence; or

     (b) Have a resident catheterized to control incontinence for the convenience of the employees of the facility.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2724  Residents having contractures. (NRS 449.0302)

     1.  A person who has contractures must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless the contractures do not adversely affect the ability of the resident to perform normal bodily functions and:

     (a) The resident is able to care for the contractures without assistance; or

     (b) Supervision in caring for the contractures is provided by a medical professional who is trained to provide such supervision.

     2.  The caregivers employed by a residential facility with a resident who has contractures shall ensure that the performance by the resident of any exercises to improve the resident’s range of motion or any other exercises prescribed by a physician is supervised by a medical professional who has been trained to provide such supervision.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2726  Residents having diabetes. (NRS 439.200, 449.0302, 449.0304)

     1.  A person who has diabetes must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The resident’s glucose testing is performed by:

          (1) The resident himself or herself without assistance; or

          (2) With the consent of the resident, a caregiver who meets the requirements of NAC 449.196; and

     (b) The resident’s medication is administered:

          (1) By the resident himself or herself without assistance;

          (2) By a medical professional, or licensed practical nurse, who is:

               (I) Acting within his or her authorized scope of practice and in accordance with all applicable statutes and regulations; and

               (II) Trained to administer the medication; or

          (3) If the conditions set forth in subsection 2 are satisfied, with the assistance of a caregiver employed by the residential facility.

     2.  A caregiver employed by a residential facility may assist a resident in the administration of the medication prescribed to the resident for his or her diabetes if:

     (a) A physician, physician assistant or advanced practice registered nurse has determined that the resident’s physical and mental condition is stable and is following a predictable course.

     (b) The amount of the medication prescribed to the resident for his or her diabetes is at a maintenance level and does not require a daily assessment, including, without limitation, the use of a sliding scale.

     (c) A written plan of care by a physician or registered nurse has been established that:

          (1) Addresses possession and assistance in the administration of the medication for the resident’s diabetes; and

          (2) Includes a plan, which has been prepared under the supervision of a registered nurse or licensed pharmacist, for emergency intervention if an adverse condition results.

     (d) The medication prescribed to the resident for his or her diabetes is not administered by injection or intravenously or is administered using an auto-injection device in accordance with the requirements of NRS 449.0304 and NAC 449.1985.

     (e) The caregiver has successfully completed training and examination approved by the Division regarding the administration of such medication.

     3.  The caregivers employed by a residential facility with a resident who has diabetes shall ensure that:

     (a) Sufficient amounts of medicines, equipment to perform tests, syringes, needles and other supplies are maintained and stored in a secure place in the facility;

     (b) Syringes and needles are disposed of appropriately in a sharps container which is stored in a safe place; and

     (c) The caregivers responsible for the resident have received instruction in the recognition of the symptoms of hypoglycemia and hyperglycemia by a medical professional who has been trained in the recognition of those symptoms.

     4.  The caregivers of a residential facility with a resident who has diabetes and requires a special diet shall provide variations in the types of meals served and make available food substitutions in order to allow the resident to consume meals as prescribed by the resident’s physician. The substitutions must conform with the recommendations for food exchanges contained in the Exchange Lists For Meal Planning, published by the American Diabetes Association, Incorporated, and the American Dietetic Association, which is hereby adopted by reference. A copy of the publication may be obtained from the American Diabetes Association, Incorporated, Order Fulfillment Department, P.O. Box 930850, Atlanta, Georgia 31193-0850, at a cost of $2.50.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R109-18, 1-30-2019)

      NAC 449.2728  Residents requiring regular intramuscular, subcutaneous or intradermal injections. (NRS 439.200, 449.0302, 449.0304)

     1.  Except as otherwise provided by NAC 449.2726, a person who requires regular intramuscular, subcutaneous or intradermal injections must not be admitted to a residential facility or be permitted to remain as a resident of the facility unless the injections are administered by:

     (a) The resident; or

     (b) A medical professional, or licensed practical nurse, acting within his or her authorized scope of practice and in accordance with all applicable statutes and regulations,

Ê who has been trained to administer those injections.

     2.  The caregivers employed by a residential facility with a resident who requires regular intramuscular, subcutaneous or intradermal injections shall ensure that:

     (a) Sufficient amounts of medicines, equipment to perform tests, syringes, needles and other supplies are maintained and stored in a secure place in the facility; and

     (b) Syringes and needles are disposed of appropriately in a sharps container which is stored in a safe place.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R109-18, 1-30-2019)

      NAC 449.2732  Residents requiring protective supervision. (NRS 449.0302)

     1.  Except as otherwise provided in subsection 2, a person who requires protective supervision may not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The resident is able to follow instructions;

     (b) The resident is able to make his or her needs known to the caregivers employed by the facility;

     (c) The resident can be protected from harming himself or herself and other persons; and

     (d) The caregivers employed by the facility can meet the needs of the resident.

     2.  If a person who requires protective supervision is unable to follow instructions or has difficulty making his or her needs known to the employees of the facility, the person may be admitted to the facility or be permitted to remain as a resident of the facility if the facility complies with the provisions of NAC 449.2754 and 449.2756.

     3.  The administrator of a residential facility with a resident who requires protective services shall ensure that:

     (a) The caregivers employed by the facility are capable of providing the supervision for that resident without neglecting the needs of the other residents of the facility; and

     (b) There is a written plan for providing protective supervision for that resident.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97)

      NAC 449.2734  Residents having tracheostomy or open wound requiring treatment by medical professional; residents having pressure or stasis ulcers. (NRS 449.0302)

     1.  A person who has a tracheostomy or an open wound that requires treatment by a medical professional must not be admitted to a residential facility or be permitted to remain as a resident of a residential facility unless:

     (a) The wound is in the process of healing or the tracheostomy is stable or can be cared for by the resident without assistance;

     (b) The care is provided by or under the supervision of a medical professional who has been trained to provide that care; or

     (c) The wound is the result of surgical intervention and care is provided as directed by the surgeon.

     2.  If a person who has a pressure or stasis ulcer or who is at risk of developing a pressure or stasis ulcer is admitted to a residential facility or permitted to remain as a resident of a residential facility:

     (a) The condition must have been diagnosed by a physician;

     (b) The condition must be cared for by a medical professional who is trained to provide care for and reassessment of that condition; and

     (c) Before a caregiver provides care to the person who has a pressure or stasis ulcer or who is at risk of developing a pressure or stasis ulcer, the caregiver must receive training related to the prevention and care of pressure sores from a medical professional who is trained to provide care for that condition.

     3.  The administrator of the facility shall ensure that records of the care provided to a person who has a pressure or stasis ulcer pursuant to subsection 2 are maintained at the facility. The records must include an explanation of the cause of the pressure or stasis ulcer.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.2736  Procedure to exempt certain residents from restrictions. (NRS 449.0302)

     1.  The administrator of a residential facility may submit to the Division a written request for permission to admit or retain a resident who is prohibited from being admitted to a residential facility or remaining as a resident of the facility pursuant to NAC 449.271 to 449.2734, inclusive.

     2.  A written request submitted pursuant to this section must include, without limitation:

     (a) Records concerning the resident’s current medical condition, including updated medical reports, other documentation of current health, a prognosis and the expected duration of the condition;

     (b) A plan for ensuring that the resident’s medical needs can be met by the facility;

     (c) A plan for ensuring that the level of care provided to the other residents of the facility will not suffer as a result of the admission or retention of the resident who is the subject of the request; and

     (d) A statement signed by the administrator of the facility that the needs of the resident who is the subject of the written request will be met by the caregivers employed by the facility.

     3.  A written request submitted to the Division pursuant to this section must be received:

     (a) Before the administrator admits a resident; or

     (b) At the onset of a medical condition set forth in NAC 449.271 to 449.2734, inclusive.

     4.  A residential facility must receive the permission requested pursuant to subsection 1 before the facility admits a resident who is otherwise prohibited from being admitted to the facility pursuant to NAC 449.271 to 449.2734, inclusive.

     5.  A residential facility may retain a resident who is otherwise prohibited from remaining as a resident of the facility pursuant to NAC 449.271 to 449.2734, inclusive, for 10 days after the facility submits to the Division the written request required pursuant to subsection 1.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R204-99, 2-10-2000)

      NAC 449.2738  Review of medical condition of resident; relocation or transfer of resident having certain medical needs or conditions. (NRS 449.0302)

     1.  If, after conducting an inspection or investigation of a residential facility, the Bureau determines that it is necessary to review the medical condition of a resident, the Bureau shall inform the administrator of the facility of the need for the review and the information the facility is required to submit to the Bureau to assist in the performance of the review. The administrator shall, within a period prescribed by the Bureau, provide to the Bureau:

     (a) The assessments made by physicians concerning the physical and mental condition of the resident; and

     (b) Copies of prescriptions for medication or orders of physicians for services or equipment necessary to provide care for the resident.

     2.  If the Bureau or the resident’s physician determines that the facility is prohibited from caring for the resident pursuant to NAC 449.271 to 449.2734, inclusive, or is unable to care for the resident in the proper manner, the administrator of the facility must be notified of that determination. Upon receipt of such a notification, the administrator shall, within a period prescribed by the Bureau, submit a plan to the Bureau for the safe and appropriate relocation of the resident pursuant to NRS 449A.100 to a place where the proper care will be provided.

     3.  If an inspection or investigation reveals that the conditions at a residential facility may immediately jeopardize the health and safety of a resident, the administrator of the facility shall, as soon as practicable, ensure that the resident is transferred to a facility which is capable of properly providing for his or her care.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

Medical Services, Medical Records and Other Records Concerning Residents

      NAC 449.274  Medical care of resident after illness, injury or accident; periodic physical examination of resident; rejection of medical care by resident; written records. (NRS 449.0302)

     1.  If a resident of a residential facility becomes ill or is injured, the resident’s physician and a member of the resident’s family must be notified at the onset of illness or at the time of the injury. The facility shall:

     (a) Make all necessary arrangements to secure the services of a licensed physician to treat the resident if the resident’s physician is not available; and

     (b) Request emergency services when such services are necessary.

     2.  A resident who is suffering from an illness or injury from which the resident is expected to recover within 14 days after the onset of the illness or the time of the injury may be cared for in the facility. The decision as to the period within which the resident is expected to recover from the illness or injury and the needs of the resident must be made by the resident’s physician or, if he or she is unavailable, by another licensed physician.

     3.  A written record of all accidents, injuries and illnesses of the resident which occur in the facility must be made by the caregiver who first discovers the accident, injury or illness. The record must include:

     (a) The date and time of the accident or injury or the date and time that the illness was discovered;

     (b) A description of the manner in which the accident or injury occurred or the manner in which the illness was discovered; and

     (c) A description of the manner in which the members of the staff of the facility responded to the accident, injury or illness and the care provided to the resident.

Ê This record must accompany the resident if he or she is transferred to another facility.

     4.  The facility shall ensure that appropriate medical care is provided to the resident by:

     (a) A caregiver who is trained to provide that care;

     (b) An independent contractor who is trained to provide that care; or

     (c) A medical professional.

     5.  Before admission and each year after admission, or more frequently if there is a significant change in the physical condition of a resident, the facility shall obtain the results of a general physical examination of the resident by his or her physician. The resident must be cared for pursuant to any instructions provided by the resident’s physician.

     6.  The members of the staff of the facility shall:

     (a) Ensure that the resident receives the personal care that he or she requires.

     (b) Monitor the ability of the resident to care for his or her own health conditions and document in writing any significant change in his or her ability to care for those conditions.

     7.  This section does not prohibit a resident from rejecting medical care. If a resident rejects medical care, an employee of the facility shall record the rejection in writing and request that the resident sign that record as a confirmation of his or her rejection of medical care. If the resident rejects medical care that a physician has directed the facility to provide, the facility shall inform the resident’s physician of that fact within 4 hours after the care is rejected. The facility shall maintain a record of the notice provided to the physician pursuant to this subsection.

     8.  As used in this section, “significant change” means a change in a resident’s condition that results in a category 1 resident becoming a category 2 resident or otherwise results in an increase in the level of care required by the resident.

     [Bd. of Health, Group Care Facilities §§ 8.1-8.4, eff. 12-18-75]—(NAC A 3-6-86; R003-97, 10-30-97; R073-03, 1-22-2004)

      NAC 449.2742  Administration of medication: Responsibilities of administrator, caregivers and employees of facility. (NRS 439.200, 449.0302, 449.0304)

     1.  The administrator of a residential facility that provides assistance to residents in the administration of medications shall:

     (a) Ensure that a physician, pharmacist or registered nurse who does not have a financial interest in the facility:

          (1) Reviews for accuracy and appropriateness, at least once every 6 months, the regimen of drugs taken by each resident of the facility, including, without limitation, any over-the-counter medications and dietary supplements taken by a resident; and

          (2) Provides a written report of that review to the administrator of the facility.

     (b) Include a copy of each report submitted to the administrator pursuant to paragraph (a) in the file maintained pursuant to NAC 449.2749 for the resident who is the subject of the report.

     (c) Make and maintain a report of any actions that are taken by the caregivers employed by the facility in response to a report submitted pursuant to paragraph (a).

     (d) Develop and maintain a plan for managing the administration of medications at the residential facility, including, without limitation:

          (1) Preventing the use of outdated, damaged or contaminated medications;

          (2) Managing the medications for each resident in a manner which ensures that any prescription medications, over-the-counter medications and nutritional supplements are ordered, filled and refilled in a timely manner to avoid missed dosages;

          (3) Verifying that orders for medications have been accurately transcribed in the record of the medication administered to each resident in accordance with NAC 449.2744;

          (4) Monitoring the administration of medications and the effective use of the records of the medication administered to each resident;

          (5) Ensuring that each caregiver who administers a medication is in compliance with the requirements of subsection 6 of NRS 449.0302 and NAC 449.196;

          (6) Ensuring that each caregiver who administers a medication is adequately supervised;

          (7) Communicating routinely with the prescribing physician or other physician of the resident concerning issues or observations relating to the administration of the medication; and

          (8) Maintaining reference materials relating to medications at the residential facility, including, without limitation, a current drug guide or medication handbook, which must not be more than 2 years old or providing access to websites on the Internet which provide reliable information concerning medications.

     (e) Develop and maintain a training program for caregivers of the residential facility who administer medication to residents, including, without limitation, an initial orientation on the plan for managing medications at the facility for each new caregiver and an annual training update on the plan. The administrator shall maintain documentation concerning the provision of the training program and the attendance of caregivers.

     (f) In his or her first year of employment as an administrator of the residential facility, receive, from a program approved by the Bureau, at least 16 hours of training in the management of medication consisting of not less than 12 hours of classroom training and not less than 4 hours of practical training and obtain a certificate acknowledging completion of such training.

     (g) After receiving the initial training required by paragraph (f), receive annually at least 8 hours of training in the management of medication and provide the residential facility with satisfactory evidence of the content of the training and his or her attendance at the training.

     (h) Annually pass an examination relating to the management of medication approved by the Bureau.

     2.  Within 72 hours after the administrator of the facility receives a report submitted pursuant to paragraph (a) of subsection 1, a member of the staff of the facility shall notify the resident’s physician of any concerns noted by the person who submitted the report. The report must be reviewed and initialed by the administrator.

     3.  Before assisting a resident in the administration of any medication, including, without limitation, any over-the-counter medication or dietary supplement, a caregiver must obtain written information describing the side effects, possible adverse reactions, contraindications and toxicity of the medication.

     4.  Except as otherwise provided in this subsection, a caregiver shall assist in the administration of medication to a resident if the resident needs the caregiver’s assistance. A caregiver may assist the ultimate user of:

     (a) Controlled substances or dangerous drugs only if the conditions prescribed in subsection 6 of NRS 449.0302 are met.

     (b) Insulin using an auto-injection device only if the conditions prescribed in NRS 449.0304 and NAC 449.1985 are met.

     5.  An over-the-counter medication or a dietary supplement may be given to a resident only if the resident’s physician has approved the administration of the medication or supplement in writing or the facility is ordered to do so by another physician. The over-the-counter medication or dietary supplement must be administered in accordance with the written instructions of the physician. The administration of over-the-counter medications and dietary supplements must be included in the record required pursuant to paragraph (b) of subsection 1 of NAC 449.2744.

     6.  Except as otherwise provided in this subsection, a medication prescribed by a physician must be administered as prescribed by the physician. If a physician orders a change in the amount or times medication is to be administered to a resident:

     (a) The caregiver responsible for assisting in the administration of the medication shall:

          (1) Comply with the order;

          (2) Indicate on the container of the medication that a change has occurred; and

          (3) Note the change in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744;

     (b) Within 5 days after the change is ordered, a copy of the order or prescription signed by the physician must be included in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744; and

     (c) If the label prepared by a pharmacist does not match the order or prescription written by a physician, the physician, registered nurse or pharmacist must interpret that order or prescription and, within 5 days after the change is ordered, the interpretation must be included in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744.

     7.  If a resident refuses, or otherwise misses, an administration of medication, a physician must be notified within 12 hours after the dose is refused or missed.

     8.  An employee of a residential facility shall not draw medication into a syringe or administer an injection unless authorized by law to do so.

     9.  If the medication of a resident is discontinued, the expiration date of the medication of a resident has passed, or a resident who has been discharged from the facility does not claim the medication, an employee of a residential facility shall destroy the medication, by an acceptable method of destruction, in the presence of a witness and note the destruction of the medication in the record maintained pursuant to NAC 449.2744.

     10.  The administrator of a facility is responsible for any assistance provided to a resident of the residential facility in the administration of medication, including, without limitation, ensuring that all medication is administered in accordance with the provisions of this section.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R204-99, 2-10-2000; R073-03, 1-22-2004; R119-10, 1-13-2011; R109-18, 1-30-2019)

      NAC 449.2744  Administration of medication: Maintenance and contents of logs and records. (NRS 449.0302)

     1.  The administrator of a residential facility that provides assistance to residents in the administration of medications shall maintain:

     (a) A log for each medication received by the facility for use by a resident of the facility. The log must include:

          (1) The type and quantity of medication received by the facility;

          (2) The date of its delivery;

          (3) The name of the person who accepted the delivery;

          (4) The name of the resident for whom the medication is prescribed; and

          (5) The date on which any unused medication is removed from the facility or destroyed.

     (b) A record of the medication administered to each resident. The record must include:

          (1) The type of medication administered;

          (2) The date and time that the medication was administered;

          (3) The date and time that a resident refuses, or otherwise misses, an administration of medication; and

          (4) Instructions for administering the medication to the resident that reflect each current order or prescription of the resident’s physician.

     2.  The administrator of the facility shall keep a log of caregivers assigned to administer medications that indicates the shifts during which each caregiver was responsible for assisting in the administration of medication to a resident. This requirement may be met by including on a resident’s medication sheet an indication of who assisted the resident in the administration of the medication, if the caregiver can be identified from this indication.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)

      NAC 449.2746  Administration of medication: Restrictions concerning medication taken as needed by resident; written records. (NRS 449.0302)

     1.  A caregiver employed by a residential facility shall not assist a resident in the administration of a medication that is taken as needed unless:

     (a) The resident is able to determine his or her need for the medication;

     (b) The determination of the resident’s need for the medication is made by a medical professional qualified to make that determination; or

     (c) The caregiver has received written instructions indicating the specific symptoms for which the medication is to be given, the exact amount of medication that may be given and the frequency with which the medication may be given.

     2.  A caregiver who administers medication to a resident as needed shall record the following information concerning the administration of the medication:

     (a) The reason for the administration;

     (b) The date and time of the administration;

     (c) The dose administered;

     (d) The results of the administration of the medication;

     (e) The initials of the caregiver; and

     (f) Instructions for administering the medication to the resident that reflect each current order or prescription of the resident’s physician.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)

      NAC 449.2748  Medication: Storage; duties upon discharge, transfer and return of resident. (NRS 449.0302)

     1.  Medication, including, without limitation, any over-the-counter medication, stored at a residential facility must be stored in a locked area that is cool and dry. The caregivers employed by the facility shall ensure that any medication or medical or diagnostic equipment that may be misused or appropriated by a resident or any other unauthorized person is protected. Medications for external use only must be kept in a locked area separate from other medications. A resident who is capable of administering medication to himself or herself without supervision may keep the resident’s medication in his or her room if the medication is kept in a locked container for which the facility has been provided a key.

     2.  Medication stored in a refrigerator, including, without limitation, any over-the-counter medication, must be kept in a locked box unless the refrigerator is locked or is located in a locked room.

     3.  Medication, including, without limitation, any over-the-counter medication or dietary supplement, must be:

     (a) Plainly labeled as to its contents, the name of the resident for whom it is prescribed and the name of the prescribing physician; and

     (b) Kept in its original container until it is administered.

     4.  Except as otherwise provided in subsection 5, when a resident is discharged or transferred from a residential facility, all medications prescribed for the resident must be provided to the resident or to the facility to which he or she is transferred.

     5.  If a resident is transferred to a hospital or skilled nursing facility, the residential facility shall hold the resident’s medications until the resident returns or for 30 days after the transfer, whichever is less, unless the hospital or skilled nursing facility requests the residential facility to provide the hospital or skilled nursing facility with the medications. If the resident does not return within 30 days after the transfer, the residential facility shall promptly dispose of any remaining medications. Upon the return of the resident from the hospital or skilled nursing facility, the residential facility shall, if there has been any change in the resident’s medication regimen:

     (a) Contact a physician, within 24 hours after the resident returns, to clarify the change; and

     (b) Document the physician contact in the record maintained pursuant to paragraph (b) of subsection 1 of NAC 449.2744.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R204-99, 2-10-2000; R073-03, 1-22-2004)

      NAC 449.2749  Maintenance and contents of separate file for each resident; confidentiality of information. (NRS 449.0302)

     1.  A separate file must be maintained for each resident of a residential facility and retained for at least 5 years after he or she permanently leaves the facility. The file must be kept locked in a place that is resistant to fire and is protected against unauthorized use. The file must contain all records, letters, assessments, medical information and any other information related to the resident, including, without limitation:

     (a) The full name, address, date of birth and social security number of the resident.

     (b) The address and telephone number of the resident’s physician and the next of kin or guardian of the resident or any other person responsible for the resident.

     (c) A statement of the resident’s allergies, if any, and any special diet or medication he or she requires.

     (d) A statement from the resident’s physician concerning the mental and physical condition of the resident that includes:

          (1) A description of any medical conditions which require the performance of medical services;

          (2) The method in which those services must be performed; and

          (3) A statement of whether the resident is capable of performing the required medical services.

     (e) Evidence of compliance with the provisions of chapter 441A of NRS and the regulations adopted pursuant thereto.

     (f) The types and amounts of protective supervision and personal services needed by the resident.

     (g) An evaluation of the resident’s ability to perform the activities of daily living and a brief description of any assistance he or she needs to perform those activities. The facility shall prepare such an evaluation:

          (1) Upon the admission of the resident;

          (2) Each time there is a change in the mental or physical condition of the resident that may significantly affect his or her ability to perform the activities of daily living; and

          (3) In any event, not less than once each year.

     (h) A list of the rules for the facility that is signed by the administrator of the facility and the resident or a representative of the resident.

     (i) The name and telephone number of the vendors and medical professionals that provide services for the resident.

     (j) A document signed by the administrator of the facility when the resident permanently leaves the facility.

     2.  The document required pursuant to paragraph (j) of subsection 1 must indicate the location to which the resident was transferred or the person in whose care the resident was discharged. If the resident dies while a resident of the facility, the document must include the time and date of the death and the dates on which the person responsible for the resident was contacted to inform him or her of the death.

     3.  Except as otherwise provided in this subsection, a resident’s file must be kept confidential. A resident’s file must be made available upon request at any time to an employee of the Bureau who is acting in his or her capacity as an employee of the Bureau.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)

Special Types of Services and Facilities

      NAC 449.275  Residential facility which provides residents with hospice care: Responsibilities of staff; retention of resident with special medical needs. (NRS 449.0302)

     1.  A residential facility that provides services to a resident who elects to receive hospice care shall obtain a copy of the plan of care required pursuant to NAC 449.0186 for that resident.

     2.  The members of the staff of the facility shall:

     (a) Maintain at the facility a written record of the care and services provided to a resident who receives hospice care; and

     (b) Report any deviation from the established plan of care to the resident’s physician within 24 hours after the deviation occurs.

     3.  If the Division grants a request made pursuant to NAC 449.2736 by the administrator of a residential facility that provides hospice care, the residential facility may retain a resident who:

     (a) Is bedfast, as defined in NAC 449.2702; or

     (b) Requires skilled nursing or other medical care on a 24-hour basis.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004)

      NAC 449.2751  Residential facility which provides assisted living services: Application for endorsement; general requirements. (NRS 449.0302)

     1.  Each residential facility that wishes to provide assisted living services must apply to the Division to obtain an endorsement on its license authorizing the residential facility to provide assisted living services.

     2.  The Division may deny an application for an endorsement that is made pursuant to subsection 1 or suspend or revoke an existing endorsement granted pursuant to subsection 1:

     (a) Based upon the grounds set forth in NAC 449.191 or 449.1915; or

     (b) If the residential facility for which the applicant is applying or the residential facility which has an endorsement does not satisfy the requirements set forth in this section or subsections 7 and 8 of NRS 449.0302.

     3.  If a residential facility provides assisted living services, the written policies that the residential facility is required to develop pursuant to NAC 449.258 must include, without limitation, procedures to be followed:

     (a) To ensure that the residential facility complies with the requirements set forth in subsections 7 and 8 of NRS 449.0302;

     (b) By the administrator to ensure that residents of the residential facility whose physical or mental condition is significantly changing over time are identified;

     (c) To obtain a medical professional to assess and monitor, as necessary, but not less than once every quarter in each calendar year, each resident of the residential facility whose physical or mental condition is declining over time; and

     (d) To provide services to residents of the residential facility pursuant to the assessment and monitoring performed pursuant to paragraph (c).

     4.  The administrator of a residential facility that provides assisted living services shall ensure that:

     (a) A medical professional is notified whenever there has been a significant change in the physical or mental condition of a resident of the residential facility whose physical or mental condition is declining over time; and

     (b) The residential facility maintains a list of resources for financial assistance and other social services that may decrease the need for a resident of the residential facility whose physical or mental condition is declining over time to move out of the residential facility.

     5.  The services provided by a residential facility that provides assisted living services must include, without limitation, services that will enable the residential facility to retain residents who have the medical needs or conditions described in NAC 449.2712 to 449.2734, inclusive, and 449.275.

     (Added to NAC by Bd. of Health by R097-06, eff. 7-14-2006; A by R119-10, 1-13-2011)

      NAC 449.2754  Residential facility which provides care to persons with Alzheimer’s disease: Application for endorsement; general requirements. (NRS 449.0302)

     1.  A residential facility which offers or provides care for a resident with Alzheimer’s disease or related dementia must obtain an endorsement on its license authorizing it to operate as a residential facility which provides care to persons with Alzheimer’s disease. The Division may deny an application for an endorsement or suspend or revoke an existing endorsement based upon the grounds set forth in NAC 449.191 or 449.1915.

     2.  If a residential facility is authorized to operate as a residential facility which provides care to persons with Alzheimer’s disease and as another type of facility, the entire facility must comply with the requirements of this section or the residents who suffer from Alzheimer’s disease or other related dementia must be located in a separate portion of the facility that complies with the provisions of this section.

     3.  A residential facility which provides care to persons with Alzheimer’s disease may admit or retain a resident who requires confinement in locked quarters.

     4.  A residential facility which provides care to persons with Alzheimer’s disease must be administered by a person who:

     (a) Has not less than 3 years of experience in caring for residents with Alzheimer’s disease or related dementia in a licensed facility; or

     (b) Has a combination of education and training that the Bureau determines is equivalent to the experience required pursuant to paragraph (a).

     5.  The administrator of such a facility shall prescribe and maintain on the premises of the facility a written statement which includes:

     (a) The facility’s policies and procedures for providing care to its residents;

     (b) Evidence that the facility has established interaction groups within the facility which consist of not more than six residents for each caregiver during those hours when the residents are awake;

     (c) A description of:

          (1) The basic services provided for the needs of residents who suffer from dementia;

          (2) The activities developed for the residents by the members of the staff of the facility;

          (3) The manner in which the behavioral problems will be managed;

          (4) The manner in which the medication for residents will be managed;

          (5) The activities that will be developed by the members of the staff of the facility to encourage the involvement of family members in the lives of the residents; and

          (6) The steps the members of the staff of the facility will take to:

               (I) Prevent residents from wandering from the facility; and

               (II) Respond when a resident wanders from the facility; and

     (d) The criteria for admission to and discharge and transfer from the facility.

     6.  The written statement required pursuant to subsection 5 must be available for review by members of the staff of the facility, visitors to the facility and the Bureau.

     7.  The administrator shall ensure that the facility complies with the provisions of the statement required pursuant to subsection 5.

     8.  The members of the staff of the facility shall develop a program of activities that promotes the mental and physical enhancement of the residents. The following activities must be conducted at least weekly:

     (a) Activities to enhance the gross motor skills of the residents;

     (b) Social activities;

     (c) Activities to enhance the sensory abilities of the residents; and

     (d) Outdoor activities.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2756  Residential facility which provides care to persons with Alzheimer’s disease: Standards for safety; personnel required; training for employees. (NRS 449.0302)

     1.  The administrator of a residential facility which provides care to persons with Alzheimer’s disease shall ensure that:

     (a) Swimming pools and other bodies of water are fenced or protected by other acceptable means.

     (b) Operational alarms, buzzers, horns or other audible devices which are activated when a door is opened are installed on all doors that may be used to exit the facility.

     (c) At least one member of the staff is awake and on duty at the facility at all times.

     (d) Each employee of the facility who has direct contact with and provides care to residents with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, successfully completes the training and continuing education required pursuant to NAC 449.2768.

     (e) Knives, matches, firearms, tools and other items that could constitute a danger to the residents of the facility are inaccessible to the residents.

     (f) The facility has an area outside the facility or a yard adjacent to the facility that:

          (1) May be used by the residents for outdoor activities;

          (2) Has at least 40 square feet of space for each resident in the facility;

          (3) Is fenced; and

          (4) Is maintained in a manner that does not jeopardize the safety of the residents.

Ê All gates leading from the secured, fenced area or yard to an unsecured open area or yard must be locked and keys for gates must be readily available to the members of the staff of the facility at all times.

     (g) All toxic substances are not accessible to the residents of the facility.

     2.  The training required pursuant to NAC 449.2768 may be used to satisfy the requirement of paragraph (f) of subsection 1 of NAC 449.196 for the year in which the training is received.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004; R071-04, 8-4-2004)

      NAC 449.2758  Residential facility which provides care for elderly persons or persons with disabilities: Training for caregivers. (NRS 449.0302)

     1.  Within 60 days after being employed by a residential facility for elderly persons or persons with disabilities, a caregiver must receive not less than 4 hours of training related to the care of those residents.

     2.  As used in this section, “residential facility for elderly persons or persons with disabilities” means a residential facility that provides care to elderly persons or persons with disabilities who require assistance or protective supervision because they suffer from infirmities or disabilities.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004)

      NAC 449.2762  Residential facility which offers or provides care for adults with intellectual disabilities or adults with developmental disabilities: Application for endorsement; training for caregivers. (NRS 449.0302)

     1.  A residential facility which offers or provides care and protective supervision for a resident with an intellectual disability or a resident with a developmental disability must obtain an endorsement on its license authorizing it to operate as a residential facility for adults with intellectual disabilities. The Division may deny an application for an endorsement or suspend or revoke an existing endorsement based upon the grounds set forth in NAC 449.191 or 449.1915.

     2.  Within 60 days after being employed by a residential facility for adults with intellectual disabilities, a caregiver must receive not less than 4 hours of training related to the care of persons with intellectual disabilities.

     3.  If a resident with an intellectual disability is referred to the facility by a referring agency, the members of the staff of the facility may conduct a program to modify the behavior of the resident if that program is developed by the agency that referred the resident to the facility.

     4.  As used in this section, “residential facility for adults with intellectual disabilities” means a residential facility that provides care and protective supervision for persons with intellectual disabilities or persons with developmental disabilities, including, without limitation, birth trauma, anoxia, brain trauma or other genetic or developmental disorders.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2764  Residential facility which offers or provides care for persons with mental illnesses: Application for endorsement; training for employees. (NRS 449.0302)

     1.  A residential facility which offers or provides care and protective supervision for a resident with mental illness must obtain an endorsement on its license authorizing it to operate as a residential facility for persons with mental illnesses. The Division may deny an application for an endorsement or suspend or revoke an existing endorsement based upon the grounds set forth in NAC 449.191 or 449.1915.

     2.  A person who provides care for a resident of a residential facility for persons with mental illnesses shall, within 60 days after becoming employed at the facility, attend not less than 8 hours of training concerning care for residents who are suffering from mental illnesses.

     3.  As used in this section, “residential facility for persons with mental illnesses” means a residential facility that provides care and protective supervision for persons with mental illnesses, including, without limitation, schizophrenia, bipolar disorder, psychosis and other related disorders.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R052-99, 9-27-99; R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2766  Residential facility which offers or provides care for persons with chronic illnesses and debilitating diseases: Application for endorsement; training for employees. (NRS 449.0302)

     1.  A residential facility which offers or provides care and protective supervision for a resident with a chronic illness or progressively debilitating disease must obtain an endorsement on its license authorizing it to operate as a residential facility for persons with chronic illnesses. The Division may deny an application for an endorsement or suspend or revoke an existing endorsement based upon the grounds set forth in NAC 449.191 or 449.1915.

     2.  Within 60 days after being employed by a residential facility for persons with chronic illnesses, an employee of the facility shall obtain at least 4 hours of in-service training relating to the care provided to such persons and in the actions necessary to control infections.

     3.  Evidence of training received pursuant to subsection 2 must be included in the employee’s personnel file.

     4.  As used in this section, “residential facility for persons with chronic illnesses” means a residential facility that provides care and protective supervision for persons with chronic illnesses or progressively debilitating diseases, including, without limitation, acquired immunodeficiency syndrome and cancer.

     (Added to NAC by Bd. of Health by R003-97, eff. 10-30-97; A by R073-03, 1-22-2004; R119-10, 1-13-2011)

      NAC 449.2768  Residential facility which provides care to persons with dementia: Training for employees. (NRS 449.0302, 449.094)

     1.  Except as otherwise provided in subsection 2, the administrator of a residential facility which provides care to persons with any form of dementia shall ensure that:

     (a) Each employee of the facility who has direct contact with and provides care to residents with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, successfully completes:

          (1) Within the first 40 hours that such an employee works at the facility after he or she is initially employed at the facility, at least 2 hours of training in providing care, including emergency care, to a resident with any form of dementia, including, without limitation, Alzheimer’s disease, and providing support for the members of the resident’s family.

          (2) In addition to the training requirements set forth in subparagraph (1), within 3 months after such an employee is initially employed at the facility, at least 8 hours of training in providing care to a resident with any form of dementia, including, without limitation, Alzheimer’s disease.

          (3) If such an employee is licensed or certified by an occupational licensing board, at least 3 hours of continuing education in providing care to a resident with dementia, which must be completed on or before the anniversary date of the first date the employee was initially employed at the facility. The requirements set forth in this subparagraph are in addition to those set forth in subparagraphs (1) and (2), may be used to satisfy any continuing education requirements of an occupational licensing board, and do not constitute additional hours or units of continuing education required by the occupational licensing board.

          (4) If such an employee is a caregiver, other than a caregiver described in subparagraph (3), at least 3 hours of training in providing care to a resident with dementia, which must be completed on or before the anniversary date of the first date the employee was initially employed at the facility. The requirements set forth in this subparagraph are in addition to those set forth in subparagraphs (1) and (2).

     (b) The facility maintains proof of completion of the hours of training and continuing education required pursuant to this section in the personnel file of each employee of the facility who is required to complete the training or continuing education.

     2.  A person employed by a facility which provides care to persons with any form of dementia, including, without limitation, dementia caused by Alzheimer’s disease, is not required to complete the hours of training or continuing education required pursuant to this section if he or she has completed that training within the previous 12 months.

     (Added to NAC by Bd. of Health by R071-04, eff. 8-4-2004)

Deficiencies

      NAC 449.27702  Determination of severity and scope of deficiency; assignment of grade. (NRS 449.0302)

     1.  The Bureau shall determine:

     (a) The severity of a deficiency of a residential facility in accordance with the provisions of NAC 449.99861; and

     (b) The scope of a deficiency of a residential facility in accordance with the provisions of NAC 449.9986.

     2.  After the Bureau conducts a survey of a residential facility, the Bureau shall add the severity and scope scores for all deficiencies of the facility indicated in the survey and assign a grade to the facility as follows:

 

 

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.27704  Placard: Issuance and display; failure to comply. (NRS 449.0302)

     1.  After the Bureau assigns a grade to a residential facility pursuant to NAC 449.27702, the Bureau shall issue a placard to the residential facility.

     2.  The administrator shall, within 24 hours after receipt of the placard, display or cause the placard to be displayed conspicuously in a public area of the residential facility.

     3.  If the placard is not displayed in accordance with the provisions of subsection 2, the Bureau will assess against the residential facility a deficiency with a severity and scope score equal to the highest severity and scope score indicated in the most recent survey of the facility conducted by the Bureau.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005)

      NAC 449.27706  Resurvey: Application and fee; failure to comply. (NRS 439.150, 439.200, 449.0302)

     1.  If the Bureau issues a placard to a residential facility that includes a grade of “B,” the administrator may submit an application to the Bureau for a resurvey of the facility not later than 30 days after the facility receives the placard. The fee for an application for a resurvey is $400 and must accompany the application.

     2.  If the Bureau issues a placard to a residential facility that includes a grade of “C” or “D,” the administrator must submit an application to the Bureau for a resurvey of the facility not later than 30 days after the facility receives the placard. The fee for an application for a resurvey is $600 and must accompany the application.

     3.  The Bureau may revoke the license of a residential facility that is required to submit an application for a resurvey pursuant to subsection 2 if the facility fails to submit the application in accordance with the provisions of that subsection.

     4.  As used in this section, “resurvey” has the meaning ascribed to it in NAC 449.99838.

     (Added to NAC by Bd. of Health by R122-05, eff. 11-17-2005; A by R155-10, 12-16-2010)

BUSINESSES THAT PROVIDE REFERRALS TO GROUP HOUSING ARRANGEMENTS

      NAC 449.27811  Definitions. (NRS 439.200, 449.0302, 449.0305)  As used in NAC 449.27811 to 449.27831, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.27813 to 449.27819, inclusive, have the meanings ascribed to them in those sections.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R048-22, 12-29-2022)

      NAC 449.27813  “Client” defined. (NRS 439.200, 449.0302, 449.0305)  “Client” means a person who is referred by a referral agency for compensation to a group housing arrangement.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R048-22, 12-29-2022)

      NAC 449.27817  “Financial assessment” defined. (NRS 439.200, 449.0302, 449.0305)  “Financial assessment” means an assessment to determine the intended source of payment by a client for services which will be provided by a group housing arrangement for 6 months, including the eligibility status of the client for services as determined by Medicaid and Medicare.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R048-22, 12-29-2022)

      NAC 449.27818  “Group housing arrangement” defined. (NRS 439.200, 449.0302, 449.0305)  “Group housing arrangement” means a residential facility for groups or any other group housing arrangement that provides assistance, food, shelter or limited supervision to a person with a mental illness, intellectual disability, developmental disability or physical disability or who is aged or infirm.

     (Added to NAC by Bd. of Health by R048-22, eff. 12-29-2022)

      NAC 449.27819  “Needs assessment” defined. (NRS 449.0302, 449.0305)  “Needs assessment” means an assessment of a client to document the abilities of the client to function independently, including a complete list of the areas in which the client requires assistance.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99)

      NAC 449.27823  License not required by certain persons to make referrals; application for licensure; referral through licensed referral agency. (NRS 439.200, 449.0302, 449.0305)

     1.  A licensed nurse or social worker working in a medical facility or a facility for the dependent licensed by the Bureau may make a referral for a client of the facility or program to a group housing arrangement without first obtaining a license to operate as a referral agency. A person employed by this State or the governing body of any county or city within this State, who is employed in a position in which the person’s duties require him or her to make referrals for clients to group housing arrangements, may make those referrals without first obtaining a license to operate as a referral agency.

     2.  An applicant for a license to operate as a referral agency must submit to the Division a completed application on a form provided by the Division. The application for the initial license must include, without limitation:

     (a) Evidence that the applicant has obtained a contract of insurance for protection against liability to third persons which may be incurred while operating as a referral agency; and

     (b) The physical address of the applicant where the records of the referral agency will be maintained.

     3.  A licensed nurse, public guardian, social worker, physician, physician assistant or hospital may provide a referral to a group housing arrangement through a licensed referral agency.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R124-05, 11-17-2005; R048-22, 12-29-2022)

      NAC 449.27827  Requirements for employees. (NRS 439.200, 449.0302, 449.0305)

     1.  Employees of a referral agency must have a working knowledge of the provisions of NRS and NAC that govern the licensing of group housing arrangements.

     2.  An employee of a referral agency who is not licensed as a nurse, social worker, physician or physician assistant shall not gather any information needed to complete a needs assessment or financial assessment of a client, or engage in the process of referring a client to a group housing arrangement.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R048-22, 12-29-2022)

      NAC 449.27829  Responsibilities of referral agency. (NRS 439.200, 449.0302, 449.0305)

     1.  A referral agency shall:

     (a) Complete a needs assessment and financial assessment for each client and make referrals for the services that would best meet the physical, psychosocial and financial needs and wishes of the client; and

     (b) Submit to the group housing arrangement to which a client is referred a copy of the needs assessment completed by the referral agency for the client.

     2.  A referral agency shall not:

     (a) Accept any fee, inducement or incentive, for any reason, from a group housing arrangement, or from any person or entity associated with a group housing arrangement; or

     (b) Give a discharge planner, case manager, social worker or any other person who has the responsibility of discharge planning, a fee or incentive for prospective clients.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R048-22, 12-29-2022)

      NAC 449.27831  Contract for services; fees; maintenance of client records. (NRS 439.200, 449.0302, 449.0305)

     1.  Before a referral agency may provide any services to a client, the referral agency must obtain a written contract from the client or his or her legal representative to provide the services. The contract must:

     (a) Be signed by a representative of the referral agency and the person who is paying for the services or his or her representative; and

     (b) Include, without limitation, a description of the services to be provided pursuant to the contract and all fees associated with the provision of those services.

     2.  If, within 30 days after a client is admitted to a group housing arrangement, the referral of the client to the group housing arrangement is determined by the facility, the Bureau or a physician to be inappropriate, the referral agency shall:

     (a) Refund the full amount of the fee paid by the client or his or her representative; or

     (b) Assist the client with an acceptable referral to another group housing arrangement for no additional fee.

     3.  A referral agency shall not receive more than one fee from a client within any 6-month period unless, during that period, the client or his or her representative requests another referral by the referral agency.

     4.  A referral agency shall maintain an organized file for each client that includes, without limitation:

     (a) A copy of the needs assessment and financial assessment completed by the referral agency for the client;

     (b) A copy of the completed contract to provide the services to the client; and

     (c) Information outlining the process used by the referral agency for determining the appropriate referral of the client.

Ê A referral agency shall maintain its file of a client for at least 5 years at the place of business of the referral agency.

     (Added to NAC by Bd. of Health by R132-99, eff. 11-29-99; A by R048-22, 12-29-2022)

HOSPITALS

General Provisions

      NAC 449.279  Definitions. (NRS 439.200, 449.0302)  As used in NAC 449.279 to 449.394, inclusive, unless the context otherwise requires, the words and terms defined in NAC 449.286 to 449.300, inclusive, have the meanings ascribed to them in those sections.

     (Supplied in codification; A by Bd. of Health by R050-99, 9-27-99; R133-18, 12-19-2018; R048-22, 12-29-2022)

      NAC 449.286  “Governing body” defined. (NRS 449.0302)  “Governing body” means the person or group of persons, including a board of trustees, board of directors or other body, in whom the final authority and responsibility is vested for conduct of a hospital.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.287  “Hospital” defined. (NRS 449.0302)  “Hospital” has the meaning ascribed to it in NRS 449.012.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.289  “Inpatient” defined. (NRS 439.200, 449.0302)  “Inpatient” means a person who has been formally admitted into a hospital for diagnosis or treatment and:

     1.  Is expected, at the time of admission, to receive care or occupy a bed at the hospital at midnight on at least 2 consecutive days; or

     2.  Actually receives care or occupies a bed at the hospital at midnight on at least 2 consecutive days.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R133-18, 12-19-2018)

      NAC 449.297  “Outpatient” defined. (NRS 439.200, 449.0302)  “Outpatient” means a person who has been registered or accepted for care in a hospital but who is not an inpatient.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R133-18, 12-19-2018)

      NAC 449.298  “Outpatient department” defined. (NRS 449.0302)  “Outpatient department” means that part of a hospital used for the treatment and diagnosis of patients not residing in the hospital.

     [Bd. of Health, Health Facilities Reg. Part I part Ch. III, eff. 10-9-69]

      NAC 449.299  “Patient” defined. (NRS 449.0302)  “Patient” means a person who:

     1.  Is receiving diagnostic, therapeutic or preventive health services; or

     2.  Is under observation or treatment for an illness or injury, or under care during and after pregnancy.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.300  “Restraint” defined. (NRS 449.0302)  “Restraint” means the control of the activity of a patient to protect the patient or others from injury by the seclusion of the patient or the use of mechanical devices. The term does not include the control of the activity of a patient by the use of mechanical supports that are used in rehabilitative situations to achieve proper body alignment.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

Licensing and Administration

      NAC 449.307  Applicability of license; coverage against certain liabilities. (NRS 449.0302)

     1.  A hospital must be operated and conducted in the name designated on the license, with the name of the person responsible for its operation also appearing on the face of the license. The license is not transferable.

     2.  Each hospital must retain proof that it is adequately covered against liabilities resulting from claims incurred in the course of operation.

     3.  Except as otherwise provided in this subsection, separate licenses are required for hospitals which are maintained on separate premises even though the hospitals are under the same management. The provisions of this subsection do not apply to outpatient departments, clinics or separate buildings on the same grounds.

     4.  A separate license is not required for the provision of special services within a hospital. This subsection does not relieve a hospital to which a special service is being added from the requirement of obtaining the approval of the Division to amend its license pursuant to NRS 449.087 before providing that service.

     [Bd. of Health, Health Facilities Reg. Part II Ch. II §§ 1-4, eff. 10-9-69; A 8-26-74]—(NAC A by R044-97, 10-30-97; R050-99, 9-27-99; R117-05, 11-17-2005)

      NAC 449.310  Limitation on number of patients; annual on-site inspection not required under certain circumstances. (NRS 449.0302)

     1.  A hospital shall not have more patients than the number of beds for which it is licensed, except in emergencies. If there is an emergency, the hospital shall notify the Bureau.

     2.  If a hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association, the Bureau is not required to make an annual on-site inspection of the hospital.

     [Bd. of Health, Health Facilities Reg. Part II Ch. II §§ 5-9, eff. 10-9-69; A 8-26-74]—(NAC A by R035-97, 10-30-97; R050-99, 9-27-99)

      NAC 449.312  Change in ownership, use or construction; correction of deficiencies. (NRS 449.0302)

     1.  Upon a change in ownership, change of use or change in construction, a hospital shall notify the Bureau of the changes and identify all areas of noncompliance with the guidelines specified in NAC 449.3154 before the change in ownership, use or construction may take place.

     2.  Upon a change of use or change in construction, a hospital must come into compliance with the guidelines before it may admit patients into the area in which the change is made.

     3.  The Bureau shall notify a hospital in writing of the existence of any deficiencies and the hospital shall correct those deficiencies within a reasonable amount of time. Except for major deficiencies, including deficiencies which require structural alterations of a building or a portion of a building, and except as otherwise provided in this subsection, reasonable time for the purposes of this subsection shall be deemed to be not more than 180 days. Upon written request and just cause shown, the Bureau may grant an extension of the time in which a deficiency must be corrected based on extenuating circumstances.

     4.  If the deficiencies are likely to cause serious injury, serious harm or impairment to public health and welfare, the hospital shall take immediate action to correct the deficiencies or the hospital will not be allowed to continue to operate.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § XVI subsec. F, eff. 10-9-69; A 8-26-74; Ch. II part § XI, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.313  Responsibilities and duties of governing body; bylaws; appointment and duties of chief executive officer; protocol for organ donations; annual operating budget. (NRS 449.0302)

     1.  A hospital shall have an effective governing body which is legally responsible for the conduct of the hospital.

     2.  The governing body of a hospital shall adopt a workable set of bylaws which must be in writing and available to all members. The governing body shall:

     (a) Determine, in accordance with state law, which categories of practitioners are eligible for appointment to the medical staff of the hospital;

     (b) Appoint members to the medical staff after considering the recommendations of the existing members of the medical staff;

     (c) Ensure that the medical staff has bylaws;

     (d) Approve the bylaws of the medical staff and any other rules and regulations adopted by the medical staff;

     (e) Ensure that the medical staff is accountable to the governing body for the quality of care which the medical staff provides to patients; and

     (f) Ensure that the criteria for the selection of members to the medical staff include competence, training, experience and judgment.

     3.  The governing body shall appoint a qualified chief executive officer using as its criteria the actual experience, nature and duration of hospital administration and graduate work in hospital administration of the appointee. Following his or her selection, the chief executive officer is responsible for the management of the hospital and for providing liaisons among the governing body, medical staff, nursing staff and other departments, units and services within the hospital. The chief executive officer shall keep the governing body fully informed of the conduct of the hospital through regular written reports. The chief executive officer must be allowed sufficient freedom from other responsibilities to provide adequate attention to the administration and management of the hospital.

     4.  The governing body shall ensure, in accordance with hospital policy, that:

     (a) Each patient is under the care of at least one of the following persons:

          (1) A doctor of medicine or osteopathy.

          (2) A doctor of dental surgery or dental medicine who is licensed to practice dentistry in this State and who is acting within the scope of his or her license.

          (3) A doctor of podiatric medicine, but only with respect to those functions which he or she is licensed to perform in this State.

          (4) A doctor of optometry who is licensed to practice optometry in this State.

          (5) A chiropractic physician who is licensed to provide chiropractic services in this State, but only with respect to the treatment of the spine by means of manual manipulation to correct a subluxation which is demonstrated by X-ray to exist.

     (b) A doctor of medicine or osteopathy is on duty or on call at all times.

     (c) A doctor of medicine or osteopathy is responsible for the care of each patient with respect to any medical or psychiatric problem that:

          (1) Is present when the patient is admitted into the hospital or develops after the patient is admitted; and

          (2) Is not specifically within the scope of practice of a doctor of dental surgery, dental medicine, podiatric medicine or optometry, or of a chiropractic physician, as that scope of practice is defined by the bylaws, rules and regulations of the medical staff.

     5.  To identify potential organ donors, a hospital shall have written protocols that:

     (a) Ensure that the family of each potential donor knows of its option to donate organs or tissues, or both, or to decline to make such a donation; and

     (b) Encourage discretion and sensitivity with respect to the circumstances, views and beliefs of the families of potential donors.

     6.  A hospital in which organ transplants are performed:

     (a) Must be a member of the Organ Procurement and Transplantation Network established and operated in accordance with section 372 of the Public Health Service Act, 42 U.S.C. § 274; and

     (b) Shall abide by the rules and regulations of the Organ Procurement and Transplantation Network.

     7.  A hospital shall have an overall institutional plan which includes an annual operating budget that is prepared according to generally accepted accounting principles. The annual operating budget must include anticipated income and expenses, except that the hospital is not required to identify item-by-item the components of each anticipated income or expense.

     8.  The governing body is responsible for the services furnished in the hospital, regardless of whether the services are furnished by staff or pursuant to contracts. The hospital shall maintain a list of contracted services which includes the scope and nature of the services provided.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § 1, eff. 10-9-69; A 8-26-74; ch. II § I, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.314  Quality of care; scope of services. (NRS 449.0302)

     1.  A hospital must be administered in a manner that enables the hospital to use its resources effectively and efficiently to meet the needs of and provide quality care to its patients. The governing body of a hospital shall develop and provide services for the care of its patients based on the identified needs of those patients.

     2.  The scope of services provided by each department, unit or service within a hospital must be defined in writing and must be approved by the administration and the medical staff of the hospital. Each department, unit or service within a hospital shall provide patient care in accordance with its scope of services. The policies and procedures of a hospital and of each department, unit or service within the hospital must, to the extent necessary, be integrated with the policies and procedures of the other departments, units and services within the hospital.

     3.  The governing body of a hospital shall:

     (a) Ensure that the competence of all members of the hospital staff is assessed, maintained, demonstrated and improved;

     (b) Provide an orientation process for persons hired to work at the hospital that includes initial job training and information; and

     (c) Assess the ability of the members of the hospital staff to fulfill their specified responsibilities.

     4.  A hospital shall ensure that it is staffed by a sufficient number of personnel, whose qualifications are consistent with their job responsibilities, to provide care to the patients of the hospital.

     5.  The chief executive officer of a hospital is responsible for operating the hospital in accordance with the authority conferred on him or her by the governing body.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3152  Quality improvement program. (NRS 449.0302)

     1.  The governing body of a hospital shall ensure that the hospital has an effective, comprehensive quality improvement program to evaluate the provision of care to its patients.

     2.  The quality improvement program must:

     (a) Be ongoing;

     (b) Include a written plan for carrying out the program; and

     (c) Provide for the creation of a committee to oversee the program.

     3.  All services related to patient care, including services furnished by a contractor, must be evaluated by the committee.

     4.  Nosocomial infections, medication therapy and deaths occurring in the hospital must be evaluated by the committee.

     5.  All medical and surgical services performed in the hospital must be evaluated by the committee as those services relate to the appropriateness of the diagnosis and treatment.

     6.  The committee shall initiate an assessment of a service or the provision of care when any statistical analysis detects an undesirable variation in performance.

     7.  The committee shall take and document appropriate remedial action to address deficiencies found through the quality improvement program. The committee shall document the outcome of any remedial action taken.

     8.  When the findings of an assessment relate to the performance of an individual licensed practitioner, the medical staff shall determine how such a finding will be used in any peer review, ongoing monitoring and periodic evaluations of the competence of the practitioner. If the findings of the assessment relate to the performance of a person who is not a licensed practitioner, the director of the department, unit or service in which that person works shall determine how the finding will be used in evaluating the competence of the person.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.3154  Construction, remodeling, maintenance and change of use: General requirements; prerequisites to approval of licensure. (NRS 439.200, 449.0302)

     1.  Except as otherwise provided in this section, a hospital shall comply with the provisions of NFPA 101: Life Safety Code, adopted by reference pursuant to NAC 449.0105.

     2.  Except as otherwise provided in this section, any new construction, remodeling or change in the use of a hospital must comply with the applicable provisions of the guidelines adopted by reference in paragraphs (c), (d) and (e) of subsection 1 of NAC 449.0105, unless the remodeling is limited to refurbishing an area of the hospital, including, without limitation, painting the area, replacing the flooring in the area, repairing windows in the area and replacing window or wall coverings in the area.

     3.  Except as otherwise provided in subsection 4, a hospital shall meet all applicable:

     (a) Federal and state laws;

     (b) Local ordinances, including, without limitation, zoning ordinances; and

     (c) Life safety, environmental, health, fire and local building codes,

Ê related to the construction and maintenance of the hospital. If there are any differences between the state and local codes, the more restrictive standards apply.

     4.  A hospital which is inspected and approved by the State Public Works Division of the Department of Administration in accordance with the provisions set forth in chapter 341 of NRS and chapter 341 of NAC is not required to comply with any applicable local building codes related to the construction and maintenance of the hospital.

     5.  A complete copy of the building plans for new construction and remodeling of a hospital, drawn to scale, must be submitted to the entity designated to review such plans by the Division of Public and Behavioral Health pursuant to the provisions of NAC 449.0115. Before the construction or remodeling may begin, plans for the construction or remodeling must be approved by the Division of Public and Behavioral Health.

     6.  The Bureau shall not approve the licensure of a hospital until all construction has been completed and a survey is conducted at the site. The plan review is only advisory and does not constitute prelicensing approval.

     7.  Notwithstanding any provision of this section to the contrary, a hospital which was licensed on January 1, 1999, shall be deemed to be in compliance with this section if the use of the physical space in the hospital does not change and the existing construction of the hospital does not have any deficiencies which are likely to cause serious injury, serious harm or impairment to public health and welfare.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R076-01, 10-18-2001; R068-04, 8-4-2004; R122-16, 9-21-2017; R048-22, 12-29-2022)

      NAC 449.3156  Compliance with certain guidelines for design and construction; correction of deficiencies. (NRS 439.200, 449.0302)

     1.  Notwithstanding any provision of NAC 449.3154 to the contrary, a hospital shall be deemed to be in compliance with the applicable provisions of the guidelines adopted by reference in paragraphs (c), (d) and (e) of subsection 1 of NAC 449.0105, if:

     (a) The hospital submitted architectural plans to the Bureau on or before February 1, 1999;

     (b) The hospital began construction on or before August 1, 1999;

     (c) The plans were determined by the Bureau to be in compliance with the provisions of NAC 449.002 to 449.99939, inclusive, that were in effect on December 1, 1998;

     (d) The hospital is built in accordance with those provisions;

     (e) The use of the physical space in the hospital has not changed; and

     (f) There are no deficiencies in the construction of the hospital which are likely to cause serious injury, serious harm or impairment to public health and welfare.

     2.  If there are deficiencies that are likely to cause serious injury, serious harm or impairment to public health and welfare, the hospital shall take immediate action to correct the deficiencies or the hospital will not be allowed to continue to operate.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R068-04, 8-4-2004; R122-16, 9-21-2017; R048-22, 12-29-2022)

Policies and Procedures for Operation of Hospital

      NAC 449.316  Physical environment: Safety and well-being of patients; plan for emergency preparedness; safety management. (NRS 449.0302)

     1.  The buildings of a hospital must be solidly constructed with adequate space and safeguards for each patient. The condition of the physical plant and the overall hospital environment must be developed and maintained in a manner so that the safety and well-being of patients are ensured.

     2.  A hospital shall develop and carry out a comprehensive plan for emergency preparedness which:

     (a) Addresses internal and external emergencies, both local and widespread; and

     (b) Is based on current standards for disaster management and fire safety.

     3.  A hospital shall ensure that the hospital staff and patients are adequately protected from fire and other disasters. To ensure that it has adequate fire protection, a hospital shall provide for the installation of extinguishers, sprinkling devices, fire barriers and the elimination of fire hazards.

     4.  The governing body shall analyze identified issues relating to safety management within the environment of care and develop or approve recommendations for addressing those issues. The governing body shall carry out and monitor the effectiveness of the recommendations.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § II part subsec. A & subsec. E, eff. 10-9-69; A 8-26-74; Ch. II part § II, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.317  Risk management. (NRS 449.0302)  Each hospital shall have in effect a comprehensive program for risk management and shall designate one person to be responsible for the implementation and maintenance of the program for risk management.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.318  Accreditation by national accrediting organization required; exceptions; submission of proof of accreditation to Division. (NRS 439.200, 449.0302)

     1.  A hospital must be accredited by an approved national accrediting organization unless the hospital:

     (a) Is a psychiatric hospital or rural hospital;

     (b) Has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e);

     (c) Contains a distinct part skilled nursing facility or a nursing facility, as defined in 42 C.F.R. § 483.5;

     (d) Is a hospital described in 42 U.S.C. § 1395ww(d)(1)(B)(iv) and accepts payment through Medicare;

     (e) Is owned by this State or a political subdivision thereof;

     (f) Is licensed only for rehabilitation beds; or

     (g) Was initially licensed before December 19, 2018, and has been licensed continually after that date.

     2.  A hospital that is required to comply with the requirements of subsection 1 shall submit to the Division proof of such compliance:

     (a) Not later than 12 months after obtaining an initial license;

     (b) With each application for renewal submitted pursuant to NAC 449.0116; and

     (c) As required by NAC 449.0108.

     3.  As used in this section, “approved national accrediting organization” means a national accrediting organization, as defined in 42 C.F.R. § 488.1, that has been approved by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services pursuant to 42 C.F.R. § 488.5.

     (Added to NAC by Bd. of Health by R133-18, eff. 12-19-2018; A by R048-22, 12-29-2022)

      NAC 449.319  Requirements for personal needs of patients. (NRS 449.0302)

     1.  A hospital shall provide patients access to their belongings as is appropriate based on the needs of the patients and the phase of treatment of the patients.

     2.  A hospital shall communicate and enforce a nonsmoking policy throughout the hospital.

     3.  A hospital shall provide a clean and comfortable bed and mattress for each patient. Bed linen, blankets, pillows, washcloths and towels that are clean and in good condition must be provided to each patient. A hospital shall have such systems as are necessary to ensure that an adequate supply of clean linen is provided to each patient.

     4.  A hospital shall provide each inpatient with necessary bedside equipment and supplies based on the needs of the inpatient. The necessary equipment and supplies must include, without limitation, a water pitcher and equipment for personal hygiene. The equipment and supplies must be maintained in a sanitary manner.

     5.  In public areas and in areas in which patient care is provided, a hospital shall:

     (a) Provide adequate and comfortable lighting levels;

     (b) Provide comfortable and safe temperature levels; and

     (c) Maintain comfortable sound levels.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § II part subsec. A, eff. 10-9-69; A 8-26-74; Ch. II part § II, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.321  Requirement to be primarily engaged in providing certain services; determination of whether requirement is met; exemption for certain hospitals. (NRS 439.200, 449.0302)

     1.  A hospital must be primarily engaged in providing the services described in 42 U.S.C. § 1395x(e)(1) to inpatients, unless the hospital:

     (a) Is a psychiatric hospital or rural hospital;

     (b) Has been certified as a critical access hospital by the Secretary of Health and Human Services pursuant to 42 U.S.C. § 1395i-4(e); or

     (c) Contains a distinct part skilled nursing facility or nursing facility, as defined in 42 C.F.R. § 483.5.

     2.  Except as otherwise provided in subsections 3 and 4, the Division shall determine whether a hospital meets the requirements of subsection 1 based on a totality of the circumstances.

     3.  Except as otherwise provided in subsection 4, the Division shall deem a hospital to be in compliance with subsection 1 if the hospital:

     (a) Has 20 or fewer inpatient beds;

     (b) Has been licensed and operating for less than 12 months; and

     (c) Contains a number of inpatient beds that is equal to or greater than the capacity for patients in the emergency room at the hospital.

     4.  The provisions of subsection 3 do not apply to a hospital that was initially licensed on or before December 19, 2018, and has been licensed continually after that date.

     5.  The Division shall determine that a hospital does not meet the requirements of subsection 1 if the hospital did not maintain:

     (a) A minimum average daily census of at least two inpatients, as determined pursuant to subsection 6; and

     (b) An average length of stay of at least 2 days during the 12 months immediately preceding the date on which the Division evaluates the hospital, as determined pursuant to subsection 6.

     6.  For the purposes of this section:

     (a) Average daily census must be calculated by dividing the sum for the evaluation period of the number of inpatients in the hospital at midnight of each day of the evaluation period by the number of days in the evaluation period.

     (b) Average length of stay must be calculated by dividing the total number of inpatient hospital days in an evaluation period by the number of discharges from the hospital in the evaluation period. As used in this paragraph, “inpatient hospital day” means:

          (1) The day on which a patient is admitted to a hospital;

          (2) The day on which a patient is discharged from a hospital, including, without limitation, the day on which a patient dies; and

          (3) Each day after the day on which a patient is admitted to a hospital and before the patient is discharged.

     (Added to NAC by Bd. of Health by R133-18, eff. 12-19-2018)

      NAC 449.322  Housekeeping and laundry services. (NRS 449.0302)

     1.  A hospital shall establish organized housekeeping services planned, operated and maintained to provide a pleasant, safe and sanitary environment. Adequate personnel, using accepted practices and procedures, shall keep the hospital free from offensive odors, accumulations of dirt, rubbish, dust and safety hazards.

     2.  Suitable equipment and supplies must be provided for cleaning all surfaces. The equipment must be maintained in a safe, sanitary condition. Storage areas, attics and cellars must be kept safe and free from accumulations of extraneous materials such as refuse, discarded furniture and equipment, and old newspapers. Combustibles such as cleaning rags and compounds and hazardous substances must be labeled properly and stored in safe places. Paper towels, tissues and similar supplies must be stored in a manner to prevent their contamination before use.

     3.  Cleaning must be performed in a manner to minimize the spread of pathogenic organisms. Floors must be cleaned regularly. Polishes on floors must provide a nonslip finish. Throw or scatter rugs must not be used except for nonslip entrance mats.

     4.  Housekeeping personnel must receive adequate supervision. Continuous in-service training programs must be established for housekeeping personnel.

     5.  A hospital shall develop and carry out standards and systems for the operation of laundry services. Laundry services, whether owned by the hospital or provided pursuant to a contract, must:

     (a) Maintain standards for a safe work environment for employees;

     (b) Address issues relating to the control of infections; and

     (c) Be operated in a manner that does not disrupt the patient care provided by the hospital.

     6.  A hospital shall develop and carry out:

     (a) Standards and systems for the storage and handling of clean linen and soiled linen; and

     (b) Written policies relating to the handling, storage, transportation and processing of its linen.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § II part subsec. A, eff. 10-9-69; A 8-26-74; Ch. II part § II, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.325  Prevention, control and investigation of infections and communicable diseases. (NRS 449.0302)

     1.  A hospital shall:

     (a) Provide a sanitary environment to avoid sources and transmission of infections and communicable diseases; and

     (b) Develop and carry out an active program for the prevention, control and investigation of infections and communicable diseases.

     2.  A hospital shall designate at least one person as an infection control officer, who shall develop and carry out policies governing the control of infections and communicable diseases.

     3.  The infection control officer of a hospital shall:

     (a) Develop a system for identifying, reporting, investigating and controlling infections and communicable diseases of patients and personnel of the hospital; and

     (b) Maintain a record of incidents within the hospital related to infection and communicable disease.

     4.  The chief executive officer, the medical staff and the chief administrative nurse of a hospital:

     (a) Shall ensure that the quality improvement program established pursuant to NAC 449.3152 and the training program for the entire hospital address those problems identified by the infection control officer of the hospital; and

     (b) Are responsible for the implementation of successful corrective plans of action in affected problem areas.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § II part subsec. A & subsec. D, eff. 10-9-69; A 8-26-74; Ch. II part § II, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.327  Preparation, sterilization, storage and distribution of sterile supplies and medical and surgical equipment. (NRS 449.0302)

     1.  To meet the ongoing needs of its patients, a hospital shall:

     (a) Provide a designated area for the preparation, sterilization and storage of sufficient sterile supplies and medical and surgical equipment; and

     (b) Dispense the sterile supplies and equipment to all departments, units and services within the hospital.

     2.  A hospital which prepares, sterilizes and stores its supplies and equipment directly shall develop systems and standards that are consistent with:

     (a) The standards for the control of infection established by the infection control officer of the hospital;

     (b) The standards developed by the Occupational Safety and Health Administration for the preparation, sterilization and storage of such supplies and equipment; and

     (c) When applicable, the manufacturer’s guidelines for the use and maintenance of the equipment.

     3.  If the supplies and equipment are sterilized on the premises of a hospital, the process of sterilization must be supervised by a person who has received specialized training in the operation of the process of sterilization, including training in methods of testing the process to verify the efficiency of the process of sterilization.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.329  Admission of patients. (NRS 449.0302)  A hospital shall:

     1.  Develop and carry out policies and procedures for admitting patients to the appropriate levels of care; and

     2.  Ensure that each patient, or the parent, guardian or other person legally responsible for the patient, receives information about the proposed care of the patient.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.331  Provision of emergency services and medical care; transfer agreements with long-term care facilities; attestation of compliance. (NRS 439.200, 449.0302)

     1.  A hospital shall develop and carry out policies and procedures to ensure that emergency services and medical care are provided in accordance with NRS 439B.410 and 450B.790 and 42 C.F.R. § 489.24 and to ensure compliance with the provisions of NRS 450B.795.

     2.  All hospitals not having their own long-term facility shall have transfer agreements with long-term care facilities. Transfer agreements between facilities must be in writing and on file at each facility concerned. The agreements must provide for:

     (a) The transfer of patients between facilities whenever the need for transfer is medically determined; and

     (b) The exchange of appropriate medical and administrative information between facilities.

     3.  In addition to the application required by NAC 449.011 or 449.0116, as applicable, a hospital applying for initial licensure or the renewal of its license shall submit to the Division an attestation under penalty of perjury that the hospital is in compliance with the requirements of this section.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § XVI subsecs. A, B & D, eff. 10-9-69; Ch. II part § XI, eff. 10-9-69]—(NAC A by R050-99, 9-27-99; R138-07, 1-30-2008; R133-18, 12-19-2018; R048-22, 12-29-2022)

      NAC 449.332  Discharge planning. (NRS 439.200, 449.0302)

     1.  A hospital shall:

     (a) Have a process for discharge planning that applies to all inpatients; and

     (b) Develop and carry out policies and procedures regarding the process for discharge planning.

     2.  The process for discharge planning must include the participation of registered nurses, social workers or other personnel qualified, through education or experience, to perform discharge planning.

     3.  A hospital shall, at the earliest possible stage of hospitalization, identify each patient who is likely to suffer adverse health consequences upon discharge if the patient does not receive adequate discharge planning. The hospital shall provide for an evaluation of the needs related to discharge planning of each patient so identified.

     4.  An evaluation of the needs of a patient relating to discharge planning must include, without limitation, consideration of:

     (a) The needs of the patient for postoperative services and the availability of those services;

     (b) The capacity of the patient for self-care; and

     (c) The possibility of returning the patient to a previous care setting or making another appropriate placement of the patient after discharge.

     5.  If the evaluation of a patient relating to discharge planning indicates a need for a discharge plan, a discharge plan must be developed under the supervision of a registered nurse, social worker or other person qualified to perform discharge planning.

     6.  An evaluation of a patient relating to discharge planning and a discharge plan for the patient may be requested by the patient, a physician, a member of the family of the patient or the guardian of the patient, if any.

     7.  If a hospital finds that a patient does not need a discharge plan, the attending physician may still request a discharge plan for the patient. If the attending physician makes such a request, the physician shall collaborate as much as necessary with the hospital staff in the development of the discharge plan.

     8.  Activities related to discharge planning must be conducted in a manner that does not contribute to delays in the discharge of the patient.

     9.  The evaluation of the needs of a patient relating to discharge planning and the discharge plan for the patient, if any, must be documented in his or her medical record.

     10.  The discharge plan must be discussed with the patient or the person acting on behalf of the patient.

     11.  The patient, members of the family of the patient and any other person involved in caring for the patient must be provided with such information as is necessary to prepare them for the posthospital care of the patient.

     12.  If, during the course of a patient’s hospitalization, factors arise that may affect the needs of the patient relating to his or her continuing care or current discharge plan, the needs of the patient must be reassessed and the plan, if any, must be adjusted accordingly.

     13.  A hospital shall arrange for the initial implementation of the discharge plans of its patients.

     14.  If identified in a discharge plan, referral of a patient to outpatient services or transfer of the patient to another facility must be accomplished in a manner that meets the identified needs of the patient, including, without limitation:

     (a) Upon the referral or transfer, necessary sharing of administrative and medical information about the patient with the receiving service or other facility or making such information available to the service or other facility; and

     (b) Providing for the security of and accountability for the personal effects of the patient.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R133-18, 12-19-2018)

      NAC 449.337  Dietary services: General requirements. (NRS 449.0302)

     1.  A hospital shall provide each patient with a nourishing, palatable, well-balanced diet that meets the daily nutritional and dietary needs of the patient.

     2.  The menu for a patient must meet the nutritional needs of the patient in accordance with:

     (a) Recognized dietary practices; and

     (b) The orders of the practitioners responsible for the care of the patient.

     3.  A hospital shall ensure that not less than three meals are served daily to patients and not more than 15 hours elapse between the evening meal and breakfast served the following day.

     4.  Nourishment and feeding between meals must be provided as required by diet prescription and must be available to each patient unless otherwise ordered by the physician of the patient.

     5.  Except as otherwise provided in this subsection, menus must be followed. A meal may vary from the planned menu if the change is noted in writing in the records maintained by the dietary services.

     6.  A hospital shall ensure that the food and religious preferences of a patient are respected to the extent practicable and that substitute food is available through the use of a selective menu or substitutes from appropriate food groups.

     7.  A hospital shall ensure that persons who are responsible for therapeutic diets have sufficient knowledge of food values to make appropriate substitutions when necessary.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § V, eff. 10-9-69; Ch. II § V, eff. 10-9-69]—(NAC A by R035-97, 10-30-97; R050-99, 9-27-99)

      NAC 449.338  Dietary services: Provision for needs of patients; facilities; standards; permits; records. (NRS 449.0302)

     1.  A hospital shall provide for the general dietary needs of its patients, including the preparation of modified special diets.

     2.  Adequate space for the preparation and service of food must be provided. Equipment for the preparation and service of food must be placed to provide aisles of sufficient width to permit easy movement of personnel, mobile equipment and supplies.

     3.  Well-ventilated food storage areas of adequate size must be provided.

     4.  Adequate space must be maintained to accommodate equipment, personnel and procedures necessary for the proper cleaning and sanitizing of dishes and other utensils.

     5.  Office or other suitable space must be provided for the dietitian and dietetic service supervisor.

     6.  In providing for the preparation and serving of food, a hospital shall:

     (a) Comply with the standards prescribed in chapter 446 of NRS and the regulations adopted pursuant thereto;

     (b) Obtain the necessary permits from the Division;

     (c) Maintain a report of each inspection concerning the sanitation of the hospital for at least 1 year after the date of the inspection; and

     (d) Maintain a report of each corrective action taken to address a deficiency noted in a report described in paragraph (c) for at least 1 year after the date of the corrective action.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R068-04, 8-4-2004; R155-10, 12-16-2010)

      NAC 449.3385  Dietary services: Personnel. (NRS 449.0302)

     1.  A hospital shall maintain an organized dietary service that is staffed by an adequate number of personnel. The hospital shall ensure that personnel are on duty to provide dietary services for at least 12 hours each day and that the personnel are competent to perform their duties as outlined in their job descriptions. The dietary service must be integrated with the other departments, units and services within the hospital.

     2.  The dietary service must be under the direction of a licensed dietitian or other professional person who:

     (a) Is qualified in the field of institutional management, nutritional sciences or hotel restaurant management;

     (b) Has completed an academic program in culinary arts; or

     (c) Is certified as a dietary manager by the Association of Nutrition & Foodservice Professionals and has additional work experience with medical and therapeutic diets.

     3.  The director of the dietary service may be employed on a full-time or part-time basis, or as a consultant.

     4.  A hospital shall have on staff a licensed dietitian or a consultant who is licensed as a dietitian who shall provide in-service training for all dietetic service personnel and maintain a record of the in-service training provided which includes a description of the subjects covered by the training, the date that the training was given, the duration of the training and a list of the persons who attended the training.

     5.  Personnel of the dietary service must:

     (a) Be trained in basic techniques of food sanitation;

     (b) While working in the dietary service, be clean and wear clean clothing, including a cap or hairnet, or both; and

     (c) Be excluded from duty when affected by a skin infection or communicable disease.

     6.  If an employee of the dietary service has a beard or moustache, or both, which is not closely cropped, the employee shall cover the beard or moustache, or both, while on duty.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R068-04, 8-4-2004; R090-12, 12-20-2012)

      NAC 449.339  Dietary services: Nutritional status of patients. (NRS 449.0302)

     1.  A hospital shall carry out a program for the systematic nutritional risk-screening of its patients to detect actual and potential malnutrition at an early stage.

     2.  A hospital shall ensure that each patient maintains acceptable parameters of nutritional status, including, without limitation, body weight and protein levels, unless the patient’s clinical condition demonstrates that the maintenance of those parameters is not possible.

     3.  A patient who is fed by an enteral feeding system must receive the appropriate treatment and services to prevent complications to the extent possible.

     4.  Parenteral nutrition support must be used to nourish a patient who meets clinical guidelines that are developed in accordance with nationally recognized standards of practice and approved by the medical staff of the hospital.

     5.  A patient must receive a therapeutic diet when it is determined that he or she has a nutritional problem.

     6.  The director of the dietary service shall develop and carry out policies and procedures for nutritional care and dietetic services. The policies and procedures must be readily available to nursing, dietary and medical staff. The director shall evaluate the policies and procedures for nutritional care and services provided by the dietary service on a regular basis and revise those policies and procedures as necessary.

     7.  If it is determined that the nutritional status of a patient is at risk, nutritional care for that patient must be:

     (a) Planned and provided based on an assessment of his or her nutritional status by a licensed dietitian or the attending physician, or both; and

     (b) Integrated into his or her plan of care.

Ê The response of the patient must be monitored and reassessed as needed.

     8.  Pertinent dietary information must be included in a patient’s transfer records or discharge records, or both, to ensure continuity of nutritional care.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99; A by R090-12, 12-20-2012)

      NAC 449.3395  Dietary services: Sanitary conditions; supplies. (NRS 449.0302)

     1.  A hospital shall store, prepare, distribute and serve food under sanitary conditions.

     2.  A hospital shall maintain on its premises at least a 1-week supply of staple foods and at least a 2-day supply of perishable foods. The supplies must be appropriate to meet the requirements of the menu. All food must be of good quality and procured from sources approved or considered satisfactory by federal, state and local authorities. Food that is contained in a container or can that:

     (a) Is unlabeled, if the contents of the container or can are not readily identifiable without opening the container or can;

     (b) Is rusty, leaking or broken; or

     (c) Has dents or swelling,

Ê is not acceptable and must not be maintained.

     3.  All kitchens and kitchen areas in a hospital must be kept clean, kept free from litter and rubbish, and protected from rodents, roaches, flies and other insects. The hospital shall take such measures as are necessary for preventive pest control. All utensils, counters, shelves and equipment must be kept clean, maintained in good repair, and free from breaks, corrosions, open seams, cracks and chipped areas. Plastic ware, china and glassware that is unsightly, unsanitary or hazardous because of chips, cracks or loss of glaze must be discarded.

     4.  After each use, utensils used for eating or drinking or used in the preparation of food or drink must be cleaned and disinfected, or discarded.

     5.  Kitchen sinks must not be used for washing hands. Separate facilities for washing hands, which includes soap, running water and individual towels, must be provided.

     6.  Kitchen wastes that are not disposed of by mechanical means must be:

     (a) Kept in containers which:

          (1) Are leak proof;

          (2) Are made of nonabsorbent materials; and

          (3) Can be tightly closed; and

     (b) Disposed of as frequently as necessary to prevent a nuisance or unsightliness.

     7.  Ice which is used in connection with food or drink must be from a sanitary source and must be handled and dispensed in a sanitary manner.

     8.  A person other than personnel of the dietary service may not be in the kitchen area unless the person is required to be there in the performance of his or her duties.

     9.  Equipment of the type and in the amount necessary for the proper preparation, service and storage of food and for proper dishwashing must be provided and maintained in good working order.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)

      NAC 449.340  Pharmaceutical services. (NRS 449.0302)

     1.  A hospital shall have a pharmacy directed by a registered pharmacist, who may be a full-time, part-time or consulting pharmacist, or a drug room supervised by no less than a currently licensed professional nurse. If a hospital has an organized pharmaceutical service, the full-time, part-time or consulting pharmacist shall develop, supervise and coordinate all the activities of the service.

     2.  The pharmacy and area for drug storage must be administered in accordance with all applicable state and federal laws.

     3.  Except as otherwise provided in this subsection, the medical staff shall develop policies and procedures to minimize errors in the administration of the drugs. The medical staff may designate the organized pharmaceutical service of the hospital to develop the policies and procedures required by this subsection.

     4.  The pharmaceutical service of a hospital shall have an adequate number of personnel to ensure quality pharmaceutical services, including emergency services.

     5.  Drugs and biologicals must be controlled and distributed in a manner which is consistent with applicable state and federal laws.

     6.  When a pharmacist is not available, drugs and biologicals may be removed from the pharmacy or storage area only by personnel designated by the policies of the medical staff and pharmaceutical service, which must be established in accordance with all applicable state and federal laws, to remove the drug or biological.

     7.  Errors in administering a drug to a patient, adverse reactions by a patient to a drug and incompatibilities between a drug and patient must be immediately reported to the attending physician of the patient and, if appropriate, to the committee that oversees the quality improvement program established pursuant to NAC 449.3152.

     8.  Misuses and losses of controlled substances must be reported, in accordance with all applicable state and federal laws, to the person responsible for the pharmaceutical service and the chief executive officer of the hospital.

     9.  Information relating to drug interactions, drug therapy, side effects, toxicology, dosage indications for use and routes of administration must be made available to the professional members of the hospital staff.

     10.  A formulary system must be established by the medical staff to ensure the provision of quality pharmaceuticals at reasonable costs.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § VII subsecs. A-C, eff. 10-9-69; Ch. II part § VII, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.343  Orders for medication and biologicals. (NRS 449.0302)

     1.  Except as otherwise provided in this section, an order for medication or biologicals for a patient must be in writing and signed by the practitioner, or other appropriate professional person authorized by state or federal law to order the medication or biological, who is responsible for the care of the patient.

     2.  When a telephone or verbal order is used to order medications or biologicals, the order must be:

     (a) Accepted only by a person who is authorized by the policies and procedures of the medical staff, which must be consistent with state law, to accept such an order; and

     (b) Signed or initialed by the prescribing practitioner in accordance with hospital policy.

     3.  An order for a medication or a biological must include the name of the medication or biological and the dosage, time or frequency of administration and route of administration of the medication or biological.

     4.  Medication and biologicals that are not specifically prescribed as to time or number of doses must be automatically stopped after a reasonable time that has been predetermined by the medical staff for that medication or biological.

     5.  Emergency medications approved by the medical staff or advisory physician must be kept readily available in the pharmacy or drug room and in compliance with all federal, state and local laws.

     [Bd. of Health, Health Facilities Reg. Part III Ch. I § VII subsecs. D-H, eff. 10-9-69; Ch. II part § VII, eff. 10-9-69]—(NAC A by R050-99, 9-27-99)

      NAC 449.344  Administration of medication; security. (NRS 449.0302)

     1.  Only members of the hospital staff who are legally authorized to administer medications may do so.

     2.  Security of all medications must be maintained in accordance with applicable state law.

     3.  The quality improvement program established pursuant to NAC 449.3152 must include a system of security to monitor and improve the process of administering medications.

     (Added to NAC by Bd. of Health by R050-99, eff. 9-27-99)