(a)    Each nursing home shall develop and implement a quality assurance program.

(b)    (1)    Each nursing home shall designate a qualified individual to coordinate and manage the nursing home’s quality assurance program.

(2)    Each nursing home shall establish a quality assurance committee and shall include at least the following members:

(i)    The nursing home administrator;

(ii)    The director of nursing;

(iii)    The medical director;

(iv)    A social worker;

(v)    A licensed dietitian; and

(vi)    A geriatric nursing assistant.

(3)    The quality assurance committee shall:

(i)    Meet at least monthly;

(ii)    Maintain records of all quality assurance activities;

(iii)    Keep records of committee meetings that shall be available to the Department during any on–site visit; and

(iv)    Prepare monthly reports that shall be presented to the ombudsman, the resident’s council, and the family council.

(4)    The quality assurance committee for a nursing home shall review and approve annually the quality assurance plan for the nursing home.

(5)    Each nursing home shall establish a written quality assurance plan that:

(i)    Includes procedures for concurrent review for all residents;

(ii)    Provides criteria that routinely monitors nursing care including medication administration, prevention of decubitus ulcers, dehydration and malnutrition, nutritional status and weight loss or gain, accidents and injuries, unexpected deaths, changes in mental or psychological status, and any other data necessary to monitor quality of care;

(iii)    Includes methods to identify and correct problems; and

(iv)    Is readily available to nursing home residents and their families, guardians, or surrogate decision makers.

(6)    The quality assurance plan shall be submitted to the Department every 2 years.

(7)    The nursing home administrator shall take appropriate remedial actions based on the recommendations of the nursing home’s quality assurance committee.

(8)    The Secretary may not require the quality assurance committee to disclose the records and the reports prepared by the committee except as necessary to assure compliance with the requirements of this section.

(9)    If the Department determines that a nursing home is not implementing its quality assurance program effectively and that quality assurance activities are inadequate, the Department may impose appropriate sanctions on the nursing home to improve quality assurance including mandated employment of specified quality assurance personnel.

(c)    (1)    Each nursing home shall display on each floor of the nursing home a notice that explains the current ratio of licensed personnel to residents and unlicensed personnel to residents.

(2)    The notice shall be:

(i)    Posted in a location that is visible and accessible to residents and their family or guardians and any potential consumers; and

(ii)    On a form provided by the Department.