Ala. Admin. Code r. 420-5-3-.04

Current through Register Vol. 43, No. 02, November 27, 2024

Section 420-5-3-.04 - General Rules

(1) Personnel.

(a) There shall be one person in charge of the institution at all times. This person may be the owner of the business or a person employed for the purpose who is qualified to assume the management and operation of the institution.

(b) Each institution shall have sufficient employees present at all times for the adequate care of patients or residents and maintenance of the institution. All persons in charge of, employed by, or associated with the institution must be of suitable character and temperament to function in their appointed capacities and to provide for the care and comfort of the patients or residents. Adequacy of personnel shall be determined by the State Board of Health.

1. There shall be housekeeping, cooking, and kitchen personnel sufficient to maintain the institution in a sanitary condition at all times.

2. Adequate personal and nursing care shall be provided when such care is necessary, either through registered nurses, practical nurses, or attendants. A registered nurse may be required when in the opinion of the State Board of Health the patients or residents require skilled nursing care.

(c) Each person employed shall be required to furnish a health certificate showing such employee to be free from communicable disease.

(d) The names and qualifications of all professional employees shall be on file and available for inspection by authorized representatives of the State Board of Health.

(e) If the center conducts a school or educational program as part of the institution's program, staff members should have special qualifications in diagnostic and remedial instruction; special qualifications in physical, occupational, and speech therapy.

(f) The school program and qualifications of teachers should be approved by the county and/or State Department of Education.

(g) There should be one or more persons trained or experienced in medical social case work and social group work.

(h) Each institution shall have an adequate organized medical staff.

(i) Included on the medical staff should be such specialists as pediatricians, orthopedists, neurosurgeons, neuropsychiatrists and physchiatrists. This medical staff should assume responsibility for continuous care and treatment of patients. (It is not considered sufficient if members of the medical staff are called only on presumed need.)

(2) Admission Policies.

(a) Admissions must be made only on the basis of a complete medical work-up. This medical work-up must contain:

1. A statement of the physical condition of the patient;

2. A recommended treatment and/or educational program; and

3. A specified trial period in the institution.

(b) The institution shall not give false hopes or make promises which cannot be filled.

(c) Admission must be limited to the patients that the institution is qualified by staff and equipment to serve adequately.

(d) A social investigation should be made before admission. This investigation should be recorded and include all the information consistent with good case work.

(e) Whenever there is found to be evidence of fraud or misrepresentation to secure money or property from residents, patients, or applicants, or there is any evidence of misappropriation or conversion of money or property of residents, patients, or applicants, the State Board of Health shall report such facts to the prosecuting attorney of the county where such institution is located, or to the Attorney General of the State for further investigation and prosecution.

(3) Medical Care and Treatment.

(a) No medication or treatment shall be given except on the written orders of a licensed physician. All treatment and medication ordered or advised by a physician shall be in writing and shall be recorded and signed by him; also discontinuance of medication shall be signed by him and dated. Such records shall be kept as a permanent record in the institution.

(b) Any illness, accident or death of a patient shall be reported immediately to members of the patient's family.

(c) All children should be given necessary vaccination and inoculation for communicable diseases.

(d) Dental examinations should be made of all children at least once a year, and necessary follow-up treatment should be carried out.

(e) In the case of acute infection or of any communicable disease, such patients must be isolated at once. One or more rooms shall be available for such isolation, depending upon the size of the institution.

(f) Each child must have his own toilet articles, clothing, etc.

(g) Patients shall receive kind, considerate care and treatment at all times. No patient shall be abused or punished by any method of physical force, confinement to a room, or by withholding of food.

(h) All poisonous substances must be plainly labeled and kept in a locked cabinet or closet.

(i) First aid supplies shall be kept in a place readily accessible to the person or persons providing care in the institution.

(j) A flexible therapy and educational program must be established on the basis of the need of the children, as was determined by the medical work-up in the admission procedure.

(k) Parent participation in the institution's program should be encouraged at all times.

(l) There should be frequent staff conferences to discuss individual children and the therapy and education program.

(m) Continuous medical supervision must be provided by one or more physicians who are specialists or experienced in convulsive disorders. It is not considered sufficient if a physician is only on an "on call" basis.

(n) Whenever a patient requires hospitalization, medical, nursing, or other care beyond the facilities of the institution, prompt effort shall be made to secure such care.

(o) A balanced diet, adjusted to the age and physical development of the children should be provided. In the event special diets are ordered by the physician, such diets shall be served as prescribed and made a matter of record.

(4) Records.

(a) An adequate permanent record of each patient, either typewritten or legibly written with pen and ink, which will give a chronological account of the institution's contact with the patient and his family shall be kept. Following is minimum information:

1. Name.

2. Age.

3. Sex.

4. Name and address of nearest relative or sponsor.

5. Date of admission.

6. Diagnosis.

7. Date of discharge or death.

8. Name, address, and telephone number of patient's physician.

(b) The amount of weekly or monthly fee shall be set forth in writing. A definite and specific financial agreement shall be made.

(c) Inventory and disposition of personal property, money or valuables possessed at the time of entrance and death or discharge shall be made. A copy of this record must be given to the family or legal representative.

(d) There must be a complete medical and treatment record for each patient. This record must show:

1. The basis for admission as determined by the medical work-up.

2. All medication and treatment.

3. Any illness or accident.

4. Vaccinations and inoculations for communicable diseases.

5. Dental examinations and follow-up treatment.

(5) Building and Equipment.

(a) All buildings which house patients or residents must be inspected in relation to sanitation by the local or state health authorities and recommended to be reasonably safe for the care of cerebral palsy patients.

(b) The local or state authorities for fire protection must certify that the home is free from ordinary fire hazards.

(c) The building shall be maintained in repair and cleanliness at all times.

(d) Adequate porches or yard space for the use of patients shall be available.

(e) The entire building must be equipped with screens and free from flies.

(f) The State Board must be satisfied that all precautions are being taken to guard against the presence of rodents and vermin.

(g) If at all practicable, all water shall be obtained from a public water supply. If not obtained from a public water supply, the water shall meet the approval of the State Board of Health.

(h) An adequate sewage disposal system must be provided which shall meet the approval of the State Board of Health.

(i) Adequate provision for the collection and disposal of garbage, ashes, and waste material must be made. Covered containers must be used for garbage and metal containers for ashes.

(j) The home must be adequately heated at all times.

(k) Each room shall be comfortably furnished. Suitable provision for individual belongings shall be made.

(l) Sleeping rooms, except for infant nurseries, shall contain not less than 500 cubic feet of air space for each occupant and shall have at least one outside window and the window area must be 1/8 of the floor area.

(m) Separate beds shall be furnished with clean mattresses, clean and warm bedding and rubber sheeting when necessary. Beds must be so arranged that an attendant will have easy access to each bed.

(n) Adequate artificial lighting shall be available in all rooms, stairways, and hallways of the building. Night lights shall be provided in all hallways, stairways, and bathrooms.

(o) Sanitary toilet, bath and lavatory shall be provided on each floor where residents or patients stay. There should be one toilet for each six persons, one lavatory for each six persons, one tub bath or one shower bath for each ten. Non-skid mats and safety hand grips shall be provided for protecting those who use tubs or showers. Toilet rooms shall not connect directly with any room in which food is prepared, served or stored.

(p) Only ambulatory persons may be housed above the first floor of a building which is not fireproof. There must be railings on all stairways.

(q) Telephone service must be available in the home in order to summon help in case of fire or other emergency.

(r) If both sexes are cared for, facilities shall be properly arranged for segregation and privacy, as needed.

(s) Any licensee or applicant desiring to construct new facilities or to make alterations or additions to its facilities shall, before commencing such alteration, addition, or new construction, submit plans and specifications therefor to the State Board of Health for preliminary inspection and recommendations with respect to compliance with the rules herein authorized.

(6) Food Service. The preparation and handling of food shall conform with the Alabama State Board of Health's Rules Governing the Manufacture, Preparation, Display and Service of Food, Confections and Beverages.

L. O'Neal Green

Ala. Admin. Code r. 420-5-3-.04

Filed September 1, 1982.

Statutory Authority:Code of Ala. 1975, § 22-21-20.