Part 400. Rules for Nursing Homes

20 CAR § 400-2604. Right to assess civil penalties not merged in other remedies. Assessment of a civil penalty provided in this subpart shall not affect the right of the Office of Long-Term Care to take other such action as may be authorized by law or rule.

20 CAR § 400-2605. Class A violations. (a) Class A violations are: (1) Violations that create a condition or occurrence relating to the operation and maintenance of a long-term care facility which results in death or serious harm to a resident; or (2) Violations that create a con…

20 CAR § 400-2606. Class B violations. The following conduct, acts, or omissions, when not resulting in death or serious physical harm to a resident, or the substantial probability thereof, but creates a condition or occurrence relating to the operation and maintenance of a long-…

20 CAR § 400-2607. Class C violations. (a) Class C violations are related to administrative and reporting requirements that do not directly threaten the health, safety, or welfare of a resident. (b) The following examples of Class C violations and the points assigned to each are …

20 CAR § 400-2608. Class D violations. (a) Class D violations are defined as the failure of any long-term care facility to submit in a timely manner a statistical or financial report as required by rule. (b) All Class D violations shall be assigned two hundred and fifty (250) poi…

20 CAR § 400-2609. Notification of violations. (a) If upon inspection or investigation the Office of Long-Term Care determines that a licensed long-term care facility is in violation of any sanction rule herein described, any federal or state law or regulation, then it shall prom…

20 CAR § 400-2610. Hearings on the imposition of civil money. (a) A licensee may contest the imposition of civil penalty by sending a written request for hearing to the Secretary of the Department of Human Services who shall designate a hearing officer to preside over the case an…

20 CAR § 400-2611. Denial of admissions. (a) The Director of the Office of Long-Term Care may deny Medicaid payment for new admissions to a long-term care facility issued a Class A or B violation until such time the director determines that such facility: (1) Has corrected the vi…

20 CAR § 400-301. Management. (a) Bylaws. The governing body shall adopt effective patient care policies and administrative policies and bylaws governing the operation of the facility in accordance with legal requirements. (b) Administrator. (1)(A) Each nursing home shall have a …

20 CAR § 400-302. General administration. (a) Visitation rights. (1) Visitation rights of certified skilled nursing facility residents are governed by federal resident visitation rights and procedures specified in 42 C.F.R. § 483.10(f)(4). (2) Visitation rights of residents of an…

20 CAR § 400-303. Personnel administration. (a) The administrator shall establish and maintain a personnel file for each employee. (b)(1) Applications for each employee shall contain sufficient information to support placement in the position to which assigned. (2) All applicatio…

20 CAR § 400-304. Staff development. (a)(1) Job orientation shall be provided for all personnel to acquaint them with the: (A) Needs of the residents; (B) Physical facility; (C) Disaster plan; and (D) Employee’s specific duties and responsibilities. (2) There should be written do…

20 CAR § 400-305. Emergency call data. (a) The administrator shall be responsible for ensuring that emergency call information is posted in a conspicuous place so as to be immediately available to all personnel of the nursing home. (b) Emergency call data shall include at least t…

20 CAR § 400-306. Reporting suspected abuse, neglect, exploitation, incidents, accidents, deaths from violence, and misappropriation of resident property. (a)(1) Pursuant to federal regulation 42 C.F.R. § 483.13 and state law Arkansas Code § 5-28-101 et seq., and Arkansas Code § …

20 CAR § 400-401. Patient care policies. The administrator, in consultation with one (1) or more physicians and one (1) or more registered professional nurses, department heads, and other related professional health care personnel, shall develop and at least annually review appro…

20 CAR § 400-402. Restraint of residents. (a)(1) Patients shall not be unduly restrained. (2) Patients shall not be confined to rooms or restrained except when: (A) Necessary to prevent injury to the patient or others; and (B) Alternative measures are not sufficient to accomplish…

20 CAR § 400-403. Protection of patient property. An inventory of a patient's personal belongings should be maintained for all items brought to the facility on admission and updated as appropriate for items added or sent home or disposed of.

20 CAR § 400-404. Notification of change in patient’s status. (a) There shall be written policies and procedures available at each nurses' station for personnel to follow requiring the notification of the patient's attending physician and other responsible persons in the event of…

20 CAR § 400-405. Physician’s services policies. The facility shall have a written policy indicating that the health care of every patient is under the supervision of a physician who, based on a medical evaluation of the patient's immediate and long-term needs, prescribes a plann…

20 CAR § 400-406. Specialized rehabilitative service policies. If a facility offers specialized rehabilitative services, written administrative and patient care policies and procedure for rehabilitative services shall be developed for appropriate therapists and representatives of…

20 CAR § 400-407. Social service policies. Facilities that do not directly provide social service shall have written procedures for referring patients in need of social services to appropriate service agencies.

20 CAR § 400-408. Confidentiality of social information. Policies and procedures shall be established for ensuring the confidentiality of all patients' social information.

20 CAR § 400-409. Rights of residents. Facilities shall establish policies and procedures setting forth the rights of residents and prohibiting their mistreatment or abuse.

20 CAR § 400-410. Registration of complaints. Facilities shall establish policies for the registration and disposition of complaints without threat of discharge or other reprisal against any patient.

20 CAR § 400-411. Admission, transfer, and discharge policies. These policies shall include, at a minimum, the following: (1) Patients shall be admitted to the facility only on the recommendation of a physician licensed to practice medicine in the State of Arkansas; (2)(A) All pe…

20 CAR § 400-412. Confidentiality of medical record information. There shall be written policies adopted by the management of the nursing home covering confidentiality of medical records and procedures regarding release of medical information.

20 CAR § 400-413. Infection prevention and control. (a) Infection prevention and control policies and procedures. (1) Infection prevention and control policies and procedures of a certified skilled nursing facility are governed by federal regulations at 42 C.F.R. § 483.80 and app…

20 CAR § 400-414. Handling of oxygen and flammable gases. Policies shall be written for the proper handling of oxygen and flammable gases.

20 CAR § 400-415. Personnel policies. Written personnel policies shall be provided and shall be available to all personnel and to the Division of Provider Services and Quality Assurance.

20 CAR § 400-416. Transportation of residents. (a) The facility shall establish a written policy regarding transportation of residents, when necessary, to: (1) The hospital; (2) Medical clinics; and (3) Dentist offices. (b) The facility must assume responsibility for seeing that …

20 CAR § 400-417. Bedpan sanitation. Written policies shall be established to ensure all individually assigned bed pans are sanitized by: (1) The boiling method for a minimum of twenty (20) minutes at least once a week; or (2) Other methods approved by the Division of Provider Se…

20 CAR § 400-501. Specialized rehabilitative services. (a) If the facility does not offer specialized rehabilitative services directly, patients in need of such services, such as physical therapy, occupational therapy, speech pathology, and audiology, shall not be admitted or ret…

20 CAR § 400-502. Advisory dentist. (a) Facilities shall establish a written cooperative agreement with an advisory dentist or dental service. (b) The agreement shall include provisions for a dentist or dental service. (c) The agreement shall include provisions for a dentist to: …

20 CAR § 400-503. Social services. If a facility provides social services directly and the designated staff member is not a qualified social worker, a written agreement shall be established to provide consultation from such a qualified person or a recognized social agency.…

20 CAR § 400-504. Activity director. (a) In a nursing facility, if the staff member designated responsible for the activity program is not a qualified patient activity coordinator, a written agreement shall be established with a person so qualified. (b) The master social worker (…

20 CAR § 400-505. Medical and remedial services. A nursing home shall establish a written agreement for all medical and remedial services, i.e., laboratory, radiological, and other services, required by the resident but not regularly provided within the facility.

20 CAR § 400-506. Transfer agreement. (a) A facility shall have in effect a written transfer agreement with one (1) or more hospitals sufficiently close to the facility to make feasible the transfer of patients. (b) It shall be the duty of each nursing home administrator to suppl…

20 CAR § 400-601. Electronic records generally. (a)(1) Facilities have the option of utilizing electronic records rather than, or in addition to, paper or “hardcopy” records. (2) The facility must have: (A) Safeguards to prevent unauthorized access to the records; and (B) A proce…

20 CAR § 400-602. Physicians’ orders. (a) When facility personnel take telephone orders from physicians or other individuals authorized by law or rules to issue orders, the facility documents the appropriate information, including but not limited to, the: (1) Date and time of the…

20 CAR § 400-603. Use of electronic records or signatures in lieu of written records or signatures. For purposes of this part, in all instances in which the rules require, or appears to require, the facility to use written records or written signatures, the facility may use elect…

20 CAR § 400-701. General. Every institution must be maintained, managed, and equipped to provide adequate care, safety, and treatment of each resident.

20 CAR § 400-702. Facility grounds and parking. (a) All homes shall be provided with dust free drives and parking lots. (b) Parking areas shall be provided in a ratio of one (1) individual parking space for each five (5) licensed beds.

20 CAR § 400-703. Doors. (a) All exterior doors shall be effectively weather stripped. (b) Doors shall swing into rooms except closet, toilet, and exit doors. (c) The doors to all rooms, toilets, baths, and closets shall be legibly marked with names or numbers, as appropriate to …

20 CAR § 400-704. Standard patient rooms, bath, and toilet facilities. (a) Standard patient rooms shall not have more than five (5) beds. (b)(1) Single standard patient rooms shall measure at least one-hundred square feet (100 sq. ft.). (2) Multipatient rooms shall provide a mini…

20 CAR § 400-705. Intensive care room. (a) An intensive care room shall be: (1) Provided for each thirty-five (35) beds or major portion thereof; and (2) Located near the nurses' station. (b) Each room shall have the standard square footage as set forth in this part. (c) The room…

20 CAR § 400-706. Corridors. Corridors in facilities licensed prior to 1973 shall be at least six feet (6’) wide.

20 CAR § 400-707. Handrails. (a)(1) Standard handrails shall be provided on each side of the corridor in all areas used by patients. (2) However, a six-foot passageway must be maintained. (b) For six-foot corridors, a handrail shall be required only on one (1) side.…

20 CAR § 400-708. Bedpan cleaning and storage room. (a) There shall be one (1) properly equipped bedpan cleaning room with deep metal sink. (b) In addition to bedpan cleaning equipment, appropriate hand-washing facilities shall be provided. (c) The room shall include equipment fo…

20 CAR § 400-709. Day room and dining room. (a) A well-lighted, clean, orderly, and ventilated room or rooms shall be provided for patient activities and for dining areas. (b)(1) A minimum of twenty square feet (20 sq. ft.) per bed shall be provided for this purpose. (2) At least…

20 CAR § 400-710. Ceilings, walls, and floors. (a) Ceiling. (1) Kitchens, and other rooms where food and drink are prepared shall have a smooth, nonperforated surface that is washable. (2) Wallpaper shall not be used. (b) Walls. (1) The walls of the facility shall be a smooth sur…