§ 201.3. Definitions.

 The following words and terms, when used in this subpart, have the following meanings, unless the context clearly indicates otherwise:

   Abuse—The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental and psychosocial well-being. This presumes that instances of abuse of all residents, even those in a coma, cause physical harm, or pain or mental anguish. The term includes the following:

     (i)   Verbal abuse—Any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance, regardless of their age, ability to comprehend or disability. Examples of verbal abuse include:

       (A)   Threats of harm.

       (B)   Saying things to frighten a resident, such as telling a resident that the resident will never be able to see his family again.

     (ii)   Sexual abuse—Includes sexual harassment, sexual coercion or sexual assault.

     (iii)   Physical abuse—Includes hitting, slapping, pinching and kicking. The term also includes controlling behavior through corporal punishment.

     (iv)   Mental abuse—Includes humiliation, harassment, threats of punishment or deprivation.

     (v)   Involuntary seclusion—Separation of a resident from other residents or from his room or confinement to his room (with/without roommates) against the resident’s will, or the will of the resident’s legal representative. Emergency or short term monitored separation from other residents will not be considered involuntary seclusion and may be permitted if used for a limited period of time as a therapeutic intervention to reduce agitation until professional staff can develop a plan of care to meet the resident’s needs.

     (vi)   Neglect—The deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health.

   Act—The Health Care Facilities Act (35 P. S. § §  448.101—448.904).

   Administration of drugs—The giving of a dose of medication to a patient as a result of an order of a practitioner licensed by the Commonwealth to prescribe drugs.

   Administrator—An individual who is charged with the general administration of a facility, whether or not the individual has an ownership interest in the facility and whether or not the individual’s functions and duties are shared with one or more other individuals. The administrator shall be currently licensed and registered by the Department of State under the Nursing Home Administrators License Act (63 P. S. § §  1101—1114.2).

   Alteration—An addition, modification or modernization in the structure or usage of a building or section thereof or change in the services rendered.

   Ambulatory resident—An individual who is physically and mentally capable of getting in and out of bed and walking a normal path to safety in a reasonable period of time, including the ascent and descent of stairs without the aid of another person.

   Audiologist—A person licensed as an audiologist by the Pennsylvania State Board of Examiners in Speech-Language and Hearing, or excluded from the requirement of licensure under the Speech-Language and Hearing Licensure Act (63 P. S. § §  1701—1719).

   Authorized person to administer drugs and medications—Persons qualified to administer drugs and medications in facilities are as follows:

     (i)   Physicians and dentists who are currently licensed by the Bureau of Professional and Occupational Affairs, Department of State.

     (ii)   Registered nurses who are currently licensed by the Bureau of Professional and Occupational Affairs, Department of State.

     (iii)   Practical nurses who have successfully passed the State Board of Nursing examination.

     (iv)   Practical nurses licensed by waiver in this Commonwealth who have successfully passed the United States Public Health Service Proficiency Examination.

     (v)   Practical nurses licensed by waiver in this Commonwealth who have successfully passed a medication course approved by the State Board of Nursing.

     (vi)   Student nurses of approved nursing programs who are functioning under the direct supervision of a member of the school faculty who is present in the facility.

     (vii)   Recent graduates of approved nursing programs who possess valid temporary practice permits and who are functioning under the direct supervision of a professional nurse who is present in the facility. The permits shall expire if the holders of the permits fail the licensing examinations.

     (viii)   Physician assistants and registered nurse practitioners who are certified by the Bureau of Professional and Occupational Affairs.

   Basement—A story or floor level below the main or street floor. If, due to grade differences, there are two levels qualifying as a street floor, a basement is a floor below the lower of the two street floors.

   CRNP—Certified Registered Nurse Practitioner—A registered nurse licensed in this Commonwealth who is certified by the State Board of Nursing and the State Board of Medicine as a CRNP, under the Professional Nursing Law (63 P. S. § §  211—225) and the Medical Practice Act of 1985 (63 P. S. § §  422.1—422.45).

   Charge nurse—A person designated by the facility who is experienced in nursing service administration and supervision and in areas such as rehabilitative or geriatric nursing or who acquires the preparation through formal staff development programs and who is licensed by the Commonwealth as one of the following:

     (i)   A registered nurse.

     (ii)   A registered nurse licensed by another state as a registered nurse and who has applied for endorsement from the State Board of Nursing and has received written notice that the application has been received by the State Board of Nursing. This subparagraph applies for 1 year, or until Commonwealth licensure is completed, whichever period is shorter.

     (iii)   A practical nurse who is a graduate of a Commonwealth recognized school of practical nursing or who has 2 years of appropriate experience following licensure by waiver as a practical nurse.

     (iv)   A practical nurse shall be designated by the facility as a charge nurse only on the night tour of duty in a facility with a census of 59 or less.

   Clinical laboratory—A place, establishment or institution, organized and operated primarily for the performance of bacteriological, biochemical, hematological, microscopical, serological or parasitological or other tests by the practical application of one or more of the fundamental sciences to material originating from the human body, by the use of specialized apparatus, equipment and methods, for the purpose of obtaining scientific data which may be used as an aid to ascertain the state of health. The tests are conducted using specialized apparatus, equipment and methods, for the purpose of obtaining scientific data which may be used as an aid to ascertain the state of health.

   Clinical records—Facility records, whether or not automated, pertaining to a resident, including medical records.

   Controlled substance—A drug, substance or immediate precursor included in Schedules I—V of the Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § §  780-101—780-144).

   Corridor—A passageway, hallway or other common avenue used by residents and personnel to travel between buildings or sections of the same building to reach a common exit or service area. The service area includes, but is not limited to, living room, kitchen, bathroom, therapy rooms and storage areas not immediately adjoining the patient’s sleeping quarters.

   Department—The Department of Health of the Commonwealth.

   Dietetic service supervisor—A person who meets one of the following requirements:

     (i)   Is a dietitian.

     (ii)   Is a graduate of a dietetic technician or dietetic assistant training program, correspondence course or classroom course approved by the American Dietetic Association.

     (iii)   Is a member of the American Dietetic Association or the Dietary Managers Association.

     (iv)   Is a graduate of a State approved course that provided 90 or more hours of classroom instruction in food service supervision and has experience as a supervisor in a health care institution with consultation from a dietitian.

     (v)   Has training and experience in food service supervision and management in a military service equivalent in content to the program in subparagraph (iv).

     (vi)   Has a baccalaureate degree from a State approved or accredited college or university and has at least 12 credit hours in food service, nutrition or diet therapy and at least 1 year of supervisory experience in the dietary department of a health care facility.

   Dietitian—A person who is either:

     (i)   Registered by the Commission on Dietetic Registration of the American Dietetic Association.

     (ii)   Eligible for registration and who has a minimum of a bachelor’s degree from a United States regionally accredited college or university and has completed the American Dietetic Association (ADA) approved dietetic course requirements and the requisite number of hours of ADA approved supervised practice.

   Director of nursing services—A registered nurse who is licensed and eligible to practice in this Commonwealth and has 1 year of experience or education in nursing service administration and supervision, as well as additional education or experience in areas such as rehabilitative or geriatric nursing, and participates annually in continuing nursing education. The director of nursing services is responsible for the organization, supervision and administration of the total nursing service program in the facility.

   Drug administration—An act in which a single dose of a prescribed drug or biological is given to a resident by an authorized person in accordance with statutes and regulations governing the act. The complete act of administration entails removing an individual dose from a previously dispensed, properly labeled container, verifying it with the physician’s orders, giving the individual dose to the proper resident and promptly recording the time and dose given.

   Drug dispensing—An act by a practitioner or a person who is licensed in this Commonwealth to dispense drugs under the Pharmacy Act (63 P. S. § §  390-1—390-13) entailing the interpretation of an order for a drug or biological and, under that order, the proper selecting, measuring, labeling, packaging and issuance of the drug or biological for a resident or for a service unit of the facility.

   Drug or medication—A substance meeting one of the following qualifications:

     (i)   Is recognized in the official United States Pharmacopeia, or official National Formulary or a supplement to either of them.

     (ii)   Is intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or other animals.

     (iii)   Is other than food and intended to affect the structure or a function of the human body or other animal body.

     (iv)   Is intended for use as a component of an article specified in subparagraph (i), (ii) or (iii), but not including devices or their components, parts or accessories.

   Elopement—When a resident leaves the facility without the facility staff being aware that the resident has done so.

   Existing facility—A long-term care nursing facility or section thereof which was constructed and licensed as such on or before July 24, 1999.

   Exit or exitway—A required means of direct egress in either a horizontal or vertical direction leading to the exterior grade level.

   Facility—A licensed long-term care nursing facility as defined in Chapter 8 of the act (35 P. S. § §  448.801—448.821).

   Full-time—A minimum of a 35-hour work week involving a minimum of 4 days per week.

   Interdisciplinary team—A team including the resident’s attending physician, a registered nurse with responsibility for the resident and other appropriate staff in disciplines as determined by the resident’s needs, and the resident. If the resident is cognitively impaired and unable to fully participate, the team shall include to the extent practicable, the participation of the resident, and shall also include the resident’s family, a responsible person or the resident’s legal representative.

   Licensed practical nurse—A practical nurse licensed to practice under the Practical Nurse Law (63 P. S. § §  651—667.8).

   Licensee—The individual, partnership, association or corporate entity including a public agency or religious or fraternal or philanthropic organization authorized to operate a licensed facility.

   Locked restraints—A mechanical apparatus or device employed to restrict voluntary movement of a person not removable by the person. The term includes shackles, straight jackets and cage-like enclosures and other similar devices.

   Medical record practitioner—A person who is certified or eligible for certification as a registered records administrator (RRA) or a health information technologist/accredited record technician by the American Health Information Management Association (AHIMA) and who has the number of continuing education credits required for each designation by the AHIMA.

   NFPA—National Fire Protection Association.

   Nonambulatory resident—A resident who is not physically or mentally capable of getting in and out of bed and walking a normal path to safety in a reasonable period of time, including the ascent and descent of stairs, without the aid of another person.

   Nonproprietary drug—A drug containing a quantity of controlled substance or drug requiring a prescription, a drug containing biologicals or substances of glandular origin—except intestinal-enzymes and liver products—and drugs which are administered parenterally.

   Nurse aide—An individual providing nursing or nursing-related services to residents in a facility who:

     (i)   Does not have a license to practice professional or practical nursing in this Commonwealth.

     (ii)   Does not volunteer services for no pay.

     (iii)   Has met the requisite training and competency evaluation requirements as defined in 42 CFR 483.75 (relating to administration).

     (iv)   Appears on the Commonwealth’s Nurse Aide Registry.

     (v)   Has no substantiated findings of abuse, neglect or misappropriation of resident property recorded in the Nurse Aide Registry.

   Nursing care—A planned program to meet the physical and emotional needs of the resident. The term includes procedures that require nursing skills and techniques applied by properly trained personnel.

   Nursing service personnel—Registered nurses, licensed practical nurses and nurse aides.

   Occupational therapist—A person licensed as an occupational therapist by the State Board of Occupational Therapy Education and Licensure.

   Occupational therapy assistant—A person licensed as an occupational therapy assistant by the State Board of Occupational Therapy Education and Licensure.

   Pharmacist—A person licensed by the State Board of Pharmacy to engage in the practice of pharmacy.

   Pharmacy—A place properly licensed by the State Board of Pharmacy where the practice of pharmacy is conducted.

   Physical therapist—A person licensed as a physical therapist by the State Board of Physical Therapy.

   Physical therapy assistant—A person registered as a physical therapy assistant by the State Board of Physical Therapy.

   Physician assistant—An individual certified as a physician assistant by the State Board of Medicine under the Medical Practice Act of 1985 (63 P. S. § §  422.1—422.45), or by the State Board of Osteopathic Medical Examiners under the Osteopathic Medical Practice Act (63 P. S. § §  271.1—271.18).

   Practice of pharmacy—The practice of the profession concerned with the art and science of the evaluation of prescription orders and the preparing, compounding and dispensing of drugs and devices, whether dispensed on the prescription of a medical practitioner or legally dispensed or provided to a consumer. The term includes the proper and safe storage and distribution of drugs, the maintenance of proper records, the participation in drug selection and drug utilization reviews and the responsibility of relating information as required concerning the drugs and medicines and their therapeutic values and uses in the treatment and prevention of disease. The term does not include the operations of a manufacturer or distributor as defined in The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. § §  780-101—780-144).

   Prescription—A written or verbal order for drugs issued by a licensed medical practitioner in the course of this professional practice.

   Proprietary drug—A drug which does not contain a quantity of a controlled substance which can be purchased without a prescription and may be purchased from sources other than a pharmacy, and is usually sold under a patented or trade name.

   Registered nurse—A nurse licensed to practice in this Commonwealth under The Professional Nursing Law (63 P. S. § §  211—225.5).

   Resident—A person who is admitted to a licensed long-term care nursing facility for observation, treatment, or care for illness, disease, injury or other disability.

   Resident activities coordinator—A person who meets one of the following requirements:

     (i)   Is a qualified therapeutic recreation specialist.

     (ii)   Has 2 years of experience in a social or recreational program, within the last 5 years, 1 year of which was full-time in a patient activities program in a health care setting.

   Residential unit—A section or area where persons reside who do not require long-term nursing facility care.

   Responsible person—A person who is not an employe of the facility and is responsible for making decisions on behalf of the resident. The person shall be so designated by the resident or the court and documentation shall be available on the resident’s clinical record to this effect. An employe of the facility will be permitted to be a responsible person only if appointed the resident’s legal guardian by the court.

   Restraint—A restraint can be physical or chemical.

     (i)   A physical restraint includes any apparatus, appliance, device or garment applied to or adjacent to a resident’s body, which restricts or diminishes the resident’s level of independence or freedom.

     (ii)   A chemical restraint includes psychopharmacologic drugs that are used for discipline or convenience and not required to treat medical symptoms.

   Skilled or intermediate nursing care—Professionally supervised nursing care and related medical and other health services provided for a period exceeding 24 hours to an individual not in need of hospitalization, but whose needs are above the level of room and board and can only be met in a long-term care nursing facility on an inpatient basis because of age, illness, disease, injury, convalescence or physical or mental infirmity. The term includes the provision of inpatient services that are needed on a daily basis by the resident, ordered by and provided under the direction of a physician, and which require the skills of professional personnel, such as, registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech pathologists or audiologists.

   Social worker—An individual with the following qualifications:

     (i)   A Bachelor’s Degree in social work or a Bachelor’s Degree in a human services field including sociology, special education, rehabilitation counseling and psychology.

     (ii)   One year of supervised social work experience in a health care setting working directly with individuals.

   Speech/language pathologist—A person licensed as a speech/language pathologist by the State Board of Examiners in Speech-Language and Hearing, or excluded from the requirements of licensure under the Speech-Language and Hearing Licensure Act (63 P. S. § §  1701—1719).

   The provisions of this §  201.3 amended under section 803 of the Health Care Facilities Act (35 P. S. §  448.803); and section 2102(g) of The Administrative Code of 1929 (71 P. S. §  532(g)).

   The provisions of this §  201.3 adopted August 29, 1975, effective September 1, 1975, 5 Pa.B. 2233; amended October 1, 1976, effective October 2, 1976, 6 Pa.B. 2441; amended February 11, 1977, effective February 12, 1977, 7 Pa.B. 437; amended May 6, 1977, effective May 7, 1977, 7 Pa.B. 1236; amended May 26, 1978, effective May 27, 1978, 8 Pa.B. 1466; amended July 6, 1979, effective July 7, 1979, 9 Pa.B. 2252; amended April 23, 1982, effective April 24, 1982, 12 Pa.B. 1316; amended January 31, 1987, effective July 1, 1987, 17 Pa.B. 514; corrected June 19, 1987, 17 Pa.B. 2462; amended July 23, 1999, effective July 24, 1999, 29 Pa.B. 3999. Immediately preceding text appears at serial pages (202309) to (202317).

   This section cited in 28 Pa. Code §  211.9 (relating to pharmacy services).