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 ICF/IID;
(2) Works no less than 35 hours per week at
the ICF/IID, which may include day, evening, night, and weekend
hours;
(3) Delegates, in writing,
an alternate onsite, qualified designee who shall assume the responsibilities
of the administrator in his or her absence;
(4) Ensures development and implementation of
ICF/IID policies and procedures on:
a.
Patient's rights as required by
RSA
151:20;
b. Advance directives and DNR orders as
required by RSA 137-J;
c. Discharge
planning as required by
RSA
151:26;
d. The use restraints in residents under the
age of 18 in accordance with RSA 126-U;
e. The use of seclusion in accordance with
RSA 126-U; and
f. Reportable
incident reporting;
(5)
Monitoring and evaluating the quality of resident care and resident care
services in the ICF/IID pursuant to
He-P
815.24;
(6) Identifying and making available
education programs designed to maintain the personnel's expertise in areas
related to the services provided in the ICF/IID; and
(7) Any new administrator shall be appointed
by the board of directors of the ICF/IID and possess:
a. A master's degree in the field of human
services, business administration, or public administration, awarded by a
regionally accredited college or university, plus 2 years of experiences as a
professional in human services, which included administrative responsibilities;
or
b. A bachelor's degree with a
minimum of 12 credits in the field of human services, business administration,
or public administration, awarded by a regionally accredited college or
university, plus 3 years of experience as a professional in human services,
which included administrative responsibilities.
(b) There shall be a full time director of
nursing services who is currently licensed in the state of New Hampshire
pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who
is an RN with at least 2 years relevant experience in resident care.
(c) The director of nursing services shall be
responsible for:
(1) Establishment of
standards of nursing practice used in the ICF/IID;
(2) Ensuring that the admission process and
resident assessment process coordinates resident requirements for nursing care
with available nursing resources;
(3) Participating with the administrator and
personnel to improve the quality of nursing care at the ICF/IID;
(4) Nursing care as authorized by the nurse
practice act and according to RSA 326-B;
(5) The overall health and safety of
residents; and
(6) Maintaining
written personnel schedules, which shall be retained on-site for a period of at
least 90 days and which include:
a. At least
one licensed nurse in the facility 24 hours a day;
b. At least one registered nurse, for 8
consecutive hours a day 7 days a week; and
c. Nursing assistants who have been verified
in accordance with the New Hampshire board of nursing.
(d) Each ICF/IID shall have a
medical director who is a licensed physician in the state of New
Hampshire.
(e) 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.
(f) In addition to (e) 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. A list of the core services required by
He-P
815.15(g);
b. The ICF/IID's facility rules;
c. The grounds for transfer or discharge and
termination of the agreement, pursuant to
RSA
151:21, V;
d. The ICF/IID's policy for resident
discharge planning;
e. Information
regarding nursing, other health care services, or supplies not provided in the
core services, to include:
1. The availability
of services;
2. The ICF/IID's
responsibility for arranging services; and
3. The fee and payment for services, if
known; and
f.
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 ICF/IID premises;
5. Handling of resident funds pursuant to
RSA
151:24 and
He-P
815.14(ac);
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 residents' bill of rights
under RSA
151:21 and the ICF/IID'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 ICF/IID'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 office of
the long term care ombudsman; and
(6) Information on advance directives and DNR
status.
(g) 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
815.16;
(5) Food services in accordance with
He-P
815.25;
(6) Housekeeping, laundry, and maintenance
services;
(7) On-site activities or
access to community activities designed to meet the resident interests of
residents to sustain and promote physical, intellectual, social, and spiritual
well-being of all residents, and access to educational services if ages 3 to
21; and
(8) Assistance in arranging
medical and dental appointments, including arranging transportation to and from
such appointments and reminding the residents of the appointments.
(h) 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.
(i) Consistent with Medicaid Utilization
Control regulations at 42
CFR §
456.380 at the time of admission,
clients shall be evaluated by a licensed practitioner to identify all diagnoses
and complaints, provide orders for all medications and treatments and provide
recommendations for restorative and rehabilitative services.
(j) The licensee shall have each resident
seen by a licensed practitioner at least annually and a health examination
completed and documented.
(k) The
health examination referenced in (j) 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;
(7) Dietary
needs;
(8) Evaluation of vision and
hearing; and
(9) Routine screening
laboratory examinations as determined necessary by the physician.
(l) An initial nursing care plan
shall be initiated upon admission and completed within 48 hours of the
resident's admission.
(m) 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 (i) and
(k) above.
(n) 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.
(o)
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 (p) below.
(p) Pursuant to
RSA
151:21, IX, in an emergency,
physical restraints may be authorized by the personnel designated in (r)(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.
(q) All
restraints involving residents under the age of 18, shall be in accordance with
RSA 126-U and reported to the department in accordance with He-C 901.
(r) The ICF/IID 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.
(s) The
written policies and procedures required in (r) above shall include policies
and procedures for restraints involving residents under the age of 18, which
shall be in accordance with RSA 126-U and include reporting to the department
in accordance with He-C 901.
(t) A
resident or parent or guardian, if the resident is a minor, may refuse all care
and services.
(u) When a resident
or parent or guardian, if the resident is a minor, 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 or parent or guardian
of the potential results of their refusal;
(2) Notify the licensed practitioner of the
resident's or parent or guardian's refusal of care;
(3) Notify the agent, as applicable, unless
the resident or parent or guardian objects; and
(4) Document in the resident's or parent or
guardian record a pattern of refusal of care and the reason for the refusal, if
known, including education to the resident or parent or guardian, of the risk
of refusal.
(v) 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) Advance directives and DNR status;
and
(10) Any other pertinent
information not specified in (1)-(9) above.
(w) The licensee may only perform POCT, that
are waived complexity as designated by the federal drug administration (FDA)
and known as CLIA-waived laboratory tests, unless the facility is also licensed
by the State of New Hampshire as a laboratory under He-P 808.
(x) If CLIA-waived laboratory testing is
performed by personnel, the licensee shall:
(1) Obtain the appropriate CLIA certificate
as per 42 CFR Part 493.15 ; and
(2)
Develop and implement a POCT policy, which educates and provides procedures for
the proper handling and use of POCT devices, including the documentation of
training and demonstrated competency of all testing personnel.
(y) The licensee shall have
current copies of manufacturer's instructions and package inserts and shall
follow all manufacturer's instructions and recommendations for the use of POCT
meters and devices to include, but not limited to:
(1) Storage requirements for POCT meters and
devices, test strips, test cartridges, and test kits;
(2) Performance of test specimen
requirements, testing environment, test procedure, troubleshooting error codes
and messages, and reporting results; and
(3) All recommended and required quality
control procedures for POCT meters and devices.
(z) Licensee's performing CLIA-waived
laboratory testing or specimen collection shall be incompliance with He-P 808,
He-P 817, and 42 CFR 493.
