La. Admin. Code tit. 48 § I-8777

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-8777 - Services

A. Assessment, Service Coordination, and Monitoring

1. Within seven days of admission, the facility shall complete an assessment to determine the needs and preferences of the client. The assessment shall include but is not limited to:

a. review of physical health, psycho-social status and cognitive status and determination of services necessary to meet those needs;

b. a summary of the clients health needs, if any, including medication, treatment and special diet orders obtained from professionals with responsibility for the clients physical or emotional health;

c. a written description of the activities of daily living and instrumental activities of daily living for which the client requires assistance, if any, obtained from the client, the clients physician, family or representative;

d. the clients interests, likes and dislikes;

e. recreational and social activities which are suitable or desirable;

f. a plan for handling special emergency evacuation needs; and

g. additional information or documents pertinent to the clients service planning, such as guardianship papers, power of attorney, living wills, do-not-resuscitate orders, or other relevant medical documents.

2. Within 30 days after admission, the facility, with input from the client, and/or his/her representative shall develop and implement a service plan using information from the assessment. The service plan shall include:

a. the clients needs;

b. the scope, frequency and duration of services and monitoring that will be provided to meet the clients needs;

c. staff responsible for providing the services inclusive of third-party providers;

d. current medication list from the clients primary care physician; and

e. identification of the level of assistance that the client requires.

3. The facility shall have a reporting procedure in place for notifying appropriate individuals of any changes in a clients condition.

4. The clients service plan shall be revised when a clients condition or preferences change and signed by the client and the representative, if applicable, and the designated facility staff.

5. The service plan shall be monitored on an ongoing basis to assess its appropriateness and to identify when a clients condition or preferences have changed.

6. A documented review of the clients service plan shall be made at least every three months.

7. All plans and reviews shall be signed by the client, facility staff and the representative, if applicable.

B. Personal and Supportive Services

1. The facility shall provide adequate services and oversight/supervision, including adequate security measures, continuously as needed for any client.

2. The facility shall provide or coordinate services, to the extent needed or desired by clients.

3. The client may participate in these services as written in his/her service plan. The following services are required to be offered:

a. assistance with all ADLs and IADLs;

b. at least three nutritious, varied, and palatable meals a day, seven days a week, that take into account clients dietary requirements, preferences and needs in residential facilities:

i. nourishing snacks, such as fruits and beverages, shall be available to residents at all times; and

ii. the ABI facility shall furnish medically prescribed diets to all clients for which it is designated in the service plan;

c. basic personal laundry services in residential facilities;

d. opportunities for individual and group socialization and to utilize community resources to create a normal and realistic environment for community interaction within and outside the facility (i.e. barber/beauty services, social/recreational opportunities);

e. services for clients who have behavior problems requiring ongoing staff support, intervention, and supervision to ensure no danger or infringement of the rights of other clients or individuals;

f. household services essential for the health and comfort of client (e.g. floor cleaning, dusting, bed making, etc.) in residential facilities;

g. assistance with self-administration of medications; and

h. a program of recreational activities.

C. Medication Management. The ABI facility shall have a medication management program. The medication management program shall be formulated in consultation with the clients primary physician and overseen by the nursing director.

1. The facility shall have written policies and procedures for the implementation of the medication management program.

2. The facility shall assist clients in the self-administration of prescription and non-prescription medication as agreed to in their contract or service plan, as allowed by state statute/regulations and overseen by the nursing director. Only clients who have awareness of their medication regime shall be provided assistance by direct care staff with self-administration of medications.

3. Assistance with self-administration of medications shall be limited to the following:

a. the client may be reminded to take his/her medication;

b. the medication regimen, as indicated on the container may be read to the client;

c. the dosage may be verified by staff, according to the container label; and

d. staff may physically assist the client in pouring or handling medications, including opening the medicine container (i.e. bottle, mediset, blister pak, etc.), if the client lacks the ability to open the container.

4. If the client has been assessed as able to utilize a pill organizer box, such pill organizer box may be filled by the nursing director or designee, the client with supervision or the clients representative.

5. The facility shall thoroughly review the medication administration staffs ability to follow policy and procedures regarding assisting with medication administration.

6. An employee that provides assistance with the self-administration of medications to a client shall have documented training on the policies and procedures for medication assistance including the limitations of this assistance.

a. Documentation of training shall include the signature of the employee.

b. Training shall be repeated at least annually.

c. Training for direct care staff assisting with medication management shall include but not be limited to the following:

i. legal aspects of medication assistance;

ii. understanding roles and responsibilities in medication assistance;

iii. definitions of medical terminology;

iv. classifications of medications;

v. identification of medication;

vi. dosing and measurement of medications;

vii. mechanism of action, therapeutic effects of drugs, and response to medications;

viii. education on side effects, observation, reporting and documentation of side effects; and

ix. care and safe handling of medications.

7. Direct care staff assisting with medication management shall meet the following:

a. be a minimum of 18 years of age;

b. able to read, write and comprehend the English language; and

c. have no current evidence of drug use, drug abuse or diversion of drugs and no record of conviction of a felony.

8. Limitations. Medication assistance is limited to assistance with oral medication, inhalant medication, topical applications, suppository medication, eye and ear drops as prescribed and documented in the service plan.

a. Direct care staff providing medication assistance shall not assist with any intramuscular, intravenous or subcutaneous medications.

b. Direct care staff providing medication assistance shall not receive or assume responsibility for writing oral or telephone orders from a physician.

c. Direct care staff providing medication assistance shall not alter medication dosages, as delivered from the pharmacy, without being instructed to do so by the nursing director, in accordance with prescribed medication orders.

9. The facility shall ensure that a clients medications shall be securely stored by the client in the clients own bedroom or stored in a secure central location in the facility, as appropriate for each individual client.

D. Transportation

1. The facility shall have the capacity to provide or to arrange transportation as necessary for the following:

a. medical services, including ancillary services for medically related care (e.g., physician, pharmacist, therapist, podiatrist);

b. personal services, including barber/beauty services;

c. personal errands; and

d. social/recreational opportunities.

2. The facility shall ensure and document that any vehicle used in transporting clients, whether such vehicles are operated by a staff member or any other person acting on behalf of the facility, is inspected, licensed and insured in accordance with state law.

3. When transportation services are provided by the facility, whether directly or by third party contract, the facility shall document and ensure that drivers have a valid drivers license and that drivers have a current insurable driving record as evidenced by a drivers license status inquiry report available on-line from the Office of Motor Vehicles.

4. When transportation services are provided by the ABI facility, the facility shall ensure that drivers are trained and experienced in assisting a resident being transported, in accordance with the individual clients needs and service plan.

5. Vehicles used for transporting clients shall be handicapped accessible and sufficiently equipped to safely meet the needs of the clients served.

E. Meals (Residential Facilities)

1. A facility shall ensure that a client is provided at least three meals, or their equivalent, daily and at regular times.

a. There shall not be more than 14 hours between the evening meal and breakfast of the following day, unless there is a nourishing snack served and/or available between the evening and morning meal.

b. Meal times shall be comparable to those in a normal home.

2. The facility shall make reasonable accommodations to:

a. meet religious and ethnic preferences;

b. meet the temporary need for meals delivered to the clients room;

c. meet clients temporary schedule changes as well as clients preferences (e.g. to skip a meal or prepare a simple late breakfast); and

d. make nutritious snacks, fruits and beverages available to clients when requested.

3. All food preparation areas (excluding areas in clients units) shall be maintained in accordance with state and local sanitation and safe food handling standards.

4. Staff shall be available in the dining area to serve the food and to give individual assistance as needed.

5. Written reports of inspection by the OPH, Sanitarian Services shall be kept on file in the facility.

6. Specific times for serving meals shall be established and posted.

7. Meals shall be prepared and served in a way that assures that they are appetizing, attractive and nutritious and promotes socialization among the clients.

8. Food shall be palatable, sufficient in quantity and quality and properly prepared by methods that conserve the nutritive value, flavor and appearance.

9. The facility shall have kitchens and dining rooms that are appropriately and adequately furnished to serve the number of clients residing in the facility in a comfortable environment.

a. Dining room(s) may be sized to accommodate clients in either one or two settings.

b. The facility shall have a central kitchen or a warming kitchen.

c. The facility's kitchen(s) and dining room(s) shall meet applicable sanitation and safety standards and shall be well lighted and ventilated.

F. Menus (Residential Facilities)

1. Menus shall be planned and written at least one week in advance and dated as served. The current weeks menu shall be posted in a conspicuous place in the facility.

2. The facility shall furnish medically prescribed diets to clients in accordance with their service plan and shall be planned or approved by a licensed dietician.

3. Records of all menus as served shall be kept on file for at least 30 days.

4. All substitutions made on the master menu shall be recorded in writing.

G. Food Supplies

1. All food in the facility shall be labeled as safe for human consumption.

2. Grade "A" pasteurized fluid milk and fluid milk products shall be used or served. Dry milk products may not be used, except for cooking purposes.

H. Food Protection

1. If food is prepared in a central kitchen and delivered to separate facilities, provision shall be made for proper maintenance of food temperatures and a sanitary mode of transportation.

2. facility's refrigerator(s) shall be maintained at a temperature of 45 degrees Fahrenheit or below.

3. Freezers shall be maintained at a temperature of 0 degrees Fahrenheit or below.

4. Thermometers shall be required for all refrigerators and freezers.

5. Food stored in the refrigerator shall be covered.

6. Pets are not allowed in food preparation and serving areas.

I. Ice and Drinking Water

1. The water supply shall be adequate, of a safe sanitary quality and from an approved source.

2. Clean sanitary drinking water shall be available and accessible in adequate amounts at all times.

3. The ice scoop shall be maintained in a sanitary manner. The handle of the ice scoop shall at no time come in contact with the ice.

J. Recreation

1. The facility shall have a range of indoor and outdoor recreational and leisure opportunities to meet the needs and preferences of clients.

2. The facility shall provide and/or coordinate access to community-based activities.

3. There shall be a monthly posted list of recreational and leisure activities in the facility and the community.

La. Admin. Code tit. 48, § I-8777

Promulgated by the Department of Health, Bureau of Health Services Financing, LR 432181 (11/1/2017).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 40:2120.31-40.