216-RICR-40-10-16
216-RICR-40-10-16. Rehabilitation Hospital Centers (version Amendment, 08/29/2018 to 01/04/2022)
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16.1 Authority
These regulations are
promulgated pursuant to the authority conferred under R.I. Gen. Laws
§ 23-17-10
and are established for the purpose of adopting minimum standards for
rehabilitation hospital centers in Rhode Island.
16.2 Incorporated Materials
A. These regulations hereby
adopt and incorporate the Commission on Accreditation of
Rehabilitation Facilities’ “Standards for Facilities Serving
People with Disabilities” (2017) by reference, not including any
further editions or amendments thereof and only to the extent that
the provisions therein are not inconsistent with these regulations.
B. These regulations hereby
adopt and incorporate NFPA 232: Standard for the Protection of
Records. National Fire Protection Association (2017) by reference,
not including any further editions or amendments thereof and only to
the extent that the provisions therein are not inconsistent with
these regulations.
C. These regulations hereby
adopt and incorporate NFPA 99: Health Care Facilities Code, National
Fire Protection Association, (2015) by reference, not including any
further editions or amendments thereof and only to the extent that
the provisions therein are not inconsistent with these regulations.
D. These regulations hereby
adopt and incorporate the American National Standards “Specifications
for Making Buildings and Facilities Accessible and Usable by the
Physically Handicapped” (1980), by reference, not including any
further editions or amendments thereof and only to the extent that
the provisions therein are not inconsistent with these regulations.
E. These regulations hereby
adopt and incorporate the Facility Guidelines Institute’s
"Guidelines for Design and Construction of Hospital and
Outpatient Facilities" (2014) by reference, not including any
further editions or amendments thereof and only to the extent that
the provisions therein are not inconsistent with these regulations.
16.3 Definitions
A. Wherever used in this Part
the following terms shall be construed as follows:
1. “Bed complement" of
a rehabilitation hospital center means the number of beds a center
has in actual use, equal to or less than the licensed capacity.
2. “Capacity" of a
rehabilitation hospital center means the maximum potential number of
beds which may be accommodated within the center.
3. "Change in operator"
means a transfer by the governing body or operator of a center to any
other person (excluding delegations of authority to the medical or
administrative staff of the center) of the governing body's authority
to:
a. Hire or fire the chief
executive officer (administrator) of the center;
b. Maintain and control the
books and records of the center;
c. Dispose of assets and incur
liabilities on behalf of the center; or
d. Adopt and enforce policies
regarding operation of the center.
(1) This definition is not
applicable to circumstances wherein the governing body of a center
retains the immediate authority and jurisdiction over the activities
enumerated in §§ 16.3(A)(3)(a) through (d) of this Part.
4. "Change in owner"
means:
a. In the case of a center
which is a partnership, the removal, addition or substitution of a
partner which results in a new partner acquiring a controlling
interest in such partnership;
b. In the case of a center
which is an unincorporated sole proprietorship, the transfer of the
title and property to another person;
c. In the case of a center
which is a corporation;
(1) A sale, lease, exchange or
other disposition of all, or substantially all of the property and
assets of the corporation; or
(2) A merger of the
corporation into another corporation; or
(3) The consolidation of two
or more corporations, resulting in the creation of a new corporation;
or
(4) In the case of a center
which is a business corporation, any transfer of corporate stock
which results in a new person acquiring a controlling interest in
such corporation; or
(5) In the case of a center
which is a non-business corporation, any change in membership which
results in a new person acquiring a controlling vote in such
corporation.
5. "Director" means
the Director of the Rhode Island Department of
Health.
6. “Discharge” means a
patient’s exit or release from a Center to the patient’s
residence following an inpatient admission.
7. “Equity” means non-debt
funds contributed towards the capital costs related to a change in
owner or change in operator of a rehabilitation hospital center which
funds are free and clear of any repayment or liens against the assets
of the proposed owner and/or licensee and that result in a like
reduction in the portion of the capital cost that is required to be
financed or mortgaged.
8. "Health Services
Council" means the advisory body to the Rhode Island Department
of Health established in accordance with R.I. Gen. Laws § 23-17-13.1
appointed and empowered in accordance with R.I. Gen. Laws § 23-15-7
to serve as the advisory body to the state agency in its review
functions.
9. “Licensed capacity"
of a rehabilitation hospital center means the number of beds a center
is licensed to operate.
10. “Lift team” means
Rehabilitation hospital center employees specifically trained to
perform patient lifts, transfers, and repositioning in accordance
with safe patient handling policy.
11. “Musculoskeletal
disorders” means conditions that involve the nerves, tendons,
muscles, and supporting structures of the body.
12. "Person" means
any individual, trust or estate, partnership, corporation (including
associations, joint stock companies), limited liability company,
state, or political subdivision or instrumentality of a state.
13. "Physician"
means an individual licensed to practice medicine or osteopathy in
Rhode Island pursuant to the provisions of R.I. Gen. Laws Chapter
5-37 .
14. "Progressive levels"
means inpatient, day patient and outpatient or other levels of
rehabilitation programs and services through which a patient
progresses based on established criteria for each level of care and
on the individual patient's plan of care.
15. "Rehabilitation"
means the process of providing through an interdisciplinary team,
coordinated comprehensive services deemed appropriate to the needs of
a person with a disability, in a program designed to achieve
objectives of improved functional ability, health, welfare and the
realization of one's maximum physical, social, psychological and
vocational potential for useful and productive activity and to
enhance independent and self-sufficiency.
16. "Rehabilitation
hospital center", or “Center” means a facility which has a
distinct organizational entity, an organized medical staff, nursing
service and a range of rehabilitation services, which provides
progressive levels of functional rehabilitation services to persons
who require diagnosis and treatment for non-acute chronic injury,
illness or other disabilities, excluding substance mental and/or
rehabilitation facilities licensed by other state agencies. Such
rehabilitation hospital centers however, shall not be construed to
have the same meaning as the term “hospital” as defined in the
rules and regulations for Licensing of Hospitals (Part 4 of this
Subchapter), nor to imply the provisions of a range of acute care as
could be provided under the aforementioned regulations.
17. “State Fire Marshal”
means the Division of the State Fire Marshal, Department of Public
Safety, State of Rhode Island.
18. “Safe patient handling”
means the use of engineering controls, transfer aids, or assistive
devices whenever feasible and appropriate instead of manual lifting
to perform the acts of lifting, transferring, and/or repositioning
health care patients and residents.
19. “Safe patient handling
policy” means protocols established to implement safe patient
handling.
20. "State agency"
means the Rhode Island Department of Health.
16.4 General Requirements for
Licensure
A. No person acting severally
or jointly with any other person, shall establish, conduct or
maintain a rehabilitation hospital center in this state without a
license in accordance with the requirements of R.I. Gen. Laws §
23-17-4 .
B. A certificate of need is
required as a precondition to the establishment of a new
rehabilitation hospital center in accordance with R.I. Gen. Laws
Chapter 23-15 .
16.5 Application for License or
Changes in Owner, Operator, or Lessee
A. Application for a license
to conduct, maintain or operate a rehabilitation hospital center
shall be made to the state agency upon forms provided by it one month
prior to expiration date of license and shall contain such
information as the state agency reasonably requires which may include
affirmative evidence of ability to comply with the provisions of R.I.
Gen. Laws Chapter 23-17
and this Part.
1. Each application shall be
accompanied by an application fee as set forth in the Fee Structure
for Licensing, Laboratory and Administrative Services Provided by the
Department of Health (Part 10-05-2 of this Title) per facility plus
an additional fee per licensed bed as set forth in the Fee Structure
for Licensing, Laboratory and Administrative Services Provided by the
Department of Health (Part 10-05-2 of this Title).
B. Application for changes in
the owner, operator, or lessee of a rehabilitation hospital center
shall be made on forms provided by the state agency and shall
contain, but not be limited to, information pertinent to the
statutory purpose expressed in R.I. Gen. Laws § 23-17-3
or to the considerations enumerated in § 16.6(E) of this Part. Three
(3) copies of such applications are required to be provided.
1. Each application filed
pursuant the provisions of this section shall be accompanied by a
non-refundable, non-returnable application fee, as set forth in the
Fee Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health (Part 10-05-2 of this Title).
16.6 Issuance and Renewal of
License
A. Upon receipt of an
application for a license, the state agency issue a license or
renewal thereof for a period of no more than one (1) year if the
applicant meets the requirements of R.I. Gen. Laws Chapter 23-17
and this Part. Said license, unless sooner suspended or revoked,
shall expire by limitation on the 31st day of December following its
issuance and may be renewed from year to year after inspection and
approval by the state agency.
1. All renewal applications
shall be accompanied by an annual inspection fee as set forth in the
Fee Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health (Part 10-05-2 of this Title) per
facility plus an additional fee per licensed bed as set forth in the
Fee Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health (Part 10-05-2 of this Title).
B. A license shall be issued
to a specific licensee for a specific location and shall not be
transferable. The license shall be issued only for the premises and
the individual owner, operator or lessee, or to the corporate entity
responsible for its governance, as identified in the application.
1. Any change in owner,
operator, or lessee of a licensed rehabilitation hospital center
shall require prior review by the Health Services Council and
approval of the state agency as provided in § 16.6(E) of this Part
as a condition precedent to the transfer, assignment or issuance of a
new license.
C. A license issued hereunder
shall be the property of the state and loaned to such licensee and it
shall be kept posted in a conspicuous place on the licensed premises.
D. Reviews of applications for
changes in the owner, operator, or lessee of licensed rehabilitation
hospital centers shall be conducted according to the following
procedures:
1. Within ten (10) working
days of receipt, in acceptable form, of an application for a license
in connection with a change in the owner, operator or lessee of an
existing rehabilitation hospital center, the state agency will notify
and afford the public thirty (30) days to comment on such
application.
2. The decision of the state
agency will be rendered within ninety (90) days from acceptance of
the application.
3. The Health Services Council
shall transmit its advisory to the state agency in writing. The
decision of the licensing agency shall be based upon the findings and
recommendations of the Health Services Council unless the state
agency shall afford written justification for variance therefrom.
4. All applicants reviewed by
the state agency and all written materials pertinent to the state
review, including minutes of all Health Services Council meetings,
shall be accessible to the public upon request.
E. Except as otherwise
provided in the Act (R.I. Gen. Laws Chapter 23-17 ),
a review by the Health Services Council of an application for a
license, in the case of a proposed change in the owner, operator, or
lessee of a licensed rehabilitation hospital center may not be made
subject to any criterion unless the criterion directly relates to the
statutory purpose expressed in R.I. Gen. Laws § 23-17-3 . In
conducting reviews of such applications the Health Services Council
shall specifically consider and it shall be the applicant’s burden
of proof to demonstrate:
1. The character, commitment,
competence, and standing in the community of the proposed owners,
operators or directors of the rehabilitation hospital center as
evidenced by:
a. In cases where the proposed
owners, operators, or directors of the health care facility currently
own, operate, or direct a health care facility, or in the past five
years owned, operated or directed a health care facility, whether
within or outside Rhode Island, the demonstrated commitment and
record of that (those) person(s):
(1) In providing safe and
adequate treatment to the individuals receiving the health care
facility's services;
(2) In encouraging, promoting
and effecting quality improvement in all aspects of health care
facility services; and
(3) In providing appropriate
access to health care facility services;
b. A complete disclosure of
all individuals and entities comprising the applicant; and
c. The applicant’s proposed
and demonstrated financial commitment to the health care facility.
2. The extent to which the
center will continue, without material effect on its viability at the
time of change of owner, operator or lessee, to provide safe and
adequate treatment for individuals receiving the rehabilitation
hospital center's services as evidenced by:
a. The immediate and long term
financial feasibility of the proposed financing plan;
(1) The proposed amount and
sources of owner's equity to be provided by the applicant;
(2) The proposed financial
plan for operating and capital expenses and income for the period
immediately prior to, during and after the implementation of the
change in owner, operator or lessee of the health care facility;
(3) The relative availability
of funds for capital and operating needs;
(4) The applicant's
demonstrated financial capability;
(5) Such other financial
indicators as may be requested by the state agency.
3. The extent to which the
center will continue to provide safe and adequate treatment for
individuals receiving the rehabilitation hospital center's services
and the extent to which the facility will encourage quality
improvement in all aspects of the operation of the health care
facility as evidenced by:
a. The applicant’s
demonstrated record in providing safe and adequate treatment to
individuals receiving services at facilities owned, operated, or
directed by the applicant; and
b. The credibility and
demonstrated or potential effectiveness of the applicant's proposed
quality assurance programs.
4. The extent to which the
center will continue to provide appropriate access with respect to
traditionally underserved populations as evidenced by:
a. In cases where the proposed
owners, operators, or directors of the health care facility currently
own, operate, or direct a health care facility, or in the past five
years owned, operated or directed a health care facility, both within
and outside of Rhode Island, the demonstrated record of that
person(s) with respect to access of traditionally under served
populations to its health care facilities; and
b. The proposed immediate and
long-term plans of the applicant to ensure adequate and appropriate
access to the programs and health care services to be provided by the
health care facility.
5. In consideration of the
proposed continuation or termination of health care services by the
rehabilitation hospital center:
a. The effect(s) of such
continuation or termination on access to safe and adequate treatment
of individuals, including but not limited traditionally underserved
populations.
b. And in cases where the
application involves a merger, consolidation or otherwise legal
affiliation of two or more health care facilities, the proposed
immediate and long term plans of such health care facilities with
respect to the health care programs to be offered and health care
services to be provided by such health care facilities as a result of
the merger, consolidation or otherwise legal affiliation.
F. Subsequent to reviews
conducted under §§ 16.6(D) and (E) of this Part, the issuance of a
license by the licensing agency may be made subject to any condition,
provided that no condition may be made unless it directly relates to
the statutory purpose expressed in R.I. Gen. Laws § 23-17-3 ,
or to the review criteria set forth in § 16.6(E) of this Part. This
shall not limit the authority of the state agency to require
correction of conditions or defects which existed prior to the
proposed change of owner, operator, or lessee and of which notice had
been given to the facility by the licensing agency.
16.7 Capacity
Each license shall be issued
for the specified licensed bed capacity of the rehabilitation
hospital center. No center shall have more inpatients than the number
of beds for which it is licensed.
16.8 Inspections
A. The state agency shall
make, or cause to be made, such inspections and investigations as it
deems necessary in accordance with R.I. Gen. Laws § 23-17-10 and
this Part.
B. Every center shall be given
prompt notice by the state agency of all deficiencies reported as a
result of an inspection or investigation.
C. Written reports and
recommendations of inspections shall be maintained on file in each
center for a period of no less than thee (3) years.
16.9 Denial,
Suspension, Revocation of License, Curtailment of Activities or
Closure
A. The state agency is
authorized to deny, suspend or revoke the license or curtail
activities of any center which:
1. Has failed to comply with
the rules and regulations pertaining to licensing of rehabilitation
hospital centers; and
2. Has failed to comply with
the provisions of R.I. Gen. Laws Chapter 23-17 .
3. Lists of deficiencies noted
in inspections conducted in accordance with § 16.8 of this Part
shall be maintained on file in the state agency, and shall be
considered by the state agency in rendering determinations to deny,
suspend or revoke the license or curtail activities of a center.
B. Where the state agency
deems that operation of a center results in undue hardship to
patients as a result of deficiencies, the state agency is authorized
to deny licensure to centers not previously licensed, or to suspend
for a stipulated period of time or revoke the license of a center
already licensed or curtail activities of the center.
C. Whenever an action shall be
proposed to deny, suspend or revoke a center's license, or curtail
its activities, the state agency shall notify the center by certified
mail, setting forth reasons for the proposed action, and the
applicant or licensee shall be given an opportunity for a prompt and
fair hearing in accordance with R.I. Gen. Laws §§ 23-17-8
and 42-35-9 .
1. However, if the licensing
agency finds that public health, safety, or welfare imperatively
requires emergency action and incorporates a finding to that effect
in its order, the state agency may order summary suspension of
license or curtailment of activities pending proceedings for
revocation or other action in accordance with R.I. Gen. Laws §§
23-1-21
and 42-35-14(c) .
D. The
appropriate state and federal placement and reimbursement agencies
shall be notified of any action
taken by
the state agency
pertaining to
either denial,
suspension, or
revocation of
license or curtailment of
activities.
E. The state agency shall be
notified immediately when a licensee/owner determines to cease
operations and close a center.
F. At least (30) days prior to
voluntary cessation of any facility license, the Department of Health
shall be provided with an acceptable plan for orderly closure which
shall include, but is not limited to the following; notification and
transfer of patients, transfer, storage, or proper disposal of
medical records; and notification of the public.
G. A license shall immediately
become void and shall be returned to the state agency whenever the
center ceases delivering patient care.
16.10 Organization and Management
16.10.1 Governing Body
A. There shall be an organized
governing body or equivalent legal authority ultimately responsible
for:
1. The management, fiscal
affairs, and operation of the rehabilitation hospital center;
2. The assurance of quality
care and services; and
3. Compliance with all
federal, state and local laws and regulations pertaining to
rehabilitation, fire, safety, sanitation, communicable and reportable
diseases, and other relevant health and safety requirements and with
all rules and regulations of this Part.
B. The governing body or other
legal authority shall furthermore be responsible to define the
population and communities to be served and the scope of services to
be provided.
C. The governing body or other
legal authority shall also be responsible to:
1. Provide physical resources
and equipment to facilitate the delivery of prescribed services and
to ensure that the entire center is accessible to the disabled;
2. Provide a sufficient number
of trained, experienced and competent personnel to provide
appropriate care and supervision for all patients and to ensure that
patients’ needs are met; and
3. Determine that
qualifications of personnel, including consultants, as may be
required in this Part, and to consider such qualifications as
education, training, experience, board certification, and evidence of
current professional practice and licensure as may be required by law
or regulation, and such other relevant factors.
D. The
governing body
or other
legal authority
shall designate:
1. an
administrator who
shall be
responsible for the management and operation of the center; and
2. a medical director who
assumes overall
responsibility for
the health
and rehabilitation
care and
to ensure
achievement and maintenance of quality standards of
professional practice.
E. The governing body shall
adopt and maintain written by-laws and rules and regulations or
acceptable equivalent which defines responsibilities for the
operation and performance of the organization, identified purposes,
and means of fulfilling such. Such by-laws, rules and regulations
shall include:
1. A statement of purpose;
2. A statement of
qualifications for membership and method of selecting members of the
governing body;
3. A statement of the
authority and responsibility delegated to the administrator, the
medical director and to the medical staff;
4. Provision for the selection
and appointment of medical director and medical staff;
5. Provision for the approval
of the medical staff by-laws and/or rules and regulations;
6. Provision of guidelines for
the relationships among the governing body, the administrator, the
medical director and medical staff;
7. A policy statement
concerning the development and implementation of short and long range
plans in accordance with R.I. Gen. Laws Chapter 23-17 ;
8. A policy statement
concerning the publication of an annual report, including a certified
financial statement; and
9. Provision that contracts
with outside providers of services be restricted to those which
comply with federal, state and local laws and regulations and in
accordance with § 16.10.8 of this Part.
F. In addition, the governing
body or other legal authority shall establish administrative policies
pertaining to no less than the following:
1. Responsibilities of the
administrator and the medical director;
2. Conflict of interest on the
part of the governing body, professional staff and employees;
3. The services to be
provided;
4. Criteria for the selection,
admission, discharge and transfer of patients from one level of care
to another (inpatient - day patient - outpatient) or transfer to
another facility; (see § 16.11.1(B) of this Part)
5. Patient/family consent and
involvement in the development of patient care plan;
6. Developing support network
as may be deemed appropriate;
7. Linkages and referrals with
community and other health care facilities or agencies to assure
continuity of patient care and to support services of the center; and
8. Such other matters as may
be relevant.
16.10.2 Administrator
The
administrator shall be directly responsible to the governing body for
the management and operation of the center and shall provide liaison
between the governing body and the medical staff.
16.10.3 Medical Director
A. The overall responsibility
for the rehabilitation and health care needs and services of patients
shall be under the direction of a physician who is licensed in the
State of RI and certified by the American Board of Physical Medicine
and Rehabilitation, or who has specific education and experience in
rehabilitation and who shall be responsible for:
1. The coordination and
supervision of holistic health care and rehabilitation programs and
services:
2. The achievement and
maintenance of quality assurance of professional practices through a
mechanism for the assessment of patient care outcomes;
3. Participation in the
interdisciplinary team and in the development, implementation and
assessment of patient of care;
4. Establishment and
maintenance of a quality assurance program in accordance with the
provisions of § 16.11.9 of this Part; and such other
responsibilities as may be deemed appropriate.
16.10.4 Medical Staff
A. Each center shall have an
organized medical staff responsible to the governing body who shall
be responsible to maintain standards of professional performance
through staff appointment criteria, continuing peer review and other
appropriate evaluation mechanisms.
B. The medical staff, subject
to the approval of the governing body, shall adopt by-laws and/or
rules and regulations incorporating details of its general powers,
duties and responsibilities including the types of committees,
delineation and clinical privileges of non-physician practitioners
and designation of personnel qualified to prescribe or administer
drugs.
C. A copy of approved medical
staff by-laws and/or rules and regulations and revisions thereto,
shall be submitted to the state agency.
16.10.5 Organization
A. The internal organization
of the center shall be structured to include appropriate clinical
programs and services consonant with the health and rehabilitative
needs of its defined population.
B. Each center shall maintain
clearly written definitions of its organization authority,
responsibilities and relationships.
C. Each clinical program and
service shall maintain:
1. Clearly written definitions
of its organization, authority, responsibilities and relationships;
2. Written patient care
policies and procedures; and
3. Written provision for
systematic evaluation of programs and services.
D. Every licensed center and
its insurance carrier shall cooperatively, as a part of their
administrative function, establish an internal risk management
program in accordance with the requirements of R.I. Gen. Laws §
23-17-24 .
16.10.6 Personnel and Safe
Patient Handling
A. The
center shall
maintain a
sufficient number
of qualified
personnel to
provide effective
patient care and all other related services.
1. Various categories of
personnel working in patient care areas shall be clearly identifiable
to patients and the public.
B. There
shall be written personnel policies and procedures which shall be
made available to personnel.
C. There shall be a job
description for each position which delineates the qualifications,
duties, authority and responsibilities inherent in each position.
1. For those selected
non-licensed personnel authorized to administer drugs in accordance
with § 16.11.4(B)(3) of this Part, a job description delineating
qualifications, duties and responsibilities shall be provided.
D. Provisions shall be made
for orientation and continuing in-service education for personnel.
E. There
shall be written evidence that staff demonstrate competencies
necessary to work in specific areas and/ or with specific patient
populations.
F. Upon hire and prior to
delivering services, a pre-employment health screening shall be
required for each individual who has or may have direct contact with
a patient in the rehabilitation hospital. Such health screening shall
be conducted in accordance with the rules and regulations pertaining
to Immunization, Testing, and Health Screening for Health Care
Workers (Part 20-15-7 of this Title).
G. National criminal
background checks shall be conducted in accordance with R.I. Gen.
Laws §§ 23-17.7.1-17, 23-17-62 and 23-17.7.1-20 for Center
personnel whose employment involves routine contact with a patient.
H. Personnel records shall be
maintained for each employee, shall be available at all times for
inspection and shall include:
1. Current and background
information covering qualifications for employment;
2. Records of completion of
required training and educational programs;
3. Records of all required
health examinations which shall be kept confidential; and
4. Evidence of current
registration, certification or licensure for all personnel subject to
statutory requirements.
I. An in-service educational
program shall be conducted on an ongoing basis, which shall include
an orientation program for new personnel and a program for the
development and improvement of skills of all personnel. The
in-service program shall be geared to the rehabilitation needs of
patients, food service sanitation, fire prevention and safety,
confidentiality of patient information, rights of patients and any
other area related to rehabilitation.
1. Provision shall be made for
written documentation of programs, including attendance. Flexible
program schedules shall be formulated at least two months in advance.
J. A
health care facility shall require all persons, including students,
who examine, observe, or treat a patient or resident of such facility
to wear a photo identification badge which states, in a reasonably
legible manner, the first name, licensure/registration status, if
any, and staff position of such person.
K. Safe Patient Handling. Each
licensed center hospital shall establish a safe patient handling
committee, which shall be chaired by a professional nurse or other
appropriate licensed health care professional. A center may utilize
any appropriately configured committee to perform the
responsibilities of this section. At least half of the members of the
committee shall be hourly, non-managerial employees who provide
direct patient care.
1. Each licensed center shall
develop a written safe patient handling program, with input from the
safe patient handling committee, to prevent musculoskeletal disorders
among health care workers and injuries to patients. As part of this
program, each licensed health care facility shall:
a. Implement a safe patient
handling policy for all shifts and units of the facility that will
achieve the maximum reasonable reduction of manual lifting,
transferring, and repositioning of all or most of a patient's weight,
except in emergency, life-threatening, or otherwise exceptional
circumstances;
b. Conduct a patient handling
hazard assessment. This assessment should consider such variables as
patient-handling tasks, types of nursing units, patient populations,
and the physical environment of patient care areas;
c. Develop a process to
identify the appropriate use of the safe patient handling policy
based on the patient's physical and mental condition, the patient's
choice, and the availability of lifting equipment or lift teams. The
policy shall include a means to address circumstances under which it
would be medically contraindicated to use lifting or transfer aids or
assistive devices for particular patients;
d. Designate and train a
registered nurse or other appropriate licensed health care
professional to serve as an expert resource, and train all clinical
staff on safe patient handling policies, equipment, and devices
before implementation, and at least annually or as changes are made
to the safe patient handling policies, equipment and/or devices being
used;
e. Conduct an annual
performance evaluation of the safe patient handling with the results
of the evaluation reported to the safe patient handling committee or
other appropriately designated committee. The evaluation shall
determine the extent to which implementation of the program has
resulted in a reduction in musculoskeletal disorder claims and days
of lost work attributable to musculoskeletal disorder caused by
patient handling, and include recommendations to increase the
program's effectiveness; and
f. Submit an annual report to
the safe patient handling committee of the facility, which shall be
made available to the public upon request, on activities related to
the identification, assessment, development, and evaluation of
strategies to control risk of injury to patients, nurses and other
health care workers associated with the lifting, transferring,
repositioning, or movement of a patient.
2. Nothing in this section
precludes lift team members from performing other duties as assigned
during their shift.
3. An employee may, in
accordance with established facility protocols, report to the
committee, as soon as possible, after being required to perform a
patient handling activity that he/she believes in good faith exposed
the patient and/or employee to an unacceptable risk of injury. Such
employee reporting shall not be cause for discipline or be subject to
other adverse consequences by his/her employer. These reportable
incidents shall be included in the facility's annual performance
evaluation.
16.10.7 Interdisciplinary
Team
A. The governing body or other
legal authority shall designate an interdisciplinary team composed of
staff personnel which includes:
1. Patient/family;
2. Physician(s) (to include
physician(s) who are experts in the treatment of specific conditions
and also in the rehabilitation of the patient as a whole);
3. Professional (registered)
nurse;
4. Social worker;
5. Physical, occupational,
speech and hearing, psychologists; and
6. Such other staff and
non-staff personnel as may be deemed necessary.
B. The interdisciplinary team
shall be responsible for patient education, the development,
implementation and assessment of patient/family plans of care, and in
addition:
1. The supervision of care,
clinical health and rehabilitation services provided;
2. The provision of direct
patient care as may be required and appropriate;
3. The review on an ongoing
regularly scheduled basis of patient/family plans of care, and the
revision of such plans of care, and development of a discharge plan
as may be required;
4. The development of policies
and procedures governing patient/family care and services; and
5. Such other duties as may be
deemed appropriate.
16.10.8 Contracts or
Agreements
A. There shall be written
contract(s) or agreement(s) for the provisions of those services
which are not provided directly by the center. The contract(s) or
agreement(s) shall clearly delineate the responsibilities of the
parties involved and shall include no less than the following
provisions:
1. The responsibilities,
functions, objectives, terms of agreement, financial arrangements,
charges and other pertinent requirements shall be clearly delineated
in the terms of the contract or agreement negotiated between the
parties involved;
2. Assurance that the services
to be provided are in accordance with the plan of care;
3. The manner in which the
contracted services are coordinated, supervised and evaluated;
4. Establish the frequency of
patient care assessment; and
5. Such other provision as may
be deemed appropriate.
16.10.9 Clinical Records
A. A clinical record shall be
established and maintained for every person admitted to any level of
care (inpatient, day patient or outpatient). Such record shall follow
the patient at each level of care in order to insure continuity of
care.
B. Written policies and
procedures shall be established regarding content and completion of
clinical records.
C. Entries in the clinical
record shall be made by the responsible person providing care or
services in accordance with the center's policies and procedures.
D. The clinical record shall
contain sufficient information to identify the patient and the
problem and to describe the rehabilitation treatment modalities of
care and the patient's response to the rehabilitation care and
services.
E. The content of the clinical
records (inpatient, day patient, outpatient) shall conform with
applicable standards of § 16.2(A) of this Part
F. Provisions shall be made
for the safe storage of clinical records of reproduction in
accordance with § 16.2(B) of this Part.
G. All clinical records either
original or accurate reproductions shall be preserved for a minimum
of five (5) years following discharge of the patient in accordance
with R.I. Gen. Laws § 23-3-26 .
1. Records of minors shall be
kept for at least five (5) years after such minor shall have reached
the age of 18 years.
16.10.10 Rights of Patients
A. Every
center shall observe the standards as enumerated in R.I. Gen. Laws
Chapter 23-17 -19.1
with respect to each patient who is admitted to its
center.
B. A
copy of the Rights of Patients shall be given to each patient or his/
her representative upon admission and shall be posted in a
conspicuous place on the
premises in accordance with R.I. Gen. Laws § 23-17-19.2.
16.10.11 Financial
Disclosure
A. Any health care facility
licensed pursuant to R.I. Gen. Laws Chapter 23-17, which refers
clients to another such licensed health care facility or to a
residential care/assisted living facility licensed pursuant to R.I.
Gen. Laws Chapter 23-17.4, or to a certified adult day care program
in which the referring entity has a financial interest shall, at the
time a referral is made, disclose in writing the following
information to the client:
1. That the referring entity
has a financial interest in the facility or provider to which the
referral is being made; and
2. That the client has the
option of seeking care from a different facility or provider which is
also licensed and/or certified by the state to provide similar
services to the client.
3. The referring entity shall
also offer the client a written list prepared by the Department of
Health of all such alternative licensed and/or certified facilities
or providers. Said written list may be obtained by contacting:
Rhode
Island Department of Health
Center
for Health Facility Regulations
3
Capitol Hill, Room 306 Providence, RI 02908
401.222.2566
16.10.12 Abuse, Neglect, or
Mistreatment
A. The center shall report
within 24 hours, to the state agency, allegations of patient abuse,
neglect or mistreatment as defined in R.I. Gen. Laws Chapter 23-17-8.
1. The center shall maintain
evidence that all allegations of abuse, neglect, and/or mistreatment
have been thoroughly investigated and that further potential abuse
has been prevented while the investigation is in progress.
Appropriate corrective action shall be taken, as necessary. The
results of said investigation shall be reported to the state agency
within five (5) business days.
16.10.13 Uniform Reporting
System
A. Each center shall establish
and maintain records and data in such a manner as to make uniform the
system of periodic reporting. The manner in which the requirements of
this regulation may be met shall be prescribed from time to time in
directives promulgated by the Director with the advice of the Health
Services Council.
B. Each center shall report to
the state agency detailed financial and statistical data pertaining
to its operations, services, and facilities. Such reports shall be
made at such intervals and by such dates as determined by the
Director and shall include but not be limited to the following:
1. Utilization of the center
and its services;
2. Unit cost of center
services;
3. Charges for rooms and
services;
4. Financial condition of the
center; and
5. Quality of rehabilitative
care.
C. The state agency is
authorized to make the reported data available to any state agency
concerned with or exercising jurisdiction over the reimbursement or
utilization of the center.
D. The directives promulgated
by the Director pursuant to this Part shall be sent to each center to
which they apply. Such directives shall prescribe the form and manner
in which the financial and statistical data required shall be
furnished to the state agency.
16.11 Patient Care Services
16.11.1 Management
Responsibility
A. The rehabilitation hospital
center through its Medical Director shall be responsible to ensure
that all health and holistic rehabilitation services and programs,
including services provided per contract or arrangement are rendered
in a safe and effective manner consistent with acceptable standards
of practice, policies of the center and the requirements of this
Part.
1. Furthermore, the Medical
Director shall be responsible to ensure that all patients receive
adequate medical/surgical treatment, as may be required for specific
conditions, in an appropriate facility.
B. The center shall assure the
continuity of patient care in the inpatient, day patient and
outpatient settings through written policies, procedures and criteria
pertaining to no less than the following:
1. Criteria and policies and
procedures for admissions to each level of care and initial
assessment of patient care needs;
2. Signed informed consent;
3. Ongoing assessment of
patient/family needs;
4. Development and review of
the plan of care by the interdisciplinary team;
5. Transfer of patients for
acute medical-surgical problems; (see § 16.11.1(A) of this Part)
6. The provision of
appropriate information to patient/family at the points of transfer
between levels of care;
7. Community or other
resources, including consultation services, to insure continuity of
care to meet patient care needs;
8. Constraints imposed by
limitations of services, patient and home conditions, or other; and
9. Such other criteria as may
be deemed appropriate.
16.11.2 Plan of Care
A. After initial assessment of
patient rehabilitative needs, a written plan of care shall be
established by the interdisciplinary team for each patient admitted
to the center and at each level of care and with the participation of
the patient or responsible party. Such plan shall designate the
intensity of services required in relation to the disability and the
individual's response to treatment and shall include provisions
pertaining to:
1. Pertinent diagnosis and
prognosis;
2. Identification of the
intensity of patient care needs including :
a. The range of rehabilitation
services required;
b. The level of care required;
c. The frequency of
therapeutic services required;
d. Medications;
e. Management of discomfort
and pain control; and
f. Other rehabilitative needs
and prescribed therapies;
3. Such other relevant
modalities of care, training and services as may be appropriate to
meet the patient's rehabilitative needs.
B. Patient care plans shall be
reviewed and updated at periodic intervals as specified in the plan
of care by the multidisciplinary team.
16.11.3 Levels of Care
A. Inpatient Care: shall be
for the provision of intensive functional rehabilitation services
through the interdisciplinary team, for patients who require
uninterrupted rehabilitation and nursing care services including a
range of intensive rehabilitation services referred to in § 16.11.4
of this Part as related to patient's disability and response to
treatment.
B. Day Care: shall be for the
provision of rehabilitation services through the Interdisciplinary
Team to patients whose condition continues to require intensive
functional rehabilitation services as provided in the inpatient
setting, but who can accommodate to a less protective environment
such as his or her home, without interrupting the rehabilitation
process.
C. Outpatient: shall refer to
the provision of coordinated and integrated assessment and/or
rehabilitation services with emphasis on continuity of care,
education and training to individuals with disabling impairments
requiring less intensive rehabilitation, supervision and support
services.
16.11.4 Rehabilitation
Services
A. Physician Services: shall
be available and/or on call on a twenty-four (24) hour basis and be
provided by physician(s) who shall be responsible for the diagnosis
and treatment of disabled patients, and who shall participate with
members of the interdisciplinary team in the development,
implementation and assessment of patient care plans.
B. Nursing Services: shall be
provided on a twenty-four (24) hour basis under a licensed
professional (registered) nurse in accordance with R.I. Gen. Laws
Chapter 5-34 ,
who has training and experience in rehabilitation nursing and who
shall be responsible to meet the rehabilitative nursing needs of
patients as prescribed in the patient's plan of care and in
accordance with acceptable standards of practice.
1. There shall be a sufficient
number of licensed professional (registered) nurses on duty at all
times to plan, assign, supervise, implement and evaluate nursing care
as well as to provide direct patient care as required.
2. The number and type of
licensed nurses and ancillary nursing personnel shall be based on
evaluation of patient care needs and staff capabilities for each
patient care unit.
3. Administration of drugs by
non-licensed personnel, selected non-licensed personnel with
demonstrated competency, who have satisfactorily completed a state
approved training program in drug administration may administer oral
or topical drugs, if adequate medical and nursing supervision is
provided in accordance with R.I. Gen. Laws Chapter 5-34 .
C. Social Services: shall be
provided as prescribed in the plan of care and in accordance with
acceptable standards of practice and center policies. Social Workers
hired after January 1, 2019 shall be qualified on the basis of
education, training and experience in accordance with the provisions
of R.I. Gen. Laws Chapter 5-39.1. Staff providing social services
hired before December 31, 2018 shall have at least a bachelor's
degree in social work from a school accredited or approved by the
Council on Social Work Education.
D. Therapeutic Services: All
therapeutic services shall be provided as prescribed by the
interdisciplinary team in the plan of care. Such therapeutic services
shall be provided by appropriate staff or consultants in accordance
with the center's policies and procedures and consistent with
prevailing standards of practice. Furthermore, therapists staff or
consultants shall participate in the development, implementation and
assessment of patient care plans.
1. Therapists and assistants
(physical, occupational, speech, audiologist) shall furthermore hold
current licensure, certification or registration as may be required
under R.I. Gen. Laws Chapters 5-34 ,
5-40 ,
and 5-40.1 .
E. Psychological Services:
shall be provided by qualified psychologists who are certified in the
State of Rhode Island in accordance with R.I. Gen. Laws Chapter 5-44 .
Such services shall be provided as prescribed in the plan of care and
the psychologist(s) shall also participate in the development,
implementation and assessment of the patient's plan of care.
F. Pastoral Care: Clergymen or
members of various denominational organizations or churches shall
have access to patients. Patients shall be notified of the
availability of such services.
G. Prosthetic/Orthotic
Services: shall be rendered as prescribed in the plan of care and
provided by individuals with training and experience in prosthetics
and/or orthotic services, who shall also participate in the
development, implementation and assessment of the plan of care.
H. Allied Rehabilitation
Services: such as pre-vocational, vocational, driver training shall
also be provided in accordance with center policies and through
written agreement with agencies providing vocational training or
driver education.
I. Other Rehabilitation
Services: all other rehabilitation services, including recreation
services, provided by the center shall be provided by individuals
with appropriate qualifications and rendered in accordance with
acceptable standards or practice.
16.11.5 Infection Control
A. The center shall make
provisions through patient care and personnel policies for the
control of infection and for the protection of patients and
personnel. Policies shall pertain to no less than the following:
1. Sanitation and medical
asepsis;
2. Disposal of solid waste
materials;
3. Admission and isolation of
patients with known or suspected infections, diseases and other
protective isolation;
4. The establishment of a
center-wide surveillance program which shall include an infection
surveillance officer to conduct all infection surveillance
activities. This shall include a system of periodic reporting,
evaluation and recording of the occurrence of infections among
personnel and patients;
5. The monitoring of staff
personnel to insure the implementation of policies and procedures for
the control of infection control.
B. Reporting of Communicable
Diseases: Each center shall report promptly to the Rhode Island
Department of Health, Division of Disease Control, cases of
communicable diseases designated as "reportable diseases"
in accordance with the rules and regulations pertaining to Reporting
and Testing of Infectious, Environmental, and Occupational Diseases
(Part 30-05-1 of this Title) when such cases are diagnosed.
1. When outbreaks of food
borne illness are suspected, such occurrences shall be updated
immediately to the Rhode Island Department of Health, Division of
Disease Control or to the Division of Food Protection and Sanitation.
16.11.6 Dietary Services
A. A center shall maintain a
dietary service directed by a full-time person qualified by training
and experience in organization and administration of food service.
B. Each center shall have at
least one Registered Dietitian, licensed by the state and certified
by the Commission on Dietetic Registration, employed on either a
full-time, or regular part-time basis to direct nutritional aspects
of patient care and to advise on food preparation and service.
C. Adequate space, equipment
and supplies shall be provided for the efficient, safe and sanitary
receiving, storage, refrigeration, preparation and service of food
and other related aspects of the food service operation in accordance
with the Rhode Island Food Code (Part 50-10-1 of this Title)
1. Any construction, addition,
alteration affecting food service operations shall be in conformance
with the requirements of R.I. Gen. Laws § 23-1-31 .
D. The food service operation
shall comply with applicable standards of the Rhode Island Food Code
(Part 50-10-1 of this Title).
E. Written policies and
procedures shall be established for dietary services, pertaining to
but not limited to the following:
1. Responsibilities and
functions of personnel;
2. Advising the administrator
on all nutritional aspects of patient care, food service and
preparation;
3. Alterations or modification
to diet orders;
4. Food purchasing, storage
preparation and service;
5. Safety and sanitation
relative to personnel and equipment;
6. Ancillary dietary services,
including food storage and preparation in satellite kitchens, and
vending operations;
7. Providing dietary
counseling to patients when necessary; and
8. Ice making in accordance
with Good Manufacturing Practices for Food (Part 50-10-4 of this
Title).
F. Any center engaged in
processing or handling or both, of frozen foods shall be subject to
standards of Good Manufacturing Practices for Food (Part 50-10-4 of
this Title).
G. There shall be a diet
manual maintained by the dietary service which shall be reviewed,
periodically revised as necessary and approved by the medical staff.
Diets served to patients shall comply with the principles set forth
in the diet manual.
H. All patient diets shall be
ordered in writing by the physician.
I. A dining room shall be
available for those patients who wish to participate in group dining
in accordance with § 16.13.3(A)(5) of this Part.
J. Self-help feeding program
shall be available to those patients who need them to maintain
maximum independence in the activities of daily living.
K. A center contracting for
food service shall require as a part of the contract, that the
contractor comply with the provisions of the rules and regulations of
this Part.
L. All menus shall be planned
at least one week in advance and shall provide for a variety of
foods, adjusted for seasonal changes, and reflecting the dietary
preferences of patients. Menus shall be posted in a conspicuous place
in the dietary department and records of such shall be retained for
thirty (30) days.
16.11.7 Laboratory and
Radiology Services
A. Clinical laboratory
services shall be in accordance with the provisions of R.I. Gen. Laws
§ 23-16.2-3
and the Federal CLIA regulation: 42 C.F.R. § 439. The Center must
also maintain the appropriate CLIA certificate to the level of
testing being performed.
B. A center providing
radiology services must meet the requirements of regulations
regarding Radiation (Subchapter 20 of this Chapter).
1. Authentication reports of
radiological interpretations, consultations shall be part of the
patient's clinical record.
C. Centers contracting with
outside resources for laboratory and/or radiology services shall
contract only with:
1. Laboratories which meet the
requirements of the rules and regulations for Clinical Laboratories
and Stations (Part 60-05-4 of this Title); and
2. Radiation facilities which
meet the requirements of the rules and regulations for Radiation
(Subchapter 20 of this Chapter).
16.11.8 Pharmacy
A. Each Rehabilitation
Hospital Center shall provide pharmaceutical services either directly
within the institution or by contractual arrangement. In either
instance, there shall be evidence of a current pharmacy license in
compliance with R.I. Gen. Laws § 5-19.1-8. Pharmaceutical services
shall be provided in accordance with the rules and regulations
pertaining to Pharmacists, Pharmacies, and Manufacturers, Wholesalers
and Distributors (Subchapter 15 Part 1 of this Chapter).
B. An
emergency medication kit, approved by the pharmaceutical service
committee or its equivalent, shall be kept at each nursing station.
16.11.9 Quality Assurance
Program
A. Each center shall establish
and maintain on an ongoing basis a Quality Assurance Program which
involves assessment of all quality assurance activities conducted in
the provision of its health care and rehabilitation program and
services at all levels which shall include no less than:
1. Establishment of standards
and criteria for the assessment of the quality of health and
rehabilitation program and services provided and the appropriateness
of the resources utilized;
2. Assessment of
rehabilitation outcomes;
3. Ongoing review of
rehabilitation programs and services by physicians and other health
professionals;
4. A mechanism to assure the
utilization of systematic data collection based on valid samples of
the total patient population to measure performance and patient
results, and to make recommendations to physicians and centers of
needed changes;
5. Provisions for combining
utilization data and financial data into management reports which
shall be available to the Director of Health;
6. Arrangements of routine
reporting of results of quality assurance program activities to the
governing body, administration, providers, and the Director of
Health; and
7. Written procedures for
taking appropriate remedial action whenever, as determined under the
quality assurance program, inappropriate or substandard services have
been provided or services which should have been furnished have not
been provided.
16.11.10 Equipment
A. Each center shall have an
assortment of styles and sizes of adaptive equipment for patient
evaluation and training in the following areas:
1. Beds - e.g., beds &
accessories, mattresses, waterproof bed protection, enuresis, alarms,
self-fitting aids, bed and cantilever tabled, protective devices for
incontinency.
2. Pressure relief -e.g., beds
and cushions designed for pressure relief, sheepskins.
3. Chairs -e.g., geriatric,
adjustable and mobile chairs, self-lift seats, therapeutic training
wheelchairs.
4. Communication -e.g.,
reading aids, writing and speech aids, deaf aids, remote control
apparatus.
5. Eating and Drinking Aids
-e.g., non-slip materials, trays, cutlery.
6. Electro Diagnostic - EMG
7. Hoists and Lifting
Equipment -e.g., portable, fixed and electric hoists, manual lifting
aids, car hoists, stair climbers.
8. Leisure Activities - e.g.,
music, sports, hobbies, crafts, sewing.
9. Sport & Physical
Recreation -e.g., (facilities for disabled people) clubs concerned
with sports for disabled.
10. Personal Toilet and
Personal Care -e.g., commodes, hair washing, showers, aids for
incontinency.
11. Prosthetics and Orthotics
- adjustable models.
12. Walking Aids and
Wheelchairs
13. Household
equipment/fittings
14. Clothing/footwear
15. Therapeutic Devices: nerve
muscle stimulators; exercise equipment -e.g., weight/pulleys,
ergometer, treadmill; Modalities: mv/heat/ microwave, traction;
Positioning; Hydrotherapy (whirlpool and therapeutic pool)
16. Other Diagnostic: E.K.G.;
Pulmonary function; Biofeedback & video feedback; audio and
visual equipment; and prevocational, e.g. adjustable heights and
accessible work stations.
16.12 Environmental and
Maintenance Services
16.12.1 Disaster
Preparedness
A. Each center shall develop
and maintain a written disaster preparedness plan which shall include
plans and procedures to be followed in case of fire or other
emergencies.
B. The plan and procedures
shall be developed and coordinated with assistance of qualified
safety and other appropriate experts, including the appropriate state
and local agencies and representatives concerned with emergency,
safety, rescue and disaster preparedness.
C. The plan shall include
procedures to be followed pertaining to no less than the following:
1. Fire, explosion, hurricane,
loss of power and/or water, flooding and other calamities;
2. Transfer of casualties;
3. Location and use of alarm
systems, signals and fire fighting equipment;
4. Containment of fire;
5. Notification of appropriate
persons;
6. Relocation of patients and
evacuation routes;
7. Handling of drugs and
biologicals; and
8. Any other essentials as may
be warranted.
D. A copy of the plan shall be
available at every nursing unit.
E. Emergency steps of action
shall be clearly outlined and posted in conspicuous locations
throughout the center.
F. Simulated drills testing
the effectiveness of the plan shall be conducted for all shifts at
least twice a year. Written reports and evaluation of all drills
shall be maintained by the facility.
G. All personnel shall receive
training in disaster preparedness as part of their employment
orientation.
16.12.2 Housekeeping
A. A full-time employee of the
center shall be designated responsible for housekeeping services,
supervision and training of housekeeping personnel.
B. Sufficient housekeeping and
maintenance personnel shall be employed to maintain a comfortable,
safe, clean, sanitary and orderly environment in the center.
1. Housekeeping personnel may
assist in food distribution but not food preparation. Careful hand
washing should be done prior to assisting in food distribution.
C. Written housekeeping
policies and procedures shall be established for the operation of
housekeeping services throughout the facility. Copies shall be
available for all housekeeping personnel.
D. All parts of the center and
its premises shall be kept clean, neat and free of litter and rubbish
and offensive odors.
E. Equipment and supplies
shall be provided for cleaning of all surfaces. Such equipment shall
be maintained in a safe, sanitary condition and shall be properly
stored.
F. Hazardous cleaning
solutions, compounds, and substances shall be labeled, stored in a
safe place, and kept in an enclosed section separate from other
cleaning materials.
G. Cleaning shall be performed
in a manner which will minimize the development and spread of
pathogenic organisms in the environment.
H. Exhaust ducts from kitchens
and other cooking areas shall be equipped with proper filters and
cleaned at regular intervals. The ducts shall be cleaned as often as
necessary and inspected by the facility no less than twice a year.
I. Centers contracting with
outside resources for housekeeping services shall require conformance
with existing regulations
16.12.3 Laundry Service
A. Each center shall make
provisions for the cleaning of all linens and other washable goods.
B. A center providing laundry
service shall have adequate space and equipment for the safe and
effective operation of a laundry service. In unsewered areas,
approval shall be obtained of the sewage system from the state agency
to ensure its adequacy.
C. Written policies and
procedures for the operation of the laundry service, including
special procedures for the handling and processing of contaminated
linens, shall be established.
D. There shall be distinct
areas for the separate storage and handling of clean and soiled
linens.
1. The soiled linen area and
the washing area shall be negatively pressurized or otherwise
protected to prevent introduction of airborne contaminants.
2. The clean linen area and
the drying area shall be physically divorced from the soiled linen
area and the washing area.
E. All soiled linen shall be
placed in closed containers prior to transportation.
F. To safeguard clean linens
from cross-contamination they shall be transported in containers used
exclusively for clean linens which shall be kept covered at all times
while in transit and stored in areas designated exclusively for this
purpose.
G. Centers contracting for
services with an outside resource shall require conformance with this
Part.
16.13 Physical Plant
16.13.1 New Construction,
Additions or Modifications
A. All construction, as
defined in rules and regulations pursuant to R.I. Gen. Laws Chapter
23-15
shall be subject to the following provisions:
1. R.I. Gen. Laws Chapter
23-15 .
2. Rhode Island Food Code
(Part 50-10-1 of this Title).
3. R.I. Gen. Laws § 23-1-31 .
4. R.I. Gen. Laws Chapter
23-28.1 .
5. R.I. Gen. Laws Chapter
23-27.3 .
6. Incorporated materials at §
16.2(D) of this Part.
7. Facility Guidelines
Institute’s "Guidelines for Design and Construction of
Hospital and Outpatient Facilities" (2014). “
8. Incorporated materials at §
16.2(A) of this Part.
9. In addition, any other
applicable state and local law, codes and regulations shall apply.
Where there is a difference between codes, the code having the higher
standard shall apply.
16.13.2 General Provisions
- Physical Environment
A. Each center shall be
constructed, equipped and maintained to protect health and safety of
disabled patients, personnel and the public. All equipment and
furnishings shall be maintained in good condition, properly
functioning and replaced when necessary.
B. The entire physical plan,
including functional units of the center, service areas, shall be
accessible to, and functional for disabled patients, personnel and
the public. All necessary accommodations shall be made to meet the
needs of persons with mobility disabilities or sight, hearing and
coordination or perception disabilities in accordance with “The
American Nation Standard-Specifications for Making Buildings and
Facilities Accessible to and Usable by the Physically Handicapped
(ANSI)”, incorporated above in § 16.2(D) of this Part and the
Facility Guidelines Institute’s "Guidelines for Design and
Construction of Hospital and Outpatient Facilities" (2014).
C. Blind non-ambulatory,
physically handicapped or patients with mobility disabilities which
limit self-preservation capability shall not be housed above the
street level floor unless the center is equipped with an elevator and
meets other requirements of ANSI as incorporated above in in §
16.2(D) of this Part. Furthermore, the center must meet R.I. Gen.
Laws § 23-28.1 .
D. All rooms utilized by
patients shall have proper ventilation and shall have outside opening
with satisfactory screens. Grounds surrounding the center shall be
accessible to and usable by patients and shall be maintained in an
orderly and well-kept manner.
16.13.3 Functional Units
and Service Areas
A. All functional units and
service areas of the rehabilitation hospital center shall be based on
the guidelines for rehabilitation facilities in the Facility
Guidelines Institute’s "Guidelines for Design and Construction
of Hospital and Outpatient Facilities" (2014) and Standards for
Facilities Serving People with Disabilities” incorporated above in
§ 16.2(A) of this Part. Such functional units and service areas
shall include:
1. Nursing unit (for
Inpatients);
2. Day Patient and Out Patient
units;
3. Dietary Unit pursuant to §
16.11.6 of this Part;
4. Psychological/Social or
Vocational Services Unit;
5. Patients' Dining,
Recreation and Day Spaces.
a. If a multi-purpose room is
used, there must be sufficient space to accommodate dining and
patient activities of both inpatient and day patients and present
interference with each other;
b. Storage shall be provided
for recreational equipment and supplies.
6. Unit for Teaching
Activities of Daily Living: bathing, dressings, going to toilet,
continence, feeding and transfer;
7. Physical and Occupational
Units, Prosthetics and Orthotics; and
8. Such other units as may be
required in accordance with the aforementioned rules and regulations.
16.13.4 Special Care Unit
A
patient room shall be designated for isolation purposes. Such room
shall be properly identified with precautionary signs, shall have
outside ventilation, private toilet and hand washing facilities.
16.13.5 Therapeutic Pools
Centers
providing therapeutic pool services shall be subject to the
applicable rules and regulations of Aquatic Venues (Part 50-05-4 of
this Title).
16.13.6 Fire and Safety
A. Each center shall meet the
requirements of R.I. Gen. Laws Chapter 23-28.1
pertaining to fire and safety.
B. A monitoring program for
the internal enforcement of all applicable fire and safety laws and
regulations shall be established. Such program shall include written
procedures for the implementation of policies, regulations and
statutes. A log of such monitoring shall be maintained.
16.13.7 Lighting and
Electrical Services/Emergency Power
A. All electrical and other
equipment used in the center shall be maintained free of defects
which could be a potential hazard to patients or personnel. Periodic
calibration and/or preventive maintenance of equipment shall be
provided and documentation of all testing shall be maintained.
B. All electrical appliances
used by centers shall have the Underwriters Laboratories label or be
approved by local electrical inspection authorities.
C. Each center shall be
equipped with an alternate emergency power source. The emergency
electrical power system shall have a sufficient capacity to supply
power to maintain the operation of any life-support systems, lighting
egress, fire detection equipment, alarm and extinguishing system.
1. Monthly testing of
emergency power shall be documented and reports retained for at least
three (3) years.
16.13.8 Incinerators
A. Incinerators
within hospitals shall be segregated from other parts of the building
by non-combustible construction, with walls, floors and ceilings
having a fire resistance rating of not less than two hours. Openings
to such rooms shall be protected by Class B fire doors, and equipped
with positive self-closing devices in accordance with R.I. Gen Laws
Chapter 23-28.1.
B. Incinerators within the
center shall meet the Department of Environmental Management’s "Air
Pollution Control Regulation No. 12 - Incinerators".
16.13.9 Plumbing
A. All plumbing material and
plumbing systems or parts thereof installed shall meet the minimum
requirements of R.I. Gen. Laws Chapter 23-27.3. The local codes will
supersede the aforementioned only if they are more stringent.
B. All plumbing shall be
installed in such a manner as to prevent back siphonage or cross
connections between potable and non-potable water supplies.
C. Fixtures from which grease
is discharged shall be served by a line in which a grease trap is
installed. The grease trap shall be cleaned sufficiently often to
sustain efficient operation.
16.13.10 Waste Water
Disposal
Any new center shall be
connected to a public sanitary sewer.
16.13.11 Waste Disposal
A. Medical Waste. Medical
waste as defined in the Rhode Island Department of Environmental
Management’s Medical Waste Regulations (250-RICR-140-15-1) shall be
managed in accordance with the provisions of the aforementioned
regulations.
1. Such hazardous waste
materials shall be placed in watertight and durable containers in
accordance with acceptable practices for transportation.
B. Other Waste. Wastes which
are not classified as medical waste, hazardous wastes or which are
not otherwise regulated by law or rule may be disposed in dumpsters
or load packers provided the following precautions are maintained:
1. The recommendations of the
United States Consumer Product Safety Commission, subchapter
B-Consumer Product Safety Commission Regulations, should serve as
guidelines in establishing protective measures against hazardous
dumpsters and load packers.
2. Dumpsters shall be tightly
covered, leak proof, inaccessible to rodents and animals, and placed
on concrete slabs preferably graded to a drain. Water supply shall be
available within easy accessibility for washing down of the area. In
addition, the pick-up schedule shall be maintained with more frequent
pick-ups when required. The dumping site of waste materials must be
in sanitary landfills approved by the Department of Environmental
Management.
3. Load packers must conform
to the same restrictions required from dumpsters and in addition,
load packers shall be: high enough off the ground to facilitate the
cleaning of the underneath area of the stationary equipment; and the
loading section should be constructed and maintained to prevent
rubbish from blowing from said area site.
16.13.12 Water Supply
A. Water for consumption shall
be obtained from a community water system defined in rules and
regulations pertaining to Public Drinking Water (Part 50-05-1 of this
Title) approved by the Department of Health.
B. The water shall be
distributed to conveniently located taps and fixtures throughout the
buildings and shall be adequate in volume and pressure for all center
purposes, including firefighting.
16.14 Practices and Procedures,
Confidentiality
16.14.1 Variance Procedure
A. The state agency may grant
a variance either upon its own motion or upon request of the
applicant from the provisions of any rule or regulation in a specific
case if it finds that a literal enforcement of such provision will
result in unnecessary hardship to the applicant and that such
variance will not be contrary to the public interest, public health
and/or health and safety of patients.
B. A request for a variance
shall be filed by an applicant in writing setting forth in detail the
basis upon which the request is made.
1. Upon the filing of each
request for variance with the state agency and within thirty (30)
days thereafter, the state agency shall notify the applicant by
certified mail of its approval or in the case of a denial, a hearing
date, time and place may be scheduled if the center appeals the
denial.
16.14.2 Deficiencies and
Plans of Correction
A. The state agency shall
notify the governing body or other legal authority of a facility of
violations of individual standards through a notice of deficiencies
which shall be forwarded to the facility within fifteen (15) days of
inspection of the facility unless the director determines that
immediate action is necessary to protect the health, welfare, or
safety of the public or any member thereof through the issuance of an
immediate compliance order in accordance with R.I. Gen. Laws §
23-1-21 .
B. A facility which received a
notice of deficiencies must submit a plan of correction to the state
agency within fifteen (15) days of the date of the notice of
deficiencies. The plan of correction shall detail any requests for
variances as well as document the reasons therefore.
C. The state agency will be
required to approve or reject the plan of correction submitted by a
facility in accordance with § 16.14.2 of this Part within fifteen
(15) days of receipt of the plan of correction.
D. If the state agency rejects
the plan of correction, or if the facility does not provide a plan of
correction within the fifteen (15) day period stipulated in §
16.14.2 of this Part, or if a facility whose plan of correction has
been approved by the licensing agency fails to execute its plan
within a reasonable time, the state agency may invoke the sanctions
enumerated in § of this Part. If the facility is aggrieved by the
action of the state agency, the facility may appeal the decision and
request a hearing in accordance with R.I. Gen. Laws Chapter 42-35 .
E. The notice of the hearing
to be given by the Department of Health shall comply in all respects
with the provisions of R.I. Gen. Laws Chapter 23-45. The hearing
shall in all respects comply with the provisions therein.
16.14.3 Rules Governing
Practices and Procedures
All
hearings and reviews required under the provisions of R.I. Gen. Laws
Chapter 23-17
shall be held in accordance with the provisions of the rules and
regulations regarding Practices and Procedures Before the Rhode
Island Department of Health (Part 10-05-4 of this Title) and Access
to Public Records (Part 10-05-1 of this Title).
16.14.4 Confidentiality
Disclosure
of any health care information relating to individuals shall be
subject to the provisions of the "Confidentiality of Health Care
Information" of R.I. Gen. Laws Chapter 5-37.3
and other relevant statutory and federal requirements.