4658 NURSING HOMES

4658.0445 CLINICAL RECORD. Subpart 1. Unit record. A resident's clinical record must be started at admission and incorporated into a central unit record system. The clinical record must contain sufficient information to identify the resident, contain a record of resident assessme…

4658.0450 CLINICAL RECORD CONTENTS. Subpart 1. In general. Each resident's clinical record, including nursing notes, must include: A. the condition of the resident at the time of admission; B. temperature, pulse, respiration, and blood pressure, according to part 4658.0520, subpa…

4658.0455 TELEPHONE AND ELECTRONIC ORDERS. A. Orders received by telephone, facsimile machine, or other electronic means must be kept confidential according to Minnesota Statutes, sections 144.291 to 144.298, 144.651, and 144.652. B. Orders received by telephone or other electron…

4658.0460 MASTER RESIDENT RECORD. A permanent record must be kept listing at a minimum the full name of the resident, resident identification number, date of birth, date of admission, date of discharge, and discharge disposition. The master resident record must be kept in such a …

4658.0465 TRANSFER, DISCHARGE, AND DEATH. Subpart 1. Discharge summary at death. When a resident dies, the nursing home must compile a discharge summary that includes the date, time, and cause of death. Subp. 2. Other discharge. When a resident is transferred or discharged for an…

4658.0470 RETENTION, STORAGE, AND RETRIEVAL. Subpart 1. Retention. A resident's records must be preserved for a period of at least five years following discharge or death. Subp. 2. Storage. Space must be provided for the safe and confidential storage of residents' clinical record…

4658.0475 COMPUTERIZATION. If a nursing home is converting to an electronic paperless health information management system: A. policies and procedures must be established and maintained that require password protection of the clinical database; B. any outside contract for health …

4658.0490 PENALTIES FOR CLINICAL RECORDS RULE VIOLATIONS. Penalty assessments will be assessed on a daily basis for violations of parts 4658.0430 to 4658.0475 and are as follows: A. part 4658.0430, $300; B. part 4658.0435, $250; C. part 4658.0440, $50; D. part 4658.0445, subpart …

4658.0500 DIRECTOR OF NURSING SERVICES. Subpart 1. Qualifications and duties. A nursing home must have a director of nursing services who is a registered nurse. Subp. 2. Requirement of full-time employment. A director of nursing services must be employed full time, no less than 3…

4658.0505 RESPONSIBILITIES; DIRECTOR OF NURSING SERVICES. The written job description for the director of nursing services must include responsibility for: A. the total nursing care of residents and the accuracy of the nursing care records; B. establishing and implementing proced…

4658.0510 NURSING PERSONNEL. Subpart 1. Staffing requirements. A nursing home must have on duty at all times a sufficient number of qualified nursing personnel, including registered nurses, licensed practical nurses, and nursing assistants to meet the needs of the residents at al…

4658.0520 ADEQUATE AND PROPER NURSING CARE. Subpart 1. Care in general. A resident must receive nursing care and treatment, personal and custodial care, and supervision based on individual needs and preferences as identified in the comprehensive resident assessment and plan of ca…

4658.0525 REHABILITATION NURSING CARE. Subpart 1. Program required. A nursing home must have an active program of rehabilitation nursing care directed toward assisting each resident to achieve and maintain the highest practicable physical, mental, and psychosocial well-being acco…

4658.0530 ASSISTANCE WITH EATING. Subpart 1. Nursing personnel. Nursing personnel must determine that residents are served diets as prescribed. Residents needing help in eating must be promptly assisted upon receipt of the meals and the assistance must be unhurried and in a manne…

4658.0580 PENALTIES FOR NURSING SERVICES RULE VIOLATIONS. Penalty assessments will be assessed on a daily basis for violations of parts 4658.0500 to 4658.0530 and are as follows: A. part 4658.0500, subpart 1, $300; B. part 4658.0500, subpart 2, $300; C. part 4658.0500, subpart 3,…

4658.0600 DIETARY SERVICE. Subpart 1. Food quality. Food must have taste, aroma, and appearance that encourages resident consumption of food. Subp. 2. Nutritional status. The nursing home must ensure that a resident is offered a diet which supplies the caloric and nutrient needs …

4658.0605 DIRECTION OF DIETARY DEPARTMENT. Subpart 1. Dietitian. The nursing home must employ a qualified dietitian either full time, part time, or on a consultant basis. For purposes of this chapter, a "qualified dietitian" means a person who: A. is registered by the Commission …

4658.0610 DIETARY STAFF REQUIREMENTS. Subpart 1. Sufficient personnel. The nursing home must employ sufficient personnel competent to carry out the functions of the dietary service. "Sufficient personnel" means enough staff to plan, prepare, and serve palatable, attractive, and n…

4658.0615 FOOD TEMPERATURES. Potentially hazardous food must be maintained at 40 degrees Fahrenheit (four degrees centigrade) or below, or 150 degrees Fahrenheit (66 degrees centigrade) or above. "Potentially hazardous food" means any food subject to continuous time and temperatu…

4658.0620 FREQUENCY OF MEALS. Subpart 1. Time of meals. The nursing home must provide at least three meals daily at regular times. There must be no more than 14 hours between a substantial evening meal and breakfast the following day. A "substantial evening meal" means an offerin…

4658.0625 MENUS. Subpart 1. Menu planning. All menus must be planned in advance, dated, and followed. Any changes in the meals actually served must be of equal nutritional value. The general menu for a seven-day period must be posted prior to the start of that seven-day period at…

4658.0630 RETURNED FOOD. Returned portions of food and beverages from individual servings may be reused if the food or beverage is served in a sealed wrapper or container which has not been unwrapped or opened and is not potentially hazardous. Statutory Authority: MS s 144A.04; 1…

4658.0635 CONDIMENTS. Condiments, seasonings, and salad dressing for resident use must be provided in individual packages or from dispensers. Statutory Authority: MS s 144A.04; 144A.08; 256B.431 History: 19 SR 1803 Published Electronically: October 11, 2007

4658.0640 MILK. Fluid milk and fluid milk products used must be pasteurized and must meet Grade A quality standards in Minnesota Statutes, chapter 32. The milk must be dispensed directly from the original container in which it was packaged, shipped, and received. This container m…

4658.0645 ICE. Ice must be stored and handled in a sanitary manner. Stored ice must be kept in an enclosed container. If the container is not mechanically cooled, it must be cleaned at least daily and more often if needed. If an ice scoop is used, the scoop must be stored separat…

4658.0650 FOOD SUPPLIES. Subpart 1. Food. All food must be clean, wholesome, free from spoilage, free from adulteration and misbranding, and safe for human consumption. Canned or preserved food which has been processed in a place other than a commercial food-processing establishm…

4658.0655 TRANSPORT OF FOOD. The food service system must be capable of keeping food hot or cold until served. A dumbwaiter or conveyor, which cab or carrier is used for the transport of food and soiled dishes, must be sanitized immediately after the transportation of soiled dish…

4658.0660 FLOOR CLEANING AND TRASH. Subpart 1. Cleaning during food preparation. There must be no sweeping or mopping in the food preparation or service areas of the kitchen during the time of food preparation or service, except when necessary to prevent accidents. Subp. 2. Nondi…

4658.0665 DISHES AND UTENSILS REQUIREMENTS. The requirements in items A to E apply to the use of dishes and utensils. A. Only dishes and utensils with the original smooth finishes may be used. Cracked, chipped, scratched, or permanently stained dishes, cups, or glasses or damaged…

4658.0670 DISHWASHING. Subpart 1. Requirements. The dishwashing operation must provide separation in the handling of soiled and clean dishes and utensils, and must conform with either part 4658.0675 or 4658.0680 for washing, rinsing, sanitizing, and drying. Subp. 2. Sanitization;…

4658.0675 MECHANICAL CLEANING AND SANITIZING. Subpart 1. Generally. Mechanical cleaning and sanitizing must be done in the manner described by subparts 2 to 8. Subp. 2. Cleaning and sanitizing. Cleaning and sanitizing may be done by spray-type or immersion utensil washing machine…

4658.0680 MANUAL CLEANING AND SANITIZING. Subpart 1. Generally. Manual cleaning and sanitizing must be done in the manner described in subparts 2 to 9. Subp. 2. Three compartment sink. For manual washing, rinsing, and sanitizing of utensils and equipment, a sink with at least thr…

4658.0685 PENALTIES FOR DIETARY AND FOOD SERVICES AND SANITATION RULE VIOLATIONS. Penalty assessments for violations of parts 4658.0600 to 4658.0680 are as follows: A. part 4658.0600, subpart 1, $350; B. part 4658.0600, subpart 2, $350; C. part 4658.0600, subpart 3, $100; D. part…

4658.0700 MEDICAL DIRECTOR. Subpart 1. Designation. A nursing home must designate a physician to serve as medical director. Subp. 2. Duties. The medical director, in conjunction with the administrator and the director of nursing services, must be responsible for: A. the developme…

4658.0705 MEDICAL CARE AND TREATMENT. Subpart 1. Physician supervision. A nursing home must ensure that each resident has a physician designated to authorize and supervise the medical care and treatment of the resident during the resident's stay in the nursing home, and must ensu…

4658.0710 ADMISSION ORDERS AND PHYSICIAN EVALUATIONS. Subpart 1. Physical examination. A resident must have a current admission medical history and complete physical examination performed and recorded by a physician, physician assistant, or nurse practitioner within five days bef…

4658.0715 MEDICAL INFORMATION FOR CLINICAL RECORD. A physician or physician designee must provide the following information for the clinical record: A. the report of the admission history and physical examination; B. the admitting diagnosis; C. a description of the general medica…

4658.0720 PROVIDING DAILY ORAL CARE. Subpart 1. Daily oral care plan. A nursing home must establish a daily oral care plan for each resident consistent with the results of the comprehensive resident assessment. A. A resident's daily oral care plan must indicate whether or not the…

4658.0725 PROVIDING ROUTINE AND EMERGENCY ORAL HEALTH SERVICES. Subpart 1. Routine dental services. A nursing home must provide, or obtain from an outside resource, routine dental services to meet the needs of each resident. Routine dental services include dental examinations and…

4658.0730 NURSING HOME REQUIREMENTS. Subpart 1. Training. Nursing home staff providing daily oral care must be trained and competent to provide daily oral care for residents. Subp. 2. Written agreement. A nursing home must maintain a written dental provider agreement with at leas…

4658.0750 PENALTIES FOR PHYSICIAN AND DENTAL SERVICES RULE VIOLATIONS. Penalty assessment will be assessed on a daily basis for violations of parts 4658.0700 to 4658.0730 and are as follows: A. part 4658.0700, subpart 1, $100; B. part 4658.0700, subpart 2, items A to F, $300; C. …

4658.0800 INFECTION CONTROL. Subpart 1. Infection control program. A nursing home must establish and maintain an infection control program designed to provide a safe and sanitary environment. Subp. 2. Direction of program. A nursing home must assign one person, either a registere…

4658.0805 PERSONS PROVIDING SERVICES. All persons providing services, including volunteers, with a communicable disease as listed in part 4605.7040 or with infected skin lesions must not be permitted to work in the nursing home unless it is determined that the person's condition …

4658.0820 FOOD POISONING AND DISEASE REPORTING. Any occurrence of food poisoning or reportable disease as listed in part 4605.7040 must be reported immediately to the Minnesota Department of Health, Acute Disease Epidemiology Division, 717 Delaware Street SE, Minneapolis, Minneso…

4658.0850 PENALTIES FOR INFECTION CONTROL RULE VIOLATIONS. Penalty assessments will be assessed on a daily basis for violations of parts 4658.0800 to 4658.0820 and are as follows: A. part 4658.0800, $300; B. part 4658.0805, $300; and C. part 4658.0820, $100. Statutory Authority: …

4658.0900 ACTIVITY AND RECREATION PROGRAM. Subpart 1. General requirements. A nursing home must provide an organized activity and recreation program. The program must be based on each individual resident's interests, strengths, and needs, and must be designed to meet the physical…

4658.0950 PENALTIES FOR ACTIVITY AND RECREATION PROGRAM RULE VIOLATIONS. Penalty assessments will be assessed on a daily basis for violations of part 4658.0900 and are as follows: A. subparts 1, 3, and 6, $300; and B. subparts 2, 4, and 5, $100. Statutory Authority: MS s 144A.04;…