Section 481.58.54. Special unit or facility dedicated to the care of persons with chronic confusion or a dementing illness (CCDI unit or facility).

       58.54(1) A nursing facility which chooses to care for residents in a distinct part shall obtain a license for a CCDI unit or facility. In the case of a distinct part, this license will be in addition to its ICF license. The license shall state the number of beds in the unit or facility. (III)

        a.           Application for this category of care shall be submitted on a form provided by the department. (III)

        b.           Plans to modify the physical environment shall be submitted to the department. The plans shall be reviewed based on the requirements of 481—Chapter 61. (III)

       58.54(2) A statement of philosophy shall be developed for each unit or facility which states the beliefs upon which decisions will be made regarding the CCDI unit or facility. Objectives shall be developed for each CCDI unit or facility as a whole. The objectives shall be stated in terms of expected results. (II, III)

       58.54(3) A résumé of the program of care shall be submitted to the department for approval at least 60 days before a separate CCDI unit or facility is opened. A new résumé of the program of care shall be submitted when services are substantially changed. (II, III)

The résumé of the program of care shall:

        a.           Describe the population to be served; (II, III)

        b.           State philosophy and objectives; (II, III)

        c.           List admission and discharge criteria; (II, III)

        d.           Include a copy of the floor plan; (II, III)

        e.           List the titles of policies and procedures developed for the unit or facility; (II, III)

        f.            Propose a staffing pattern; (II, III)

        g.           Set out a plan for specialized staff training; (II, III)

        h.           State visitor, volunteer, and safety policies; (II, III)

        i.            Describe programs for activities, social services and families; (II, III) and

        j.            Describe the interdisciplinary care planning team. (II, III)

       58.54(4) Separate written policies and procedures shall be implemented in each CCDI unit or facility. There shall be:

        a.           Admission and discharge policies and procedures which state the criteria to be used to admit residents and the evaluation process which will be used. These policies shall require a statement from the attending physician agreeing to the placement before a resident can be moved into a CCDI unit or facility. (II, III)

        b.           Safety policies and procedures which state the actions to be taken by staff in the event of a fire, natural disaster, emergency medical or catastrophic event. Safety procedures shall also explain steps to be taken when a resident is discovered to be missing from the unit or facility and when hazardous cleaning materials or potentially dangerous mechanical equipment is being used in the unit or facility. The facility shall identify its method for security of the unit or facility and the manner in which the effectiveness of the security system will be monitored. (II, III)

        c.           Program and service policies and procedures which explain programs and services offered in the unit or facility including the rationale. (III)

        d.           Policies and procedures concerning staff which state minimum numbers, types and qualifications of staff in the unit or facility. (II, III)

        e.           Policies about visiting which suggest times and ensure the residents’ rights to free access to visitors. (II, III)

        f.            Quality assurance policies and procedures which list the process and criteria which will be used to monitor and to respond to risks specific to the residents. This shall include, but not be limited to, drug use, restraint use, infections, incidents and acute behavioral events. (II, III)

       58.54(5) Preadmission assessment of physical, mental, social and behavioral status shall be completed to determine whether the applicant meets admission criteria. This assessment shall be completed by a registered nurse and a staff social worker or social work consultant and shall become part of the permanent record upon admission of the resident. (II, III)

       58.54(6) All staff working in a CCDI unit or facility shall have training appropriate to the needs of the residents. (II, III)

        a.           Upon assignment to the unit or facility, everyone working in the unit or facility shall be oriented to the needs of people with chronic confusion or dementing illnesses. They shall have special training appropriate to their job description within 30 days of assignment to the unit or facility. (II, III) The orientation shall be at least six hours. The following topics shall be covered:

       (1)             Explanation of the disease or disorder; (II, III)

       (2)             Symptoms and behaviors of memory-impaired people; (II, III)

       (3)             Progression of the disease; (II, III)

       (4)             Communication with CCDI residents; (II, III)

       (5)             Adjustment to care facility residency by the CCDI unit or facility residents and their families; (II, III)

       (6)             Inappropriate and problem behavior of CCDI unit or facility residents and how to deal with it; (II, III)

       (7)             Activities of daily living for CCDI residents; (II, III)

       (8)             Handling combative behavior; (II, III) and

       (9)             Stress reduction for staff and residents. (II, III)

        b.           Licensed nurses, certified aides, certified medication aides, social services personnel, housekeeping and activity personnel shall have a minimum of six hours of in-service training annually. This training shall be related to the needs of CCDI residents. The six-hour training shall count toward the required annual in-service training. (II, III)

       58.54(7) There shall be at least one nursing staff person on a CCDI unit at all times. (I, II, III)

       58.54(8) The CCDI unit or facility license may be revoked, suspended or denied pursuant to Iowa Code chapter 135C and Iowa Administrative Code 481—Chapter 50.

This rule is intended to implement 1990 Iowa Acts, chapter 1016.