HB1322: relative to the rules for the operation and regulation of supported residential care facilities.

HB 1322 - AS INTRODUCED

2003 SESSION

03-2273

01/09

HOUSE BILL 1322

AN ACT relative to the rules for the operation and regulation of supported residential care facilities.

SPONSORS: Rep. Elliott, Hills 42

COMMITTEE: Health, Human Services and Elderly Affairs

ANALYSIS

This bill codifies the rules relative to the operation and regulation of residential care facilities.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03-2273

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Three

AN ACT relative to the rules for the operation and regulation of supported residential care facilities.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 New Subdivision; Rules for the Operation and Regulation of Supported Residential Care Facilities. Amend RSA 151 by inserting after section 31 the following new subdivision:

Rules for the Operation and

Regulation of Supported Residential Care Facilities

151:32 Purpose. The purpose of these rules is to regulate supported residential care facilities which are non-medical, public or privately owned and operated community-based living arrangements which in addition to provision of residential care services such as shelter, food, and protective oversight to a population of adult, elderly, disabled, special needs and/or special care residents supported residential care provides, directly or by contract, health-related services required by the residents for less than 24-hour care or for 24-hour care for a short duration acute illness.

151:33 Definitions. In this subdivision:

I. "Activities of daily living" means activities such as:

(a) Walking.

(b) Bathing.

(c) Shaving.

(d) Brushing teeth.

(e) Combing hair.

(f) Dressing.

(g) Eating.

(h) Getting into and out of bed.

(i) Laundry.

(j) Cleaning room.

(k) Managing money.

(l) Shopping.

(m) Using public transportation.

(n) Writing letters.

(o) Making telephone calls.

(p) Obtaining and keeping appointments.

(q) Monitoring and supervision of medication.

(r) Recreational and leisure activities.

(s) Management of incontinence.

II. "Administrator" means a person responsible for all aspects of the operation of a residential care home 24-hours-per-day.

III. "Administration of medication" means provision of one or more doses of medication to residents by licensed nurses or other personnel qualified by law or rule to administer medication.

IV. "Adult" means persons 18 years or older.

V. "Adult day care" means care and supervision of adults in a non-residential day care program licensed by the division.

VI. "Admission agreement" means the document signed by both the resident and the facility administrator detailing what both the resident and the facility agree to do.

VII. "Adverse reaction" means a physical or mental negative change after taking medication.

VIII. "Ambulatory" means capable of walking.

IX. "Chemical restraint" means any medication prescribed either to control a resident's behavior or emotional state without a supporting diagnosis or for the convenience of facility staff.

X. "Cognitive abilities" means the ability of the resident to respond appropriately to verbal requests, and to understand his or her surroundings.

XI. "Cognitive deficits" means residents who have a decrease or limitation in cognitive abilities.

XII. "Deficiencies" means:

(a) Failure to meet resident needs identified in the care plan, fire and other safety issues;

(b) Failure to meet medication standards with the potential for resident harm;

(c) Failure to protect residents from abuse and neglect; and

(d) Failure to maintain sanitation which affects resident health and well being.

XIII. "Dementia" means any condition or disease process resulting in an impairment or deterioration of cognitive ability including Alzheimer's disease.

XIV. "Division" means the division of public health services of the department of health and human services.

XV. "Documented negative outcome" means identification of at least 3 deficiencies or one repeat deficiency which affects the resident's health, safety, and well being.

XVI. "Drug allergies" means an adverse reaction to application or ingestion of medication due to an allergic response.

XVII. "Functional activities and limitations" means an evaluation of the resident's level of functioning with regard to activities of daily living and determination of any restrictions which will require assistance by the facility.

XVIII. "Health examination" means an assessment and physical examination of the resident's health by a licensed practitioner.

XIX. "Ineffective drug therapy" means use of medication which apparently does not have the desired effect.

XX. "Inservice" means a training program sponsored by the facility which is designed to increase knowledge and effectiveness of staff.

XXI. "Licensed practitioner" means a physician, physician's assistant, advanced registered nurse practitioner, or doctor of osteopathy.

XXII. "Management of resident funds" means receiving funds, holding or safeguarding funds, placing or withdrawing funds from a resident's account or facility's account in the name of the resident.

XXIII. "Medical, nursing or health related services" means services which provide care or treatment for injury, illness or infirmity provided by a licensed, registered or certified health care provider.

XXIV. "Medication" means a substance available by prescription or non-prescription, which is used as a curative or remedial substance.

XXV. "Mobile" means ambulatory or able to move about with assistive devices such as walkers, canes, and wheelchairs without physical assistance from staff.

XXVI. "Personal care" means assistance with activities of daily living and protective care and oversight.

XXVII. "Personal preference over-the-counter medications" means non-prescription medications, which have been approved by the physician for a resident to purchase, retain and self administer according to label instructions.

XXVIII. "Physical restraint" means hands-on or mechanical means used to prevent the resident from being mobile.

XXIX. "Plan of care" or "care plan" means a daily guide, developed as a result of the assessment process, of the provision of services to the residents.

XXX. "Prescription" means the document or statement by which medication is ordered by a physician or other person authorized to prescribe medication or treatment.

XXXI. "Resident" means the person who is admitted to the supported residential care facility for care, services, and training regardless of the length of stay.

XXXII. "Resident record" means a separate file maintained for each resident by the supported residential care home's administrator which contains information about the resident.

XXXIII. "Sanitizing" means to scrub, clean, and render non-infectious by use of a bacteriocidal or bacteriostatic agent.

XXXIV. "Self administration" means an act whereby a resident administers his or her own medication.

XXXV. "Self evacuate" means the resident can initiate and complete movement from any location in the facility to an exit with or without staff assistance.

XXXVI. "Short term residential care or respite care" refers to residents who are admitted to the supported residential care facility for 15 days or less.

XXXVII. "Significant change in functional, medical and mental status" means either an improvement or a decrease in functional abilities, health or cognitive ability.

XXXVIII. "Significant side effects" means negative reactions to medication sufficient to cause distress or discomfort and which may or may not require medical intervention.

XXXIX. "Social, occupational and recreational services and training" means provision for visitations, religious affiliations, assistance with handling personal funds and correspondence, and assistance in developing skills to manage daily living needs.

XL. "Supervision" means the process by which the resident is guided and assisted in the activities and behaviors necessary to achieve and maintain his or her maximum independence.

XLI. "Supported residential care" means a licensing level as described in RSA 151:9, VII(a)(2).

XLII. "Supported residential care facility" means a residential care facility as described in RSA 151:2, I(e)(2).

XLIII. "Temporary episodic illness" means sickness or disability which does not occur on an ongoing or continuous basis but occurs from time to time.

XLIV. "Unusual incident" means any event which requires intervention by the facility staff on behalf of the resident which is not identified in the resident's care plan or facility's policy or procedures.

XLV. "Verbal prompting" means spoken reminders by the staff to residents to perform certain functions such as toileting, and taking medication.

151:34 Organization and Administration.

I. Each facility shall have a full time administrator designated in writing by the licensee to be responsible for the day-to-day operation of the facility.

II. For all facilities the administrator shall:

(a) Be at least 21 years of age.

(b) Not have been convicted of a misdemeanor or felony.

(c) Have 3 letters of reference from persons who can attest to his or her knowledge, skills, and ability to run a supported residential care facility.

III. In addition to paragraph II, administrators of supported residential care facilities licensed for 4 to 16 residents, shall have:

(a) A high school diploma or equivalency certificate plus 3 years of work experience in a health or human services field; or

(b) An associate's degree or higher from an accredited college or university in a health or business field and one year of work experience in a health or human services field.

IV. In addition to subparagraph II, administrators of supported residential care facilities licensed for 17 or more residents, shall have:

(a) A high school diploma plus 5 years of direct care experience;

(b) An associate's degree or higher from an accredited college or university plus 3 years experience in a health or human services field; or

(c) A bachelor's degree or higher in a health, business or related field.

V. Administrative responsibilities of the administrator shall be to:

(a) Comply with all applicable federal state and local laws and regulatory requirements.

(b) Designate, in writing, an adult who shall have the authority to act for the administrator at the facility.

(c) Develop written policies and procedures for the provision of services.

(d) Employ qualified personnel to provide for the safety and protection of all residents.

VI. A medical director shall not be required in a supported residential care facility. The resident's individual licensed practitioner shall be responsible for taking care of the resident.

VII. A director of nursing shall not be required in a supported residential care facility. However, the facility shall make provision for a registered nurse to be available on staff or as a consultant for the development and implementation of resident assistance and supported care policies and programs.

151:35 Personnel Levels, Training and Records.

I. Personnel levels shall be determined by the administrator based on the services required by the resident and the size of the facility. There shall be at least one staff member on duty at all times while residents are in the facility.

II. In a facility with 16 or fewer residents, based on resident needs, the staff member shall not be required to be awake during resident sleep hours if the staff member:

(a) Sleeps in the facility; and

(b) Is available to residents.

III. In a facility of 17 or more beds, staff shall be available and awake 24-hours-a-day, 7-days-a-week.

IV. Personnel shall:

(1) Be at least 18 years of age if they are direct care staff;

(2) Not have a felony conviction;

(3) Not have been convicted of abuse, assault, neglect, or exploitation of any person as attested by the signed statement in XVI(g) below.

V. The facility shall provide additional staff to meet the resident needs or transfer the residents with unmet needs to another facility which can meet these needs if a documented negative outcome is present at an inspection.

VI. Job responsibilities, functions, requirements, and supervision of all employees shall be clearly defined in writing.

VII. Personnel employed in the facility shall have orientation and training in the performance of their duties and responsibilities a record of which shall be maintained in the employee's personnel file.

VIII. Personnel orientation shall include:

(a) The job description requirements;

(b) Fire safety and evacuation procedures;

(c) Medical emergency protocol;

(d) Resident's rights; and

(e) Facility tour and familiarization.

IX. Personnel employed by the facility shall have ongoing in-service or continuing education that shall address areas of weakness identified by the administrator in the annual performance review or evaluation of the employee.

X. Inservice or continuing education acceptable for the purpose of paragraph IX above shall include training in:

(a) Medication supervision or administration;

(b) First aid;

(c) Behavior management;

(d) Personal care;

(e) Fire safety and evacuation;

(f) Socialization; and

(g) Resident rights.

XI. The administrator shall obtain 12 contact hours of continuing education each year.

XII. A record of the continuing education shall be maintained in the administrator's personnel file, and shall be reviewed by the division at the annual inspection of the supported residential care facility.

XIII. Continuing education programs acceptable for paragraph XI shall include programs sponsored by:

(a) An accredited college or university.

(b) A state or national professional or trade association.

(c) A residential or health care facility as defined by RSA 151.

(d) Private training organizations.

(e) Governmental agencies or other agencies involved in the delivery of services to residential care facility residents.

XIV. Inservice and continuing education programs acceptable for paragraph XI shall include the following areas of study:

(a) Implementation of a resident's plan of care.

(b) Characteristics of client disabilities.

(c) Teaching recognition of resident health care and mental health problems.

(d) Identification and use of community resources.

(e) Social and recreational activities.

(f) Nutrition, basic hygiene, and dental care.

(g) First aid.

(h) Management of medications.

(i) Facility management, administration, and recordkeeping.

(j) Needs of the resident.

(k) Understanding dementias.

(l) Problems associated with aging.

(m) Residence assessment.

(n) Maintenance of the facility in a safe and sanitary manner.

(o) Resident's rights, including management of resident funds and awareness of federal and state laws prohibiting discrimination.

XV. Qualification of staff employed by the facility shall be determined based on the supportive health care services needed by the resident and provided by the facility. Staff shall be licensed, registered and/or certified as required in accordance with state law.

XVI. Personnel records shall be maintained by the facility and shall include:

(a) A completed application for employment.

(b) References.

(c) Qualifications and experience of the employee.

(d) Record of inservice training and training and involvement in the implementation of the residents' rights policy as required by RSA 151.

(e) Annual performance evaluations.

(f) Health examination and annual TB test results, Mantoux method, the first completed not more than one year prior to contact with services related to residents or food.

(g) A signed statement from the staff member indicating that he or she has not been convicted of abuse, assault, neglect, or exploitation of any person.

(h) A job description signed by the employee which shall contain:

(1) Position title;

(2) Qualifications and experience;

(3) Duties required by the position; and

(4) Mandatory training requirements.

XVII. Personnel records shall be maintained in a confidential manner by:

(a) Maintaining a separate file for each employee which shall contain information relating only to that employee.

(b) Storing the file in a locked container or cabinet in the facility.

151:36 Resident Eligibility and Acceptance.

I. The facility shall accept only those persons who:

(a) Are mobile and can self evacuate;

(b) Are able to initiate and accomplish activities of daily living with help but require physical assistance and prompting with others;

(c) Require intermittent short-term 24 hour nursing care or less than 24 hour nursing care on an ongoing basis; or

(d) Require consultation or direct care therapeutic services such as physical, occupational, recreational therapy and mental health services; or

(e) Require administration of medication.

II. For persons admitted for short term residential care, the following shall be required:

(a) A health examination shall be conducted within 30 days prior to admission to the facility which shall include any orders and medications required by the resident.

(b) An assessment focused on the services needed by the resident.

(c) An admission agreement, which shall list the services which shall be provided during the time of residence.

III. For residents who intend to live at the facility for more than a short-term stay, the following shall be required:

(a) A health examination shall be conducted by a licensed practitioner within 30 days prior to admission to the facility which shall include:

(1) Medical and social history;

(2) Functional activities and limitations;

(3) Cognitive abilities;

(4) Capability for self care;

(5) Presence or absence of communicable diseases;

(6) Medical diagnosis;

(7) Medication needs and orders; and

(8) Dietary needs.

(b) The administrator or designee, in conjunction with the resident's licensed practitioner, resident's family, the resident's personal representative or guardian as appropriate, shall complete an initial resident assessment as set forth in RSA 151:37, XI, prior to admission.

(c) The administrator shall ensure that resident assessments shall be completed at least every 6 months after the initial assessment.

(d) The supported residential care facility shall complete an admission agreement with the resident which shall include:

(1) A listing of services which shall be provided.

(2) A listing of services which shall be in addition to the services required by RSA 151:37, I and for which additional payment shall be required.

(3) Information on the facility's rules for the residents.

(4) Information on the policy and procedures for reserving a place in the home when a resident is hospitalized or out of the facility for a period of time.

(5) Grounds for termination of agreement.

(6) The notification required for involuntary transfer for reasons other than emergency situations.

IV. The facility shall not accept any resident whose assessment indicates services required which the facility cannot provide.

151:37 Residence Management.

I. The supported residential care facility shall provide the following services to the resident:

(a) Protective care, which shall include:

(1) Facility maintenance and housekeeping that assures a safe, orderly, clean and comfortable environment promoting a personalized setting that contributes to quality of life.

(2) Verbal and physical assistance with activities of daily living such as bathing, eating, toileting and dressing.

(3) Nutrition monitoring.

(4) Provision of 3 meals a day plus snacks.

(5) Personal supervision when required to offset cognitive deficits that may pose a risk to self or others if the resident is not supervised.

(6) Assistance with medications, which shall include verbal prompting, reminding and some physical assistance.

(7) Provision for the administration of medications by persons appropriately licensed, either directly or by contract with a licensed home health agency and for treatments as ordered by the resident's physician.

(b) Activities designed to enable each resident to engage in cultural, spiritual, physical, political, social, and intellectual activities within the facility and the community to sustain and promote individual potential and a usefulness to self and others.

(c) Living arrangements which shall include:

(1) One or 2 person room.

(2) Three meals per day and snacks when residents are in the facility.

(3) Laundry service or access to laundry facilities.

(4) Housekeeping services.

II. If a resident's health status changes permanently to non-mobile or the resident requires medical or nursing care on an ongoing, 24-hour-a-day basis the facility shall:

(a) Seek licensure to provide a higher level of care; or

(b) Transfer the resident to another facility where 24 hour medical and nursing care are available.

III. The facility shall provide or arrange, by contract with a licensed home health care provider, for:

(a) Provision of intermittent short-term nursing care.

(b) Less than 24-hour nursing or other medical monitoring care for an ongoing basis according to the plan of care developed in response to the initial or subsequent resident assessments.

IV. The facility shall be responsible for the arrangement for provision of additional services to residents requiring care during a temporary episodic illness or convalescence following acute hospital care.

V. Physical, chemical, or mechanical restraints shall not be used on any resident.

VI. The facility shall follow the directions of the resident's licensed practitioner regarding all health examinations and the health maintenance of each resident.

VII. Each resident shall be provided the opportunity for one complete physical examination annually unless his or her licensed practitioner determines that this frequency is not required.

VIII. Each resident shall be provided the opportunity for obtaining additional medical or dental treatment when necessary.

IX. Administration shall be responsible for notifying the resident's licensed practitioner and family or guardian within 24 hours in the event of any illness, accident, injury requiring medical attention other than first aid, or unusual incident.

X. A list of emergency telephone numbers, including the licensed practitioner to be called, shall be available next to a readily accessible telephone.

XI. The resident shall be assessed by a staff member trained in the process of resident assessment utilizing the resident assessment form in accordance with RSA 151:5-a, I every 6 months or upon any significant change in status.

XII. The resident assessment form shall contain the following sections to be completed:

(a) Activities of daily living.

(b) Cognitive, psychosocial and behavioral activities and abilities.

(c) Dietary preferences/needs.

(d) Medical needs/management and medication.

XIII. The assessment shall be used in the development of the care plan which shall be developed in accordance with RSA 151:39, I(d) and reviewed and updated each time the assessment is completed. The current assessment shall be maintained with the resident's care plan. A copy of the care plan shall be provided to staff who assist in carrying out the functions of this care plan.

151:38 Resident Transfer and Discharge.

I. No resident shall be discharged or transferred to another facility or home or place except:

(a) With the written consent of the resident, resident's guardian, or resident's designee;

(b) With the written order of the resident's licensed practitioner;

(c) For lack of payment for care rendered; or

(d) For documented non-compliance with the facility's rules included in the admission agreement.

II. The facility shall notify the designated nearest relative, guardian, or resident's designee, 30 days in advance of such involuntary transfer or discharge except in a medical or safety emergency.

III. Transfers and discharges shall be done in accordance with RSA 151:21 and RSA 151:26.

IV. Emergency transfers may occur without prior notification for emergency care. For non-emergency transfers for medical reasons, paragraphs I-III shall apply.

V. Residents who are transferred to another facility, home, or place shall have copies of the following records transferred with them:

(a) Most recent resident assessment;

(b) Care plan; and

(c) Medication records.

151:39 Residents Records.

I. Each resident record shall contain:

(a) Demographic data and important family contacts, legal guardian or resident's personal representative;

(b) Copies of executed legal directives, such as advanced directives concerning medical care, durable powers of attorney, or guardianship;

(c) Notification of resident's rights and permissions for release of information;

(d) The care plan developed by the facility in conjunction with the resident to meet the needs of the resident as identified by the resident assessment process which shall include:

(1) The date the need was identified.

(2) The specific resident need/problem.

(3) The resident's goal, outcome, and objective.

(4) The person responsible to ensure the need is addressed.

(5) The facility's plan for meeting the identified need.

(6) The date and documentation the problem/need was resolved.

(e) An updated care plan which shall be reviewed at least every 6 months or as medically indicated and shall contain documentation indicating agreement between the resident or the resident's personal representative and the facility's administrator regarding the plan.

(f) Progress notes of a frequency indicated in the plan of care, but at least quarterly, which shall include changes in functional, medical, and mental status.

(g) Supported residential care facilities shall not be required to manage resident funds, but if the facility does manage funds for any resident as indicated in the care plan, the following information shall be documented in the resident's record:

(1) A written statement specifying why the resident cannot handle his or her own funds, signed by the resident or his or her personal representative.

(2) A quarterly accounting of all residents funds which shall include:

(A) A statement of all income;

(B) A statement of all expenses, including purpose of expenses and receipts;

(C) Date of all transactions; and

(D) Amount of all transactions.

(3) The quarterly accounting shall be provided quarterly to the resident or his or her personal representative.

(h) Documentation that an annual health examination was conducted by the licensed practitioner.

(i) Documentation of the resident's health status shall include:

(1) Findings or diagnosis determined by the licensed practitioner;

(2) Dietary needs;

(3) Treatments or professional services required;

(4) Medications; and

(5) Assessment of resident's functional level.

(j) A statement signed and dated by the resident, if a resident has chosen not to undergo a health examination.

(k) A list of prescription medications ordered for the resident which shall include:

(1) The name of resident;

(2) The name of the medication which shall include generic name if generics are to be used;

(3) The medication dosage.

(4) Frequency of dosage;

(5) Indication for usage;

(6) Method of medication administration; and

(7) If "as needed" or "prn" medications:

(A) The reason why the resident takes the medication; and

(B) The maximum dosage in a 24-hour period.

(l) A list of any accidents, injuries, illnesses, or unusual incidents which shall contain:

(1) The date of the incident.

(2) A description of the incident.

(3) The date and time the licensed physician was notified.

(4) The date and time the family was notified.

(5) The actions taken, including follow-up if necessary.

(6) The signature of the person reporting the incident.

(m) Progress notes, which shall be recorded by each person providing professional services to the resident indicating date, time, and scope of service provided, and signed by the provider of the service.

(n) An emergency data sheet to accompany the resident to an acute care facility in the event of an emergency, which shall include:

(1) The resident's full name;

(2) The telephone number and address of the resident's personal representative;

(3) The resident's next of kin;

(4) Copies of advanced directives, guardianship, or powers of attorney;

(5) The resident's diagnosis;

(6) Medications taken by the resident;

(7) Resident's allergies if any;

(8) Resident's functional level and needs requirements; and

(9) Resident's date of birth, social security number, and insurance information.

(o) Signed and dated entries of the day, month, and year the emergency services were performed as well as identification of the individual who provided the service.

II. For discharged or transferred residents, the records shall contain the following:

(a) A discharge summary containing the:

(1) Date and time of discharge;

(2) Place to which the resident was discharged; and

(3) Condition of resident at time of discharge.

(b) The resident's written consent for discharge or discharge order from a licensed practitioner.

(c) Copies of the resident's guardian, advanced directives, or powers of attorney, if applicable.

(d) Any correspondence between the administrator and any government agency relative to the discharge of the resident.

(e) A receipt from a licensed funeral director in the case of a deceased resident.

III. The facility shall be responsible for retention of the resident's records in a locked cabinet and shall maintain such records for a period of 7 years from the date of the resident's discharge.

IV. All resident information shall be maintained in a locked cabinet, and the following personnel shall have authorized access to information in the resident's record:

(a) The resident;

(b) The administrator;

(c) The facilities staff;

(d) The resident's personal representative or guardian;

(e) Any individual authorized by the court; and

(f) Any individual authorized, in writing by the resident.

V. Should the facility cease operation, all resident records shall be transferred with the resident to another home or facility, with written receipt acknowledging the transfer which shall be signed by the resident and the new administrator.

VI. If a facility ceases operation, arrangements shall be made to retain discharge records for 7 years following closure.

151:40 Food Services. The following requirements shall be followed for the planning and serving of meals in supported residential care facilities:

I. The person responsible for food service in the facility shall have knowledge of the nutritional requirements for residents in the facility and of the planning and preparation of prescribed diets.

II. The recommended dietary allowances of the National Research Council of the National Academy of Sciences, Washington, D. C. shall be used to meet the food needs of the residents.

III. Each facility shall ensure that 3 or more meals in each 24-hour period shall be provided at regular hours when the residents are in the facility for the full 24-hour period. Snacks shall be available between meals and before retiring to all residents.

IV. A dated record of menus as served shall be maintained in the facility for at least the previous 30 days. Supplies of food shall be maintained on the premises as follows:

(a) Enough refrigerated perishable foods for a 24-hour period; and

(b) Enough non perishable foods for a 3-day period.

V. For homes with less than 4 residents, storage, preparation, and servicing food shall be done in accordance with the sections of the New Hampshire rules for the Sanitary Protection and Distribution of Food, He-P 2300, listed below:

(a) He-P 2310.01 (a), (d), (f) and (i).

(b) He-P 2311.01 (b).

(c) He-P 2311.02 (a), and (g).

(d) He-P 2311.03 (a).

(e) He-P 2311.05 (a), and (b).

(f) He-P 2311.07 (k), and (l).

(g) He-P 2312.01 (a).

(h) He-P 2312.02 (a), and (d).

(i) He-P 2313.01 (j) first sentence only, and (o).

(j) He-P 2314.05 (d).

(k) He-P 2315.01 (c), first sentence only.

(l) He-P 2320.01 (a), (b), (e), first sentence only and applies only during those times that food is being prepared or served.

(m) He-P 2321.01 (a), and (c).

(n) He-P 2321.02 (a), and (e).

(o) He-P 2322.01 (c).

(p) He-P 2323.01 (a).

(q) He-P 2325.01 (e), and (f).

(r) He-P 2325.03 (a) first sentence only.

VI. For homes with 4 to 16 residents, storage, preparation, and servicing food shall be done in accordance with the sections of the New Hampshire rules for the Sanitary Protection and Distribution of Food, He-P 2300, listed below:

(a) He-P 2303.01 (j), (m), (n), (z), (aa), and (aj);

(b) He-P 2310.01 (a), (d), (f), and (i);

(c) He-P 2311.01 (b);

(d) He-P 2311.02 (a), and (g);

(e) He-P 2311.03 (a);

(f) He-P 2311.05 (a), and (b);

(g) He-P 2311.07 (a-c), (i-l), and (r);

(h) He-P 2311.08 (a);

(i) He-P 2312.01 (a);

(j) He-P 2312.02 (a), and (d);

(k) He-P 2313.01 (j) first sentence only, and (o);

(l) He-P 2313.03 (a) 2 compartments shall be required instead of 3, and (c) except that 1 compartment shall be required instead of 2;

(m) He-P 2313.04 (c);

(n) He-P 2314.03 (a) using the second sink, or 2314.03 (b), or 2314.03 (c);

(o) He-P 2314.05 (a), and (d);

(p) He-P 2314.06 (a);

(q) He-P 2314.07 (a), (c), and (d);

(r) He-P 2315.01 (c) first sentence only;

(s) He-P 2317.01 (a);

(t) He-P 2318.01 (a)(4);

(u) He-P 2318.01 (b)(1), and (b)(3);

(v) He-P 2319.01 (a), and (c);

(w) He-P 2319.02 (a);

(x) He-P 2320.01 (a), (b), and (e) first sentence only and only during those times that food is being prepared or served;

(y) He-P 2321.01 (a), and (c);

(z) He-P 2321.02 (a), and (e);

(aa) He-P 2322.01 (c);

(bb) He-P 2323.01 (a-b);

(cc) He-P 2325.01 (a), and (e-f);

(dd) He-P 2325.03 (a) first sentence only.

VIII. For homes with more than 16 residents, storage, preparation, and serving food shall be done in accordance with the New Hampshire rules for the Sanitary Protection and Distribution of Food, He-P 2300.

151:41 Medications.

I. Medication not stored in a resident's room shall be stored in a specific storage area such as a medication room, cabinet, closet, cart, or refrigerator, under proper temperature according to United States Pharmacopia standards for each medication.

II. Storage areas for medication shall:

(a) Be locked and accessible only to authorized personnel.

(b) Be clean, organized, with good lighting.

(c) Store liquids, ointments, creams, or powder forms of products which are for external use separately from products for the ears, products for the eyes, or products used orally.

(d) Contain only medication currently ordered for individual residents.

III. Medications shall be kept in the containers in which they were originally sold or dispensed in and be properly closed after each use.

IV. If medication is stored in a resident's room, medication shall be maintained at proper temperature and stored in a locked drawer, container, or cabinet to safeguard them against unauthorized access. Both the resident and the administrator shall have keys to the locked drawer, container, or cabinet for access. All medication containers shall legibly display the following information:

(a) The resident's name.

(b) The drug name.

(c) The strength.

(d) The lot number.

(e) The expiration date.

V. Any medication container label changes shall be made by a physician or a pharmacist.

VII. Any medication shall be ordered on an individual basis for each resident by a licensed practitioner.

VIII. All personal preference over-the-counter medications taken by residents shall be approved by a licensed practitioner in the following manner:

(a) A list of personal preference over-the-counter medications shall be provided to the licensed practitioner by the resident or administrator;

(b) Written approval for the resident to maintain specific over-the-counter medications shall be provided by the licensed practitioner annually;

(c) Provisions shall be made to safeguard these medications from other residents in the home in accordance with paragraph I; and

(d) These medications shall not be considered a prescribed order for the resident unless they are issued under a specific prescription.

IX. A written order from a licensed practitioner for self administration without supervision shall be required annually for each resident taking medication without supervision.

XIV. A written order from a licensed practitioner shall be required annually to allow a resident to store medication in his or her room.

XV. Telephone orders from the licensed practitioner may be taken only by a pharmacist or licensed or registered nurse and shall be immediately transcribed, dated, and signed. Telephone orders shall be countersigned by a licensed practitioner within 7 working days.

XVI. The facility shall be responsible for all prescription medications which are self administered or administered to the resident and shall ensure that these medications are taken in accordance with the orders of the licensed practitioner.

XVII. Reported medication errors, such as incorrect doses and failure to make the medication available to the resident, shall be brought to the attention of the administrator, or designee, who shall keep a record of the date, resident, medication, and any harmful effects and report these to the resident's licensed practitioner.

XVIII. Supervision of medication by facility personnel shall include the observation and reporting any negative effects that a medication has on a resident to the administrator. The administrator or designee shall report the negative effects to the licensed practitioner who ordered the resident's medication.

XIX. The facility shall utilize a daily medication observation record system for any resident taking medication with supervision, and this record shall contain:

(a) The signature or identifiable initials of person who provided the supervision.

(b) The time the medication was taken.

(c) The dose taken.

(d) A notation concerning a resident's refusal to take the medication if applicable.

XX. The home shall use a system of updating medication instructions to reflect current orders so that those residents who require supervision of their self-medication can do so accurately.

XXI. Each medication ordered for the resident shall be available for use within 48 hours. The home shall be responsible for having a system of reordering medications.

XXII. Prescription medications and treatments ordered by the resident's physician may be self administered by the resident if appropriate. If administered to the resident, such shall be administered either by the facility in accordance with RSA 318 and RSA 326 or as provided by arrangement with a licensed home health agency.

XXIII. The facility shall check all medicines a resident may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, or drug allergies.

XXIV. The facility shall be responsible for reporting to the licensed practitioner any observed reaction to medication, any contraindication in medication orders or medications provided by the pharmacy, and any concerns regarding the number or type of medications prescribed if more than one licensed practitioner is involved.

XXV. Discontinued, contaminated, or expired medication, except for controlled drugs, shall be destroyed by the administrator, registered nurse or pharmacist by incineration or by flushing into the sewage system.

XXVI. Destruction of controlled drugs shall be in accordance with the provisions of RSA 318-B:17.

XXVII. Unit dose medication may be returned to pharmacies for credit only under the provisions of Ph 704.06(b).

XXVIII. When residents are on leave of absence from the facility they may take properly labeled prescription medication containers with them. If they require assistance in self-medication, the facility shall be responsible for giving the container to a person who will accept the responsibility for assisting the resident with his or her medications.

XXIX. A resident may take his or her current medication with him or her if the medication is in a labeled closed container when the resident is discharged from the facility.

XXX. The facility shall keep a record of all current medications prescribed or authorized for each resident. Such record of medication orders shall be kept on file for 7 years.

XXXI. The facility shall assure availability of medications and shall not accept money, goods, or services for free or below cost as compensation or inducement for supplying the resident's medications.

XXXII. If significant medication problems are identified during the division's annual survey or other investigations in which the safety of residents may be at risk, the division shall require the facility to obtain the routine services of a consultant pharmacist as a condition of continued licensure. This requirement shall be reviewed at the next inspection to determine if consultant pharmacy services shall continue to be required.

XXXIII. A commercial first aid kit containing items which may be necessary for the emergency treatment of minor injuries such as insect bites, cuts, scrapes, sprains and strains shall be available in the facility. Prescription medications or any other item which cannot be obtained without a physician's order shall not be included in this kit.

151:42 Sanitation.

I. Each facility shall maintain the furniture, floor, ceiling, walls and fixtures in good repair, clean and sanitary at all times.

II. A supply of hot and cold running water shall be provided.

III. Waste water shall be disposed of through a system that meets the requirements of RSA 485-A:1 and Env-Ws 1000 of the department of environmental services. Sink drains which have no connection to sanitary sewers or septic systems and similar methods of disposal above ground shall be strictly prohibited.

IV. Garbage disposal for the home shall be handled in accordance with the following:

(a) All garbage refuse shall be stored in covered receptacles until disposed of by a method approved by the local town or city;

(b) In-house garbage receptacles shall be:

(1) Kept covered except when in use;

(2) Durable;

(3) Insect and rodent proof;

(4) Water tight; and

(5) Lined or cleansed and disinfected after each emptying.

(c) Trash receptacles for paper waste may be kept uncovered in resident bedrooms.

V. Tightly fitting screens shall be provided for all doors, windows, or other outside openings which are kept open during the season when flies, mosquitoes, and other insects are prevalent. Reasonable precautions such as repair of holes, and caulking of pipe channels shall be taken to prevent the entrance of rodents and vermin.

VI. Facilities that provide in-home laundry shall handle soiled linens as little as possible. Soiled and clean linen shall be separated at all times to protect the rest of the facility from possible cross-contamination. Laundry facilities and soiled laundry traffic shall be segregated from kitchen and dietary areas. Laundry chutes shall not be permitted. Laundry rooms shall have non-porous floor.

151:43 Physical Environment.

I. The facility shall comply with all state and local codes and ordinances for:

(a) Zoning;

(b) Building;

(c) Health;

(d) Fire;

(e) Waste disposal; and

(f) Water.

II. The facility shall be accessible at all times of the year.

III. The facility shall provide a telephone and extensions accessible at all times in case of emergency.

IV. Doors and windows opening to the outside air shall be tight fitting.

V. The facility shall be free from environmental nuisances including noise and odors.

VI. Lighting shall be in accordance with the provisions of the Building Officials and Code Administration (BOCA) Building Code as adopted by the state fire code, Fir 100. Increased lighting shall be available to allow residents to participate in activities such as needlework or handicrafts which require more lighting.

VII. The heating plant shall provide and maintain from 70 to 74 degrees Fahrenheit temperature in all rooms and in all other areas used by residents except as requested by the residents.

VIII. Ventilation shall be provided throughout the entire home and whenever necessary, mechanical means such as fans shall be provided to remove excessive heat, moisture, objectionable odors, dust, and explosive or toxic gases.

IX. The number of sinks, toilets, tubs or showers required shall be in proportion to the number of persons including residents and non-residents in the home as described below:

(a) The number of sinks, toilets, tubs or showers shall be in a ratio of 1 to every 6 residents.

(b) If family members and live-in staff have separate bathroom facilities that are not routinely used by residents these shall not be counted as available to residents for the purpose of meeting these requirements.

X. All bathroom and closet door latches shall be designed for easy opening from the inside of the bathroom or closet. All bathroom door locks or latches shall be designed for easy opening of the locked door from the outside in an emergency.

XI. There shall be at least 80 square feet per one bedroom and 140 square feet per room with 2 beds exclusive of space required for closets, wardrobe, dressers and toilet room.

XII. No resident's room shall accommodate more than 2 residents.

XIII. Each resident shall have:

(a) A bed appropriate to the needs of the resident;

(b) A firm mattress with cover;

(c) A pillow, linens and blankets;

(d) Personal hygiene and grooming equipment such as comb, toothbrush and razor;

(e) Bureau with mirror;

(f) Bedside table;

(g) Lamp; and

(h) Comfortable chair.

XIV. The resident or guardian may indicate and the facility shall document that the resident does not wish or need to have one or more of the items listed in paragraph XIII and the reason for the removal.

XV. The resident may provide any of the above items from his or her own personal possessions provided that they are clean and in good repair.

XVI. Each resident room door shall be of the side-hinge type. Folding doors or curtains shall be prohibited.

XVII. Each resident room shall contain a closet or storage space for the resident's personal belongings.

XVIII. Each resident room shall have its own separate entry to permit the resident to reach his or her room without passing through the room of another person.

XIX. Residents shall have a living and/or multi-purpose room with capacity of meeting the needs of the residents for their use. Such rooms shall be provided with reading lamps, chairs, tables, and couches which shall be comfortable and in good repair.

XX. Dining facilities shall be provided with a seating capacity capable of meeting the needs of the residents in the home.

151:44 Emergencies and Fire Drills.

I. Emergency and fire drills shall be conducted on a monthly basis. Drills shall be conducted at varying times, including nights, so that all staff participate in at least one drill per quarter. Residents shall not be required to leave the building during inclement weather but shall be required to move to the designated area.

II. Emergency and fire drill reports shall include:

(a) Who was involved both for staff and residents.

(b) Day, month, year, and time of day conducted.

(c) Exits utilized.

(d) Total time to evacuate the home and/or times to complete the emergency drill.

(e) Any problems encountered and corrective actions to be taken to rectify problems.

III. The facility shall have at least one multi-purpose fire extinguisher installed and maintained in accordance with National Fire Protection Association 10, Standard for Portable Fire Extinguisher, 1988 edition on each floor.

2 Effective Date. This act shall take effect 60 days after its passage.