Current through Register No. 40, October 3, 2024
(a) The residence
administrator shall arrange for an annual health assessment of each individual
by a physician or other licensed practitioner for the purpose of evaluating
health status and making recommendations regarding strategies for promoting
and/or maintaining optimal health.
(b) The residence administrator shall, in
conjunction with the service coordinator, have arrangements to access medical
services at all times, including emergency services. The residence shall have a
written plan that specifies the procedures to be followed in medical
emergencies.
(c) In the event of
emergency concerning an individual including hospitalization, serious illness,
serious injury, imminent death, or death, the residence administrator or
service coordinator shall:
(1) Promptly
notify the individual's next of kin, guardian, and spouse or significant other,
as applicable; and
(2) Respect and
follow the wishes of the individual or guardian with regard to religious
matters, if applicable.
(d) Providers having personal knowledge of an
emergency as described in (c) above shall notify the individual's service
coordinator immediately, and in writing within 24 hours.
(e) The written notification shall be kept on
file at the area agency and a copy of the notice retained in the individual's
residential record.
(f) In the
event of the death of an individual:
(1) The
provider agency shall immediately notify the area agency; and
(2) The area agency shall:
a. Notify the bureau within 12 hours and
submit written mortality notification of the following to the bureau within 24
hours:
1.The individual's name, address, date of birth, gender,
race, and ethnicity;
2.The date and place of death and whether or not hospice
was involved;
3.The individual's medical diagnoses;
4.The names and phone numbers of any family members and
guardians notified, and the date of notification;
5.A description of the individual's living situation and
whether it had changed within the previous 6 months;
6.The apparent cause of death as recorded by the attending
licensed practitioner; and
7.A detailed description of the events surrounding the
individual's death, including what happened, what care was provided, and who
was involved; and
b.
Perform a mortality review as required in (g) and (h) below.
(g) Each area agency
shall assess the relationship of any individual's unanticipated death to
service provision and the natural course of any illness or underlying
condition.
(h) Such a mortality
review shall evaluate and, where applicable, document the following:
(1) The individual's medical plan of
care;
(2) Medical interventions
required within the past year:
(3)
Medical records, including physical exams and hospitalizations within the past
year;
(4) The individual's health
status over the previous 3 months; and
(5) The type and amount of residential care
provided.
(i) In any
case of known or suspected neglect, abuse, or exploitation, the provider aware
of the situation shall:
(1) Follow procedures
as outlined in He-M 310, rights of persons receiving developmental services in
the community, and any other applicable rules relative to rights protection
procedures; and
(2) Report the
situation to the division of children, youth, and families in accordance with
RSA
169-C:29 and/or the bureau of elderly and
adult services as required by
RSA 161-F:42-57, as
applicable.
(j) All
agency staff and providers who administer medications to any individual
receiving services in a He-M 1001 certified setting shall be authorized in
accordance with He-M 1201.
(k) A
provider shall have the following responsibilities with respect to an
individual's food and fluids:
(1) The
individual's preferences and requirements shall be taken into
account;
(2) Varied and
nutritionally balanced meals, including adequate fluids, shall be provided in
the morning, at midday, and in the evening, unless other arrangements for meals
have been made;
(3) Information
regarding the signs and symptoms of dehydration specific to the individual
shall be requested and retained;
(4) Access to food shall not be restricted
unless a licensed practitioner deems it necessary for the health of the
individual and the legal guardian consents to the restriction;
(5) Special diets, dietary supplements, and
dietary restrictions or modifications shall be according to a licensed
practitioner's orders or the individual's religious practices;
(6) If an individual requires specific
methods or techniques for maintaining adequate nutrition and/or hydration, as
determined by a licensed practitioner, such methods or techniques shall be
implemented and documented in the individual's clinical record; and
(7) No attempt to feed or hydrate an
individual against his or her shall be made unless medically prescribed by a
licensed practitioner and approved by the legal guardian.
(l) Providers shall label toxic substances as
to contents and antidote and safely store such substances away from food
preparation and food storage areas.
(m) Prior to providing services, a community
residence shall develop an emergency evacuation plan that indicates the
location of all evacuation routes and exits and provides for the safe
evacuation of all persons within 3 minutes.
(n) An individual and his or her guardian
shall be notified if any current or prospective household member smokes within
the home.
(o) Upon moving to a new
community residence, each individual shall be oriented to evacuation procedures
by the provider.
(p) Within 5
business days of an individual's moving into a community residence or a change
in residential provider, a service coordinator and licensed nurse shall visit
the individual in the home to determine if the transition has resulted in
adverse changes in the health or behavioral status of the individual.
(q) A service coordinator shall document the
visit described in (o) above in the individual's record.
(r) If negative changes are noted, a service
coordinator shall develop a remediation plan and include it within the
individual's record.
(s) Within 5
days of an individual's moving into a community residence, the provider shall:
(1) Conduct a fire evacuation drill to assess
the individual's ability to evacuate the residence in less than 3 minutes;
and
(2) Based on the drill,
complete and document a fire safety assessment that includes the following
individual risk factors:
a. Response to
alarm;
b. Response to
instruction;
c. Vision and hearing
difficulties;
d. Impaired
judgment;
e. Mobility problems;
and
f. Resistance to
evacuation.
(t) The fire safety assessment shall
indicate:
(1) The staff or provider to
individual ratio during both sleep and non-sleep hours;
(2) The name and phone number of agency
back-up in the event of an emergency; and
(3) The date completed and signature of the
person documenting the individual's risk factors.
(u) For each individual unable to evacuate
his or her residence within 3 minutes, a fire safety plan shall be developed
and approved by the individual or guardian, provider, and residential
administrator that identifies:
(1) The
cause(s) for such inability;
(2)
The specific assistance needed by the individual and to be furnished by the
provider; and
(3) A training
approach to reduce the evacuation time to 3 minutes or less.
(v) Evacuation drills shall:
(1) Be held at varied times of the
day;
(2) Involve all persons in the
home at the time of the drill;
(3)
For community residences of 4 or more individuals, comply with
He-P 814.23(k)
; and
(4) For community residences of 3 or fewer
individuals, include transmission of the alarm signal unless doing so would
register as a false alarm to the fire department or alarm company.
(w) A written record of each
evacuation drill shall:
(1) Be kept on file at
each community residence; and
(2)
Indicate:
a. The names of all the individuals
involved;
b. The date of the
drill;
c. The time of
day;
d. The time taken to evacuate;
and
e. The exits
utilized.
(x)
If a community residence for 3 or fewer individuals has been evacuated in 3
minutes or less during each of 6 consecutive monthly drills, one of which has
been a sleep-time drill, the residence shall thereafter conduct a drill at
least once quarterly, with one drill per year to be during sleep
hours.
(y) If a community residence
serves 4 or more individuals, the residence shall conduct monthly drills, with
at least 3 drills per year to be held during sleep hours.
(z) A community residence that has a complete
sprinkler system and fire alarm system that immediately notifies the local fire
department shall be exempt from the requirement to complete a fire drill in
less than 3 minutes if documentation is provided that such systems are in
compliance with local fire codes.
(aa) If a
new individual moves into a community residence for 3 or fewer individuals, the
community residence shall:
(1) Conduct
monthly drills until all individuals have evacuated the residence in 3 minutes
or less for 3 consecutive monthly drills; and
(2) Thereafter conduct a drill at least once
quarterly, with one drill per year to be during sleep hours.
(ab) For any individual receiving
less than 24-hour supervision, a personal safety assessment pursuant to (ac)
below shall be completed.
(ac) The
personal safety assessment shall identify an individual's ability to
demonstrate the following safety skills:
(1)
Respond to a fire including exiting safely and seeking assistance;
(2) Care for personal health, including
understanding health issues, taking medication, seeking assistance for health
needs and applying basic first aid;
(3) Seek safety if victimized or sexually
exploited;
(4) Negotiate one's
community, including finding one's way, riding in vehicles safely, handling
money safely, and interacting with strangers appropriately;
(5) Respond appropriately in severe weather
and other natural disasters, including storms, extreme temperature;
and
(6) Maintain a safe home,
including:
a. Operating heating, cooking, and
other appliances; and
b. Responding
to common household problems such as a blocked toilet, power failure and gas
odors.
(ad)
The individual's team, including the individual, shall develop a personal
safety plan if the personal safety assessment determines that the individual
needs assistance to respond appropriately to the situations outlined in (ac)
above.
(ae) A personal safety plan
shall:
(1) Identify the supports necessary
for an individual to respond to each of the contingencies listed in (ac)
above;
(2) Indicate who will
provide the needed supports;
(3)
Describe how the supports will be activated in an emergency;
(4) Indicate approval of the individual or
legal guardian, and provider, residential coordinator, and service
coordinator;
(5) Be reviewed by the
provider at the time of the individual's service agreement; and
(6) Be revised whenever there is a change in
the individual's residence or ability to respond to the contingencies listed in
the plan.
(af) The
individual or his or her guardian shall approve the personal safety plan prior
to the individual being without supervision for specified periods of time. Any
revisions to the plan shall require the individual's or guardian's prior
approval.
(See Revision Note at part heading for He-M 1001) #5867,
eff 9-1-94, EXPIRED: 9-1-00
New. #7681, eff 4-23-02; amd by
#8209, eff 11-23-04; ss by #9696, INTERIM, eff 4-23-10, EXPIRES: 10-20-10; ss
by #9776-A, eff 10-1-10
