Ariz. Admin. Code § 9-10-516

Current through Register Vol. 30, No. 45, November 8, 2024

Section R9-10-516 - Physical Health Services

A. An administrator shall ensure that:

1. A resident has an attending physician;

2. An attending physician is available 24 hours a day;

3. An attending physician designates a physician who is available when the attending physician is not available;

4. A physical examination is performed on a resident by a physician or by a physician assistant or registered nurse practitioner designated by the resident's attending physician:

a. If indicated, based on the resident's placement evaluation or comprehensive assessment; and

b. At least once every 12 months after the date of admission, including an assessment of the acuity of the resident's medical condition;

5. If a resident's physical examination, placement evaluation, or comprehensive assessment indicates a need for:

a. Intermittent nursing services, the resident's attending physician, in conjunction with the director of nursing, develops a nursing care plan of treatment for the resident, which is integrated into the resident's individual program plan; or

b. Continuous nursing services, the resident's attending physician, in conjunction with the director of nursing, develops a medical care plan of treatment for the resident, which is integrated into the resident's individual program plan; and

6. Vaccinations for influenza and pneumonia are available to each resident at least once every 12 months unless:

a. The attending physician provides documentation that the vaccination is medically contraindicated;

b. The resident or the resident's representative refuses the vaccination or vaccinations and documentation is maintained in the resident's medical record that the resident or the resident's representative has been informed of the risks and benefits of a vaccination refused; or

c. The resident or the resident's representative provides documentation that the resident received a pneumonia vaccination within the last five years or the current recommendation from the U.S. Department of Health and Human Services, Center for Disease Control and Prevention.

B. An administrator shall ensure that:

1. Nursing services are available 24 hours a day in an ICF/IID;

2. For an ICF/IID authorized to admit a resident requiring:

a. Continuous nursing services, a registered nurse is on the premises; or

b. Intermittent nursing services, a nurse is on the premises according to the schedule in a resident's nursing care plan; and

3. The director of nursing or an individual designated by the director of nursing participates in the quality management program.

C. A director of nursing shall ensure that:

1. A method is established and documented that identifies the types and numbers of nursing personnel that are necessary to provide nursing services to residents based on:

a. The acuity of the residents, and

b. The ICF/IID's scope of services;

2. Sufficient nursing personnel, as determined by the method in subsection (C)(1), are on the ICF/IID's premises to meet the needs of a resident for nursing services;

3. A registered nurse participates in the development, review, and updating of a resident's nursing care plan or medical care plan;

5. Personnel members providing direct care to a resident with a nursing care plan or medical care plan receive direction from a nurse;

6. At least once every three months, a nurse:

a. Assesses the health of a resident without a nursing care plan or medical care plan;

b. Documents the results in the resident's medical record; and

c. If the assessment indicates the need for physical health services or behavioral care, initiates action, according to policies and procedures, to address the resident's needs;

7. Nursing personnel provide education and training to:

a. Residents on hygiene and other behaviors that promote health; and

b. Personnel members on:

i. Detecting signs of illness or injury or significant changes in condition,

ii. First aid, and

iii. Basic skills for caring for residents;

8. As soon as possible but not more than 24 hours after one of the following events occur, a nurse notifies a resident's attending physician and, if applicable, the resident's representative, if the resident:

a. Is injured,

b. Is involved in an incident that requires medical services, or

c. Has a significant change in condition; and

9. Only a medication required by an order is administered to a resident.

D. An administrator shall ensure that:

1. Dental services are provided to a resident by an individual licensed as:

a. A dentist under A.R.S. Title 32, Chapter 11, Article 2; or

b. A dental hygienist under A.R.S. Title 32, Chapter 11, Article 4;

2. If needed, based on a resident's initial assessment, a dentist or dental hygienist in subsection (D)(1) participates as part of an interdisciplinary team in the development of the resident's individual program plan;

3. A resident is provided with a complete dental examination within one month after admission, unless the ICF/IID has documentation of the resident's dental examination completed within 12 months before admission;

4. If a resident's dental examination indicates the resident needs dental treatment:

a. A dentist or dental hygienist in subsection (D)(1) participates as part of an interdisciplinary team in the review and updating of the resident's individual program plan, and

b. The resident is provided with dental treatment;

5. A dental examination is performed by a dentist or dental hygienist in subsection (D)(1) on a resident at least once every 12 months and treatment is provided as needed;

6. If needed, a resident is provided with emergency dental services;

7. A resident is provided with education and training in oral hygiene; and

8. A resident's medical record contains documentation of:

a. Each dental examination of the resident,

b. All dental treatment provided to the resident, and

c. The resident's education and training in oral hygiene.

E. An administrator shall ensure that:

1. A resident's vision and hearing are assessed as part of the resident's comprehensive assessment and, if applicable, as part of the update of the comprehensive assessment; and

2. If an issue is identified with the resident's vision or hearing, the resident is provided, as applicable, with:

a. Treatment to address the identified issue, or

b. An assistive device to address an issue.

Ariz. Admin. Code § R9-10-516

Adopted as an emergency effective October 26, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Readopted without change as an emergency effective January 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-1). Emergency expired. Readopted without change as an emergency effective April 27, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-2). Emergency expired. Readopted without change as an emergency effective July 31, 1989, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 89-3). Permanent rules adopted with changes effective October 30, 1989 (Supp. 89-4). Section repealed effective April 4, 1994 (Supp. 94-2). New Section made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Amended by exempt rulemaking at 20 A.A.R. 1409, effective 7/1/2014. Adopted by final rulemaking at 25 A.A.R. 1222, effective 4/25/2019. Amended by exempt rulemaking at 26 A.A.R. 72, effective 1/1/2020.