Arkansas Administrative Code

20 CAR § 400-1306. Nursing care requirements. (a) Charting. (1) Summary charting should address: (A) The resident's problems/needs; (B) Interventions to resolve those needs; and (C) The progress made toward achieving the resident goals as listed on the care plan. (2) All discipli…

20 CAR § 400-1307. Treatment and medications. (a)(1) No medication or treatment shall be given without the written order of the physician or dentist. (2) Drugs shall be administered in accordance with orders. (3) Venapuncture by licensed practical nurses to obtain blood samples f…

20 CAR § 400-1308. Rehabilitative nursing. (a)(1) Nursing personnel shall be trained in rehabilitative nursing measures. (2) This shall be documented in the orientation program, and in-service on this subject shall be conducted at least annually. (b) The facility shall have an ac…

20 CAR § 400-1309. Supervision of patient nutrition. Nursing personnel shall: (1) Be aware of the nutritional needs, food, and fluid in-take of patients; and (2) Assist promptly where necessary in the feeding of patients.

20 CAR § 400-1401. Definitions. For purposes of this subpart, the following definitions apply: (1) "Average direct care hours per resident day" means the total number of hours of direct care services provided by direct care staff in a month, divided by the number of calendar days…

20 CAR § 400-1402. Condition of licensure. (a) As a condition of licensure by the Department of Human Services, a nursing facility, except a private pay-only nursing facility, shall be certified to participate in: (1) The federal Medicare program as a skilled nursing facility; (2…

20 CAR § 400-1403. Consistency with federal requirements. (a) Under 42 U.S.C. § 1395i-3 and 42 U.S.C. § 1396r, a certified nursing facility: (1) Is subject to federal requirements of participation; and (2) Must demonstrate substantial compliance with applicable federal requiremen…

20 CAR § 400-1404. Average direct care hours per resident — Certified nursing facilities. (a) Each certified nursing facility shall: (1) Provide each month direct care services by direct care staff equivalent to at least three and thirty-six hundredths (3.36) average direct care …

20 CAR § 400-1405. Average direct care hours per resident — Private pay-only nursing facilities. (a) Each private pay-only nursing facility shall: (1) Provide each month direct care services by direct care staff equivalent to at least three and thirty-six hundredths (3.36) averag…

20 CAR § 400-1406. Certified medication assistants. (a) Any licensed nursing facility may elect to use certified medication assistants (medication assistants-certified) to perform the delegated nursing function of medication administration and related tasks: (1) Under the supervi…

20 CAR § 400-1407. Modern staffing practices supported. (a) A licensed nursing facility may: (1) Engage the services of direct care staff and other personnel on a full-time or part-time basis and through employment, contracting, and staffing agencies, or any combination thereof; …

20 CAR § 400-1408. Posting of staffing information. Each licensed nursing facility shall comply with the information posting requirements of 42 C.F.R. § 483.35.

20 CAR § 400-1409. Waivers and variances. (a) In the event of a public health emergency, natural disaster, other major emergency, or severe labor shortage, the Department of Human Services may temporarily waive the average direct care hours per resident day standard in 20 CAR §§ …

20 CAR § 400-1501. Services based on resident needs. In addition to rehabilitative nursing, the facility shall, as ordered by a physician, provide, according to the needs of each patient, specialized and supportive services, i.e., physical therapy, speech pathology, audiology, an…

20 CAR § 400-1502. Written plan of care. If provided, specialized rehabilitative services shall be provided under a written plan of care, initiated by the attending physician, and developed in consultation with appropriate therapist or therapists and nursing services.

20 CAR § 400-1503. Review of resident progress. A report of the patient's progress shall be communicated to the attending physician within two (2) weeks of the initiation of the specialized rehabilitative services and regularly thereafter.

20 CAR § 400-1504. Re-evaluation of plan. The plan of specialized rehabilitative care shall be re-evaluated as necessary, but at least every thirty (30) days by the physician and/or the therapist.

20 CAR § 400-1505. Documentation of services. The physician's orders, the plan of specialized rehabilitative care, services rendered, evaluation of progress, and other pertinent information shall be recorded in the patient's medical record and dated and signed by the physician or…

20 CAR § 400-1601. Responsibility for pharmacy compliance. (a) The administrator shall be responsible for full compliance with federal and state laws governing procurement, control, and administration of all drugs. (b) Full compliance is expected with the Comprehensive Drug Abuse…

20 CAR § 400-1602. Pharmacy consultants permit. (a) Each nursing home shall have a formal arrangement with a licensed pharmacist to provide supervision and consultation on methods and procedures for ordering, storing, administering, disposition, and record keeping of drugs and bi…

20 CAR § 400-1603. Prescriptions on individual basis. (a) All drugs prescribed for each patient shall be on an individual prescription basis. (b) Medications prescribed for a specific patient shall not be administered to another patient.

20 CAR § 400-1604. Administration of medication. (a) No medication shall be given without a written order by a physician or dentist. (b)(1) All medications shall be given by authorized nursing personnel. (2) The administrator or his or her appointed assistant shall be responsible…

20 CAR § 400-1605. Equipment for administering medications. (a) There shall be calibrated medicine containers to correctly measure liquid medications. (b) Calibrated medicine containers include calibrated syringes when used to measure odd liquid dosages, such as 4cc, 8cc, etc. (c…

20 CAR § 400-1606. Medicine cards. (a) In administering medications, medication cards current with the physician’s orders must be used. (b) Medicine cards shall be provided to include: (1) Name of patient; (2) Rooms or bed number; (3) Medication and dosage; and (4) Hours to be gi…

20 CAR § 400-1607. Stop order policy. (a) Medications not specifically limited as to time or number of doses when ordered by the physician shall be controlled by the facility’s policy regarding automatic stop orders. (b) The facility’s automatic stop order policy, at a minimum, s…

20 CAR § 400-1608. Storage of drugs. (a) All drugs on the premises of a nursing home, except for the emergency tray, as defined by the State Board of Health and the Arkansas State Board of Pharmacy, shall be properly labeled containers dispensed upon prescription by the pharmacy.…

20 CAR § 400-1609. Emergency drug box. (a)(1) A container that contains emergency stimulants and drugs for life saving measures must be maintained. (2) This box should: (A) Be located where it can be readily available to nursing personnel but kept in a secure place; and (B) Have …

20 CAR § 400-1610. Record of controlled drugs. (a)(1) A record shall be kept in a bound ledger book with consecutively numbered pages of all controlled drugs procured and administered. (2) This record shall contain on each separate page the: (A) Name, strength, and quantity of dr…

20 CAR § 400-1611. Controlled drug accountability. (a)(1) There shall be a count of all C-II controlled medications at each change of shift. (2) All C-III, C-IV, and C-V controlled medications should be counted at least once daily unless a true unit dose system is used. (3)(A) Th…

20 CAR § 400-1612. Review of medication by the nurse and/or pharmacist. (a) There shall be for each patient a separate medication/drug regimen review sheet. (b) This sheet is to be used to document the performance of a medication/drug regimen review by the pharmacist and/or regis…

20 CAR § 400-1613. Review of medications by consultant pharmacist. (a)(1) In an intermediate care facility, the review of the medication/drug regimen of the skilled care patients must be done at least each month, and at least quarterly on the intermediate and minimum care patient…

20 CAR § 400-1614. Cycle-fill, pharmacy notification, and disposition of unused drugs. (a)(1) Schedule II, III, IV, and V drugs dispensed by prescription for a patient and no longer needed by the patient must be delivered in person or by registered mail to the Drug Control Divisi…

20 CAR § 400-1615. Pharmacy-prepared medication container systems designed for administration with the use of medication cards (unit dose system). (a) All policies and procedures related to systems of this type must first be approved by the Office of Long-Term Care before that sy…

20 CAR § 400-1701. Staffing. (a)(1) Staff supervisory responsibility for the dietetic services is assigned to a full-time, qualified dietetic service supervisor or certified dietary manager. (2) A qualified supervisor has: (A) Completed an approved food service manager’s course; …

20 CAR § 400-1702. Hygiene of staff. (a) All food service employees shall: (1) Wear appropriate, light-colored clothing, including hairnet; and (2) Keep themselves and their clothing clean. (b) All persons working as food handlers in nursing homes shall have in their possession o…

20 CAR § 400-1703. Minimum daily food requirements. (a) All patients shall be served an approved, appetizing, adequate diet that conforms to the recommended dietary allowances of the Food and Nutrition Board, National Research Council or with, “Food for Fitness — a Daily Guide” l…

20 CAR § 400-1704. Frequency of meals. (a) At least three (3) meals are served daily. (b)(1) There shall be at least a five-hour span between: (A) Breakfast and the noon meal; and (B) Noon meal and supper. (2) The meals shall be served at approximately the same hours each day. (c…

20 CAR § 400-1705. Meal service. (a) All foods shall be served at the proper temperatures and procedures established and implemented to serve the patient cold foods between forty-five to fifty-five degrees Fahrenheit (45˚F to 55˚F), and hot foods should register one hundred forty…

20 CAR § 400-1706. Menus. (a)(1) Menus shall be: (A) Planned and written two (2) weeks in advance; and (B) Posted at least one (1) week in advance. (2) Menus for each level shall be written. (3) Arrows, etc., are not acceptable. (b)(1) Weekly menus shall not be repeated more ofte…

20 CAR § 400-1707. Therapeutic diets. (a)(1) There shall be a system of written communications between dietetic services and nursing services, i.e., diet order forms. (2) Nursing services should send a written patient diet list monthly and diet change slips as diets are changed b…

20 CAR § 400-1708. Preparation and storage of food. (a)(1) An adequately sized storage room shall be provided with adequate shelving. (2)(A) Seamless containers with tight-fitting lids, clearly labeled, shall be provided for bulk storage of dry foods. (B) It is recommended that t…

20 CAR § 400-1709. Sanitary conditions. (a) Food shall be procured from sources approved or considered satisfactory by federal, state, and local authorities. (b) Floors shall be cleaned after each meal. (c)(1) Dishes, silverware, and glasses shall be free of: (A) Breaks; (B) Tarn…

20 CAR § 400-1710. Dietetic services staffing. (a)(1) Staffing shall be correlated to the: (A) Size of the facility; and (B) Total patient meals served. (2) Facilities with: (A) Fifty-nine (59) beds or less shall be staffed at ten (10) minutes for each meal served; (B) Sixty (60)…

20 CAR § 400-1801. Policies and procedures. (a) Separate policies must be written for social services and activity programs. (b) They shall be individualized for the individual long-term care facility. (c) They shall reflect the actual programs in operation at that facility. (d) …

20 CAR § 400-1802. Job description. (a) Separate for social services designee/worker. (b) Include actual functions of position. (c) Include other duties that may be assigned to designee/worker.

20 CAR § 400-1803. Social services records. (a) Social history/assessment. (1) Should give clear picture of individual over life span to date. (2) Incomplete information should specify reason for such. (3) Reflects current: (A) Functioning level; (B) Limitations; (C) Strengths; a…

20 CAR § 400-1804. Staffing and consultation for social services/activities. (a) The social services designee shall comply with the qualification requirements as set forth in federal regulations. (b) There shall be: (1) One (1) full-time social services designee/activities direct…