Part VII. Health Care Services
6VAC35-71-870. [Reserved].
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-880. Local health authority.
A physician, health administrator, government authority, health care contractor, supervising registered nurse or head nurse, or health agency shall be designated the local health authority responsible for organizing, planning, and monitoring the timely provision of appropriate health care services, including arrangements for all levels of health care and the ensuring of quality and accessibility of all health services, including medical, nursing, dental, and mental health care, consistent with applicable statutes, prevailing community standards, and medical ethics. All medical, psychiatric, dental, and nursing matters are the province of the physician, dentist, and nurse, respectively.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-890. Provision of health care services.
A. The health care provider shall be guided by recommendations of the American Academy of Family Practice or the American Academy of Pediatrics, as appropriate, in the direct provision of health care services.
B. Treatment by nursing personnel shall be performed pursuant to the laws and regulations governing the practice of nursing within the Commonwealth. Other health trained personnel shall provide care within their level of training and certification.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-900. Health care procedures.
A. The department shall have and implement written procedures for promptly:
1. Providing or arranging for the provision of medical and dental services for health problems identified at admission;
2. Providing or arranging for the provision of routine ongoing and follow-up medical and dental services after admission;
3. Providing emergency services for each resident as provided by statute or by the agreement with the resident's legal guardian, if under the age of 18, or the resident, if over the age of 18;
4. Providing emergency services for any resident experiencing or showing signs of suicidal or homicidal thoughts, symptoms of mood or thought disorders, or other mental health problems; and
5. Ensuring that the required information in subsection B of this section is accessible and up to date.
B. The following written information concerning each resident shall be readily accessible to designated staff who may have to respond to a medical or dental emergency:
1. The physician or dentist to be contacted;
2. Name, address, and telephone number of a relative or other person to be notified; and
3. Information concerning:
a. Use of medication;
b. All allergies, including medication allergies;
c. Substance abuse and use; and
d. Significant past and present medical problems.
C. Other health trained personnel shall provide care as appropriate to their level of training and certification and shall not administer health care services for which they are not qualified or specifically trained.
D. The facility shall retain documentation of the training received by health trained personnel necessary to perform any designated health care services. Documentation of applicable, current licensure or certification shall constitute compliance with this section.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-910. [Reserved].
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-920. [Reserved].
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-930. Consent to and refusal of health care services.
A. The resident or parent or legal guardian, as applicable, shall be advised by an appropriately trained medical professional of (i) the material facts regarding the nature, consequences, and risks of the proposed treatment, examination, or procedure; and (ii) the alternatives to it.
B. Health care services, as defined in 6VAC35-71-10 (definitions), shall be provided in accordance with § 54.1-2969 of the Code of Virginia.
C. Residents may refuse, in writing, medical treatment and care. This subsection does not apply to medication refusals that are governed by 6VAC35-71-1070 (medication).
D. When health care is rendered against the resident's will, it shall be in accordance with applicable laws and regulations.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-940. Health screening at admission.
Written procedure shall require that:
1. To prevent newly arrived residents who pose a health or safety threat to themselves or others from being admitted to the general population, all residents shall immediately upon admission undergo a preliminary health screening consisting of a structured interview and observation by health care personnel or health trained staff.
2. Residents admitted to the facility who are identified through the screening required in subdivision 1 of this section as posing a health risk to themselves or others shall be separated from the facility's general population until they are no longer a risk. During the period of separation, the residents shall receive services approximating those available to the facility's general population, as deemed appropriate to their condition.
3. Immediate health care is provided to residents who need it.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-950. Tuberculosis screening.
A. Within seven days of placement, each resident shall have had a screening assessment for tuberculosis. The screening assessment can be no older than 30 days.
B. A screening assessment for tuberculosis shall be completed annually on each resident.
C. The facility's screening practices shall be performed consistent with the current requirements of the Virginia Department of Health, Division of Tuberculosis Prevention and Control and the federal Department of Health and Human Services Centers for Disease Control and Prevention, for the detection, diagnosis, prophylaxis, and treatment of pulmonary tuberculosis.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-960. Medical examinations.
A. Within five days of arrival at a JCC, all residents who are not directly transferred from another JCC shall be medically examined by a physician or a qualified health care practitioner operating under the supervision of a physician to determine if the resident requires medical attention or poses a threat to the health of staff or other residents. This examination shall include the following:
1. Complete medical, immunization, and psychiatric history;
2. Recording of height, weight, body mass index, temperature, pulse, respiration, and blood pressure;
3. Reports of medical laboratory testing and clinical testing results, as deemed medically appropriate, to determine both clinical status and freedom from communicable disease;
4. Medical examination, including gynecological assessment of females, when appropriate;
5. Documentation of immunizations administered; and
6. A plan of care, including initiation of treatment, as appropriate.
B. For residents transferring from one JCC to another, the report of a medical examination within the preceding 13 months shall be acceptable.
C. Each resident shall have an annual physical examination by or under the direction of a licensed physician.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-970. Dental examinations.
A. Within seven days of arrival at a JCC, all residents who are not directly transferred from another JCC shall undergo a dental examination by a dentist.
B. For residents transferring from one JCC to another, the report of a dental examination within the preceding 13 months shall be acceptable.
C. Each resident shall have an annual dental examination by a dentist and routine prophylactic treatment.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-980. Immunizations.
Each resident's immunizations shall be updated consistent with the regulations (12VAC5-90-110) of the Virginia Department of Health, Office of Epidemiology, Division of Immunization, at the time the record is reviewed. Exemptions for immunizations shall be granted consistent with state or federal law.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-990. Health screening for intrasystem transfers.
A. All residents transferred between JCCs shall receive a medical, dental, and mental health screening by health trained or qualified health care personnel upon arrival at the facility. The screening shall include:
1. A review of the resident's health care record;
2. Discussion with the resident on his medical status; and
3. Observation of the resident.
B. All findings shall be documented and the resident shall be referred for follow-up care as appropriate.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1000. Infectious or communicable diseases.
A. A resident with a known communicable disease that can be transmitted person-to-person shall not be housed in the general population unless a licensed physician certifies that:
1. The facility is capable of providing care to the resident without jeopardizing residents and staff; and
2. The facility is aware of the required treatment for the resident and the procedures to protect residents and staff.
B. The facility shall implement written procedures, approved by a medical professional, that:
1. Address staff (i) interactions with residents with infectious, communicable, or contagious medical conditions; and (ii) use of standard precautions;
2. Require staff training in standard precautions, initially and annually thereafter; and
3. Require staff to follow procedures for dealing with residents who have infectious or communicable diseases.
C. Employees providing medical services shall be trained in tuberculosis control practices.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1010. [Reserved].
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1020. Residents' health records.
A. Each resident's health record shall include written documentation of (i) the initial physical examination, (ii) an annual physical examination by or under the direction of a licensed physician including any recommendation for follow-up care, and (iii) documentation of the provision of follow-up medical care recommended by the physician.
B. Each physical examination report shall include:
1. Information necessary to determine the health and immunization needs of the resident, including:
a. Immunizations administered at the time of the exam;
b. Vision exam;
c. Hearing exam;
d. General physical condition, including documentation of apparent freedom from communicable disease including tuberculosis;
e. Allergies, chronic conditions, and handicaps, if any;
f. Nutritional requirements, including special diets, if any;
g. Restrictions on physical activities, if any; and
h. Recommendations for further treatment, immunizations, and other examinations indicated.
2. Date of the physical examination; and
3. Signature of a licensed physician, the physician's designee, or an official of a local health department.
C. Each resident's health record shall include written documentation of (i) an annual examination by a licensed dentist and (ii) documentation of follow-up dental care recommended by the dentist based on the needs of the resident.
D. Each resident's health record shall include notations of health and dental complaints and injuries and shall summarize symptoms and treatment given.
E. Each resident's health record shall include, or document the facility's efforts to obtain, treatment summaries of ongoing psychiatric or other mental health treatment and reports, if applicable.
F. Written procedure shall provide that residents' active health records shall be:
1. Kept confidential from unauthorized persons and in a file separate from the case record;
2. Readily accessible in case of emergency; and
3. Made available to authorized staff consistent with applicable state and federal laws.
Statutory Authority
G. Residents' inactive health records shall be retained and disposed of as required by The Library of Virginia.§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1030. First aid kits.
A. Each facility shall have first aid kits that shall be maintained in accordance with written procedures that shall address the (i) contents; (ii) location; and (iii) method of restocking.
B. The first aid kit shall be readily accessible for minor injuries and medical emergencies.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1040. Sick call.
A. All residents shall have the opportunity daily to request health care services.
B. Resident requests for health care services shall be documented, reviewed for the immediacy of need and the intervention required, and responded to daily by qualified medical staff. Residents shall be referred to a physician consistent with established protocols and written or verbal orders issued by personnel authorized by law to give such orders.
C. The frequency and duration of sick call shall be sufficient to meet the health needs of the facility population. For the purpose of this section, sick call shall mean the evaluation and treatment of a resident in a clinical setting, either on or off site, by a qualified health care professional.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1050. Emergency medical services.
A. Each JCC shall have access to 24-hour emergency medical, mental health, and dental services for the care of an acute illness or unexpected health care need that cannot be deferred until the next scheduled sick call.
B. Procedures shall include arrangements for the following:
1. Utilization of 911 emergency services;
2. Emergency transportation of residents from the facility;
3. Security procedures for the immediate transfer of residents when appropriate;
4. Use of one or more designated hospital emergency departments or other appropriate facilities consistent with the operational procedures of local supporting rescue squads;
5. Response by on-call health care providers to include provisions for telephonic consultation, guidance, or direct response as clinically appropriate; and
6. On-site first aid and crisis intervention.
C. Staff who respond to medical or dental emergencies shall do so in accordance with written procedures.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1060. Hospitalization and other outside medical treatment of residents.
A. When a resident needs hospital care or other medical treatment outside the facility:
1. The resident shall be transported safely and in accordance with applicable security procedures that are applied consistent with the severity of the medical condition; and
2. Staff shall escort and supervise residents when outside the facility for hospital care or other medical treatment, until appropriate security arrangements are made. This subdivision shall not apply to the transfer of residents under the Psychiatric Inpatient Treatment of Minors Act (§ 16.1-355 et seq. of the Code of Virginia).
B. In accordance with applicable laws and regulations, the parent or legal guardian, as appropriate and applicable, shall be informed that the resident was taken outside the facility for medical attention as soon as is practicable.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1070. Medication.
A. All medication shall be properly labeled consistent with the requirements of the Virginia Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia). Medication prescribed for individual use shall be so labeled.
B. All medication shall be securely locked, except when otherwise ordered by a physician on an individual basis for keep-on-person or equivalent use.
C. All staff responsible for medication administration who do not hold a license issued by the Virginia Department of Health Professions authorizing the administration of medications shall successfully complete a medication training program approved by the Board of Nursing and receive annual refresher training as required before they can administer medication.
D. Staff authorized to administer medication shall be informed of any known side effects of the medication and the symptoms of the effects.
E. A program of medication, including procedures regarding the use of over-the-counter medication pursuant to written or verbal orders signed by personnel authorized by law to give such orders, shall be initiated for a resident only when prescribed in writing by a person authorized by law to prescribe medication.
F. All medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the requirements of § 54.2-2408 of the Code of Virginia and the Virginia Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia).
G. A medication administration record shall be maintained of all medicines received by each resident and shall include:
1. Date the medication was prescribed or most recently refilled;
2. Drug name;
3. Schedule for administration, to include notation of each dose administered or refused;
4. Strength;
5. Route;
6. Identity of the individual who administered the medication; and
7. Dates the medication was discontinued or changed.
H. In the event of a medication incident or an adverse drug reaction, first aid shall be administered if indicated. As addressed in the physician's standing orders, staff shall promptly contact a physician, nurse, pharmacist, or poison control center and shall take actions as directed. If the situation is not addressed in standing orders, the attending physician shall be notified as soon as possible and the actions taken by staff shall be documented. A medical incident shall mean an error made in administering a medication to a resident including the following: (i) a resident is given incorrect medication; (ii) medication is administered to the incorrect resident; (iii) an incorrect dosage is administered; (iv) medication is administered at a wrong time or not at all; and (v) the medication is administered through an improper method. A medication incident does not include a resident's refusal of appropriately offered medication.
I. Written procedures shall provide for (i) the documentation of medication incidents, (ii) the review of medication incidents and reactions and making any necessary improvements, (iii) the storage of controlled substances, and (iv) the distribution of medication off campus. The procedures must be approved by a department's health administrator. Documentation of this approval shall be retained.
J. Medication refusals shall be documented including action taken by staff. The facility shall follow procedures for managing such refusals, which shall address:
1. Manner by which medication refusals are documented; and
2. Physician follow-up, as appropriate.
K. Disposal and storage of unused, expired, and discontinued medications shall be in accordance with applicable laws and regulations.
L. The telephone number of a regional poison control center and other emergency numbers shall be posted on or next to each nonpay telephone that has access to an outside line in each building in which residents sleep or participate in programs.
M. Syringes and other medical implements used for injecting or cutting skin shall be locked and inventoried in accordance with facility procedures.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.
6VAC35-71-1080. Release physical.
Each resident shall be medically examined by a physician or qualified health care practitioner operating under the supervision of a physician within 30 days prior to release, unless exempted by the responsible physician based on a sufficiently recent full medical examination.
Statutory Authority
§§ 16.1-309.9, 66-10, and 66-25.1 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 29, Issue 25, eff. January 1, 2014.