Current through Register No. 40, October 3, 2024
(a) The licensee
shall ensure that sufficient numbers of qualified personnel are present in the
ALR-RC to meet the needs of residents at all times as determined by each
RAT.
(b) For those ALR-RCs licensed
for 17 or more beds, at least one awake personnel shall be on duty at all
times, including overnight, while residents are in the ALR-RC.
(c) For those ALR-RCs licensed for 16 or
fewer beds, at least one awake personnel shall be on duty at all times,
including overnight, while residents are in the ALR-RC, unless:
(1) There is a communication system whereby
residents can contact and awaken the sleeping personnel member via an intercom
or other communication system in the personnel member's room;
(2) If the ALR-RC has residents with a
history of exit seeking, the licensee has installed and maintains a functioning
wander prevention system that will awaken the sleeping personnel; and
(3) All residents:
a. Require nothing more then occasional
reminding or cueing;
b. Require
nothing more then verbal prompting for mobility and evacuation
issues;
c. Have no acute medical
needs or ongoing nursing needs; and
d. Have no history of being verbally or
physically abusive.
(d) For all applicants for employment, for
all volunteers, for all independent contractors who will provide direct care or
personal care services to residents or who will be unaccompanied by an employee
while performing non-direct care or non-personal care services within the
facility, and for all household members, the licensee shall:
(1) Obtain and review a criminal records
check from the New Hampshire department of safety, except, pursuant to
RSA
151:2-d, VI, for those
licensed by the New Hampshire board of nursing; and
(2) Review the results of the criminal
records check in (1) above in accordance with (e) below; and
(3) Verify the qualifications of all
applicants prior to employment.
(e) Unless a waiver is granted in accordance
with (g) (2) below, the licensee shall not offer employment, contract with, or
engage a person in (d) above, or allow a household member to continue to reside
in the residence, if the person:
(1) Has been
convicted of a felony in this or any other state;
(2) Has been convicted of a sexual assault,
other violent crime, assault, fraud, theft, abuse, neglect, or exploitation in
this or any other state;
(3) Has
had a finding by the department or any administrative agency in this or any
other state for assault, fraud, theft, abuse, neglect, or exploitation of any
person; or
(4) Otherwise poses a
threat to the health, safety, or well-being of residents.
(f) If the information identified in (e)
above regarding any person in (d) above is learned after the person is hired,
contracted with, or engaged, or after the person becomes a household member,
the licensee shall immediately notify the department and either:
(1) Cease employing, contracting with, or
engaging the person, or not permit the household member to continue to reside
in the residence; or
(2) Request a
waiver of (e) above.
(g)
If a waiver of (e) above is requested, the department shall review the
information and the underlying circumstances in (e) above and shall either:
(1) Notify the licensee that the person
cannot or can no longer be employed, contracted with, or engaged by the
licensee, or the person cannot or can no longer reside in the facility if,
after investigation, it determines that the person poses a threat to the
health, safety, or well-being of a resident; or
(2) Grant a waiver of (e) above if, after
investigation, it determines that the person does not pose a current threat to
the health, safety, or well-being of a resident(s) .
(h) The licensee shall check the names of the
persons in (d) above against the bureau of elderly and adult services (BEAS)
state registry, maintained pursuant to
RSA 161-F:49 and He-E
720, and against the NH board of nursing, nursing assistant registry,
maintained pursuant
RSA
326-B:26 and
42 CFR
483.156, prior to employing, contracting
with, or engaging them, or prior to allowing or continuing to allow a household
member to reside at the residence.
(i) The licensee shall not employ, contract
with, engage, or allow to reside in the facility any person in (d) above who is
listed on the BEAS state registry or the NH board of nursing, nursing assistant
registry unless a waiver is granted by BEAS or the NH board of nursing,
respectively.
(j) In lieu of (d)
and (h) above, the licensee may accept from independent agencies contracted by
the licensee or by an individual resident to provide direct care or personal
care services a signed statement that the agency's employees have complied with
(d) and (h) above and do not meet the criteria in (e) and (i) above.
(k) All administrators appointed after the
2017 effective date of these rules shall be at least 21 years of age and have
one of the following combinations of education and experience:
(1) A bachelor's degree from an accredited
institution and one year of experience working in a health care
facility;
(2) A New Hampshire
license as an RN and at least 6 months of experience working in a health care
facility;
(3) An associate's degree
from an accredited institution and at least 2 years of experience working in a
health care facility; or
(4) A New
Hampshire license as an LPN and at least one year of experience working in a
health care facility.
(l) All administrators shall obtain and
document 12 hours of continuing education related to the operation and services
of the ALR-RC each annual licensing period, in accordance with (t) and (u)
below.
(m) All direct care
personnel shall be at least 18 years of age unless they are:
(1) A licensed nursing assistant working
under the supervision of a nurse in accordance with Nur 700; or
(2) Involved in an established educational
program working under the supervision of a nurse.
(n) The licensee shall inform personnel of
the line of authority at the ALR-RC.
(o) The licensee shall educate personnel
about the needs and services required by the residents under their
care.
(p) Prior to having contact
with residents or food, personnel shall:
(1)
Submit to the licensee the results of a physical examination or a health
screening performed by a licensed nurse or a licensed practitioner and the
results of a 2-step tuberculosis (TB) test, Mantoux method, or other method
approved by the Centers for Disease Control, both conducted not more than 12
months prior to employment, contract, or engagement;
(2) Be allowed to work while waiting for the
results of the second step of the TB test when the results of the first step
are negative for TB; and
(3) Comply
with the requirements of the Centers for Disease Control and Prevention
"Guidelines for Preventing the Transmission of M. tuberculosis
in Health-Care Settings" (2005 edition), available as noted in Appendix A, if
the person has either a positive TB test, or has had direct contact or
potential for occupational exposure to M. tuberculosis through shared air space
with persons with infectious tuberculosis.
(q) In lieu of (p) (1) above, independent
agencies contracted by the facility or by an individual resident to provide
direct care or personal care services may provide the licensee with a signed
statement that its employees have complied with (p) (1) and (3) above before
working at the ALR-RC.
(r) Prior to
having contact with residents or food, personnel shall receive a tour of and
orientation to the ALR-RC that includes the following:
(1) The residents' rights in accordance with
RSA
151:20;
(2) The ALR-RC's resident complaint
procedures;
(3) The duties and
responsibilities of the position;
(4) The emergency medical
procedures;
(5) The emergency and
evacuation procedures;
(6) The
infection control procedures as required by
He-P
804.22;
(7) The procedures for food safety for
personnel involved in preparation, serving, and storing of food; and
(8) The mandatory reporting requirements
including
RSA
161-F:46 and
RSA
169-C:29.
(s) The licensee shall provide all personnel
with an annual continuing education or in-service education training, which at
a minimum contains the following:
(1) The
licensee's resident's rights and complaint procedures required under RSA
151;
(2) The licensee's infection
control program;
(3) The licensee's
written emergency plan; and
(4) The
mandatory reporting requirements including
RSA
161-F:46 and
RSA
169-C:29.
(t) The facility administrator, licensed
nurse, if available, or the administrator's designee who has completed the
4-hour medication assistance supervision program required by
He-P 804.17(ak)
shall provide and document in writing, an
annual review of its policies and procedures for self administration of
medication without assistance, self administration of medication with
assistance, and self-directed medication administration to all direct care
personnel.
(u) The ALR-RC shall
maintain a separate employee file for each employee, which shall include the
following:
(1) A completed application for
employment or a resume;
(2) Proof
that the individual meets the minimum age requirements;
(3) A statement signed by each individual
that he or she has received a copy of and received training on the
implementation of the licensee's policy setting forth the residents rights and
responsibilities as required by
RSA
151:21;
(4) A copy of the results of the criminal
record check as described in (d) above;
(5) A job description signed by the
individual that identifies the:
a. Position
title;
b. Qualifications and
experience; and
c. Duties required
by the position;
(6)
Record of satisfactory completion of the orientation program required by (r)
above;
(7) Information as to the
general content and length of all in-service or educational programs
attended;
(8) Record of
satisfactory completion of all required education programs and demonstrated
competencies that are signed and dated by the employee;
(9) A copy of each current driver's license,
including proof of insurance, if the employee transports residents using their
own vehicle;
(10) Documentation
that the required physical examinations or health screenings, TB test results,
and radiology reports of chest x-rays, if required, have been completed by the
appropriate health professionals;
(11) The statement required by (w) below;
and
(12) The results of the
registry checks in (h) above.
(v) The ALR-RC shall maintain the records,
but not necessarily a separate file, for all volunteers and for all independent
contractors who provide direct care or personal care services to residents or
who will be unaccompanied by an employee while performing non-direct care or
non-personal care services within the facility, as follows:
(1) For volunteers, the information in (u)
(1), (3), (4), (6), and (8) -(12) above; and
(2) For independent contractors, the
information in (u) (3), (4), (6), and (8) -(12) above, except that the letter
in (j) and (q) above may be substituted for (u) (4), (10), and (12) above, if
applicable.
(w) All
personnel shall sign a statement at the time the initial offer of employment,
contract, or engagement is made and then annually thereafter stating that they:
(1) Do not have a felony conviction in this
or any other state;
(2) Have not
been convicted of a sexual assault, other violent crime, assault, theft, fraud,
abuse, neglect, or exploitation or pose a threat to the health, safety, or
well-being of a resident; and
(3)
Have not had a finding upheld by the department or any administrative agency in
this or any other state for assault, fraud, theft, abuse, neglect, or
exploitation of any person.
(x) An individual shall not have to
re-disclose any of the matters in (w) above if the documentation is available
and the department has previously reviewed the material and determined that the
individual can continue employment, contract, or engagement.
(y) The licensee shall protect and store in a
secure and confidential manner all records described in (u) and (v)
above.
(z) The licensee shall
document evidence of immunization against influenza and pneumococcal disease
for all consenting employees and shall provide to its consenting employees
annual immunizations against influenza, to include:
(1) That immunizations shall be provided and
reported in accordance with
RSA
151:9-b, I-V; and
(2) The facility shall have a plan that
identifies and documents, with dates, employees that have received or declined
to receive immunizations.
(aa) Personnel shall not be impaired while on
the job by any substances including, but not limited to, legally prescribed
medication, therapeutic cannabis, or alcohol.
(ab) The ALR-RC shall have a written policy,
as described in
RSA
151:41, establishing procedures for the
prevention, detection, and resolution of controlled substance abuse, misuse,
and diversion, which shall apply to all personnel, and which shall be the
responsibility of a designated employee or interdisciplinary team.
(ac) The policy in (ab) above shall include:
(1) Education;
(2) Procedures for monitoring the
distribution and storage of controlled substances;
(3) Voluntary self-referral by employees who
are addicted;
(4) Co-worker
reporting procedures;
(5) Drug
testing procedures to include at a minimum, testing where reasonable suspicion
exists;
(6) Employee assistance
procedures;
(7)
Confidentiality;
(8) Investigation,
reporting, and resolution of controlled drug misuse or diversion; and
(9) The consequences for violation of the
controlled substance abuse, misuse, and diversion prevention policy.
#9121, eff
4-3-08
