New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-M - Former Division of Mental Health and Developmental Services
Chapter He-M 1000 - HOUSING
Part He-M 1002 - CERTIFICATION STANDARDS FOR BEHAVIORAL HEALTH COMMUNITY RESIDENCES
Section He-M 1002.06 - Health and Safety

Universal Citation: NH Admin Rules He-M 1002.06

Current through Register No. 40, October 3, 2024

(a) Each individual shall have an annual health assessment by a physician or other licensed practitioner for the purpose of evaluating health status and making recommendations regarding strategies for promoting and maintaining optimal health.

(b) A community residence shall adopt protocols that:

(1) Explain to residential staff how medical situations are expected to be handled; and

(2) Assist residential staff in the identification of unusual medical situations.

(c) A community residence shall orient all staff to procedures identified in (b) above upon hiring and annually thereafter.

(d) The residence administrator shall, in conjunction with the case manager, have arrangements to access medical services at all times, including emergency services.

(e) The community residence shall have a written policy that specifies the procedures to be followed in the event of medical or psychiatric emergencies.

(f) In the event of an emergency concerning an individual including hospitalization, serious illness, serious bodily harm or injury, or imminent death or death, the residence administrator or case manager shall, within 24 hours, notify:

(1) The individual's guardian, if applicable;

(2) The individual's next of kin; and

(3) Any other person the individual previously indicated should be notified.

(g) A residence administrator shall annually review and update, as necessary, the names, addresses, and phone numbers of the people notified pursuant to (f) above.

(h) With regard to religious matters, the wishes of the individual or guardian, if applicable, shall be respected and followed in the event of an emergency as identified in (f) above.

(i) In the event of the death of an individual, the provider agency shall immediately notify the CMHP and the department.

(j) Providers having personal knowledge of an emergency shall verify that an individual's case manager and next of kin, guardian, or any other such person as previously indicated by the individual have been notified within 24 hours.

(k) The provider agency shall document the information in (f) above, and retain a copy with the case manager at the CMHP and at the community residence.

(l) In any case of known or suspected neglect, abuse or exploitation, the provider aware of the situation shall follow procedures as outlined in He-M 309, rights of persons receiving mental health services in the community, and any other applicable rules relative to client rights protection procedures.

(m) In addition to the requirements of (l) above, the provider shall report the situation to the division of children, youth and families in accordance with RSA 169-C:29 or the bureau of elderly and adult services as required by RSA 161-F:42-57, as applicable.

(n) Medication administration for individuals shall be conducted in accordance with He-M 1202.

(o) 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 when preparing meals;

(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) 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;

(4) Special diets, dietary supplements, and dietary modifications shall be according to a licensed practitioner's orders and the consumer's religious practices;

(5) If a consumer 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 consumer's clinical record; and

(6) No attempt to feed or hydrate a consumer against his or her will shall be made unless medically prescribed by a licensed practitioner and approved by the legal guardian.

(p) Providers shall label toxic substances as to contents and antidote and safely store such substances away from food preparation and food storage areas.

(q) 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.

(r) The provider shall orient each individual newly admitted to a community residence to the evacuation procedures.

(s) Within 5 business days of an individual's moving into a community residence or a change in residential provider, a case manager 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.

(t) A case manager shall document the visit described in (s) above in the individual's record.

(u) If negative changes are noted at the visit described in (s) above, a case manager shall develop a remediation plan for the provider agency to carry out and include it within the individual's record.

(v) Within 5 days of an individual 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 judgement;

e. Mobility problems; and

f. Resistance to evacuation.

(w) 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.

(x) 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 to be furnished by the provider; and

(3) A training approach to reduce the evacuation time to 3 minutes or less.

(y) 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; 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.

(z) 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 individuals and other persons involved;

b. The date of the drill;

c. The time of day;

d. The time taken to evacuate; and

e. The exits utilized.

(aa) 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.

(ab) 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.

(ac) 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. A fire safety plan shall be developed and maintained in accordance with He-M 1002.06(x) above for each individual that demonstrates the approach to be taken to reduce the evacuation time.

(ad) 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 4 consecutive monthly drills; and

(2) Thereafter conduct a drill at least once quarterly, with one drill per year to be during sleep hours.

(ae) For any individual living in a community residence receiving less than 24-hour supervision, a personal safety assessment pursuant to (af) below shall be completed.

(af) The personal safety assessment shall identify an individual's knowledge of and ability to perform each of the following safety skills:

(1) Responding to a fire, including exiting safely and seeking assistance;

(2) Caring for personal health, including understanding health issues, taking medications, seeking assistance for health needs and applying first aid;

(3) Seeking safety if victimized or sexually exploited;

(4) Negotiating one's community, including finding one's way, riding in vehicles safely, and interacting with strangers appropriately;

(5) Responding appropriately in severe weather and other natural disasters, including storms and extreme hot or cold temperature; and

(6) Maintaining a safe home, including:

a. Operating heating, cooking, and other appliances; and

b. Responding to common household problems such as a clogged toilet, a power failure, or gas odors.

(ag) The personal safety assessment required in (ae) above shall include approval of the individual or legal guardian, and the residence administrator.

(ah) The personal safety assessment required in (ae) above shall be reviewed annually, and whenever there is a change in the individual's residence or his or her ability to respond to the contingencies listed in the assessment.

(ai) If the personal safety assessment determines that the individual needs assistance to respond appropriately to situations outlined in (ah) above:

(1) A personal safety plan shall be developed by the individual and other members of the individual's team; and

(2) The individual shall receive 24-hour supervision until the personal safety plan is implemented.

(aj) A personal safety plan shall:

(1) Identify the supports necessary for an individual to respond to each of the contingencies listed in (ad) above;

(2) Indicate who will provide the needed supports;

(3) Describe how the supports will be activated in an emergency;

(4) Indicate written approval of the individual or legal guardian, provider, residential coordinator, and case manager;

(5) Be reviewed by the provider at the time of the individual's ISP; 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.

(ak) The community residence shall obtain the written approval in (ai) (4) above prior to the implementation of the personal safety plan and the individual receiving unsupervised time.

#3071, eff 7-25-85, EXPIRED: 7-25-91

New. #7762, eff 9-26-02; amd by #8210, eff 11-23-04; amd by #9795, INTERIM, eff 9-26-10, EXPIRES: 3-25-11; ss by #9894-A, eff 3-25-11

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