55 Pa. Code § 2600.26 – Quality management.

(a) The home shall establish and implement a quality management plan.
(b) The quality management plan shall address the periodic review and evaluation of the following:
1. (1) The reportable incident and condition reporting procedures.
2. (2) Complaint procedures.
3. (3) Staff person training.
4. (4) Licensing violations and plans of correction, if applicable.
5. (5) Resident or family councils, or both, if applicable.
(c) The quality management plan shall include the development and implementation of measures to address the areas needing improvement that are identified during the periodic review and evaluation.