Chapter 5 - ADMINISTRATION5.A. Organizational Structure and Lines of Authority All Home Health Care Services Providers will identify in writing the services provided, administrative control, and lines of authority for the delegation of responsibility down to the patient/client care level. A policy and procedure manual(s), including patient care protocols, for the organization and operation of the facility shall be established implemented and reviewed at least annually. Each review of the manual(s) shall be documented and dated. This written material shall be maintained at the home health care agency's main office so that Department staff can examine it during monitoring visits. This material will include:
5.A.1. A statement describing the organizational goal(s) of the home health care agency, its philosophy and objectives and the services provided by the agency,5.A.2. An organizational diagram clearly outlining the relationship between personnel having responsibility and accountability within the organization including any sub units of the provider,5.A.3. Job description of the Administrator. The administrator is a person having the authority and responsibility for the operation of the home health care services agency and for staff performance in accordance with applicable requirements and policies of the agency. The administrator is a licensed physician, registered nurse, or a individual who has training and experience in a health services administration, with at least one (1) year of supervisory or administrative experience in home health care services or related health programs.5.A.4. Job descriptions of employees. These job descriptions shall include the qualifications necessary for the position, an outline of the scope of duties, competencies, responsibilities and accountability required of employees in that position;5.A.5. A description of the orientation programs provided for employees directly employed by the home haft care agency. This orientation information shall indicate: a. The organization goals of the agency,b. The review of the agency's policies and procedures;c. Ongoing inservice programs and staff training;d. Other community resources related to the delivery of home health care services;e. Job duties to be performed by the employees;f. Job duties to be performed by other Home Health Care Services Provider personnel and a description of the relationship of these duties to patient/client careg. Patient/chat care protocols; andh. A review of the agency's written protocols for the identification and reporting of abuse, neglect, or misappropriation of client's/patient's property.5.A.6. If the organization has an advisory or governing body a set of by-laws specifying the following will be required: c. Administration's role,d. Frequency of meetings, ande. Recorded minutes. The by-laws shall be adopted and updated as deemed necessary by the advisory or governing body.
5.B. Business Records 5.B.1. Business records of the Home Health Care Services Provider shall be kept and retained in a manner consistent with all applicable city, state and federal laws, ordinances and regulations with proper audit trails available. Business records, contracts, and newspaper advertisements will be retained for a minimum of five (5) years.5.B.2. If a Home Health Care Services Provider has sub units, relevant administrative records shall be maintained for each sub unit.5.B.3. Copies of the current licenses of all licensed health professionals employed directly or through a contractual relationship with the agency shall be maintained by the agency. Certificates verifying completion of applicable training courses for all certified nursing assistants ad home health aides employed directly or through a contractual relationship by the agency shall also be maintained by the agency.5.B.4. The Home Health Care Services Provider shall keep a personnel file for each health care professional and paraprofessional employed or contracted which shall include, but not be limited to: b. Evidence of current qualifications;c. Evidence of orientation and inservice training;5.C. Qualifications for Professional Personnel The following health care professionals employed directly or through a contractual relationship with a home health care agency may provide home health care services by virtue of possession of a current license to practice their health care discipline in the State of Maine:
5.C.1. Registered professional nurses;5.C.2. Physical therapists;5.C.3. Speech pathologists;5.C.4. Occupational therapists,5.C.6. Licensed practical nurses; and5.D. Quality Assurance The Home Health Care Services Provider shall establish a quality assurance program. The program will reflect ongoing objective assessment of important aspects of patient/client care and the correction of identified problems. It will consist of a clinical record review at least quarterly and an overall agency review at least annually, The results of the review/evaluation are reported to, and acted upon, by those responsible for operation of the agency.
C.M.R. 10, 144, ch. 119, 5