SC Regulation 60-17 (DPH) — Standards for licensing nursing homes

Disclaimer

DPH provides this copy of the regulation for the convenience of the public and makes every effort to ensure its accuracy. However, this is an unofficial version of the regulation. The regulation's most recent final publication in the South Carolina State Register presents the official, legal version of the regulation.

Statutory Authority: S.C. Code Section 44-7-260

Full regulation text: Regulation 60-17 (DPH)

SECTION 100 – DEFINITIONS AND REFERENCES

101. Definitions
1. References

SECTION 200 – LICENSE REQUIREMENTS AND FEES

201. License Requirements
1. License Fees
1. Exceptions to Licensing Standards

SECTION 300 – ENFORCING REGULATIONS

301. General
1. Inspections and Investigations
1. Consultations

SECTION 400 – ENFORCEMENT ACTIONS

401. General
1. Violation Classifications

SECTION 500 – POLICIES AND PROCEDURES (II)

SECTION 600 – STAFF AND TRAINING

601. General (II)
1. Administrator
1. Direct Care Staff (II)
1. Medical Staff (I)
1. Staff (I)
1. Inservice Training (II)
1. Health Status (II)
1. Volunteers
1. Private Sitters

SECTION 700 – REPORTING

701. Accidents and Incidents
1. Fire and Disasters (III)
1. Communicable Diseases and Animal Bites (I)
1. Administrator Change
1. Joint Annual Report
1. Facility Closure
1. Zero Census

SECTION 800 – RESIDENT RECORDS

801. Content (II)
1. Physician Orders (II)
1. Individual Care Plan (ICP) (II)
1. Record Maintenance
1. Electronic Resident Records

SECTION 900 – ADMISSION AND RETENTION

SECTION 1000 – RESIDENT CARE AND SERVICES

1001. General
1. Fiscal Management (II)
1. Recreation
1. Physician Services (II)
1. Social Services
1. Dental Services
1. Oxygen Therapy (II)
1. Laboratory Services
1. Outpatient Services
1. Other Services to Residents
1. Transportation (I)
1. Restraints (II)
1. Discharge and Transfer

SECTION 1100 – RIGHTS AND ASSURANCES

1101. General (II)
1. Resident and Family Councils (II)

SECTION 1200 – RESIDENT PHYSICAL EXAMINATION AND TUBERCULOSIS SCREENING (I)

SECTION 1300 – MEDICATION MANAGEMENT

1301. General
1. Medication and Treatment Orders (II)
1. Administering Medication (II)
1. Pharmacy Services
1. Medication Containers (II)
1. Medication Storage
1. Medication Control and Accountability (II)
1. Emergency Medications (II)
1. Disposition of Medications

SECTION 1400 – MEAL SERVICE

1401. General (II)
1. Food and Food Storage (II)
1. Food Equipment and Utensils
1. Meals and Services (II)
1. Meal Service Staff
1. Diets (II)
1. Menus
1. Ice and Drinking Water (II)

SECTION 1500 – EMERGENCY PROCEDURES AND DISASTER PREPAREDNESS

1501. Emergency Care (II)
1. Disaster Preparedness (II)
1. Licensed Bed Capacity During An Emergency (II)
1. Emergency Call Numbers (II)
1. Continuity of Essential Services (II)
1. Use of the Facility or Services in Response to a Public Health Emergency (II)

SECTION 1600 – FIRE PREVENTION

1601. Arrangements for Fire Department Response and Protection (II)
1. Tests (II)
1. Fire Response Training (I)
1. Fire Drills (I)

SECTION 1700 – INFECTION CONTROL AND ENVIRONMENT

1701. Staff Practices (II)
1. Tuberculosis Risk Assessment (I)
1. Staff Tuberculosis Screening (I)
1. Resident Tuberculosis Screening (I)
1. Isolation Procedures (II)
1. Vaccinations (II)
1. Housekeeping (II)
1. Infectious Waste (II)
1. Pets (II)
1. Clean and Soiled Linen and Clothing (II)
1. Laundry (II)

SECTION 1800 – QUALITY IMPROVEMENT PROGRAM

SECTION 1900 – DESIGN AND CONSTRUCTION

1901. General (II)
1. Codes and Standards (II)
1. Submission of Plans (II)
1. Construction Permits (II)
1. Utility Rooms

SECTION 2000 – FIRE PROTECTION EQUIPMENT AND SYSTEMS

2001. Fire Alarms and Sprinklers (II)
1. Emergency Generator Service

SECTION 2100 – PREVENTIVE MAINTENANCE

SECTION 2200 – EQUIPMENT AND SYSTEMS

2201. Gases (I)
1. Furnishings and Equipment (I)

SECTION 2300 – WATER SUPPLY, HYGIENE, AND TEMPERATURE CONTROL

SECTION 2400 – ELECTRICAL

2401. General
1. Panelboards (II)
1. Lighting
1. Receptacles (II)
1. Ground Fault Protection (I)
1. Exit Signs (I)

SECTION 2500 – HEATING, VENTILATION, AND AIR CONDITIONING (HVAC)

SECTION 2600 – GENERAL CONSTRUCTION REQUIREMENTS

2601. Common Areas
1. Resident Rooms
1. Resident Room Floor Area
1. Visitor Accommodations
1. Baths and Restrooms
1. Work Stations
1. Signal System (II)
1. Doors (II)
1. Elevators (II)
1. Handrails and Guardrails (II)
1. Janitor's Closet (II)
1. Storage Areas
1. Telephone Service
1. Location
1. Outdoor Area

SECTION 2700 – SEVERABILITY

SECTION 2800 – GENERAL

Regulation History as Published in State Register

Date	Document Number	Volume	Issue
April 23, 1979	-	3	8, Part 5
June 13, 1980	-	4	11
February 28, 1992	1345	16	2
June 27, 2008	3134	32	6
June 26, 2009	4013	33	6, Part 1
March 25, 2016	4543	40	3
May 23, 2025	5352	49	5

SECTION 100 – DEFINITIONS AND REFERENCES

101. Definitions

For the purpose of this regulation, the following definitions shall apply:

A. Abuse. Physical abuse or psychological abuse.

Physical Abuse. The act of intentionally inflicting or allowing to be inflicted physical injury on a resident by an act or failure to act. Physical abuse includes, but is not limited to, slapping, hitting, kicking, biting, choking, pinching, burning, actual or attempted sexual battery, use of medication outside the standards of reasonable medical practice for the purpose of controlling behavior, and unreasonable confinement. Physical abuse also includes the use of a restrictive or physically intrusive procedure to control behavior for the purpose of punishment except that a therapeutic procedure prescribed by a physician or other legally authorized healthcare professional or that is part of a written ICP by a physician or other legally authorized healthcare professional is not considered physical abuse. Physical abuse does not include altercations or acts of assault between residents.
Psychological Abuse. The deliberate use of any oral, written, or gestured language or depiction that includes disparaging or derogatory terms to a resident or within the resident's hearing distance, regardless of the resident's age, ability to comprehend, or disability, including threats or harassment or other forms of intimidating behavior causing fear, humiliation, degradation, agitation, confusion, or other forms of serious emotional distress.

B. Activities of Daily Living (ADL). Those personal functions performed by an individual in the course of a day that include, but are not limited to, walking; bathing; shaving; brushing teeth; combing hair; dressing; eating; getting in or getting out of bed; toileting; ambulating and other similar activities.

C. Administering Medication. The direct application of a single dose of a medication to the body of a resident by injection, ingestion, or any other means. It includes the acts of preparing and giving medications in accordance with the orders of a physician or other legally authorized healthcare provider as to medication, dosage, route and frequency; observing, recording, and reporting desired effects, adverse reactions, and side effects of medication therapy; intervening when emergency care is required as a result of medication therapy; appropriately instructing the resident regarding his or her medication; recognizing accepted prescribing limits and reporting deviations to the prescriber.

D. Administrator. The individual designated by the licensee who has the authority and responsibility to manage the facility, who is in charge of all functions and activities of the facility, and who is appropriately licensed as a nursing home Administrator by the South Carolina State Board of Long-Term Health Care Administrators.

E. Adult. A person eighteen (18) years of age or older.

F. Advance Directive. Any document recognized under state law indicating a resident's choice with regard to a specific service, treatment, medication or medical procedure option that may be implemented in the future, such as power of attorney, healthcare directive, limited or restricted treatment cardio-pulmonary resuscitation (CPR), do not resuscitate (DNR), and organ tissue donation.

G. Airborne Infection Isolation (AII). A room designed to maintain Airborne Infection Isolation, formerly called a negative pressure isolation room. An Airborne Infection Isolation room is a single-occupancy resident-care room used to isolate persons with suspected or confirmed infectious tuberculosis (TB) disease. Environmental factors are controlled in Airborne Infection Isolation rooms to minimize the transmission of infectious agents that are usually spread from person-to-person by droplet nuclei associated with coughing or aerosolization of contaminated fluids. Airborne Infection Isolation rooms may provide negative pressure in the room (so that air flows under the door gap into the room), an air flow rate of six to twelve (6-12) air changes per hour (ACH), and direct exhaust of air from the room to the outside of the building or recirculation of air through a high efficiency particulate air (HEPA) filter.

H. Annual (Annually). A time period that requires an activity to be performed at least every twelve to thirteen (12 to 13) months.

I. Application. A completed application form and any supplemental documentation and information required by this regulation, for example, fee, emergency evacuation plan.

J. Assessment. A procedure for determining the nature and extent of the problem(s) and needs of a resident and/or a potential resident to ascertain if the facility can adequately address those problems, meet those needs, and to secure information for use in the development of the ICP. Included in the process is an evaluation of the physical, emotional, behavioral, social, spiritual, nutritional, recreational, and, when appropriate, pain management, vocational, educational, legal status or needs of a resident and/or a potential resident. Consideration of each resident's needs, strengths, and weaknesses shall be included in the assessment.

K. Blood Assay for Mycobacterium tuberculosis (BAMT). A general term to refer to in vitro diagnostic tests that assess for the presence of tuberculosis (TB) infection with M. tuberculosis. This term includes, but is not limited to, IFN-gamma release assays (IGRA).

L. Certified Nurse Aide (CNA). A person whose duties are assigned by a licensed nurse and who has successfully completed a state-approved training program or course with a curriculum prescribed by the South Carolina Department of Health and Human Services, holds a certificate of training from that program or course and is listed on the South Carolina Registry of Certified Nurse Aides.

M. Consultation. A visit by Department representatives who will provide information to the licensee in order to facilitate compliance with these regulations.

N. Contact Investigation. Procedures that occur when a case of infectious TB is identified, including finding persons (contacts) exposed to the case, testing and evaluation of contacts to identify Latent TB Infection (LTBI) or TB disease, and treatment of these persons, as indicated.

O. Controlled Substance. A medication or other substance included in Schedule I, II, III, IV, and V of the Federal Controlled Substances Act and the South Carolina Controlled Substances Act.

P. Controlling Interest. In the case of a corporation, controlling interest means more than fifty percent (50%) of the total combined voting power of all classes of stock of the corporation entitled to vote or more than fifty percent (50%) of the capital, profits or beneficial interest in the voting stock of the corporation. In the case of a partnership, association, trust or other entity, controlling interest means more than fifty percent (50%) of the capital, profits or beneficial interest in the partnership, association, trust or other entity.

Q. Department. The South Carolina Department of Public Health.

R. Designee. A staff member designated by the Administrator to act on his or her behalf.

S. Direct Care Staff Member and Direct Care Volunteer. A licensed nurse, or nurse aide; any other licensed professional who provides to residents 'hands on' direct care or services and includes, but is not limited to, a physical, speech, occupational, or respiratory care therapist; a person who is not licensed but provides 'hands on' physical assistance or care to a resident. It does not include a family member, a faculty member or student enrolled in an educational program, including clinical study in a nursing home.

T. Discharge. The termination of resident or outpatient status in a facility by which the facility no longer maintains active responsibility for the care of the resident or outpatient.

U. Dispensing Medication. The transfer of possession of one (1) or more doses of a medication or device by a licensed pharmacist or individual as permitted by law, to the ultimate consumer or his or her agent pursuant to a lawful order of a practitioner in a suitable container appropriately labeled for subsequent administration to, or use by a resident.

V. Do Not Resuscitate (DNR) Order. An order entered by the resident's attending physician in the resident's record that states that in the event the resident suffers cardiac or respiratory arrest, cardio-pulmonary resuscitation should not be attempted. The order may contain limiting language to allow only certain types of cardio-pulmonary resuscitation to the exclusion of other types of cardio-pulmonary resuscitation.

W. Electronic Signature. An electronic sound, symbol, or process attached to or logically associated with a record and executed or adopted by an individual with the legal authority to sign the record.

X. Exploitation. 1) Causing or requiring a resident to engage in an activity or labor that is improper, unlawful, or against the reasonable and rational wishes of a resident. Exploitation does not include requiring a resident to participate in an activity or labor that is a part of a written ICP or that is prescribed or authorized by the resident's attending physician; 2) an improper, unlawful, or unauthorized use of the funds, assets, property, power of attorney, guardianship, or conservatorship of a resident by an individual for the profit or advantage of that individual or another individual; 3) or causing a resident to purchase goods or services for the profit or advantage of the seller or another individual through undue influence, harassment, duress, force, coercion, or swindling by overreaching, cheating, or defrauding the resident through cunning arts or devices that delude the resident and cause him or her to lose money or other property.

Y. Facility. A nursing home licensed by the Department.

Z. Health Assessment. An evaluation of the health status of a staff member or volunteer by a physician, other legally authorized healthcare provider, or registered nurse, pursuant to written standing orders and/or protocol approved by a physician's signature.

AA. Incident. An unusual unexpected adverse event, including harm, injury, or death of staff or residents, accidents, for example, medication errors, adverse medication reactions, elopement of a resident.

BB. Individual Care Plan (ICP). A documented regimen of appropriate care, treatment, services or written action plan prepared by the facility for each resident, based on assessment data, for example, social services, which is to be implemented for the benefit of the resident.

CC. Inspection. A visit by a Department representative(s) for the purpose of determining compliance with this regulation.

DD. Institutional Nursing Home. A nursing home (established within the jurisdiction of a larger nonmedical institution) that maintains and operates organized facilities and services to accommodate only students, residents or inmates of the institution.

EE. Interdisciplinary Team. A group designated by the facility to provide or supervise care, treatment, and services provided by the facility. The group normally includes the following persons: a registered nurse, dietary, social services, direct care staff members, nurse aides, and activity professionals.

FF. Investigation. An official inquiry by an authorized individual(s) to a licensed or unlicensed facility for the purpose of determining the validity of allegations received by the Department relating to this regulation.

GG. Isolation. The separation of individuals known or suspected (via signs, symptoms, or laboratory criteria) to be infected with a contagious disease to prevent them from transmitting disease to others.

HH. Latent TB Infection (LTBI). Infection with M. tuberculosis. Persons with Latent TB Infection carry the organism that causes TB but do not have TB disease, are asymptomatic, and are noninfectious. Such persons usually have a positive reaction to the tuberculin skin test and/or positive BAMT.

II. Legally Authorized Healthcare Provider. An individual authorized by law and currently licensed in South Carolina to provide specific medical treatments, care, or services to staff members and/or residents, for example, advanced practice registered nurses, physician assistants.

JJ. Legend Drug.

A medication required by federal law to be labeled with any of the following statements prior to being dispensed or delivered: a. "Caution: Federal law prohibits dispensing without prescription"; b. "Rx only";
A medication required by federal or state law to be dispensed pursuant to a prescription medication order or restricted to use by practitioners only;
Any medication products designated by the South Carolina Board of Pharmacy to be a public health threat; or
Any prescribed compounded prescription within the meaning of the South Carolina Pharmacy Practice Act.

KK. License. A printed certificate issued by the Department to the licensee that authorizes the operation of a nursing home.

LL. Licensed Nurse. A person licensed by the South Carolina Board of Nursing as a registered nurse or licensed practical nurse or a person licensed as a registered nurse or licensed practical nurse who resides in another state that has been granted multi-state licensing privileges by the South Carolina Board of Nursing. This person may practice nursing in any facility or activity licensed by the Department subject to the provisions and conditions as indicated in the Nurse Licensure Compact Act.

MM. Licensee. The individual, corporation, organization, or public entity that has received a license to provide care, treatment, and services at a facility and with whom rests the ultimate responsibility for compliance with this regulation.

NN. Medication. A substance that has therapeutic effects, including, but not limited to, legend drugs, nonlegend and herbal products, vitamins, and nutritional supplements.

OO. Monthly. A time period that requires an activity to be completed at least twelve (12) times a year within intervals ranging from twenty-five to thirty-five (25 to 35) days.

PP. Neglect. The failure or omission of a direct care staff member or direct care volunteer to provide the care, goods, or services necessary to maintain the health or safety of a resident including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services. Neglect may be repeated conduct or a single incident that has produced or could result in physical or psychological harm or substantial risk of death. Noncompliance with regulatory standards alone does not constitute neglect.

QQ. Nonlegend Medication. A medication that may be sold without a prescription and that is labeled for use by the consumer in accordance with the requirements of the laws of this state and the federal government.

RR. Nursing Home. A facility with an organized nursing staff to maintain and operate organized facilities and services to accommodate two (2) or more unrelated individuals over a period exceeding twenty-four (24) hours which is operated either in connection with a hospital or as a freestanding facility for the express or implied purpose of providing intermediate or skilled care for persons who are not in need of hospital care.

SS. Occupational Therapist. A person currently licensed as such by the South Carolina Board of Occupational Therapy Examiners.

TT. Pharmacist. A person currently registered as such by the South Carolina Board of Pharmacy.

UU. Physical Examination. An examination of a resident that addresses those issues identified in Section 1200 of this regulation.

VV. Physical Therapist. A person currently licensed as such by the South Carolina Board of Physical Therapy Examiners.

WW. Physician. A person currently licensed as such by the South Carolina Board of Medical Examiners.

XX. Physician Order. A physician's written authorization or prescription for the provision of services.

YY. Physician Assistant. A person currently licensed as such by the South Carolina Board of Medical Examiners.

ZZ. Quality Improvement Program. The process used by a facility to examine its methods and practices of providing care, treatment, and services, identify the ways to improve its performance, and take actions that result in higher quality of care and services for the facility's residents.

AAA. Quarterly. A time period that requires an activity to be performed at least four (4) times a year within intervals ranging from eighty-one to ninety-nine (81 to 99) days.

BBB. Repeat Violation. The recurrence of any violation cited under the same section of the regulation within a thirty-six-month (36-month) period. The time period determinant of repeat violation status is not interrupted by licensee changes.

CCC. Resident. Any person, other than a staff member or volunteer, who resides in a facility and occupies a licensed bed.

DDD. Resident Council. A group of residents having the right to meet as a group to address resident issues and to make recommendations and suggest ways to improve resident care and services.

EEE. Resident Room. An area enclosed by four (4) ceiling high walls (or as determined by the Department) that can house one (1) or more residents of the facility.

FFF. Respite Care. Short-term care (a period of six (6) weeks or less) provided to an individual to relieve the family members or other individuals caring for the individual, but for not less than twenty-four (24) hours.

GGG. Responsible Party. A person who is authorized by the resident or by law to make decisions on behalf of a resident, to include, but not be limited to, a court-appointed guardian (or legal guardian as referred to in the Bill of Rights for Residents of Long-Term Care Facilities) or conservator, or individual with a healthcare power of attorney or other durable power of attorney.

This covers the Table of Contents, Regulation History, and Definitions A through GGG of Section 101 verbatim from the source. The source text provided cuts off mid-sentence within definition "HHH. Restraint," and no further sections (102 through 2800, including the substantive operational sections on licensing, staff training, resident records, medication management, fire prevention, and construction) were included in the material supplied — see the full source document linked above for those sections.