Current through all regulations passed and filed through September 16, 2024
(A) The residential care facility, in
accordance with this rule,
will
ensure that written initial and periodic health assessments of
prospective and current residents are conducted.
The different components of the health assessment may be performed by different
licensed health professionals, consistent with the type of information
bring
collected and the professional's scope of practice, as defined by
applicable law. In conducting the assessment, the licensed health professional
may use resident information obtained by or from unlicensed staff as long as
the licensed health professional evaluates such information in accordance with
their applicable scope of practice. The residential care facility
is obligated
to ensure that all components of the assessments
obligated by this rule are completed and that
residents do not
need accommodations or services beyond those that
the residential care facility provides. Each residential care facility
is obligated
to, on an annual basis, offer to each resident a vaccination against
influenza and a vaccination against pneumococcal pneumonia as
obligated by section
3721.041 of the Revised
Code.
(B) Each resident
is obligated
to be initially assessed within forty-eight hours of admission, except
that paragraphs (C)(11) and (C)(12) of this rule
are obligated
to be performed within fourteen days after admission. If the resident had
an assessment meeting the
criteria set forth in paragraph (C) of this rule
performed no more than ninety days before beginning to reside in the
residential care facility, the resident
does not
need to
obtain another initial assessment.
(C) The initial health assessment
is obligated
to include documentation of the following:
(1) Preferences of the resident including
hobbies, usual activities, bathing, sleeping patterns, socialization and
religious;
(2) Medical diagnoses,
if applicable;
(3) Psychological,
intellectual disabilities, and developmental diagnoses history, if
applicable;
(4) Health history and
physical, including cognitive functioning and sensory and physical impairments,
and the risk of falls;
(5)
Prescription medications, over-the-counter medications, and dietary
supplements;
(6) Nutrition and
dietary needs, including any food allergies and intolerances,
food preferences, and need for any adaptive equipment, and needs for assistance
and supervision of meals;
(7)
Height, weight, and history of weight changes;
(8) A functional assessment which evaluates
how the resident performs activities of daily living and instrumental
activities of daily living. For the purposes of this paragraph, "instrumental
activities of daily living" means using the telephone, acquiring and using
public and private transportation, shopping, preparing meals, performing
housework, laundering, and managing financial affairs;
(9) Type of care or services, including the
amount, frequency, and duration of skilled nursing care the resident needs as
determined by a licensed health professional in accordance with the resident's
assessment under paragraph (C) of this rule;
(10) A determination by a physician or other
licensed healthcare professional working within their scope of practice, as to
whether or not the resident is capable of self-administering medications. The
documentation
will specify what assistance with
self-administration, as authorized by paragraph (F) of rule
3701-16-09 of the Administrative
Code, if any, is needed or if the resident needs to have medications
administered in accordance with paragraphs (G) and (H) of rule
3701-16-09 of the Administrative
Code;
(11) If skilled care is
provided to the resident by staff members, a determination by a physician or
other licensed healthcare professional working within their scope of practice
of:
(a) Whether the resident's personal care
needs have been affected by the skilled nursing care needs, other than the
administration of medication or supervision of special diets; and
(b) Whether any changes are
necessary in the manner personal care services are
provided. The individual conducting the assessment
is obligated to
establish the extent, if any, of the changes necessary.
(12) If skilled nursing care is provided to
the resident by staff members, the resident's attending physician or other
licensed healthcare professional working within their scope of practice,
will
sign orders documenting the need for skilled nursing care, including the
specific procedures and modalities to be used and the amount, frequency, and
duration. This care is obligated to be provided and reviewed pursuant to
paragraph (B) of rule
3701-16-09.1 of the
Administrative Code.
(13) If the
resident has been determined to have medical, psychological, or developmental
or intellectual impairment, the assessment is obligated to
include:
(a) A plan for addressing the
resident's assessed needs;
(b) The
need for physical environment and design features to support the functioning of
the resident; and
(c) The need for
increased supervision, due to decreased safety awareness or other assessed
condition.
(D) Subsequent to the initial health
assessment, the residential care facility
will assess
each resident's health at least annually unless medically indicated sooner. The
annual health assessment is obligated to be performed within thirty days of the
anniversary date of the resident's last health assessmentand include documentation of at least the following:
(1) Changes in medical diagnoses, if
any;
(2) Updated nutritional
needs, including any food allergies and
intolerances;
(3) Height, weight
and history of weight changes;
(4)
Prescription medications, over-the-counter medications, and dietary
supplements;
(5) A functional
assessment as described in paragraph (C)(8) of this rule;
(6) If the resident has been determined to
have medical, psychological, or developmental or intellectual impairment, an
assessment as described in paragraph (C)(13) of this rule;
(7) Type of care or services, including the
amount, frequency, and duration of skilled nursing care, the resident needs as
determined by a licensed health professional in accordance with paragraph (D)
of this rule;
(8) A determination
by a physician or other licensed healthcare professional working within their
scope of practice, as to whether or not the resident is capable of
self-administering medications. The documentation
will
specify what assistance with self-administration, as authorized by paragraph
(F) of rule
3701-16-09 of the Administrative
Code, if any, is needed or if the resident needs to have medications
administered in accordance with paragraphs (G) and (H) of rule
3701-16-09 of the Administrative
Code; and
(9) If skilled care is
provided to the resident by staff members, a determination by a physician or
other licensed healthcare professional working within their scope of practice,
of:
(a) Whether the resident's personal care
needs have been affected by the skilled nursing care needs, other than the
administration of medication or supervision of special diets; and
(b) Whether any changes are
necessary in the manner personal care services are
provided. The individual conducting the assessment will establish
the extent, if any, of the changes necessary.
(E) The residential care facility
will
ensure
that each resident's health is assessed if a change in condition or
functional abilities warrants a change in services or equipment. The assessment
is obligated
to include, as applicable, documentation of paragraphs (D)(1) to (D)(9)
of this rule. The facility is obligated to make a good faith effort to obtain
information from residents about assessments independently obtained outside the
facility.
(F) Prior to admitting or
transferring a resident to a special care unit that restricts the resident's
freedom of movement, the residential care facility is obligated to
ensure that a physician or other licensed healthcare professional working
within their scope of practice, has made a determination that the admission or
transfer to the special care unit is needed.
The facility is
obligated to update this determination to include both improvement and decline, during the
periodic reassessment
obligated by paragraph (D) of this rule. Prior to
admission to the special care unit, the residential care facility
is obligated
to provide the resident with an updated resident agreement
obligated by rule
3701-16-07 of the Administrative
Code and with the facility's policy on care of residents by means of a special
care unit
obligated by paragraph (E)(5) of that rule. No
resident is
allowed to be admitted to a secured special care unit based solely on his
or her diagnosis.
(G) If a resident
needs services or accommodations beyond that which a residential care facility
is authorized to provide or beyond that which the specific facility provides,
refuses needed services, or fails to obtain needed services for which the
resident agreed to be responsible under the resident agreement
obligated by rule
3701-16-07 of the Administrative
Code, the residential care facility is obligated to
take the following action:
(1) Except in
emergency situations, the residential care facility is obligated to
meet with the resident, and, if applicable, the resident's sponsor and discuss
the resident's condition, the options available to the resident including
whether the needed services may be provided through a medicaid waiver program,
and the consequences of each option;
(2) If the lack of needed services has
resulted in a significant adverse change in the resident, the residential care
facility is
obligated to seek appropriate intervention in accordance with paragraph
(A) of rule
3701-16-12 of the Administrative
Code. If an emergency does not exist the facility is obligated to
provide or arrange for the provision of any needed services that the resident
has not refused until the resident is discharged or transferred or the resident
and the facility have mutually resolved the issue in a manner that does not
jeopardize the resident's health or the health, safety or welfare of the other
residents. This paragraph does not authorize a facility to provide skilled
nursing care beyond the limits established in section
3721.011 of the Revised Code;
and
(3) The residential care
facility is
obligated to transfer or discharge the resident in accordance with
section 3721.16 of the Revised Code and
Chapter 3701-61 of the Administrative Code if the resident needs skilled
nursing care or services beyond what the facility provides and the residential
care facility, based on the meeting with the resident
obligated by paragraph (G)(1) of this rule, determines
that such action is necessary to assure the health, safety and welfare of the
resident or the other residents of the facility. The residential care facility
may retain a resident who refuses available services if doing so does not
endanger the health, safety, and welfare of other residents and the resident
does not need services beyond that which a facility is
authorized to provide under Chapter 3721. of the Revised Code and rules
3701-16-01 to
3701-16-18 of the Administrative
Code.
