| (B) Medications may be destroyed beyond reclamation
on site by the facility director. Drugs should be destroyed by incineration,
if possible. Small amounts of drugs may be flushed into the sewer
system unless prohibited by local ordinance. Large quantities of drugs
may be destroyed by removing the drugs from the prescription containers,
placing them in a strong plastic container, and adulterating the drugs
with water or bleach.
(i) A record of the destruction shall be maintained
by the facility and include:
(I) the name, strength, and quantity of the drug;
(II) the method of destruction; and
(III) the signature of the facility director who destroyed
the drugs and signatures of two other individuals who witnessed the
destruction.
(ii) This record shall be retained in the resident's
file.
(12) Controlled substances and drugs under storage
control of the facility shall be kept separately locked in a permanently
affixed compartment within the medicine room or medication storage
cart.
(A) A separate record must be maintained for each controlled
substance and drug.
(B) The record shall include, but not be limited to,
prescription number, name and strength of drug, date received by the
facility, date and time each dose is provided, signature of person
providing the dose, name of resident, and the original amount received
with the balance verifiable by drug inventory at least daily.
(13) All residents' medications shall be properly labeled
in accordance with applicable laws and regulations.
(d) Dietary services.
(1) A dining room, rooms, or space with appropriate
furnishings shall be provided. The dining space and furnishings should
allow the residents who can come to the dining room to dine at one
sitting. Where alternate or second meal services are employed, quantity
and quality shall be maintained.
(2) The facility shall have a kitchen or dietary area
to meet the food service needs of the residents. It shall include
provisions for the storage, refrigeration, preparation, and serving
of food; for dish and utensil cleaning; and for refuse storage and
removal.
(3) Meal service at intervals of at least three meals
per day, seven days per week, shall be provided or arranged to be
commensurate with the needs of the residents. Meals shall be palatable
and meet the nutritional needs of the residents.
(4) Procedures to prevent cross contamination shall
be observed in the storage, preparation, and distribution of food;
in the cleaning of dishes, equipment, and work area; and in the storage
and disposal of waste. The facility shall provide storage of food
for emergency use for a minimum of four calendar days.
(5) All dishes and utensils shall be washed in an automatic
dishwasher or by the use of manual dishwashing procedures.
(A) A three-compartment sink shall be used if washing,
rinsing and sanitizing of utensils and equipment is done manually;
or a two-compartment sink may be utilized if single service tableware
is provided, or when an approved detergent sanitizer is used.
(B) Cleaning and sanitizing may be done by spray-type
or immersion dishwashing machines or by any other type of machine
or device if it is demonstrated that it thoroughly cleans and sanitizes
equipment and utensils either by chemical or mechanical sanitization.
(6) Sanitary hand washing and drying provisions shall
be provided in the kitchen area and shall include soap, water and
individual disposable towels.
(e) Social services/pastoral care. Services to meet
identified social, spiritual, and emotional needs shall be offered
to the resident. Services may also be available to the resident's
family, responsible party, and significant other persons. Acceptance
of these services will be at the option of the resident.
(f) Personal care services.
(1) The facility shall provide personal care services
in accordance with the individualized needs of each resident.
(2) Personal care services shall include normal activities
of daily, and may include:
(A) assistance with their medications;
(B) assistance with hygiene;
(C) assistance with dressing;
(D) assistance with ambulation; and
(E) emotional support.
(g) Laboratory services.
(1) A facility that provides laboratory services shall
comply with the Clinical Laboratory Improvement Amendments of 1988
(CLIA 1988), in accordance with the requirements specified in 42 Code
of Federal Regulations (CFR), Chapter IV, Part 493, §§493.1-493.1780.
CLIA 1988 applies to all facilities with laboratories that examine
human specimens for the diagnosis, prevention, or treatment of any
disease or impairment of, or the assessment of the health of, human
beings.
(2) The facility shall ensure that all laboratory services
provided to its residents through a contractual agreement are performed
in a facility certified in the appropriate specialties and subspecialties
of service in accordance with the requirements specified in 42 CFR,
Chapter IV, Part 493 to comply with CLIA 1988.
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