N.H. Admin. Code § He-P 815.15

Current through Register No. 45, November 7, 2024

Section He-P 815.15 - Required Services

(a) The licensee shall provide administrative services which include the appointment of a full-time, on-site administrator who:

(1) Is responsible for the day-to-day operations of the ICF/IID;

(2) Works no less than 35 hours per week at the ICF/IID, which may include day, evening, night, and weekend hours;

(3) Delegates, in writing, an alternate onsite, qualified designee who shall assume the responsibilities of the administrator in his or her absence;

(4) Ensures development and implementation of ICF/IID policies and procedures on:

a. Patient's rights as required by RSA 151:20;

b. Advance directives and DNR orders as required by RSA 137-J;

c. Discharge planning as required by RSA 151:26;

d. The use restraints in residents under the age of 18 in accordance with RSA 126-U;

e. The use of seclusion in accordance with RSA 126-U; and

f. Reportable incident reporting;

(5) Monitoring and evaluating the quality of resident care and resident care services in the ICF/IID pursuant to He-P 815.24;

(6) Identifying and making available education programs designed to maintain the personnel's expertise in areas related to the services provided in the ICF/IID; and

(7) Any new administrator shall be appointed by the board of directors of the ICF/IID and possess:

a. A master's degree in the field of human services, business administration, or public administration, awarded by a regionally accredited college or university, plus 2 years of experiences as a professional in human services, which included administrative responsibilities; or

b. A bachelor's degree with a minimum of 12 credits in the field of human services, business administration, or public administration, awarded by a regionally accredited college or university, plus 3 years of experience as a professional in human services, which included administrative responsibilities.

(b) There shall be a full time director of nursing services who is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact, and who is an RN with at least 2 years relevant experience in resident care.

(c) The director of nursing services shall be responsible for:

(1) Establishment of standards of nursing practice used in the ICF/IID;

(2) Ensuring that the admission process and resident assessment process coordinates resident requirements for nursing care with available nursing resources;

(3) Participating with the administrator and personnel to improve the quality of nursing care at the ICF/IID;

(4) Nursing care as authorized by the nurse practice act and according to RSA 326-B;

(5) The overall health and safety of residents; and

(6) Maintaining written personnel schedules, which shall be retained on-site for a period of at least 90 days and which include:

a. At least one licensed nurse in the facility 24 hours a day;

b. At least one registered nurse, for 8 consecutive hours a day 7 days a week; and

c. Nursing assistants who have been verified in accordance with the New Hampshire board of nursing.

(d) Each ICF/IID shall have a medical director who is a licensed physician in the state of New Hampshire.

(e) Prior to or upon the time of admission, the licensee shall provide the resident a written copy of the admission agreement, except in the case of an emergency admission where the written agreement shall be given as soon as practicable.

(f) In addition to (e) above, at the time of admission, the licensee shall provide a written copy to the resident and the guardian or agent, if any, or personal representative, and receive written verification of receipt for the following:

(1) An admissions packet including the following information:

a. A list of the core services required by He-P 815.15(g);

b. The ICF/IID's facility rules;

c. The grounds for transfer or discharge and termination of the agreement, pursuant to RSA 151:21, V;

d. The ICF/IID's policy for resident discharge planning;

e. Information regarding nursing, other health care services, or supplies not provided in the core services, to include:

1. The availability of services;

2. The ICF/IID's responsibility for arranging services; and

3. The fee and payment for services, if known; and

f. Information regarding:

1. Arranging for the provision of transportation;

2. Arranging for the provision of third party services, such as a hairdresser or cable television;

3. Acting as a billing agent for third party services;

4. Monitoring third party services contracted directly by the resident and provided on the ICF/IID premises;

5. Handling of resident funds pursuant to RSA 151:24 and He-P 815.14(ac);

6. Bed hold, in compliance with RSA 151:25;

7. Storage and loss of the resident's personal property;

8. Smoking;

9. Roommates; and

10. The licensee's policy regarding the use of restraints;

(2) A copy of the residents' bill of rights under RSA 151:21 and the ICF/IID's policy and procedure for implementing the bill of rights pursuant to RSA 151:20, II;

(3) A copy of the resident's right to appeal an involuntary transfer or discharge under RSA 151:26, II(5);

(4) The ICF/IID's policy and procedure for handling reports of abuse, neglect, or exploitation, which shall be in accordance with RSA 161-F:46 and RSA 169-C:29;

(5) Information on accessing the office of the long term care ombudsman; and

(6) Information on advance directives and DNR status.

(g) The licensee shall provide the following core services:

(1) Services of a licensed nurse provided 24 hours a day;

(2) Services of an RN provided at least 8 hours within a 24-hour period;

(3) Emergency response and crisis intervention;

(4) Medication services in accordance with He-P 815.16;

(5) Food services in accordance with He-P 815.25;

(6) Housekeeping, laundry, and maintenance services;

(7) On-site activities or access to community activities designed to meet the resident interests of residents to sustain and promote physical, intellectual, social, and spiritual well-being of all residents, and access to educational services if ages 3 to 21; and

(8) Assistance in arranging medical and dental appointments, including arranging transportation to and from such appointments and reminding the residents of the appointments.

(h) The licensee shall:

(1) Make available basic supplies necessary for residents to maintain grooming and personal hygiene, such as soap, shampoo, toothpaste, toothbrush, and toilet paper;

(2) Identify in the admission packet the cost, if any, of basic supplies for which there will be a charge; and

(3) Not be required to pay for a specific brand of the supplies referenced in (1) above.

(i) Consistent with Medicaid Utilization Control regulations at 42 CFR § 456.380 at the time of admission, clients shall be evaluated by a licensed practitioner to identify all diagnoses and complaints, provide orders for all medications and treatments and provide recommendations for restorative and rehabilitative services.

(j) The licensee shall have each resident seen by a licensed practitioner at least annually and a health examination completed and documented.

(k) The health examination referenced in (j) above shall include in the medical record:

(1) Diagnoses, if any;

(2) Medical history;

(3) Medical findings, including the presence or absence of communicable disease;

(4) Vital signs;

(5) Prescribed and over-the-counter medications;

(6) Allergies;

(7) Dietary needs;

(8) Evaluation of vision and hearing; and

(9) Routine screening laboratory examinations as determined necessary by the physician.

(l) An initial nursing care plan shall be initiated upon admission and completed within 48 hours of the resident's admission.

(m) The nursing care plan shall:

(1) Be updated following the completion of each future assessment in (i) above;

(2) Be made available to personnel who assist residents in the implementation of the plan; and

(3) Address the needs identified by (i) and (k) above.

(n) Nursing notes shall be written as per the licensee's policy, and appropriate to resident condition, resident change in condition, and in accordance with professional standards.

(o) Pursuant to RSA 151:21, IX, residents shall be free from chemical and physical restraints except when they are authorized in writing by a licensed practitioner for a specific and limited time necessary to protect the resident or others from injury, or as permitted by the CMS conditions of participation, or as allowed by (p) below.

(p) Pursuant to RSA 151:21, IX, in an emergency, physical restraints may be authorized by the personnel designated in (r)(3) below in order to protect the resident or others from injury, and such action shall be promptly reported to the resident's physician and documented in the resident's clinical record.

(q) All restraints involving residents under the age of 18, shall be in accordance with RSA 126-U and reported to the department in accordance with He-C 901.

(r) The ICF/IID shall have written policies and procedures for implementing physical, chemical, and mechanical restraints, including:

(1) What type of emergency restraints may be used;

(2) When restraints may be used;

(3) What professional personnel may authorize the use of restraints;

(4) The documentation of their use in the resident record including the physician order as applicable;

(5) How the licensee plans for reduction of restraint use for any resident requiring restraints;

(6) Initial personnel training and subsequent education and training required to demonstrate competence related to the use of physical, chemical, and mechanical restraints;

(7) The least restrictive to the most restrictive method to be utilized to control a resident's behavior; and

(8) That the training shall be conducted by individuals who are qualified by education, training, and experience.

(s) The written policies and procedures required in (r) above shall include policies and procedures for restraints involving residents under the age of 18, which shall be in accordance with RSA 126-U and include reporting to the department in accordance with He-C 901.

(t) A resident or parent or guardian, if the resident is a minor, may refuse all care and services.

(u) When a resident or parent or guardian, if the resident is a minor, refuses care or services that could result in a threat to their health, safety, or well-being, or that of others, the licensee or their designee shall:

(1) Inform the resident or parent or guardian of the potential results of their refusal;

(2) Notify the licensed practitioner of the resident's or parent or guardian's refusal of care;

(3) Notify the agent, as applicable, unless the resident or parent or guardian objects; and

(4) Document in the resident's or parent or guardian record a pattern of refusal of care and the reason for the refusal, if known, including education to the resident or parent or guardian, of the risk of refusal.

(v) The licensee shall provide the following information to emergency medical personnel in the event of an emergency transfer to another medical facility:

(1) Full name and the name the resident prefers, if different;

(2) Name, address, and telephone number of the resident's next of kin, guardian, or agent, if any;

(3) Diagnosis, as applicable;

(4) Medications, as applicable, including last dose taken and when the next dose is due;

(5) Allergies;

(6) Functional limitations;

(7) Date of birth;

(8) Insurance information;

(9) Advance directives and DNR status; and

(10) Any other pertinent information not specified in (1)-(9) above.

(w) The licensee may only perform POCT, that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808.

(x) If CLIA-waived laboratory testing is performed by personnel, the licensee shall:

(1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15 ; and

(2) Develop and implement a POCT policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.

(y) The licensee shall have current copies of manufacturer's instructions and package inserts and shall follow all manufacturer's instructions and recommendations for the use of POCT meters and devices to include, but not limited to:

(1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, and reporting results; and

(3) All recommended and required quality control procedures for POCT meters and devices.

(z) Licensee's performing CLIA-waived laboratory testing or specimen collection shall be incompliance with He-P 808, He-P 817, and 42 CFR 493.

N.H. Admin. Code § He-P 815.15

Derived from Number 10, Filed March 9, 2023, Proposed by #13568, Effective 2/25/2023, Expires 2/25/2033.