Current through Register No. 40, October 3, 2024
(a) The licensee
shall provide administrative services that include the appointment of an
administrator who:
(1) Is responsible for the
day-to-day operations of the ALR-RC;
(2) Works no less than 35 hours per week at
the ALR-RC, which may include day, evening, night, and weekend hours;
(3) Meets the requirements of
He-P
804.18(k);
(4) Designates, in writing, a staff member
who shall assume the responsibilities of the administrator in his or her
absence; and
(5) In the event the
administrator will be absent for a period to exceed 30 consecutive days, the
facility shall notify the department who the interim administrator will be and
submit credentials to verify he or she meets the requirements of (3)
above.
(b) At the time
of application for admission, the licensee shall provide the resident and the
guardian, agent, or personal representative, if any, a written copy of the
residential service agreement pursuant to RSA 161-J, except that a copy of the
residential service agreement shall not be required if the facility admission
agreement includes all of the provisions of a residential service
agreement.
(c) In addition to (b)
above, at the time of admission, the licensee shall provide the resident and
the guardian, agent, or personal representative, if any, and receive written
verification of receipt, a written copy of the admission agreement that
includes the following:
(1) The basic daily,
weekly, and monthly fee;
(2) A list
of the core services required by
He-P
804.14(c) that are covered by the
basic rate;
(3) Information
regarding the timing and frequency of cost of care increases;
(4) The time period covered by the admission
agreement;
(5) The criteria and
acuity level that the resident must maintain in order to remain a resident at
an ALR-RC in accordance with
He-P
804.15(a);
(6) The ALR-RC's house rules;
(7) The grounds for immediate termination of
the agreement, pursuant to
RSA
151:21, V;
(8) The ALR-RC's responsibility for resident
discharge planning;
(9) Information
regarding care, services, or supplies not provided in the core services, to
include:
a. The availability of
services;
b. The ALR-RC's
responsibility for arranging services; and
c. The fee and payment for services, if
known;
(10) The
licensee's policies and procedures regarding:
a. Arranging for the provision of
transportation;
b. Arranging for
the provision of third party services, such as a hairdresser or cable
television;
c. Monitoring third
party services contracted directly by the resident and provided on the ALR-RC
premises;
d. Handling of resident
funds pursuant to RSA 151:24 and
He-P
804.14(s);
e. Bed hold, in compliance with
RSA
151:25;
f. Storage and loss of the resident's
personal property; and
g.
Smoking;
(11) The
licensee's medication management services;
(12) The list of grooming and personal
hygiene supplies provided by the ALR-RC as part of the basic daily, weekly, or
monthly rate;
(13) A copy of the
most current version of the patients' bill of rights under RSA 151: 21 and the
ALR-RC's policy and procedure for implementing the bill of rights pursuant to
RSA
151:20, II;
(14) A copy of the resident's right to appeal
an involuntary transfer or discharge under
RSA
151:26, II(a)(5);
(15) The ALR-RC'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;
(16) Information on accessing the long-term
care ombudsman;
(17) Information on
advanced directives;
(18) Whether
or not personnel are trained in cardiopulmonary resuscitation (CPR), first aid,
or both, or whether or not the facility has an AED on-site and available for
use in an emergency;
(19)
Information that if the facility changes its current acceptance of payment
sources, it shall provide 60 days' notice of such change; and
(20) A statement that a resident's inability
to cover the cost of care may result in discharge.
(d) The ALR-RC shall assess each resident's
needs using the "CARES Tool" (April 2022)."
(e) All personnel who administer the RAT
shall be trained to complete the RAT by the department or entities listed in
RSA
151:5-a, III.
(f) The assessment described in (d) above
shall:
(1) Be completed no more than 30 days
prior to or within 24 hours following admission to the ALR-RC;
(2) Be completed in consultation with the
resident and guardian, agent, or personal representative, if any; and
(3) Be repeated every 6 months or after any
significant change as defined in
He-P
804.03(bv).
(g) The facility shall have documented
evidence that the resident and guardian, agent, or personal representative, if
any, has had an opportunity to take part in completing and reviewing the
completed RAT.
(h) If the RAT
identifies the need for a nursing assessment, the nursing assessment shall be
completed within 72 hours of the completion of the RAT.
(i) If the nursing assessment indicates that
the resident cannot safely evacuate, the resident shall be ineligible for care
and services at the ALR-RC.
(j) If
the nursing assessment completed in accordance with (h) above is completed by a
licensed practical nurse (LPN), the assessment shall be reviewed and co-signed
by the registered nurse (RN) or physician that is supervising the LPN prior to
implementation.
(k) If the RAT
indicates a need for a care plan, the care plan shall be:
(1) Completed within 24 hours of the initial
RAT and within 24 hours of the completion of all subsequent RATs except where a
nursing assessment is required in which case, the care plan shall be completed
within 24 hours following the nursing assessment;
(2) Made available to personnel who assist
residents;
(3) Completed in
consultation with the resident and guardian, agent, or personal representative,
if any; and
(4) If the resident and
guardian, agent, or personal representative, if any, are unable or unwilling to
participate as required by (3) above, it shall be documented in the resident
record.
(l) The care
plan identified in (k) above shall include on an ongoing basis:
(1) The date the problem or need was
identified;
(2) A description of
the problem or need;
(3) The goal
or objective of the plan;
(4) The
action or approach to be taken;
(5)
The responsible person(s) or position; and
(6) The date of reevaluation, review, or
resolution.
(m) Each
care plan shall be reviewed at least every 6 months to determine if:
(1) All items identified in the care plan are
being met;
(2) The care plan will
be continued for another 6 months; and
(3) The care plan will be revised to meet the
current needs of the resident.
(n) Progress notes for each resident shall be
written at least quarterly and include, at a minimum:
(1) Changes in mobility, weight, memory, skin
integrity, continence, medications, behavior, and personal care needs;
and
(2) A summary of visits to
licensed practitioners and referrals.
(o) For individuals receiving medical,
nursing, or rehabilitative care or services, or hospice care, the facility
shall ensure that a discipline specific care plan:
(1) Is completed within 24 hours of the
discipline specific assessment;
(2)
Is completed in consultation with the resident and guardian, agent, or personal
representative, if any;
(3) Is
updated following the completion of all future discipline specific
assessments;
(4) Is available to
personnel who assist residents in the implementation of the discipline specific
care plan;
(5) Addresses the needs
identified in the discipline specific assessment;
(6) Includes the date the medical, nursing,
or rehabilitative care or services, or hospice care need was
identified;
(7) Identifies the
resident goal or approach to be taken to address the medical, nursing, or
rehabilitative care or services, or hospice care need;
(8) Includes the date of reevaluation of the
medical, nursing, or rehabilitative care or services, or hospice care need and
the name of the responsible person; and
(9) Is maintained in the resident's
record.
(p) For
individuals receiving medical, nursing, or rehabilitative care or services, or
hospice care, progress notes shall be written at every visit by the
practitioner performing the service.
(q) At the time of a resident's admission,
the licensee shall obtain orders from a licensed practitioner for medications,
prescriptions, and therapeutic diets, as applicable.
(r) The licensee shall have each resident
obtain a health examination by a licensed practitioner within 30 days prior to
admission or within 72 hours following admission to the ALR-RC.
(s) The health examination referenced in (r)
above shall include:
(1) Diagnoses, if
any;
(2) The medical
history;
(3) A list of current
medications including over-the-counter medications, treatments, and therapeutic
diets, if applicable; and
(4)
Allergies.
(t) Each
resident shall have at least one health examination every 12 months by a
licensed practitioner, unless the licensed practitioner determines that an
annual health examination is not necessary and specifies in writing an
alternative time frame, or unless the resident refuses in writing. Any such
resident refusal shall be made annually.
(u) A resident may refuse all care and
services.
(v) When a resident
refuses care or services that could result in a threat to the resident's
health, safety, or well-being, or that of others, the licensee or personnel
shall:
(1) Inform the resident of the
potential consequences of their refusal;
(2) Notify the licensed practitioner and
guardian, if any, of the resident's refusal of care or services; and
(3) Document in the resident's record the
items in (1) and (2) above, the refusal of care or services, and the resident's
reason for the refusal.
(w) The licensee shall maintain an emergency
data sheet, updated as needed and at a minimum at the conclusion of each RAT
assessment, in the resident's record and promptly give a copy to emergency
medical personnel in the event of an emergency transfer to another medical
facility.
(x) The emergency data
sheet referenced in (w) above shall include:
(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;
(4) Medications,
including last dose taken and when the next dose is due;
(5) Allergies;
(6) Functional limitations to include but not
be limited to physical limitations, hearing loss, visual imparement, and
cognitive challenges;
(7) Date of
birth;
(8) Insurance
information;
(9) Advanced
directives; and
(10) Any other
pertinent information not specified in (1)-(9) above.
(y) If a facility has independent living
units within the same structure which are not separated by a firewall from the
licensed facility, they shall be subject to the same requirements as licensed
units with regard to fire and building codes, including inspections.
(z) If ALR-RC services as defined by
He-P
804.03(l) are provided by the staff
of the facility to individuals in an independent living unit, the unit(s) must
be redesignated as licensed units in the ALR-RC and an application for a bed
increase must be completed as required by
He-P
804.08(a)(5) and (b) (3).
#9121, eff
4-3-08
The amended version of this section by
New
Hampshire Register Volume 42, Number 19, eff.
4/20/2022 is not yet
available.
