State Plan for Title XIX ATTACHMENT 4.11-A State of Alaska Page 1 ___________________________________________________________________________________

Relations with Standard Setting and Survey Agencies The standards specified in paragraphs (a) and (b) of section 4.11, page 42 of the Plan are set forth in Title 7 of the Alaska Administrative Code, Chapter 12, “Facilities and Local Units”, Articles 1-11 which encompass General Acute Care, Rural Primary Care, and Specialized Hospitals, Nursing Facilities, ICF/MR, Ambulatory Surgical Facilities, Freestanding Birth Centers, and Home Health Agencies.

TN No:03-15 Approval Date: _1/13/2004___ Effective Date: October 1, 2003 Supersedes TN No. MA 74-1 and MA 78-77

~ttac~M~nt 4.11-Aoaoe 2HEALTH AND SOCIAL SERVICES -State of ALASKA

-Register 62, July 1977 7 AAC 12.010

(D) A license is valid only for the licenseeand premises named in the license.

for which medical or surgical services would beappropriate for ~, diagnosis, or treatment.

(FJ Separate licenses are required forinstitutions maintained on separate premises,even though they are operated under the samemanage:nent; provided, however, that severalseparate licenses are not required for separatebuildings on the same ground.

(2) Hospitalization. Within the meaning ofthe Hospital Licensing Law, "hospitalization" isdefined as the reception and care of any personfor the purpose of providing room, board, andnursing service and other hospital facilitiesrequired in connection with the diagnosis andtreatment of any condition of infirmity.

(F) The license shall be posted in aconspicuous place on the p~mises, in thepublic lobby or waiting room of theinstitution.

(3) Medical Staff. The "medical staff" of ahospital shall be defined as an organized bodycomposed of aU individuals who are appointedto the staff of a hospital by its governing board.

(G) Each license to operate a hospital ordifferent types of hospitals shall expire onJune 30, following the date of issue, and if arenewal is desired, the licensee shall makeapplication at least 30 days prior to theexpiration date upon a fotm adopted by theLicensing Agency.

(4) Registered Nurse. A "registered nurse"shall be a person graduated from a school ofnursing and who is currently registered in theState of Alaska.

(c) For the purpose of administering thehospital licensing law, all institutions subject tolicensure shall be classified in the followingmanner:

(H) Revocation of Ucense

(i) A license issued to any hospital ordifferent types of hospitals will besuspended or revoked by the LicensingAgency in any case. whe~ the agencyfmds that there has been a substantialfailure to comply with the ~quirementsestablished under the Hospital LicensingLaw, AS 18.20.020-.130.

(1) General Hospital. Any institutionproviding "hospitalization" for inpatientmedical and surgic3l care of acute illness orinjury and for obstetrics.

(2) Specialized Hospitals and Sanatoria. Anyinstitution providing '.hospitalization" for onetype of care such as mental hospital, psychiatrichospital, tuberculosis hospital. chronic diseasehospital, maternity hospital, maternity home,etc. .

(ii) A license may be revoked if theagency, upon investigation, finds that anyillegal act affecting the welfare of apatient in the institution has beenpermitted. (3) Specialized Unit of a General Hospital.

When a general hospital provid~ ten or morebeds in a segregated unit fora specialized typeof care such as psychiatric. tuberculosis, chronicdisease, etc., such a unit is a speci:ilized urit of ageneral hospitaI. For licensing purposes, onelicensc sh:1l1 be issued to a general hospitalhaving one or more specialized units, when suchunits are adjacent to or located on propertyadjoining that of the general hospital. (Refer tosubsection (a)(l )(E).)

(1) Each license shall be returned to theagency immediately upon its suspension orrevoc:ltion, or if the institution voluntarilyceases operation.

(b) DefInitions

( 1) Hospital. Any institution orestablishment, public or private. providingfacilities to the general public over a continuousperiod of 24 hours e.1ch day for the bedsidetreatment and c~~ of two or more nonrelatedindividuals suffering from inness. injury.deformity. abnonn.1lity, or any other condition

(4) Small Hospital. Any institution providinghospitalization willi a bed ..;tpacity limited to 2Sbeds or less.

7-28.7

te of ALft.SKA/lister 62, July 1977

Attachment 4.11-A7 AAC 12.010HEALTH AJ."lD SOCIAL SERVICES :cage 2a

/ (d) General Provision

') All hospitals licensed as of the effective.; of these regulations shall comply with theseregulations. .

(2) Hospital Planning. \V1ten any individual orgroup in a given locality believes a need existSfor a hospital and would like to investigate theneed for and possibilities of such a hospital, theDepartment of Health and Social Services shallbe so notified in writing. The Department ofHealth and Social Services shall thereupon makeavailable to such body all of the latestinfnnnation relative to hospital needs in thathospital area.

(3) When the occupancy rates of a hospitalare determined by the Department of Healthand Social Services to be so excessively high asto thereby create serious overcrowding andinterferen:e \vith the provision of proper C--4!efor patients, the D~partment of Health andSocial Services shall so infonn the governingbody which shall thereupon make provisions forexpansion of the bed capacity and needed~rvices, or make other arrangements to alleviate

~h conditions.

(4) On and after the effective date of theseregulations, any building or struCture not thenoperating as a hospital but which is convertedfor use 3$ a hospital, shall be of fIre-resistiveconstruction and, upon completion, shallconfonn with sec. 20 of this chapter of thesehospital regulations. The Department of Healthand Social Services shall be advised immediatelyin writing when the acquisition or purchase of abuilding or structure is contemplated for use as ahospit31.

.(e) Administration of Hospitals and Sanatoria

(1) Nonprofit Corporation

(A) Governing Body. There shall b~ a"Board of Directors, Board of Trustees, orother similar body in each institution whichshall be the supreme authority in the hospitalresponsible for its management, control, and

7-28.8

At:.achment 4.1l.-APage 3

State of AL.\SKA

j AAC 1~.OIOHEALTH AJ.\ID SOCIAL SERVICESRegister 45, ApriJ 1973

operation, including the appointment of aqualified medical staff, the conservation anduse of hospital moneys, and the formulationof administrative policy.

char6e of and be responsibleadministration of the institution.

for thc:

Organized and(2) Profit Corporationoperated for profit.

(i) It should be composed of at leastthree representative residents in the areaserved by the institution, or as many moreadditional members who need not be suchresidents, as are required to effectefficient direction. It is recognized that ahospital operated by a reiigious order orbody may have an established governingbody as its supreme authority which maybe composed and organized of officials ormembers of such religious body ororganization and in accordance with thepractice or rule thereof, notwithstandinglack of residence in the area served by theinstitution. For such hospital, operated bya religious organization, it isrecommended that a local boar1 ofresidents be established to act as theauthority in all matters which may bedelegated to it by the rule of theorganization and to act in an advisorycapacity and referTaJ authority to thesupreme authority of the organizAtion.

(A) TIle owner, partners, or in the case ofa private corporation, the board of trusteesof a profit-making hospital, shall carry outthe same functions reserved for the governingbody of a nonprofit institution. Suchpersons, or board, shall be the ultimateauthority in the hospital responsible for tilefonnulation of its policies, management.control, and operation, including theappointment of its medical staff, theestablishment of rules and regulationsrequired for the proper care of patients, andsuch other duties and responsibilities as arenecessa.ry to carry out the purpose of theinstitution. The owner, or the board nftrustees of any privately incorporatedhospital shall certify to the Departmen t ofHealth and Social ~rvices the names,addresses. occupation, or professions of theowners.

(i) Any change in tlle ownership. or theidentity of the person or persons acting asthe ultimate authority in an institutionshall be reported to the Department ofHealth and Social Services within 30 daysof the date of which such changeoccuned. W'

(il) The governing body shall consist ofat least a president or chairman, vice'president, secretary and treasurer. It shallhave the power to appoint such officersand committees as it may require to assistin carrying out its functions.

(ii) The owner. partner, or the board oftrustees of any profit-making hospitalshall notify the Department of Health andSocial Services within 30 days. in writing,of the terminOition of service of theadministrator as well as of theappointment. name, and address of th~new administrator, including dates ofchange.

(ill) It shall conduct regular meetingsand such special meetings as are required.

(iv) The governing body of theinstitution shall notify the Department ofHealth and Soci61l Services within 30 days.in writing, of thc termination of service ofthe ;luministrator as well as of theappointment, name. and address of thenew administrator, including dates ofchange.

(B) All profit-making institutions shallhave an administrative officer.superintendent, or director. He shall beselected by the person or persons exercisingthe ultimate authority in each institution. Heshall be responsible for cxrying Ollt thepolicies of the owners anJ for the over311administration .:If all departments andbranches in the institution.

(B) All institutions shall h6lve anadministrative officer. superintendent, ordirectcr. who shall be select~d by thegoverning body to serve undr:r its directionand be responsible for carrying cut itspolicies. The ;1uministr:1tive offil:er 511:111 h6lve

7-~9

State of ALASKA Attachment "';. ".l.~.

Page :;Register 45, April 1973 HEALTH AND SOCIAL SERVICI::S IIi I AAL 1.l.UIU --

.~) The Medical Staff (F) It is recommended that the medicalstaff, with approval of the governing body,adopt by-laws, rules, and regulations inconformance with those recommended in"Principles For Establishing Medical StaffBy-Laws, Rules, and Regulations" by theJoint Commission on Accreditation ofHospitals, 660 North Rush Street, Ctlicago11, Illinois.

((A) The medical staff shall be responsible

to the governing body of the hospital for theclinical and scientific work of the hospital. Itshall be called upon to advise regardingprofessional problems and policies.

(B) In any hospital used by three or morepractitioners, the medical staff should be anorganized group which shall formulate, andwith the approval of the governing body,adopt by-laws. rules, regulations. and policiesfor the proper conduct of its work andeligibility for membership to the staff,subject to final action by the governing body.The medical staff shall

(4) Personnel

(A) Written policies. procedures. rules.and regulations shall b~ established for theadministrative and technical guidance of thepersonnel of the entire hospital. Employeesshall be instructed in the requirements,policies, and procedures pertaining to theirrespective duties.

r(i) designate one of its members as

chief of staff;(B) At all times there shall be enough

qualified personnel on duty to provide thestandard of care and maintenance in thehospital, which is necessary for the well-beingof the persons received for care. This includesnight duty, vacation, and other relief periods.A record shall be kept of the length of serviceof each employee.

(ii) hold regular meetings for whichminutes and records of attendance shallbe k~~t;

(iii) review and analyze, at regularinter\'als, the clinical experience of thehosr.: tal.

r

(C) All persons admitted to the hospitalshall be under the professional care of amember of the medical staff.

(C) Nursing Personnel

(i) The department of nursing shall beorganized to provide complete andefficient nursing care to each patient, cytdthe authority. responsibility, and functionof each nurse shall be clearly deCmed.

(0) No medication or treatment shall begiven to a patient except by the written orderof a member of the medical staff. Emergencyorders, given by telephone, shall be reducedto writing immediately upon receipt and shallbe signed by the staff member within 24hours after the order is given.

(ii) All graduate nurses employed in ahospital must be licensed in the State ofAlaska to practice their profession.Temporary pennits shall be honored forsuch period as may be reasonablynecessary to permit fmal action on thenurse's application for a license by theAlaska Nurses' Examining Board for thestate but in no case shall the temporarypermit be for a longer period than threemonths. Lit.-enses must be renewedannually, in accordance with the StateLaw, AS 08.68.250 - .260. Nursesemployed by a hospital to practice aresubject to immediate restrictions from t.~epractice of nursing in such hospital uponrecommendation of the Nu~s'

(E) All hospitals shall have a licensedphysician available on call for emergencies atall times; provided, however, this regulationshall nC't apply during such time that anyhospital is without the services of a licensedphysician and/or every diligent effort hasbeen made to secure a competen t licensedphysician. Provided further, that in no eventshall any hospital be without a competentlicensed physician for any reasonable timenot to exceed three months.

7-30

?"J} -/'t'J1!/

State of ALAS~ Attachment 4.11-:\Page 5

Examining Board of the State of Alaskawhen 5uch recommendation precedesdenial of license to practice in the state.

consisting of a general physicalexamination, including a chest X-ray andstool cultures if a history of typhoid feveris elicited. A physical examination,including chest X-ray, should be repeatedannually on all such personnel. Otherpersonnel who show signs of other'respiratory infections, skin lesions.diarrhea, and other communicable disease,should be excluded from work and returnonly after a checkup by a physician.

(ill) The superintendent or director ofnursing service shall be a competent andwell-trained person, with administrativeand executive ability, and she shall be agraduate nurse and currently licensed topractice in the State of Alaska.

(iv) Supervisors and head nurses shallhave had preparation courses andexperience commensurate with theresponsibility of the sp'ecific assignment.

(ii) Personnel absent from duty becauseof any reportable communicable disease.infection. or exposure thereto, shall beexcluded from the hospital untilexamined by a physician designated forsuch purpose, and shall be certified byhim to the Administrator as not sufferingany condition that may endanger thehealth of patient.) or employees.

(v) Applications for employment as :1professional or practical nurse shall besubmitted in writing to the personresponsible for nursing personnel, ande:lch application mall contain accurateinformation as to the education, training,experience, and personal background ofeach applicant. Professional and practicalnurses already licensed to practice in thestate shall submit their CUITent statelicense, or registration card to the personresponsible for the nursing personnel forreview. Such responsible person shallmaintain a continuing record of thecurrent registration numbers ofprofessional and practical nurses on thestaff, and shall be responsible for seeingthat all professional and practical nurseson the suff maintain renewal of theirlicensure. Duties of the professional andpractical nurse staff shall be cle:J.rlydefined and not in conflict withrestrictions in responsiblities set forth inthe Alaska Nurse Practice Act, AS 08.68.They shall be instructed in all dutiesassigned to them.

(f) Records and Reports

(I) Accurate and complete confidientialmedical records shall be prepared for allpatients. These shall, be filed in such a manner asto be accessible to the medical and nursing staff.

(A) A trained medical record librarian, orother authorized hospital employee, shall begiven the responsibility for the propercustody, supervision, indexing, and filing ofthe completed medical records of patients.. W"

(B) Space and equipment shall b~provided for the recording and completion ot-the record by the physician as well as forindexing, filing, and safe storage of medicalrecords. .

(C) Accurate and complete medicalrecords shall be maintained on all patientsfrom the time of admission to the time ofdischarge. To be considered complet~. amedical record should include:

(vi) There shall be regular meetings ofthe graduate nursing staff to review andanalyze the nursing service to determinethe quality of the nursing care rendered topatients and to increase the efficiency ofthe nursing service. (i) adequate identification data;

(ii) admitting diagnosis (to be completedwithin 24-48 hours);D) Health of Employees

(i) All regular paid p~rsonn~1 should~given pre-t:m ploy~men [ I:xaminations

(iii) history and physical examinationincluding hi..;tory of pregn6lncy on

7-3 -,IVI,ooi -f" ..,.--/

State of ALAS~.1. Attachment 4.J.l-APage 6

Register 45. April 1973 .HEALTH AND SOCIAL SERV.ICES 7 AAC 12.010-

maternity cases (to be completed within24-48 hours);

(F) The history and physical examinationrecord shall be completed and signed by theattending staff member prior to theperformance of any surgery except in case ofemergency. when an admission noteincluding significant findings and diagnosisshall be written.

(iv) progress notes

(v) signed doctor's orders;

(vi) operative notes where applicable(to include course of delivery onmaternity cases);

(G) All medical records shall contain theorders for medication and other serviceswritten in ink and signed by the prescribingphysician, or undersigned by him within 24hours. In surgery cases, a copy of thepathologist's tissue report shall be made apart of the patient's permanent medicalrecord.

(vii) special reports and examinationsincluding clinical and laboratory findings,X-ray findings, records of consultation,anesthesia reports, etc.; (

(viii) nurse's notes;(2) The following hospital records shall be

main tamed in a fOnD and manner acceptable tothe Department of Health and Social Servicesand such reports from them shall be made asrequested:

(ix) discharge diagnosis

(x) autopsy report where applicable;

(xi) fun and true name of patient andspouse or nearest relative and address; (A) record uf admission and discharge~,

total patient days, average length of stay. andnumber of autopsies perfonned. Separatedata shall be main tained for

(xii) the place of residence of thepatient prior to hospitcJization. and placeof residcnce following discharge. (

excluding(i) adultsnewborns;

and children,(D) A medi~ record shall be maintained

on all newborn infants and shall include aphysical examination perfonned andrecorded by the physician, and a statementrelative to the physical condition of theinfant at the time of discharge. When thechild leaves the hospital with any personother than his parent, the hospital shouldobtain and record the true name of theperson or persons with whom the childleaves, and the place of residence where it isplanned that he is to be taken. (Reporting ofchildren born out of wedlock, and any childtaken from the hospital by persons otherthan his own parent. and referrals for childplacement and adoptions shall be inaccordance with AS 29.10.189.)

(Ii) newbornstillbi11hs;

infants. excluding

(B) register of births;

(C) register of deaths

(D) the official original records of birth,death, and stillbirth, required by law for ea.;hof these events, are the prime responsibilityof the attending physician. The hospital shallbe responsible for the completeness andaccuracy of the data furnished from itsrecords, and for the prompt filing of theoriginal with the proper V.S; Commissiont;rwhen so requested by the attending physicianin accordance with instructions by tileBureau of Vital Statistics;

\

(E) The medical staff shall have a policyrequiring tltat tlte medical records shall bccompleted within a reasonable time followingthe discharge of the patient. The completion")f the medical record shall be the

:sponsibility of tlte attending physician.

(E) register of Oper.1tions

(F) register of out-patients

7-32MA 1Jf-

Register 45. April 1973 HEALTH AND SOCIAL SERVICES AAC 12.010

(G) narcotics shall 00 h;mdlt:d in compl~tcconformance with the Federal Narcotic Lawand. the Uniform Narcotic Act adopted bythe State of Alaska, AS 17.10 and AS 17.12.Hospitals shall keep a daily record of thekind and quantity of narcotics dispensed oradministered, the name of the physicianupon whose authority, and the purpose forwhich dispensed or administered. The initialsor signature of the practitioner ordering thedrug shall appear on the pati~nt's chart. or ona separate prescription properly executed bythe physician, flied with the phannacist incharge of the pharmacy before the narcoticleaves his control. If both chart andprescription are used, the chart shall bear areference to the prescription. The nurse'snotes and the doctor's orders in the patient'schart shall carry a record of narcoticstogether with their signature. A periodiccheckup shall be made to verify that theamounts purchased balance with thedispensed and on hand amounts;

coagulation time, blood group and matching,and for quantitative blood sug:lr determination.It i.o; also recommended that mailing containersfor the submission of specimens for tuberculosis.intestinal parasites, enteric fever, diptheriaculture, m:llaria, serological agglutination tests,and agglutination tests for syphilis be securedfrom the Section of Laboratories, Departmentof Health and Social Services and a supply kepton hand for the convenience of physicians.

(4) It shall be the policy of all hospitalsproviding services for surgical care, to haveavailable facilities for the pathologicalexamination of all tissue specimens, either onthe premises or by arrangement throughaffiliation, or other means, with a competentpathological laboratory .

(h) X-ray service shall be provided in oravailable to the hospital.

(1) A physician shall have responsibility forthe supervision of the X-ray service. The X-raypersonnel shall be qualified by education,training, and experience for the type of serviceperfonned.

(H) all original hospital records orphotographs of same shall be stored in thehospital, and !lone shall be disposed ofexcept by the approval of the Department ofHealth and Social Services. (2) Diagnostic and thereapeutic X-ray

facilities shall be adequate for the ~rvicesprovided. Protection against radiation hazardsshall be provided for the patients, operators, andother personnel.

shall be(g) Olemical laboratory serviceprovided in or available for the hospital.

(I) Personnel. A physician shaJl haveresponsibility for the supervision of thelaboratory. The laboratory personnel shall bequalified by education, training, and experienl;efor the type of service perfonned.

..(3) Hospitals providing Radio Isotope, or

other atomic treatment services, shall report tht:type of such services to the Department ofHealth and Social Services.

(2) Facilities and equipment for theperfOrn1a.1ce of routine clinical diagnosticprocedurta;s. and other laboratory tech!1iquesshall be adequate ror the ~rvices provided.

Furnishings(i) Accommodations.Equipment for Care

and

(1) Nursing Departm~nt

A) Patient Rooms(3) The extent of these services shall be basedon the services rendered by the hospital. It isrecommended that hospitals rendering generalservice, including surgery. and obstetrics,provide facilities for at least the following:Examination of urine for sugar. albumen.acitone bodies. and microscopi(; examinations.sedim~nt; for the detennin:ltion of bloodhemoglobin. erythrocyte count. leucol:ytecount. differential count. volum~ index.

(i) All bedrooms used for patients shallbe outside rooms, dry. well ventilated.naturally lighted, and otherwise suitabl~for occupancy. Each bedroom shall havedirect access to cofTidor.

(ii) Rooms extending b~low groundlevel shall not be used as beuroomj fo..

7-33

~

R.:gistt:.T 45. April 1973 7 AAC 2.010HEALTH AND SOCIAL SERVICES

patients except that any patient bedroom,in use prior to the effective date of theseregulations, may be continued provided itdoes not extend more than three feetbelow ground level.

(ii) at least one chair(

(ill) a locker or closet for storage ofclothing. Where one closet is used for twoor more persons, provisions shall be madefor separation of patients' clothing;

(in) No patient shall, at any time, beadmitted for regular bed care to any roomother than one regularly designed as apatient room or ward, except in case ofemergency, and then only as a temporarymeasure.

(iv) a bedside table with compartmentor drawer to accommodate personalpossession for each person;

(v) I;ubicl~ curtains or bed scre~ns toafford privacy in all multi-b~d rooms:

(iv) Patients' beds should not be placedin corridors nor should furniture orequipment be kept in corridors except inthe process of moving from one room toanother.

((vi) a device for signaling attendants,which shall b~ kept in working order at alltimes except in psychiatric and pediatricunits, where an emergency call should beavailable in each patient's room for theuse of the nurse;(v) There should be a space of at least

three feet between beds, and sufficientspace around the bed to facilitate nursingcare and to accommodate the necessaryequipment for care. Beds shall be locatedto avoid drafts or other discomforts topatients.

(vii) handwashing facilities, located inthe room or convenient to the room, forthe use of patients and pcrsonnel. It isrecommended that these be equippedwith gooseneck spouts and wrist actioncontrols; (

(vi) The window area of each bedroomsl1all equal at least one-eighth of the totalfloor area. The minimum floor areastlould be at least 100 square feet in singleb~droom~ and at least 80 square feet perbed in multi-bedrooms. All hospitals inoperation, as of the effective date of theseRegulations, shall comply with therequirements of this subsection (i) of thissection to the extent possible, but nothingcontained herein shall be so construed asto require major alterations by suchhospitals, nor shall a license be suspendedor revoked for an inability to complyfully with subsection (i) of this section.

(viii) a clinical then1)(')meter to besterilized before each use;

(ix) individuaJ bedpans, wash basins,emesis basins. and mouth wash cups shallbe provided for each patient confinecl,to~d. This equipment shall be stored sothat it will not be interchanged and shallbe sterilized when the patient isdischarged;

(x) no linen shall be interchangeablefrom one patient to another before beingproperly laundered.

l

(B) the following items shall be providedfor each patient unless clinicallycontraindicated:

(i) a comfortable, hospital-type bed, aclean mattress, waterproof sheeting orpad, pillows, and necessary covering.Dean bedding, towels, washcloths, bathblankets, and other necessary suppliesshall be kept on hand for use at all times;

(C) There shall be one nurses' stationprovided for each nursing unit. Each stationshall be conveniently located for patientservice and observation of signals. It shallhave a locked, well-illuminated medicinecabinet. Where narcotics are kept on thenursing station, a separate, locked,permanently secured cabinet for narcoticsshall be provided. Adequate lighting space for

7-34

"I\A ~f-

kceping p:ttj~nts' charts, ;and fur pcr~unn\.:1 torecord and chart shaJl bc maintcained.

used only when alternative ml:~sun:s arenot sufficient to accomplish the~rpurposes. Careful consideration shall beJiven to the methods by which they canbe speedily removed in case of fir\: orother emergency.

. (D) There 3hal] be at least oneconveniently located, wel].illuminated andventilated utility room for each :1ursing unit.Such room shall provide adequate space andfacilities for the emptying, cleansing.sterilizing, and storage of equipment.Bathtubs or lavatories, or laundry trays shallnot be used for these purposes. A segregationof clean and dirty activities shall bemain tained.

(ii) Hot water bags must be coveredbefore being placed in a bed, and carefullychecked as to temperature and leakage.Electrical heating pads shall be checkedperiodically, at least annuaJly, by anelectrician.

(E) A linen closet or linen supplycupboard shall be provided convenien t to thenurses' station.

(-2) Surgical Department

(A) All hospitals providing for the: surgic&llcare of patients shall have an operating roomor rooms. scrub-up facilities, clean-upfacilities. and space for tht: storage or surgil:alsupplies and instruments. The surgical SLlitcshall be located to prevent routine tr:1ffil.:throUgJl it to any other part of the hospital.It is recommended that the surgical andobstetrical suites be entirely separate.

(F) Supplies and equipment for medicClIand nursing care shall be provided accordingto the type" of patients accepted. Stor:lgeareas shall be provided for supplies andequipment. A separate enclosed space shallbe provided and identified for the storage ofsterile supplies. Sterile supplies andequipment for the administration of bloodand intravenous, or subcutaneous solutions,shall be readily available. Acceptablearrangements shall be made for the provisionof whole blood whenever indicated.

(B) The operating room shall be of :lsufficient size to accomodate the personneland eqt!ipment needed.

(C) There shall be satisfactoryillumination of the operative field as well asaeneral illumination.

(G) A room, or rooms, equipped for theisolation of cases, or suspected cases ofcommunicable disease, shall be provided.Policies and procedures for the care ofinfectious patients, including the handling oflinens, utensils, dishes, and other supplies andequipment, shall be established. The hospitaland its staff shall provide for compliancewith the regulations for the control ofcommunicable disease of the Department ofHealth and Social Services. (7 AAC27.0 1 0.080)

(D) Adequate work s'pace, sterilizingspace, and sterile storage space shall beprovided. A central sterilizing and supplyroom is recommended. Sterilizers ilndautoclaves of the proper type, and necessarycapacity for the sterilization or utensils.instruments, dressings, water and othersolutions, shall be provided and maintainedin an opcrating condi[ions. Provision ofsterile water in flasks is recommendeu.Special precautions shall be taken so [hil[sterile supplies are readily identifiable 3S suchand are completely separated from unsterilesupplies.

(H) .~l medicatiol1s which have beenprepared for an individual patient shall bediscarded when orders have beendiscontinued, or patient has been dismissed.Individual narcotic medications shall bereturned to the phamtacy for accounting. (E) In hospitals providing care for surgic;JI

patients, provisions should be made for tilesetting aside of surgical beds and surgic;ilwards, and the arrangemen t shall b~ in amanner such as to protect elective and clt::1n

(i) Restraints shall be applied onlywhen they are necessary to prevl:nt injuryto the patient or to othcrs. :1nd sl1:111 bc

7-35

,v~~ -';"

State of AL.\SKA

Register 45, April 19;3 HEALTH AND SOCIAL SERVICES 7AAC 2.010

'7jcal cases from cross-infectionJean or infectious surgical cases.

from (B) The delivery room shall be ofsufficient size to accommodate the personneland equipment needed.

(3) Anesthesia(C) There shall be satisfactory

illumination of the delivery field as wen asgeneral illumination.

(A) Anesthesia shall be administered by aperson adequately trained and competent inanesthesia administration, or under the closesupervision of a physician. (0) One labor bed for each ten maternity

beds, or fraction thereof, should be providedin a labor room or rooms adjacent to or inthe delivery suite unless the patient's ownroom is used for labor. It is suggested thatthe labor room be acoustically-treated andprovided with a toilet and lavatory.

(B) Suitable equipment for theadministration of the type of anesthesia usedshall be available. Where conductive flooringis installed in anesthetizing areas, allequipment shall have safety features asreflected in reference listed below.

(

(E) Maternity patients shall not be placedin rooms with other than maternity patients.(C) Oxygen and equipment for its use

shall be available.(F) Minimum Equipment Requirements

for .Delivery Room. The following shall beprovided in the delivery room:

(D) Proper provision shall be made for thesafe storage of anesthetic materials asreflected in reference listed below.

{i} Equipment for anesthesia and forthe administration of oxygen to themother;

Part II of Standard No. 56, currentissue, entitled "Recommended Safe

-actice for Ho~pital Operating Rooms"__ublished by the National FireProtection Association, 60 BatterymarchStreet, Boston 10, Massachusetts, whichpart of said standard is hereby adopted.,y reference as Standards of theDepartment of Health and -. Social

Services..

((ii) a source of oxygen with a

mechanism for controlling theconcentration of oxygen and with asuitable device for administering oxygento the infant;

(ill) a safe and suitable type of suctiolfdevice for cleaning the infant's upperrespiratory tract of mucus and other fluid;(4) Obstetrical Department

(iv) a properly heated bassinet forreception of the newborn infant. Thisshall include no hazardous electricalequipment;

~(A) Hospitals providing for the obstetrical

care of maternity patients shall have adelivery room or rooms in a ratiocommensurate with the size of the hospital,scrub-up facilities, clean-up facilities, andspace for the storage of obstetrical suppliesand instruments. The obstetrical ~uite shallbe located to prevent routine traffic throughit to any other part of the hospital. Anexception is made for those hospitals which,on the effective date of these Regulations,provide a single room which is ~d for bothsurgery and delivery purposes. Scrub-upfacilities, clean-up facilities, and space for the

rage of supplies and instruments shall be.vided in such hospitals. Precautions shall

~ taken to avoid cross-infection.

(v) sterile equipment suitable forclamping, cutting, tying and dressing theumbilical cord;

(vi) provision for the prophylactictreatment of the infant's eyes;

(vii) a device, as well as an establishedprocedure, fOT easy and positiveidentification of the infant before removalfrom the delivery room. This shall be of a (

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Register 4S. April 1973 JIJ;.ALTH AND SOCIAL SERVICES AAC 12.010

type which cannot be inadvertentlyremoved during routine care of the infant;

(iv) An observation window should beinstalled between the corridor and nurseryto facilitate the viewing of infants.

(viii) sterile supplies and equipment forthe administration of blood andintravenous, or subcutaneous solutions,shall be readily available. Acceptablearrangements shall be made for theprovision of whole blood wheneverindicated.

(v) Each nursery department shall haveone or more incubators wherebytemperatures. humidity and oxygen canbe controlled and measured.

(vi) A separate premature nursery andwork room are advisable for hospitalswith 25 or more maternity beds, on thebasis of 30 square feet per incubator and amaximum of six incubators per nursery.

(G) Maternity patients with infection.fever or other conditions, or symptomswhich may constitute a hazard to othermaternity patients, shall be isolatedimmediately in a separate room which isproperly equipped for isolation in an are:lremoved from the obstetrical dep:lrtrnent.

(vii) It is suggested that the oxygenconcentration be checked bymeasurement with an oxygen analyzer atleast every eight hours, or that anincubator attached. minus 40 per centoxygen ~oncentration limiting device beused.

(5) Nursery Department

A) Each hospital with a maternity serviceshall provide at least one newborn nurseryfor the exclusive use of well infants deliveredwithin the institution. The number ofbassinets provided shall be at least equal tothe number of maternity beds. It is suggestedthat each newborn nursery be limited totwelve bassinets. Each nursery should beprovided with a lavatory with goose-neckspout and other than hand-operated faucets.

(6) Examination and Work Room(A) An adjoining examination and work

room shall be provided for each nursery orbetween each two nurseries.

(B) The work room shall be of adequatesize to provide facilities necessary to preparepersonnel for work in the nursery, for theexamination and treatment of infants byphysicians. for charting, for storage ofnursery linen, for disposal of soiled linen. forstorage and dispensing of reedings and forinitial rinsing of bottles and nipples.

(i) In hospitals constructed after theeffective date of these Regulations, thetotal nursery space, exclusive of the workroom, shall provide a floor area of at least24 square feet for each bassinet, with adistance of at least two feet between eachbassinet and aisle space of ilt least threefeet.

(C) E:lch work room shall be providedwith a scrub-up sink, having foot, knee, orelbow-acting controls; counter with countersink having a goose-neck spout and otherthan hand-operated controls.(li) Hospitals operating as of the

effective date of these Regulations. shouldcomply with subsections (i), (5), (A) ofthis section. to the extent possible. but nohospital should have a nursery area whichprovides less than 18 inches between eachbassinet and an aisle space of at le:lst threefeet, exclusive of the work room or workarea.

(D) Hospitals operating as of the effectjvedate of these Regulations shall comply withsubsections (i), (6), (A), (B), (C) of thissection, to the extent possible, but if aseparate examination and work room is notprovided, there shall be a segregatedexamination and work area in the nursery.TIle work area shall be of :ldequate size andprovide the facilities and equipmentnecessary to prepare personnel for work inthe nursery. for the ex:lmination anJ

(ui) Each bassint:.t should be mountt:.don a single st:Jnd and bt:. removable tofacilitate cleaning.

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Register 45. April 1973 7 AAC 12.~tOHEALTH AND SOCIAL Sr. RVICES

quartcrs for a psy(;hi~tri(; pCitient in the hospital,then thcse rooms should ht: used for psychiCitricpatients unlcss spccific physician's orders to thecontrary are written in the medical record. If ageneral acute patient is occupying thepsychiatric room when it is needed for :Ipsychiatric patient, orders to remove the generalacute patient must be written in the patient'smedical record by his attending physician. Ifthere is a nurse on the staff who has had trainingin the care of the psychiatric patient, thehospital should establish a course to be given totheir practical nurses, nurse aides, andattendants in the care of psychiatric patients.

'-eatrnent of infants)rage of nursery

...lspensing of feedings.

forthe

by physiciltns,linen and for

(7) Space and equipment for clean-uppreparation and refrigeration to be usedexclusively for infant formulas, should beprovided apart from care areas and apart fromother food service areas. A registered nurse or adietitian should be responsible for the formulapreparation.

(8) There shall be a room available for thecare of newborn infants suspected of having acommunicable disease and for newborn infantsadmitted from the outside. Where a suspectnursery is available, it should provide 40 squarefeet per bassinet with a maximum of sixbassinets, and have a ~parate work room.Isolation technique should be used in thesuspect nursery.

((2) The use of mechanical restraints is to be

avoided. If used, they shall be applied only onwritten order of the physician-in-charge.

(3) Patients shaU be placed in seclusion onlyby written order of the physician-in-charge. Theplacing of more than one patient in u singleroom for seclusion is prohibited.(9) Infants found to have an infectious

condition shall be transferred promptly to anisolation area elsewhere in the hospital. (4) No patient may be placed in mechanical

restraints or seclusion unless there is a nurse ornurse attendant continually on the immediatefloor to watch the patient.

~ediatric Services (

(I) A hospital providing for care of childrenshall have registered nursing personnelcommensurate with the needs of the hospitaland the size of the service.

(5) Sharp instruments, knives, ice picks,matches, or other objects which might be usedfor homicidal or suicidal purposes, must neverbe available to the patients without supervision.

(2) Hospitals providing pediatric care shallhave proper facilities for the caring of childrenapart from the services for adult patients, apartfrom the newborn nursing service, and thereshall be proper facilities and procedures for theisolation of children with infectious, contagious,or communicable conditions.

(1) Food Service and Food Sanitation

(1) The Preparation and Service of Food

(A) The dietary department shall be underthe supervision of a trained dietitian or otherperson experienced in the handling,preparation, and serving of foods; in thepreparation of special diets; and in thesupervision and management of food servicepersonnel. This person shalt be responsiblefor compliance with safe practices in foodservice and sanitation.

~(k) Psychiatric Services

(l) Upon admission to the hospital, thedoctor's written orders for psychiatric patientsshould indicate whether or not there will be aneed for seclusions, restraints, special nurse, orattendant. If there is a question with respect tothe need for seclusion, restraints, special nurse,or special attendant which arises after thepatient has been admitted, such order should be

n by the doctor. If such order is a verbal}hone order, it should be signed by the

;tor within 24 hours. If there are special

(B) There shall be sufficient space andequipment for the proper preparation andserving of food for both patients andpersonnel. The kitchen shall be used for noother purpose than activities connected withthe dietary service :Ind the washing and

l

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Register 45, April 1973 HEALTH AND SOCIAL SERVICES 7 AA.c 12.010

storage of dishes and utensils. A dining roomor rooms shall be provided for personnel. It isrecommended that a separate dishwashingarea or room be provided.

at 170 degrees Fahrenheit shall beprovided. Drain boards shall be part of thethree-compartment sink and adequatespace shall be available for drainage. Thedishes shall be washed in the firstcompartment of the sink with warm watercontaining a suitable detergent; rinsed inclear water in the second compartment;and disinfected by complete immersion inthe third compartment for at least twominutes in water at a temperature notlower than 170 degrees Fahrenheit.Temperature readings shall be detenninedby a thennorneter. Dishes and utensilsshall be air-dried.

(C) Food for patients and employees shallbe nutritious, free from contamination,properly prepared, palatable, and easilydigestible. A rue of the menus served shall bemaintained for at least 30 days.

(D) All foods sh.1il be sorted :md served soas to be protected from dust, flies, rodents,vennin, unnecessary handling, overheadleakage, and other means of contamination.All readily perishable food shall be stored incle:m refrigerators at a temperJture of 50degrees F:lhrenheit or lower. Eachrefrigerator shall be equipped with athennometer.

(ii) Mechanic3l. Water pressure in thelines supplying the wash and rinse sectionof the dishwashing machine shall not beless than 15 pounds per sqU~""e in.:h normore than 30 pounds per square inch. TIlerinse water shall be at a temperature notlower than 180 degrees Fahrenheit at themachine. The machines shall be equippedwith thennometers which will indicateaccurately the temperature of the washwater and rin~ water. Dishes and utensilsshall be air-dried.

(E) All fluid milk. cream. and milkproducts should be safe for humanconsumption. Where pasteurized milk is notavailable. condensed. evaporated or driedmilk shall be used. Ice used in contact withfood or drink shall be obtained from a sourceacceptable to. the Department of Health andSocial Services and handled and dispensed ina sani tary manner. (H) All rooms. in which food is stored,

prepared, or served, or in which utensils arewashed, shall be weU-ventilated. The cookingarea shall be ventilated to controltemperatures, smoke and odop.

. (F) Handwashing facilities with hot andcold running water, soap, and individualtowels shall be accessible for the use of allfood handlers and so located in the kitchento pennit direct observation by thesupervisor. No employee shall resume workafter using the toilet room without firstwashing his hands.

(I) Garbage shall be disposed of in amanner acceptable to the Department ofHealth ~d Social Services. When stored, itshall be retained in water-tight metal cansequipped with tightly fitting met:ll covers.AI) cont.1.iners for the collectiol1 of garbageand refuse shall be kept in a sanitarycondition.

(G) Dishwashing Facilities and Methods.Either of the following methods may beemployed in dishoNashing:

(i) Manual. A three-compartment sinkor equivalent of a size adequate to permitthe introduction of long-handled wirebaskets of dishes shall be provided. Thereshall be a sufficient number of baskets tohold the dishes used during the peak loadfor a period sufficient to permit completeair-drying. Water-lt~ating equipm~ntcapable of maintaining th~ temperature 01'the water in the disinfection comp:lrtmcnt

(1) Conveniently lo\.':lted toilet andlavatory facilities shall be provided foremployees engaged in food handling. Toiletrooms shall not open directly into any roomin which food is prepared or utensils arehandled or stored.

(2) Sanita[ion

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7 AAC 12.010HEALTH AND SOCIAL SERVICESRegister 45. April 1973

(A) The water supply shall be of safe.tary quality, suitable for use, and shall be

,utained from a water supply system, thelocation, construction, and operation ofwhich meets the requirements of 7 AAC 14.Hot water of a temperature required for itsspecific use shall be available as needed. Forthe protection of patients and personnel,thennostatically controlled valves shall beinstalled where indicated.

(1) The hospital structure and its equipmentshall be kept in good repair and operated at alltimes with regard for the health, treatment,comfort, safety and wen-being of the patientsand personnel.

(

(2) Fire protection for the hospital shall beprovided in accordance with the requirements ofthe State Fire Marshal. All hospitals shall have awritten fire manual, outlining a plan for themovement of patients to a safe location in caseof rire. Approval by the State Fire Marshal ofthe fire protection of a hospital should be apre-requisite for licensure.

(B) Sewage shall be discharged in to amunicipal sewerage system where such asystem is available; otherwise, the sewageshall be collected, treated, and disposed of ina sewage disposal system which is acceptableto the Department of Health and SocialServices.

l(3) Walls, floors and ceilings shall be kept

clean and in good repair at all times. They shallbe of a type to pennit good maintenanceincluding frequent washings, cleaning, orpainting.(C) The plumbing and drainage, or other

arrangements for the disposal of excreta andwastes shall be in accordance with theRegulations of the Department of Health andSocial Services.

(4) Lighting

(A) All areas shall be adequately ligllted.

(B) All lighting and electrical fiXtures,including emergencv lighting in operatingrooms, delivery rooms and spaces whereexplosive gases are used or stored, shallcomply with standards as reflected in Part IIof Standard No. 56, current issue. entitled"Recommended Safe Practice for HospitalOperating Rooms" published by the NationalFire Protection Association, 60 Batterymarch~Street, Boston 10, Massachusetts, which partof said Standard is hereby adopted byreference as Standards of the Department ofHealth and Social Services.

(D) The toilets shall be conveniently~ated and provided in number ample for: according to the number of patients and

personnel of both sexes. The minimumrequirement is one toilet for each eightpatients or fraction tl1ereof.

(

(E) Handwashing facilities of the propertype in each instance shall be readilyavailable for physicians, nurses and otherpersonnel. Lavatories shall be provided in theratio of at least one lavatory for each eightpatients or fraction thereof. Lavatories shallbe readily accessible to all toilets. Individualtowels and soap shall be available at all times.The use of the common towel is prohibited.

(C) Safe emergency lighting equipmentshall be provided and distributed so as to bereadily available to personnel on duty in theevent of a power failure. There shall be atleast a battery operated lamp withvapor-proof switch, in readiness at all times.for use in the delivery and operating rooms.

\

(F) A bathtub or shower shall be providedin the ratio of at least one tub or shower foreach 30 patients or fraction thereof.

(G) Outside openings including doors andwindows shall be properly screened orotherwise protected to prevent the entranceof flies, mosquitoes, and other insects.

(D) The heating system shall be capable ofmaintaining temperatures adequate for thecomfort and protection of all patients at alltimes.

Physical Plant((E) Kitchens, laundries. toilet rooms and

utility rooms shall be ventilated by windows

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State of ALASKA ttachmp;nt 4."age 15

Register 62. July 1977 HEALTH AND SOCIAL SERVICES 7 AAC 1~.OIO7 AAC 12.040

or mechanical means to control temperaturesand offensive odors. If ventilation is used inoperating rooms, delivery rooms, or otheranesthetizing areas, the system shall confonnto the requirements of these Regulations 7AAC 12.020(e)(I) for Hospital Constructionand Equipment.

(K) Space shall be provided for thestorage of supplies and equipment. Comdorsshall not be used as storage areas.

(n) Hospitals devoted to the care oftuberculous patients. and hospitals havingdepartments for the care of tuberculous patientsshall meet the requi.--em~nts as reflected in theMWmal Medical and Administrative Standardsfor Tuberculous Hospital Administration,current issue, as promulgated by the AmericanTrudeau Society, 1790 Broadway, New York,New York, which appears in tht! AmericanReview of Tuberculosis and Pulmonary Diseases,Volume 72, Number 5, and is hereby adoptecby reference as Standards of the Department ofHealth and Social Services. (In effect before7/28/59) .

(F) All stairways and ramps shall beprovided with handrails on both sides andwith nonskid treads.

(G) All dangerous areas and equipmentshall be provided with proper guards andappropriate devices to prevent accidents.Elevators, dumbwaiters and machinery shallbe so constructed and maintained as tocomply with all local and State Fire Code,and as reflected in "Safety Code forElevators, Escalators, and Dumbwaiters," A17.1, published by the American StandardsAssociation, Incorporated, 70 East 45thStreet, New York 17, New York. AllelectriCal wiring, appliances, fIXtures andequipment shall be installed to comply withthe requirements of the State Fire Code andlocal Codes and where not covered, they shallcomply with Standards as reflected inreference NBFU No. 70, entitled "NationalElectrical Code" published by the NationalBoard of Fire Underwriters, 85 John Street,New York 7, New York, and said Standard ishereby adopted by reference as Standards ofthe Department of Health and SocialServices.

AS 18.20.020AS 18.20.030AS 18.20.040AS 18.20.060

Authority

7 AAC 12.020. REGULATIONS FORHOSPIT AL CONSTRUCTION ANDEQUIPMENT. Repealed. (Err. 4/28/77 . Reg. 62)

7 AAC 12.030. PREPARATION OF PLANSAND SPECIFICA nONS FOR HOSPITALS.Repealed. (Err. 4/28/77, Reg. 62)

7 AAC 12.040. UCENSING. OPERAnON.AND MAINTENANCE OF NURSING HOMES.(a) Licensing Requirements

(1) Any person or persous desiring toestablish, conduct, or maintain, or who holdsout, represents or advertises by any means, theestablishment, maintenance or conducting of anursing home as defined in these requirements~shall obtaL, a license from the Department ofHealth and Social Services. The use of the nameor title "Nursing Home" by any person orpersons to identify a facility for the care andtreatment of human illness other than a facilitysubject to the licensure provisions of theserequirements is prohibited.

(H) An incinerator shall be provided forthe safe disposal of infected dressings.surgical and obstetrical wastes and othersimilar materials.,

(I) Adequate telephone service shall beprovided in order to assure efficient serviceand operation of the institution and tosummon help promptly in case of emergency.

(1) The hospital shall make pro\'ision forthe proper laundering of linen and washablegoods. Where linen is sent to an outsidelaundry. the hospital shall take reasonableprecautions to see that contaminated lint:n isproperly handled.

(2) Application for license to oper:lte anursing home shall be furnished upon requestmade to the Department of Health and Soci:llServices.

(3) The licensee is ~le officer or member ofstaff or governing body on whom rest$ tile

741(cor:ec~~J)

.)I.d.,:!; \Jf '-L~~~ "1.1.t1,-rlll~111. '+.II-~

nace 167 AAC 12.040Register 62, July 1977 HEALTH AND SOCIAL SERVICES

~ponsibility for maintaining'..ndards for the institution.

approved

(4) A license is valid only for the licensee andpremises named in the license.

(5) Separate licenses are required forinstitutions maintained on separate premises,even though they are operated under the samemanagement. Provided, however, that severalseparate licenses are not required fOT separatebuildings on the same ground.

(6) The license shall be posted in aconspicuous place on the premises, in the publiclobby or waiting room of the institution.

(7) Each license to operate a nursing homeshall expire on June 30 following the date ofSue, and if a renewal is d~d, the licensee.ihall make application at least 30 days prior tothe expiration date upon a fonn adopted by thelicensing agency.

(8) Revocation of a License

(A) A license issued to any nursing homewill be suspended or revoked by the licensinga~ncy in any case where the agency findsthat there has been a substantial failure to

742/7-56(~rTeCted)

Register 45. April 1973 HEALTH AND SOCIAL SERVICES 7AAC 2.040

comply \vith the requirements establishedunder the Nursing Home Licensing Law, AS18.20~

( 1) When any individual or group in a givenlocality believes a need exists for a nursing homeand would like to investigate the need for andpossibilities of such a nursing home. theDepartment of Health and Social Strvices shallbe so notified in writing. The Department ofHealth and Social Services shall thereupon makeavailable to such body all the latest infonnationrelative to nursing home needs in that area.Nothing in these regulations shall prohibit thedevelopment of a nursing home in any location.provided such nursing home meets the stand'JIdsof construction, equipment, licensing.maintenance, and operation as prescribed inthese regulations.

(B) A license may be revoked if theagency, upon investigation, fmds that anyillegal act affecting the welfare of a patient inthe institution has been permitted.

(9) Each license shall be returned to theagency immediately upon its suspension orrevocation, or if the institu tion voluntarilyceases operation.

(b) Definitions

(2) When the occupancy rates of a nursinghome are determined by the Department ofHealth and Social Services to be so excessivelyhigh as to thereby creatc serious overcrowdiJ1gand interference with the provision of propercare for patients, the Department of Health andSocial Services shall so infonn the governingbody which shall thereupon make provisions forexpansion of the bed capacity and neededservices, or make other arrangements to alleviatesuch conditions. '

(1) Nursing home: A facility which isoperated in connection with a hospital or inwhich nursing care and medical services arepre-JCribed by or performed under the generaldirection of persons lice 11. sed to practicemedicine or surgery within the state for theaccommodation of convalescents or otherpersons who are not acutely ill and not in needof hospital care, but who do require skillednursing care and related medical services. Theterm "nursing home" s.~a11 be restricted to thosefacilities. the purpose of which is to provideskilled nursing care and related medical servicesfor a period of not less than 24 hours per day toindividuals admitted because of illness, diseaseor physical or mental infIrmity.

(d) Administration of Nursing Homes

(1) Non-Profit Corporation

(A) There shall be a Board of Directors,Board of Trustees, or other sfmilar body ineach institution which shall be the supremeauthority in the nursing home responsible forits management, control and operation, theappointment of the medical staff, theconservation and use of nursing homemoneys, and the formulation ofadministrative policy:

(2) Hospitalization: Within the meaning ofthe Hospital Licensing uw, "hospitalization" isdefmed as the reception and care of any personfor the purpose of providing room, board, andnursing service and nursing home faCIlitiesrequired in connection with the diagnosis andtreatment of any condition or infumity.

(3) Medical staff: The medical staff of anursin~ home shall be de tined a$ an org:1nizedbody composed of all individuals who areappointed to the staff of a nursing home by itsgoverning board.

(i) It shl)uld be composed of :it le:lstthree representative residents in the are~served by the institution. or as many moreadditional members who need not be suchresidents. as are required to effectefficient direction. It is recognized that anursing home operated by a religiousorder or body may have an establishedgoverning body as its sllpreme authoritywhich may be composed and Orf:lnized ofofficials or mem hers of su~h religiousbody or org:lniz3tion and in :Jccordan~e

(t) Registered nurse: A registered nurse shallbe a person graduated from a school of nursingand who is currently registered in the State ofAlaska.

(c) Gener.11 Provisions

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Register 45, April 1973 7 AAC 2.040HEALTH AND SOC:IAL S.~RVIC~I~S

authority in the nursing home responsible forthe fonnulation of its policies, management,control, and operation, including theappointment of its medical staff, theestablishment of rules and regulationsrequired for the proper care of patients, andsuch other duties and responsibilities as arenecessary to carry out the purpose of theinstitution. The owner, partner, or the boardof trustees of any privately incorporatednursing home shall certify to the Departmentof. Health and Social Services the names,addresses, occupations, or professions of theowners

with the practice or rule thereof,notwithstanding lack of residence in thearea served by the institution. For suchnursing home, operated by a reljgiousorganization, it is recommended that alocal board of residents be established toact as the authority in all matters whichmay be delegated to it by the rule of theorganizatjon and to act in an advisorycapacity and referral authority to thesupreme authority of the organization.

(ii) The governing body shall consist ofat least a president or chaimtan, vicepresident, secretary and treasurer. It shallhave the power to appoint such officersand committees as jt may require to assistjn carrying out its functions.

(i) Any changes in the ownership or theidentity of the person or persons acting asthe ultimate authority in an institutionshall be reported to the Department ofHealth and Social Services within 30 daysof the date on which such changeoccurred.

(iii) It shall conduct regular meetingsand such special meetings as are required.

(iv) The governing body of theinstitution shall notify the Department ofHealth and Social Services within 30 days,in writing, of the termination of theservice of the administrator as well as ofthe appointment, name, and address ofthe new administrator, including dates ofchange.

(ii) The owner, partner, or the board oftrustees of any profit-making nursinghome shall notify the Department ofHealth and Social Services within 30 days,in writing of the termination of service ofthe administrator as well as of theappointment, name, and address of thenew administrator, including date ofchange.(B) All institutions shall have an

administrative officer, superintendent, ordirector, who shall be selected by thegoverning body to serve under its directionand be responsible for carrying out itspolicies. The administrative officer shall havecharge of and be responsible for theadministration of the institution. AfterSeptember 15, 1972 no nursing home willqualify for licensure unless it is administeredby a nursing home administrator who islicensed by the Alaska Nursing -HomeAdministrators Licensing Board.

(B) All profit-making institutions shall..

have an administrative officer,superintendent or director. He shall beselected by the person or persollsexercising the ultimate authority in eachinstitution. He shall be responsible forcarrying out the policies of the ownersand for the overall administration of alldepartments and branches in theinstitution. After September 15. 1972 nonursing home will qualify for licensureunless it is administered by a nursinghome administrator who is licensed by theAlaska Nursing Home AdministratorLicensing Board.

(Organized and(2) Profit CorporationOperated for Profit)

(A) The owner, partners, or in the case ofa private corporation, the board of trusteesof a profit-making nursing home, shall carryout the same functions reserved for thegoverning body of a non-profit institution.Such persons, or board, shall be the ultimate

(3) The Medica! Staff

(A) All persons admitted to the nursinghome shall be under the professional care ofa licensed physician.

7-58MA ::;zt/-

1973 HEALTH AND SOCIAL SERVICESRcgistcr 45. Apr: 7AAC 2.040

{ (8) No mt:dication or treatment shall beJiven to a pati~nt except on the written orderof a licensed physician. Emergency orders,given by telephone shall be reduced towriting immediat~ly upon receipt and shallbe signed by the licensed physician within 14hours after the order is given.

license by the Alaska Nurses' ExaminingBoard for the state but in no case shall thetemporary permit be for a longer periodthan three months. Licenses must berenewed annualJy, in accordance with thestate law, AS 08.68. Nurses employed bya nursing home to practice are subject toimmediate restrictions from the practiceof nursing in such nursing home uponrecorr.mendation of the Nurses'Examining Board of the State of Alaskawhen such recommendation precedesdeniaJ of license to practice in the state.

(C) All nursing homes shall have a licensedphysician available on call for emergencies atall times; provided, however, this regulationshall not apply during such time that anynursing home is without the services of alicensed physician and/or every diligenteffort has been made to secure a competentlicensed physician. Provided further, that inno event shall any nursing home be without acompetent licensed physician for anyreasonable time not to exceed three months.

(iii) The superintendent or director ofnursing service shall be a competent andwell-trained person, with administrativeand executive ability, and she shall be agraduate nurse and currently licensed topractice in the State of Alaska.

(4) Personnel(iv) Supervisors and head nurses shall

have had preparation courses andexperience commensurate with theresponsibility of the specific assignment.

(A) Written policies, procedures. rules,and regulations shall be established for] theadministrative and techniical guidance of thepersonnel of the entire nursing home.Employees shall be instructed in therequirements, poiicies, ~d procedurespertaining to their respective duties.

(v) Applications for employment as aprofessional or practical nurse shall besubmitted in writing to the personresponsible for nursing personnel, andeach application shall contain accurateinfon11ation as to the education, training,experience, and personal background ofeach applicant. Profession~ and practicalnurses already licensed to practice in thestate shall submit their current statelicense, or registration card to the personresponsible for the nursing personnel forreview. Such responsible person shallmaintain a continuing record of thecurrent registration numbers ofprofessional and practical nurses on thestaff, and shall be respon~ib!e seeing thatall professional .1.nd practic;l1 nurses on thestaff maintain renewal of their licensure.Duties of the professional and practicalnurse staff shall be clearly defined and notin conflict with restrictions inresponsibilities set forth in the AlaskaNurse Practice Act. AS 08.68. They shanbe instructed in all duties ;!$Signed tothem.

(B) At all times there shall be enoughqualified personnel on duty to provide thestandard of care and main t~nance in thenursing home, which is necessary for thewell-being of the persons received for care.This includes night duty, vacation, and otherrelief periods. A record shall be kept of thelength of services of each employee.

(C) Nursing Personnel

(i) Tht: department of nursing shall beo~ized to provide complete andefficient nursing care to each patient, andthe authority. responsibility. and functionof each nurse shall be clearly defined.

(ii) All grJduate nurses employed in anursing home must be licensed in theState of Alaska to practice theirprofessiun. Temporary permits shall behonored for such period :lS may bere:1sonal')ly necessary to permit finalaction 011 the nufSt='s :lppli~ation for a (vi) Tllere shOlll b~ regular meetings ot'

7-59:j. :;!.;-

State of ALASKA Attachment 4.11-APa~e 34

Register 45, April 1973 HEALTH AND SOCIAL SERVICES 7 AAC 2.040

(vi) There shall be regular meetings ofthe nursing staff to review and analyze thenursing service to determine the quality ofthe nursing care rendered to patients andto increase the efficiency of the nursingservice.

other than one regularly designed as a patientroom or ward except in case of emergency.and then only as a temporary measure.

(D) Patients' beds should not be placed incorridors nor should furniture or equipmentbe kept in corridors except in the process ofmoving from one room to another.(D) Health of Employees

(i) All regular paid personnel should begiven pre-employment examinationsconsisting of a general physicalexamination, including a chest X-ray andstool cultures if a history of typhoid feveris elicited. A physical examination,including chest X-ray, should be repeatedannually on all such personnel. Otherpersonnel who show signs of otherrespiratory infections, skin lesions,diarrhea, and other communicable disease,should be excluded from work to returnonly after a checkup by a physician.

(E) There should be a space of at leastthree feet between beds, and sufficient spacearound the bed to facilitate nursing care andto accommodate the necessary equipment forcare. Beds shall be located to avoid drafts orothcr discomforts to patients.

(F) The window area of each bedroomshall equal at least one-eighth of a total floorarea. The minimum floor area should be atleast 100 sq uare feet in single bedrooms andat least 80 sq uare feet per bed inmulti-bedrooms. All nursing homes inoperation, as of the effective date of theseregulations, shall comply with therequirements of sec. 010. (e) to the extentpossible, but nothing contained herein shallbe so construed as to require majoralterations by such nursing homes, nor shall alicense be suspended or revoked for aninability to comply fully with sec. OIO.(e).

(ii) Personnel absent from duty becauseof any reportable communicable disease,infection, or exposure thereto, shall beexcluded from the hospital untilexamined by a physician designated forsuch purpose, and shall be certified byhim to the administrator as not sufferingany condition that may endanger thehealth of patients or employees. (2) Equipment for Patient Rooms. The

following items shall be provided for eachpatient unless clinically contraindicated ..(e) Accommodations,

Equipment for CareFurnishings and

(A) a comfortable, hospital-type bed, aclean mattress, waterproof sheeting or pad.pillows and necessary covering. Cleanbedding, towels, washcloths, bath blankets.and other necessary supplies shall be kept onhand for use at all times;

(1) Patient Rooms

(A) All bedrooms used for patients shallbe outside rooms, dry, well ventilated,naturally lighted, and otherwise suitable foroccupancy. Each bedroom shall have directaccess to corridor. (B) at least one chair;

(B) Rooms extending below ground levelshall not be used as bedrooms for patientsexcept that any patient bedroom, in use priorto the effective date of these regulations,may be continued provided it does notextend more than three feet below groundlevel.

(C) a locker or closet for storage ofclothing. Where one closet is used for two ormore persons, provisions shall be made forseparation of patients' clothing;

(0) a bedside table with compartment ordrawer to accommodate personal possessionsfor each person;

(C) No patient shaJJ, at any time, beadmitted for regular bed care to any room

7-60MA .::14--

Register 45. April 1973 HEALTH AND SOCIAL SERVICES 7 AAC 1.040

(E) cubi<.:le curtains or bed screens toafford. privacy in all multi-bed rooms;

(I) There shall be sufficient space andeq~ipment for the proper preparation andserving of food for both patients and personnel.The kitchen shall be used for no other purposethan activities connected with the dietary serviceand the washing and storage of dishes andutensils. A dining room or rooms shall beprovided for personnel. It is recommended thata separate dish washing area or room beprovided.

(F) a device for signaling attendants,which shall be kept in working order at alltimes except in psychiatric and pediatricunits, where an emergency call should beavailable in each patient's room for the use ofthe nurse;

(G) handwashing f.1.cilities, located in theroom or convenient to the room, for the useof patients and personnel. It is recommendedthat these be equipped with gooseneckspouts and wrist action controls;

(2) Food for patients and employees shall benutritious. free from contamination, properlyprepared. palatable. and e'J.Sily digestible. A fileof the menus served shall be maintained for atleast 30 days.

(H) a clinical thermometer to be sterilizedbefore each use;

(1) individual bedpans, wash basin$. emesisbasins, and mouth wash cups shall beprovided for each patien t confined to bed.This equipment shall be stored so that it willnot be interchanged and shall be sterilizedwhen the patient is discharged;

(3) All foods shall be stored and served so asto be protected from dust, flies, rodents, vermin,unnecessary handling, overhe:ld leakage, andother means of contamination. All readilyperishable food shall be stored in cleanrefrigerators at a temperature of 50 degreesFahrenheit or lower. Each refrigerator shall beequipped with a thermometer.

(J) no linen shall be interch:mgeable fromone patient to another before being properiylaundered.

(4) All fluid milk, cream, and milk productsshould be safe for human consumption. Wher~pasteurized milk is not available, condensed,evaporated or dried milk shall be used. Ice usedin contact with food or drink shall be obtainedfrom a source acceptable to the Department ofHealth and Social Services and handled anddispensed in a sanitary manner. --

(3) All medications which have been preparedfor an individual patient shall be di:>carded whenorders have been discontinued, or patient hasbeen dismissed. Individual narcotic medicationsshall be returned to the pharmacy foraccounting. (5) Handwashing facilities with hot and cold

running water, soap. and individual towels shallbe accessible for the use of al1 food handlers andso located in the kitchen to pennit directobservation by the supervisor. No employeeshall resume work after using the toilet roomwithout first washing his hands.

(A) Restraints shall be applied only whenthey are necess3IY to prevent injury to thepatient or to others, and shall be used onlywl.en alternative measures are not sufficientto accomplish their purposes. Carefulconsideration shall be given to the methodsby which they C.1n be speedily removed incase of fire or other emergency.

(6) Either of the follo',ving methods may beemployed in dishwashing:

(B) Hot water bags must be coveredbefore being placed in a bed, and carefullychecked as to temperature and leakage.Electric:ll heating pads shall be checkedperiodically. at least annually, by anelectrician.

(A) a three-,;ompartment sink orequivalent of a size adequate to permit theintroduction of long-handled wire baskets ofdishes shall be provided. There shall be asuffi"ient number of haskets to hold thedishes used during the peak load for a periodsuffit:ient to permit complet~ air-dr"jing.Water-h~:1ting ~qtlipmen[ I::lpable of(f) Foou S~rvi\.'~ and Goou Sanitation

7-61

~.040Register 45, April) 973 HEALTH AND SOCIAL SERVICES 7 AA(

construction, and opcration or wllicll mccts till'req uiremcnl.. of 18 AAC HO. Ilot witter or atemperdture required for it~ spc\:ific U!Ie shall heavailable as ncedcu. F()r thc protection orpatients and personnel, thermostaticallycontrolled valves shall he installed wllcrcindicated.

maintaining thc tcmpcratllTC of th~ water inthe disinfection compartment at 170 dl:gr~~:\Fahrenheit shall be provided. Drain boardsshall be part of the three-compartment sinkand adequate space shall be available fordrainage. The dishes shall be washed in therust compartment of the sink with warmwater containing a suitable detergent; rinsedin clear water in the second compartmcnt;and disinfected by comp1ete immersion inthe third compartment for at least twominutes in water at a temperature not 1owerthan 170 degrees Fahrenheit. Temperaturereadings shall be determined by athermometer. Dishes and utensils shall beair-dried.

(2) Sewage shall b~ uischargt:u into mllnicipalsewerclge system where such cJ sY!itcm isavailable; otherwise. the sewage shall bccollected, treated, and disposed of in a sewagedisposal system which meets the requirements of18 AAC 60.

(3) The plumbing and drainage, or otherarrangements for the disposal of excreta andwastes shall be in accordance with 7 AAC22.010-.080.

(B) Water pressure in the lines supplyingthe wash and rinse section of the dishwashingmachine shall not be less than 15 pounds persquare inch for more than 30 pounds persquare inch. The rinse water shall be at atemperature not lower than 180 degreesFahrenheit at the machine. TIle machinesshall be equipped with thermometers whichwill indicate accurately the temperature ofthe wash water and rinse water. Dishes andutensils shall be air-dried.

(4) The toilets shall be conveniently locatcdand provided in nllml"ICr ample for use accordingto the number of patiellts and pcrsollnel. or botllsexes. TIle minimum rcquircmcnt is onc toilctfor each eight patients or fraction thcreor.

(5) Handwashing facilities of the proper tYI1Cin each instance shall be readily available forphysicians, nurses and other personnel.Lavatories shall be provided in the ratio of atleast one lavatory for each eight patients orfraction thereof. Lavatories shall be readilyaccessible to all toilets. Individual towels andsoap shall be available at all times. The lIseofthe common towel is prohibited.

(7) AU rooms in which food is stored,prepared, or ~rved, or which utensils arewashed, shall be well-ventilated. The cookingarea shall be ventilated to control temperature,smoke and odors.

(8) Garbage shall be disposed of in a manneracceptable to the Department of Health andSocial Services. When stored it shall be retainedin water-tight metal cans equipped with tightlyfitting metal covers. All containers for thecollections of garbage and refuse shall be kept ina sanitary conditon.

(6) A bathtub or shower shall be provided inthe ratio of at least one tub or shower for each30 patients or fraction thereof.

(7) Outside opening... including door!' ..nowindows shall be properly screened or othcrwiseprotectcd to prevent thc cntrance of nie!i.moSQuitocs. and other in!;Ccts.(9) Conveniently located toilet and lavatory

facilities shall be provided for employeesengaged in food handling. Toilet rooms shall notopen directly into any room in which food isprepared or utenSils are handled or stored.

(h) Physical Plant

(1) The nursing home structure and itsequipment shall be kept in good repair andoperated at all times with regard for health.treatment, comfort, safety and well-being of thepatients and personnel.

(g) Sanitation

(I) The water supply shall be of safe sanitaryquality, suitable for use, and shall be obtainedfrom a water supply system, the location,

-62MA 1l:f

State of ALASKA ;ttaC1!:tent 4.oaqe 37

Register 63, October 1977 HEALTH AND SOCIAL SERVICES 1 AAC 12.0401 AAC 12.061

(2) Fire protection for the nursing home shallbe provided in accordance with the requirementsof the State Fue MaIShal. All nursins homesshall have a written fire manual, outlininS a planfor the movement of patients to a safe locationin case of fire. Approval by the State FireMarshal of the fire protection of a nursins homeshould be a prerequisite for licensure.

(1) Nursing homes, licensed as of theeffective date of these regulations. shall complywith the requirements contained in this section,entitled "Regulations for the Licer.sing,Operation, and Maintenance of Nursing Homes"where applicable, to give skill~d nursing care andrelated medical services to individuals admittedto nwsing homes.

. (3) Walls, floors and ceilings shall be kept

dean and in good repair at all times. They shallbe of a type to pennit good maintenanceincluding frequent washings, cleaning. orpainting.

(2) Nursing hom~ licensed after July 28,1959, must be in compliance with 7 AAC 09,Design and Construction of Health Facilities.

(3) When construction of a new nursinghome is contemplated, it must be in compliancewith 7 AAC 09, Design and Construction ofHealth Facilities. (In effect before 7/28/59; am1/28/73, Reg. 45; am 9/24/77 ,Reg. 63)

Authority: AS 18.20.060

(4) Lighting

(A) All areas shall be adequately lighted.

(B) When construction of a new nursinghome is contemplated, it shall be incompliance with 7 AAC 09, Design andConstruction of Health Facilities.

HistorlC:l1 Note: The ianauase Crom "After September 15. 191:~ nunil1l home..:' added by mlCf1ency regulations .'!ledAu:ust 31. 1972. Register 43. Said emergency fllUiationsteqUiRd Ii~nsure by A1asb Nuninl Home AdminiStratorsLicmsinc Boud ~ted by emer:ency regulations mid AulUSt31, 191:, Re;jster 43. RemaiN=--; lanlUa~ in effect Oft andbefore July 28. 1959, the effective date of the AJ3.sko1AdmmisuattYe PtOCedure Act.

(i) Reports and Records

(I) The admission, medical, and nuISingrecords shall be main tamed and made freelyaccessible to those responsible for the care ofthe patient. They shall be open to the inspectionof the licensing agent of the Department ofHealth and Social Services.

7 AAC 12.045. ALASKA NURSING HOMEADMINISTRATOR LICENSING BOARD;UCENSING REQUIREMENTS. Annulled underAS 44.62.320. passed 5/3/76.

7 AAC 12.050. NURSING HOMECONSTRUCTION AND EQUIPMENT.Repealed. (Err. 4/28/77. Reg. 621

(2) Admission and death records shall bekept as prescribed by the Department of Healthand Social Services for license and as is requiredby the Bureau of Vibl Statistics. Such recordsshall be preserved. When a home is closing orownership is being transferred, the lic:nsee shallapply to the Department of Health and SocialSelVices for the instruction as to disposition ofthe admission and death records.

7 AAC 12.060. PREPAR.-\TION OFNURSING HOME PLANS ANDSPECIFICA nONS. Repealed. (Efr. 4/28/77.Reg. 62)

~"

-"

ARTICLE IA.INTE R.\1 ED IA TE CARE F ACIL~z:.S

(3) Physicians' C)rd~rs sh:ill be preserv~d with,the record of th~ patient. Section

61.62.64.65.66.68.

(4) An annual report regarding s:rvicesfurnished during tile preceding Ye:1r !hall b~submitted to the Department of H~alth andSocial Services on torms furnished for thispurpose. .

Ucensing of intermedi~te care facilityApplic:ltion for and issU:lnce of licenseReVoc3tion or deni3l of licenseStandards of operationSafety and S:lnitation st:J.ndardsDefinitions

1 AAC 12.061. LICENSING OFINTERI\fED L~ TE CARE F ACILrrY . No pe.-son

(j) Nursing Homes' Compliant;:

7-63

.~ttachment 4.11-Ao.,aae 387 AAC 12.0617 AAC 12.066

State of ALASKA

Register 63, October 1977 HEAL lli AND SOCIAL SERVICES

may operate an institution which constitutes antermediate care facility, or an intermediate.re facility which is a distinct part of another

itlStitoltion, without a license issued by thedepartment. (Eff. 3/29/75, Reg. 53)

Authority: AS 18.20.020AS 18.20.060

denial in writing by the department withoutunnecessary delay. The licensee or applicantmay appeal the action to the commissioner ofthe department within 90 days of the receipt ofnotice of revocation or denial. (Err. 3/29/75,Reg. 53)

Authority: AS 18.20.050AS 18.20.060

1 AAC 12.062. APPUCATION FOR ANDISSUAJ."-tCE OF UCENSE. (a) An applicationConn for a license to operate an intennediatecare facility will be furnished upon request tothe department.

7 AAC 12.065. STANDARDS OFOPERATION. No intermediate care facility willbe licensed unless on or after the effective dateof secs. 61-68 of this chapter it meets thestandard prescribed by

(0) The licensee is the officer or member ofthe staff or governing body on whom rests theresponsibility for maintaining approvedstandards for the facility.

4S CFR Sec. 249.12, Standards for IntennediateCare Facilities, as revised January 17, 1974

and if it is an intennediate care facility for thementally retarded, it also complies on and afterMarch 18, 1977 with the provisions of

(c) A license is valid only for the licensee andp~mises named in the license and is nottsansferable. Any change in location orownership shall be reported immediately to thedepartment

45 CFR Sec. 249.13, Standards for IntermediateCare Facilities for the Mentally Retarded orPersons with Related Conditions, as revisedJanuary 17, 1974(d) Separate licenses are required for

.~temlediate care facilities maintained on.;parate premises, even though they are

operated by the same management. However,several separate licenses are not required forsepara~e buildings on the same ground.

which are adopted by reference. Copies of 45CFR Secs. 249.12 and 249.13 will be furnishedto applicants and licensees by the d=partInent.(Eif. 3/29/75, Reg. 53)

Authority: AS 18.20.060(e) The license shall be posted in a

conspicuous plac~ on the premises in the publiclobby or waiting room of the intermediate carefacility.

i AAC 12.066. SAFETY A..~D SA.~ATIONSTANDARDS. No intennediate care facility willbe licensed unless it meets the standards forsafety and sanitation prescribed for healthfacilities by 7 AAC 09. Design and Constructionof 'Health Facilities. (Efr. 3/29/i5. Reg. 53; am9/24i11, Reg. 63)

~

(0 Each license to operate an intermediatecare facility expires on June 30 following thedate of issue. and if a renewal is desired, thelicensee shall make application at least 30 daysprior to th~ expiration date upon :J. formadopt~d by the department. (EfT. 3/29/75. Reg.S3)

Authority: AS 18.20.060

Authority: AS 18.20.040AS 18.20.060

7 AAC 12.064. REVOCATION OR DENIALOF LICENSE. Any person whose license hasbeen revoked tor cause will be advised in writingby the department 90 days before the effective~ate of the revocation. An appliQnt for a.:ensc, or renewal of :I license, whose

Ipplication is denied will be advised of tilej)

7-64

t,ttaC:ime;nt 4. I I-~"aoe 3Q

HEALTH AND SOCIAL SERVICES' 7 AAC 12.0687 AAC 12.070

~'ta'te OT J:..LA~I"..\

Register 63. October 1977

7 AAC 12.068. DEFINrrIONS. As used in~ 61-68 of this chapter

Services" as used herein refers to the AlaskaCommissioner of Health and Social Services.

(1) "department" me3.nS the Department ofHealth "and Social Services;

(2) "Commissioner of Health and SocialServices'. refers to the executive officer of theAlaska Department of Health a.'1d SocialServices, appointed by the Governor.(2) "distinct part" means an identifiable unit

such as an entire ward or contiguous wards,wing, floor or building which meets allrequirements for an intermediate care facility,although it shares such central services andfacilities as management services, food services,building maintenance and laundry with otherunits;

. (3) "Community or settlement,'. for thepurpose of administering this act, is defined asan y place having approximately 1,000penn anent residents, or any other placedesignated by the Commissioner of Health andSocial Services as having special health problems.

(3) "'institution for the mentally retarded orpersons with related conditions" means aninstitution (or distinct part of one) operatedprimarily for the diagnosis, treatment orrehabilitation of the mentally retarded orpersons with related conditions which providesin a protected residential setting, individualizedongoing evaluation, planning, 24-hour-a-daysupervision, coordination and integration ofhealth or rehabilitation services to help eachindividual reach his maximum of functioningapabilities;

(4) "Health Unit'. shall consist of onecommunity or settlement as detmed above, plussuch contiguous areas as may be designated bythe Commissioner of Health and Social Services.

(5) "Local Board of Health" refers to thepersor.s appointed for each health unit. Suchboard may consist of

(A) the president of the school board andtwo persons appointed by the school board;or

(B) three persons appointed by theCommissioner of Health and Social Serviceswhere no school board exists; or

(4) "intermediate care facility" means aninstitution which provides. on a regular basis.health-related care and services to individualswho do not require the degree of care andtreatment which a hospital or skil1ed nursingr:1t:ility i.~ d\.'Si~nL'd to proviuc. but who hCC:lll~Cor t11cir mcntal or physit::J1 condition requireClre and services (above t.'1e level of room andboard) which can be made available to themonly through institutional facilities. (Erf.3/29/75. Reg. 53)

(C) the board of health as established by:1n iI1cOrt}()r&ltcd town.

~.(6) "Health district" shall consist of two or

more contiguous health units.

(7) "District board of health'. refers to thepersons appointed for the district by theCommissioner of Health and Social Services.

.-Authority: AS 18.20.020

AS 18.20.060J..

(8) "Local or district departm~nt of health'"ARTICLE 2.LOCAL HEALTH UNITS AND DISTRICTS

Section70.80.

Creation of units and districtsState aid to loC:ll health districts

7 AAC 12.0;0. CRE..\TION OF UNTIS ANDDISTRlCfS. (a) Definitions

of He:llti\ and Social(1) "Coommissioner

7-65/7-73(corrdCted)