Qualifications

This subchapter shall be applicable to small homes serving three (3) or less residents. Homes qualifying under this subsection shall be exempt from other subsections of this Chapter except as may be specifically referenced in this subsection. (1) Licensure requirements. The requirements of Subchapter 3 of this Chapter shall be applicable to homes licensed for three (3) or less beds. (2) Construction requirements and physical plant. The requirements of Subchapter 5 of this Chapter shall be applicable to homes licensed for three (3) beds or less. (3) Environmental health and sanitary requirements. The requirements of Subchapter 7 of this Chapter shall also be applicable to homes licensed for three (3) or less beds. (4) Dietary requirements. In accordance with the needs of the residents, Subchapter 9 of this Chapter shall be applicable to small homes. (5) Staffing requirements. Each small residential care home shall employ sufficient personnel appropriately qualified and trained to meet the needs of the residents. (A) Number of personnel (i) Each small home shall have a person who holds a residential care home administrator's certificate of training who is responsible for the home. (ii) Other staff shall be employed in accordance with the needs of the residents. (B) Staff qualifications (i) The person designated as administrator shall be at least 21 years of age and of reputable and responsible character, who has obtained a certificate of training for a residential care administrator. (ii) All other staff shall have training and/or experience relevant to their job description. (iii) Persons responsible for providing professional services must be appropriately certified, registered, or licensed. (C) Staff training. In order to ensure a level of competency to meet the needs of each individual served in the home, personnel must complete the following training requirements: (i) All employees shall be currently certified in first-aid OAC 310:680 OKLAHOMA STATE DEPARTMENT OF HEALTH 34 October 01, 2017 and cardiopulmonary resuscitation (Red Cross training or the equivalent). First Aid and CPR certificates shall be renewed as required to remain current. (ii) Individuals who administer medications in a small residential care home shall be certified in an approved training program for medication administration (M.A.T.). (iii) In addition, staff who are responsible for administering medication shall annually receive at least eight (8) hours of training by the administrator of the home in patient reporting and observation, record keeping, independent or daily living skills, leisure skills and recreation, human relations and such other training relevant to residential care home programs and operations. (iv) All small residential care homes shall provide a new employee orientation program which includes instruction in policies and procedures regarding the areas of abuse and neglect, resident rights, confidentiality, procedure for handling emergencies, and job descriptions. (v) All direct care staff shall begin eight (8) hours of in- service within ninety days of employment and complete within twelve months of employment. Eight (8) hours of in-service shall be required annually thereafter. (D) Personnel practices (i) Residents shall not supervise other residents. (ii) The behavior of the staff shall reflect sensitivity to the needs of individuals served for privacy and dignity. (6) Medication storage and administration (A) Storage and Maintenance (i) Medications shall be stored in an area that is locked, is well lighted, and room temperature not to exceed 86 degrees Fahrenheit. (ii) Medication requiring refrigeration shall be kept in a refrigerator within a temperature range of 36° Fahrenheit to 48° Fahrenheit and separate from food and other items. A method of locking these medications shall be provided. (iii) Medications shall not be stored with any other non-drug item. (iv) Each individual's medications shall be kept separate. (v) Externally applied medications shall be stored separately from medications taken internally. (vi) The medication of each resident shall be kept or stored in the original container. (vii) No prescribed medication or over-the-counter medication for one resident may be administered to or allowed in the possession of another resident. (viii) All prescription medication shall be clearly labeled to include the resident's full name, physician's name, prescription number, strength of drug, dosage, directions for use, date of issue, quantity, and name, address, and phone number of pharmacy or physician dispensing the drug. (ix) Resident's name shall be on all over-the-counter drugs used. (x) All drugs shall be kept locked, and documented when OAC 310:680 OKLAHOMA STATE DEPARTMENT OF HEALTH 35 October 01, 2017 taken by the resident. (xi) Only persons responsible for administering medications shall have possession of the key to the locked medication area. (xii) Labels on containers shall be legible and firmly affixed. (xiii) No one shall alter labels on prescription containers. If a medication dosage change is made by the physician, then the container must be flagged showing a label change is to be made. (xiv) An individual inventory record and documentation for accountability shall be maintained for each Schedule II drug prescribed for each resident. (xv) Schedule II drugs shall be kept in a separate locked box within the locked medication area. (xvi) All new or refilled prescribed medication shall be counted upon receipt in the home and documented in each resident's medication record. (xvii) Discontinued medications may be kept up to three (3) months and must be separated from the current medications within the locked medication area. (xviii) The home shall have a written policy for safe disposal of discontinued medications and it shall be a method approved by the Department of Health. Documentation shall be retained in the individual resident's record. (xix) When a resident is admitted to a home, or returns to a home from a temporary leave, the medication brought into the home shall be counted and documented by the person admitting the resident and countersigned by the resident or responsible party. (xx) When a resident is discharged, moves, or goes on a temporary leave from the home, the unused medication shall be sent with the resident or the responsible party. The resident record shall contain documentation of quantities of medication sent, as well as the signature of the resident or responsible party receiving the medications and of the staff person releasing the medications. (xxi) Unused drugs prescribed for residents who have died shall be kept for one (1) month and then destroyed in accordance with item xix of this section of the Standards. (B) Administration of medications (i) Only persons who have completed an approved course in medication administration shall administer medications. (ii) The person responsible for medication administration shall personally prepare the dosage, observe the resident swallowing the medication, and chart the medication. (iii) The person administering the medication shall maintain an accurate written record of medications administered. (iv) Charting the administration of medications shall be done within an hour after it is taken and correct procedure followed to assure that medications are not documented by memory. (v) All medications shall be administered according to label directions. (C) Monitoring medications (i) Only persons who have completed an approved course in OAC 310:680 OKLAHOMA STATE DEPARTMENT OF HEALTH 36 October 01, 2017 medication administration shall monitor medications. (ii) An accurate written record of medication monitoring shall be made by the individual monitoring the medication. This record must identify the individual responsible for the medication monitoring. (iii) Charting the monitoring of medication shall be done within an hour after it is taken and correct procedure followed to assure that medications are not documented by memory. (iv) All medications monitored shall be taken according to label requirements. (v) Records of medications monitored for residents preparing for self-administration shall be documented by the resident and acknowledged by the staff member monitoring the medication. (D) Self-Administration (i) Self-administration of all medications, prescription and over-the-counter, is permitted only after the resident has been monitored and documentation shows the resident capable of self- administration of medications. Monitoring shall include observation of resident taking the proper medication, in the proper dosage, at the correct time, documenting medication taken, and storing the medication in a safe manner. (ii) The home staff shall conduct at least a monthly documented review of the individual's self-administration program which shall include a count of each medication included in the self- administration program. (iii) All medications must be stored in locked containers. (7) Residents' Funds. Subchapter 15 of this Chapter shall be applicable to small residential care homes. (8) Involuntary Transfer or Discharge of Residents. Subchapter 17 of this Chapter shall also apply to small residential care homes. (9) Residents' Rights. Subchapter 19 of this Chapter shall be applicable to small residential care homes.