N.H. Admin. Code § He-M 1001.06

Current through Register No. 50, December 12, 2024

Section He-M 1001.06 - Health and Safety

(a) The residence administrator shall arrange for an annual health assessment of each individual by a physician or other licensed practitioner for the purpose of evaluating health status and making recommendations regarding strategies for promoting and/or maintaining optimal health.

(b) The residence administrator shall, in conjunction with the service coordinator, have arrangements to access medical services at all times, including emergency services. The residence shall have a written plan that specifies the procedures to be followed in medical emergencies.

(c) In the event of emergency concerning an individual including hospitalization, serious illness, serious injury, imminent death, or death, the residence administrator or service coordinator shall:

(1) Promptly notify the individual's next of kin, guardian, and spouse or significant other, as applicable; and

(2) Respect and follow the wishes of the individual or guardian with regard to religious matters, if applicable.

(d) Providers having personal knowledge of an emergency as described in (c) above shall notify the individual's service coordinator immediately, and in writing within 24 hours.

(e) The written notification shall be kept on file at the area agency and a copy of the notice retained in the individual's residential record.

(f) In the event of the death of an individual:

(1) The provider agency shall immediately notify the area agency; and

(2) The area agency shall:

a. Notify the bureau within 12 hours and submit written mortality notification of the following to the bureau within 24 hours:

1.The individual's name, address, date of birth, gender, race, and ethnicity;

2.The date and place of death and whether or not hospice was involved;

3.The individual's medical diagnoses;

4.The names and phone numbers of any family members and guardians notified, and the date of notification;

5.A description of the individual's living situation and whether it had changed within the previous 6 months;

6.The apparent cause of death as recorded by the attending licensed practitioner; and

7.A detailed description of the events surrounding the individual's death, including what happened, what care was provided, and who was involved; and

b. Perform a mortality review as required in (g) and (h) below.

(g) Each area agency shall assess the relationship of any individual's unanticipated death to service provision and the natural course of any illness or underlying condition.

(h) Such a mortality review shall evaluate and, where applicable, document the following:

(1) The individual's medical plan of care;

(2) Medical interventions required within the past year:

(3) Medical records, including physical exams and hospitalizations within the past year;

(4) The individual's health status over the previous 3 months; and

(5) The type and amount of residential care provided.

(i) In any case of known or suspected neglect, abuse, or exploitation, the provider aware of the situation shall:

(1) Follow procedures as outlined in He-M 310, rights of persons receiving developmental services in the community, and any other applicable rules relative to rights protection procedures; and

(2) Report the situation to the division of children, youth, and families in accordance with RSA 169-C:29 and/or the bureau of elderly and adult services as required by RSA 161-F:42-57, as applicable.

(j) All agency staff and providers who administer medications to any individual receiving services in a He-M 1001 certified setting shall be authorized in accordance with He-M 1201.

(k) A provider shall have the following responsibilities with respect to an individual's food and fluids:

(1) The individual's preferences and requirements shall be taken into account;

(2) Varied and nutritionally balanced meals, including adequate fluids, shall be provided in the morning, at midday, and in the evening, unless other arrangements for meals have been made;

(3) Information regarding the signs and symptoms of dehydration specific to the individual shall be requested and retained;

(4) Access to food shall not be restricted unless a licensed practitioner deems it necessary for the health of the individual and the legal guardian consents to the restriction;

(5) Special diets, dietary supplements, and dietary restrictions or modifications shall be according to a licensed practitioner's orders or the individual's religious practices;

(6) If an individual requires specific methods or techniques for maintaining adequate nutrition and/or hydration, as determined by a licensed practitioner, such methods or techniques shall be implemented and documented in the individual's clinical record; and

(7) No attempt to feed or hydrate an individual against his or her shall be made unless medically prescribed by a licensed practitioner and approved by the legal guardian.

(l) Providers shall label toxic substances as to contents and antidote and safely store such substances away from food preparation and food storage areas.

(m) Prior to providing services, a community residence shall develop an emergency evacuation plan that indicates the location of all evacuation routes and exits and provides for the safe evacuation of all persons within 3 minutes.

(n) An individual and his or her guardian shall be notified if any current or prospective household member smokes within the home.

(o) Upon moving to a new community residence, each individual shall be oriented to evacuation procedures by the provider.

(p) Within 5 business days of an individual's moving into a community residence or a change in residential provider, a service coordinator and licensed nurse shall visit the individual in the home to determine if the transition has resulted in adverse changes in the health or behavioral status of the individual.

(q) A service coordinator shall document the visit described in (o) above in the individual's record.

(r) If negative changes are noted, a service coordinator shall develop a remediation plan and include it within the individual's record.

(s) Within 5 days of an individual's moving into a community residence, the provider shall:

(1) Conduct a fire evacuation drill to assess the individual's ability to evacuate the residence in less than 3 minutes; and

(2) Based on the drill, complete and document a fire safety assessment that includes the following individual risk factors:

a. Response to alarm;

b. Response to instruction;

c. Vision and hearing difficulties;

d. Impaired judgment;

e. Mobility problems; and

f. Resistance to evacuation.

(t) The fire safety assessment shall indicate:

(1) The staff or provider to individual ratio during both sleep and non-sleep hours;

(2) The name and phone number of agency back-up in the event of an emergency; and

(3) The date completed and signature of the person documenting the individual's risk factors.

(u) For each individual unable to evacuate his or her residence within 3 minutes, a fire safety plan shall be developed and approved by the individual or guardian, provider, and residential administrator that identifies:

(1) The cause(s) for such inability;

(2) The specific assistance needed by the individual and to be furnished by the provider; and

(3) A training approach to reduce the evacuation time to 3 minutes or less.

(v) Evacuation drills shall:

(1) Be held at varied times of the day;

(2) Involve all persons in the home at the time of the drill;

(3) For community residences of 4 or more individuals, comply with He-P 814.23(k) ; and

(4) For community residences of 3 or fewer individuals, include transmission of the alarm signal unless doing so would register as a false alarm to the fire department or alarm company.

(w) A written record of each evacuation drill shall:

(1) Be kept on file at each community residence; and

(2) Indicate:

a. The names of all the individuals involved;

b. The date of the drill;

c. The time of day;

d. The time taken to evacuate; and

e. The exits utilized.

(x) If a community residence for 3 or fewer individuals has been evacuated in 3 minutes or less during each of 6 consecutive monthly drills, one of which has been a sleep-time drill, the residence shall thereafter conduct a drill at least once quarterly, with one drill per year to be during sleep hours.

(y) If a community residence serves 4 or more individuals, the residence shall conduct monthly drills, with at least 3 drills per year to be held during sleep hours.

(z) A community residence that has a complete sprinkler system and fire alarm system that immediately notifies the local fire department shall be exempt from the requirement to complete a fire drill in less than 3 minutes if documentation is provided that such systems are in compliance with local fire codes.

(aa) If a new individual moves into a community residence for 3 or fewer individuals, the community residence shall:

(1) Conduct monthly drills until all individuals have evacuated the residence in 3 minutes or less for 3 consecutive monthly drills; and

(2) Thereafter conduct a drill at least once quarterly, with one drill per year to be during sleep hours.

(ab) For any individual receiving less than 24-hour supervision, a personal safety assessment pursuant to (ac) below shall be completed.

(ac) The personal safety assessment shall identify an individual's ability to demonstrate the following safety skills:

(1) Respond to a fire including exiting safely and seeking assistance;

(2) Care for personal health, including understanding health issues, taking medication, seeking assistance for health needs and applying basic first aid;

(3) Seek safety if victimized or sexually exploited;

(4) Negotiate one's community, including finding one's way, riding in vehicles safely, handling money safely, and interacting with strangers appropriately;

(5) Respond appropriately in severe weather and other natural disasters, including storms, extreme temperature; and

(6) Maintain a safe home, including:

a. Operating heating, cooking, and other appliances; and

b. Responding to common household problems such as a blocked toilet, power failure and gas odors.

(ad) The individual's team, including the individual, shall develop a personal safety plan if the personal safety assessment determines that the individual needs assistance to respond appropriately to the situations outlined in (ac) above.

(ae) A personal safety plan shall:

(1) Identify the supports necessary for an individual to respond to each of the contingencies listed in (ac) above;

(2) Indicate who will provide the needed supports;

(3) Describe how the supports will be activated in an emergency;

(4) Indicate approval of the individual or legal guardian, and provider, residential coordinator, and service coordinator;

(5) Be reviewed by the provider at the time of the individual's service agreement; and

(6) Be revised whenever there is a change in the individual's residence or ability to respond to the contingencies listed in the plan.

(af) The individual or his or her guardian shall approve the personal safety plan prior to the individual being without supervision for specified periods of time. Any revisions to the plan shall require the individual's or guardian's prior approval.

N.H. Admin. Code § He-M 1001.06

(See Revision Note at part heading for He-M 1001) #5867, eff 9-1-94, EXPIRED: 9-1-00

New. #7681, eff 4-23-02; amd by #8209, eff 11-23-04; ss by #9696, INTERIM, eff 4-23-10, EXPIRES: 10-20-10; ss by #9776-A, eff 10-1-10

Amended by Volume XXXVIII Number 45, Filed November 8, 2018, Proposed by #12650, Effective 10/24/2018, Expires 4/22/2028.