10.07.02.23

.23 Special Care Units — General.

A. A nursing home which holds a current and valid operating license may establish special care units with the approval of the:

(1) Office of Health Care Quality; and

(2) Departmentís Office of Capital Planning, Budgeting and Engineering Services.

B. A facility may notify the Department of its intention to establish a special care unit before developing and submitting the required documents for approval as described in §C of this regulation.

C. The nursing home shall obtain Departmental approval of the following pertaining to the special care unit:

(1) A description and scope of services to be provided;

(2) An organization chart of the special care unit and its relationship to the rest of the nursing home;

(3) A description of staffing patterns;

(4) Qualifications, duties, and responsibilities of personnel;

(5) A quality assurance plan which includes:

(a) Assignment of responsibility for monitoring and evaluation activities;

(b) Identification of the predominant aspects of care provided;

(c) Identification of indicators and appropriate clinical criteria for monitoring the most important aspects of care;

(d) Establishment of thresholds (levels or trends) for the indicators that will trigger evaluation of care;

(e) Monitoring of the important aspects of care by collecting and organizing data for each indicator;

(f) Evaluation of care when thresholds are reached in order to identify opportunities to improve either care or problems;

(g) Taking actions to improve care or to correct the problems;

(h) Assessing the effectiveness of the actions, documenting the improvement in care, and assessing the quality assurance process; and

(i) Communication of the results of the monitoring and evaluation process to relevant individuals or services;

(6) Policies and procedures, including:

(a) The transfer or referral of residents who require services that are not provided by the special care unit;

(b) The administration of medications that are relevant to the special care residents in the special care units;

(c) Infection control measures to minimize the transfer of infection in the special care unit;

(d) Pertinent safety practices, including the control of fire and mechanical hazards; and

(e) Preventive maintenance for equipment in the special care unit;

(7) Protocols for obtaining specialized services, such as arterial blood gases or other STAT services;

(8) Protocols for emergency situations; and

(9) An inventory of any specialized equipment to be housed on the unit to provide services in the special care unit.

D. A facility that has been approved to establish a special care unit shall meet all applicable requirements of this chapter.

E. Physician Coordinator.

(1) If the facility's medical director does not have special training and experience in the discipline of the assigned special care unit, the facility shall hire a physician who is appropriately trained and experienced to provide:

(a) Overall medical supervision of the special care unit; and

(b) Coordination of all services for the assigned special care unit.

(2) The facility shall verify the candidate's credentials before employment as physician coordinator.

(3) The physician coordinator, or a designee who meets the requirements of §E(1) of this regulation, shall:

(a) Respond personally or arrange for another qualified physician to respond to situations warranting medical intervention; and

(b) Be available to provide any required consultation.

F. Staffing. The nursing home shall ensure that each unit is sufficiently staffed with qualified personnel to provide appropriate treatment and meet the care needs of the residents.

G. Nursing Services.

(1) The director of nursing shall designate a registered nurse who has education, training, and experience in caring for the needs of the special care residents to coordinate all nursing care within the special care unit.

(2) Nursing staff shall be:

(a) Knowledgeable about the emotional and rehabilitative aspects of the special care unit residents; and

(b) Capable of initiating appropriate therapeutic interventions when needed.

H. Design.

(1) A special care unit shall meet the general construction requirements of Regulations .08, .42, and .41 of this chapter, and the requirements in this regulation.

(2) The nursing home shall ensure that floor space allocated to each bed meets minimum requirements listed in Regulation .49 of this chapter, and is sufficient to accommodate the special equipment necessary to meet the needs of residents.

I. Radiologic and Laboratory Services. The facility shall ensure that diagnostic radiologic and clinical laboratory services are available 24 hours a day. The services may be provided through contractual arrangements with providers that meet applicable federal and State laws and regulations.

J. Quality Assurance Program. The facility shall:

(1) Develop a quality assurance plan to monitor and evaluate the care provided in each special care unit; and

(2) Monitor and evaluate the quality and appropriateness of care provided by the special care unit as part of the facility's overall quality assurance program.