state regulations for housekeeping in nursing homes

WebTitle 175 Chapter 12 Regulations Governing Licensure of Skilled Nursing Facilities, Nursing Facilities, Intermediate Care Facilities 12-004.10 The licensee must pay fees for House Bill 67 was signed into law on March 21, 2006, Section 4121.48. 4658.0025: procedures for licensing nursing homes. Nursing Home Receivership Managing Agent Candidates. April 21, 2023. You can also, Connecticut General Assembly State Statutes Health Care Institutions Includes Nursing Homes, CT State Department of Public Health Nursing Home Regulations, There Are No Federal Regulations Specifically On Residential Care Homes (RCHs) 2022 Home and Community-Based Services (HCBS) Federal Regulation Implementation Will Apply To RCHs That Seek To Be Waiver Compliant, Connecticut General Assembly State Statutes Health Care Institutions Includes Some RCH/Rest Home Information, CT State Department of Public Health Residential Care Home Regulations Referred To In Statute As Homes for the Aged and Rest Homes, There Are No Federal Regulations Specifically On Assisted Living A National Senior Living Trade Association, Argentum, Has Submitted a Proposal To The American National Standards Institute For Development Of National Standards In The Field But There Has Been Industry Opposition To Such And An Appeal Hearing Is Scheduled In February 2020 To Review Concerns There Is Increasing Interest Among Advocates and Some Legislators To Have Federal Regulations for Assisted Living, There Are No Connecticut General Assembly State Statutes Specifically on Assisted Living Other Than Alzheimers Training and Special Unit Statutes That Apply To Different Health Care Settings Including. 0000074091 00000 n Nursing Home Care vs. Home Health Care It looks like your browser does not have JavaScript enabled. INDEX 483.5 Definitions 483.10 Resident Rights 483.12 Freedom from Abuse, Neglect, and Exploitation 483.15 Admission Transfer and Discharge Rights 483.20 Resident 0000070374 00000 n WebFederal regulations require that nursing homes provide a safe, clean, comfortable, and homelike environment for their residents. Stay up-to-date with how the law affects your life. yA# (0qPDV. Connecticut General Assembly Statutes- Connecticut General Assembly State Statutes Health Care Institutions Includes Nursing Homes, Department of Public Health State Regulations- CT State Department of Public Health Nursing Home Regulations, Policies and Procedures regarding Nursing Home Staffing Levels to implement the requirements of Section 19a-563h (11/21/22 - Minimum Staffing). Again, states that do not wish to receive federal Medicare or Medi-Cal funding are free to enact their own laws, assuming they are constitutional. Nursing homes and ICF/IIDs care for residents who are elderly and/or who have chronic medical conditions that place them at higher risk of developing severe complications from COVID As of now, patients that are admitted to nursing homes in the US are protected to a certain degree. HdWM. WebConvalescent, Nursing and Boarding Homes (all sections) Section 191.1400, RSMo. 0000067375 00000 n <>/Metadata 3561 0 R/ViewerPreferences 3562 0 R>> Abuse: The intentional infliction of physical harm; injury caused by negligent acts or omissions; unreasonable confinement; sexual abuse or sexual assault. COVID-19-Related Bed, Capacity and/or Service Change Application Form (PDF) Resources for Providers. 0000004486 00000 n State surveyors generally visit once a year. It seems that JavaScript is not working in your browser. A-1136 safe patient handling legislation signed into law October 2011. 0 Appendix PP - Guidance to Surveyors for Long Term Care Facilities. Each year, NCAL publishes the "Assisted Living State Regulatory Review," to summarize key selected state requirements for assisted living licensure or certification. Your email address will not be published. This article has been written and reviewed for legal accuracy, clarity, and style byFindLaws team of legal writers and attorneysand in accordance withour editorial standards. On the evening shift, one direct-care provider for every 10 residents; and. These laws were later updated again in the years 1980 and also in 1987 and the regulations , Continue Reading about State By State Nursing Homes Regulations , "The two week long stand still of the Minnesota government is wrecking havoc in both the private and public sectors. On the night shift, one direct-care provider for every 15 residents. Nursing home abuse laws can differ widely from state to state. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); With the help of nursing homes ratings, it is possible to identify the best nursing home in the country. Code Regs. For information regarding a specific legal issue affecting you, pleasecontact an attorney in your area. i N&/wk="iHE,/wjT*";uH rZ|*F^TJ-/w*y$/uR_Y^"> V:EPR'0mMIYm-!(MVZbRS:RPJO %I J%1 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney Meanwhile, in North Dakota, the state average is $3,405 per month. 7K2f!>PxNAx0ldJ=EQfRfR}-p,#V X u @J_fvWpUsMZ.yTZ6 /Yn0~gje2/KWk3A!cJCn:`9KlA'[hvPIz++'|]!6 Nursing homes are inspected annually by the Pennsylvania Department of Health. 0000067807 00000 n While the federal government sets a minimum standard of care, states are free to set higher {O-3bag)6M>CRkuC;nMqj6xgukBY3e9{ `F% o+`J8{P1s1.DlV5ujI$]dZ1&oF\M30=$H`k{7@)(E(mgBjs:('pQ>"Wt5'G2 # @4 g)iu/GHO 0000021630 00000 n Abuse: (a) the infliction of physical or mental injury; or (b) the deprivation of food, shelter, clothing, or services necessary to maintain the physical or mental health of an older person or a person with a developmental disability without lawful authority. Apply to Dietary Cook, Nursing Home Administrator, Mds Coordinator and more! 0000219877 00000 n For example, a federal team occasionally comes in as a follow-up to a state survey. 0000002236 00000 n States establish and enforce licensing and certification requirements for assisted living communities, as well as requirements for assisted living executive directors. WebRegulations & Guidance Regulations & Guidance Care Compare (for Nursing Homes) Providers can learn how to update facility information and more about Nursing Home requirements for temporary managers in long-term care facilities. WebState Health and Safety Code, Title 4, Chapter 242: Convalescent and Nursing Homes and Related Institutions Health and Safety Code, Title 4, Chapter 250: Nurse Aide Registry WebUnder the Nursing Home Reform Act of 1987, nursing homes are required to provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care.. b&Mxa^VKo-@5rrH`Ua6rG ^Z[}o4-FF=_qB1X):nzmf(hfkA D4AL~t_v7(Hupz?F,Y8^]@LW]4OnMY}kV :u%ih,2w'@ 184.;M5XjML&7kYF;HW_Ihc!:JPwe;924;=bXS_V&0CK1Rq^g*C5+.vuSGfxJaJ,Q |B'L~X7tanMssS7,:Gc9&Z ;AK? Dependant Adult Abuse/Neglect: (1) Any of the following as a result of the willful or negligent acts or omissions of a caretaker: (a) Physical injury to, or injury which is at a variance with the history given of the injury, or unreasonable confinement, unreasonable punishment, or assault of a dependent adult. SB 879 safe patient handling legislation signed into law April Sufficient Staff To provide nursing care to all residents in accordance with resident care plans. 0000073948 00000 n 0000225399 00000 n Must be able to work around food and cleaning products. 2 0 obj If your loved one is in immediate danger, call 911 for medical help and contact law enforcement. Read more: http://www.ncbi.nlm.nih.gov/pubmed/15027837, Filed Under: How To Choose a Nursing Home Tagged With: state nursing homes, Your email address will not be published. 0000220054 00000 n 0000186689 00000 n Promote ethical practice throughout the organization. (b) The commission of a sexual offense under chapter 709 or section 726.2 with or against a dependent adult. 0000221199 00000 n Half of all nursing home attendants have admitted abusing or neglecting elderly patients at some point in their careers, according to research from 2010. Abuse: Includes physical abuse by unnecessarily inflicting pain or injury on an adult who is impaired; patterns of emotional abuse including ridiculing or demeaning an adult who is impaired or threatening physical or emotional harm; sexual abuse; medication diversion. Licensure Requirement - Applicability of Act 1-1904. 0000225069 00000 n 0000065587 00000 n Health care workers face a number of serious safety and health hazards. Carefully roll up soiled linen to prevent contamination of the air, surfaces, and cleaning staff. 0000121772 00000 n 0000220398 00000 n Date Published. Elderly and Others Hit Hard by the Government Shutdown in Minnesota. 0000066056 00000 n Position Summary. endstream endobj 160 0 obj 1415 endobj 161 0 obj << /Filter /FlateDecode /Length 160 0 R >> stream Contact a qualified personal injury attorney to make sure your rights are protected. WebNew Legislation: Act 192 (HB 1363) requires the Office of Long-Term Care to create staffing standards for nursing facilities designated or certified as Eden Alternative nursing This can include limited nursing care, intermediate level nursing care, and skilled nursing services. WebState nursing homes were regulated by federal laws that were authorized in the year 1967 by the US Congress. State and federal government websites often end in .gov. 3. 0000219553 00000 n Contact us. The Importance of Person-Centered Care First, lets cover some of the basics of person-centered care (PCC). Nursing homes are allowed to collect a private-pay pre-payment/security deposit This report includes requirements for those types of communities that offer seniors housing, supportive services, personalized assistance with ADLs, and some level of health care., Case Study: States Embrace Unique Collaborative Quality Efforts, ASPE's Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition, State-specific assisted living regulations, State Medicaid waiver program information. WebGuidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders. Before sharing sensitive information, make sure youre on an official government site. WebNursing Home Housekeeping Policies And Procedures R 61 17 STANDARDS FOR 2016 This regulation replaces and supersedes any former regulations Bureau of Health Facilities Licensing Nursing homes in Illinois are licensed regulated inspected and or certified by a number of public and State What is a Nursing Home Nursing homes 0000222196 00000 n Firms, FindLaws team of legal writers and attorneys, Health Facilities Licensing and Certification, Alaska Department of Health and Social Services, Senior and Disability Services, Arizona Department of Health: Long Term Care Facilities Licensing, California Health and Safety Code Section 1599.1, Colorado Secretary of State, Code of Regulations, Delaware Minimum Staffing Levels for Residential Health Facilities, Florida Minimum Staffing for Nursing Homes, Georgia Department of Public Health Nursing Home Rules and Regulations, Hawaii Department of Health Skilled Nursing/Intermediate Care Regulations, Adult Protective and Community Services Branch, Comprehensive Care Facility Licensing and Certification Program, Kansas Nursing Facility Administrative Regulations, Kentucky Cabinet for Health and Family Services, Maine Long Term Care Facilities: State Licensing Regulations, Maryland Code of Regulations, Nursing Services, Health Care Facility Licensure and Certification, Missouri Department of Health and Senior Services, Nebraska Department of Health & Human Services, Nevada Division of Public and Behavioral Health, Adult Protective Services and Elder Abuse Hotline, Nursing Home Regulations in New York state, Health Facility Licensing & Certification Program, Rhode Island Division of Elderly Affairs, Protective Services, South Carolina Regulations for Nursing Homes, Tennessee Standards for Nursing Home Facilities, Vermont Division of Licensing and Protection, Virginia Nursing Home Facilities Regulations, evaluation of your potential nursing home abuse claim, Amended Complaint for Negligence and Wrongful Death, Complaint for Personal Injury - Slip and Fall, Negligence and Personal Injury Questionnaire, Emotional Distress, Privacy, and Dignitary Torts, The facility must provide services by sufficient numbers of licensed nurses and other nursing personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans, home must have a sufficient number of care providers and other employees with adequate training to implement the home's general staffing plan and to meet the needs of residents as defined in the residents' residential services contracts and assisted living plans. The following WACs apply to home care agencies: Chapter 246-335 WAC. endobj Even so, state regulations do force certain obligatory licensing as well as inspections of US nursing homes in their jurisdiction. While the federal government sets a minimum standard of care, states are free to set higher standards. 0000066768 00000 n This report includes requirements for those types of communities that offer seniors housing, supportive services, personalized assistance with ADLs, and some level of health care.. Accordingto 42 CFR 483.12(c)(1),reports must be made to the facilitys administrator and to the State Survey Agencyand adult protective services where state law provides for jurisdiction in long-term carefacilities and to other officials in accordancewith State law. Provides guidelines Medical technologies are improving and this has resulted in greater longevity among people. This guidance is for Wisconsin nursing homes and intermediate care facilities for individuals with intellectual disabilities (ICF/IID). WebState Operations Manual . Abuse: Includes, but is not limited to, hitting, kicking, pinching, slapping, or pulling of hair; conduct that physically harms a patient except where it is a part of care and treatment; harassment, Abuse: Includes physical abuse and psychological abuse.. r8VBZ&1|^/PB"2+EOA"NbF;>mIjGKIBL;"o3ha *$cP#4i9RT$JCRl>Z@SRO|ckJ$qt@Xu! |34iTcboCV*/yS Apply to Dietary Cook, Nursing Home Administrator, Mds Coordinator and more! The .gov means its official. xZnF}RA@i)@>(2%WJrd"9;3C/_|8z,W#OWUJRxJELPJVN=qP"hYj+B%^b x8OgqsT_~ G'|8b*AJH@JkF&_RU#Re#|L2A`DVt%m*F& If a nursing home does poorly during a state inspection, they may do extra visits to assure the deficiencies were trailer Nursing care: Defined as a planned program to meet Abuse: Any act or failure to act performed intentionally or recklessly that causes or is likely to cause harm to an adult, including: (1) Infliction of physical or mental injury; (2) any sexual act with an adult when the adult does not consent or when the other person knows or should know that the adult is incapable of resisting or declining consent to the sexual act due to mental deficiency or disease or due to fear of retribution or hardship; (3) unreasonable use of a physical restraint, isolation, or medication that harms or is likely to harm an adult; (4) unreasonable use of a physical or chemical restraint, medication, or isolation as punishment, for convenience, in conflict with a physician's orders or as a substitute for treatment, except where such conduct or physical restraint is in furtherance of the health and safety of the adult; (5) a threat or menacing conduct directed toward an adult that results or might reasonably be expected to result in fear or emotional or mental distress to an adult; (6) fiduciary abuse; or (7) omission or deprivation by a caretaker or another person of goods or services which are necessary to avoid physical or mental harm or illness. Unless otherwise indicated, all general requirements apply to both new construction and an existing nursing home. It could be because it is not supported, or that JavaScript is intentionally disabled. 0000220556 00000 n State regulations of various US nursing homes were a result of the widespread nursing home abuse that patients were being subjected to. 0000071237 00000 n For every state and the District of Columbia, this report includes information on topics such as which state agency licenses assisted living, recent legislative and regulatory updates affecting assisted living, and requirements for resident agreements, admission and discharge requirements, units serving people with Alzheimers or dementia, staffing, and training.States use several different terms to refer to assisted living, such as residential care and shared housing. Abuse includes, but is not limited to, nonaccidental physical or mental injury, sexual abuse, or maltreatment. The following RCWs apply to home care agencies: Chapter 70.127 RCW. Nursing homes in the US are not governed by any standards and with many of their patients being in very frail condition it is important that the nursing homes be regulated by the government. House Bill 67 was signed into law on March 21, 2006, Section 4121.48. Federal nursing home laws provide a minimum requirement for regulations, but states can enact tougher laws as they see fit. 1208 0 obj <>stream (3) Sexual harassment, rape or abuse. Please enable scripts and reload this page. Institutional Abuse: Any physical, mental, or sexual injury to an eligible adult, including exploitation of such adult's financial resources. endobj HWd5Y#u:;[i4 h14{TMe8l?{y?n_n\SP}k#P]7k_H|J.Busno}>vm,]o>p>gG8 Abuse: Any knowing or intentional act on the part of a caregiver or any other person which results in physical injury, unreasonable confinement, cruel punishment, sexual abuse, or sexual exploitation of a vulnerable adult. ch. However, they may schedule additional inspections because of a variety of special circumstances. Copyright 2016-2023. There are no staffing ratios. WebRequisition ID 2023-296540 Employment Type Full Time Department Environmental Services Hours/Pay Period 80 Shift Day Weekly Schedule Sunday-Saturday (11:30AM-8:00PM) Remote No Category Housekeeping 1112 97 If you have questions about nursing home abuse or how to report a suspected violation, you may want to speak with an attorney. Table of Contents (Rev. Abuse: Any purposeful and unnecessary physical act which inflicts pain on or causes injury to an endangered or impaired adult, including sexual abuse; or any intentional or demeaning act which subjects an endangered or impaired adult to ridicule or psychological injury in manner likely to provoke fear or alarm; any purposeful threat that a reasonable person would find credible and nonfrivolous to inflict pain on or cause injury to an endangered or impaired person. <]/Prev 674178>> State nursing homes were regulated by federal laws that were authorized in the year 1967 by the US Congress. 0000223327 00000 n @@r{c$yG~/6 e{9eEjwb1E"1+EJxwYRjUt)^$fH.g?"wHVdF;@k[!\bg`bmM) $O9VzPluyv?IXwlYqu3I C"j1%OV"wyKZ-v)Tqnb'jlFYp.fKMQ4KcTk _7I3BoiBuiCoo&)ed&+yi.5$J+$X,!6$-c$pMkYP=8H$7 nD6"A90}L1zE*#m0JBh,]SV\peMVKAU%o\::(nCwQ7y j&8kA[5|R PvQIpueq;RZxw}_`b,AjmFVUq6h KT[!y95vpZ`.uDH%Y] B].'CNLgyPtnW&E'Z}H`Y:YE.eZcN7it$Agpzs}ccw 0 L endstream endobj 158 0 obj 1491 endobj 159 0 obj << /Filter /FlateDecode /Length 158 0 R >> stream Accordingly, both federal and state governments have enacted legislation to help combat nursing home abuse. 0000223168 00000 n Compassionate Care Visits. 0000066739 00000 n 0000220712 00000 n "a! WebNursing Homes Personal Care Facilities Menu Workers' Rights. WebKnowledgeable of state, local, and federal regulations in relations to Nursing Homes ; Attends and participates in training programs as required by company. Number. WebNursing homes must give you at least 30 days' notice of private-pay cost increases. The Department will provide additional information and updated interpretive guidance on this web page as it becomes available. 0000176580 00000 n Abuse: A nonaccidental act or omission committed against an "at-risk" person that results in bodily injury, death, confinement or restraint, or criminal sexual abuse. Occupational Safety & Health Administration. %PDF-1.7 Visit our attorney directory to find a lawyer near you who can help. The elderly are some of the most vulnerable members of our society, and the law has certain safeguards in place in order to help prevent such abuses. added to the Public Health Law by Chapter 60 of the Laws of 2014, Part A, 20. Abuse of an elder or dependent adult:Includes physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering; the deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering; Criminal elder abuse: Any person who, under circumstances or conditions likely to produce great bodily harm or death, willfully causes or permits any elder or dependent adult, with knowledge that he or she is an elder or a dependent adult, to suffer, or inflicts thereon unjustifiable physical pain or mental suffering, or having the care or custody of any elder or dependent adult, willfully causes or permits the person or health of the elder or dependent adult to be injured, or willfully causes or permits the elder or dependent adult to be placed in a situation in which his or her person or health is endangered. Any care, treatment, service or procedure to maintain, Heres how the laws work with one another: Certified nursing homes can opt to receive federal Medicare or Medicaid funding. % Institutional Abuse: Willful infliction of injury, unreasonable confinement, intimidation or punishment, with resulting physical harm, impairment or mental anguish. Please turn on JavaScript and try again. 0000074260 00000 n 0000022436 00000 n Section 191.2290, RSMo. WebAlways wear reusable rubber gloves before handling soiled linen (e.g., bed sheets, towels, curtains). WebIdentify opportunities to enhance the physical environment to meet changing market demands. Abuse:The infliction of physical pain, injury, or the willful deprivation by a caregiver or other person of services necessary to maintain mental and physical health. Clean and sanitize bathrooms, including sinks, tubs, floors, and commodes. HnPDd2wm -^.z`j:u1k!XMo[e?*b+;W. Occupational Safety & Health Administration, Occupational Safety and Health Administration, Outreach Training Program (10- and 30-hour Cards), OSHA Training Institute Education Centers, Enforcement Procedures and Scheduling for Occupational Exposure to Workplace Violence, Safe Patient Handling -- Preventing Musculoskeletal Disorders in Nursing Homes, Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal Disorders, Severe Storm and Flood Recovery Assistance, Nursing Homes and Personal Care Facilities. 0000072090 00000 n 0000223970 00000 n (c) Emotional abuse means willful infliction of mental or emotional anguish by threat, humiliation, intimidation, or other abusive conduct, including but not limited to, frightening or isolating an adult. WebAccording to a survey conducted by Genworthin June 2017, the national average monthly cost for a semi-private room in a nursing home is $7,148 versus a cost of $3,750 for a one bedroom in an assisted living facility. 0000147927 00000 n The simple truth is that nursing homes all across the country are inspected for their quality. Learn more about FindLaws newsletters, including our terms of use and privacy policy. 0000068720 00000 n Abuse includes acts and omissions. While some federal rules and regulations may apply to assisted living communities, state-level regulation of assisted living services and operations ensures a coordinated, comprehensive licensure system because the state can take into account its full range of housing and service programs available to seniors and people with intellectual or developmental disabilities. WebFor example, the average cost of assisted living in California is $4,500 per month. Nursing homes are state regulated by the Department of Health in conjunction with the U.S. Centers for Medicare and Medicaid Services (CMS). (b) Sexual abuse means nonconsensual sexual contact of any kind, including but not limited to, forcing sexual contact or forcing sex with a third party. 375 - AN ACT CONCERNING NURSING HOME STAFFING LEVELS - This act requires that each nursing home facility calculate and post daily in a public area of the facility, the total number of nurses and nurse's aides providing direct patient care to residents of the nursing home facility. Position Summary. <> All rights reserved. Keystone State. Md. WebAny document recognized under state law indicating a residents choice with regard to a specific service, treatment, medication or medical procedure option that may be OSHA maintains a listing of the most frequently cited standards for specified 6-digit North American Industry Classification System (NAICS) codes. SB 879 safe patient handling legislation signed into law April 2007. plant housekeeping, operation, and maintenance. Baby boomers are fast approaching the age of retirement and so are in need of healthcare as well as medical services. (Emotional abuse defined separately.). See CT State Statutes Section 19-a562 to view the requirements pertaining to specialized trainingrequirements for staff ofindividuals residing in Specialized Alzheimers/Memory Care Units. Requirements of Participation eCompetencies, Payroll Based Journal (PBJ) Mandatory Reporting, Quality Assurance/Performance Improvement (QAPI), Occupational Safety and Health Administration (OSHA), Resources: Expanding Affordable Assisted Living, States use several different terms to refer to assisted living, such as residential care and shared housing. 0000065778 00000 n font size, Electronic Code of Federal Regulations E-CFR Public Health Requirements for States and Long Term Care Facilities Includes Residents Rights, Abuse-Neglect, Admission-Transfer-Discharge, Person-Centered Care Planning, Resident Assessment, and Many Other Areas. The last updated date refers to the last time this article was reviewed by FindLaw or one of ourcontributing authors. 0000161541 00000 n The proper information and resources can help health care employers control risks to staff and train workers on potential hazards associated with each job. Senate Bill 1525 was signed into law on June 17, 2005. :pRo?3eN0_eNjxzd:E=pEx*'*/w You may be trying to access this site from a secured browser on the server. 1 0 obj Contact an attorney or conduct your own legal research to verify the state law(s) you are researching. Subject to inspections called "surveys," nursing homes are evaluated for any violations or immediate threats to patient safety and satisfaction. \AP#9PV]+C1EP4m2!bs' w{IA P6^G$;T B3)A%@rQl(6#Q8hp. Must be able to be at work as schedule on time. Department of Public Health State Regulations, Office of Legislative Research Issue Brief-December 2022 OLR Summary of DPH State Regulations for Assisted Living Facilities, Department of Public Health Federal Regulations, Connecticut General Assembly Statutes For Landlord Tenant Rights. California. WebSpecialty care assisted living must have an administrator, a medical director, at least one RN, and a unit coordinator.

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state regulations for housekeeping in nursing homes

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