Tenn. Comp. R. & Regs. 1200-08-25-.07 - SERVICES PROVIDED

(1) An ACLF may provide medical services as follows:
(a) Administer medications to residents that are typically self-administered as subject to limitations described within these rules and regulations.
(b) All other medical services prescribed by the physician that could be provided to a private citizen in the citizen's home, including, but not limited to:
1. Part-time or intermittent nursing care;
2. Various therapies;
3. Podiatry care;
4. Medical social services;
5. Medical supplies;
6. Durable medical equipment; and
7. Hospice services.
(c) Intravenous medications may only be administered to:
1. Existing residents who receive them on an intermittent basis; and
2. Residents receiving hospice care.
(2) Medical services in an ACLF shall be provided by:
(a) Appropriately licensed or qualified staff of an ACLF;
(b) Appropriately licensed or qualified contractors of an ACLF;
(c) A licensed home care organization;
(d) Another appropriately licensed entity; or
(e) Appropriately licensed staff of a nursing home.
(3) Oversight of medical services in an ACLF shall be consistent with oversight provided in private residential settings as defined through rules and regulations promulgated by the applicable licensing boards and shall ensure quality of care to residents.
(4) Medicare reimbursable services shall be provided to an ACLF resident by a certified Medicare provider.
(5) Resident medication. An ACLF shall:
(a) Ensure that medication shall be self-administered in accordance with the resident's plan of care;
(b) Ensure that all drugs and biologicals shall be administered by a licensed or certified health care professional operating within the scope of the professional license or certification and according to the resident's plan of care.
(c) Ensure that during the course of administering medication, a medication aide shall not be assigned any other non-medication administration duties. However, a medication aide shall not be precluded from responding, as appropriate, to an emergency;
(d) Store all medications via a locked or closed container and/or room which includes, but is not limited to, some type of box, piece of furniture, an individual resident room, and/or a designated room within the facility which maintains resident medication out of the sight of other residents; and
(e) Ensure that facility staff shall not repackage medication and shall not administer medication from repackaging.
(6) An ACLF shall dispose of medications as follows:
(a) Upon discharge of a resident, unused prescription medication shall be released to the resident, the resident's family member, or the resident's legal representative, unless specifically prohibited by the attending physician.
(b) Upon death of a resident, unused prescription medication must be destroyed in the manner outlined, and by the individuals designated, in the facility's medication disposal policy, unless otherwise requested by the resident's family member or the resident's legal representative and accompanied by a written order by a physician. The ACLF's medication disposal policy shall be written in accordance with current FDA or current DEA medication disposal guidelines;
(c) The ACLF shall properly dispose of prescription medication administered by the facility in accordance with the facility's medication disposal policy, which shall be written in accordance with current FDA or current DEA medication disposal guidelines.
(d) The ACLF may dispose of prescription medication that is self-administered by the resident according to the facility's medication disposal policy, which shall be written in accordance with current FDA or current DEA medication disposal guidelines, or the facility may provide information to the resident's family member or the resident's legal representative regarding the proper method to dispose of the medication.
(e) If the resident is a hospice patient, hospice shall be responsible for disposing of the prescription medication upon the death of the resident.
(f) The ACLF's medication disposal policy shall be performed by a licensed or certified health care professional and either the facility's administrator, or a second licensed or certified health care professional.
(g) The ACLF's medication disposal policy shall also address the disposal of scheduled drugs, non-scheduled drugs, and devices that are misbranded, expired, deteriorated, not kept under proper conditions, and kept in containers with illegible or missing labels.
(7) An ACLF shall provide personal services as follows:
(a) Each ACLF shall provide each resident with at least the following personal services:
1. Protective care;
2. Safety when in the ACLF;
3. Daily awareness of the individual's whereabouts;
4. The ability and readiness to intervene if crises arise;
5. Room and board; and
6. Non-medical living assistance with activities of daily living.
(b) Laundry services. An ACLF shall:
1. Provide arrangements for laundry of ACLF linens and residents' clothing;
2. Provide appropriate separate storage areas for soiled linens and residents' clothing; and
3. Maintain clean linens in sufficient quantity to provide for the needs of the residents. Linens shall be changed whenever necessary.
(c) Dietary services.
1. An ACLF shall have organized dietary services that are directed and staffed by adequate qualified personnel. An ACLF may contract with an outside food management company if the company has a dietitian who serves the ACLF on a full-time, part-time, or consultant basis, and if the company maintains at least the minimum standards specified in this section while providing for constant liaison with the ACLF for recommendations on dietetic policies affecting resident treatment.
2. An ACLF shall have an employee who:
(i) Serves as director of the food and dietetic service;
(ii) Is responsible for the daily management of the dietary services and staff training; and
(iii) Is qualified by experience or training.
3. An ACLF shall ensure that menus meet the needs of the residents as follows:
(i) The practitioner or practitioners, as qualified within the scope of practice, responsible for the care of the residents shall prescribe therapeutic diets as necessary.
(ii) An ACLF shall meet nutritional needs, in accordance with recognized dietary practices and in accordance with orders of the practitioner or practitioners responsible for the care of the residents.
(iii) An ACLF shall have a current therapeutic diet manual approved by the dietitian readily available to all ACLF personnel.
(iv) Menus shall be planned one week in advance.
4. An ACLF shall:
(i) Provide at least three (3) meals constituting an acceptable and/or prescribed diet per day. There shall be no more than fourteen (14) hours between the evening and morning meals. All food served to the residents shall be of good quality and variety, sufficient quantity, attractive and at safe temperatures. Prepared foods shall be kept hot (140°F. or above) or cold (41°F. or less) as appropriate. The food must be adapted to the habits, preferences and physical abilities of the residents. Additional nourishment and/or snacks shall be provided to residents with special dietary needs or upon request.
(ii) Provide sufficient food provision capabilities and dining space.
(iii) Maintain and properly store a forty-eight (48) hour food supply at all times.
(iv) Provide appropriate, properly-repaired equipment and utensils for cooking and serving food in sufficient quantity to serve all residents.
5. An ACLF shall maintain a clean and sanitary kitchen.
6. Employees shall wash and sanitize equipment, utensils and dishes after each use.
(d) An ACLF shall provide a suitable and comfortable furnished area for activities and family visits. Furnishings shall include a calendar and a functioning television set, radio, and clock.
(e) An ACLF shall provide current newspapers, magazines or other reading materials.
(f) An ACLF shall have a telephone accessible to all residents to make and receive personal telephone calls twenty-four (24) hours per day.

Notes

Tenn. Comp. R. & Regs. 1200-08-25-.07
Original rule filed February 9, 1998; effective April 25, 1998. Amendment filed November 25, 1999; effective February 8, 1999. Amendment filed August 26, 2002; effective November 9, 2002. Amendment filed February 18, 2003; effective May 4, 2003. Repeal and new rule filed January 24, 2006; effective April 9, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Public necessity rule filed May 13, 2009; effective through October 25, 2009. Emergency rule filed October 22, 2009; effective through April 20, 2010. Amendment filed September 24, 2009; effective December 23, 2009. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed July 10, 2018; effective 10/8/2018.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-206, 68-11-209, and 68-11-261.

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