A HIV supportive living facility must
ensure that substantially all core services are routinely provided directly by
HIV supportive living facility employees. A HIV supportive living facility may
use contracted staff if necessary to supplement HIV supportive living facility
employees in order to meet the needs of residents.
Nursing services. The HIV supportive
living facility must provide nursing care and services by, or under the
supervision of, a registered nurse (R.N.) at all times.
1. Nursing services must be directed and
staffed to assure the nursing needs of residents are met.
2. Resident care responsibilities of nursing
personnel must be specified.
care services must be provided in accordance with recognized standards of
Social Services. Medical Social Services must be provided by a qualified social
worker under the direction of a physician.
(c) Physician Services. In addition to
palliation and management of HIV care, physician employees of the HIV
supportive living facility including the physician member(s) of the
interdisciplinary group, must also meet the general medical needs of the
residents to the extent these needs are not met by the attending
Counseling services must be made available to the individual, the individual's
family and/or significant other, and staff. Counseling includes bereavement
counseling, provided both prior to and after the resident's death, as well as
dietary, therapeutic, spiritual and any other counseling services identified in
the plan of care for the individual and family and/or significant other while
the individual is a resident of the HIV supportive living facility.
1. Bereavement counseling. There must be an
organized program for the provision of bereavement services under the
supervision of a qualified professional. The plan of care for these services
should reflect family/significant other needs, services to be provided, and the
frequency of services.
counseling. Dietary counseling, when required, must be provided by a qualified
counseling. Spiritual counseling must include notice to residents as to the
availability of clergy.
Additional counseling. Counseling may be provided by other members of the
interdisciplinary group as well as by other qualified professionals as
determined by the HIV supportive living facility.
Plan of Care. A written plan
of care must be established and maintained for each individual admitted to a
HIV supportive living facility, and the care provided to an individual must be
in accordance with the plan.
Establishment of plan. The plan must be established by the attending physician,
the medical director or the physician's designee and the interdisciplinary
group prior to providing care.
Review of plan. The plan must be reviewed and updated as the resident's
condition changes, but at intervals of no more than (14) days, by the attending
physician, the medical director or the physician's designee and the
interdisciplinary group. These reviews must be documented.
(c) Content of plan. The plan must include an
assessment of the individual's needs and identification of the HIV care
services required including the management of discomfort and symptom relief It
must state in detail the scope and frequency of services needed to meet the
resident's and family's/significant other's needs.
(d) Coordinator. The HIV supportive living
facility must designate a licensed professional nurse to coordinate the
implementation of the plan of care of each resident.
Volunteers. The HIV supportive living
facility may use volunteers, in defined roles, under the supervision of a
designated HIV supportive living facility employee.
1. Training. The HIV supportive living
facility must provide appropriate orientation and training that is consistent
with acceptable standards of HIV supportive living facility practice.
2. Role. Volunteers shall be used in
administrative or direct resident care roles.
3. Recruiting and retaining. The HIV
supportive living facility must document active and ongoing efforts to recruit
and train volunteers.
Availability of clergy. The HIV supportive living facility must make reasonable
efforts to arrange for visits of clergy and other members of religious
organizations in the community to residents who request such visits and must
advise residents of this opportunity.
(3) Continuation of Care. A HIV supportive
living facility must assist in coordinating continued care should the resident
be transferred or discharged from the HIV supportive living facility.
(4) Drugs and treatments shall be
administered by appropriately licensed facility personnel acting within the
scope of their license. Oral orders for drugs and treatments shall be given to
appropriately licensed personnel acting within the scope of their licenses,
immediately recorded, signed and dated, and countersigned and dated by the
physician within ten (10) days of issuance of the oral order.
Performance Improvement Program. The HIV
supportive living facility must ensure that there is an effective facility-wide
performance improvement program to evaluate resident care and performance of
the organization. The administrator shall assure that a Performance Improvement
Committee, composed of a physician, a licensed professional nurse, a social
worker and a pastoral or other counselor, is in place to ensure that the
facility has adequate policies and procedures in place, to review performance
monitoring and activities, and to provide oversight and address identified care
issues within the facility. The performance improvement program must be ongoing
and have a written plan of implementation which assures that:
(a) All organized services related to
resident care, including services furnished by a contractor, are
infections and medication therapy are evaluated;
(c) All services performed in the facility
are evaluated as to the appropriateness of diagnosis and treatment;
(d) The HIV supportive living facility must
have an ongoing plan, consistent with available community and facility
resources, to provide or make available services that meet the
medically-related needs of its HIV care residents;
(e) The facility must develop and implement
plans for improvement to address deficiencies identified by the performance
improvement program and must document the outcome of the remedial
(f) Performance Improvement
Program records are not disclosable except when such disclosure is required to
demonstrate compliance with this section;
(g) Good faith attempts by the Performance
Improvement Program Committee to identify and correct deficiencies will not be
used as a basis for sanctions.
(a) The HIV supportive living facility must
provide a sanitary environment to avoid sources and transmission of infections
and communicable diseases. There must be an active program for the prevention,
control, and investigation of infections and communicable diseases.
The administrator shall assure that an
Infection Control Committee, including the medical director and members of the
nursing staff and administrative staff, develops guidelines and techniques for
the prevention, surveillance, control and reporting of facility infections.
Duties of the committee shall include the establishment of:
1. Written infection control
2. Techniques and systems
for identifying, reporting, investigating and controlling infections in the
3. Written procedures
governing the use of aseptic techniques and procedures in the
4. Written procedures
concerning food handling, laundry practices, disposal of environmental and
resident wastes, traffic control and visiting rules, sources of air pollution,
and routine culturing of autoclaves and sterilizers;
5. A log of incidents related to infectious
and communicable diseases;
Formal provisions to educate and orient all appropriate personnel in the
practice of aseptic techniques such as handwashing, proper grooming, masking
and dressing care techniques, disinfecting and sterilizing techniques, and the
handling and storage of resident equipment and supplies; and
7. Continuing education for all facility
personnel on the cause, effect, transmission, prevention, and elimination of
Supportive Living Center shall have an annual influenza vaccination program
which shall include at least:
1. The offer of
influenza vaccination to all staff and independent practitioners at no cost to
the person or acceptance of documented evidence of vaccination from another
vaccine source or facility. The HIV Supportive Living Center will encourage all
staff and independent practitioners to obtain an influenza
Education of all employees about the
(i) Flu vaccination,
(ii) Non-vaccine control measures,
(iii) The diagnosis,
transmission, and potential impact of influenza;
4. An annual evaluation of the influenza
vaccination program and reasons for non-participation; and
5. A statement that the requirements to
complete vaccinations or declination statements shall be suspended by the
administrator in the event of a vaccine shortage as declared by the
Commissioner or the Commissioner's designee.
(d) The administrator, the medical director
and a licensed professional nurse must ensure that the facility-wide
performance improvement program and training programs address problems
identified by the infection control program and must be responsible for the
implementation of successful corrective action plans in affected problem
(e) The facility shall
develop policies and procedures for testing a resident's blood for the presence
of blood borne infections in the event that an employee of the facility, a
student studying at the facility, or other health care provider rendering
services at the facility is exposed to a resident's blood or other body fluid.
The testing shall be performed at no charge to the resident, and the test
results shall be confidential.
The facility and its employees shall adopt appropriate policies to evaluate
staff for exposure to blood-borne pathogens, and utilize standard or universal
precautions for preventing transmission of infections, HIV, and communicable
(g) Precautions shall be
taken to prevent the contamination of sterile supplies by soiled supplies.
Sterile supplies shall be packaged and stored in a manner that protects the
sterility of the contents, decontamination and preparation areas shall be
(h) Space and facilities
for housekeeping equipment and supply storage shall be provided in each service
area. Storage for bulk supplies and equipment shall be located away from
resident care areas. The building shall be kept in good repair, clean, sanitary
and safe at all times.
facility shall appoint a housekeeping supervisor who shall be responsible for:
1. Organizing and coordinating the facility's
and storing sufficient housekeeping supplies and equipment for facility
3. Assuring the
clean and sanitary condition of the facility to provide a safe hygienic
environment for residents and staff. Cleaning shall be accomplished in
accordance with the infection control rules and regulations herein and facility
facilities located in the HIV supportive living facility shall:
1. Be equipped with an area for receiving,
processing, storing and distributing clean linen;
2. Be located in an area that does not
require transportation for storage of soiled or contaminated linen through food
preparation, storage or dining areas;
3. Provide space for storage of clean linen
and for bulk storage within clean areas of the facility; and
4. Provide carts, bags or other acceptable
containers appropriately marked to identify those used for soiled linen and
those used for clean linen to prevent dual utilization of the equipment and
The facility shall name an individual who is responsible for laundry service.
This individual shall be responsible for:
Establishing a laundry service, either within the HIV supportive living
facility or by contract, that provides the facility with sufficient clean,
sanitary linen at all times;
Knowing and enforcing infection control rules and regulations for the laundry
3. Assuring the
collection, packaging, transportation and storage of soiled, contaminated, and
clean linen is in accordance with all applicable infection control rules,
regulations and procedures; and,
Assuring that a contract laundry service complies with all applicable infection
control rules, regulations and procedures.
Personal Care Services. Aide services
must be available and adequate in frequency to meet the needs of the residents.
(a) The personal care aide shall be assigned
to a particular resident by a licensed professional nurse. Written instructions
for resident care shall be prepared by a registered nurse or therapist as
appropriate. Duties may include the performance of simple procedures to assist
residents with basic care services, including simple procedures such as
feeding, personal grooming, ambulating, socializing, medication prompting,
reporting changes in the resident's condition and needs, completing appropriate
records, exercising and other household services essential to health
(b) The registered nurse
shall monitor and assess the aide's competence in providing care and determine
whether goals are being met.
There shall be regularly scheduled continuing in-service programs which include
on-the-job training as needed.
(8) Physical therapy, occupational therapy,
respiratory therapy and speech language pathology. Physical therapy services,
occupational therapy services, respiratory therapy services and speech-language
pathology services must be available, and when provided, offered in a manner
consistent with accepted standards of practice.
Speech therapy services shall be provided
only by or under supervision of a qualified speech language pathologist in good
standing, or by a person qualified as a Clinical Fellow subject to Tennessee
Board of Communications Disorders and Sciences Rule
Medical supplies. Medical supplies and
appliances including drugs and biologicals, must be provided as needed for the
palliation and management of HIV or conditions directly attributable to the HIV
(a) Administration. All drugs and
biologicals must be administered in accordance with accepted standards of
practice and only by appropriately licensed employees of the HIV supportive
(b) The HIV
supportive living facility must have a policy for the disposal of controlled
drugs when those drugs are no longer needed by the resident.
(c) Drugs and biologicals may be administered
by the resident or a family member or significant other if the resident's
attending physician has approved.
A resident file containing past and
current findings in accordance with accepted professional standards shall be
maintained for every HIV care resident. The record must be complete, promptly
and accurately documented, readily accessible and systematically organized to
facilitate retrieval. Each file is a comprehensive compilation of information.
Entries are made for all services provided. Entries are made and signed by the
person providing the services. The record includes all services whether
furnished directly or under arrangements made by the HIV supportive living
facility. Each individual's record must contain:
1. The initial and subsequent
2. The plan of
4. Consent and authorization
and election forms;
medical history; and
documentation of all services, volunteers and events (including evaluations,
treatments, progress notes, etc.).
(b) All resident records, either written,
electronic, graphic or otherwise acceptable form, must be retained in their
original or legally reproduced form for a minimum period of at least (10) years
after which such records may be destroyed. However, in cases of residents under
mental disability or minority, their complete HIV supportive living facility
records shall be retained for the period of minority or known mental
disability, plus one (1) year, or ten (10) years following the discharge of the
resident, whichever is longer. Records destruction shall be accomplished by
burning, shredding or other effective method in keeping with the confidential
nature of the contents. The destruction of records must be made in the ordinary
course of business, must be documented and in accordance with the HIV
supportive living facility's policies and procedures, and no record may be
destroyed on an individual basis.
(c) Even if the HIV supportive living
facility discontinues operations, records shall be maintained as mandated by
these rules and the Tennessee Medical Records Act (see T.C.A. §§
68-11-308). If a resident is
transferred to another health care facility or agency, a copy of the record or
an abstract shall accompany the resident when the HIV supportive living
facility is directly involved in the transfer.
(d) The HIV supportive living facility must
have a procedure for ensuring the confidentiality of resident records.
Information from, or copies of, records may be released only to authorized
individuals, and the facility must ensure that unauthorized, individuals cannot
gain access to, or alter, resident records. Original resident records must be
released by the facility only in accordance with federal and state
(e) For purposes of this
rule, the requirements for signature or countersignature by a physician or
other person responsible for signing, countersigning and entry may be satisfied
by the electronic entry by such person of a unique code assigned exclusively to
him or her, or by entry of other unique electronic or mechanical symbols,
provided that such person has adopted same as his or her signature in
accordance with established protocol or rules.
(f) All entries must be legible, complete,
dated and authenticated according to facility policy.
(a) The HIV supportive living facility shall
have pharmaceutical services that meet the needs of the residents and are in
accordance with the Tennessee Board of Pharmacy statutes and regulations. The
facility is responsible for developing policies and procedures that minimize
(b) All internal and
external medications and preparations intended for human use shall be stored
separately. They shall be properly stored in medicine compartments, including
cabinets on wheels, or drug rooms. Such cabinets or drug rooms shall be kept
securely locked when not in use and the key must be in the possession of the
supervising nurse or other authorized persons. Poisons or external medications
shall not be stored in the same compartment and shall be labeled as
(c) Schedule II drugs must be
stored behind two (2) separately locked doors at all times and accessible only
to persons in charge of administering medication.
(d) Every HIV supportive living facility
shall comply with all state and federal regulations governing Schedule II
(e) A notation shall be made
in a Schedule II drug book and in the resident's nursing notes each time a
Schedule II drug is given. The notation shall include the name of the resident
receiving the drug, name of the drug, the dosage given, the method of
administration, the date and time given and the name of the physician
prescribing the drug.
(f) All oral
orders shall be immediately recorded, designated as such and signed by the
person receiving them and countersigned by the physician within ten (10)
All orders for drugs,
devices and related materials must be in writing and signed by the practitioner
or practitioners responsible for the care of the resident. Electronic and
computer-generated records and signature entries are acceptable. When telephone
or oral orders must be used, they shall be:
Accepted only by personnel that are authorized to do so by the medical staff
policies and procedures, consistent with federal and state law; and,
2. Signed or initialed by the prescribing
practitioner according to HIV supportive living facility policy.
(h) Medications not specifically
limited as to time or number of doses when ordered are controlled by automatic
stop orders or other methods in accordance with written policies. No Schedule
II drug shall be given or continued beyond seventy-two (72) hours without a
written order by the physician.
Medication administration records (MAR) shall be checked against the
physician's orders. Each dose shall be properly recorded in the clinical record
after it has been administered.
Preparation of doses for more than one scheduled administration time shall not
(k) Medication shall
be administered only by licensed medical or licensed nursing personnel or other
licensed health professionals acting within the scope of their
(l) Unless the unit dose
package system is used, individual prescriptions of drugs shall be kept in the
original container with the original label intact showing the name of the
resident, the drug, the physician, the prescription number and the date
(m) Legend drugs shall
be dispensed by a licensed pharmacist.
(n) Any unused portions of prescriptions
shall be turned over to the resident only on a written order by the physician.
A notation of drugs released to the resident shall be entered into the medical
record. All unused prescriptions left in a HIV supportive living facility must
by destroyed on the premises and recorded by a pharmacist. Such record shall be
kept in the HIV supportive living facility.
(13) Laboratory Services. The HIV supportive
living facility must maintain or have available, either directly or through a
contractual agreement, adequate laboratory services to meet the needs of the
residents. The HIV supportive living facility must ensure that all laboratory
services provided to its residents are performed in a facility licensed in
accordance with the Tennessee Medical Laboratory Act (TMLA). All technical
laboratory staff shall be licensed in accordance with the TMLA and shall be
qualified by education, training and experience for the type of services
Food and Dietetic
(a) The HIV supportive living
facility must designate a person, either directly or by contractual agreement,
to serve as the food and dietetic services director with responsibility for the
daily management of the dietary services.
(b) There must be a qualified dietitian, full
time, part-time, or on a consultant basis who is responsible for the
development and implementation of a nutrition care process to meet the needs of
residents for health maintenance, disease prevention and, when necessary,
medical nutrition therapy to treat an illness, injury or condition.
Menus must meet the needs of the
1. Therapeutic diets must be
prescribed by the practitioner or practitioners responsible for the care of the
residents and must be prepared and served as prescribed.
2. Special diets shall be prepared and served
3. Nutritional needs
must be met in accordance with recognized dietary practices and in accordance
with orders of the practitioner or practitioners responsible for the care of
4. A current
therapeutic diet manual approved by the dietitian and medical director must be
readily available to all medical, nursing, and food service
programs, including orientation, on-the-job training, inservice education, and
continuing education shall be offered to dietetic services personnel on a
regular basis. Programs shall include instruction in the use of equipment,
personal hygiene, proper inspection, and the handling, preparing and serving of
(e) A minimum of three (3)
meals in each twenty-four (24) hour period shall be offered. A supplemental
night meal shall be offered if more than fourteen (14) hours lapse between
supper and breakfast. Additional nourishment shall be provided to residents
with special dietary needs. A minimum of three (3) days supply of food shall be
(f) Food shall be
protected from dust, flies, rodents, unnecessary handling, droplet infection,
overhead leakage and other sources of contamination0 whether in storage or
while being prepared and served and/or transported through hallways.
(g) Perishable food shall not be allowed to
stand at room temperature except during necessary periods of preparation or
serving. Prepared foods shall be kept hot (140°F or above) or cold
(45°F or less). Appropriate equipment for temperature maintenance, such as
hot and cold serving units or insulated containers, shall be used.
(h) Dishwashing machines shall be used
according to manufacturer specifications.
(i) All dishes, glassware and utensils used
in the preparation and serving of food and drink shall be cleaned and sanitized
after each use.
(j) The cleaning
and sanitizing of handwashed dishes shall be accomplished by using a
three-compartment sink according to the current U.S. Public Health Service
(k) The kitchen
shall contain sufficient refrigeration equipment and space for the storage of
refrigerators and freezers shall have thermometers. Refrigerators shall be kept
at a temperature not to exceed 45°F. Freezers shall be kept at a
temperature not to exceed 0°F.
(m) Written policies and procedures shall be
followed concerning the scope of food services in accordance with the current
edition of the "U.S. Public Health Service Recommended Ordinance and Code
Regulating Eating and Drinking Establishments" and the current U.S. Public
Health Service Sanitation Manual should be used as a guide to food