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Ohio Administrative Code (Last Updated: January 12, 2021) |
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3701 Department of Health - Administration and Director |
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Chapter3701-17. Nursing Homes |
3701-17-06. Responsibility of operator and nursing home administrator; quality assurance and performance improvement
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(A) The operator is responsible for:
(1) Operation of the nursing home;
(2) Payment of the annual license renewal fee to the director;
(3) Submission of such reports as may be required, using an electronic system prescribed by the director, including the immediate reporting of real, alleged, or suspected abuse, neglect, or misappropriation; and
(4) Compliance with Chapter 3721. of the Revised Code, Chapters 3701-13 and 3701-61, and rules 3701-17-01 to 3701-17-26 of the Administrative Code, and all federal, state, and local laws applicable to the operation of a nursing home.
(B) Each operator shall appoint an administrator. The administrator is responsible for:
(1) Daily operation of the nursing home in accordance with rules 3701-17-01 to 3701-17-26 of the Administrative Code;
(2) Implementation of the provisions of section 3721.12 of the Revised Code, including the development of policies and procedure that ensure the rights of residents are not violated;
(3) Ensuring that individuals used by the home are competent to perform their job responsibilities and that services are provided in accordance with acceptable standards of practice; and
(4) If the nursing home is physically part of a hospital, inform a prospective resident, prior to admission, that the home is licensed as a nursing home and is not part of the acute care service of the hospital.
(C) Each nursing home shall establish and maintain an ongoing quality assurance and performance improvement (QAPI) program to address all systems of care and management practices, including clinical care, quality of life, and resident choice. As part of the QAPI program, each home shall, at minimum:
(1) Establish a quality assurance committee that shall meet on an ongoing basis, but at least quarterly to systematically:
(a) Monitor and evaluate the quality of care and quality of life provided in the home;
(b) Track, investigate, and monitor incidents, accidents, and events that have occurred in the home;
(c) Track and monitor the effectiveness of the infection control program;
(d) Identify problems and trends; and
(e) Develop and implement appropriate action plans to correct identified problems; and
(2) Participate in at least one quality improvement project every two years from those approved by the department of aging through the nursing home quality initiative established under section 173.60 of the Revised Code.
(D) The records of meetings of the quality assurance committee by this rule are not required to be disclosed to the director. The nursing home shall document, and the director shall verify through interviews with committee members and, as necessary, direct care staff, that:
(1) The home has a quality assurance committee which addresses quality concerns;
(2) Staff know how to access that process; and
(3) The committee has established a protocol or method for addressing specific quality problems in the nursing home that the home believes to have now been resolved.
(E) Good faith attempts by the committee to identify and correct quality deficiencies will not be used as a basis for sanctions.