Current through Register No. 40, October 3, 2024
(a) The licensee
shall provide administrative services which include the appointment of a
full-time, on-site administrator who:
(1) Is
responsible for the day-to-day operations of the nursing home;
(2) Meets the requirements of
He-P 803.17(b) (1)
; and
(3) Delegates, in writing, an alternate
onsite, qualified designee who shall assume the responsibilities of the
administrator in his or her absence.
(b) Prior to or upon the time of admission,
the licensee shall provide the resident a written copy of the admission
agreement, except in the case of an emergency admission where the written
agreement shall be given as soon as practicable.
(c) In addition to (b) above, at the time of
admission, the licensee shall provide a written copy to the resident and the
guardian or agent, if any, or personal representative, and receive written
verification of receipt for the following:
(1) An admissions packet including the
following information:
a. The basic daily,
weekly, or monthly rate;
b. A list
of the core services required by
He-P
803.14(b) ;
c. Information regarding the timing and
frequency of cost of care increases;
d. The nursing home's house rules;
e. The grounds for transfer or discharge and
termination of the agreement, pursuant to
RSA
151:21, V;
f. The nursing home's policy for resident
discharge planning;
g. Information
regarding nursing, other health care services, or supplies not provided in the
core services, to include:
1. The availability
of services;
2. The nursing home's
responsibility for arranging services; and
3. The fee and payment for services, if
known; and
h.
Information regarding:
1. Arranging for the
provision of transportation;
2.
Arranging for the provision of third party services, such as a hairdresser or
cable television;
3. Acting as a
billing agent for third party services;
4. Monitoring third party services contracted
directly by the resident and provided on the nursing home premises;
5. Handling of resident funds pursuant to
RSA 151:24
and
He-P
803.14(y) ;
6. Bed hold, in compliance with
RSA
151:25;
7. Storage and loss of the resident's
personal property;
8.
Smoking;
9. Roommates;
and
10. The licensee's policy
regarding the use of restraints;
(2) A copy of the patients' bill of rights
under
RSA
151:21 and the nursing home's policy and
procedure for implementing the bill of rights pursuant to
RSA 151:20,
II;
(3) A copy of the resident's right to appeal
an involuntary transfer or discharge under
RSA 151:26,
II(5) ;
(4) The nursing home's policy and procedure
for handling reports of abuse, neglect or exploitation, which shall be in
accordance with
RSA
161-F:46 and
RSA
169-C:29;
(5) Information on accessing the long-term
care ombudsman; and
(6) Information
on advanced directives.
(d) The licensee shall provide the following
core services:
(1) Services of a licensed
nurse provided 24 hours a day;
(2)
Services of an RN provided at least 8 hours within a 24-hour period;
(3) Emergency response and crisis
intervention;
(4) Medication
services in accordance with
He-P
803.16;
(5) Food services in accordance with
He-P
803.20;
(6) Housekeeping, laundry and maintenance
services;
(7) On-site activities
and/or access to community activities designed to meet the individual interests
of residents to sustain and promote physical, intellectual, social, and
spiritual well-being of all residents; and
(8) Assistance in arranging medical and
dental appointments, including arranging transportation to and from such
appointments and reminding the residents of the appointments.
(e) The licensee shall:
(1) Make available basic supplies necessary
for residents to maintain grooming and personal hygiene, such as soap, shampoo,
toothpaste, toothbrush, and toilet paper;
(2) Identify in the admission packet the
cost, if any, of basic supplies for which there will be a charge; and
(3) Not be required to pay for a specific
brand of the supplies referenced in (1) above.
(f) At the time of a resident's admission,
the licensee shall obtain orders from a licensed practitioner for medications,
prescriptions, treatments, diet, c, and any other pertinent interventions to
maintain the residents health and safety needs.
(g) The licensee shall have each resident
seen by a physician at least once every 30 days for the first 90 days after
admission, and at least once every 60 days thereafter. During this visit a
health examination shall be completed and documented.
(h) The health examination referenced in (g)
above shall include in the medical record:
(1)
Diagnoses, if any;
(2) Medical
history;
(3) Medical findings,
including the presence or absence of communicable disease;
(4) Vital signs;
(5) Prescribed and over-the-counter
medications;
(6) Allergies;
and
(7) Dietary needs.
(i) Assessments utilizing the 3.0
version of the Centers for Medicare and Medicaid Services Resident Assessment
Instrument (RAI) including the minimum data set (MDS) with care area assessment
(CAA) shall be completed on each resident as follows:
(1) A comprehensive MDS shall be completed
within 14 days after admission;
(2)
A comprehensive MDS shall be repeated annually or after any significant change,
as defined in
He-P 803.03(bw)
; and
(3) A quarterly MDS shall be completed at
least every 3 months.
(j) The care plan portion of the RAI shall be
developed within 14 days of the MDS and revised based on needs identified by
the MDS.
(k) An initial nursing
care plan shall be initiated upon admission and completed within 48 hours of
the resident's admission.
(l) The
nursing care plan shall:
(1) Be updated
following the completion of each future assessment in (i) above;
(2) Be made available to personnel who assist
residents in the implementation of the plan; and
(3) Address the needs identified by (h) and
(i) above.
(m) Nursing
notes shall be written as per the licensee's policy, and appropriate to
resident condition, resident change in condition, and in accordance with
professional standards.
(n)
Pursuant to
RSA
151:21, IX, residents shall
be free from chemical and physical restraints except when they are authorized
in writing by a licensed practitioner for a specific and limited time necessary
to protect the resident or others from injury, or as permitted by the CMS
conditions of participation, or as allowed by (o) below and
He-P 803.21(d)
.
(o) Pursuant to
RSA
151:21, IX, in an emergency,
physical restraints may be authorized by the personnel designated in (p) (3)
below in order to protect the resident or others from injury, and such action
shall be promptly reported to the resident's physician and documented in the
resident's clinical record.
(p) The
nursing home shall have written policies and procedures for implementing
physical, chemical, and mechanical restraints, including:
(1) What type of emergency restraints may be
used;
(2) When restraints may be
used;
(3) What professional
personnel may authorize the use of restraints;
(4) The documentation of their use in the
resident record including the physician order as applicable;
(5) How the licensee plans for reduction of
restraint use for any resident requiring restraints;
(6) Initial personnel training and subsequent
education and training required to demonstrate competence related to the use of
physical, chemical and mechanical restraints;
(7) The least restrictive to the most
restrictive method to be utilized to control a resident's behavior;
and
(8) That the training shall be
conducted by individuals who are qualified by education, training, and
experience.
(q) A
resident may refuse all care and services.
(r) When a resident refuses care or services
that could result in a threat to their health, safety or well-being, or that of
others, the licensee or their designee shall:
(1) Inform the resident and guardian of the
potential results of their refusal;
(2) Notify the licensed practitioner of the
resident's refusal of care;
(3)
Notify the agent, as applicable, unless the resident objects; and
(4) Document in the resident's record a
pattern of refusal of care and the resident's reason for the refusal, if known,
including education to the resident of the risk of refusal.
(s) The licensee shall provide the
following information to emergency medical personnel in the event of an
emergency transfer to another medical facility.
(1) Full name and the name the resident
prefers, if different;
(2) Name,
address and telephone number of the resident's next of kin, guardian, or agent,
if any;
(3) Diagnosis, as
applicable;
(4) Medications, as
applicable, including last dose taken and when the next dose is due;
(5) Allergies;
(6) Functional limitations;
(7) Date of birth;
(8) Insurance information;
(9) Advanced directives; and
(10) Any other pertinent information not
specified in (1) -(9) above.
#9856-A, eff
1-26-11
