Rule 48.11.1 Operator. There shall be a full-time employee designated as the operator of the licensed facility who shall be responsible for the management of the licensed
facility. The operator shall be at least twenty-one years of age and shall be a high school graduate, or have passed the GED, and shall not be a resident of the
licensed facility. The operator shall have verification that he is not listed on the “Mississippi Nurses Aide Abuse Registry.” When the operator is not within the
licensed facility, there shall be an individual onsite at the licensed facility who shall represent the operator, and be capable of assuming the responsibility of
the operator. Said person must be at least twenty-one years or age and shall be a high school graduate, or have passed the GED, and shall have verification that he is not
listed on the “Mississippi Nurses Aide Abuse Registry.”

Rule 48.11.2 Operator Mentoring. Operators shall be scheduled to spend two (2) concurrent days with the licensing agency for the purpose of training and mentoring.
Placement of an operator with the licensing agency may include, but not be limited to, assignments within the licensing agency’s central offices or placement
with a survey team. Any costs associated with placements for the purposes of this section shall be borne by the licensed facility at which the operator is employed.
The operator shall keep confidential and not disclose to any other persons any identifying information about any person or entity that he/she learned while
observing operations as required by this section, except as otherwise mandated by law.
1. This section shall apply to operators who:
2. have been employed by a licensed facility for less than six (6) months, during
which time the placement must be completed.
3. This section shall not apply to operators who:
4. have previously participated in placement as required by this section or
5. who was previously employed by the licensing agency in a surveyor capacity.
6. Failure to successfully complete the placement required under this section shall
disqualify the operator from serving in such a capacity of a licensed facility until a
placement is completed.
7. This section shall go into effect on January 1, 2002, and thereafter.

Rule 48.11.3 Surveyor Mentoring. Surveyors shall be scheduled to spend two (2) concurrent days with a licensed facility for the purpose of training and mentoring. Selection
of a licensed facility for placement of the surveyor shall be done at the discretion of the licensing agency, except no licensed facility shall be required to accept
more than two (2) placements in any calendar year. Upon completion of said training, the surveyor shall not participate in a survey of the same licensed facility
for a period not to exceed one year from the date of training placement. Any costs associated with the placement of a surveyor for the purposes of this section
shall be borne by the licensing agency. The surveyor shall keep confidential and not disclose to any other persons any identifying information about any person or
entity that the surveyor learned while observing operations as required by this section, except as otherwise mandated by law. This section shall apply to
surveyors who have been employed by the licensing agency in a surveyor capacity for less than six (6) months, during which time the placement must be completed.
1. This section shall not apply to surveyors who were previously employed by a
licensed facility.
2. Failure to successfully complete the placement required under this section shall
disqualify the surveyor from serving in such capacity for the licensing agency
until placement is completed.

Rule 48.11.4 Other Personnel. All direct care employees shall be a minimum of 18 years of age and shall have verification that they are not listed on the “Mississippi Nurses
Aide Abuse Registry.” Personnel shall receive training on a quarterly basis on topics and issues related to the population being served in the licensed facility.
Training shall be documented by a narrative of the content and signatures of those attending. Personnel shall be employed and on duty, awake, and fully dressed to
provide personal care to the residents. The following staffing ratio shall apply:
1. one (1) resident attendant per fifteen (15) or fewer residents for the hours of 7:00 a.m. until 7:00 p.m.
2. one (1) resident attendant per twenty-five (25) or fewer residents for the hours of
7:00 p.m. until 7:00 a.m.

Rule 48.11.5 Criminal History Record Checks.
1. Pursuant to Section §43-11-13, Mississippi Code of 1972, the covered entity shall require to be performed a disciplinary check with the professional licensing
agency, if any, for each employee to determine if any disciplinary action has been taken against the employee by the agency, and a criminal history checks on:
a. Every new employee of a covered entity who provides direct patient care or services and who is employed after or on July 01, 2003, and
b. Every employee of a covered entity employed prior to July 01, 2003, who has documented disciplinary action by his or her present employer.

2. Except as otherwise provided in this paragraph, no employee hired on or after July 1, 2003, shall be permitted to provide direct patient care until the results of the criminal history record check revealed no disqualifying record or the employee has been granted a waiver. Provide the covered entity has documented evidence of submission of fingerprints for the background check, any person may be employed and provide direct patient care on a temporary basis pending the results of the criminal history record check by any employment offer, contract, or arrangement with the person shall be voidable if he/she receives a disqualifying criminal record check and no waiver is granted.

3. If such criminal history record check discloses a felony conviction; a guilty plea; and/or a plea of nolo contendere to a felony for one (1) or more of the following
crimes which have not been reversed on appeal, or for which a pardon has not been granted, the applicant/employee shall not be eligible to be employed at the license facility:
a. possession or sale of drugs
b. murder
c. manslaughter
d. armed robbery
e. rape
f. sexual battery
g. sex offense listed in Section 45-33-23, Mississippi Code of 1972
h. child abuse
i. arson
j. grand larceny
k. burglary
l. the gratification of lust
m. aggravated assault
n. felonious abuse and/or battery of a vulnerable adult

4. Documentation of verification of the employee’s disciplinary status, if any, with the employee’s professional licensing agency as applicable, and evidence of
submission of the employee’s fingerprints to the licensing agency must be on file and maintained by the facility prior to the new employees first date of
employment. The covered entity shall maintain on file evidence of verification of the employee’s disciplinary status from any applicable professional licensing
agency and of submission and/or completion of the criminal record check, the signed affidavit, if applicable, and/or a copy of the referenced notarized letter
addressing the individual’s suitability for such employment.

5. Pursuant to Section §43-11-13, Mississippi Code of 1972, the licensing agency shall require every employee of a covered entity employed prior to July 01, 2003,
to sign an affidavit stating that he or she does not have a criminal history as outlined in paragraph (c) above.

6. From and after December 31, 2003, no employee of a covered entity hired before July 01, 2003, shall be permitted to provide direct patient care unless the
employee has signed an affidavit as required by this section. The covered entity shall place the affidavit in the employee’s personnel file as proof of compliance with this section.

7. If a person signs the affidavit required by this section, and it is later determined that the person actually had been convicted of or pleaded guilty or nolo
contendere to any of the offenses listed herein, and the conviction or pleas has not been reversed on appeal or a pardon has not been granted for the conviction or
plea, the person is guilty of perjury as set out in Section 43-11-13, Mississippi Code of 1972. The covered entity shall immediately institute termination
proceedings against the employee pursuant to the facility’s policies and procedures.

8. The covered entity may, in its discretion, allow any employee unable to sign the affidavit required by paragraph (g) of this subsection or any employee applicant
aggrieved by the employment decision under this subsection to appear before the covered entity’s hiring officer, or his or her designee, to show mitigating
circumstances that may exist and allow the employee or employee applicant to be employed at the covered entity. The covered entity, upon report and
recommendation of the hiring officer may grant waivers for those mitigating circumstances, which shall include, but not be limited to: (1) age at which the
the crime was committed; (2) circumstances surrounding the crime; (3) length of time since the conviction and criminal history since the conviction; (4) work history;
(5) current employment and character references; and (6) other evidence demonstrating the ability of the individual does not pose a threat to the health or
safety of the patients in the licensed facility.

9. The licensing agency may charge the licensed entity submitting the fingerprints a fee not to exceed Fifty Dollars ($50.00).

10. Should the result of an employee applicant’s criminal history record check reveal no disqualifying event, then the covered entity shall, within two (2) weeks of the
notification of no disqualifying event, provide the employee applicant with a notarized letter signed by the chief executive officer of the covered entity, or his
or her authorized designee, confirming the employee applicant’s suitability for employment based on his or her criminal history record check. An employee
the applicant may use that letter for a period of two (2) years from the date of the letter to seek employment at any covered entity licensed by the Mississippi State
Department of Health without the necessity of an additional criminal record check. Any covered entity presented with the letter may rely on the letter with respect to an employee applicant’s criminal background and is not required for a period of two (2) years from the date of the letter to conduct or have conducted a
criminal history record checks as required in this subsection.

11. For individuals contracted through a third party who provide direct patient care as defined herein, the covered entity shall require proof of a criminal history record
check.

12. Pursuant to Section 43-11-13, Mississippi Code of 1972, the licensing agency, the covered entity, and their agents, officers, employees, attorneys, and
representatives shall be presumed to be acting in good faith for any employment the decision or action is taken under this section. The presumption of good faith maybe
overcome by a preponderance of the evidence in any civil action. No licensing agency, covered entity, nor their agents, officers, employees, attorneys, and
representatives shall be held liable in any employment discrimination suit in which an allegation of discrimination is made regarding an employment decision
authorized under this section.

Rule 48.11.6 Employee’s Health Status. All licensed facility personnel shall receive a health screening by a licensed physician, a nurse practitioner/physician assistant, or a
registered nurse prior to employment and annually thereafter. Records of this health screening shall be kept on file in the licensed facility.

Rule 48.11.7 Employee Testing for Tuberculosis.
1. Each employee, upon employment of a licensed entity and prior to contact with any patient/resident, shall be evaluated for tuberculosis by one of the following
methods:
a. IGRA (blood test) and an evaluation of the individual for signs and symptoms of tuberculosis by medical personnel; or
b. A two-step Mantoux tuberculin skin test administered and read by a licensed medical/nursing person certified in the techniques of tuberculin testing and an
evaluation of the individual for signs and symptoms of tuberculosis by a licensed Physician, Physician’s Assistant, Nurse Practitioner or a Registered
Nurse.

2. The IGRA/Mantoux testing and the evaluation of signs/symptoms may be administered/conducted on the date of hire or administered/read no more than 30
days prior to the individual’s date of hire; however, the individual must not be allowed contact with a patient or work in areas of the facility where patients have
access until receipt of the results of the IGRA/assessment or at least the first of the two-step Mantoux test has been administered,/read and assessed for signs
and symptoms completed.

3. If the Mantoux test is administered, results must be documented in millimeters. Documentation of the IGRA/TB skin test results and assessment must be
documented in accordance with accepted standards of medical/nursing practice and must be placed in the individual’s personnel file no later than 7 days of the
individual’s date of employment. If an IGRA is performed, results and quantitative values must be documented.

4. Any employee noted to have a new positive IGRA, a newly positive Mantoux skin test, or signs/symptoms indicative of tuberculin disease (TB) that last longer
than three weeks (regardless of the size of the skin test or results of the IGRA), shall have a chest x-ray and be evaluated for active tuberculosis by a licensed
the physician within 72 hours. The employee shall not be allowed to work in any area here residents have routine access until evaluated by a physician/nurse
practitioner/physician assistant and approved to return. Exceptions to this
requirement may be made if the employee is asymptomatic and;

a. The individual is currently receiving or can provide documentation of having received a course of tuberculosis prophylactic therapy approved by the
Mississippi State Department of Health (MSDH) Tuberculosis Program for tuberculosis infection, or
b. The individual is currently receiving or can provide documentation of having received a course of multi-drug chemotherapy approved by the MSDH Tuberculosis Program; or
c. The individual has a documented previous significant tuberculin skin reaction or
IGRA reaction.

5. For individuals noted to have a previous positive to either Mantoux testing or the IGRA, annual re-evaluation for the signs and symptoms must be conducted and
must be maintained as part of the employee’s annual health screening. A follow-up annual chest x-ray is NOT required unless symptoms of active tuberculosis
develop.

6. If using the Mantoux method, employees with a negative tuberculin skin test and a negative symptom assessment shall have the second step of the two-step
Mantoux tuberculin skin test performed and documented in the employee’s personal record within fourteen (14) days of employment.

7. The IGRA or the two-step protocol is to be used for each employee who has not been previously skin tested and/or for whom a negative test cannot be documented within the past 12 months. If the employer has documentation that the employee has had a negative TB skin test within the past 12 months, a single test performed thirty (30) days prior to employment or immediately upon hire will fulfill the two-step requirements. As above, the employee shall not have contact with residents or be allowed to work in areas of the facility to which residents have routine access prior to reading the skin test, completing a signs and symptoms assessment, and documenting the results and findings.

8. Facilities shall comply with recommendations from the Centers for Disease Control and/or the Mississippi State Department of Health regarding baseline
employee TB testing and routine serial TB employee testing and education. Staff exposed to an active infectious case of tuberculosis shall be treated as contacts
and be managed appropriately. Individuals found to have a significant Mantoux tuberculin skin test reaction and a chest x-ray not suggestive of active
tuberculosis, shall be evaluated by a physician or nurse practitioner/physician assistant for treatment of latent tuberculin infection.

Rule 48.11.8 Admission Agreement. Prior to, or at the time of admission, the operator and the resident or the resident’s responsible party shall execute in writing a financial
agreement. This agreement shall be prepared and signed in two or more copies, one copy is given to the resident or his/her responsible party, and one copy placed
on file in the licensed facility.
1. As a minimum, this agreement shall contain specifically:
a. Basic charges agreed upon (room, board, laundry, and personal care).
b. Period to be covered in the charges.
c. Services for which special charges are made.
d. Agreement regarding refunds for any payments made in advance.
e. A statement that the operator shall make the resident’s responsible party aware,
in a timely manner, of any changes in resident’s status, including those which
require transfer and discharge; or operators who have been designated as a
resident’s responsible party shall ensure prompt and efficient action to meet
resident’s needs.

2. No agreement or contract shall be entered into between the licensee and the president or his responsible agent which will relieve the licensee of the
responsibility for the protection of the person and personal property of the individual admitted to the licensed facility for care.

3. Any funds are given or provided for the purpose of supplying services to any patient in any licensed facility, and any funds otherwise received and held from, for or on
behalf of any such resident shall be deposited by the director or other proper officer of the licensed facility to the credit of that patient in an account which
shall be known as the Resident’s Personal Deposit Fund. No more than one (1) month charge for the care, support, maintenance, and medical attention of the
patient shall be applied from such account at any one (1) time. After the death, discharge, or transfer of any resident for whose benefit any such fund has been
provided, any unexpended balance remaining in his personal deposit fund shall be applied for the payment of care, cost of support, maintenance, and medical attention which is accrued. In the event, any unexpended balance remains in that resident’s personal deposit fund after complete reimbursement has been made for payment of care, support, maintenance, and medical attention, and the director or another proper officer of the licensed facility has been or shall be unable to locate the person or persons entitled to such unexpended balance, the director or other the proper officer may, after the lapse of one (1) year from the date of such death, discharge, or transfer, deposit the unexpended balance to the credit of the licensed
facility’s operating fund.

4. The resident or his responsible party shall be furnished a receipt signed by the licensee of the licensed facility or his lawful agent, for all sums of money paid to
the licensed facility.

5. Written notification shall be given to the resident/responsible party when basic charges and/or licensed facility policies change.

Rule 48.11.9 Records and Reports.
1. The operator shall maintain a record of the residents for whom he or she serves as the conservator or a representative payee. This record shall include evidence of
the means by which the conservatorship or representative payee relationship was established and evidence of separate accounts in a bank for each resident whose
conservator or representative payee is the operator of the licensed facility.
2. Inspection reports from the licensing agency, any branch or division thereof by the operator in the licensed facility, and submitted to the licensing agency as
required, or when requested.
3. Resident records shall contain the following:
a. Admission agreement(s) and financial statements.
b. Residents’ rights and licensed facility’s rules, signed, dated, and witnessed.
c. Medical evaluation and referral from physician or nurse practitioner/physician assistant.
d. Current medication record, including any reactions to such medication.
e. Social services and activity contacts.
f. General information form.
g. Representative payee statement, if applicable.
h. Physician orders or nurse practitioner/physician assistant orders (including, but not limited to, therapies, diets, medications, etc.) and medication administration
records.
4. The records as described in this section shall be made available to the resident, the resident’s family, or another responsible party for the resident upon reasonable
request.
5. Reporting of Tuberculosis Testing. The facility shall report and comply with the
annual MDH TB Program surveillance procedures.

Rule 48.11.10 Licensed Facility Policies. Written policies shall be available which indicate services to be provided, and which include policies regarding admission, transfer
and discharge of residents.

Rule 48.11.11 Residents’ Rights. These rights and licensed facility rules must be in writing and be made available to all residents, employees, sponsors, and posted for public
viewing. Each resident shall:
1. Have the right to attend religious and other activities of his/her choice.
2. Have the right to manage his/her personal financial affairs, or is given at least a
quarterly accounting of financial transactions made on his/her behalf should the facility accepts the written delegation from the resident or from his/her responsibly
party of this responsibility to the facility for any period of time in conformance with State law.
3. Not be required to perform services for the licensed facility.
4. Have the right to communicate with persons of his/her choice, and may receive
mail unopened or in compliance with the policies of the home.
5. Be treated with consideration, kindness, respect, and full recognition of his/her dignity and individuality.
6. May retain and use personal clothing and possessions as space permits.
7. May voice grievances and recommend changes in licensed facility policies and services.
8. Shall not be confined to the licensed facility against his/her will, and shall be allowed to move about in the community at liberty. Physical and/or chemical
restraints are prohibited.
9. Not be limited in his/her choice of a pharmacy or pharmacist provider in accordance with State law.

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