Current through September 17, 2024
Each Intermediate Care Facility for Individuals with
Intellectual Disabilities must be organized, managed and administered in a
manner by the licensee consistent with the size, resources, and type of
services provided to ensure each client receives appropriate care and treatment
in a safe manner and in accordance with current standards of practice. Each
Intermediate Care Facility for Individuals with Intellectual Disabilities must
meet the regulations identified in 175 NAC 1, this chapter, and must satisfy
all the elements of the Centers for Medicare and Medicaid (CMS) Conditions of
Participation for an Intermediate Care Facility for Individuals with
Intellectual Disabilities as set out in 42 Code of Federal Regulations (CFR)
483.150 - 483.480, the Conditions of Coverage for Emergency Preparedness
Requirements for an Intermediate Care Facility for Individuals with
Intellectual Disabilities, and the State Fire Code and Life Safety Code.
006.01
LICENSEE
RESPONSIBILITIES. The licensee has the legal responsibility for
the total operation of the facility. The responsibilities of the licensee
include:
(A) Monitoring policies to assure the
appropriate administration and management of the Intermediate Care Facility for
Individuals with Intellectual Disabilities;
(B) Ensuring the Intermediate Care Facility
for Individuals with Intellectual Disabilities is in compliance with all
applicable and state and federal statutes and rules and regulations;
(C) Ensuring quality services are provided to
all clients whether services are furnished directly by the facility or through
contract with another entity;
(D)
Periodically reviewing reports and recommendations regarding the Quality
Assurance Performance Improvement (QAPI) program and implementing programs and
policies to maintain and improve the quality of services;
(E) Designating an administrator who is
responsible for the day to day management of the Intermediate Care Facility for
Individuals with Intellectual Disabilities and defining the duties and
responsibilities of the administrator in writing;
(F) Notifying the Division of Public Health
in writing within 5 working days when a vacancy in the administrator position
occurs including who will be responsible for the position duties until another
administrator is appointed; and
(G)
Notifying the Division of Public Health in writing within 5 working days when
the vacancy of the administrator position is filled including the effective
date and name of the person appointed.
006.02
ADMINISTRATION. The administrator is responsible for
planning, organizing, and directing the operation of the Intermediate Care
Facility for Individuals with Intellectual Disabilities. The administrator must
report in all matters related to maintenance, operation, and management of the
Intermediate Care Facility for Individuals with Intellectual Disabilities to
the licensee and be responsible to the licensee. The administrator's
responsibilities include:
(1) Ensuring that
the facility protect and promote the health, safety, and well-being of the
individuals;
(2) Maintaining staff
appropriate to meet individuals' needs;
(3) Designating a substitute, who is
responsible and accountable for management of the ICF/ID, to act in the absence
of the administrator;
(4)
Developing procedures which require the reporting of any evidence of abuse,
neglect, or exploitation of any individual served by the facility in accordance
with Neb. Rev. Stat. §
28-372 of the Adult Protective
Services Act or in the case of a child, in accordance with Neb. Rev. Stat.
§
28-711.
006.02(A)
REPORTING.
Each licensee must ensure that any incident where staff has reason to believe
that abuse, neglect, or exploitation of a client has occurred is reported to:
(i) The Adult and Child Abuse and Neglect
Hotline via telephone immediately; and
(ii) Local law enforcement as required by
state and federal laws.
006.02(B)
INVESTIGATION. Each must ensure any incident where
staff has reason to believe that abuse, neglect, or exploitation of a client
has occurred is thoroughly investigated and the investigation documented in a
written report. Within 5 working days of the incident, the facility must submit
the written investigative report to the Division of Public Health.
006.02(C)
PROTECTION. Each licensee must ensure that clients are
protected throughout the investigation. Actions must be taken as a result of
the investigation to ensure client safety and to prevent the potential for
recurrence.
006.03
STAFF REQUIREMENTS. The licensee must ensure all
persons who provide a service to clients meet applicable state laws. The
licensee must ensure that all persons for whom a license, certification or
registration is required hold the license, certification or registration in
accordance with applicable state laws. Staff may not provide care or treatment
that is outside of the scope of practice permitted by the credential held by
the individual.
006.03(A)
STAFF
CREDENTIALS. Each licensee must verify and maintain evidence of
the current, active licensure, registration, certification or other credential
for each staff member. This must include, but is not limited to, verification
prior to staff assuming assigned job duties; and evidence that such status is
checked and maintained throughout the entire time of employment.
006.03(B)
CRIMINAL BACKGROUND AND
REGISTRY CHECKS. Criminal background and registry checks must be
completed prior to employment for each licensed and unlicensed direct care
staff members. Documentation of such check must be retained in each staff
member's personnel file for the duration of employment.
006.03(B)(i)
CRIMINAL BACKGROUND
CHECKS. Criminal background checks must be completed through a
governmental law enforcement agency or a private entity that maintains criminal
background information.
006.03(B)(ii)
REGISTRY
CHECKS. A check 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)
Nebraska State Patrol Sex Offender Registry.
006.03(B)(iii)
COMPLIANCE. The licensee must:
(1) Not employ staff with a conviction or
prior employment history of child or vulnerable adult abuse, neglect, or
mistreatment or with adverse findings on the Nurse Aide Registry regarding
abuse or neglect of individuals served, or misappropriation of the property of
individuals served;
(2) Determine
how to use the criminal background and registry information, except for the
Nurse Aide Registry, in making hiring decisions; and
(3) Document any decision to hire a person
with a criminal background or adverse registry findings, except for the Nurse
Aide Registry. The documentation must include the basis for the decision and
how it will not pose a threat to individuals' safety or property.
006.04
ADMINISTRATION OF MEDICATION. individuals must receive
medications only as legally prescribed by a medical practitioner in accordance
with the five rights and prevailing professional standards.
006.04(A)
METHODS OF
ADMINISTRATION OF MEDICATION. When the facility is responsible for
the administration of medication, it must be accomplished by the following
methods:
006.04(A)(i)
SELF
ADMINISTRATION. Individuals must be permitted to self-administer
medications if desired, with or without supervision, when the interdisciplinary
team has determined the individual is capable of doing so safely. When
individuals self-administer medication, the licensee maintains responsibility
for the overall supervision, safety and welfare of the individual.
006.04(A)(ii)
LICENSED HEALTH
CARE PROFESSIONAL. When licensed health care professionals for
whom medication administration is included in their scope of practice are used,
the licensee must ensure the medications are properly administered in
accordance with prevailing professional standards and state and federal law.
006.04(A)(iii)
PERSONS
OTHER THAN A LICENSED HEALTH CARE PROFESSIONAL. When persons other
than a licensed health care professional are used in the provision of
medications, the licensee must only use individuals who are registered
medication aides and must comply with 172 NAC 95 and 172 NAC 96.
006.04(B)
HANDLING OF
MEDICATIONS. The licensee must ensure clients receive medications
as prescribed by a medical practitioner. There must be a method for verifying
the identity of each client and the following:
(i) Medications sent with a client for
temporary absences from the premises are in containers identified for the
client;
(ii) Medications must be
sent with a client upon discharge upon client request;
(iii) Medications authorized for one client
must not be used for another client or staff;
(iv) Any errors in administration or
provision of prescribed medications must be reported to the client's licensed
health care professional in a timely manner upon discovery and a written report
of the error prepared; and
(v) Any
adverse reaction to a medication must be reported immediately upon discovery to
the client's licensed health care professional and recorded in the client's
record.
006.04(C)
DISPOSAL OF MEDICATIONS. Medications that are
discontinued by the medical practitioner, and those medications which are
beyond their expiration date, must be destroyed. The facility must identify who
will be responsible for disposal of medications and the method to dispose of
medications in a timely and safe manner. Documentation of the destruction of
medications must be retained for a minimum of 5 years.
006.05
ADMISSION AND
RETENTION. Written policies and procedures must be implemented and
revised, as necessary, for admission and retention to ensure admission only of
clients who have developmental disabilities or related conditions who are in
need of an active treatment program; and retention only of such clients unless
the following exception applies to the client.
006.05(A)
EXCEPTION.
If the licensee chooses to participate in providing services to individuals who
meet the exception to the retention requirements, the licensee must implement
and revise, as necessary, written policies and procedures to address the
retention of individuals who have been receiving and benefiting from active
treatment in the Intermediate Care Facility for Individuals with Intellectual
Disabilities and who have developed conditions where they no longer can benefit
from an active treatment program. These conditions are associated with aging,
dementia, decline in health, and terminal illness. The facility must ensure the
following:
(i) Documentation from the
individual's attending physician that the transfer or discharge of the
individual would be harmful to the individual's physical, emotional, or mental
health;
(ii) Current and accurate
assessments relevant to the individual's condition and needs;
(iii) The individual program plan or plan of
care must document:
(1) The continued stay is
in the best interest of the individual, and that transfer or discharge would be
harmful to the individual;
(2) The
interdisciplinary team rationale for the decision for continued stay;
(3) The specific current needs of the
individual; and
(4) The plan and
treatment approach to address the individual's current needs and
conditions;
(iv) The
licensee must provide services to meet the individual's current needs and
condition(s); and
(v) The licensee
must primarily serve individuals who are receiving and benefiting from an
active treatment program.
