(a) Type C violations are neither directly detrimental to the patients, nor directly impact their care, but have only an indirect relationship to patient care. Type C civil monetary penalties shall be imposed for those violations that require an intermediate sanction to ensure consistent compliance whenever a nursing home fails to correct a violation, or whenever a violation is repeated, as provided in subsection (b).
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Terms Used In Tennessee Code 68-11-804

  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Dependent: A person dependent for support upon another.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
  • Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
  • Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
  • Testify: Answer questions in court.
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(b) Whenever a deficiency that may constitute a type C violation is found, the health facilities commission shall issue a written citation. The nursing home shall plan specific steps to correct the deficiency, identify the date on which these corrections will be completed, and return its written plans to the health facilities commission within ten (10) days of receiving the citation. The health facilities commission shall either find the plan and the schedule to be reasonable, given the nature of the deficiency and its impact upon the patients in the facility, or require a different plan or schedule of completion. After the date on which the planned corrections are to have been completed, the health facilities commission shall reinspect the nursing home. If the violation has been corrected, no civil monetary penalty shall be imposed, unless the violation has been repeated. If the same violation continues, a type C civil monetary penalty shall be assessed. If the same violation is found during a subsequent inspection or investigation, conducted within twelve (12) months of the finding of the first violation, then a type C civil penalty shall be assessed without any further opportunity to correct the violation before the penalty is imposed, and without regard to whether or not a civil penalty was actually imposed for the first violation.
(c) A type C civil monetary penalty shall be imposed, under the circumstances set forth in subsection (b), for any violation of the following standards:

(1)

(A) Nursing homes shall retain legible copies of the following records and reports concerning the facility for the thirty-six (36) months next following their issuance:

(i) Local fire safety inspections;
(ii) Local building code inspections, if any;
(iii) Fire marshal reports;
(iv) Health facilities commission licensure and fire safety inspections and surveys;
(v) Health facilities commission quality assurance surveys, including follow-up visits, and certification inspections, if the facility has entered into an agreement to provide services to the medicaid or medicare medical assistance programs;
(vi) Federal health care financing administration surveys and inspections, if any;
(vii) Orders of the executive director of the health facilities commission or board, if any; and
(viii) Comptroller of the treasury’s audit reports and findings, if any;
(B) Copies of these records and reports shall be maintained in a single file at a location convenient to the public; and, during normal business hours, they shall be promptly produced for the inspection of any person who requests to view them. Each resident and each person assuming any financial responsibility for a resident must be fully informed, before or at the time of admission, of the availability of these reports to the public, of their location within the nursing home, and given an opportunity to inspect the file before entering into any monetary agreement with the facility;
(2) The governing board of the nursing home shall establish, and the administrator shall implement, written policies and procedures setting forth the rights of patients to the protection and preservation of dignity, individuality, and, to the extent medically feasible, independence. These policies and procedures may be individual to the nursing home and specific to its program. Staff of the facility shall be trained to respect these considerations and shall execute these policies and procedures. Patients, their families, or other representatives must be fully informed of these rights; and the patient shall acknowledge receipt of a copy of the policy accompanied by all of the facility’s rules governing patient conduct and responsibilities, at the time of admission and whenever amended;
(3) No nursing home shall retaliate against or, in any manner, discriminate against any person because of a complaint made in good faith and without malice to the board, the health facilities commission, the adult protective service, the comptroller of the treasury, the long-term care ombudsman, or other agency having jurisdiction. A nursing home shall neither retaliate, nor discriminate, because of information lawfully provided to these authorities, because of a person’s cooperation with them, or because a person is subpoenaed to testify at a hearing involving one (1) of these authorities;
(4) Nursing homes shall notify the patient’s physician of the condition of a patient, when it is medically indicated;
(5) Each patient has a right to have the patient’s personal records kept confidential and private. The nursing home shall have policies to govern access and duplication of the patient’s records. Except for those persons authorized by law to inspect the records, written consent by the patient must be obtained before any information can be released. If the patient is mentally incompetent, written consent is required by the patient’s legal representative;
(6) The facility shall maintain and allow each patient access to a written record of all financial arrangements and transactions involving the individual patient’s funds. The facility shall provide each patient, or the patient’s authorized representative, with a written itemized statement at least quarterly of all financial transactions involving the patient’s funds. The facility shall keep any funds received from a patient for safekeeping in an account separate from the facility’s funds, and patient funds shall not be used by the facility;
(7) All internal and external medications and preparations intended for human use shall be stored separately. They shall be properly stored in medicine compartments, including cabinets on wheels, or drug rooms. The cabinets or drug rooms shall be kept securely locked when not in use, and the key shall be in the possession of the supervising nurse or other authorized persons then on duty. Poisons or external medications shall not be stored in the same compartment and shall be labeled as such;
(8) Schedule II drugs must be stored behind two (2) separately locked doors at all times and accessible only to persons in charge of administering medication;
(9) In general patient areas, each room shall be served by at least one (1) nurse’s calling station and each bed shall be provided with a call button. Two (2) call buttons serving adjacent beds may be served by one (1) calling station. Calls shall register in the nurses’ station and shall activate a visible signal in the corridor. A nurses’ call emergency button shall be provided for patient’s use at each patient toilet, bath and shower room. Nursing personnel shall answer calls in a timely manner;
(10) The nursing home must ensure that a physician examines each patient on admission or no more than sixty (60) days before the admission;
(11) A dietary history must be accomplished on each patient as a part of the patient’s admission record;
(12) Abnormal food intake shall be routinely recorded as part of the patient’s chart;
(13) If the nursing service is under the direction of a licensed practical nurse, a licensed registered nurse must be available on the nursing home premises to consult, to review and to advise on the quality of nursing care for at least forty-eight (48) weeks in each calendar year. The registered nurse-consultant shall be on the premises at least eight (8) hours each week and, in nursing homes with fifty-one (51) or more licensed beds, a minimum of twelve (12) hours each week. The nursing home shall maintain documentation of the consultative service provided by the registered nurse;
(14) Nursing homes shall plan, develop and conduct monthly in-service education programs for nursing personnel and other employees of the nursing homes. An organized orientation program shall be developed and implemented for all nursing personnel;
(15) Each nurse assistant shall receive at least ten (10) hours each year of in-service training related to the nurse assistant’s job responsibilities. A record verifying attendance by each nurse assistant shall be kept in the nursing home files;
(16) Any admission in excess of the licensed bed capacity is prohibited, except when an emergency admission has been previously approved by the health facilities commission;
(17) The nursing home shall develop and periodically review with all employees a prearranged written plan for fire prevention and safety, elimination of hazards, and the orderly evacuation of all patients in case of a fire, internal disaster or other emergency. The plan of evacuation shall be posted throughout the home. Fire drills shall be held at least once each quarter on each work shift;
(18) Cleaning supplies, toxic substances and equipment shall be secured at all times to prevent access by patients. Toxic substances shall not be left unattended when not secured;
(19) The nursing home shall be clean, sanitary and in good repair at all times;
(20) When the temperature of any patient area falls below sixty-five degrees Fahrenheit (65°F) or exceeds eighty-five degrees Fahrenheit (85°F), or is reasonably expected to, the facility staff shall be alerted to the potential danger, and the health facilities commission shall be notified;
(21) Nursing homes shall maintain readily-available linen in sufficient quantity to meet the needs of the patients;
(22) Food shall be protected from dust, flies, rodents, unnecessary handling, droplet infection, overhead leakage and other sources of contamination, whether in storage or while being prepared and served or transported through hallways;
(23) Incidents, such as a fire in the nursing home, burning of a patient, suspected abuse of a patient, or an unusual accident that causes injury to a patient, shall be recorded, investigated within the facility, and reported pursuant to § 68-11-211;
(24) The nursing home’s medical consultant shall review all accidents and unusual incidents occurring on the premises, identify hazards to health and safety, and recommend corrective action to the nursing home administrator;
(25)

(A) To provide electricity during an interruption of the normal electric supply, the nursing home shall be equipped with an emergency power source on the premises. It shall have fuel supply to operate the generator for a minimum of twenty-four (24) hours at rated full load;
(B) However, no civil monetary penalty shall be imposed solely because the nursing home lacks an emergency generator, if the nursing home meets all of the following standards:

(i) It is otherwise capable of providing emergency electrical power appropriate to the needs of the facility;
(ii) It maintains an emergency power source meeting the equivalency requirements of § 517 of the 1981 edition of the National Electric Code; and
(iii) It does not admit, or retain, patients dependent on electric life support equipment;
(26) Dishwashing machines shall have a hot water supply of one hundred forty degrees Fahrenheit (140°F) to one hundred sixty degrees Fahrenheit (160°F) for washing and one hundred eighty degrees Fahrenheit (180°F) for sanitizing, if within the original design capacity of the machine;
(27) All refrigerators and freezers shall have thermometers. Refrigerators shall be kept at an air temperature not to exceed forty-five degrees Fahrenheit (45°F) whenever food is stored in the unit. Freezers shall be kept at an air temperature sufficient for stored foods to remain frozen, but freezer air temperatures shall never exceed twenty degrees Fahrenheit (20°F);
(28) The nursing home must ensure that a physician writes and signs orders for care, any diagnostic tests, any medication and treatment;
(29) The nursing home must have an agreement with a physician and a hospital that will care for a patient who does not have a private physician or hospital of choice;
(30) Clean linens shall be physically separated from soiled linens. Each type of linen shall be received, sorted, processed, held, stored and issued in designated areas, physically separated from the other. However, no civil monetary penalty shall be imposed solely because a nursing home has failed to construct new separations for the linens, if the nursing home was licensed on July 1, 1987, and if it has not made substantial alterations to its existing building since that date;
(31) All nursing homes shall disinfect contaminated articles and surfaces, such as mattresses, linens, thermometers and oxygen tents;
(32) Patients shall be aided in receiving necessary dental care;
(33) Perishable food shall not be allowed to stand at room temperature except during necessary periods of preparation or serving. Prepared foods shall be kept hot, at one hundred forty degrees Fahrenheit (140°F) or above, or cold at forty-five degrees Fahrenheit (45°F) or lower. Appropriate equipment for temperature maintenance, such as hot and cold serving units or insulated containers, shall be used; and
(34)

(A) The nursing home shall carry out the following functions, all of which shall be documented in a written medical equipment management plan:

(i) Develop and maintain a current itemized inventory of medical equipment used in the facility, that is owned or leased by the operator of the facility;
(ii) Develop and maintain a schedule for the maintenance, inspection and testing of medical equipment according to manufacturers’ recommendations or other generally accepted standards. The schedule shall include the date and time maintenance, inspection and testing was actually performed, and the name of the individual who performed the tasks; and
(iii) Ensure maintenance, inspection and testing were conducted by facility personnel adequately trained in the procedures or by a contractor qualified to perform the procedures.
(B) For purposes of subdivision (34)(A) only, “medical equipment” means equipment used for the diagnosis, treatment and monitoring of patients, including, but not limited to, oxygen care equipment and oxygen delivery systems, enteral and parenteral feeding pumps, and intravenous pumps.
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