(a) Class A violations are:

1. (1) Violations that create a condition or occurrence relating to the operation and maintenance of a long-term care facility which results in death or serious harm to a resident; or
2. (2) Violations that create a condition or occurrence relating to the operation and maintenance of a long-term care facility which creates a substantial probability that death or serious physical harm to a resident will result from the violation.

(b) The following Class A violations and the points assigned to each are provided and are subject to the conditions set out in 20 CAR § 400-2603:

1. (1)

   1. (A) Death of a resident, two thousand five hundred (2,500).
   2. (B) Any condition or occurrence relating to the operation of a long-term care facility in which the conduct, act, or omission of a person or actor purposely, knowingly, recklessly, or negligently results in the death of a resident shall be a Class A violation;

2. (2)

   1. (A) Serious physical harm to a resident, two thousand five hundred (2,500).
   2. (B) Any condition or occurrence relating to the operation of a long-term care facility in which the conduct, act, or omission of a person or actor purposely, knowingly, recklessly, or negligently results in serious physical harm to a resident shall be a Class A violation;

3. (3)

   1. (A) Probability of death or serious physical harm.
   2. (B) The following conduct, acts, or omissions, when not resulting in death or serious physical harm but which create a substantial probability that death or serious physical harm to a resident will result therefrom, are conditions or occurrences relating to the operation of a long-term care facility which are Class A violations:

(b) (b) Two thousand five hundred (2,500) points shall be assigned when a facility fails to provide proper storage of poisonous substances;

1. (ii)

(b) (b) One thousand five hundred (1,500) points shall be assigned when a facility fails to maintain required direct care staffing or a safe environment and this failure directly causes a fall by a resident. Examples: Equipment not properly maintained; or A fall due to personnel not responding to patient requests for assistance;

1. (iii)

(b) (b) Two thousand five hundred (2,500) points shall be assessed when a facility fails to maintain required direct care staffing or measures are not taken when it is known that a resident is combative and assaultive with other residents, and this failure causes an assault upon a resident of the facility by another resident.

1. (c) (c) A Class A violation shall also exist when a facility fails to perform adequate screening of personnel and this failure causes an assault upon a resident by an employee of the facility;

   1. (iv)

(b) (b) Two thousand two hundred fifty (2,250) points shall be assigned when a facility personnel improperly apply physical restraints contrary to published rules or fail to check and release restraints as directed by physician's orders or rules;

1. (v)

(b) (b) Two thousand five hundred (2,500) points shall be assigned when a facility does not follow or meet nosocomial infection control standards as outlined by rules or as ordered by the physician;

1. (vi)

(b) (b) Two thousand five hundred (2,500) points shall be assigned when a facility fails to secure proper medical assistance or orders from a physician;

1. (vii)

(b) (b) Two thousand five hundred (2,500) points shall be assigned when a facility does not take decubitus ulcer measures as ordered by the physician and such failure results in death or serious injury to a resident, or facility personnel fail to notify the physician of such ulcers;

1. (viii)

(b) (b) Two thousand five hundred (2,500) points when facility personnel perform treatment or treatments contrary to a physician's order and such treatment results in death or serious injury to the resident;

1. (ix)

(b) (b) Two thousand five hundred (2,500) points shall be assigned when facility personnel knowingly withhold medication from a resident as ordered by a physician and such withholding of medication or medications results in death or serious injury to a resident, or the facility personnel fail to order and/or stock medication or medications prescribed by the physician and the failure to order and/or stock medication or medications results in death or serious injury to the resident;

1. (x)

(b) (b) One thousand eight hundred and fifty (1,850) points shall be assigned when a facility does not provide necessary supervision of residents to prevent a resident from wandering away from the facility and such failure results in death or serious injury to a resident, or a facility does not provide adequate measures to ensure that residents with an elopement history do not wander away from the facility.

1. (c) (c) Examples of preventative measures include but are not limited to documentation that:
2. (1) (1) An elopement history has been discussed with the family of the resident;
3. (2) (2) Alarms have been placed on exit doors;
4. (3) (3) Personnel have been trained to make additional efforts to watch the resident with such history; and

5. (4) (4) The physician of such a resident has been made aware of such history;

   1. (xi)

(b) (b) Two thousand five hundred (2,500) points shall be assigned when a facility fails to reasonably maintain its heating and air conditioning system as required by rule.

1. (c) (c) Isolated incidents of breakdown or power failure shall not be considered a Class A violation under this section;

   1. (xii)

(b) (b) Two thousand (2,000) points shall be assigned when a facility does not train staff in fire/disaster procedures as required by rules or when staffing requirements are not met; and

1. (xiii)

(b) (b) Two thousand five hundred (2,500) points shall be assigned when a facility fails to maintain the required life safety code systems.

1. (c) (c) Isolated incidents of breakdown shall not be considered a Class A violation under this section if the facility has immediately notified the Office of Long-Term Care upon discovery of the problem and has taken all necessary measures to correct the problem.