Current through Register Vol. 63, No. 12, December 1, 2024
(1) There shall be a provider, resident
manager, or substitute caregiver on duty 24 hours per day in an AFH in
accordance with ORS 443.725(3).
(2) Medications and Prescriber's Orders:
(a) There shall be a copy of a medication,
treatment, or therapy order signed by a physician, nurse practitioner, or other
licensed prescriber in the individual's file for the use of any medications,
including over the counter medications, treatments, and other therapies except
as otherwise permitted under OAR
309-040-0390(3)-(4);
(b) A provider, resident manager, or
substitute caregiver shall dispense medications, treatments, and therapies as
prescribed by a physician, nurse practitioner, or other licensed prescriber.
Changes to orders for the dispensing and administration of medication or
treatment may not be made without a written order from a physician, nurse
practitioner, or other licensed prescriber. A copy of the medication,
treatment, or therapy order shall be maintained in the individual's record. The
provider, resident manager, or substitute caregiver shall promptly notify the
individual's case manager of any request for a change in the individual's
orders for medications, treatments, or therapies;
(c) Each individual's medications shall be
clearly labeled with the pharmacist's label or the manufacturer's originally
labeled container and kept in a locked location except as otherwise permitted
under OAR 309-040-0390(3)-(4).
The provider or provider's family medication shall be stored in a separate
locked location. All medication for pets or other animals shall be stored in a
separate locked location. Unused, outdated, or recalled medications may not be
kept in the AFH and shall be disposed in a manner to prevent diversion into the
possession of people other than for whom it was prescribed. The provider shall
document disposal of all unused, outdated, and recalled medication on
individuals' drug disposal forms;
(d) Medications may not be mixed together in
another container prior to administration except as packaged by the pharmacy or
by physician order;
(3)
The program must ensure at least one unexpired opioid overdose kit for
emergency response to suspected overdose is available in the facility at all
times. Opioid overdose kits do not require a prescription and are not specific
to an individual (see ORS
689.684).
(a) All opioid overdose kits must include an
ultraviolet light-protected hard case and must contain, but not be limited to:
(A) Two doses of an FDA-approved
short-acting, non-injectable, opioid antagonist medication;
(B) One pair non-latex gloves;
(D) One disposable face shield for rescue
breathing; and
(E) One
short-acting, non-injectable, opioid antagonist medication administration
instruction card.
(b)
Opioid overdose kits must be:
(A) Installed in
an easily accessible, highly visible, and unlocked location;
(B) At a height of no more than 48 inches
from the floor;
(C) In a location
without direct sunlight;
(D) In an
area where temperatures are maintained between 59 degrees Fahrenheit and 77
degrees Fahrenheit; and
(E) Have a
sign clearly indicating the location and content of the kit.
(c) Short-acting, non-injectable,
opioid antagonist medication not within installed opioid overdose kits must be
stored in a locked cabinet with other resident medications.
(d) Opioid overdose kits must be:
(A) Checked daily to ensure the required
components have not been removed or damaged, with documentation of daily checks
maintained for three years;
(B)
Checked monthly to ensure the short-acting, non-injectable, opioid antagonist
medication has not expired, with documentation of monthly checks maintained for
three years; and
(C) Restocked
immediately after use.
(e) Upon recognizing a person is likely
experiencing an overdose, program staff must immediately respond based on the
medical emergency procedures of the facility.
(f) A person who has reasonable cause to
believe an individual is experiencing an overdose, and in good faith
administers short-acting, non-injectable, opioid antagonist medication, is
protected against civil liability or criminal prosecution unless the person,
while rendering care, acts with gross negligence, willful misconduct, or
intentional wrongdoing as described in Oregon Revised Statute (ORS)
689.681.
(g) Administration of
short-acting, non-injectable, opioid antagonist medication must be documented
by the caregiver who administered the medication. Documentation must be
submitted to the Authority within 48 hours of the incident and must include:
(A) Name of the individual;
(B) Description of the incident including
date, time, and location;
(C) Time
9-1-1 contacted;
(D) Time of
administration(s) of short-acting, non-injectable, opioid antagonist
medication;
(E) Individual's
response;
(F) Transfer of care to
EMS; and
(G) Signature of
caregiver.
(H) Program staff must
fully cooperate with emergency medical service (EMS) personnel. Program staff
must not interfere with or impede the administration of emergency medical
services.
(4)
Opioid overdose medication and kits which are the personal property of a
resident, do not need to be kept in a locked location or maintained as
described under OAR 309-040-0390(3).
(5) A written medication administration
record (MAR) for each individual shall be kept of all medications administered
by the program staff to that individual, including over the counter
medications. The MAR shall indicate name of medication, dosage and frequency of
administration, route or method, dates and times given, and be immediately
initialed by the caregiver dispensing using only blue or black indelible ink.
Treatments, therapies, and special diets shall be immediately documented on the
medication administration record including times given, type of treatment or
therapy, and initials of the caregiver giving it using only blue or black
indelible ink. The medication administration record shall have a legible
signature for each set of initials using only blue or black indelible ink;
(a) The MAR shall include documentation of
any known allergy or adverse reactions to a medication and documentation and an
explanation of why a PRN medication was administered and the results of such
administration;
(b) For any
individual who is self-administering medication, the individual's record shall
include the following documentation:
(A) That
the individual has been trained for self-administering of prescribed medication
or treatment or that the prescriber has provided documentation that training
for the individual is unnecessary;
(B) That the individual is able to manage his
or her own medication regimen, and the provider shall keep medications stored
in an area that is inaccessible to others and locked;
(C) Of retraining when there is a change in
dosage, medication, and time of delivery;
(D) Of review of self-administration of
medication as part of the residential care plan process; and
(E) Of a current prescriber order for
self-administration of medication.
(c) Injections may be self-administered by
the individual or administered by a relative of the individual, a currently
licensed registered nurse, a licensed practical nurse under registered nurse
supervision, or providers who have been trained and are monitored by a
physician or delegated by a registered nurse in accordance with administrative
rules of the Board of Nursing chapter 851, division 047. Documentation
regarding the training or delegation shall be maintained in the individual's
record;
(6) Nursing
tasks may be delegated by a registered nurse to providers and other caregivers
only in accordance with administrative rules of the Board of Nursing chapter
851, division 47. This includes but is not limited to the following conditions:
(a) The registered nurse has assessed the
individual's condition to determine there is not a significant risk to the
individual if the provider or other caregiver performs the task;
(b) The registered nurse has determined the
provider or other caregiver is capable of performing the task;
(c) The registered nurse has taught the
provider or caregiver how to do the task;
(d) The provider or caregiver has
satisfactorily demonstrated to the registered nurse the ability to perform the
task safely and accurately;
(e) The
registered nurse provides written instructions for the provider or caregiver to
use as a reference;
(f) The
provider or caregiver has been instructed that the task is delegated for this
specific person only and is not transferable to other individuals or taught to
other care providers;
(g) The
registered nurse has determined the frequency for monitoring the provider or
caregiver's delivery of the delegated task; and
(h) The registered nurse has documented a
residential care plan for the individual including delegated procedures,
frequency of registered nurse follow-up visits, and signature and license
number of the registered nurse doing the delegating.
(7) The initial residential care plan shall
be developed within 24 hours of admission to the AFH.
(8) This section and its subsections are
effective July 1, 2016, and enforceable as described in OAR
309-040-0315(7):
(a) During the initial 30 calendar days
following the individual's admission to the AFH, the provider shall continue to
assess and document the individual's preferences and care needs. The provider
shall complete and document the assessment in an RCP within 30 days after
admission, unless the individual is admitted to the AFH for crisis-respite
services;
(b) An RCP is an
individualized plan intended to implement and document the provider's delivery
of services and identifies the goals to be accomplished through those services.
The RCP shall describe the individual's needs, preferences, capabilities, and
what assistance the individual requires for various tasks;
(c) The provider shall develop the RCP based
upon the findings of the individual assessment and the person-centered service
plan with participation of the individual and through collaboration with the
individual's primary mental health treatment provider. With consent of the
individual, family members, representatives from involved agencies, and others
with an interest in the individual's circumstances may be invited to
participate in the development of the RCP. The provider shall have proper,
prior authorization from the individual or the individual's representative
prior to such contact;
(d) The RCP
shall adequately consider and facilitate the implementation of the individual's
person-centered service plan by addressing the following:
(A) Address the implementation and provision
of services by the provider consistent with the obligations imposed by the
person-centered service plan;
(B)
Identify the individual's service needs, desired outcomes, and service
strategies to advance all areas identified in the person-centered service plan,
the individual's physical and medical needs, medication regimen, self-care,
social-emotional adjustment, behavioral concerns, independent living capability
and community navigation, as well as any other area of concern or the other
goals set by the individual;
(C) If
the person-centered service plan is unavailable for use in developing the RCP,
providers shall still develop an RCP based on the information available. Upon
the person-centered service plan becoming available, the providers shall amend
the RCP as necessary to comply with this rule; and
(D) The provider shall attach the
person-centered service plan to the RCP.
(e) The RCP shall be signed by the
individual, the provider, or the provider's designee, and others, as
appropriate, to indicate mutual agreement with the course of services outlined
in the plan;
(f) The provider shall
review and update each individual's RCP every six months and when an
individual's condition changes. The review shall be documented in the
individual's record at the time of the review and include the date of the
review and the provider's signature. If an RCP contains many changes and
becomes less legible, the provider shall write a new care plan.
(9) A person-centered service plan
shall be completed in the following circumstances:
(a) A person-centered service plan
coordinator under contract with the Division shall complete a person-centered
service plan with each individual pursuant to OAR
411-004-0030. The provider shall
make a good faith effort to implement and complete all elements the provider is
responsible for implementing as identified in the person-centered service
plan;
(b) The person-centered
service plan coordinator documents the person-centered service plan on behalf
of the individual and provides the necessary information and supports to ensure
the individual directs the person-centered service planning process to the
maximum extent possible;
(c) The
person-centered service plan shall be developed by the individual, and as
applicable, the legal or designated representative of the individual, and the
person-centered service plan coordinator. Others may be included only at the
invitation of the individual and, as applicable, the individual's
representative;
(d) To avoid
conflict of interest, the person-centered service plan may not be developed by
the provider for individuals receiving Medicaid. The Division may grant
exceptions when it determines that the provider is the only willing and
qualified entity to provide case management and develop the person-centered
service plan in a specific geographic area;
(e) For private pay individuals, a
person-centered service plan may be developed by the individual, or as
applicable, the legal or designated representative of the individual, and
others chosen by the individual. Providers shall assist private pay individuals
in developing person-centered service plans when no alternative resources are
available. Private pay individuals are not required to have a written
person-centered service plan.
(10) A person-centered service plan shall be
developed through a person-centered service planning process. The
person-centered service planning process includes the following:
(a) Is driven by the individual;
(b) Includes people chosen by the
individual;
(c) Provides necessary
information and supports to ensure the individual directs the process to the
maximum extent possible and is enabled to make informed choices and
decisions;
(d) Is timely,
responsive to changing needs, occurs at times and locations convenient to the
individual, and is reviewed at least annually;
(e) Reflects the cultural considerations of
the individual;
(f) Uses language,
format, and presentation methods appropriate for effective communication
according to the needs and abilities of the individual and, as applicable, the
individual's representative;
(g)
Includes strategies for resolving disagreement within the process, including
clear conflict of interest guidelines for all planning participants, such as:
(A) Discussing the concerns of the individual
and determining acceptable solutions;
(B) Supporting the individual in arranging
and conducting a person-centered service planning meeting;
(C) Utilizing any available greater community
conflict resolution resources;
(D)
Referring concerns to the Office of the Long-Term Care Ombudsman; or
(E) For Medicaid recipients, following
existing, program-specific grievance processes.
(h) Offers choices to the individual
regarding the services and supports the individual receives and from whom, and
records the alternative HCB settings that were considered by the
individual;
(i) Provides a method
for the individual to request updates to the person-centered service plan for
the individual;
(j) Is conducted to
reflect what is important to the individual to ensure delivery of services in a
manner reflecting personal preferences and ensuring health and
welfare;
(k) Identifies the
strengths and preferences, service and support needs, goals, and desired
outcomes of the individual;
(L)
Includes any services that are self-directed, if applicable;
(m) Includes but is not limited to
individually identified goals and preferences related to relationships, greater
community participation, employment, income and savings, healthcare and
wellness, and education;
(n)
Includes risk factors and plans to minimize any identified risk factors;
and
(o) Results in a
person-centered service plan documented by the person-centered services plan
coordinator, signed by the individual, participants in the person-centered
service planning process, and all individuals responsible for the
implementation of the person-centered service plan, including the provider, as
described in these rules. The person-centered service plan is distributed to
the individual and other people involved in the person-centered service plan as
described in these rules.
(11) Required contents of the person-centered
service plan:
(a) When the provider is
required to develop the person-centered service plan, the provider shall ensure
that the plan includes the following:
(A) HCBS
and setting options based on the needs and preferences of the individual and
for residential settings, the available resources of the individual for room
and board;
(B) The HCBS and
settings are chosen by the individual and are integrated in and support full
access to the greater community;
(C) Opportunities to seek employment and work
in competitive integrated employment settings for those individuals who desire
to work. If the individual wishes to pursue employment, a non-disability
specific setting option shall be presented and documented in the
person-centered service plan;
(D)
Opportunities to engage in greater community life, control personal resources,
and receive services in the greater community to the same degree of access as
people not receiving HCBS;
(E) The
strengths and preferences of the individual;
(F) The service and support needs of the
individual;
(G) The goals and
desired outcomes of the individual;
(H) The providers of services and supports,
including unpaid supports provided voluntarily;
(I) Risk factors and measures in place to
minimize risk;
(J) Individualized
backup plans and strategies, when needed;
(K) People who are important in supporting
the individual;
(L) The person
responsible for monitoring the person-centered service plan;
(M) Language, format, and presentation
methods appropriate for effective communication according to the needs and
abilities of the individual receiving services;
(N) The written informed consent of the
individual;
(O) Signatures of the
individual, participants in the person-centered service planning process, and
all people and providers responsible for the implementation of the
person-centered service plan as described below in subsection (c) of this
section;
(P) Self-directed
supports; and
(Q) Provisions to
prevent unnecessary or inappropriate services and supports.
(b) When the provider is not
required to develop the person-centered service plan but provides services to
the individual, the provider shall provide relevant information and provide
necessary support for the person-centered service plan coordinator or other
persons developing the plan to fulfill the characteristics described in these
rules;
(c) The individual decides
on the level of information in the person-centered service plan that is shared
with providers. To effectively provide services, providers shall have access to
the portion of the person-centered service plan that the provider is
responsible for implementing;
(d)
The person-centered service plan is distributed to the individual and other
people involved in the person-centered service plan as described in these
rules;
(e) The person-centered
service plan shall justify and document any individually-based limitation to be
applied as outlined in OAR
309-040-0393 when an
individual's rights under OAR
309-040-0410(2)(b) through
(i) may not be met due to threats to the
health and safety of the individual or others;
(f) The person-centered service plan shall be
reviewed and revised:
(A) At the request of
the individual:
(B) When the
circumstances or needs of the individual change; or
(C) Upon reassessment of functional needs as
required every 12 months.
(12) Because it may not be possible to
assemble complete records and develop a person-centered service plan during the
crisis-respite individual's short stay, the provider is not required to develop
a person-centered service plan under these rules, but shall, at a minimum,
develop an initial care plan as required by section (7) of these rules to
identify service needs, desired outcomes, and service strategies to resolve the
crisis or address the individual's other needs that caused the need for
crisis-respite services. In addition, the provider shall provide relevant
information and provide necessary support for the person-centered service plan
coordinator as described in section (11)(b) of this rule.
(13) The provider shall develop an individual
record for each individual. The provider shall keep the individual record
current and available on the premises for each individual admitted to the AFH.
The provider shall maintain an individual record consistent with the following
requirements:
(a) The record shall include:
(A) The individual's name, previous address,
date of entry into AFH, date of birth, sex, marital status, religious
preference, preferred hospital, Medicaid or Medicare numbers where applicable,
guardianship status, and;
(B) The
name, address, and telephone number of:
(i)
The individual's legal representative, designated representative, family,
advocate, or other significant person;
(ii) The individual's preferred primary
health provider, designated back up health care provider or clinic;
(iii) The individual's preferred
dentist;
(iv) The individual's day
program or employer, if any;
(v)
The individual's case manager; and
(vi) Other agency representatives providing
services to the individual.
(C) Individual records shall be available to
the Authority conducting inspections or investigations as well as to the
individual or the individual's representative;
(D) Original individual records shall be kept
for a period of three years after discharge when an individual no longer
resides in the AFH;
(E) In all
other matters pertaining to confidential records and release of information,
providers shall comply with ORS
179.505.
(b) Medical Information:
(A) History of physical, emotional, and
medical problems, accidents, illnesses or mental status that may be pertinent
to current care;
(B) Current orders
for medications, treatments, therapies, use of restraints, special diets, and
any known food or medication allergies;
(C) Completed medication administration
records from the license review period;
(D) Name and claim number of medical
insurance and any pertinent medical information such as hospitalizations,
accidents, immunization records including previous TB tests, incidents or
injuries affecting the health, safety, or emotional well-being of any
individual.
(c)
Individual Account Record:
(A) Individual's
Income Sources;
(B) Refer to the
individual's residential care plan with supporting documentation from the
income sources to be maintained in the individual's individual
record;
(C) The individual or the
individual's representative shall agree to specific costs for room and board
and services within the pre-set limits of the state contract. A copy shall be
given to the individual, the individual's representative, and the original in
the individual's individual record;
(D) Individual's record of discretionary
funds.
(d) If an
individual maintains custody and control of his or her discretionary funds,
then no accounting record is required;
(e) If a designee of the AFH maintains
custody and control of an individual's discretionary fund, a signed and dated
account and balance sheet shall be maintained with supporting documentation for
expenditures $10 and greater. The AFH designee shall have specific written
permission to manage an individual's discretionary fund;
(f) The provider shall maintain a copy of the
written house rules with documentation that the provider discussed the house
rules with the individual;
(g) A
written incident report of any unusual incidents relating to the AFH including
but not limited to individual care. The incident report shall include how and
when the incident occurred, who was involved, what action was taken by staff,
and the outcome to the individual. In compliance with HIPAA rules, only the
individual's name may be used in the incident report. Separate reports shall be
written for each individual involved in an incident. A copy of the incident
report shall be submitted to the CMHP within five working days of the incident.
The original shall be placed in the individual's individual record;
(h) Any other information or correspondence
pertaining to the individual;
(i)
Progress notes shall be maintained within each individual's record and document
significant information relating to all aspects of the individual's functioning
and progress toward desired outcomes as identified in the individual's personal
care plan. A progress note shall be entered in the individual's record at least
once each month.
(14)
Residents' Bill of Rights:
(a) The provider
shall guarantee the Residents' Bill of Rights as described in ORS
443.739. The provider shall post
a copy of the Residents' Bill of Rights in a location that is accessible to
individuals, individuals' representatives, parents, guardians, and advocates.
The provider shall give a copy of the Residents' Bill of Rights to each
individual, individuals' representative, parent, guardian, and advocate along
with a description of how to exercise these rights;
(b) The provider shall explain and document
in the individual's file that a copy of the Residents' Bill of Rights was given
to each individual at admission and is posted in a conspicuous place including
the name and phone number of the office to call to report complaints.
(15) Providers, resident managers,
or substitute caregivers may not use physical restraints for individuals
receiving personal care services authorized or funded through the
Division.
(16) The provider shall:
(a) Conspicuously post the State license and
Abuse and Complaint poster where it can be seen by individuals;
(b) Cooperate with Division personnel or
designee in complaint investigation procedures, abuse investigations, and
protective services, planning for individual care, application procedures, and
other necessary activities, and allow access of Division personnel to the AFH,
its individuals, and all records;
(c) Give care and services, as appropriate to
the age and condition of the individual and as identified on the RCP. The
provider shall ensure that physicians' orders and those of other medical
professionals are followed and that the individual's physicians and other
medical professionals are informed of changes in health status or if the
individual refuses care;
(d) House
Rules:
(A) The provider shall develop
reasonable written house rules regarding hours, visitors, use of tobacco and
alcohol, meal times, use of telephones and kitchen, monthly charges and
services to be provided and policies on refunds in case of departure,
hospitalization, or death;
(B) The
provider shall discuss house rules with the individual and families at the time
of arrival and be posted in a conspicuous place in the facility. The provider
shall maintain written documentation in the individual record that the provider
discussed the house rules with the individual along with a copy of the house
rules;
(C) House rules are subject
to review and approval by the Division and may not violate individual's rights
as stated in ORS 430.210;
(D) House rules may not restrict or limit the
individual rights under OAR
309-040-0410(2).
This subsection is effective July 1, 2016, and enforceable according to
309-040-0315(7).
(e) In the provider's absence, the
provider shall have a resident manager or substitute caregiver on the premises
to provide care and services to individuals. For absences greater than 72
consecutive hours, the CMHP shall be notified of the name of the substitute
caregiver for the provider or resident manager;
(f) A provider, resident manager, or
substitute caregiver shall be present in the home at all times;
(g) Allow and encourage individuals to
exercise all civil and human rights accorded to other citizens;
(h) Not allow or tolerate physical, sexual,
or emotional abuse or punishment, or exploitation, or neglect of
individuals;
(i) Provide care and
services as agreed to in the RCP;
(j) Keep information related to individuals
confidential as required under ORS
179.050;
(k) Ensure that the number of individuals
requiring nursing care does not exceed the provider's capability as determined
by the Division or CMHP;
(L) Not
admit individuals who are clients of Aging and People with Disabilities without
the express permission of the Division;
(m) Notify the Division prior to a closure
and give individuals, the individuals' representative, families, and CMHP staff
30 days written notice of the planned change except in circumstances where
undue delay might jeopardize the health, safety, or well-being of individuals,
providers, or caregivers. If a provider has more than one AFH, an individual
may not be shifted from one AFH to another without the same period of notice
unless prior approval is given and agreement obtained from individuals, family
members, and CMHP;
(n) Exercise
reasonable precautions against any conditions that threatens the health,
safety, or welfare of individuals;
(o) Immediately notify the appropriate RCP
Team members (in particular the CMHP representative and family or guardian) if:
The individual has a significant change in medical status; the individual has
an unexplained or unanticipated absence from the AFH; the provider becomes
aware of alleged or actual abuse of the individual; the individual has a major
behavioral incident, accident, illness, hospitalization; the individual
contacts or is contacted by the police; or the individual dies, and follow-up
with an incident report.
(17) The provider shall write an incident
report for any unusual incident and forward a copy of the incident report to
the CMHP within five working days of the incident. Any incident that is the
result of or suspected of being abuse shall be reported to the Office of
Investigations and Training within 24 hours of occurrence.
Statutory/Other Authority: ORS
413.042
Statutes/Other Implemented: ORS
443.705 -
443.825