216 R.I. Code R. 216-RICR-40-10-17.5

Current through December 26, 2024

Section 216-RICR-40-10-17.5 - Organization and Management

17.5.1Governing Body

A. Each home nursing care provider or home care provider shall have an organized governing body or equivalent legal authority ultimately responsible for:

1. The management, fiscal affairs and operation of the home nursing care provider or home care provider;

2. The assurance of quality care and services; and

3. Compliance with all federal, state, and local laws and Regulations pertaining to a home nursing care provider or home care provider and this Part.

B. The governing body, or equivalent legal authority, shall provide appropriate personnel, physical resources and equipment to facilitate the delivery of prescribed services and shall furthermore:

1. Appoint an Administrator and/or Director of Nursing Services in accordance with the provisions of § 17.5.2(O) of this Part;

2. Identify the range of services to be provided which must include no less than those services required in §§ 17.5.2(D) and 17.8.1(B) of this Part as applicable;

3. Define the geographic areas to be served; and

4. Carry out such other functions as may be relevant to the organization and operation of the home nursing care provider or home care provider.

C. The governing body, or equivalent legal authority, shall adopt and maintain by-laws or acceptable equivalent which defines responsibilities for the operation and performance of the organization, and shall identify purposes and means of fulfilling same. In addition, the governing body or equivalent legal authority, shall establish administrative policies pertaining to no less than the following:

1. Responsibilities of the Administrator and/or Director of Nursing Services;

2. Acquiring and maintaining employee bonding insurance (theft and damage) (a minimum amount of ten thousand dollars ($10,000.00) per loss) and liability insurance (a minimum amount of five hundred thousand dollars ($500,000.00) per occurrence);

3. The modalities of services to be provided;

4. Circumstances under which definitive care cannot be provided and procedures for referral;

5. Linkages and referrals with other health care facilities, which shall include a mechanism for recording, transmitting and receiving information essential to the continuity of patient care. Such information shall contain no less than the following:

a. Patient identification data such as: name, address, age, gender, name of next-of-kin, health insurance coverage, etc.

b. Diagnosis and prognosis, medical status of patient, brief description of current illness, plan of care, including such information as medications, treatments, dietary needs, baseline laboratory data;

c. Functional status;

d. Therapeutic services such as: physical therapy, infusion therapy, occupational therapy, or speech therapy;

e. Psychosocial needs; and

f. Such other information pertinent to ensure continuity of patient care.

6. Reports of patient's condition and transmission thereof to the patient's attending clinician;

7. Policies and procedures regarding persons employed by the facility; Said policies shall include, but not be limited to, the following:

a. Compliance with health screening and in-service education requirements of § 17.5.3 of this Part;

b. Timely completion of the Bureau of Criminal Identification (BCI) check in accordance with R.I. Gen. Laws § 23-17-34;

c. Timely judgment regarding continued employment of an employee upon whom disqualifying information has been found (see § 17.5.3(L) of this Part.

8. Accreditation by a nationally recognized accrediting body must be achieved within two (2) years of the date on which the home care provider/home nursing care provider is initially licensed. Further, such accreditation must be maintained in order to remain licensed in good standing.

9. Such other matters as may be relevant to the organization and operation of the home nursing care provider or home care provider.

D. The governing body or other legal authority shall organize services to ensure an integrated continuum of patient care. An organizational chart with written description of the organization, authorities, responsibilities, accountability, and relationships shall be maintained which shall include but not be limited to:

1. A description of each service offered;

2. Policies and procedures pertaining to each service;

3. A description of the system for the maintenance of the patient's clinical record; and

4. Standards of clinical practice.

E. Quality Improvement

1. The governing body shall ensure that there is an effective, ongoing, agency-wide quality improvement program to evaluate the provision of patient care. Further, the home nursing care provider or home care provider shall have written policies and procedures establishing a mechanism for the annual evaluation of professional standards of practice and administrative practices, conducted by professional personnel, including home nursing care provider or home care provider staff.

a. Such evaluation shall assess the extent to which the home nursing care provider's or home care provider's programs and services are appropriate, adequate, effective and efficient based on data such as: number of patients on services, patient visits, reasons for discharge, diagnoses, sources of referral, patients denied services, community needs, staff days for each service offered and such other criteria as may be deemed appropriate.

2. The organized agency-wide quality improvement program shall be ongoing and shall have a written plan of implementation. The written quality improvement plan shall include at least the following:

a. Program objectives;

b. Organization(s) involved;

c. Oversight responsibility (e.g., reports to the governing body);

d. Home nursing care provider-wide or home care provider-wide scope;

e. Program administration and coordination;

f. Involvement of all patient care disciplines/services;

g. Methodology for monitoring and evaluating quality of care;

h. Priority setting and problem resolution;

i. Determination of the effectiveness of action(s) taken;

j. Documentation of the quality improvement plan review.

3. All patient care services, including services rendered by a contractor, shall be evaluated.

4. The home nursing care provider or home care provider shall take and document appropriate remedial action to address problems identified through the quality improvement program. The outcome(s) of the remedial action shall be documented and submitted to the governing body for their consideration.

5. The provisions of § 17.5.1(E)(2) of this Part shall be deemed to have been met if the agency has met similar requirements of a national accrediting body, as approved by the Director.

F. Uniform Reporting System

1. Each home nursing care provider or home care provider shall establish and maintain records and data in such a manner as to make uniform a system of periodic reporting. The manner in which the requirements of this Part may be met shall be prescribed from time to time in directives promulgated by the Director.

2. Each home nursing care provider or home care provider shall report to the licensing agency detailed statistical data pertaining to its operation and services. Such reports and data shall be made at such intervals and by such dates as determined by the Director.

3. The licensing agency is authorized to make the reported data available to any state or federal agency concerned with or exercising jurisdiction over the home nursing care provider or home care provider.

4. The directives promulgated by the Director pursuant to this Part shall be sent to each home nursing care provider or home care provider to which they apply. Such directives shall prescribe the form and manner in which the statistical data required shall be furnished to the licensing agency.

G. Disaster/Emergency Planning

1. Each home nursing care provider or home care provider shall develop and maintain an emergency preparedness plan that is reviewed and updated annually.

a. At a minimum, the emergency preparedness plan must include all of the provisions contained in 42 C.F.R. § 484.102 that include but are not limited to:

(1) Emergency preparedness policies and procedures;

(2) Communications plan that is in conformity with all federal, state, and local laws and regulations;

(3) Training and testing program.

b. Any home nursing care provider or home care provider that is part of a healthcare system consisting of multiple separately licensed healthcare facilities may participate in the healthcare system's coordinated emergency preparedness program, provided that it meets the requirements of 42 C.F.R. § 484.102.

2. The emergency preparedness plan shall be developed with the assistance of qualified safety, emergency management, and/or other appropriate experts.

3. Each home nursing care provider or home care provider shall develop back-up or contingency plans to address possible internal systems and/or equipment failures.

H. Pending and Actual Labor Disputes/Actions

1. Health care facilities shall provide the licensing agency with prompt notice of pending and actual labor disputes/actions which would impact delivery of patient care services including, but not limited to, strikes, walk-outs, and strike notices. Health care facilities shall provide a plan, acceptable to the Director, for continued operation of the facility, suspension of operations, or closure in the event of such actual or potential labor dispute/action.

I. Latex

1. Any home nursing care provider or home care provider that utilizes latex gloves shall do so in accordance with the provisions of the rules and regulations pertaining to Part 20-15-3 of this Title, Use of Latex Gloves by Health Care Workers, in Licensed Health Care Facilities, and by Other Persons, Firms, or Corporations Licensed or Registered by the Department.

J. Reporting of Resident Abuse, Mistreatment, or Neglect

1. Duty to Report resident abuse, mistreatment, or neglect is pursuant to R.I. Gen. Laws § 23-17.8- 2. The report shall be on forms provided by the licensing Agency and shall contain information as outlined in R.I. Gen. Laws § 23-17.8-2.

17.5.2Service Accessibility

A. Accessibility to agency: Each home nursing care provider or home care provider shall establish a mechanism to enable patients to make telephone contact with responsible staff of the home nursing care provider or home care provider on a twenty-four (24) hour basis, seven (7) days a week.

B. Medical supplies and equipment: Each home nursing care provider or home care provider shall assist patients in arranging for the procurement of medical supplies and equipment as may be prescribed in the plan of care.

C. Written Agreements

1. There shall be written agreements for the provision of service(s) not provided directly by the home nursing care provider or home care provider which clearly delineate the responsibilities of the parties involved and shall include no less than the following provisions:

a. Designation of service(s) to be provided which must be within the scope and limitations set forth in the plan of care and which must not be altered in type, amount, frequency, or duration (except in case of adverse reaction) by the individual or home nursing care provider or home care provider;

b. The responsibility of the licensed home nursing care provider or home care provider for the provision of services to the patient;

c. Assurance of compliance with the patient care policies of the licensed home nursing care provider or home care provider;

d. Establishment of procedures for and frequency of patient care assessment and attendance at case conferences;

e. Mechanism for submission of clinical progress notes on patient care;

f. Documented evidence that personnel and services under contract meet the requirements specified in this Part for home nursing care provider or home care provider personnel and services, including licensure, health screenings, and criminal background checks. In instances where the contracted services are provided by another Department CHFR licensee, said license shall suffice to meet the requirements of § 17.5.2(C) of this Part.

g. Reimbursement mechanism, charges and terms for renewal or termination of the agreement; and

h. Such other provisions as may be mutually agreed upon.

D. Scope of Services

1. Each home nursing care/home care provider shall provide either directly, or by written contractual agreement with another Department-licensed agency, homemaker, nursing assistant services or other therapeutic service(s) (e.g., physical/occupational therapy).

2. Additional health services or related services may be provided by agencies as may be deemed appropriate to meet community needs in a manner consistent with professionally-recognized standards of practice and all applicable current laws and Regulations.

17.5.3Personnel

A. Each home nursing care provider or home care provider shall employ a sufficient number of qualified personnel to provide effective patient care and other related services.

B. A job description for each classification of position shall be established, clearly delineating qualifications, duties, authority and responsibilities inherent in each position.

C. Written personnel policies supporting sound patient care and personnel practices shall be made available to all full-time or part-time personnel and shall include provisions for:

1. Annual evaluation of employee performance that is reviewed with and signed by the employee within forty-five (45) days of the evaluation; and

2. Such other matters as deemed appropriate.

D. An inservice educational program shall be conducted on an ongoing basis, which shall include an orientation program for staff personnel employed by the home nursing care provider or home care provider providing direct care and a continuing program for the development and improvement of skills of staff to ensure the delivery of quality home care services. The inservice program shall include but not be limited to, infection control measures, Health Insurance Portability and Accountability Act (HIPAA) general provisions, recognition and reporting of abuse, neglect, mistreatment, and exploitation.

E. A mechanism to establish an audit trail of employees shall be implemented and shall include, at a minimum, for each employee:

1. Date of employment by the home nursing care provider or home care provider agency; and

2. Date(s), name(s), and address(es) of each assignment.

F. For every person employed by the home nursing care provider or home care provider who is licensed, certified, or registered by the Department, a mechanism shall be in place to electronically verify such licensure via the Department's licensure database.

G. Personnel files shall be maintained for each employee and shall be available at all times for inspection by the licensing agency. Such files shall include no less than the following documentation:

1. A certified copy of birth certificate or copy of the U.S. Immigration and Naturalization Service Employment Eligibility Verification form ("I-9"); or immigration papers or resident alien card;

2. Information pertaining to qualifications for employment;

3. Records of completion of required training and educational programs;

4. Evidence of current licensure or certification as may be required by law;

5. Resume of previous employment;

6. Records of required health examination which shall be kept confidential and in accordance with provisions of § 17.5.3(K) of this Part;

7. Documentation of complaints and follow-up;

8. Findings of a criminal records check, if employed after July 26,1993;

9. Reference check prior to employment;

10. Employee orientation, evaluation (annual) and documentation of in-service education; and

11. Such other matters as may be relevant to the organization and operation of the agency.

H. Supervision of Homemakers

1. All homemaker services performed by a homemaker shall be in accordance with the provisions of R.I. Gen. Laws Chapter 23-17, and this Part.

2. Homemaker services shall be rendered in accordance with a plan of care and shall be supervised by a nurse, licensed in Rhode Island, or by an individual with a bachelor's degree in social work, home economics, gerontology or other related field of study, and who shall be responsible for no less than the following:

a. Conducting the initial in-home assessment and assessments no less than every three (3) months thereafter or more frequently as the condition of the patient/client may require;

b. Monitoring the performance of the homemakers and maintaining appropriate clinical records;

c. Coordinating management of services (inter and intra-agency);

d. Assigning only delegable duties in accordance with § 17.5.3(J) of this Part;

e. Maintaining a record for each patient/client with appropriate documentation of services rendered which is signed by the homemaker rendering services;

f. Such other functions and activities as may be deemed necessary and appropriate.

I. Training Program for Homemakers

1. Homemakers shall be required to have successfully completed a basic training program of twenty (20) hours of classroom instruction, and with no less than five (5) hours of practical experience in addition to the required classroom instruction.

2. The course of instruction shall be designed to provide skill in all the duties listed in § 17.5.3(J) of this Part and to provide homemaker skills, information, and an orientation to basic human needs. The course of instruction curriculum must include, but is not limited to:

a. Orientation to homemaker agency, including policies and procedures, ethical responsibilities/accountability, confidentiality, and the function of the homemaker as a team member;

b. Understanding basic human needs, including the needs of children/older persons, physically/disabled people, people with terminal illness, and people with mental illness/dementia;

c. Infection control, including hand washing, cross contamination, and universal precautions appropriate to the homemaker;

d. Emergency procedures; and

e. Care of the home, including planning and serving meals, shopping, food preparation, basic nutrition, cleanliness/general housekeeping, accident prevention, care of food preparation areas/dishes, laundry and ironing, making unoccupied beds, and disposal of trash/medical waste.

3. Upon completion of the homemaker training program, each homemaker must satisfactorily pass the final examination of the training program in order to be eligible to function as a homemaker.

J. Duties of Homemakers

1. A homemaker who has satisfactorily completed a training program approved by the Director, as described in § 17.5.3(I) of this Part, may perform the following duties under an established plan of care and under the supervision of a qualified person in accordance with § 17.5.3(H) of this Part:

a. Change bed linens (unoccupied);

b. Grocery shopping;

c. General housekeeping (washing dishes, cleaning kitchen, bathroom, patient's/client's room);

d. Laundry and ironing;

e. Meal preparation;

f. Shopping, errand-running;

g. Recording services rendered.

2. Notwithstanding the provisions of § 17.5.3(J)(1) of this Part, additional duties may be assigned to homemakers provided such duties do not include the duties of a nursing assistant, as listed in Subchapter 05 Part 22 of this Chapter, Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs.

a. Such additional duties must be clearly delineated in agency policies and procedures, but may not be in conflict with other state regulations.

3. A health care facility shall require all persons, including students, who examine, observe, or treat a patient or resident of the facility to wear a photo identification badge which states, in a reasonably legible manner:

a. The first name;

b. Licensure registration status, if any;

c. Fluency in languages other than English, if any; and

d. Staff position of that person.

4. A home nursing care provider or home care provider shall be considered for all purposes an employer and those persons that it supplies on a temporary basis shall be considered employees and not independent contractors and home nursing care providers or home care providers shall be subject to all state and federal laws which govern employer/employee relationships.

K. Health Screening

1. Upon hire and prior to delivering services, a pre-employment health screening shall be required for each individual who has or may have direct contact with a patient of the home care provider/home care nursing provider. Such health screening shall be conducted in accordance with Immunization, Part 20-15-7 of this Title, Testing, and Health Screening for Health Care Workers, promulgated by the Department of Health.

L. Criminal Records Check

1. Criminal records checks shall be in accordance with R.I. Gen. Laws § 23-17-34.

M. Administrator and/or Director of Nursing Services

1. A full-time administrator as defined in this Part shall be appointed by and be responsible to the governing body or other legal authority for no less than the following:

a. The management and operation of the agency;

b. The implementation of policies, statutory and regulatory provisions;

c. Acting as liaison between the governing body and the professional and paraprofessional staff and the community;

d. The preparation and implementation of an effective budgeting, accounting and reporting system;

e. The establishment of standards of professional practice developed in cooperation with the governing board and staff;

f. The establishment of policies and procedures governing the range of health care services provided by the home nursing care provider or home care provider;

g. The establishment of a quality improvement program which includes a review mechanism for patient care management;

h. The preparation of an annual report;

i. The employment of qualified professional and paraprofessional staff; and

j. For such other related functions as may be delegated by the governing body or other legal authority.

2. In the event that a non-nurse is appointed administrator of the home nursing care provider or home care provider, the nursing service shall be under the direction of a Registered Nurse who is licensed in Rhode Island and who shall be responsible to the Administrator for the management of professional services, the standards of practice, and other related professional aspects of patient care services.

216 R.I. Code R. 216-RICR-40-10-17.5

Amended effective 3/24/2022
Amended effective 5/6/2024