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Title 48, Part I3.The bathrooms shall be outfitted as follows.Chapter 97. Nursing Facilitiesa. All plumbing and piping connections to fixturesshall be enclosed and not accessible to tampering bypatients.Subchapter A. General Provisions§9701. Definitionsb. The doors on the toilet rooms shall swing out orbe double hinged.Abuse the willful infliction of injury or the causing ofthe deterioration of a resident by means including, but notlimited to, physical, verbal, emotional, psychological, sexualabuse, exploitation, or extortion of funds or other things ofvalue to such an extent that the resident’s health, moral, oremotional well-being is endangered.c. If mirrors are located in the toilet rooms, theyshall be fabricated with laminated safety glass or protectedby polycarbonate laminate, or safety screens.d. Bathroom/toilet room hardware and accessoriesshall be of special design to give consideration to theprevention of injury and suicide.1. The determination of abuse shall not be mitigatedby a resident’s age, ability to comprehend or disability.Abuse determination shall be based on the reasonable personconcept.4. Shower sprinkler heads shall be recessed or of adesign to minimize patient tampering.Administrator—any individual who is or may be chargedwith the general administration of a nursing facility and whohas been licensed and registered by the Board of Examinersof Nursing Home Administrators in accordance with theprovisions of Louisiana Revised Statute 37:2501.H. The Level II CRC-SU shall have a separate bathroomand a break room designated for staff use.I. Separate and apart from the seclusion room requiredin a Level I CRC-SU, the Level II CRC-SU shall have aminimum of one seclusion room for each capacity for 12patients.Advanced Practice Registered Nurse (APRN)—a licensedregistered nurse who is certified by a nationally recognizedcertifying body as having an advanced nursing specialty andwho meets the criteria for an advanced practice registerednurse as established by the Louisiana State Board ofNursing. An advanced practice registered nurse shallinclude:1. The seclusion room in the Level II CRC-SU shallmeet the same requirements specified for the seclusion roomin the Level I CRC-SU.2. The patient rooms in the Level II CRC-SU may beused as seclusion rooms provided they meet the samerequirements as specified for the seclusion room in the LevelI CRC-SU.J. The Level II CRC-SU shall have separateconsultation room(s) with a minimum floor space of 100square feet each, provided at a room-to-bed ratio of oneconsultation room for each capacity for 12 patients.Consultation rooms within the unit shall be available for usefor interviews with the patient and/or their families. Theconsultation room(s) shall be designed for acoustical andvisual privacy.1.certified nurse midwife;2.certified registered nurse anesthetist;3.clinical nurse specialist; or4.nurse practitioner.Alzheimer's Special Care Unit—any nursing facility asdefined in R.S. 40:2009.2, that segregates or provides aspecial program or special unit for residents with a diagnosisof probable Alzheimer's disease or related disorder so as toprevent or limit access by a resident to areas outside thedesignated or separated area, or that advertises, markets, orotherwise promotes the nursing facility as providingspecialized Alzheimer/dementia care services.K. The Level II CRC-SU shall have a room with aminimum of 225 square feet for group therapy, treatmentteam planning and conferencing.Ancillary Service—a service such as, but not limited to:L. The Level II CRC-SU shall have a room within theunit with a minimum of 120 square feet for examination andtreatment of patients.M. The Level II CRC-SU shall have an area foraccommodation of charting, storage of records, and thestorage and preparation of medications. Provisions shall bemade for securing patient records and medications in thisarea.AUTHORITY NOTE: Promulgated in accordance with R.S.36:254 and R.S. 40:2100-2115.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Bureau of Health Services Financing, LR36:518 (March 2010), amended by the Department of Health,Bureau of Health Services Financing, LR 45:557 (April 5.physical therapy;6.speech pathology;7.occupational therapy8.psychological; and9.social services.Louisiana Administrative CodeFebruary 2022
PUBLIC HEALTH—GENERALApplicant—the legal entity that applies for the license toopen, conduct, manage or maintain a nursing facility.humans. Persons with COVID-19 have had a wide range ofsymptoms reported-ranging from mild symptoms to severeillness.Biological—a preparation used in the treatment orprevention of disease that is derived from living organismsor their by-product.Culture Change the common name given to the nationalmovement for the transformation of older adult services,based on person-directed values and practices where thevoices of elders and those working with them are consideredand respected. Core person-directed values are:Change of Information (CHOI) any change in facilityinformation required by regulation or statute to be submittedto the department that does not change the ownershipstructure and/or respective ownership interests held bystakeholders of the current legal entity.Change of Ownership (CHOW)—any change in the legalentity responsible for the operation of the nursing facility.Management agreements are generally not changes ofownership if the former owner continues to retain policyresponsibility and approve or concur in decisions involvingthe nursing facility's operation. However, if these ultimatelegal responsibilities, authorities and liabilities aresurrendered and transferred from the former owner to thenew manager, then a change of ownership has occurred.Examples of actions that constitute a change of ownershipinclude, but are not limited on; and5.purposeful living.Designated Contact resident’s legal representative orinterested family member.Dietary Manager—a person who:1. unincorporated sole proprietorship transfer oftitle and property of another party constitutes change ofownership;1.is a licensed dietitian;2.is a graduate of a dietetic technician program;3. has successfully completed a course of study, bycorrespondence or classroom, which meets the eligibilityrequirements for certification by the Dietary Manager'sAssociation;2. corporation the merger of the provider’scorporation into another corporation, or the consolidation oftwo or more corporations, resulting in the creation of a newcorporation, constitutes change of ownership:a. transfer of corporate stock or the merger ofanother corporation into the provider corporation does notconstitute a change of ownership. Admission of a newmember to a nonprofit corporation is not a change ofownership;4. has successfully completed a training course at astate approved school (vocational or university) whichincludes course work in foods, food service supervision anddiet therapy. Documentation of an eight-hour course offormalized instruction in diet therapy conducted by theemploying nursing facility's qualified dietitian is permissibleif the course meets only the foods and food servicesupervision requirements; or3. limited liability company the removal, addition orsubstitution of a member in a limited liability company doesnot constitute a change of ownership; or5. is currently enrolled in an acceptable course of notmore than 12 months which will qualify an individual uponcompletion.4. partnership in the case of a partnership, theremoval, addition or substitution of a partner, unless thepartners expressly agree otherwise as permitted byapplicable state law, constitutes a change of ownership.Director of Nursing (DON)—a registered nurse, licensedby the state of Louisiana, who directs and coordinatesnursing services in a nursing facility.Drug Administration—an act in which a single dose of aprescribed drug or biological is given to a resident by anauthorized person in accordance with all laws andregulations governing such acts. The complete act ofadministration entails:Charge Nurse—an individual who is licensed by the stateof Louisiana to practice as an RN or LPN and designated asa charge nurse by the nursing facility.Chemical Restraint—a psychopharmacologic drug that isused for discipline or convenience and not required to treatmedical symptoms.1. removing an individual dose from a previouslydispensed, properly labeled container (including a unit dosecontainer);Controlled Dangerous Substance—a drug, substance orimmediate precursor in schedule I through V of R.S. cable, contagious, and infectious disease/virus(more specifically, a coronavirus) identified as the cause ofan outbreak of respiratory illness first detected in Wuhan,China. COVID-19 is a new disease, caused by a novel (ornew) coronavirus that has not previously been seen inLouisiana Administrative CodeFebruary 20221242.verifying the dose with the physician's orders;3.giving the individual dose to the proper resident;4.monitoring the ingestion of the dose; and5.promptly recording the time and dose given.
Title 48, Part IDrug Dispensing—an act which entails the interpretationof an order for a drug or biological and, pursuant to theorder, the proper selection, measuring, labeling, packaging,and issuance of the drug or biological for a resident or for aservice unit of the nursing facility by a licensed pharmacist,physician or dentist.Neglect—the failure to provide the proper or necessarymedical care, nutrition or other care necessary for aresident’s well-being, unless the resident exercises his/herright to refuse the necessary care.Nursing Facility—any private home, institution, building,residence or other place, serving two or more persons whoare not related by blood or marriage to the operator, whetheroperated for profit or not, and including those placesoperated by a political subdivision of the state of Louisianawhich undertakes, through its ownership or management, toprovide maintenance, personal care, or nursing services forpersons who, by reason of illness or physical infirmity orage, are unable to properly care for themselves. The termdoes not include the following:Legal Representative a resident’s legal guardian or otherresponsible person as determined by the specific legallyrecognized status of the relationship (e.g., full interdiction,partial interdiction, continuing tutorship, competent major,or other legally recognized status).Licensed Bed—a bed set up, or capable of being set up,within 24 hours in a nursing facility for the use of oneresident.1. a home, institution or other place operated by thefederal government or agency thereof, or by the State ofLouisiana;Licensed Dietitian—a dietitian who is licensed to practiceby the Louisiana Board of Examiners in Dietetics andNutrition.2. a hospital, sanitarium or other medical institutionwhose principal activity or business is the care and treatmentof persons suffering from tuberculosis or from mentaldiseases;Licensed Practical Nurse (LPN)—an individual currentlylicensed by the Louisiana State Board of Practical NurseExaminers to practice practical nursing in Louisiana.Locked Unit or Specialized Care Unit a restrictedsection or area of the nursing facility which limits freeaccess of residents suffering from severe dementia,Alzheimer’s or other disease process or condition whichseverely impairs their ability to recognize potential hazards.Such units shall not be established for the sole purpose ofhousing individuals with mental illness.3. a hospital, sanitarium or other medical institutionwhose principal activity or business is the diagnosis, careand treatment of human illness through the maintenance andoperation of organized facilities;4. any municipal, parish or private child welfareagency, maternity hospital or lying-in home required by lawto be licensed by some department or agency;Louisiana Department of Health (LDH)–the ‘department’,previously known as the Department of Health and Hospitalsor DHH.5. any sanitarium or institution conducted by and forChristian Scientists who rely on the practice of ChristianScience for treatment and healing;LSC Appeal equivalent method of compliance related toLife Safety Code (LSC) requirements for participation,granted or approved by state and/or federal certificationagencies.6. any nonprofit congregate housing program whichpromotes independent living by providing assistance withdaily living activities such as cooking, eating, dressing,getting out of bed and the like to persons living in a sharedgroup environment who do not require the medicalsupervision and nursing assistance provided by nursingfacilities. No congregate housing program, except thoselicensed or operated by the state of Louisiana, shall:Major Alteration any repair or replacement of buildingmaterials and equipment which does not meet the definitionof minor alteration.Medication Attendant Certified (MAC)—a person certifiedby LDH to administer medications to nursing facilityresidents.a. use the term "nursing facility" or any other termimplying that it is a licensed health care facility; orMedical Director—a physician licensed in Louisiana whodirects and coordinates medical care in a nursing facility.b. administer medications or otherwise provide anyother nursing or medical service; orMinor Alteration—repair or replacement of buildingmaterials and equipment with materials and equipment of asimilar type that does not diminish the level of constructionbelow that which existed prior to the alteration. This doesnot include any alteration to the function or original designof the construction.7.any adult residential care facility.Physical Restraint—any physical or mechanical device,material or equipment attached or adjacent to the resident'sbody that the individual cannot remove easily which restrictsfreedom of movement or normal access to one's body.Physician—an individual currently licensed by theLouisiana State Board of Medical Examiners to practicemedicine and/or surgery in Louisiana.Misappropriation—taking possession of a resident’spersonal belongings without the resident’s permission to doso, or the deliberate misplacement, exploitation or wrongfultemporary or permanent use of a resident’s belongings ormoney without the resident’s consent.Physician Assistant—a person who is a graduate of aprogram accredited by the Council on Medical Education ofthe American Medical Association or its successors, or who125Louisiana Administrative CodeFebruary 2022
PUBLIC HEALTH—GENERALhas successfully passed the national certificate examinationadministered by the National Commission on theCertification of Physicians' Assistants, or its predecessors,and who is approved and licensed by the Louisiana Board ofMedical Examiners to perform protocol services under thesupervision of a physician or group of physicians approvedby the board to supervise such assistant.2.speech language pathology;3.occupational therapy; and4.mental health rehabilitative services.Sponsor—an adult relative, friend or guardian of aresident who has an interest or responsibility in the resident'swelfare.Reasonable Person Concept the degree of actual orpotential harm one would expect a reasonable person in asimilar situation to suffer as a result of alleged abuse, neglector misappropriation of a resident’s funds.State Fire Marshal (OSFM) Louisiana Department ofPublic Safety and Corrections, Office of the State FireMarshal.Written Notification-notification in hard copy or electronicformat.Registered Nurse (RN)—an individual currently licensedby the Louisiana State Board of Nursing to practiceprofessional nursing in Louisiana.AUTHORITY NOTE: Promulgated in accordance with R.S.40:2009.1-2116.HISTORICAL NOTE: Promulgated by the Department ofHealth, Bureau of Health Services Financing, LR 42:1891(November 2016), amended LR 46:1393 (October 2020).Registered Pharmacist—an individual currently licensedby the Louisiana Board of Pharmacy to practice pharmacy inLouisiana.§9703. Licensing ProcessResident—an individual admitted to the nursing facilityby, and upon, the recommendation of a physician, and whois to receive the medical and nursing care ordered by thephysician.Resident Activities Director—an individual responsible fordirecting or providing the activity services of a nursingfacility.A. All nursing facilities shall be licensed by thedepartment. It shall be unlawful to operate a nursing facilitywithout possessing a current, valid license issued by thedepartment. The department is the only licensing authorityfor nursing facilities in Louisiana. Each nursing facility shallbe separately licensed.Resident Communication System—a system that registerscalls electronically from its place of origin (the resident'sbed, toilet or bathing facility) to the place of receivership.B. An institution that is primarily for the care andtreatment of mental diseases cannot be a skilled nursingfacility or nursing facility.Restorative Care—activities designed to resolve, diminishor prevent the needs that are inferred from the resident'sproblem; includes the planning, implementation andevaluation of said activities.C. A nursing facility shall be in compliance with allrequired federal, state and local statutes, laws, ordinances,rules, regulations and fees.Sheltering in Place the election to stay in place ratherthan evacuate when an executive order or proclamation ofemergency or disaster is issued for the parish in which thenursing facility is located and a voluntary or mandatoryevacuation has been declared for its geographic location.1. be issued only to the person or entity named in thelicense application;D. A nursing facility license shall:2. be valid only for the nursing facility to which it isissued and only for the specific geographical address of thatnursing facility;Social Service Designee—an individual responsible forarranging or directly providing medically-related socialservices in the facility to assist in attaining and maintainingthe highest practicable physical, mental, and psychosocialwell-being of each resident.3. be valid for up to one year from the date ofissuance, unless revoked, suspended, modified or terminatedprior to that date, or unless a provisional license is issued;4. expire on the expiration date listed on the license,unless timely renewed by the nursing facility;Specialized Mental Health Services for the purposes ofpre-admission screening and resident review (PASRR),specialized services means any service or supportrecommended by an individualized level II determinationthat a particular nursing facility resident requires due tomental illness, intellectual disability or related condition,that supplements the scope of services that the nursingfacility must provide under reimbursement as nursingfacility services.5. not be subject to sale, assignment, donation or othertransfer, whether voluntary or involuntary; and6. be posted in a conspicuous place on the licensedpremises at all times.E. A separately licensed nursing facility shall not use aname which is substantially the same as the name of anothersuch nursing facility licensed by the department, unless suchnursing facility is under common ownership with othernursing facilities.Specialized Rehabilitative Services include, but are notlimited to:1.F. No branches, satellite locations or offsite campusesshall be authorized for a nursing facility.physical therapy;Louisiana Administrative CodeFebruary 2022126
Title 48, Part IG. No new nursing facility shall accept residents until thenursing facility has written approval and/or a license issuedby the department.initial license application packet for a nursing facility shallbe submitted to and approved by the department prior to anapplicant providing nursing facility services. The completedinitial licensing application packet shall include:H. Notice of Fees. Fees shall be required for:1.1. a completed nursing facility licensure applicationand the non-refundable licensing fee as established bystatute. All fees shall be submitted by certified or companycheck or U.S. Postal money order only, made payable to thedepartment. All state owned nursing facilities are exemptfrom fees;a replacement license for changes such as:a.name;b.address; orc.bed capacity;2.a duplicate license; and3.a change in licensee or premises.2. a copy of the released architectural plan reviewproject report for the nursing facility from OSFM;3. a copy of the on-site inspection report withdetermination as acceptable for occupancy by OSFM;I. Plan Review. Construction documents (plans andspecifications), plan review application and applicable planreview fees as established by the Office of State FireMarshal (OSFM) are required to be submitted, reviewed andfound to be acceptable for licensure by the OSFM as part ofthe licensing procedure prior to obtaining an initial license.4. a copy of the health inspection report with approvalof occupancy from the Office of Public Health (OPH);5. a disclosure of the name and address of allindividuals with 5 percent or more ownership interest, and inthe instance where the nursing facility is a corporation orpartnership, the name and address of each officer or director,and board members;J. Construction Document Preparation. Constructiondocuments shall be submitted to OSFM in accordance withOSFM requirements.6. a disclosure of the name of the management firmand employer identification number, or the name of thelessor organization, if the nursing facility is operated by amanagement company or leased in whole or in part byanother organization;K. Any increase in licensed bed capacity requires facilityneed review approval (FNR) and a plan review, as applicableby state law.L. LSC Appeal Request Equivalent Methods ofCompliance. OSFM may accept equivalent methods ofcompliance with the physical environment provisions ofthese rules in consultation with LDH.7. if applicable, clinical laboratory improvementamendments (CLIA) certificate or CLIA certificate ofwaiver;1. If a Life Safety Code (LSC) appeal is requested, thenursing facility shall:8. a floor sketch or drawing of the premises to belicensed; anda. submit the LSC appeal request and applicablefees as established by OSFM to OSFM;9. any other documentation or information required bythe department for licensure.b. demonstrate how patient safety and quality ofcare offered is not compromised by the LSC appeal request;B. If the initial licensing packet is incomplete whensubmitted, the applicant will be notified of the missinginformation and will have 90 days from receipt of thenotification to submit the additionally requested information.If the additionally requested information is not submitted tothe department within 90 days, the application will beclosed. After an initial licensing application is closed, anapplicant who is still interested in becoming a nursingfacility must submit a new initial licensing packet with anew initial licensing fee to start the initial licensing process.c. demonstrate the undue hardship imposed on thenursing facility if the LSC appeal request is not granted; andd. demonstrate its ability to completely fulfill allother requirements of service.2. The OSFM will make a written determination ofthe requests.a. LSC appeal request determinations are subject toreview in any change in circumstance and are subject toreview or revocation upon any change in circumstancesrelated to the LSC appeal determination.C. Once the initial licensing application packet has beenapproved by the department, notification of the approvalshall be forwarded to the applicant. Within 90 days of receiptof the approval notification, the applicant must notify thedepartment that the nursing facility is ready and is requestingan initial licensing survey. If an applicant fails to notify thedepartment within 90 days, the initial licensing applicationshall be closed. After an initial licensing application hasbeen closed, an applicant who is still interested in becominga nursing facility must submit a new initial licensing packetwith a new initial licensing fee to start the initial licensingprocess.AUTHORITY NOTE: Promulgated in accordance with R.S.40:2009.1-2116.HISTORICAL NOTE: Promulgated by the Department ofHealth, Bureau of Health Services Financing, LR 42:1893(November 2016).§9705. Initial Licensing Application ProcessA. An initial application for licensing as a nursingfacility shall be obtained from the department. A completed127Louisiana Administrative CodeFebruary 2022
PUBLIC HEALTH—GENERALD. Applicants shall be in compliance with all appropriatefederal, state, departmental or local statutes, laws,ordinances, rules, regulations and fees before the nursingfacility will be issued an initial license to operate.with all applicable federal, state, departmental, and localstatutes, laws, ordinances, rules, regulations.a.AUTHORITY NOTE: Promulgated in accordance with R.S.40:2009.1-2116.HISTORICAL NOTE: Promulgated by the Department ofHealth, Bureau of Health Services Financing, LR 42:1894(November 2016).a completed application;ii.appropriate fees; andb. The license shall be valid for a period of 12months unless the license is modified, revoked, suspended,or terminated.A. The department shall have the authority to issue thefollowing types of licenses.4. Provisional License. The department, in its solediscretion, may issue a provisional license to an existinglicensed nursing facility for a period not to exceed sixmonths.1. Full Initial License. The department shall issue afull license to the nursing facility when the initial licensingsurvey finds that the nursing facility is compliant with alllicensing laws and regulations, and is compliant with allother required statutes, laws, ordinances, rules, regulationsand fees. The initial license shall specify the capacity of thenursing facility. The license shall be valid for a period of 12months unless the license is modified, revoked, suspended,or terminated.a. At the discretion of the department, theprovisional license may be extended for an additional periodnot to exceed 90 days in order for the nursing facility tocorrect the noncompliance or deficiencies.b. When the department issues a provisional licenseto an existing licensed nursing facility, the provider shallsubmit a plan of correction to the department for approval,and the provider shall be required to correct all suchnoncompliance or deficiencies prior to the expiration of theprovisional license.2. Provisional Initial License. The department mayissue a provisional initial license to the nursing facility whenthe initial licensing survey finds that the nursing facility isnoncompliant with any licensing laws or regulations or anyother required statutes, laws, ordinances, rules, regulationsor fees, but the department determines that thenoncompliance does not present a threat to the health, safetyor welfare of the residents or participants. The provisionallicense shall be valid for a period not to exceed six months.c. The department shall conduct an on-site followup survey at the nursing facility prior to the expiration of theprovisional license.i.If the on-site follow-up survey determines thatthe nursing facility has corrected the deficient practices andhas maintained compliance during the period of theprovisional license, the department may issue a full licensefor the remainder of the year until the anniversary date of thenursing facility license.a. At the discretion of the department, theprovisional initial license may be extended for an additionalperiod not to exceed 90 days in order for the nursing facilityto correct the noncompliance or deficiencies.b. The nursing facility shall submit a plan ofcorrection to the department for approval and the providershall be required to correct all such noncompliance ordeficiencies prior to the expiration of the provisional initiallicense.ii.If the on-site follow-up survey determines thatthe nursing facility has not corrected the deficient practicesor has not maintained compliance during the period of theprovisional license, the provisional license shall expire andthe provider shall be required to begin the initial licensingprocess again by submitting a new initial license applicationpacket and fee if no timely informal reconsideration oradministrative appeal of the deficiencies is filed pursuant tothis Chapter.c. A follow-up survey shall be conducted prior tothe expiration of the provisional initial license.i.If all such noncompliance or deficiencies aredetermined by the department to be corrected on a follow-upsurvey, a full license may be issued.AUTHORITY NOTE: Promulgated in accordance with R.S.40:2009.1-2116.HISTORICAL NOTE: Promulgated by the Department ofHealth, Bureau of Health Services Financing, LR 42:1895(November 2016).ii.If all such noncompliance or deficiencies arenot corrected on the follow-up survey, the provisional initiallicense shall expire and the provider shall be required tobegin the initial licensing process again by submitting a newinitial license application packet and fee if no timelyinformal reconsideration or administrative appeal of thedeficiencies is filed pursuant to this Chapter.§9709. Changes in Licensee InformationA. Any change regarding the nursing facility name,“doing business as” name, mailing address, phone number orany combination thereof, shall be reported in writing to thedepartment within five days of the change. Any changeregarding the nursing facility name or “doing business as”name requires a change to the nursing facility license and3. Annual Renewal License. The department mayissue a full license that is annually renewed to an existinglicensed nursing facility, which is in substantial complianceFebruary 2022i.iii.any other documentation or information that isrequired by the department for license renewal.§9707. Types of LicensesLouisiana Administrative CodeThe nursing facility
of Nursing Home Administrators in accordance with the provisions of Louisiana Revised Statute 37:2501. Advanced Practice Registered Nurse (APRN)—a licensed registered nurse who is certified by a nationally recognized certifying body as having an advanced nursing specialty and who meets the criteria for an advanced practice registered
