Current through Register No. 40, October 3, 2024
(a) The licensee
shall comply with all relevant federal, state, and local laws, rules, codes,
and ordinances as applicable.
(b)
The licensee shall have written policies and procedures to include:
(1) The rights and responsibilities of
admitted residents in accordance with the patients' bill of rights under
RSA 151:20,
II;
(2) The policies described in He-P 804.14(r),
He-P 804.16(c) (11)
, and
He-P 804.19(e)
; and
(3) A policy that ensures the safety of all
persons present on the licensed premises where firearms are
permitted.
(c) The
licensee shall provide the following core services:
(1) Health and safety services to minimize
the likelihood of accident or injury, with protective care and oversight
provided 24 hours a day regarding:
a. The
residents' functioning, safety, and whereabouts; and
b. The residents' health status, including
the provision of intervention as necessary or required;
(2) Emergency response and crisis
intervention;
(3) Assistance with
taking and ordering medications as needed;
(4) The provision of 3 nutritious meals and
snacks in accordance with
He-P 804.21 unless
the resident chooses other options according to their admission
agreement;
(5) Housekeeping,
laundry, and maintenance services in accordance with the admission
agreement;
(6) The availability of
activities, for which the facility shall make reasonable accommodation for
residents with disabilities, to include, but not be limited to, television,
radio, internet, games, newspapers, visitors, and music, designed to sustain
and promote physical, intellectual, social, and spiritual well-being of all
residents in accordance with the admission agreement;
(7) Assistance in arranging medical and
dental appointments, which shall include assistance in arranging transportation
to and from such appointments and reminding the residents of the appointments;
and
(8) Supervision of residents
when required to offset cognitive deficits that may pose a risk to self or
others if the resident is not supervised.
(d) The licensee shall have a system to
regularly identify the ALR-RC's daily census, including times when a resident
is absent from the ALR-RC.
(e) The
licensee shall assist with arranging transportation to community activities, as
available, designed to meet the individual interests of residents to sustain
and promote physical, intellectual, social, and spiritual well-being of all
residents.
(f) 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. Such basic supplies shall be included
in the basic rate except that there may be an additional charge for specific
brands or items required to meet individual residents' needs or
requests;
(2) Identify in the
admission agreement the cost, if any, of basic supplies or other services for
which there will be a charge;
(3)
Ensure that all personnel have received the training necessary to be qualified
personnel to include demonstrated competency in the training given with
documentation maintained in the employee file;
(4) Require any paid provider of direct care,
other than an employee, providing health care related services to provide a
brief written, signed, and dated note describing the reason for the service(s),
and the next planned visit, if known; and
(5) Have a clearly identified policy for CPR
that includes the following:
a. If CPR is not
performed, the policy shall include a statement that 911 shall be called in an
emergency;
b. If CPR is performed,
there shall be either at least one person on duty per shift who is certified to
perform CPR or an AED available for use; and
c. This policy shall be signed by each
resident and their guardian, agent, or personal representative, if any, and be
located in the resident's file with their admission agreement.
(g) The licensee shall
educate personnel about the needs and services required by the residents under
their care and document such education to include demonstrated
competancies.
(h) Physical or
chemical restraints shall only be used in the case of an emergency, pursuant to
RSA 151:21,
IX.
(i) As soon as is practicable and in no case
longer than 24 hours after the use of a physical or chemical restraint, the
resident's licensed practitioner, guardian, agent, or personal representative,
if any, and the department shall be notified of the use of such
restraints.
(j) The use of
mechanical restraints, limited to locked or secured ALR-RCs, or units within an
ALR-RC, or anklets, bracelets, or similar devices that cause a door to
automatically lock when approached, thereby preventing a resident from freely
exiting the ALR-RC or unit within as permitted by the state fire code, shall be
allowed.
(k) Notwithstanding (j)
above, the following methods of mechanical restraints shall be prohibited:
(1) Full bed rails;
(2) Gates, if they prohibit a resident's free
movement throughout the living areas of the ALR-RC;
(3) Half doors, if they prohibit a resident's
free movement throughout the living areas of the ALR-RC;
(4) Geri chairs, when used in a manner that
prevents or restricts a resident from getting out of the chair at
will;
(5) Wrist or ankle
restraints;
(6) Vests or pelvic
restraints; and
(7) Other similar
devices that prevent a resident's free movement.
(l) For reportable incidents, the licensee
shall:
(1) Complete an investigation to
determine if abuse or neglect could have been a contributing factor to the
incident;
(2) Fax to 271-4968 or,
if a fax machine is not available, convey by electronic or regular mail, the
following information to the department within 48 hours of a reportable
incident:
a. The ALR-RC name;
b. A description of the incident, including
identification of injuries, if applicable;
c. The name of the licensee(s) or personnel
involved in, witnessing, or responding to the reportable incident;
d. The name of resident(s) involved in or
witnessing the reportable incident;
e. The date and time of the reportable
incident;
f. The action taken in
direct response to the reportable incident, including any follow-up;
g. If medical intervention was required, by
whom and the date and time;
h. When
the resident's guardian, agent, or personal representative, if any, was
notified;
i. The signature of the
person reporting the reportable incident;
j. The date and time the resident's licensed
practitioner was notified, if applicable; and
k. The date the facility performed the
investigation required by (1) above;
(3) As soon as practicable, notify the
guardian, agent, or personal representative, if any;
(4) As soon as practicable, notify the local
police department, the department, and the guardian, agent, or personal
representative, if any, when a resident has an elopement or unexplained absence
and the licensee has searched the building and the grounds of the ALR-RC
without finding the resident; and
(5) Notify the department with a written
report within 5 days describing the actions taken by personnel, the final
outcome or continuation of the reportable incident, and actions taken to
prevent a reoccurrence if it was not submitted in the initial report.
(m) The licensee shall comply with
the patients' bill of rights as set forth in
RSA
151:19-30.
(n) The licensee shall not exceed the maximum
number of residents or beds licensed by the department, unless authorized by
the department, such as during an emergency.
(o) The licensee shall give a resident and
the resident's guardian, agent, or personal representative, as applicable,
written notice of the following:
(1) For an
increase in the cost or fees for any ALR-RC services, 30 days advance notice
shall be required except for residents receiving Medicaid whose financial
liability is determined by the state's standard of need, or residents funded by
the department's Choices for Independence program in accordance with He-E 801
and which limitation shall only pertain to costs and fees under the direction
of these programs; or
(2) For an
involuntary change in room or bed location, the facility shall make reasonable
accommodation of individual needs and preferences and give 14 days advanced
notice, unless the change is required to protect the health, safety, and
well-being of the resident or other residents, in such case the notice shall be
as soon as practicable.
(p) In addition to the posting requirements
specified in
RSA 151:29,
the licensee shall post the following documents in a conspicuous area
accessible to residents, employees, and visitors:
(1) The current license certificate issued in
accordance with
RSA
151:2;
(2) All inspection reports for the last 12
months in accordance with
He-P 804.09(d)
and
He-P 804.11(d)
;
(3) A copy of the patients' bill of rights
specified by
RSA
151:21;
(4) A copy of the licensee's complaint
procedure, including a statement that complaints may be submitted, in writing,
to The Department of Health and Human Services, Office of Legal and Regulatory
Services, Health Facilities Administration, 129 Pleasant Street, Concord, NH
03301 or by calling 1-800-852-3345, and information on how to contact the
office of the long-term care ombudsman; and
(5) The licensee's evacuation floor plan
identifying the location of, and access to, all fire exits.
(q) The licensee shall determine
whether smoking will be allowed at the ALR-RC.
(r) If smoking is to be allowed, the licensee
shall develop and implement smoking policies and designate smoking areas in
accordance with
RSA 155:66,
RSA 155:68, and
RSA
155:69 and He-P 804.26(f) .
(s) If the licensee holds or manages a
resident's funds or possessions, it shall first receive written authorization
in accordance with
RSA 151:24
and
RSA 151:21,
VII, and such funds shall not be used for the
benefit of the licensee, other residents, or other household members.
(t) The licensee shall not falsify any
documentation required by law or provide false or misleading information to the
department.
(u) The licensee shall
not advertise or otherwise represent themselves as having a license to provide
services that they are not licensed to provide.
(v) The licensee shall comply with all
conditions of warnings and administrative remedies issued by the department and
all court orders.
(w) The licensee
shall develop quality assurance plans and policies that evaluate:
(1) The quality of care and services provided
to residents;
(2) Compliance with
RSA 151 and He-P 804;
(3) The
effectiveness of training provided to personnel; and
(4) The effectiveness of corrective actions
taken in response to statements of findings, notices to correct, and problems
identified in (1) -(3) above.
#9121, eff
4-3-08
