Nebraska Administrative Code, Chapter 15, Section 175-15-006 - STANDARDS OF OPERATION AND CARE | Nebraska Administrative Code

006.01 Licensee

The licensee must determine, implement, and monitor policies to assure that the service is administered and managed appropriately. The licensee's responsibilities include:

1. Maintain the RCS's compliance with all applicable state statutes and relevant rules and regulations;

2. Ensure the quality of all services and care provided to clients, whether furnished by the RCS staff or through contract with the RCS;

3. Ensuring clients are provided with a stable and supportive environment, through respect for the rights of clients and responsiveness to client needs; and

4. Ensuring that staff levels are sufficient to meet the clients' needs.

006.02 Person in Charge

The RCS must designate a person to be in charge of the day to day operation of the RCS. In a free-standing RCS site, the person must be onsite during the hours of operation.

006.03 Staff Requirements

The RCS must maintain a sufficient number of staff with the required training and skills necessary to meet the client's requirements for assistance or provision of personal care, activities of daily living, health maintenance activities, supervision, and support health and safety. The service must provide care to clients in a safe and timely manner.

15-006.03A Employment Eligibility: Each RCS must ensure and maintain evidence of the following:

15-006.03A1 Criminal Background Checks: The RCS must complete pre-employment criminal background checks on each unlicensed direct care staff member through a governmental law enforcement agency or a private entity that maintains criminal background information.

15-006.03A2 Registry Checks: The RCS must check each unlicensed direct care staff for adverse findings on the following Nebraska registries:

1. Nurse Aide Registry;

2. Adult Protective Services Central Registry;

3. Central Register of Child Protection Cases; and

4. State Patrol Sex Offender Registry.

15-006.03A3 The RCS must:

1. Determine how to use the criminal background and registry information, except for the Sex Offender Registry and Nurse Aide Registry, in making hiring decisions;

2. Decide whether employment can begin prior to receiving the criminal background and registry information; and

3. Document any decision to hire a person with a criminal background or adverse registry findings, except for the Sex Offender Registry and the Nurse Aide Registry. The documentation must include the basis for the decision and how it will not pose a threat to client safety or client property.

15-006.03A4 The RCS must not employ a person with adverse findings on the Sex Offender Registry, or on the Nurse Aide Registry regarding client abuse, neglect, or misappropriation of property.

15-006.03A5 Health Status: Each RCS must establish and implement policies and procedures regarding the health status of staff to prevent transmission of disease to clients. The RCS:

1. Must complete a health screening for each staff person prior to assuming job responsibilities; and

2. May, in its discretion, based on the health screening, require a staff person to have a physical examination.

15-006.03B Staff Training: The RCS must provide staff with sufficient training to meet client needs for care.

15.006.03B1 Orientation: The RCS must provide staff with orientation prior to the staff person having direct responsibility for care and services to clients. The training must include:

1. Job duties and responsibilities;

2. Client rights;

3. Client service agreements;

4. Infection control practices including handwashing techniques, personal hygiene, and disposal of infectious material;

5. Information on any physical and mental special care needs of the clients;

6. Emergency procedures and information regarding advance directives;

7. Information on abuse, neglect, and misappropriation of money or property of a client and reporting procedures; and

8. Disaster preparedness plans.

15-006.03B2 Ongoing Training: Each RCS must provide and maintain evidence of ongoing/continuous inservices or continuing education for staff. A record must be maintained including the date of the training, the topic, and participants.

15-006.03C Staffing Resources: The RCS must ensure that staffing resources and training are sufficient to meet the level of supervision and assistance with activities of daily living, personal care, and health maintenance activities that are required by the clients.

15-006.03C1 Supervision: The RCS must establish and implement policies and procedures regarding appropriate client supervision.

15-006.03D Employment Record: A current employment record must be maintained for each staff person. The record must contain at a minimum, information on orientation, inservices, employment eligibility information, and health history screening.

15-006.03E Provision of Respite Care Services: The RCS must provide staffing to ensure that services to clients are provided in a safe and timely manner to meet the needs of the client and in accordance with the instructions and direction of the caregiver.

006.04 Client Rights

Each RCS must protect and promote each client's rights. This includes the establishment and enforcement of written policies and procedures to ensure the operations of the RCS afford clients the opportunity to exercise their rights. At a minimum, each client must have the right to:

1. Respectful and safe care by competent personnel;

2. Be free from abuse, neglect, exploitation, and to be treated with dignity;

3. Receive respite care services without discrimination based upon race, color, religion, gender, or national origin;

4. Confidentiality of all records, communications, and personal information;

5. Be free of chemical and physical restraints; and

6. Be informed of changes in agency policies, procedures, and charges for service.

15-006.04A Designee/Caregiver Rights: At a minimum, each designee/caregiver must have the right to:

1. Be informed of any changes in the RCS description as indicated in 175 NAC 15-006.05;

2. Voice complaints without discrimination or reprisal against themselves or the client and have those complaints addressed;

3. Be informed of client and designee/caregiver rights during admittance; and

4. Be informed of changes in agency policies, procedures, and charges for service.

15-006.04B Designee Rights: At a minimum, each designee must have the right to formulate advance directives and have the RCS comply with the directives unless the RCS notifies the designee of their inability to do so.

15-006.04C Complaints: Each RCS must establish and implement a process of addressing all complaints received from clients, caregivers, designees, employees, and others. The process must include, but is not limited to:

1. A procedure for submission of complaints that is made available to employees, clients, or designee/caregivers; and

2. Time frames and procedures for review of complaints and provision of responses to address complaints.

006.05 Respite Care Service Description

The RCS must have a written description that is available to staff, clients, caretakers, designees, and members of the public that explains the range of respite care services that can be provided. The description must include the following:

1. The goals and objectives of the RCS;

2. The hours and days when care is provided;

3. The description of the types of clients to be served, including age, gender, care needs, and any other relevant characteristics;

4. The composition of staff and their qualifications;

5. The job responsibilities of staff; and

6. The system used for the reporting, investigating, and resolving allegations of client abuse, neglect, and exploitation.

006.06 Evaluations

The RCS must evaluate each client and have a written agreement with the client or designee to delineate the services to be provided to meet the needs identified in the evaluation. The agreement must contain the following basic components:

1. Who will provide the service;

2. Where the service will be provided; and

3. Disclosure of liability insurance held by the RCS, if any, and what the coverage provides.

006.07 Administration or Provision of Medications

Each RCS must establish and implement policies and procedures to ensure that clients receive medications only as legally prescribed by a medical practitioner in accordance with the five rights and with prevailing professional standards.

15-006.07A Methods of Administration of Medication: When the RCS is responsible for the administration of medication, it must be accomplished by the following methods:

1. Self-Administration of Medications: Clients may be allowed to self-administer medications, with or without visual supervision, when the RCS determines that the client is competent and capable of doing so and has the capacity to make an informed decision about taking medications in a safe manner. The RCS must develop and implement policies to address client self-administration of medication, including:

a. Storage and handling of medications;

b. Inclusion of the determination that the client may self-administer medication in the client's individualized service plan; and

c. Monitoring the plan to assure continued safe administration of medications by the client.

2. Licensed Health Care Professional: When the RCS uses a licensed health care professional for whom medication administration is included in the scope of practice, the RCS must ensure the medications are properly administered in accordance with prevailing professional standards.

3. Provision of Medication by a Person Other Than a Licensed Health Care Professional: When the RCS uses a person other than a licensed health care professional in the provision of medications, the RCS must follow 172 NAC 95, Regulations Governing the Provision of Medications by Medication Aides and Other Unlicensed Persons and 172 NAC 96, Regulations Governing the Medication Aide Registry where applicable. The RCS must establish and implement policies and procedures:

a. To ensure that medication aides and other unlicensed persons who provide medications are trained and have demonstrated the minimum competency standards specified in 172 NAC 96-004;

b. To ensure that competency assessments and/or courses for medication aides and other unlicensed persons are provided in accordance with the provision of 172 NAC 96-005;

c. That specify how direction and monitoring will occur when the RCS allows medication aides and other unlicensed persons to perform the routine/acceptable activities authorized by 172 NAC 95-005 and as follows:

(1) Provide routine medication; and

(2) Provision of medications by the following routes:

(a) Oral, which includes any medication given by mouth, including sublingual (placing under the tongue) and buccal (placing between the cheek and gum) routes and oral sprays;

(b) Inhalation, which includes inhalers and nebulizers, including oxygen given by inhalation;

(c) Topical applications of sprays, creams, ointments, lotions, and transdermal patches; and

(d) Instillation by drops, ointments, and sprays into the eyes, ears, and nose;

d. That specify how direction and monitoring will occur when the RCS allows medication aides and other unlicensed persons to perform the additional activities authorized by 172 NAC 95-007, which include but are not limited to:

(1) Provision of PRN medication;

(2) Provision of medications by additional routes including but not limited to gastrostomy tube, rectal, and vaginal; and/or

(3) Participation in monitoring;

e. That specify how competency determinations will be made for medication aides and other unlicensed persons to perform routine and additional activities pertaining to medication provision;

f. That specify how written direction will be provided for medication aides and other unlicensed persons to perform the additional activities authorized by 172 NAC 95-007;

g. That specify how records of medication provision by medication aides and other unlicensed persons will be recorded and maintained; and

h. That specify how medication errors made by medication aides and other unlicensed persons and adverse reactions to medications will be reported. The reporting must be:

(1) Made to the identified person responsible for direction and monitoring;

(2) Made immediately upon discovery; and

(3) Documented in client records.

15-006.07B When the RCS is not responsible for medication administration or provision, the RCS must maintain responsibility for overall supervision, safety, and welfare of the client.

15-006.07C Reporting of Medication Errors: When the RCS provides for medication administration or provision, the RCS must have policies and procedures for reporting any errors in administration or provision of any medications by the service or its employee(s). Any variance from the five rights must be reported as an error:

1. To the client's licensed practitioner;

2. To the client's designee/caregiver;

3. In a timely manner upon discovery; and

4. By written report.

15-006.07D Storage of Medication: Except when the respite care service is provided in the client's home, all medications must be stored in secured areas and stored in accordance with the manufacturer's instructions for temperature, light, humidity, or other storage instructions. If children under the age of 13 are being served, all medications must be locked.

15-006.07E Access to Medication: Except when the RCS is provided in the client's home, the RCS must ensure that only authorized staff who are designated by the RCS to be responsible for administration or provision of medications have access to medications.

15-006.07F Medication Record: The RCS must maintain records with sufficient detail to assure that:

1. Clients receive the medications authorized by a licensed health care professional; and

2. The RCS is alerted to theft or loss of medication.

15-006.07F1 Individual Client Record: Each client must have an individual medication administration record which must include:

1. Identification of the client;

2. Name of the medication given;

3. Date, time, dosage and method of administration for each medication administered or provided; and the identification of the person who administered or provided the medication; any refusal by the client; and

4. Client's medication allergies and sensitivities, if any.

006.08 Food Service

If the RCS provides food service, meals and snacks must be appropriate to the client's needs and preferences, and must meet daily nutritional requirements.

15-006.08A Menus: Menus must be planned and written based on the Food Guide Pyramid or equivalent and modified to accommodate special diets and texture adaptations as needed by the client. Menus must be made accessible to clients, caregivers, and designees.

15-006.08B Food Storage: The RCS must store, handle and dispose of food in a safe and sanitary manner and in accordance with the Nebraska Food Code.

006.09 Client Information

Each RCS must obtain written, accurate client information from the caregiver. Client information must be kept confidential.

15-006.09A Content: Client records must contain, when applicable, the following information:

1. Name of client;

2. Gender of client;

3. Date of birth of client;

4. Licensed practitioner's orders where applicable;

5. Significant medical conditions;

6. Medications and any special diet;

7. Allergies;

8. Person to contact in emergency situations;

9. Designated physician or registered nurse; and

10. Advance directives if available.

15-006.09B Client Identification: The RCS must establish policies and procedures for client identification when there are multiple clients at a site.

006.10 Disaster Preparedness and Management

The RCS must establish and implement disaster preparedness plans and procedures to ensure that client care, safety, and well-being are provided and maintained during and following instances of natural (tornado, flood, etc.) or other disasters, disease outbreaks, or other similar situations causing clients to remain at the RCS. Such plans and procedures must address and delineate:

1. How the RCS will maintain the proper identification of each client to ensure that care coincides with the client's needs;

2. How the RCS will move clients to points of safety or provide other means of protection when all or part of the building is damaged or uninhabitable due to natural or other disaster;

3. How the RCS will protect clients during the threat of exposure to the ingestion, absorption, or inhalation of hazardous substances or materials;

4. How the RCS will provide food, water, medicine, medical supplies, and other necessary items for care in the event of a natural or other disaster; and

5. How the RCS will provide for the comfort, safety, and well-being of clients in the event of 24 or more consecutive hours of:

a. Electrical or gas outage;

b. Heating, cooling, or sewer system failure; or

c. Loss or contamination of water supply.

Nebraska Administrative CodeTopic - HEALTH AND HUMAN SERVICES SYSTEMTitle 175 - HEALTH CARE FACILITIES AND SERVICES LICENSUREChapter 15 - RESPITE CARE SERVICESSection 175-15-006 - STANDARDS OF OPERATION AND CARE

Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 175 - HEALTH CARE FACILITIES AND SERVICES LICENSURE
Chapter 15 - RESPITE CARE SERVICES
Section 175-15-006 - STANDARDS OF OPERATION AND CARE