N.H. Admin. Code § He-P 818.15

Current through Register No. 45, November 7, 2024

Section He-P 818.15 - Required Services

Each ADP shall provide, at a minimum, the following core services and programs:

(a) Administrative services that include the appointment of a full time administrator who:

(1) Is at least 21 years of age;

(2) Has one of the following combinations of education and experience:

a. A bachelor's degree from an accredited institution and at least 2 years of experience working in a health-related field;

b. A registered nurse (RN), licensed in New Hampshire, or a registered nurse with a multi-state compact license, with at least one year of experience working in a health related field;

c. A licensed practical nurse (LPN) with at least 2 years of experience working in a health related field; or

d. An associate's degree from an accredited institution plus 4 years of experience in a health related field;

(3) Is responsible, directly or through delegation, for notifying the department as specified in He-P 818.14(s) of any reportable incident involving a participant(s);

(4) Shall be permitted to also hold the position of:

a. Licensed nurse, as specified in (b) below, if the person is a licensed nurse; or

b. Activities coordinator, as specified in (c) below, if the ADP is limited by its license to 6 or fewer participants per day;

(5) Designates, in writing, an alternate staff person who shall assume the responsibilities of the administrator in his or her absence; and

(6) Hires support staff necessary to assist the administrator in maintaining regulatory compliance;

(b) Nursing services that:

(1) Include the employment or contracted services of a part-time or full-time licensed nurse who:

a. Is currently licensed in the state of New Hampshire pursuant to RSA 326-B, or licensed pursuant to the multi-state compact;

b. Has at least one year of experience working with geriatric individuals or persons with disabilities;

c. Gives direction to the staff members that provide personal care, such as assistance with and supervision of ADLs, to the participants; and

d. Shall be directly or indirectly supervised by an RN if the person is a licensed practical nurse (LPN);

(2) Include the provision of initial and ongoing assessments of the participant's pain level, vital signs, and physical, cognitive. and behavioral status, as well as assessments of how the participant is adapting psychologically to their social environment; and

(3) Provide the following:

a. Nursing care as authorized by RSA 326 that includes medication administration and wound care;

b. Nutritional monitoring;

c. Care management or referral to a case manager;

d. Referrals to community service agencies when necessary; and

e. Assistance with therapeutic monitoring of capillary blood glucose levels and capillary blood Prothrombin Time, International Normalized Ratio (PT-INR) testing using a Clinical Laboratory Improvement Amendments (CLIA) approved waived testing system, per 42 CFR Part 493.15. The ADP shall be exempt from licensing under He-P 808 and He-P 817 for performance of these 2 tests;

(c) Recreational activity services that include:

(1) The employment of an activities coordinator who has 2 years of experience working with geriatric individuals or persons with disabilities; and

(2) Purposeful activities designed to meet the needs and interests of participants, including but not limited to activities that are cultural, economic, emotional, intellectual, physical, social, and spiritual;

(d) Personal care services that include:

(1) Assistance with and supervision of ADLs when needed by participants; and

(2) Minimum staffing ratios, which may be met by both nursing and activities personnel, as follows:

a. When fewer than 8 participants are in attendance, at least one paid personnel member shall be present at all times;

b. When there are 8 to 16 participants in attendance, there shall be at least 2 personnel present at all times, at least one of which shall be a paid personnel member;

c. When there are more than 16 participants in attendance, there shall be a minimum of one personnel member for each additional 8 participants or part thereof; and

d. Notwithstanding a. through c. above, ratios shall be sufficient to meet the needs of all participants at all times;

(e) Health and safety services to minimize the likelihood of accident or injury, with protective care and oversight while the participant is at the ADP, that include:

(1) Monitoring the participants' functioning, safety, and whereabouts;

(2) Monitoring the participants' health status, and providing intervention, if required; and

(3) Emergency response and crisis intervention;

(f) Social services, which shall be provided by the administrator, licensed nurse, or a social worker and include:

(1) The compilation of a social history and conducting participant psychosocial assessments;

(2) The provision of emotional support to participants and families or caregivers as needed;

(3) Assistance with the participant's adaptation to the ADP and involvement in the plan of care;

(4) Advocacy for the participant by assisting the participant to assert his or her human and civil rights; and

(5) The provision of discharge planning and assisting in participant transition to other programs or facilities; and

(g) Dietary services that include:

(1) A minimum of one meal equaling 1/3 of an adult's recommended dietary allowances as set forth by the US Department of Agriculture's "2015-2020 Dietary Guidelines for Americans," available as noted in Appendix A;

(2) Diets that are in accordance with the orders of participants' licensed practitioners;

(3) Snacks and fluids that are offered and available to the participants throughout the day so that no more than 3 hours elapses between meals and offered snacks according to a participant's number of hours in attendance;

(4) Substitutions if a participant refuses the items offered; and

(5) Food and drink that is provided to the participants that is:

a. Safe for human consumption and free of spoilage or other contamination;

b. Stored, prepared, and served in a manner consistent with safe food handling practices for the prevention of food borne illnesses, including those set forth in He-P 2300; and

c. Stored so as to protect it from dust, insects, rodents, overhead leakage, unnecessary handling, and all other sources of contamination.

N.H. Admin. Code § He-P 818.15

#9106, eff 3-18-08; ss by #9565, eff 10-16-09

Amended by Volume XXXVII Number 23, Filed June 8, 2017, Proposed by #12198, Effective 6/2/2017, Expires 6/2/2027.