Pennsylvania nursing home responsiveness requirements

The licensee, through the administrator, must report serious incidents involving residents to the appropriate DOH Division of Nursing Care Facilities field office as soon as possible and no later than 24 hours.

The licensee through the administrator shall report as soon as possible, or, at the latest, within 24 hours to the appropriate Division of Nursing Care Facilities field office serious incidents involving residents as set forth in § 51.3 (relating to notification). For purposes of this subpart, references to patients in § 51.3 include references to residents.

Defines what must be reported under § 201.14(c): any event seriously compromising quality assurance or patient safety must be reported immediately in writing, and the enumerated list expressly includes complaints of patient abuse whether or not the facility confirms them, rape, elopements, deaths from injury or unusual circumstances, and transfers to a hospital from injuries or accidents.

Complaints of patient abuse, whether or not confirmed by the facility.

Under the Older Adults Protective Services Act regulations, any administrator or employee with reasonable cause to suspect a resident is a victim of abuse must make an immediate oral report to the area protective services agency and a written report within 48 hours, and the agency must then immediately notify the state facility licensing agency.

Administrators or employees who have reasonable cause to suspect that a recipient is a victim of abuse shall: (1) Immediately make an oral report to the agency. (2) Make a written report to the agency within 48 hours.

For suspected sexual abuse, serious physical or bodily injury, or a suspicious death, the reporter must additionally make an immediate oral report to law enforcement, an oral report to the Department of Aging during the current business day (or at the opening of the next business day if after hours), and a written report within 48 hours.

Administrators or employees who have reasonable cause to suspect that a recipient is the victim of sexual abuse, serious physical injury or serious bodily injury, or that a recipient's death is suspicious, shall, in addition to the reporting requirements in § 15.151(a) (relating to general requirements): (1) Immediately make an oral report to law enforcement officials.

Pennsylvania does not write its own 24-hour physician availability rule; it adopts 42 CFR Part 483 Subpart B (which contains 483.30) wholesale as the state licensing regulation, so the federal physician-availability duty is directly enforceable as state licensure law.

The Department incorporates by reference 42 CFR Part 483, Subpart B of the Federal requirements for long-term care facilities, (relating to requirements for long-term care facilities), as licensing regulations for long-term care nursing facilities, with the exception of 42 CFR 483.1 (relating to basis and scope) and the requirements under 42 CFR Part 483 Subpart B for the transmission of data and minimum data set (MDS) reporting to the Centers for Medicare & Medicaid Services (CMS) unless the facility is participating in the Medicare or Medical Assistance Program.

Pennsylvania imposes its own hard nurse-staffing ratios on top of the federal rule (effective 7/1/2023 and 7/1/2024), requires a full-time RN director of nursing and a designated charge nurse on every tour of duty, sets a 3.2 direct-care-hours-per-resident-day floor as of 7/1/2024, and permits an LPN to stand in for an RN overnight only in facilities of 59 or fewer residents and only when an RN is on call within a 30-minute drive.

A facility with a census of 59 or under may substitute an LPN for an RN on the overnight shift only if an RN is on call and located within a 30-minute drive of the facility.

Adopts the federal 42 CFR 483.10 resident rights (including the federal telephone-access and private-communication rights) as state licensure requirements, requires them to be posted near entrances and on each floor and personally delivered with a certificate filed in the medical record, and adds four PA-only rights on top.

The governing body of the facility shall establish written policies regarding the rights and responsibilities of residents as provided for in 42 CFR 483.10 (relating to resident rights) and this section.

A prospective licensee must file a proposed emergency preparedness plan meeting 42 CFR 483.73(a) as part of its licensure application, making the federal emergency plan (which includes the communication plan and current emergency contact lists) a condition of getting and holding a PA license.

A proposed emergency preparedness plan that meets the requirements of 42 CFR 483.73(a) (relating to emergency preparedness).

Every facility must run an ongoing education program that includes, at minimum, annual in-service training on emergency preparedness in accordance with 42 CFR 483.73(d), alongside annual training on fire prevention and safety under 42 CFR 483.90.

Emergency preparedness in accordance with 42 CFR 483.73(d) (relating to emergency preparedness).

For facilities constructed, altered or renovated under approvals granted before July 1, 2023, a nurse's calling station accessible to the resident must be provided at each resident bed location, and an emergency calling station within reach of the resident must be provided at each bathing fixture and toilet unless a single bell can be reached by the resident from both. Calls must register at the nurses' station and activate a visible signal in the corridor at the resident's door, plus additional visible indicators at corridor intersections in multicorridor nursing units.

Calls shall register by a signal receiving and indicating device at the nurses' station, and shall activate a visible signal in the corridor at the resident's door. In multicorridor nursing units, additional visible signal indicators shall be installed at corridor intersections.

For construction, alteration or renovation approved on or after July 1, 2023, general bathing and shower rooms must have an emergency signal bell near the tub or shower that registers at the workstation, plus a bell at each toilet unless one bell is reachable from both.

The general bathroom or shower room used by residents shall have one emergency signal bell located in close proximity to the tub or shower and which registers at the workstation. An emergency signal bell shall also be located at each toilet unless a signal bell can be reached by the resident from both the toilet and tub or shower.

The only PA-drafted quality-assurance duty in the nursing facility chapters: the facility's quality assurance committee owns oversight of pharmaceutical services and, with pharmacist input, must write the policies for drug therapy, distribution, administration, control, accountability and use.

The oversight of pharmaceutical services shall be the responsibility of the quality assurance committee. Arrangements shall be made for the pharmacist responsible for the adequacy and accuracy of the services to have committee input.