TITLE 12. HEALTH

STATE BOARD OF HEALTH

Fast-Track Regulation

Title of Regulation: 12VAC5-371. Regulations for the Licensure of Nursing Facilities (amending 12VAC5-371-10, 12VAC5-371-30, 12VAC5-371-60, 12VAC5-371-70, 12VAC5-371-90, 12VAC5-371-100, 12VAC5-371-110, 12VAC5-371-150, 12VAC5-371-180, 12VAC5-371-300, 12VAC5-371-410; adding 12VAC5-371-55).

Statutory Authority: §§ 32.1-12 and 32.1-127 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: July 29, 2026.

Effective Date: August 13, 2026.

Agency Contact: Geoff Garner, Senior Policy Analyst, Virginia Department of Health, 9960 Mayland Drive, Suite 401, Richmond, VA 23233, telephone (804) 367-2157, fax (804) 527-4502, or email regulatorycomment@vdh.virginia.gov.

Basis: Section 32.1-12 of the Code of Virginia authorizes the State Board of Health to make, adopt, promulgate, and enforce regulations necessary to carry out the provisions of Title 32.1 of the Code of Virginia. Section 32.1-127 of the Code of Virginia requires the board to adopt regulations that include minimum standards for (i) the construction and maintenance of nursing facilities to ensure the environmental protection and the life safety of residents, employees, and the public and (ii) the vaccination of residents, unless medically contraindicated or declined by the resident.

Purpose: This action is essential to protecting the health, safety, and welfare of citizens because unclear requirements may hamper a licensee's ability to comply with the regulation, and out-of-date regulations may reference standards and practices that are not consistent with current clinical practices. The goals of this action are to improve consistency across the regulation, bring the regulatory text into alignment with the statutes, and update references to current clinical guidelines.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial because it conforms the regulation to statute and details longstanding licensing procedures. No new requirements are being developed. Additionally, the agency's subject matter experts believe that changes do not jeopardize the protection of public health, safety, and welfare. The action does not alter the intent of the regulation or the requirements placed on nursing facilities.

Substance: The amendments (i) establish that nursing facility licenses may not be transferred or assigned; (ii) consolidate and clarify plan of correction provisions, including adding minimum elements and a timeline for submission and completion; (iii) clarify frequency of inspection and set out the process by which the Office of Licensure and Certification will evaluate the need for an on-site complaint inspection; (iv) conform prohibited acts and disciplinary options to statute; (v) more clearly define a mid-term license change and the process to obtain a changed license; (vi) add provisions regarding visitation during public health emergencies related to COVID-19; (vii) update language regarding individuals required to register with the Sex Offender and Crimes Against Minors Registry to match statute; (viii) replace references to THC-A oil and cannabidiol oil with cannabis oil; (ix) make technical changes; and (x) update documents incorporated by reference.

Issues: The primary advantages to the public are (i) removal of language or requirements that are unclear, inconsistent, or outdated and (ii) addition of legislative mandates that were not yet incorporated into the regulation. The primary advantage to the agency and the Commonwealth is clarity regarding the minimum requirements for nursing facilities and the Virginia Department of Health in the administration of the nursing facility licensing program. There are no disadvantages to the public or the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. The State Board of Health (board) proposes to amend the regulation for the licensure of nursing facilities to conform to the Code of Virginia and implement multiple recent legislative mandates. The proposed changes would also group related requirements, remove outdated language, make certain terminology more consistent throughout the regulation, and update the text to reflect current practice.

Background. The proposed changes are primarily intended to implement the following legislative mandates, which the Virginia Department of Health (VDH) reports have largely been previously implemented in practice because statutory requirements apply even if a regulation has not yet been updated to reflect a particular mandate: Chapter 72 of the 2021 Acts of Assembly, Special Session I, which prohibits discriminating against health insurance enrollees on the basis of the enrollee being a litigant or potential litigant due to a motor vehicle accident.² This mandate is already in effect. Chapters 10 and 11 of the 2020 Acts of Assembly, Special Session I, which require the board to amend regulations governing nursing homes, certified nursing facilities, and hospices to require that, during a public health emergency related to COVID-19, each entity establish a protocol to allow each patient to receive visits, consistent with guidance from the Centers for Disease Control and Prevention (CDC) and as directed by the Centers for Medicare and Medicaid Services (CMS) and the board.³ This action would newly require nursing facilities to establish such a protocol. However, facilities that are certified by CMS have likely already done this since it was a federal requirement prior to the enactment of the 2020 legislation. Chapter 829 of the 2020 Acts of Assembly, which updated the language in existing requirements for nursing homes and certified nursing facilities to register with the State Police to receive notice that person living in the same zip code are on the Sex Offenders and Crimes Against Minors (SOCAM) Registry and to verify whether a potential patient is required to register with the SOCAM Registry.⁴ Although this mandate is already in effect, this action would require nursing facilities to update their written policy on this subject. Chapters 1080 and 1081 of the 2020 Acts of Assembly, which prohibited balance billing by out-of-network providers.⁵ This mandate is already in effect. Chapter 1278 of the 2020 Acts of Assembly, which redefined and replaced occurrences of THC-A oil and cannabidiol oil with cannabis oil.⁶ This action would update the regulatory language to conform to statute. Chapters 177 and 222 of the 2005 Acts of Assembly, which directed the board to add minimum design and construction guidelines for hospitals and nursing facilities in the regulations for licensure.⁷ The proposed changes in this action would replace references to the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities with the 2022 edition and update the documents incorporated by reference. This change will only be binding for new license applications whose facility plans are dated after this regulatory action is effective. Chapter 762 of the 2004 Acts of Assembly, which requires certified nursing facilities and nursing homes to provide or arrange for the optional administration of annual influenza vaccines and the pneumococcal vaccination, in accordance with CDC most recent recommendations.⁸ This mandate is already in effect. The proposed changes in this action would update the language of the regulation to match current terminology (pneumonia to pneumococcal) and update the documents incorporated by reference with the most recent CDC guidelines. Accordingly, the board proposes to make a number of changes to the regulation. The most substantive changes are summarized below. The six sections indicated with an asterisk include changes that would implement a legislative mandate.

12VAC5-371-55 is a new section, which consolidates requirements currently found in other sections of the regulation, mainly 12VAC5-371-60 and 12VAC5-371-70. The proposed changes clearly specify the minimum elements of a plan of correction and add a 45-day timeline for submission and completion of a plan of correction. Board intent is to standardize the plan of correction process and make it more similar to the federal plan of correction process, so that the same requirements are applied across all facilities.⁹

12VAC5-371-60 is renamed, and the proposed changes include adding language about frequency of inspections, which matches the current practice followed by VDH, Office of Licensure and Certification (OLC). The board also proposes to add more details regarding the inspection process so that facilities know what to expect during an inspection.¹⁰

12VAC5-371-70 is amended to include the factors taken into consideration by OLC in determining whether a complaint should be investigated. The proposed changes would give VDH flexibility in determining whether a complaint warrants an on-site inspection and allow them to make more effective use of agency resources.¹¹

12VAC5-371-90 is renamed and incorporates statutory provisions about prohibited acts and disciplinary options available. Specifically, the proposed changes would implement the legislative mandates relating to prohibitions on balance billing and discriminating against health insurance enrollees on the basis of the enrollee being a litigant or potential litigant due to a motor vehicle accident.

12VAC5-371-100 is renamed and specifies that a nursing facility must notify the OLC in writing 30 days in advance of implementing any change in the location, ownership, operator, or name of the nursing facility; change in the management contract or lease agreement to operate the nursing facility; change of services being provided, regardless of whether licensure is required for that service; and closure of the nursing facility. The current requirement only applies to a change in ownership and facility closure. The proposed changes would add that OLC shall determine if any of these changes affect the terms of the license or the continuing eligibility for a license, and that an inspector may inspect the facility during the process of evaluating a proposed change. The proposed changes would also add stipulations that licenses cannot be transferred or assigned and that a change in the operator of the facility requires that a new license be issued. Further, if the nursing facility is closing, it shall notify resident, legal representatives, and the OLC at least seven days prior to closing where all clinical records are to be located following closure or cessation of operations.

12VAC5-371-110 is updated so that references to the documents incorporated by reference to the most recent recommendations of the CDC Advisory Committee on Immunization Practices. These changes would continue to implement the 2004 legislative mandate mentioned previously.

12VAC5-371-150 is updated to match statutory language about registration, reregistration, and verification with the SOCAM Registry, pursuant to Chapter 829 of the 2020 Acts of Assembly.

12VAC5-371-180 implements Chapters 10 and 11 of the 2020 Acts of Assembly, Special Session I, by adding provisions about visitation during public health emergencies related to COVID-19. VDH reports that 282 of the 289 licensed nursing facilities are also certified by CMS and have therefore already been subject to these requirements.

12VAC5-371-300 replaces THC-A oil and cannabidiol oil with cannabis oil, implementing Chapter 1278 of the 2020 Acts of Assembly.

12VAC5-371-410 updates the documents incorporated by reference to the most recent (2022) Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, adding the Errata document issued separately, complying with a 2005 legislative mandate.

Estimated Benefits and Costs. The primary benefit of the proposed changes would be to improve clarity for nursing facilities surrounding the requirements to maintain their license, what to expect in an inspection, how to submit and undertake a plan of correction (if necessary), and current requirements and CDC guidelines. Entities wishing to build new facilities would know to use the updated 2022 Guidelines for construction plans. To the extent that these changes improve the quality of service, transparency of facility policies, and patient outcomes, both patients and their families would also benefit from the proposed changes. The proposed changes would require nursing facilities to update their policies with respect to visitation during public health emergencies and with respect to verification of potential patients with the SOCAM Registry. Other new costs may arise if a facility meets one of the newly added criteria for reporting a mid-term change of license, or if the facility is closing and must comply with new requirements with respect to informing patients and legal representatives about where medical records will be located and surrendering its license. VDH also reports that as a result of the mandate to comply with the 2022 edition of the applicable design and construction guidelines, there may be a quantifiable indirect cost equal to 0.2% increase in construction costs for a 180-bed nursing facility that has more than one story of non-combustible construction, and a 0.4% increase in construction costs for a 180-bed nursing facility that has a single story of combustible construction.¹² VDH reports that economic impact for most proposed changes have already been incurred either as a result of the legislative mandates and changes to statutory requirements, or as a result of changes to federal CMS guidelines. This includes the one-time cost to update policies and procedures regarding visitation during public health emergencies for 282 of the 289 licensed facilities that are also federally certified by CMS. However, although VDH reports that agency policy regarding visitation has been consistent with the 2020 legislative mandate, the seven licensed facilities that are not federally certified by CMS may have to update their visitation policies to reflect the new regulatory requirements if they have not already done so. In addition, VDH reports that for some nursing homes (if they were unaware of the statutory amendments), the one-time cost to update policies and procedures regarding the SOCAM Registry may not have yet been incurred. VDH estimates that each nursing facility is likely to spend about $1,250 in staff time to update each of these policies.¹³

Businesses and Other Entities Affected. VDH reports that there are 289 licensed nursing facilities, and all of them will be required to comply with the regulatory changes. Many of these facilities have already complied with the new requirements since most of the changes result from legislative mandates, which often reflect federal guidelines and requirements. Two of these licensed nursing facilities are operated by the Virginia Department of Veterans Services and one is operated by the County of Bedford. The remaining facilities are privately owned and operated. VDH could not ascertain how many entities own and operate multiple facilities but reported that a majority of facilities are owned by companies with a portfolio of nursing facilities.¹⁴ The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.¹⁵ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined. The proposed changes would create new costs for licensed nursing facilities, even if some of those changes are required by federal and state law and have already been borne by nursing facilities. Thus, an adverse impact is indicated.

Small Businesses¹⁶ Affected.¹⁷ VDH reports that they do not have sufficient information to determine which nursing facilities have fewer than 500 full-time employees.¹⁸ In addition, as mentioned previously, even if some small independent nursing homes meet the criteria for a small business, a majority of them are owned by larger business entities.

Localities¹⁹ Affected.²⁰ The proposed amendments do not introduce costs for local governments. The County of Bedford owns and operates a licensed nursing facility and is the only locality to do so. Consequently, an adverse economic impact is indicated for Bedford.²¹

Projected Impact on Employment. The proposed amendments are unlikely to impact the number of nursing facilities that obtain and remain licensed and the staffing in those facilities. Thus, the proposed amendments are not projected to significantly impact employment.

Effects on the Use and Value of Private Property. The proposed amendments raise costs for nursing facilities, which would reduce their value. The proposed amendments do not affect real estate development costs in general but would result in a small increase in construction costs for new nursing facilities based on changes contained in the updated 2022 Guidelines.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1341.

³ See https://lis.virginia.gov/cgi-bin/legp604.exe?ses=202&typ=bil&val=ch10.

⁴ See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1343.

⁵ See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1349.

⁶ See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1350.

⁷ See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1359. This mandate was first implemented in 2005 (https://register.dls.virginia.gov/vol22/iss07/v22i07.pdf) to add the 2006 Guidelines for Design and Construction of Hospital and Health Care Facilities issued by the American Institute of Architects as minimum design standards. These standards are updated every four years and the regulation has been updated accordingly via exempt actions.

⁸ See https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1351. This mandate was first implemented in 2004 (https://register.dls.virginia.gov/vol20/iss26/v20i26.pdf) and incorporated CDC guidelines for these vaccines that were current at that time.

⁹ Agency Background Document (ABD), page 13. See https://townhall.virginia.gov/l/GetFile.cfm?File=58\6170\9898\AgencyStatement_VDH_9898_v3.pdf.

¹⁰ ABD, p. 15.

¹¹ ABD, pp. 16-17. VDH reports that while the COVID-19 pandemic significantly altered the pattern of complaints for this facility type, they typically receive weekly complaints, some of which originate from the facilities themselves when they file self-report incidents. They also report that the timeline for resolving a complaint depends on how a complaint is triaged; it can be an immediate jeopardy complaint, a 10-day complaint, or a 180-day complaint.

¹² See ORM Economic Review Form, page 3: https://townhall.virginia.gov/l/ GetFile.cfm?File=58\6170\9898\ORM_EconomicImpact_VDH_9898_v2.pdf.

¹³ ABD, p. 8.

¹⁴ VDH shared that the ownership and corporate structure of nursing facilities has become a significant policy issue and has started to draw the attention of the federal government. See for example: https://www.gao.gov/products/gao-23-104813, https://www.cms.gov/newsroom/fact-sheets/disclosures-ownership-and-additional-disclosable-parties-information-skilled-nursing-facilities-and, and https://www.cms.gov/newsroom/press-releases/biden-harris-administration-makes-more-medicare-nursing-home-ownership-data-publicly-available.

¹⁵ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

¹⁶ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

¹⁷ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹⁹ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

²⁰ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

²¹ Adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined.

Agency Response to Economic Impact Analysis: The State Board of Health has reviewed the economic impact analysis (EIA) prepared by the Department of Planning and Budget. The board believes the contents of the EIA to have been substantively complete and accurate as of the date of the EIA, and no modification of the EIA is warranted.

Summary:

The amendments conform Regulations for the Licensure of Nursing Facilities (12VAC5-371) to multiple legislative mandates by (i) providing for visitation during public health emergencies related to COVID-19; (ii) clarifying obligations of nursing facilities regarding the Sex Offenders and Crimes Against Minors Registry; (iii) replacing references to THC-A oil and cannabidiol oil with cannabis oil; and (iv) updating documents incorporated by reference. Additional amendments update terminology, consolidate and clarify language to match current clinical and industry practices, and make technical changes.

12VAC5-371-10. Definitions.

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

"Abuse" means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish, or deprivation by an individual, including caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This includes verbal, sexual, physical, or mental abuse.

"ACIP" means the Advisory Committee on Immunization Practices of the CDC.

"Administrator" means the individual licensed by the Board of Long-Term Care Administrators and who has the necessary authority and responsibility for management of the nursing facility.

"Admission" means the process of acceptance into a nursing facility, including orientation, rules and requirements, and assignment to appropriate staff. Admission does not include readmission to the facility after a temporary absence.

"Advance directive" means (i) a witnessed written document, voluntarily executed by the declarant in accordance with the requirements of § 54.1-2983 of the Code of Virginia, or (ii) a witnessed oral statement, made by the declarant subsequent to the time the declarant is diagnosed as suffering from a terminal condition and in accordance with the provision of § 54.1-2983 of the Code of Virginia.

"Assessment" means the process of evaluating a resident for the purpose of developing a profile on which to base services. Assessment includes information gathering, both initially and on an ongoing basis, designed to assist the multi-disciplinary staff in determining the resident's need for care, and the collection and review of resident-specific data.

"Attending physician" means a physician currently licensed by the Board of Medicine and identified by the resident, or legal representative, as having the primary responsibility in determining the delivery of the resident's medical care.

"Barrier crime" means any offense set forth in clause (i) of the definition of barrier crime in § 19.2-392.02 of the Code of Virginia.

"Board" means the State Board of Health.

"Business day" means any day that is not a Saturday, Sunday, legal holiday, or day on which the OLC is closed. For the purposes of this chapter, any day on which the Governor authorizes the closing of the state government shall be considered a legal holiday.

"Cannabidiol Cannabis oil" means the same as the term is defined in § 54.1-3408.3 A of the Code of Virginia.

"CDC" means the Centers for Disease Control and Prevention.

"Certified nurse aide" means the title that can only be used by individuals who have met the requirements to be certified, as defined by the Board of Nursing, and who are listed in the nurse aide registry.

"Chemical restraint" means a psychopharmacologic drug (a drug prescribed to control mood, mental status, or behavior) that is used for discipline or convenience and not required to treat medical symptoms or symptoms from mental illness or mental retardation intellectual disability that prohibit an individual from reaching his highest level of functioning.

"Clinical record" means the documentation of health care services, whether physical or mental, rendered by direct or indirect resident-provider interactions. An account compiled by physicians and other health care professionals of a variety of resident health information, such as assessments and care details, including testing results, medicines, and progress notes.

"CMS" means the Centers for Medicare and Medicaid Services.

"Commissioner" means the State Health Commissioner.

"Complaint" means any allegation received by the Virginia Department of Health other than an incident reported by the facility staff. Such allegations include abuse, neglect, exploitation, or violation of state or federal laws or regulations.

"Comprehensive plan of care" means a written action plan, based on assessment data, that identifies a resident's clinical and psychosocial needs, the interventions to meet those needs, and treatment goals that are measurable and that documents the resident's progress toward meeting the stated goals.

"Construction" means the building of a new nursing facility or the expansion, remodeling, or alteration of an existing nursing facility and includes the initial and subsequent equipping of the facility.

"Criminal record report" means either the criminal record clearance with respect to convictions for barrier crimes or the criminal history record from the Central Criminal Records Exchange of the Virginia Department of State Police.

"Department" means the Virginia Department of Health.

"Dignity" means staff, in their interactions with residents, carry out activities that assist a resident in maintaining and enhancing the resident's self-esteem and self-worth.

"Discharge" means the process by which the resident's services, delivered by the nursing facility, are terminated.

"Discharge summary" means the final written summary of the services delivered, goals achieved, and post-discharge plan or final disposition at the time of discharge from the nursing facility. The discharge summary becomes a part of the clinical record.

"Drug" means (i) articles or substances recognized in the official United States "Drug" Pharmacopoeia National Formulary or official Homeopathic Pharmacopoeia of the United States, or any supplement to any of them; (ii) articles or substances intended for the use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animal; (iii) articles or substances, other than food, intended to affect the structure or any function of the body of man or other animal; and (iv) articles or substances intended for use as a component of any article specified in clause (i), (ii), or (iii). This does not include devices or their components, parts, or accessories.

"Electronic monitoring" means the use of a surveillance device with a fixed position video camera or recording device, or a combination thereof, that is installed in a resident's room and broadcasts or records activities or sounds occurring within the confines of the room. Electronic monitoring does not include use of a device that enables audio communication into the resident's room from another source.

"Emergency preparedness plan" means a component of a nursing facility's safety management program designed to manage the consequences of natural disasters or other emergencies that disrupt the nursing facility's ability to provide care.

"Employee" means a person who performs a specific job function for financial remuneration on a full-time or part-time basis.

"Facility-managed" means an electronic monitoring system that is installed, controlled, and maintained by the nursing facility with the knowledge of the resident or legal representative in accordance with the facility's policies.

"Family member" means the resident's spouse, parent, stepparent, child, stepchild, brother, sister, half-brother, half-sister, grandparent, or grandchild.

"Full-time" means a minimum of 35 hours or more worked per week in the nursing facility.

"Inspector" means an individual employed by or contracted by the department and designated by the commissioner to conduct inspections, investigations, or evaluations.

"Intelligent personal assistant" means a combination of an electronic device and a specialized software application designed to assist users with basic tasks using a combination of natural language processing and artificial intelligence, including such combinations known as digital assistants or virtual assistants.

"Legal representative" means a person legally responsible for representing or standing in the place of the resident for the conduct of the resident's affairs. This may include a guardian, conservator, attorney-in-fact under durable power of attorney, trustee, or other person expressly named by a court of competent jurisdiction or the resident as the resident's agency in a legal document that specifies the scope of the representative's authority to act. A legal representative may only represent or stand in the place of a resident for the function for which the representative has legal authority to act.

"Licensee" means a person that has received and maintains an active license under the provisions of Article 1 (§ 32.1-123 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia and this chapter.

"Medication" means any substance, whether prescription or over-the-counter drug, that is taken orally or injected, inserted, topically applied, or otherwise administered.

"Neglect" means a failure to provide timely and consistent services, treatment, or care to a resident necessary to obtain or maintain the resident's health, safety, or comfort or a failure to provide timely and consistent goods and services necessary to avoid physical harm, mental anguish, or mental illness.

"Nursing facility" means any nursing home as defined in § 32.1-123 of the Code of Virginia.

"OLC" means the Office of Licensure and Certification of the Virginia Department of Health.

"Person" means any individual, corporation, partnership, association, trust, or other legal entity, whether governmental or private, owning, managing, or operating a nursing facility.

"Physical restraint" means any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily which that restricts freedom of movement or normal access to one's own body.

"Policy" means a written statement that describes the principles and guides and governs the activities, procedures, and operations of the nursing facility.

"Procedures" means a series of activities designed to implement program goals or policy, which may or may not be written, depending upon the specific requirements within this chapter. For inspection purposes, there must be evidence that procedures are actually implemented.

"Progress note" means a written statement, signed and dated by the person delivering the care, consisting of a pertinent, chronological report of the resident's care. A progress note is a component of the clinical record.

"Qualified" means meeting current legal requirements of licensure, registration, or certification in Virginia; having appropriate training and experience commensurate with assigned responsibilities; or, if referring to a professional, possessing an appropriate degree or having documented equivalent education, training, or experience.

"Quality assurance" means systematic activities performed to determine the extent to which clinical practice meets specified standards and values with regard to such things as appropriateness of service assignment and duration, appropriateness of facilities and resources utilized, adequacy, and clinical soundness of care given. Such activities should also ensure changes in practice that do not meet accepted standards. Examples of quality assurance activities include the establishment of facility-wide goals for resident care, the assessment of the procedures used to achieve the goals, and the proposal of solutions to problems in attaining those goals.

"Readmission" means a planned return to the nursing facility following a temporary absence for hospitalization, off-site visit or therapeutic leave, or a return stay or confinement following a formal discharge terminating a previous admission.

"Resident" means the primary service recipient, admitted to the nursing facility, whether that person is referred to as a client, consumer, patient, or other term.

"Resident-managed" means an electronic monitoring system that is installed, controlled, and maintained by the resident with the knowledge of the nursing facility.

"Supervision" means the ongoing process of monitoring the skills, competencies, and performance of the individual supervised and providing regular, face-to-face guidance and instruction.

"Sworn disclosure" means a written statement or affirmation disclosing any criminal convictions or any pending criminal charges, whether within or outside the Commonwealth, by an applicant for compensated employment with a nursing facility.

"THC-A oil" means the same as the term is defined in § 54.1-3408.3 A of the Code of Virginia.

"Volunteer" means a person who, without financial remuneration, provides services to the nursing facility.

12VAC5-371-30. License.

A. This chapter is not applicable to:

1. Those entities listed in § 32.1-124 of the Code of Virginia; and or

2. Facilities established or operated for the practice of religious tenets pursuant to § 32.1-128 of the Code of Virginia, except that such facilities shall comply with the statutes and regulations on environmental protection and life safety.

B. A license to operate a nursing facility is shall be issued to a person or organization. An organization may be a partnership, association, corporation, or public entity.

C. Each license and renewal thereof shall be issued for one expire at midnight December 31 of the year issued. A nursing facility shall operate within the terms of its license, which include the:

1. Name of the nursing facility;

2. Name of the operator;

3. Physical location of the nursing facility;

4. Maximum number of beds allowed, except as provided in 12VAC5-371-40 G; and

5. Date the license expires.

D. A separate license shall be required for nursing facilities maintained on separate premises, even though they if the facilities are owned or are operated under the same management.

E. Every nursing facility shall be designated by a permanent and unique name.

F. The number of resident beds allowed in a nursing facility shall be determined by the department commissioner. Requests to increase beds must be made in writing and must include an approved Certificate of Public Need, except as provided in 12VAC5-371-40 G.

G. Nursing facility Long-term care nursing units located in and operated by hospitals shall be licensed under Regulations for the Licensure of Hospitals in Virginia (12VAC5-410). Approval for such units shall be included on the annual license issued to each hospital.

H. Any person establishing, conducting, maintaining, or operating a nursing facility without a license shall be guilty of a Class 6 felony.

I. The licensee shall at all times:

1. Maintain an active and accurate license; and

2. Post its current license in a place readily visible and accessible to the public at the nursing facility.

12VAC5-371-55. Plan of correction.

A. Upon receipt of a written inspection report, the administrator or the administrator's designee shall prepare a written plan of correction addressing each licensing violation cited at the time of inspection.

B. The administrator or the administrator's designee shall submit to the OLC a written plan of correction no more than 15 business days after receipt of the inspection report. The plan of correction shall contain, for each licensing violation cited:

1. A description of the corrective action to be taken and the position title of the employees to implement the corrective action. If employees share the same position title, the administrator or the administrator's designee shall assign the employees a unique identifier to distinguish them;

2. The expected correction date, not to exceed 45 business days from the exit date of the inspection; and

3. A description of the measures implemented to prevent a recurrence of each licensing violation.

C. The administrator or the administrator's designee shall ensure that the person responsible for the validity of the plan of correction signs, dates, and indicates the person's title on the plan of correction.

D. The OLC shall notify the administrator or the administrator's designee if the OLC determines any item in the plan of correction is unacceptable.

E. The OLC may conduct an inspection to verify any portion of a plan of correction has been implemented.

F. The administrator or the administrator's designee shall ensure the plan of correction is implemented and monitored so that compliance is maintained.

G. The commissioner may deny licensure or renewal of licensure or revoke licensure if the administrator or the administrator's designee fails to submit an acceptable plan of correction or fails to implement an acceptable plan of correction.

H. The OLC shall consider the submission date of a plan of correction to be the date the plan of correction is postmarked or the date it is received, whichever is earlier.

12VAC5-371-60. On-site inspections Inspection procedure.

A. The licensing representative OLC shall make periodic unannounced on-site inspections of the nursing facility as necessary but not less often than biennially. The licensee shall be responsible for correcting any deficiencies found during any OLC may make on-site inspection inspections of applicants for licensure. Compliance with all standards will shall be determined by the OLC.

B. The licensee or applicant shall make:

1. Make available to the licensing representative inspector any necessary requested records;

2. Permit an inspector to enter upon and into the licensee's or applicant's property to inspect or investigate, as the inspector reasonably deems necessary, in order to determine the state of compliance with the provisions of this chapter and all laws administered by the board; and

3. Allow the inspector access to interview the agents, employees, independent contractors, residents, legal representatives, resident's family members, and any person under the licensee's or applicant's control, direction, or supervision.

C. The licensee shall also allow the licensing representative to interview the agents, employees, residents, family members, and any person under its custody, control, direction or supervision.

D. C. After the on-site inspection, the licensing representative inspector shall discuss the findings of the inspection with the administrator or designee:

1. Discuss the findings of the inspection with the administrator or the administrator's designee; and

2. Provide a written inspection report to the administrator or the administrator's designee.

E. As applicable, the administrator D. If the OLC cites one or more licensing violations in the written inspection report, the administrator or the administrator's designee shall submit an acceptable a plan for correcting any deficiencies found during an on-site inspection of correction in accordance with 12VAC5-371-55.

F. The administrator will be notified whenever any item in the plan of correction is determined to be unacceptable.

G. The administrator shall be responsible for assuring the plan of correction is implemented and monitored so that compliance is maintained.

12VAC5-371-70. Complaint investigation.

A. The OLC has the responsibility to shall investigate any complaints regarding alleged violations of the standards or statutes and complaints of the abuse or neglect of persons in care. The Department of Social Services and the State Ombudsman are notified of complaints received and determine if an investigation requires an on-site inspection. In making this determination, the OLC shall consider several factors, to include:

1. Whether the complainant has first-hand knowledge of the alleged incident;

2. The nursing facility's regulatory history, including the number and severity of substantiated prior complaints;

3. Whether the OLC has recently inspected the nursing facility and whether the alleged incident would have been reviewed during the prior inspection;

4. The nature of the complaint, including degree of potential serious harm to residents; and

5. Whether the complaint may be investigated pursuant to Title XVIII or Title XIX of the Social Security Act (42 USC § 301 et seq.).

B. Complaints The OLC may request records from the licensee to assist in making a determination pursuant to subsection A of this section. The licensee shall provide the requested records no more than seven calendar days after OLC makes a request pursuant to this subsection.

C. The OLC may be received receive complaints in written or oral form and may be receive anonymous complaints.

C. D. When the investigation is complete, the OLC shall notify the licensee and the complainant, if known, will be notified in writing of the findings of the investigation.

D. As applicable E. For any licensing violation cited during a complaint investigation, the administrator or the administrator's designee shall submit an acceptable a plan for correcting any deficiencies found during a complaint investigation of correction in accordance with 12VAC5-371-55.

E. The administrator will be notified whenever any item in the plan of correction is determined to be unacceptable.

F. The administrator shall be responsible for assuring the plan of correction is implemented and monitored so that compliance is maintained.

12VAC5-371-90. Administrative sanctions Disciplinary action.

A. Nothing in this part shall prohibit the department from exercising its responsibility and authority to enforce the regulation, including proceeding directly to imposition of administrative sanctions, when the quality of care or the quality of life has been severely compromised.

A. The licensee may not:

1. Violate the provisions of this chapter or Article 1 (§ 32.1-123 et seq.) or 2 (§ 32.1-138 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia;

2. Permit, aid, or abet the commission of any illegal act in the nursing facility; or

3. Engage in a pattern of violations of § 38.2-3445.01 of the Code of Virginia.

B. The commissioner may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care. Such sanctions include:

1. Restricting or prohibiting For each violation of subsection A of this section:

a. Deny, revoke, or suspend the license to operate the nursing facility;

b. Restrict or prohibit new admissions to any nursing facility in accordance with the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia);

2. Petitioning the court to impose c. Refer the licensee for criminal prosecution pursuant to § 32.1-27 A of the Code of Virginia;

d. Petition an appropriate court for an injunction, mandamus, or other appropriate remedy against the licensee pursuant to § 32.1-27 B of the Code of Virginia;

e. Petition an appropriate court for imposition of a civil monetary penalty or to appoint a receiver, or both; or 3. Revoking or suspending the license of a nursing facility against the licensee pursuant to § 32.1-27 C or 32.1-27.1 A of the Code of Virginia; or

f. Petition an appropriate court for appointment of a receiver pursuant to § 32.1-27.1 B of the Code of Virginia; and

2. For each violation of subdivision A 3 of this section, levy a fine upon the licensee in an amount not to exceed $1,000 per violation, in accordance with the Administrative Process Act.

C. The following reasons may be considered by the department for the imposition of administrative sanctions or the imposition of civil penalties: 1. Failure to demonstrate or maintain compliance with applicable standards or for violations of the provisions Suspension of a license shall in all cases be for an indefinite time.

D. For each violation of subsection A of this section and with the consent of the person who has violated subsection A of this section, the board may provide, in an order issued by the board, for the payment of civil charges for past violations in specific sums, which may not exceed the limits specified in § 32.1-27 or 32.1-27.1 of the Code of Virginia; 2. Permitting, aiding, or abetting the commission of any illegal act in the nursing facility; or 3. Deviating significantly from the program or services for which a license was issued without obtaining prior written approval from the OLC, or failure to correct such deviations within a specified time.

D. Violations which in the judgment of the OLC jeopardize the health and safety of residents shall be sufficient cause for immediate imposition of this section.

E. The licensee will receive a notice of the department's intent to impose sanctions. The notice shall describe the reasons for imposing the sanction Upon receipt of a completed application and a nonrefundable service charge, the commissioner may issue a new license to the licensee that has had its license revoked if the commissioner determines that:

1. The conditions upon which revocation was based have been corrected; and

2. The applicant is in compliance with this chapter, Articles 1 (§ 32.1-123 et seq.) and 2 (§ 32.1-138 et seq.) of Chapter 5 of Title 32.1 of the Code of Virginia, and all other applicable state and federal law and regulations.

F. Upon receipt of the notice to impose a sanction, the licensee has the right and the opportunity to appeal according to the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia). The procedures for filing an appeal shall be outlined in the notice a completed application, the commissioner may partially or completely restore a suspended license to the licensee if the commissioner determines that:

1. The conditions upon which suspension was based have been completely or partially corrected; and

2. The interests of the public will not be jeopardized by resumption of operation.

G. The commissioner may not require an additional fee for restoring a license pursuant to subsection F of this section.

H. The licensee shall submit evidence relevant to subdivisions E 1, E 2, F 1, and F 2 of this section that is satisfactory to the commissioner or the commissioner's designee. The commissioner or the commissioner's designee may conduct an inspection prior to making a determination.

12VAC5-371-100. Surrender of a license; mid-term change of license.

A. Upon revocation or suspension of a license, the licensee must shall surrender its license to a representative of the OLC.

B. If a license is revoked, a new license may be issued by the commissioner after satisfactory evidence is submitted that the conditions upon which revocation was based have been corrected and after proper inspection has been made and compliance with this chapter and applicable state and federal law has been obtained.

C. Suspension of a license shall in all cases be for an indefinite time. The commissioner may completely or partially restore a suspended license when he determines that the conditions upon which suspension was based have been completely or partially corrected and that the interests of the public will not be jeopardized by resumption of operation.

D. Other circumstances under which a license must be surrendered include transfer of ownership and discontinuation of services. The licensee must notify the OLC, in writing, 30 days before discontinuing services.

B. A licensee shall notify the director of the OLC in writing by submitting a mid-term change application no fewer than 30 calendar days in advance of implementing any:

1. Change of location of the nursing facility;

2. Change of ownership of the nursing facility;

3. Change of operator of the nursing facility;

4. Change of name of the nursing facility;

5. Change of bed capacity, except as provided in 12VAC5-371-40 G, which shall be accompanied by an approved Certificate of Public Need if the requested change is for an increase in bed capacity;

6. Change in management contract or lease agreement to operate the nursing facility;

7. Change of services being provided, including any proposed addition or discontinuation, regardless of whether licensure is required for the service; or

8. Closure of the nursing facility.

C. The OLC shall:

1. Consider the submission date of a mid-term change application to be the date the application is postmarked or the date it is received, whichever is earlier; and

2. Notify the licensee in writing if the commissioner will issue a changed license.

D. The commissioner's issuance of changed license to the licensee shall satisfy the requirements of subdivision C 2 of this section.

E. Upon receipt of the changed license, the licensee shall surrender its prior license issued by the commissioner to the OLC and destroy any copies of the prior license.

F. A license may not be transferred or assigned. The commissioner may not issue a changed license in response to a change of operator of the nursing facility, but shall instead require the nursing facility to obtain a new license. If the nursing facility intends to implement a change of operator, it shall:

1. File for a new license, in accordance with 12VAC5-371-40, no fewer than 30 calendar days in advance of any operator change; and

2. Upon receipt of the new license, surrender its prior license issued by the commissioner to the OLC and destroy any copies of the prior license.

G. If the nursing facility is closing or will otherwise no longer be operational, it shall:

1. Notify residents, legal representatives, and the OLC, no fewer than seven calendar days prior to closing or ceasing operations, where all clinical records are to be located following closure or cessation of operations; and

2. Surrender its license to the OLC and destroy all copies of its license no more than five calendar days after the nursing facility closes or ceases operations.

H. The OLC shall determine if any changes listed in subsection B of this section affect the terms of the license or the continuing eligibility for a license. An inspector may inspect the nursing facility during the process of evaluating a proposed change.

12VAC5-371-110. Management and administration.

A. No person shall own, establish, conduct, maintain, manage, or operate any nursing facility, as defined in § 32.1-123 of the Code of Virginia, without having obtained a license.

B. The nursing facility must comply with:

1. These regulations (12VAC5-371) This chapter;

2. Other applicable federal, state, or local laws and regulations; and

3. Its The nursing facility's own policies and procedures.

C. The nursing facility shall submit, or make available, reports and information necessary to establish compliance with these regulations this chapter and applicable statutes.

D. The nursing facility shall submit, in a timely manner as determined by the OLC, and implement a written plan of action to correct any noncompliance with these regulations identified during an inspection. The plan shall include:

1. Description of the corrective action or actions to be taken;

2. Date of completion for each action; and

3. Signature of the person responsible for the operation.

E. D. The nursing facility shall permit representatives from the OLC to conduct inspections to:

1. Verify application information;

2. Determine compliance with this chapter;

3. Review necessary records; and

4. Investigate complaints.

F. A nursing facility shall give written notification 30 calendar days in advance of implementation of changes affecting the accuracy of the license. Changes affecting the accuracy of the license are:

1. Address;

2. Operator;

3. Name of the nursing facility;

4. Any proposed change in management contract or lease agreement to operate the nursing facility;

5. Implementing any proposed addition, deletion, or change in nursing facility services whether or not licensure is required;

6. A change in ownership; or

7. Bed capacity.

Notices shall be sent to the attention of the director of the OLC.

G. The current license from the commissioner shall be posted in a place clearly visible to the general public.

H. E. The nursing facility shall fully disclose its admission policies, including any preferences given, to applicants for admission.

I. F. The nursing facility shall identify its operating elements and programs, the internal relationship among these elements and programs, and the management or leadership structure.

J. The G. Unless the vaccination is medically contraindicated or the resident declines the offer of vaccination, the nursing facility shall provide, or arrange for, the administration to its residents of an annual influenza vaccination and a pneumonia pneumococcal vaccination according to the "Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season" and "Guidelines for Preventing Health-Care-Associated Pneumonia" from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, unless the vaccination is medically contraindicated or the resident declines the vaccination offer in accordance with the following recommendations of ACIP:

1. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022–23 Influenza Season, MMWR 71 (1), 2022, CDC;

2. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of ACIP - United States, MMWR 71 (4), 2022, CDC;

3. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged > 65 Years: Updated Recommendations of ACIP, MMWR 68 (46), 2019, CDC;

4. Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of ACIP, MMWR 64 (34), 2015, CDC;

5. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged > 65 Years: Recommendations of ACIP, MMWR 63 (37), 2014, CDC;

6. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6 - 18 Years with Immunocompromising Conditions: Recommendations of ACIP, MMWR 62 (25), 2013, CDC;

7. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of ACIP, MMWR 61 (40), 2012, CDC;

8. Prevention of Pneumococcal Disease Among Infants and Children - Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine: Recommendations of ACIP, MMWR 59 (RR-11), 2010, CDC; and

9. Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23), MMWR 59 (34), 2010, CDC.

K. H. Upon request of the nursing facility's family council, the nursing facility shall send notices and information about the family council mutually developed by the family council and the administration of the nursing facility, and provided to the nursing facility for such purpose, to the legal representative or a contact person of the resident's choice up to six times a year. Such notices may be included together with a monthly billing statement or other regular communication. Notices and information shall also be posted in a designated location within the nursing facility.

12VAC5-371-150. Resident rights.

A. The nursing facility shall develop and implement policies and procedures that ensure a resident's rights as defined in §§ 32.1-138 and 32.1-138.1 of the Code of Virginia.

B. The procedures shall:

1. Not restrict any right a resident has under law;

2. Provide staff training to implement resident's resident rights; and

3. Include grievance procedures.

C. The name and telephone number of the complaint coordinator of the OLC, the Adult Protective Services toll-free telephone number, and the toll-free telephone number for the State Ombudsman shall be conspicuously posted in a public place.

D. Copies of resident rights shall be given to residents upon admittance to the nursing facility and made available to residents currently in residence, to legal representatives, next of kin, or sponsoring agency or agencies, and to the public.

E. The nursing facility shall have a plan to review resident rights with each resident annually, or with the legal representative at least annually, and have a plan to advise each staff member at least annually.

F. The nursing facility shall certify, in writing, that it is in compliance with the provisions of §§ 32.1-138 and 32.1-138.1 of the Code of Virginia, relative to resident rights, as a condition of license issuance or renewal.

G. The nursing facility shall register with the Department of State Police to receive notice of the registration or, reregistration, or verification of any sex offender person required to register with the Sex Offender and Crimes Against Minors Registry pursuant to Chapter 9 (§ 9.1-900 et seq.) of Title 9.1 of the Code of Virginia within the same or a contiguous zip code area in which the nursing facility is located pursuant to § 9.1-914 of the Code of Virginia.

H. Prior to admission, each nursing facility shall determine ascertain if a potential resident is a registered sex offender when required to register with the Sex Offender and Crimes Against Minors Registry pursuant to Chapter 9 of Title 9.1 of the Code of Virginia if the potential resident is anticipated to have a length of stay:

1. Greater Is anticipated by the nursing facility to have a length of stay greater than three days; or

2. In fact stays longer than three days.

I. The nursing facility shall not restrict the rights of a resident's family and legal representative to meet in the nursing facility with the families and legal representatives of other residents.

12VAC5-371-180. Infection control.

A. The nursing facility shall establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to prevent the development and transmission of disease and infection.

B. The infection control program shall encompass the entire physical plant and all services.

C. The infection control program addressing the surveillance, prevention, and control of infections in the nursing facility shall include:

1. Procedures to isolate the infecting organism;

2. Access to handwashing equipment for staff;

3. Training of staff in proper handwashing techniques, according to accepted professional standards, to prevent cross contamination cross-contamination;

4. Implementation of universal precautions by direct resident care staff;

5. Prohibiting employees with communicable diseases or infections from direct contact with residents or their resident food, if direct contact will transmit disease;

6. Monitoring staff performance of infection control practices;

7. Handling, storing, processing, and transporting linens, supplies, and equipment in a manner that prevents the spread of infection;

8. Handling, storing, processing, and transporting regulated medical waste in accordance with applicable regulations;

9. Maintaining an effective pest control program; and

10. Staff education regarding infection risk-reduction behavior.

D. The nursing facility shall report promptly to its local health department diseases designated as "reportable" according to 12VAC5-90-80 when such cases are admitted to or are diagnosed in the nursing facility and shall report any outbreak of infectious disease as required by 12VAC5-90. An outbreak is defined as an increase in incidence of any infectious disease above the usual incidence at the nursing facility.

E. During a declared public health emergency related to a communicable disease of public health threat, the nursing facility shall establish a protocol to allow residents to receive visits from a rabbi, priest, minister, or clergy member of any religious denomination or sect consistent with guidance from the Centers for Disease Control and Prevention CDC and the Centers for Medicare and Medicaid Services CMS and subject to compliance with any executive order, order of public health, department guidance, or any other applicable federal or state guidance having the effect of limiting visitation.

1. Such protocol may restrict the frequency and duration of visits and may require visits to be conducted virtually using interactive audio or video technology.

2. Any such protocol may require the person visiting a resident pursuant to this subsection to comply with all reasonable requirements of the nursing facility adopted to protect the health and safety of the person, residents, and staff of the nursing facility.

F. During a public health emergency related to COVID-19, a nursing facility shall establish a protocol to allow each resident to receive visits, consistent with guidance from the CDC and as directed by CMS and the board, which shall include:

1. Provisions describing:

a. The conditions, including conditions related to the presence of COVID-19 in the nursing facility and community, under which in-person visits will be allowed and under which in-person visits will not be allowed and visits will be required to be virtual;

b. The requirements with which in-person visitors will be required to comply to protect the health and safety of the residents and staff of the nursing facility;

c. The types of technology, including interactive audio or video technology, and the staff support necessary to ensure visits are provided as required by this subsection; and

d. The steps the nursing facility will take in the event of a technology failure, service interruption, or documented emergency that prevents visits from occurring as required by this subsection;

2. A statement of the frequency with which visits, including virtual and in-person, where appropriate, will be allowed, which shall be at least once every 10 calendar days for each resident;

3. A provision authorizing a resident or the resident's personal representative to waive or limit visitation, provided that such waiver or limitation is included in the resident's health record; and

4. A requirement that the nursing facility publish on its website or communicate to each resident or the resident's authorized representative, in writing or via electronic means, the nursing facility's plan for providing visits to residents as required by this subsection.

12VAC5-371-300. Pharmaceutical services.

A. Provision shall be made for the procurement, storage, dispensing, and accounting of drugs and other pharmacy products in compliance with 18VAC110-20. This may be by arrangement with an off-site pharmacy, but must include provisions for 24-hour emergency service.

B. Each nursing facility shall develop and implement policies and procedures for the handling of drugs and biologicals, including procurement, storage, administration, self-administration, and disposal of drugs.

C. Each nursing facility shall have a written agreement with a qualified pharmacist to provide consultation on all aspects of the provision of pharmacy services in the nursing facility.

D. The consultant pharmacist shall make regularly scheduled visits, at least monthly, to the nursing facility for a sufficient number of hours to carry out the function of the agreement.

E. Excluding cannabidiol oil and THC-A cannabis oil, no drug or medication shall be administered to any resident without a valid verbal order or a written, dated, and signed order from a physician, dentist, podiatrist, nurse practitioner, or physician assistant, licensed in Virginia.

F. Nursing facility employees who are authorized to possess, distribute, or administer medications to residents may store, dispense, or administer cannabidiol oil or THC-A cannabis oil to a resident who has:

1. Been Has been issued a valid written certification for the use of cannabidiol oil or THC-A cannabis oil in accordance with § 54.1-3408.3 B of the Code of Virginia; and

2. Registered Is registered with the Board of Pharmacy.

G. Advanced medication aides registered by the Board of Nursing pursuant to Article 7 (§ 54.1-3041 et seq.) of Chapter 30 of Title 54.1 of the Code of Virginia may administer drugs that would be administered by a registered medication aide pursuant to § 54.1-3408 M of the Code of Virginia in an assisted living facility licensed by the Department of Social Services, in addition to drugs determined permissible by the Board of Nursing, in a nursing home licensed by the Virginia Department of Health. Advanced medication aides shall administer drugs pursuant to this section:

1. In accordance with the prescriber's instructions pertaining to dosage, frequency, and manner of administration;

2. In accordance with regulations promulgated by the Board of Pharmacy relating to security and recordkeeping;

3. In accordance with the licensed nursing home's policies and procedures; and

4. In accordance with such any other regulations promulgated by the Board of Nursing governing the practice of medication aides.

H. Verbal orders for drugs or medications shall only be given to a licensed nurse, pharmacist, or physician.

I. Drugs and medications not limited as to time or number of doses when ordered shall be automatically stopped, according to the written policies of the nursing facility, and the attending physician shall be notified.

J. Each resident's medication regimen shall be reviewed by a pharmacist licensed by the Board of Pharmacy. Any irregularities identified by the pharmacist shall be reported to the physician and the director of nursing, and their response documented.

K. Medication orders shall be reviewed at least every 60 days by the attending physician, nurse practitioner, or physician's assistant.

L. Prescription and nonprescription drugs and medications may be brought into the nursing facility by a resident's family, friend, or other person, provided:

1. The individual delivering the drugs and medications ensures timely delivery, in accordance with the nursing facility's written policies, so that the resident's prescribed treatment plan is not disrupted;

2. Each drug or medication is in an individual container; and

3. Delivery is not allowed directly to an individual resident.

In addition, prescription medications shall be obtained and labeled as required by law.

12VAC5-371-410. Architectural drawings and specifications.

A. All construction of new buildings and all additions, renovations, or alterations, or repairs of existing buildings for occupancy as a nursing facility shall conform to state and local codes, zoning ordinances, and the Virginia Uniform Statewide Building Code (13VAC5-63).

In addition, nursing facilities shall be designed and constructed consistent with Parts 1 and 2 and section Chapter 3.1 of Part 3 of the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities of the, 2022 Edition (The Facility Guidelines Institute pursuant to § 32.1-127.001 of the Code of Virginia), as amended by the August 2022 Errata for Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, 2022 Edition (The Facilities Guidelines Institute).

B. Architectural drawings and specifications for all new construction or for additions, alterations, or renovations to any existing building, shall be dated, stamped with professional seal, and signed by the architect. The architect shall certify that the drawings and specifications were prepared to conform to the Virginia Uniform Statewide Building Code and to be consistent with Parts 1 and 2 and section Chapter 3.1 of Part 3 of the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities of the, 2022 edition (The Facility Guidelines Institute), as amended by the August 2022 Errata for Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, 2022 Edition (The Facilities Guidelines Institute).

C. Additional approval may include a Certificate of Public Need.

D. Upon completion of the construction, the nursing facility shall maintain a complete set of legible "as built as-built" drawings showing all construction, fixed equipment, and mechanical and electrical systems, as installed or built.

DOCUMENTS INCORPORATED BY REFERENCE (12VAC5-371)

Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, 2018 The Facilities Guidelines Institute, 2022 Edition, Facility Guidelines Institute http://www.fgiguidelines.org

Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, MMWR 53 (RR-3), Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020–21 Influenza Season, 2020, MMWR 69 (RR-8), Centers for Disease Control and Prevention.

Errata for Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, The Facilities Guidelines Institute, 2022 Edition, https://fgiguidelines.org/guidelines/errata-addenda/ (eff. 8/2022)

Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of ACIP, MMWR 64 (34), 2015, CDC

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022–23 Influenza Season, MMWR 71 (1), 2022, CDC

Prevention of Pneumococcal Disease Among Infants and Children - Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine: Recommendations of ACIP, MMWR 59 (RR-11), 2010, CDC

Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23), MMWR 59 (34), 2010, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged > 65 Years: Recommendations of ACIP, MMWR 63 (37), 2014, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged >65 Years: Updated Recommendations of ACIP, MMWR 68 (46), 2019, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of ACIP, MMWR 61 (40), 2012, CDC

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Children Aged 6 -18 Years with Immunocompromising Conditions: Recommendations of ACIP, MMWR 62 (25), 2013, CDC

Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of ACIP - United States, MMWR 71 (4), 2022, CDC