CHAPTER He-C 4000  CHILD CARE LICENSING RULES

 

Statutory Authority:  RSA 170-E:34, I

 

PART He-C 4001  NH RESIDENTIAL CHILD CARE LICENSING RULES

 

          He-C 4001.01  Definitions.

 

          (a)  “Administer” means an act whereby a single dose of a drug is instilled into the body of, applied to the body of, or otherwise given to a resident for immediate consumption or use.

 

          (b)  “Applicant” means a person, corporation, partnership, voluntary association, or other organization, either established for profit or otherwise, who intends to operate one or more residential child care programs, and who indicates that intent to the department by submitting an application and the application attachments required by He-C 4001.02.

 

          (c)  “Authorized staff” means program staff that have completed training in medication safety and administration who are responsible for administration of medications to residents.

 

          (d)  “Child” means “child” as defined in RSA 170-E:25, I.

 

          (e)  “Child abuse” means the infliction on a child of any of the behaviors set forth in RSA 169-C:3, II (a) - (d).

 

          (f)  “Child care institution” means “child care institution” as defined in RSA 170-E:25, III.

 

          (g)  “Child endangerment” means the negligent violation of a duty of care or protection owed to a child or negligently inducing a child to engage in conduct that endangers his or her health or safety.

 

          (h)  “Child neglect” means any of the behaviors or circumstances set forth in RSA 169-C:3, XIX (a) or (b).

 

          (i)  “Clinical coordinator” means a staff member employed by the residential treatment program responsible for administrative oversight of the clinical services provided at the program. This term includes “treatment coordinator.”

 

          (j)  “Clinical staff” means individuals who have a master’s degree in a clinical field such as social work, marriage and family therapy, psychology, guidance counseling, or a degree that would make one eligible for a license from the NH board of mental health practice or NH board of psychologists.

 

          (k)  “Commissioner” means the commissioner of the NH department of health and human services, or his or her designee.

 

          (l)  “Corporal punishment” means use of aggressive physical contact or other action designed to cause the resident discomfort, used as a penalty for behavior disapproved of by the punisher.

 

          (m)  “Corrective action plan” means “corrective action plan” as defined in RSA 170-E:25, VI.

 

          (n)  “Department” means “department” as defined in RSA 170-E:25, VII.

 

          (o)  “Direct care staff” means program staff who are responsible for providing direct care to residents.

 

          (p)  “Directed corrective action plan” means a corrective action plan that is developed and issued by the department.

 

          (q)    “Evaluation” means a multi-disciplinary assessment of the resident’s level of function by professionals licensed or certified in their respective fields of practice or study, which enables facility staff to plan care that allows the resident to reach his or her highest practicable level of physical, mental, and psychosocial functioning.

 

          (r)  “Field trip” means any excursion off the premises of the residential child care program with residential child care staff, other than routine or unplanned local travel such as walks in the neighborhood, travel to the local library, or other routine travel such as travel to and from school, employment, local appointments or travel to do local errands.

 

          (s)    "Full medical withdrawal management" means a protocol for a resident receiving 24-hour nursing supervision overseen by a licensed practitioner, who may be incapable of evacuating a facility on his or her own or may have medical conditions that require immediate medical intervention, such as seizures, tremors, delirium, cardiac, or are a danger to themselves or others.

 

          (t)  “Group home” means “group home” as defined in RSA 170-E:25, II(b).

 

          (u)  “Guardian” means “guardian” as defined in RSA 170-E:25, IX.

 

          (v)  “Homeless youth” means a person 16 through 20 years of age who is unaccompanied by a parent or guardian and is without shelter where appropriate care and supervision are available, whose parent or legal guardian is unable or unwilling to provide shelter and care, or who lacks a fixed, regular, and adequate residence.

 

          (w)  “Homeless youth program” means “homeless youth program” as defined in RSA 170-E:25, II(d).

 

          (x)  “Household member" means any person who resides in a child care program other than child care personnel or children admitted to the child care program.

 

          (y)  “Incident” means:

 

(1)  Resident behavior that is extreme, including, but not limited to, behavior that is assaultive, destructive, self-injurious, or self-destructive;

 

(2)  Any behavior leading to physical intervention or seclusion of a resident; or

 

(3)  An occurrence involving an accident or injury, or requiring outside agency involvement.

 

          (z)  “Independent living” means transition to adulthood whereby the resident negotiates living on his or her own with a set of skills and goals based on the resident’s needs and interests.

 

          (aa)  “Independent living home” means “independent living home” as defined in RSA 170-E:25, X.

 

          (ab)  “License” means “license” as defined in RSA 170-E:25, XI.

 

          (ac)  “License capacity” means the maximum number of residents that can be admitted to and present in the residential child care program, as authorized by the license issued.

 

          (ad)  “Licensed clinical supervisor” means a registered nurse (RN) licensed under the state of New Hampshire pursuant to RSA 326-B, or an individual licensed by the board of licensing for alcohol and other drug use professionals or board of mental health practice to practice and supervise substance use counseling who meets the initial licensing qualifications set forth in RSA 330-C:18.

 

          (ae)  “Licensed counselor” means a master licensed alcohol and drug counselor (MLADC), a licensed alcohol and drug counselor (LADC), or a licensed mental health professional who has demonstrated competency in the treatment of substance use disorders (SUD).

 

          (af)  “Licensed health care practitioner” means a:

 

(1)  Medical doctor;

 

(2)  Physician’s assistant;

 

(3)  Advanced practice registered nurse (APRN);

 

(4)  Doctor of osteopathy;

 

(5)  Doctor of naturopathic medicine; or

 

(6)  Any other practitioner with diagnostic and prescriptive powers licensed by the appropriate state licensing board.

 

          (ag)  "Limited medical withdrawal management" means a resident is capable of evacuating the facility without assistance, is medically cleared to participate in limited medical withdrawal management by a licensed practitioner prior to or at the time of admission, and is not a danger to themselves or others. 

 

          (ah)  “Mechanical restraint” means “mechanical restraint” as defined in RSA 126-U:1, IV.

 

          (ai)  Medical director” means a practitioner licensed in accordance with RSA 329 or RSA 326-B, who is responsible for overseeing the quality of medical care and services in a specialized care program.

 

          (aj)  Medical technology dependent” means a resident with limitations so severe as to require both an assistive medical technology device to compensate for the loss of a vital body function and significant and sustained care to avert death or further disability.   Assistive medical technology devices include, but are not limited to tracheostomy tube, feeding tube, c-pap or bi-pap machines, and wheelchairs.

 

          (ak)  “Medication” means a drug prescribed for a resident by a licensed health care practitioner and over-the-counter medications.

 

          (al)  “Medication log” means a written record of medications administered to a resident.

 

          (am)  “Medication occurrence” means any error in the administration of a medication as prescribed or in the documentation of such administration, with the exception of a resident’s refusal.

 

          (an)  “Medication restraint” means “medication restraint” as defined in RSA 126-U:1, IV(a).

 

          (ao)  “Mental illness” means a substantial impairment of emotional processes, or of the ability to exercise conscious control of one's actions, or of the ability to perceive reality or to reason, when the impairment is manifested by instances of extremely abnormal behavior or extremely faulty perceptions. It does not include impairment primarily caused by:

 

(1)  Epilepsy;

 

(2)  Intellectual disability;

 

(3)  Continuous or non-continuous periods of intoxication caused by substances such as alcohol or drugs; or

 

(4)  Dependence upon or addiction to any substance such as alcohol or drugs.

 

          (ap)  “Monitoring visit” means an announced or unannounced visit made to a residential child care program by department personnel for the purpose of assessing compliance with the standards set by rule adopted by the commissioner pursuant to RSA 541-A.

 

          (aq)  “Nursing care” means the provision or oversight of a resident’s physical, mental, or emotional condition by diagnosis as confirmed by a licensed practitioner.

 

          (ar) “Orders” means instructions by a licensed practitioner, produced verbally, electronically, or in writing for medication, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

 

          (as)  “Parent” means a father, mother, legal guardian, or other person or agency responsible for the placement of a resident.

 

          (at)  “Permanency” means a permanent connection with at least one adult committed to helping the homeless youth meet his or her needs throughout his or her life.

 

          (au)  “Physical intervention” means a behavior management technique in which staff use the minimum amount of physical contact on a resident, which is necessary for the circumstances, in accordance with RSA 627:6, II(b) and RSA 126-U, to protect the resident, other residents present, the staff, and the general public.

 

          (av)  “Pre-service training” means training or education required to meet the minimum qualifications for the position of program director, as specified in He-C 4001.19 (e), or direct care staff, as specified in He-C 4001.19 (f).

 

          (aw) “Procedure” means a licensee’s written, standardized method of performing duties and providing services.

 

          (ax)  “Program director” means the individual who has responsibility for the daily operation of the residential child care program.

 

          (ay)  “Program staff” means all staff, both professional and non-professional, including direct care staff, who are responsible for the supervision, care, or treatment of residents.

 

          (az)  “Pro re nata (PRN)” means medication administered as circumstances may require in accordance with licensed practitioner’s orders.

 

          (ba)  “Rehabilitative and restorative services” means interventions provided including any medical or remedial services recommended by a physician or other prescribing practitioner within the scope of the residential treatment program’s practice to reduce a physical or mental disability and restore a recipient to his or her best functional level.

 

          (bb)  “Repeat violation” means a violation of a specific licensing rule or law for which the program has been previously cited during the past 5 years, which has not been removed as a result of an informal dispute resolution or overturned as a result of an adjudicatory procedure and that posed a health or safety risk to residents.

 

          (bc)  Reportable incident” means an occurrence of any of the following while the resident is either in the program or in the care of program personnel:

 

(1)  The death of the resident;

 

(2)  Suspected abuse or neglect of the resident; or

 

(3)  The unexplained absence of a resident from the program.

 

          (bd)  “Resident” means a child who has been admitted to a residential child care program. 

 

          (be)  “Residential child care program (program)” means “child care agency” as defined in RSA 170-E:25, II. The term also means “child-care institution” as defined in 42 CFR § 672(c)(2)(a).

 

          (bf)  “Restraint” means “restraint” as defined by RSA 126-U:1, IV.

 

          (bg)  “Runaway” means a child who is absent without leave or permission from the program that is responsible for the supervision of that child.

 

          (bh)  “Sanitize” means to clean by removing all organic material then wiping down or washing with a disinfecting or germicidal solution consisting of one tablespoon of regular strength chlorine bleach to one gallon of water which is mixed fresh daily, or a commercial product which is designed to kill germs and which, when used in accordance with manufacturer’s directions, does not pose a health or safety risk to residents.

 

          (bi)  “Seclusion” means “seclusion” as defined in RSA 126-U:1, V-a.

 

          (bj)  “Short term” means a placement which is intended to last for 60 days or less, unless the residential child care program has written documentation on file that the 60 day period has been extended by the department’s division for children, youth and families (DCYF), juvenile justice services (JJS), or by the referring agency.

 

          (bk)  “Social or non-medical withdrawal management” means a treatment service provided by appropriately trained staff who provide 24-hour supervision, observation, and support for residents who are intoxicated or experiencing withdrawal with no staff-administered medication.

 

          (bl)  "Specialized care" means "specialized care” as defined in RSA 170-E:25, II(c).  Such care includes substance use disorder and behavioral health. The term also includes “specialized care program (SCP)”.

 

          (bm)  “Substance use disorder (SUD)” means a disease that affects a person’s brain and behavior and may lead to an inability to control the use of a legal or illegal substance. Substances can include alcohol and other drugs.

 

          (bn)  “SUD program” means a residential program, excluding hospitals as defined in RSA 151:2,I(a), which provides residential SUD treatment relating to the youth’s medical, physical, psychosocial, vocational, and educational needs.

 

          (bo) “Time out” means the restriction of a resident for a period of time to a designated area from which the resident is not physically prevented from leaving, for the purpose of providing the resident the opportunity to regain self-control or as a consequence to a specific behavior.

 

          (bp)  “Treatment plan” means the program’s written, time-limited, goal-oriented therapeutic plan for the child and family, which includes strategies to address the issues that brought the child into placement, and which is developed by the family, program staff, and the agency responsible for the placement of the child.  This includes, but is not limited to, a child specific planning document prepared in cooperation with DCYF, JJS, a school district, or other placing or sending organization.  A treatment planning document that complies with certification requirements satisfies licensing requirements.

 

          (bq)  “Unit” means the department’s child care licensing unit.

 

          (br)  “Volunteer” means an unpaid person who assists with the provision of food services or activities, and who does not provide direct care or assist with direct care.   

 

          (bs)  “Withdrawal management” means a residential treatment service provided by appropriately trained staff who provide 24-hour supervision, observation, and support for youth who are intoxicated or experiencing withdrawal with prescription medication administered based on the results of an appropriate evaluation tool.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06; amd by #10319, eff 7-1-13; amd by #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151 eff 12-30-20

 

          He-C 4001.02  Application Form and Attachments.

 

          (a)  All applicants for licensure shall complete and submit an application form to the department, which includes:

 

(1)  Whether the application is for a new, renewed, or revised license;

 

(2)  Whether the program will operate a group home, child care institution, independent living home, homeless youth shelter, or specialized care program;

 

(3) Whether the applicant, owner, or business organization intends to provide short-term placements;

 

(4)  The name, physical address, mailing address, and telephone number of the program;

 

(5) The name, telephone number, and mailing address of the applicant, owner, or business organization;

 

(6)  An e-mail address for the program and the applicant, owner, or business organization, if available;

 

(7)  Federal tax identification number if one has been assigned;

 

(8)  A list of all buildings in which residents will be cared for which identifies:

 

a.  The building identifier;

 

b.  The building’s purpose or function;

 

c. The type(s) of residential child care services that the applicant, owner or business organization intends to offer in the building as specified in He-C 4001.02 (a)(2) above; and

 

d.  The proposed number of residents and age range to be cared for in each residential building;

 

(9)  The total requested resident capacity of the program;

 

(10) How the program is owned and organized, whether private, partnership, or other organization type, including name of business organization, business identification number, and the names, title/position, and telephone numbers of the officers of the business or board members, if applicable;

 

(11)  Whether the program will be operating as for-profit or non-profit;

 

(12)  The name, birth name(s), and date of birth of the program director;

 

(13)  The qualifications of the program director, including education and experience;

 

(14)  For persons who have contact with residents in the residential child care program, more than 5 hours per week, excluding residents who are admitted to the program, and including any applicant, owner, officer of the business organization, program director, executive director, board member, household member, program staff, intern, volunteer or any other individual in the state of New Hampshire or the United States, information and details disclosed by the individual on their application for employment, or otherwise known by the program, regarding the following:

 

a.  Criminal convictions in a state other than New Hampshire;

 

b.  Current criminal investigations in any state;

 

c.  Current investigations of child abuse or neglect in any state;

 

d.  Previous findings of child abuse or neglect in a state other than New Hampshire;

 

e.  Current investigation of juvenile delinquency for juvenile household members; and

 

f.  Previous adjudications of juvenile delinquency for juvenile household members;

 

(15)  The information required by (14) above shall include:

 

a.  The name and position or affiliation of the individual;

 

b. Whether this information is a charge, allegation, conviction, finding, or current investigation;

 

c. The name and city of the court of DCFY office in which the case was handled, as applicable; and

 

d.  The date of any conviction or finding;

 

(16)  A statement dated and signed by the program director and the applicant, or an individual legally authorized to sign for the applicant attesting to the following:

 

“I HAVE READ AND AM IN COMPLIANCE WITH ALL APPLICABLE RULES IN He-C 4001”;

 

“I UNDERSTAND THAT THE DEPARTMENT MAY INVESTIGATE ANY CRIMINAL CONVICTION RECORD, FINDING OF CHILD ABUSE OR NEGLECT, OR INVESTIGATION OF OR FINAL DETERMINATION REGARDING ANY JUVENILE DELINQUENCY AND WILL MAKE A DETERMINATION REGARDING WHETHER THE INDIVIDUAL POSES A CURRENT RISK TO THE HEALTH, SAFETY OR WELL BEING OF CHILDREN”; 

 

“I UNDERSTAND THAT THE DEPARTMENT MAY DELAY ITS DECISION TO APPROVE OR DENY THIS APPLICATION PENDING THE OUTCOME OF ANY INVESTIGATION, WHEN THE APPLICANT, OWNER, OR PROGRAM DIRECTOR, ARE NAMED AS THE PERPETRATOR IN ANY CURRENT INVESTIGATION OF ANY CRIME, OR IN AN ALLEGATION OF ABUSE OR NEGLECT”;

 

“I UNDERSTAND THAT PROVIDING FALSE INFORMATION ON THIS APPLICATION OR ANY OF THE ATTACHMENTS, OR FAILING TO DISCLOSE ANY INFORMATION REQUIRED ON THE APPLICATION, OR REQUIRED TO BE SUBMITTED WITH THIS APPLICATION, SHALL BE CONSIDERED GROUNDS FOR LICENSE DENIAL OR REVOCATION”;

 

“I HAVE READ THE NH RESIDENTIAL CHILD CARE PROGRAM LICENSING RULES, AND UNDERSTAND THAT FAILURE TO MAINTAIN MY PROGRAM IN COMPLIANCE WITH THE APPLICABLE RULES, MAY JEOPARDIZE MY LICENSE/PERMIT”;

 

“I AUTHORIZE ANY POLICE DEPARTMENT, COURT SYSTEM OR HUMAN SERVICE AGENCY IN THIS OR ANY OTHER STATE TO RELEASE COPIES OF ANY CRIMINAL RECORDS OR CHILD ABUSE OR NEGLECT RECORDS TO THE DEPARTMENT”; and

 

“ALL INFORMATION PROVIDED AS PART OF THIS APPLICATION AND IN THE REQUIRED ATTACHMENTS IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE”;

 

(17)  The position of the individual who signed pursuant to (16) above, such as applicant, board president, board secretary, executive director, or program director;

 

(18)  For each building, a floor plan diagram of indoor residential childcare space which shall specify:

 

a.  Room dimensions;

 

b.  Location of exits;

 

c.  How each room will be used;

 

d.  The location of bathrooms and bathroom fixtures, including toilets, sinks, bathtubs, and showers;

 

e.  The location of other hand-washing sinks; and

 

f.  The length, width, and ceiling height of each bedroom;

 

(19)  For each building, a diagram of outdoor play and recreation space which shall specify:

 

a.  The overall dimensions of the outdoor play space including the length and width of the space;

 

b. The locations of exits, gates, and stationary outdoor play or recreation equipment, including the location of and type of fencing, if any, including gates;

 

c.  The location of the outdoor play space in relation to the indoor space; and

 

d. The location and description of any outdoor water and street hazards including the presence of and location of any pools, ponds, streams, rivers, streets, roads, or other hazards that are in close proximity;

 

(20)  For renewal or revisions applications, diagrams as specified in (18) and (19) above if changes have been made in the residential child care space since the last application submitted to the department; and

 

(21)  For renewal or revision applications, a check mark in the box on the form, indicating when no changes have been made to residential child care space since the last application submitted to the department.

 

          (b)  Residential child care programs that have multiple buildings on the same or adjoining property may apply for a single license for those multiple buildings provided that:

 

(1)  In accordance with residential child care space requirements specified in He-C 4001.16, each residence has adequate square footage, common living space, and complete bathroom units for the number of residents who will reside in each building;

 

(2) An individual who meets at least the minimum qualifications of a direct care staff is designated in charge in each building; and

 

(3)  All program staff and residents are aware of the identity of the direct care staff who is designated in charge in each building.

 

          (c)  With the application, the applicant shall submit to the department a completed “Health Officer Inspection Report for Residential Child Care Agencies” form (10/2014 edition) completed by the local health officer or duly appointed designee, for each building inspected, documenting that within the 12 months of the date the department receives the application, the premises have been inspected and approved by a local health officer or duly appointed designee for operation as a residential child care program.

 

          (d)  With the application, the applicant shall submit to the department a completed “NH State Fire Code compliance report” documenting that, within the 12 months of the date the department receives the application, the premises have been inspected by the local fire department or the state fire marshal’s office, for compliance with the applicable parts and sections of the State Fire Code, under RSA 153:1, VI-a, and Saf-FMO 300, including but not limited to NFPA 1 and NFPA 101, and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5, and approved to operate as a residential child care program.

 

          (e)  The “NH State Fire Code compliance report” required under (d) above shall include the following:

 

(1)  Completed by either program personnel or the fire inspector:

 

a.  The name, address, telephone number, and license number of the residential child care program;

 

b.  The name of the applicant;

 

c.  The type of residential child care to be provided; and

 

d.  The number and age range of residents for whom the applicant intends to provide care; and

 

(2)  Completed by the fire inspector:

 

a.  The date the premises were inspected by the fire inspector;

 

b.  For each building which will be used by residents:

 

1.  An indication regarding whether the fire inspector approves or does not approve the premises to operate as a residential child care program;

 

2.  Any areas of non-compliance with the State Fire Code, under RSA 153:1, VI-a, Saf-C 6000, and Saf-FMO 300, including but not limited to NFPA 1 and NFPA 101, and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5; and

 

3.  Any conditions or restrictions placed by the fire inspector, including but not limited to, any limits relative to the number and age range of residents to be cared for in the program or any rooms, levels, or other areas of the premises not approved for use by residents;

 

c.  An indication whether or not the fire inspector approves, does not approve, or grants a conditional approval for the residential agency type(s) to operate.

 

d.  If  a conditional approval is granted, it shall include:

 

1.  The details regarding what action must be taken; and

 

2.  The date the conditional approval will expire;

 

e.  The printed name, address, telephone number, and title of the fire inspector;

 

f.  The dated signature of the fire inspector; and

 

g.  The city or town in which the fire inspector has authority.

 

          (f)  With the application, the applicant shall submit to the department documentation from the applicable town or city that the program has been granted zoning approval or a statement that no zoning approval is required.

 

          (g)  The zoning documentation required in (f) above shall include the following:

 

(1)  The name and address of the program;

 

(2)  The name of the applicant;

 

(3)  Any zoning requirements or restrictions imposed by the town or city regarding the existence of the program, including any limits regarding ages or number of residents to be cared for in the program, and any buildings on the property that do not have zoning approval; and

 

(4)  The signature of an individual authorized to sign on behalf of zoning, and date signed.

 

          (h)  With the application, the applicant shall submit to the department background check forms as specified in He-C 4001.31 for each of the following:

 

(1)  The applicant;

 

(2)  All household members; and

 

(3)  All program directors.

 

          (i)  With the application, the applicant shall submit to the department documentation of education and experience that shows that the program director meets the requirements for his or her position, as specified in He-C 4001.19(e).

 

          (j)  The documentation of education and experience required under (i) above shall include the following:

 

(1)  Copies of transcripts, certificates, diplomas, or degrees as applicable; and

 

(2)  A resume or other documentation of previous experience.

 

          (k)  With the application, applicants that are incorporated shall submit to the department a list of the names, addresses, and telephone numbers of the current board members.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.03  Procedures for License Renewal and Revisions.

 

          (a)  No less than 3 months prior to the expiration date of the current license, each licensee shall submit to the department:

 

(1)  An application form for license renewal, completed in accordance with He-C 4001.02 (a);

 

(2)  The application attachments specified in He-C 4001.02 (c) through (e), (h) through (j) and (n); and

 

(3)  The application attachments specified in He-C 4001.02 (l) and (m), if there has been a new program director since the previous application was filed.

 

          (b)  Licensees shall be subject to a lapse in license if they submit their application materials after the date their current license expires.

 

          (c)  Prior to adding additional program types, as specified in He-C 4001.02 (a)(2), changing the type(s) of program for which a program is licensed, increasing the number of residents in one or more buildings, unless the increased number has been previously approved in writing by the department and does not result in the program exceeding its license capacity, or re-locating the program, the residential child care program shall:

 

(1)  Submit an application for license revision, completed in accordance with He-C 4001.02; and

 

(2)  When there is a relocation or revision that will exceed any limits or condition on the current health officer inspection report, NH State Fire Code compliance report or zoning approval, submit the application attachments, identified in He-C 4001.02 (c) through (g) for each building for which it is seeking a license revision.

 

          (d)  A licensee shall notify the department in writing when he or she wishes to change the name of the program, so that a revised license that reflects the name change can be issued.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14

 

          He-C 4001.04  Time Frames for Departmental Response to Applications.

 

          (a)  Pursuant to RSA 541-A:29, the department shall approve or deny an application no later than 60 days from receipt of the application and any additional information requested by the department.

 

          (b)  The 60 days specified in (a) above shall begin on the date on which all requested information is received by the department.

 

          (c)  Any outstanding corrective action plan for violations of rule or statute shall be considered additional information under (a) above.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.05  Board of Directors.

 

          (a)  Each program that is incorporated shall have a duly appointed board of directors.

 

          (b)  The applicant or licensee shall:

 

(1)  If incorporated, provide a list of the names, addresses and telephone numbers of current members of the board of directors and a copy of current rules of the board of directors are on file and made promptly available on the premises of the program for review by the department upon request during all visits; and

 

(2)  If governed by any other governing body, provide a list of the names, addresses and telephone numbers of current members of the governing body, and a copy of any rules by which the governing body will operate are on file and made promptly available on the premises of the program for review by the department upon request during all visits.

 

          (c)  The board of directors for programs that are incorporated and the owner or governing body for programs that are not incorporated shall maintain a sufficient degree of oversight of the program’s operations to ensure that the program is complying with the provisions of RSA 170-E, this part, and any policies and procedures adopted by the program.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14

 

          He-C 4001.06  Statements of Findings and Corrective Action Plans.

 

          (a)  The department shall issue a statement of findings to the program when it determines that the program has one or more violations of any of the provisions of RSA 170-E or He-C 4001.

 

          (b)  The program director or designee shall complete a written corrective action plan for each violation included on the statement of findings.

 

          (c)  The corrective action plan required in (b) above shall describe:

 

(1)  How the licensee intends to correct each violation including any interim measures the program director or designee has implemented to protect the health and safety of residents until the violation can be corrected;

 

(2)  What measures will be put in place, or what systemic changes will be made to ensure that the violation does not recur; and

 

(3)  The date by which each violation was corrected or will be corrected.

 

          (d)  The program director or designee shall complete corrective action plans and return them to the department in accordance with the following:

 

(1)  The corrective action plan shall not include the names of individuals; and

 

(2)  The statement of findings and corrective action plan shall be:

 

a.  Signed and dated by the program director or designee; and

 

b.  Returned to the department no later than 3 weeks from the date the statement of findings is sent out by the department.

 

          (e)  The program director or designee shall not alter the statement of findings or corrective action plan once it has been submitted to the department.

 

          (f)  The only exceptions to (d)(2)b. above shall be as follows:

 

(1)  When a program director or designee requests an informal dispute resolution in accordance with He-C 4001.08, the corrective action plan due date shall be 3 weeks from:

 

a.  The date the program receives notice of the department’s decision regarding the informal dispute resolution if the department is not issuing a revised statement of findings; or

 

b.  The date the department issues the revised statement of findings as a result of the informal dispute resolution; and

 

(2)  A program director or designee who cannot complete and return a corrective action plan by the due date may request and receive an extension from the department.

 

          (g)  The criteria for acceptability shall be whether the corrective action plan, when implemented, will achieve compliance with RSA 170-E and He-C 4001.

 

          (h)  The department shall reject a corrective action plan when the plan fails to:

 

(1)  Achieve compliance with RSA 170-E, He-C 4001, or any other applicable licensing rules;

 

(2)  Address the violation as written;

 

(3)  Address all violations cited on the statement of findings;

 

(4)  Prevent a new violation of RSA 170-E, He-C 4001, or any other applicable law; or

 

(5)  State a completion date.

 

          (i)  When the corrective action plan submitted to the department by the program in accordance with (d) and (f) above is not acceptable, the department shall notify the licensee in writing of the reason for rejecting the proposed corrective action plan and:

 

(1)  Attempt to resolve the problem through a telephone consultation with the executive director or program director, when the unacceptable corrective action plan needs only simple, minor modifications or additions to make it acceptable; or

 

(2)  Issue a revised corrective action plan to the program with a notice advising the program why the original corrective action plan submitted by the program is not acceptable.

 

          (j)  When a program is issued a revised corrective action plan, it shall:

 

(1)  Make any revisions to the corrective action plan as approved by the department; and

 

(2)  Return and implement the revised corrective action plan in accordance with (d) above.

 

          (k)  The department shall verify that a corrective action plan, as submitted and accepted, has been implemented by any of the following:

 

(1)  Reviewing materials submitted by the licensee;

 

(2)  Conducting a follow-up inspection; or

 

(3)  Reviewing compliance during any subsequent visit conducted in accordance with RSA 170-E:31, IV, RSA 170-E:32, II or RSA 170-E:40, II.

 

          (l)  When the findings of any inspection or investigation indicate that immediate corrective action is required to protect the health and safety of the residents or personnel, the department shall order the immediate implementation of a directed corrective action plan developed by the department.

 

          (m)  The existence of a corrective action plan shall not prohibit the department from taking other enforcement action available to it under He-C 4001, RSA 170-E, RSA 541-A or other law.

 

          (n)  All statements of findings issued for violations of any of the provisions of RSA 170-E or He-C 4001, and the corrective action plans submitted in response to those violations, shall be considered public information on or after the corrective action plan due date as specified in (d)(2)b. and (f)(1) and (2) above.

 

          (o)  An applicant or licensee may appeal a violation cited on a statement of findings only as part of an adjudicatory process regarding enforcement action taken against a license.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14

 

          He-C 4001.07  Complaints and Investigations.

 

          (a)  In accordance with RSA 170-E:40, I and II, the department shall conduct an investigation of any complaint that meets the following conditions:

 

(1)  The alleged violations occurred not more than 6 months prior to the date the department was made aware of the allegation(s);

 

(2) The complaint is based upon the complainant’s first-hand knowledge regarding the allegation(s) or on information reported directly to the complainant by a resident who has first-hand knowledge regarding the allegation(s);

 

(3)  The complaint contains sufficient specific information for the department to determine that the allegation(s), if proven to be true, would constitute a violation of any of the provisions of He-C 4001 or RSA 170-E; or

 

(4)  The complaint is received from any source and alleges a violation that occurred at any time if the complaint alleges:

 

a.  Physical injury;

 

b.  Verbal or emotional abuse so severe as to create a risk of psychological trauma; or

 

c.  One or more residents were placed in danger of physical injury.

 

          (b)  After the investigation of a complaint has been completed, the department shall:

 

(1)  When it determines that the complaint is unfounded or does not violate any statutes or rules, notify the program and take no further action;

 

(2)  When it determines that the complaint is founded, prepare a statement of findings listing the violations found as a result of the investigation and any other violations found during the visit; and

 

(3)  Notify the licensee in writing of the findings.

 

          (c)  The records compiled during an investigation shall be confidential as required by RSA 170-E:40, III.

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151 eff 12-30-20

 

          He-C 4001.08  Informal Dispute Resolution.

 

          (a)  The department shall offer an opportunity for informal dispute resolution to any applicant or licensee who disagrees with a violation cited by the department on a statement of findings, provided that the applicant or licensee submits a written request for an informal dispute resolution.

 

          (b)  The informal dispute resolution shall be requested in writing by the applicant, licensee or program director no later than 14 days from the date the statement of findings was issued by the department.

 

          (c)  The department shall review the evidence presented and provide a written notice to the applicant or licensee of its decision.

 

          (d)  An informal dispute resolution shall not be available for any applicant or licensee against whom the department has initiated action to suspend, revoke, deny or refuse to issue or renew a license.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14

 

          He-C 4001.09  Enforcement Action and Administrative Appeals.

 

          (a)  The department shall revoke or suspend a license or deny an application for a new license, license renewal or license revision, in accordance with the provisions of RSA 170-E:27, II, RSA 170-E:29, III and IV, RSA 170-E:29-a, and RSA 170-E:35 if:

 

(1)  After being notified of and given an opportunity to supply missing information, the application does not meet the requirements of He-C 4001.02;

 

(2)  After being notified by the department that an adult or a juvenile who is not a resident admitted to the program may pose a risk to residents, the applicant or licensee refuses to submit a corrective action plan which ensures that the individual is removed from employment or from the household and will not have access to the residents in care;

 

(3)  An applicant or licensee has endangered or continues to endanger one or more residents by a negligent violation of a duty of care or protection owed to the child or negligently inducing such child to engage in conduct that endangers his health or safety;

 

(4)  The applicant or licensee has been found guilty of abuse, neglect, exploitation of any person or has been convicted of child endangerment, fraud or a felony against a person in this or any other state by a court of law, or has been convicted of any crimes as referenced in RSA 170-E:29, III or IV, or RSA 170-E:29-a, or had a complaint investigation for abuse, neglect, or exploitation substantiated by the department or in any other state;

 

(5)  The applicant, licensee or designee of the applicant knowingly provides materially false or misleading information to the department, including information on the application or in the application attachments;

 

(6)  The applicant, licensee or any representative or employee of the applicant fails to cooperate with any inspection, investigation or visit by the department;

 

(7)  The applicant or licensee violates any of the provisions of RSA 170-E:24 –49 or He-C 4001;

 

(8)  The applicant or licensee has demonstrated a history or pattern of multiple or repeat violations of RSA 170-E, or He-C 4001, that pose or have posed a health or safety risk to residents; or

 

(9)  The applicant or licensee fails to submit an acceptable corrective action plan or fully implement and continue to comply with a corrective action plan that has been accepted by the department in accordance with He-C 4001.06.

 

          (b)  If a license has been revoked, or has expired without timely application for renewal having been made in accordance with He-C 4001, operation shall be discontinued immediately.

 

          (c)  The department shall notify applicants or licensees affected by a decision of the department to deny, revoke or suspend a license of their right to an administrative appeal in accordance with RSA 170-E:36.

 

          (d)  If an applicant or licensee fails to request an administrative appeal in writing within 10 days of the receipt of the notice required by RSA 170-E:36, I, the action of the department shall become final.

 

          (e)  Administrative appeals under this section shall be conducted in accordance with RSA 170-E:36, II, III, and IV, RSA 170-E:37, RSA 541-A and He-C 200.

 

          (f)  Further appeals of department decisions under this section shall be governed by RSA 541-A and RSA 170-E:37.

 

          (g)  Any licensee who has been notified of the department’s intent to revoke or suspend a license or deny an application for a license renewal may be allowed to continue to operate during the appeal process except as specified in (h) below.

 

          (h)  When the department includes in its notice of revocation or suspension an order of immediate closure, pursuant to RSA 170-E:36, III or RSA 541-A:30, III, the program shall immediately terminate its operation and not operate during the appeal process except under court order, or as provided by RSA 541-A:30, III.

 

          (i)  The department shall initiate a suspension of a license rather than revocation when it determines that the action is being initiated against a program that does not have a history of repeat violations of licensing rules or statute and the action is based on a violation or situation which is:

 

(1)  Related to a correctable environmental health or safety issue, including but not limited to, a problem with a program’s water supply, septic system, heating system, or structure; and

 

(2)  Documented by the program as being temporary in nature.

 

          (j)  Except for (h) above, any suspension of a license that has not been appealed, or any suspension of a license that has been upheld on appeal shall remain in effect until the department notifies the program whose license was suspended that the suspension has been removed because:

 

(1)  The violation which resulted in the suspension has been corrected; or

 

(2) The suspension was based on loss of fire or health officer approval and the local fire inspector or inspector from the state fire marshal’s office, or health officer has reinstated the previously rescinded approval.

 

          (k)  Upon receipt of notice of the department’s intent to revoke, suspend, deny or refuse to issue or renew a license, the applicant or licensee receiving the notice shall immediately provide the department with a list of the names, addresses and phone numbers of the person or agency responsible for the placement of each current resident.

 

          (l)  Based upon information provided under (k) above, the department shall notify the person or agency responsible for the placement of each current resident that the department has initiated action to revoke or suspend the license or deny an application for a license renewal.

 

          (m)  The department shall send a copy of the notice required in (l) above to the following entities:

 

(1)  The health officer and fire inspector in the town in which the program is located;

 

(2)  The state office of the United States Department of Agriculture, Child and Adult Food Program, if the residential child care program participates in that program;

 

(3)  The New Hampshire department of education if the program has a school on the premises; and

 

(4)  The director of DCYF.

 

          (n)  When a program’s license has been revoked or denied, the department has refused to renew a license, or an application has been denied by the department, if the enforcement action specifically pertained to their role in the program, the applicant, licensee, program director or executive director, shall not be eligible to reapply for a license, or be employed as an executive director or program director for at least 5 years from:

 

(1)  The date of the department’s decision to revoke or deny the license, if no appeal is filed; or

 

(2)  The date an order is issued upholding the action of the department, if that action has been appealed.

 

          (o)  Notwithstanding (n) above, the department shall accept an application submitted after the decision to revoke or deny becomes final, provided there has been no violation of RSA 170-E:27, II, RSA 170-E:35, I, or RSA 170-E:35, XIII, only under the following circumstances:

 

(1)  The applicant or licensee, when licensed, did not demonstrate a pattern of repeat violation of licensing rules or statute;

 

(2)  The denial was based on the applicant or licensee’s inability or failure to correct a violation caused by a temporary condition which has been corrected; or

 

(3)  The licensee or applicant who was denied an initial application shows that circumstances have substantially changed such that the department now has good cause to believe that the applicant has the requisite degree of knowledge, skills and resources necessary to maintain compliance with the provisions of RSA 170-E and He-C 4001.

 

          (p)  No ongoing enforcement action shall preclude the imposition of any remedy available to the department under RSA 170-E, RSA 541-A, He-C 4001 or other law.

 

          (q)  Requests for reconsideration or appeal of any decision by a hearings officer shall be filed within 30 days of the date of the decision.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14

 

          He-C 4001.10  Duties and Responsibilities of the Licensee.

 

          (a)  The program shall abide by the provisions specified on the license.

 

          (b)  Program staff shall:

 

(1)  Display a copy of the current license issued by the department in a prominent location in each building in which residents are housed; and

 

(2)  Not alter the license issued by the department.

 

          (c)  A license shall not be transferable to a new owner or new location.

 

          (d)  Any licensee, program staff or other person involved with a program who has reason to suspect that a resident is being abused or neglected shall report the suspected abuse to DCYF at 1-800-894-5533.

 

          (e)  When direct care staff who are witness or party to any event that meets the mandated reporting requirement in RSA 169-C:29, the program shall provide opportunity and support to such staff to make the required report.  Whenever possible, the staff directly involved or witness to the event shall make reports to the department, with assistance from administrative staff as needed to assure all necessary information is available to make a complete report.

         

          (f)  Program staff shall safeguard the confidentiality of all records and personal information regarding any resident.

 

          (g)  Applicants, licensees, and all program staff shall keep confidential all records required by the department pertaining to the admission, progress, health, and discharge of residents under their care and all facts learned about residents and their families with the following exceptions:

 

(1)  Program staff shall, upon request, make available to the department all records that programs are required by RSA 170-E or He-C 4001 to keep, and to such records as necessary for the department to determine staffing patterns and staff attendance; and

 

(2)  Other than as specified in (g)(1) above, program staff shall release information regarding a specific resident only as directed by a parent of that resident, or upon receipt of written authorization to release such information, signed by that resident’s parent, unless otherwise restricted by applicable state or federal law.

 

          (h)  Information collected by the department during the application process may be released:

 

(1)  To the applicant, licensee or his or her designated representative;

 

(2)  Upon receipt of written authorization by the applicant or licensee to release information; or

 

(3)  To federal, state and local officials or the entities that provided reports.

 

          (i)  Except for law enforcement agencies or in an administrative proceeding against the applicant or licensee, the department shall keep confidential any information collected during an investigation, unless it receives an order from a court of competent jurisdiction ordering the release of specific information.

 

          (j)  Applicants, licensees, members of the board of directors or other governing body, program staff, child care interns, child care assistants, and volunteers shall cooperate with the department during all departmental visits authorized under RSA 170-E and He-C 4001.

 

          (k)  For the purposes of (j) above, cooperation shall include, but not be limited to not interfering with efforts by representatives of the department to:

 

(1)  Enter the premises and complete an inspection;

 

(2)  Document evidence or findings by taking written statements, and by photographing toys, equipment, and learning materials or conditions inside or outside residential child care space and other areas of the premises accessible to residents;

 

(3)  Make an audio recording of conversations with individuals who have consented to the audio recording;

 

(4)  Interview program staff, members of the board of directors, or other governing body, child care interns, child care assistants, volunteers, residents enrolled in the program, and any other individual whom the department determines might have information relevant to the issues being evaluated; and

 

(5)  Review and reproduce any forms or reports which the applicant or licensee is required to maintain or make available to the department under He-C 4001.

 

          (l)  Administrators, other program staff, or other individuals shall not:

 

(1)  Require or request that the individual being interviewed ask that another person be present for the interview;

 

(2)  Attempt to influence the response of any individual being interviewed by signaling them during the interview, telling them what to say, or threatening them with retaliation for providing information to the department; or

 

(3)  Require staff or residents who have been interviewed to provide statements to program administration regarding their interview.

 

          (m)  Any violation of (l) above or any attempt by or on behalf of program staff, administrators, or other individuals to prevent program staff, residents, or other individuals from responding to questions by the department, or from making a good faith report to the department regarding any concerns they have about the operation of the program relating to statutory or regulatory requirements shall be considered failure to cooperate with the department as specified in (j) and (k) above.

 

          (n)  Except for He-C 4001.12(a), all records and written policies required by He-C 4001 shall be maintained on file and shall be made promptly available on the premises of the program for review or be submitted to the department upon request as follows:

 

(1)  For 2 years from the date the resident is discharged;

 

(2)  For 2 years from the date of termination for records related to employees; and

 

(3)  For all other records 2 years from the date the record was created.

 

          (o)  The exception to (n) above shall be when program staff shows good cause as to why the requested reports or records are not immediately available.  In such case, the provider shall make the records available within 2 business days, or otherwise obtain an extension from the unit.  Good cause shall include circumstances beyond the licensee’s control or other extenuating circumstances.

 

          (p)  When the individual who has been identified and approved by the department as program director leaves the position, the licensee or designee shall:

 

(1)  Notify the department of the departure of the program director within 10 days;

 

(2)  Within 10 days of the departure of the director, notify the department of the name of the individual who is temporarily serving as the program director and who meets at least the minimum requirements of a direct care staff; and

 

(3)  Within 120 days of the date of departure of the program director, notify the department and submit information and documentation required under He-C 4001.02(i) and (j) for the new, qualified program director.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.11  Health Requirements for Program Staff and Adult Household Members.

 

          (a)  A written record of physical examination shall be on file for all program employees and household members who will have regular contact with residents.

 

          (b)  The written record of physical examination required in (a) above shall contain or identify:

 

(1)  The name of the examinee;

 

(2)  The date of the examination;

 

(3)  Any contagious or other illness that would affect the examinee’s ability to care for residents or pose a risk to the health or safety of residents;

 

(4)  A record of a negative Mantoux Tuberculin (TB) test for individuals who are determined by a licensed health care practitioner to be at high risk for exposure to Tuberculosis or the results of a chest x-ray and medical assessment when the individual has a positive TB test due to prior exposure;

 

(5)  Any known limitations or restriction that would affect the examinee’s performance of his or her residential child care responsibilities or pose a risk to the health or safety of residents;

 

(6)  The signature of the licensed health care practitioner and date signed; and

 

(7)  The typed or printed name and telephone number of the licensed health care practitioner.

 

          (c)  The initial record of physical examination for newly hired program staff shall have been completed not more than l2 months preceding the date of hire or the date the individual began having regular contact with residents.

 

          (d)  When a newly hired program staff has not had a physical exam in accordance with (b) above, an appointment for a future physical exam shall be scheduled within 10 business days of the date the individual begins having regular contact with residents.

 

          (e)  Physical examinations required under (a) above shall be repeated at least every 3 years.

 

          (f)  A written record of the repeat physical examination required in (e) above shall be on file at the program within 60 days of the expiration date of the previous physical exam record on file at the program.

 

          (g)  When the program director or designee is aware that any program direct care staff, intern, child care assistant or volunteer have symptoms of illness that prevent them from being able to perform their duties or pose a health or safety risk to children, he or she shall prohibit that individual from caring for residents until the individual has received treatment which ensures that he or she does not have a communicable disease or is no longer symptomatic.

 

          (h)  When the program director or designee is aware that any program staff, intern, child care assistant, volunteer, resident, or household member has symptoms of a reportable communicable disease or is known to have a reportable communicable disease, the program director or designee shall contact the department’s bureau of communicable disease control for instructions regarding:

 

(1)  Whether the ill staff person is required to be excluded from the program;

 

(2)  How to control the spread of contagious illness; and

 

(3)  Reporting requirements in accordance with RSA 141-C:7 and He-P 301.

 

          (i)  The only exception to (h) above shall be for human immunodeficiency virus (HIV) infection, specifically the identity of any individual with HIV infection shall be held confidential in accordance with RSA 141-F:8.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14

 

          He-C 4001.12  Communicable Disease Issues and Health Requirements for Residents and Other Children.

 

          (a)  Parental authorization for medical treatment shall be on the premises for each resident upon his or her first day of residence in the program, except for residents in short term placement, and available in accordance with He-C 4001.10(n).

 

          (b)  Physical examinations shall be completed for children admitted to the program as residents and children who reside on the premises of the program.

 

          (c)  A child health form or an equivalent record of physical examination documenting that a physical examination was completed within the past 12 months shall be on file for each child, as specified in (b) above, within 30 days of the date any child begins residing on the premises of the program.

 

          (d)  When a child has not had a physical examination as required in (c) above, the program shall schedule an appointment for a future physical exam within 10 business days of the date the child begins residing at the program.

 

          (e)  The child health form or equivalent record of physical examination required under (c) above shall include at least the following:

 

(1)  The name and date of birth of the child or resident;

 

(2)  The date of the exam;

 

(3)  Diagnoses, if any, and a description of any health condition that might affect the child or resident’s participation in the program;

 

(4)  Documentation of immunizations, including dates immunized;

 

(5)  A history of illness and hospitalizations;

 

(6)  Reports of any screening or assessment;

 

(7)  Notations about the child or resident’s physical, mental, and social development;

 

(8)  A list of current medications, both prescribed and over the counter;

 

(9)  Any known allergies;

 

(10)  Dietary needs, including special diets; and

 

(11)  The signature of a licensed health care practitioner and the date signed.

 

          (f)  Physical examinations as required under (b) above shall be completed:

 

(1)  At least every 12 months for each child younger than 6 years of age, with a 60-day grace period to allow the program to obtain the updated physical examination record; and

 

(2)  At least every 24 months for each child 6 years of age or older, with a 60-day grace period to allow the program to obtain the updated physical examination record.

 

          (g)  Each resident shall have a dental examination based upon a schedule, which shall:

 

(1)  Take into account the needs of the resident as determined by a licensed dentist; and

 

(2)  Provide for each resident to have a dental examination at intervals of 6 to 12 months.

 

          (h)  If the program is unsuccessful in obtaining dental examinations in accordance with (g)(2) above, it shall document good faith efforts to schedule an exam.

 

          (i)  A written record documenting the date of the dental exam and treatment needed or provided, shall be maintained on the premises of the program in each resident’s permanent record.

 

          (j)  Other medical exams and evaluations shall be completed for each resident as necessary to meet his or her medical needs.

 

          (k)  When a resident is believed to have a reportable communicable disease which was not diagnosed by a physician or other health care provider, the program director or designee shall report the known or suspected communicable disease to the department’s bureau of communicable disease control in accordance with RSA 141-C:7 and He-P 301.

 

          (l)  The only exception to (k) above shall be for HIV infection, specifically, the identity of any individual with HIV infection shall be held confidential in accordance with RSA 141-F:8.

 

          (m)  SCPs shall provide services in a residential setting, including access to nursing or medical care, for all children placed in the program diagnosed as having functional limitations and are dependent upon or require medical technology to maintain or improve independence and health. 

 

          (n)  SCPs shall provide for the complex health needs of residents whom are medical technology dependent:

 

(1)  In a manner that affords the least intrusive intervention available to ensure his or her safety, the safety of others, and that promotes healthy growth and development;

 

(2)  By providing services and an environment that meets each resident’s needs; and

 

(3)  By training direct care staff in the use and care of the specific medical technology device or devices that residents in their care are dependent upon.

 

          (o)  Training shall include:

 

(1)  How to recognize symptoms that may indicate a decline in the resident’s health;

 

(2)  Seizures and seizure disorders;

 

(3)  G/J tube use and care;

 

(4)  Tracheostomy care;

 

(5)  C-pap and Bi-pap care; and

 

(6)  Any intervention or procedure that will heighten direct care staff’s attention to the health and well-being of residents, such as topics on medical changes that require immediate notification for nursing assessment.

 

          (p)  All training and education required in (n) and (o) above shall be performed by the appropriate medical professional with the requisite education and licensure to perform such training or utilize outside resources if an appropriate medical professional is not available.

 

             (q)  At the time of admission of a resident with special health care needs or who is medical technology dependent, the licensee shall obtain written and signed orders from a licensed practitioner for medications, treatment, and special diet as applicable.

 

          (r)  No resident shall be admitted until the appropriate training in (n) and (o) above has been completed.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.13  Personal Hygiene.

 

          (a)  Program staff and residents shall wash their hands as needed.

 

          (b)  Individuals who are participating in food preparation or food service shall:

 

(1)  Wash their hands as often as necessary to remove soil and contamination and prevent cross contamination;

 

(2)  Cover any cuts or abrasions with a secure bandage; and

 

(3)  Not participate in food preparation or food service activities when they have:

 

a.  An infection;

 

b.  A cut or wound which is running or weeping; or

 

c.  A communicable disease that could be spread via food preparation or food service.

 

          (c)  Program staff shall not wash their hands after diapering or toileting in sinks that are used for food preparation or clean up.

 

          (d)  Program staff shall encourage each resident to brush their teeth each morning and before going to bed, and to shower daily.

 

          (e)  Each resident shall have an opportunity to have a shower or bath, with adequate hot water, once each day.

 

          (f)  Program staff shall assist residents who are medical technology dependent, or whose functional needs require direct assistance with daily personal hygiene.  Such assistance shall be care planned and provided based on resident need.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.14  Prevention and Management of Injuries, Incidents, Emergencies and Infection Control.

 

          (a)  The program shall develop policies for how direct care staff shall respond to incidents, including but not limited to:

 

(1)  Addressing threats of self-harm and suicidal behaviors by residents;

 

(2)  Medical emergencies;

 

(3)  Addressing threatening behaviors such as physical and sexual assaults on other residents or staff;

 

(4)  The reporting requirements in He-C 4001.23(g);

 

(5)  Screening any child who runs away for indications that the child may be a victim of human trafficking and notifying necessary personnel;

 

(6)  Managing the behavior of children, including how and under what circumstances seclusion or restraint is used, pursuant to RSA 126-U:2;

 

(7)  Accessibility to respite or temporary care arrangements; and

 

(8)  How staff will be orientated and trained in accordance with He-C 4001.19(k) and (l) to prepare to work with the population served by the program.

 

          (b)  All program staff responsible for the care and supervision of residents shall be familiar with the program’s policies and procedures for managing injuries and emergencies and have access to information necessary to handle emergencies.

 

          (c)  Each building that residents will spend time in shall be equipped with a telephone that is operable and accessible to residents and staff for incoming and outgoing calls.

 

          (d)  The licensee shall maintain an information data sheet in the resident’s record and promptly give a copy to emergency medical personnel in the event of an emergency transfer to a medical facility.

 

          (e)  The information data sheet referenced in (d) above shall include:

 

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

 

(2)  Name, address, and telephone number of the resident’s parent(s), guardian, or agent, if any;

 

(3)  Diagnosis;

 

(4)  Medications, both prescription and over the counter, including last dose taken and when the next dose is due;

 

(5)  Allergies;

 

(6)  Functional limitations;

 

(7)  Date of birth;

 

(8)  Insurance information; and

 

(9)  Any other pertinent information not specified in (1)-(8) above.

 

          (f)  At least one residential child care program staff person, who is trained and currently certified in cardiopulmonary resuscitation (CPR) and first aid by the American Red Cross, American Heart Association, Emergency Care and Safety Institute, National Safety Council or other nationally recognized organization or an individual certified by such organization to train, shall be present:

 

(1)  In each building that is used as a residence, at all times when residents are present; and

 

(2)  When residents are participating in any field trips off the premises of the residential child care program.

 

          (g)  The residential child care program director or designee shall obtain and maintain on file, available for review by the department, copies of current CPR and first aid certifications documenting coverage as required in (f) above.

 

          (h)  Each building and program vehicle that is used by residents shall be equipped with first aid supplies adequate to meet the needs of the residents.

 

          (i)  The first aid supplies shall be stored in a container that is accessible by residential child care program staff but not accessible to residents.

 

          (j)  First aid supplies adequate to meet the needs of the residents shall be available during all field trips.

 

          (k)  When the first aid treatment provided for minor scrapes or bruises is not effective or when a resident’s injury is more than a minor scrape or bruise, residential child care program staff shall:

 

(1)  If the injuries appear to be life threatening or appear to be severe, call emergency medical services for transport to a medical facility by ambulance;

 

(2) For all other injuries, take the injured resident to a licensed health care practitioner for medical evaluation and treatment;

 

(3)  As soon as possible after the injury occurs, notify the person or agency responsible for the resident’s placement and the parents of the injured resident whenever possible; and

 

(4)  Complete a written incident report as specified in He-C 4001.23 (a) and (b) within 24 hours of the incident.

 

          (l)  The program director or designee shall notify the unit, the parent, and the person or agency responsible for the resident’s placement within 24 hours of the death of any resident.

 

          (m)  The program director or designee shall provide a written report, detailing the circumstances of the death, to the unit and the person or agency responsible for the resident’s placement, within 72 hours of the death of any resident.

 

          (n)  In (l) or (m) above, in cases involving serious injury or death to a resident subject to restraint or seclusion in a program, the program shall, in accordance with and addition to the provisions of RSA 126-U:10, notify the commissioner, the attorney general, and the disability rights center (DRC).  Such notice shall include the notification required in RSA 126-U:7, II.

 

          (o)  The program director or designee shall conduct fire drills once each month in each building that is used as residential child care space.

 

          (p)  Monthly fire drills required in (o) above shall be held at varying times, including night time hours.

 

          (q)  Programs shall activate the actual fire alarm system for the building for at least 2 of the monthly fire drills required each year.

 

          (r)  Programs shall ensure that all residents and program staff evacuate the building during each fire drill including, if applicable, descent using the route designated on the posted fire evacuation plan.

 

          (s)  The staff person conducting the fire drill shall complete a written record of each fire drill that shall:

 

(1)  Be maintained on file at the program for one year; and

 

(2)  Be available for review by the fire inspector and the department.

 

          (t)  The written record of fire drills required under (s) above shall include at least the following:

 

(1)  The date and time the drill was conducted, and whether the actual fire alarm system was activated;

 

(2)  Exits used;

 

(3)  Number of residents evacuated and total number of people in the building at the time of the drill;

 

(4)  Name of the person conducting drill;

 

(5)  Time taken to evacuate the building;

 

(6)  Any problems encountered; and

 

(7)  A plan for correcting those problems.

 

          (u)  The program director or designee shall conduct a fire drill in the presence of a representative of the department or the local fire department upon request by either of those entities.

 

          (v)  If providing withdrawal management, any new SCPs shall comply with the appropriate chapter of NFPA 101 as published by the National Fire Protection Association and as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5, consistent with the level of needs of residents being served.

 

          (w)  All programs shall have:

 

(1)  Smoke detectors as approved in accordance with the State Fire Code, under RSA 153:1, VI-a, Saf-C 6000, and Saf-FMO 300, including but not limited to NFPA 1 and NFPA 101, as amended by the state board of fire control and ratified by the general court pursuant to RSA 153:5, consistent with the appropriate level of care being provided by the program;

 

(2)  At least one UL Listed, ABC type portable fire extinguisher, with a minimum rating of 2A-10BC installed on every level of the building with a maximum travel distance to each extinguisher not to exceed 50 feet and maintained as follows:

 

a.  Fire extinguishers shall be inspected either manually or by means of an electronic monitoring device or system at least once per calendar month, at intervals not exceeding 31 days;

 

b.  Records for manual inspection, or electronic monitoring shall be kept to demonstrate that at least 12 monthly inspections have been performed;  

 

c.  Annual maintenance shall be performed on each extinguisher by trained personnel, and a tag or label shall be securely attached that indicates that maintenance was performed; and

 

d.  The components of the electronic monitoring device or system in a. above, if used, shall be tested and maintained annually in accordance with the manufacturers listed maintenance manual; and

 

(3)  A carbon monoxide monitor on every level of the program, in accordance with Saf-C 6015.04.

 

          (x)  An emergency and fire safety program shall be developed and implemented to provide for the safety of residents and personnel.

 

          (y)  In addition to the policies required in (a) above, the program shall develop and implement an emergency operations plan (EOP), which shall:

 

(1)  Be based on the incident command system and coordinated with the emergency response agencies in the community in which the residential program is located;

 

(2)  Contain guidelines for personnel responsible for critical tasks, including, but not limited to the role of center incident commander, child care, medical treatment, and parental notification; and

 

(3)  Include response actions for natural, human-caused, or technological incidences including, but not limited to:

 

a.  Evacuation, both within building and off-site, relocation;

 

b  Secure campus;

 

c  Drop, cover, and hold;

 

d.  Lockdown;

 

e.  Reverse evacuation; 

 

f.  Shelter-in-place; and

 

g.  Bomb threat and scan.

 

          (z)  Programs shall develop a continuity of operations plan (COOP) to ensure that essential functions continue to be performed during, or resumed rapidly after, a disruption of normal activities.

 

          (aa)  All response actions in (y)(3) above shall include accommodations for children with chronic medical conditions, and children with disabilities or with access and functional needs.

 

          (ab)  Programs shall practice no less than 2 components of their EOP as described in (y) above with all staff and children at least twice per year.

 

          (ac)  All staff shall review the program's EOP in accordance with the following:

 

(1)  For currently employed staff, within the first 30 days of the development of the EOP pursuant to (y) above; or

 

(2)  For newly hired staff, within the first 30 days of employment.

 

          (ad)  In each building of the residential program, the written policies and procedures in (a) above and the EOP in (y) above shall be in an area easily accessible and known to residential staff.

 

          (ae)  Programs operating an SCP shall appoint an individual who will oversee the development and implementation of an infection control program that educates and provides procedures for staff for the prevention, control, and investigation of infectious and communicable diseases.

 

          (af)  The infection control program shall include written procedures for:

 

(1)  Proper hand washing techniques;

 

(2)  The utilization of universal precautions;

 

(3)  The management of residents with infectious or contagious diseases or illnesses;

 

(4)  The handling, storage, transportation, and disposal of those items identified as infectious waste in Env-Sw 904; and

 

(5)  The reporting of infectious and communicable diseases as required by He-P 301.

 

          (ag)  The infection control education program shall address at a minimum the:

 

(1)  Causes of infection;

 

(2)  Effects of infections;

 

(3)  Transmission of infections; and

 

(4)  Prevention and containment of infections.

 

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.15  Medication Services.

 

          (a) The licensee shall develop and implement written policies and procedures regarding administration, documentation, including a system for maintaining counts of controlled drugs, protocols for medication occurrences, and control and safety of medication that are consistent with the requirements of this section.

 

          (b)  Administration of medications to residents shall be performed by authorized staff, registered nurse (RN), licensed practical nurse (LPN) or licensed health care practitioners, accurately and in accordance with the resident’s treatment plan and the licensee’s policies.

 

          (c) Authorized staff shall know and understand the program’s written policies and procedures regarding the administration, control, and safety of medication.

 

          (d)  All residents shall be initially assessed to determine the level of support needed specific to medication administration.

 

          (e)  The assessment pursuant to (d) above shall include the resident’s:

 

(1)  Medication order(s) and medications prescribed;

 

(2)  Health status and health history; and

 

(3)  Ability to manage his or her medication, consistent with the resident’s treatment plan.

 

          (f)  Program staff shall obtain, or document their efforts to obtain, oral or written consent from the parent prior to administering any new or changed prescription medications.

 

          (g)  When the resident’s parent(s) is responsible for supplying the program with the resident’s medication, program staff shall contact the parent 2 weeks prior to the end of the supply of medication.

 

          (h)  When the responsibility of providing care to a resident is transferred to persons outside the program, for example for a home visit, and the resident is taking prescription medication:

 

(1)  The pharmacy container(s) shall be given to the person responsible for the resident;

 

(2) The program shall document the medication name, strength, prescribed dose, route of administration, and quantity of each medication provided to the persons outside the program, upon the resident’s transfer of care; and

 

(3)  Upon the resident’s return to the program, the program shall document the return of any medications including medication name, strength, prescribed dose, route of administration, and quantity of each medication with a description of why the medication was not given as the medication order stated.

 

          (i) Authorized staff shall administer only those prescription medications for which there is a medication order.

 

          (j)  Authorized staff shall administer medications only to the residents about whom they have current knowledge relative to their medication regimes.

 

          (k)  Authorized staff shall maintain a copy of each resident’s medication orders in the resident’s record.

 

          (l)  Medication orders shall be valid for no more than one year unless otherwise specified by the licensed health care practitioner.

 

          (m)  Each medication order shall legibly display the following information:

 

(1)  The resident’s name;

 

(2)  The medication name, strength, the prescribed dose, and route of administration;

 

(3)  The frequency of administration;

 

(4)  The indications for usage of all medications to be used PRN; and

 

(5)  The dated signature of the licensed health care practitioner.

 

          (n)  Written orders from a licensed health care practitioner regarding any prescription medication that is to be administered PRN shall include:

 

(1)  The indications and any special precautions or limitations regarding administration of the medication;

 

(2)  The maximum dosage allowed in a 24-hour period; and

 

(3)  The dated signature of the licensed health care practitioner.

 

          (o)  In addition to (n) above, authorized staff shall administer PRN medication in accordance with:

 

(1)  A medication order; and

 

(2)  A PRN protocol approved by the licensed health care practitioner that includes the specific condition(s) for which the medication is given.

 

          (p)  Prior to the administration of medication, authorized staff shall obtain information specific to each medication, including, at a minimum:

 

(1)  The purpose and effect(s) of the medication;

 

(2)  Response time of the medication;

 

(3)  Possible side effects, adverse reactions, and symptoms of overdose;

 

(4)  Possible medication interactions; and

 

(5)  Special storage or administration procedures.

 

          (q)  In the event of a medication occurrence, the authorized staff responsible for the administration of the medication shall forward written notification to the program director by the close of the next business day.

 

          (r)  When any medication that is administered by program staff results in serious adverse reactions including, but not limited to, impaired speech, mobility or breathing, semi-consciousness, or unconsciousness, program staff shall:

 

(1)  Immediately call 911 or notify a licensed health care practitioner for instructions regarding the need for emergency or other medical treatment;

 

(2)  Immediately comply with the instructions provided by the licensed health care practitioner;

 

(3)  Remain with the resident until he or she is fully alert and oriented and has recovered all physical capabilities that had been impaired by the medication, or until responsibility for the resident’s care is transferred to a licensed health care practitioner in a medical facility; and

 

(4)  Notify or document efforts to notify the parents within 24 hours.

 

          (s)  Prior to administering medication to any resident, program staff shall complete and document training on medication safety and administration, as specified in (t) below.

 

          (t)  Training in medication safety and administration, as required in (s) above, shall:

 

(1)  Be delivered by a physician, APRN, RN, or LPN practicing under the direction of an APRN, RN, or physician, or by another qualified individual;

 

(2)  Be provided in person, via distance learning, a video presentation, or web-based; and

 

(3)  Address the following:

 

a.  The safe storage and administration of medication, including but not limited to:

 

1.  Administration of the correct medication;

 

2.  Administration of the correct dosage of the medication;

 

3.  Administration of the medication to the correct resident;

 

4. Administration of the medication to the resident at the correct times and frequency;

 

5. Administration of the medication to the resident by the correct method of administration;

 

6.  Infection control and aseptic procedures related to administration of medication; and

 

7.  Resident’s rights regarding refusing medications;

 

b.  Possible side effects and adverse reactions to the medications to be administered and required reporting regarding those issues;

 

c.  Proper storage, disposal, security, error control, and documentation as related to the medications to be administered;

 

d.  Any other unusual occurrence related to the safe storage or administration of medication and reporting requirements regarding those issues;

 

e.  Conditions or situations requiring emergency medical intervention; and

 

f.  Methods of administration including, but not limited to oral, injection, topical application or inhalation.

 

          (u)  In addition to (t) above, authorized staff shall complete 2 hours of training annually on medication safety and administration.

 

          (v)  Documentation of training in medication safety and administration shall be maintained on file at the child care program available for review by the department.

 

          (w)  For each resident, program staff shall maintain medication information on file and available for review by the department, which includes, at a minimum:

 

(1)  A written medication order, as specified in (m) above, including special considerations for administration for each prescription medication being taken by a resident;

 

(2)  Written parental authorization to administer medication, if applicable;

 

(3)  The name and contact information of the parent, if applicable; and

 

(4)  Allergies, if applicable.

 

          (x)  In addition to (w) above, program staff shall maintain a daily medication log for each dose of medication administered to each resident.

 

          (y)  The medication log required in (x) above shall:

 

(1)  Be maintained on file in the program, available for review by the department;

 

(2)  Be completed by the authorized staff who administered the medication immediately after the medication is administered; and

 

(3)  For each medication prescribed, include at a minimum:

 

a.  The name of the resident;

 

b.  The date and time the medication was taken;

 

c.  A notation of any medication occurrence or the reason why any medication was not taken as ordered or approved;

 

d. The dated signature of the authorized staff who administered the medication to the resident; and

 

e.  For administration of a PRN, documentation including the reason for administration.

 

          (z)  The licensee shall require that all telephone orders from a licensed health care practitioner or their agent, for medications, treatments, and diets are documented in writing, including facsimiles, by the licensed health care practitioner within 24 hours.

 

          (aa)  In addition to (z) above, authorized staff shall record any changes regarding prescription medications in the resident’s medication log.

 

          (ab)  All physician medication samples shall legibly display the information described in (m)(1)–(5) above.

 

          (ac)  No person other than a licensed health care practitioner shall make changes to the written order of a licensed health care practitioner regarding prescribed medication.

 

          (ad)  All medication maintained by the program shall be stored as follows:

 

(1)  Kept in a storage area that is:

 

a.  Locked and accessible only to authorized personnel;

 

b.  Organized to allow correct identification of each resident’s medication(s);

 

c.  Illuminated in a manner sufficient to allow reading of all medication labels; and

 

d.  Equipped to maintain medication at the proper temperature;

 

(2)  Schedule II controlled substances, as defined by RSA 318-B:1-b, shall be kept in a separately locked compartment within the locked medication storage area and accessible only to authorized personnel; and

 

(3)  Topical liquids, ointments, patches, creams, and powder forms of products shall be stored in a manner such that cross-contamination with oral, optic, ophthalmic, and parenteral products shall not occur.

 

          (ae)  All medication shall be accompanied by:

 

(1)  The physician’s written order, which may be the prescription label; and

 

(2)  The manufacturer’s written instructions for dosage.

 

          (af)  Medications such as insulin, inhalers, and epi pens shall be permitted to be in the possession of a resident in accordance with the resident’s ability, as specified in the resident’s treatment plan.

 

          (ag)  All medications belonging to staff shall be stored in a locked area, separate from residents’ medications or otherwise inaccessible to residents.

 

          (ah)  The program director or designee may elect to have a supply of non-prescription medication available, including but not limited to acetaminophen, ibuprofen, aspirin, cold medicines, or antacids that may be administered to residents for minor illnesses, provided those medications are stored and administered in accordance with the requirements in this section.

 

          (ai)  All medication shall be kept in the original containers or pharmacy packaging and properly closed after each use unless otherwise allowed by law.

 

          (aj)  Any contaminated, expired, or discontinued medication, whether prescription or over the counter, shall be destroyed within 7 days of identification as contaminated, expired, or discontinued.

 

          (ak)  Destruction of prescription drugs under (aj) above shall:

 

(1)  Be accomplished by an authorized staff and witnessed by one staff; and

 

(2)  Be documented in the resident’s medication record, including the legible, dated signature of the staff person who disposed of the drugs and the staff person who witnessed the disposal.

 

          (al)  All medication shall be destroyed in accordance with the United States Environmental Protection Agency’s, “How to Dispose of Medicines Properly” guidance, (April 2011), available as noted in Appendix A.

 

          (am)  Programs providing SUD services shall have a clearly identified policy for storage and administration of naloxone that includes the following:

 

(1)  The process for regularly reviewing and updating the standing order for the naloxone kits on the premises;

 

(2)  The process for ensuring regular review of naloxone kits for expiration;

 

(3)  If naloxone is administered, the policy shall include a statement that 911 shall be called immediately; and

 

(4)  If naloxone is not administered but an overdose is suspected, the policy shall include a statement that 911 shall be called immediately.

 

          (an)  Medication administered by individuals authorized by law to administer medications shall be:

 

(1)  Prepared immediately prior to administration; and

 

(2)  Prepared, identified, and administered by the same person in compliance with RSA 318-B and RSA 326-B.

 

          (ao)  Personnel shall remain with the resident until the youth has taken the medication.

 

          (ap)  If a nurse delegates the task of medication administration to an individual not licensed to administer medications, the nurse shall follow the requirements of RSA 326-B.

 

          (aq)  Programs providing SUD services shall have a written policy establishing procedures for the prevention, detection, and resolution of controlled substance misuse, and diversion, which shall apply to all personnel, and which shall be the responsibility of a designated employee or interdisciplinary team.

 

          (ar)  The policy in (aq) above shall include:

 

(1)  Education;

 

(2)  Procedures for monitoring the distribution and storage of controlled substances;

 

(3)  Voluntary self-referral by employees who are misusing substances;

 

(4)  Co-worker reporting procedures;

 

(5)  Drug testing procedures to include at a minimum, testing where reasonable suspicion exists;

 

(6)  Employee assistance procedures;

 

(7)  Confidentiality;

 

(8)  Investigation, reporting, and resolution of controlled drug misuse or diversion; and

 

(9)  The consequences for violation of the controlled substance misuse, and diversion prevention policy.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.16  Residential Child Care Space.

 

          (a)  In all programs, space that is designated, inspected, and approved as residential child care space shall not be used for any purposes or activities that could jeopardize the health or safety of residents or otherwise negatively impact the residential child care program.

 

          (b)  Residential child care programs shall provide:

 

(1)  A living room or community space with comfortable furnishings, available, and accessible to residents for regular and informal use for general relaxation and entertainment;

 

(2)  Bedrooms that are separated by gender and that have:

 

a.  A minimum of 50 square feet of floor space per occupant;

 

b.  Ceilings that are at least 7 feet high at the highest peak;

 

c.  An outside window; and

 

d.  An operable door;

 

(3)  An area that is suitable and available for private discussions and counseling sessions;

 

(4)  Sturdy, comfortable furniture and furnishings, that are clean and in good repair;

 

(5)  Bathroom facilities that provide residents with age appropriate privacy while changing clothes, showering, attending to personal hygiene, and using the toilet;

 

(6)  When available on site, outdoor space that is maintained in a neat, safe, clean condition and is available to residents for active recreation; and

 

(7)  Screens for all operable windows in the facility.

 

          (c)  If seclusion is used, then rooms used for seclusion shall be in compliance with the provisions of RSA 126-U:5-b.

 

          (d)  Programs shall have a communication system in place so that residents and staff can effectively contact personnel when they need assistance with care or in an emergency.

 

          (e)  Programs shall assure that:

 

(1)  Damage to the residence, such as holes in walls and doors, is repaired within 7 days, or as soon as possible after the damage has occurred; and

 

(2)  Any hazardous condition in the licensed premises, including but not limited to those identified in He-C 4001.17(a),  is immediately addressed, and that residents do not have access to any hazardous conditions or materials pending repair or replacement.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.17  Health and Safety in the Residential Child Care Environment.

 

          (a)  Program staff shall maintain the residential child care environment free of conditions hazardous to residents, including but not limited to, the following:

 

(1)  Electrical hazards;

 

(2)  Guns, or live or spent ammunition;

 

(3)  Holes in flooring, loose floor tiles or loose throw rugs, which present a slipping or tripping hazard;

 

(4)  Loose and flaking paint which is accessible to residents;

 

(5)  Unclean conditions, which demonstrate a lack of regular cleaning;

 

(6)  Inadequate protections against insects and rodents; and

 

(7)  Garbage and rubbish stored in an unsanitary manner.

 

          (b)  When interior or exterior surfaces of a building built prior to 1978 are in deteriorating condition, including flaking, chipping and peeling paint, or are subject to renovations or construction, a U.S. Environmental Protection Agency certified Renovation, Repair, and Painting (RRP) contractor shall be utilized to make the deteriorated surfaces intact, in accordance with 40 CFR1.745.90(a) and (b) and He-P 1600.

 

          (c)  When there is information or evidence indicating that the building might contain asbestos hazards, the applicant, licensee, or designee shall submit evidence that the building has been inspected by a licensed asbestos inspector and is free of asbestos hazards or otherwise treated or contained in a manner approved by a licensed asbestos inspector.

 

          (d)  Program staff shall clearly label and store all toxic materials, including, but not limited to, cleaners, household chemicals and paint, separate from food items, in cabinets which are locked or otherwise inaccessible to residents. 

 

          (e)  Notwithstanding (d) above, at the discretion of the program director, residents may be allowed to use household cleaning products to complete a specific task, provided the resident completing the task shall be under the supervision of program staff while the cleaning chemicals are accessible, and the cleaning products shall not be accessible to other residents not involved in the cleaning task.

 

          (f)  Program staff shall maintain on file at the residence documentation of current vaccinations as required by law for all pets and animals that are present on the premises of the program.

 

          (g)  Pets and animals that have been determined by the department to pose a health or safety risk to children shall not be permitted on the premises of the program, including, but not limited to, the following:

 

(1)  Bats;

 

(2)  Turtles;

 

(3)  Tortoises;

 

(4)  Snakes;

 

(5)  Iguanas;

 

(6)  Other lizards or reptiles;

 

(7)  Hedgehogs;

 

(8)  Parakeets; and

 

(9)  Parrots and parrot-like birds.

 

          (h)  All enclosed living areas used by residents shall:

 

(1)  Be ventilated by means of a mechanical ventilation system or one or more screened windows that can be opened, and will not pose a hazard to residents; and

 

(2)  From September 1 through May 31, have a safe, functioning heating system, which is cleaned, serviced, and maintained at least once annually and which ensures that whenever residents are present, or expected to arrive within one hour, the temperature is maintained at:

 

a.  Not less than 65 degrees Fahrenheit during waking hours, except for areas being used for active physical exercise or recreation; and

 

b.  Not less than 55 degrees Fahrenheit during sleeping hours.

 

          (i)  Program staff, child care interns, and volunteers shall not smoke or use tobacco products while they are responsible for the care of residents or within sight of residents, nor allow residents to smoke or use tobacco, have access to tobacco products, or be exposed to second hand smoke.

 

          (j)  All living space and recreation areas used by residents shall be equipped with operable lighting sufficient to allow individuals to enter, exit and move about the premises of the program safely.

 

          (k)  All toys, equipment and learning materials shall be:

 

(1)  In good repair;

 

(2)  Safe;

 

(3)  Free of lead paint or other poisonous material; and

 

(4)  Cleaned as often as needed to keep them free of a buildup of dirt.

 

          (l)  Licensees shall provide sufficient sturdy tables and chairs to ensure each resident’s comfort for meals, snacks, and for work or play at tables.

 

          (m)  Licensees shall provide each resident with a bed equipped with:

 

(1)  A pillow and a firm mattress that is:

 

a.  Clean;

 

b.  In good repair;

 

c.  Free from rips or holes in the fabric covering that would allow residents access to the interior components of the mattress;

 

d.  Cleaned and sprayed with a disinfecting spray before being used for a new resident; and

 

e.  Replaced or sanitized promptly if soiled by urine, feces, blood, or vomit; and

 

(2)  Adequate bedding to insure his or her comfort that is cleaned and maintained as follows:

 

a.  Sheets and pillow cases shall be cleaned at least once each week and more frequently if soiled; and

 

b.  Blankets, comforters, bedspreads, and mattress covers shall be cleaned at least once each month and more frequently if soiled.

 

          (n)  Programs shall provide separate sleeping and bathroom facilities for staff and family members of staff who reside in the program.

 

          (o)  Program staff shall maintain the outside play areas free of hazards.

 

          (p)  During activities conducted in the water, including wading, swimming and boating, the following shall apply:

 

(1)  All activities shall be supervised in accordance with the following:

 

a.  Program staff shall provide close supervision to residents at all times, to include a ratio of one staff to no more than 4 residents when no lifeguard is present;

 

b.  At least one staff person who is currently certified in CPR and first aid shall be present with the residents at all times;

 

c.  At least one staff person who has completed training in water safety shall be present with the residents at all times;

 

d.  A rescue buoy, ring buoy, or water rescue throw bag shall be brought to or present at all swimming and boating activities where there is no lifeguard present; and

 

e.  Notwithstanding a. through d. above, a program may allow a resident to be at a water activity independently, if the program director provides a written and dated authorization, after assessing the following:

 

1.  A resident’s swimming ability, such as whether he or she has completed a Red Cross or other recognized swimming program;

 

2.  A resident’s ability to be independent;

 

3.  Under what circumstances the resident may be at a water activity independently; and

 

4.  Whether or not a lifeguard must be on duty or a parent or other adult must be present at the water activity; and

 

(2)  All pools used as part of the residential child care operation shall be maintained in accordance with the printed instructions of the manufacturer or installer regarding cleaning, filtration, and chemical treatment, and the following:

 

a.  Swimming pools shall be secured in a manner that is childproof and lockable; and

 

b.  Pool gates, fences, or other barriers as required in a. above shall be locked at all times, except when the residents are involved in an allowable water activity in the pool.

 

          (q)  Program staff shall comply with the following food service requirements:

 

(1)  All foods that will be served to residents shall be:

 

a.  Free from spoilage, filth, or other contamination;

 

b.  Stored in a clean dry location;

 

c.  Protected from sources of contamination;

 

d.  Stored in containers at least 6 inches above the floor;

 

e.  Stored separate from non-food items that could contaminate food or be mistaken for food;

 

f.  Stored in the original containers or in labeled containers designed for food storage; and

 

g.  Stored, handled, and prepared in a manner that protects against cross contamination between uncooked meat, poultry or fish, and other food items;

 

(2)  Canned goods that are dented, bulging, or rusted shall not be served to residents;

 

(3)  All perishable foods which are to be served to residents shall be stored at temperatures of 41 degrees Fahrenheit or below in a refrigerator and at 0 degrees Fahrenheit or below in a freezer;

 

(4)  Refrigerators and freezers used to store foods that will be served to residents shall be clean;

 

(5) Refrigerators and freezers used to store foods that will be served to residents shall be equipped with non-mercury, food-grade thermometers; and

 

(6)  Food contact surfaces shall be easily cleanable, smooth, free of cracks, breaks, and open seams or similar difficult to clean imperfections and kept clean.

 

          (r)  Toys or other items which are routinely mouthed by residents shall be cleaned and sanitized after each use by a resident, and at the end of each day.

 

          (s)  Residents who have developmental delays and are likely to put objects in their mouths, shall be closely supervised when they have access to the items noted in (t)(1)c. and (11) below.

 

          (t)  Program staff shall comply with the following child age related environmental health and safety requirements:

 

(1)  Residents younger than 6 years of age shall not have access to the following:

 

a.  Cords or strings long enough to encircle a resident’s neck, including but not limited to pull toys, telephone cords, and window blind cords;

 

b.  Balusters which are spaced more than 3 1/2 inches apart on handrails and guardrails on play structures, lofts, stairs, steps, decks, porches, balconies, or other barriers;

 

c.  Sharp knives and sharp objects or objects with sharp edges, except that, at the discretion of program staff and under close supervision, program staff may allow use of scissors or knives for specific cooking projects, craft projects, or meal times;

 

d.  Unstable or easily tipped heavy furnishings or other heavy items which, if not secured to the wall or floor or both, could easily fall on residents and would be likely to cause injury; and

 

e.  Toy boxes and any other chest type storage facilities that have a lid that does not have a safety lid support;

 

(2)  Play areas accessible to residents younger than 6 years of age shall be enclosed by a fence when the department determines that the play area is unsafe because it is located on a roof, or adjacent to any of the following:

 

a.  A street or road; or

 

b.  Any dangerous areas, any swimming pool, or any body of water;

 

(3)  All fencing required under (2) above shall:

 

a.  Be designed to restrain residents from climbing out of, over, under, or through the fence;

 

b.  Have a child proof self-latching device on any gates; and

 

c.  Be maintained in good repair, free of damage or wear that could expose residents to hazards;

 

(4)  When accessible to residents younger than 6 years of age, ground area under and extending at least 39 inches beyond the external limits of outdoor play equipment which would allow a resident to fall from a height of more than 29 inches shall be constructed and maintained at all times with an energy absorptive surface, including but not limited to sand, bark mulch, pea stone, soft wood chips, or rubber mats manufactured for use as gym mats; 

 

(5)  The energy absorptive material required in (4) above shall be:

 

a.  Maintained at a depth of at least 8 inches; and

 

b.  Checked and raked regularly to remove any foreign matter, correct compaction, and increase absorption;

 

(6)  Adult toilets and hand washing sinks used by residents younger than 6 years of age shall be equipped with footstools or platforms;

 

(7)  Foot stools or platforms required in (6) above shall:

 

a.  Have a non-porous finish that is easily cleanable; and

 

b.  Be designed to prevent tipping;

 

(8)  The fall zone under and around all indoor swings, slides, and climbing equipment from which a child could fall from a height of more than 29 inches shall be covered with mats designed for gymnastics, if they are accessible to or will be used by residents younger than 6 years of age;

 

(9)  Children younger than 3 years of age shall not have access to stairs or steps that are not equipped with safety gates;

 

(10)  Baby walkers with wheels shall be prohibited in all programs;

 

(11)  Residents younger than 4 years of age shall not have access to toys, toy parts, and other materials which pose a choking risk or are small enough to be swallowed, such as coins and balloons;

 

(12)  There shall be an individual crib or playpen for each resident 12 months of age and younger; and

 

(13)  Cribs and playpens required under (12) above shall:

 

a.  Not be stacked;

 

b.  Be free of cracked or peeling paint, splinters, and rough edges;

 

c.  Have no more than 2 3/8 inches between slats;

 

d. Have no missing, loose, broken, or improperly installed parts, screws, brackets, baseboards or other loose hardware or damaged parts on the crib or mattress supports;

 

e. Not have corner posts that extend more than one sixteenth of an inch above the end panels;

 

f.  Not have cutouts in the headboard or footboard;

 

g.  Not have holes or tears in the mesh walls or in the material that connects the walls to the bottom of the crib or play pen; and

 

h.  Have mattresses which:

 

1.  Are in good repair, free of rips or tears; and

 

2.  Fit the crib or playpen so that space between the mattress and the crib or playpen does not create a suffocation hazard.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.18  Water Supply, Septic Systems, Bathroom Facilities.

 

          (a)  The licensee shall supply a safe supply of water under pressure, which is available for drinking and household use in accordance with the following:

 

(1)  Hot water under pressure, which measures at least 100 degrees Fahrenheit, shall be available at all sinks, showers, and bathtubs located in living space that is used by residents during operating hours;

 

(2)  Hot water at taps that are accessible to residents shall be regulated to maintain a temperature at the tap of not higher than 120 degrees Fahrenheit; 

 

(3)  In accordance with Env-Dw 501.04(c), a program that has a public water system as defined in RSA 485:1-a, XV and subject to regulation by the department of environmental services, shall have on file a written document which lists the United States Environmental Protection Agency identification number of the system, assigned by the department of environmental services;

 

(4)  The written documentation required in (3) above available shall be available for review by the health officer and the department;

 

(5)  Programs that have their own independent water supply and are not considered to be public water systems as defined in RSA 485:1-a, XV, shall test their water supply in accordance with the following:

 

a.  Water testing shall be performed by a laboratory accredited under the environmental laboratory accreditation program in accordance with Env-C 300;

 

b.  For new applicants, not more than 90 days prior to the date the application is submitted to the department, water testing shall be conducted for arsenic, bacteria, nitrate, nitrite, lead, both stagnant and flushed, copper, both stagnant and flushed, fluoride, and uranium and results provided to the department with the application; and

 

c.  Ongoing water testing shall be conducted as follows and results maintained on file at the program, available for review by the health officer and the department:

 

1.  Once every 3 months for bacteria;

 

2.  Annually for arsenic, nitrate, and nitrite; and

 

3.  At least once every 3 years for stagnant lead, stagnant copper, fluoride, and uranium;

 

(6)  The results of water tests required by (a)(5)b. and c. above, and results of any other water tests shall be in compliance with the maximum contaminant levels established in Env-Dw 700 for bacteria, nitrates, nitrites, arsenic, and fluoride, and shall not exceed the action levels established in Env-Dw 714 for lead and copper;

 

(7)  Any program whose water test result has exceeded maximum contaminant levels or action levels shall:

 

a.  Immediately contact the department to report that finding, and provide the department with a plan for how it will ensure that children will not be at risk from exposure to the unsafe water; and

 

b.  Within 30 days of the date the program learns that they have failed a water test submit to the department an acceptable corrective action plan which details what action will be taken to correct the unsafe condition of the water and a date by which that action will be complete, unless the program requests, either verbally or in writing, and the department agrees to extend that deadline based on the following criteria:

 

1.  The program demonstrates that it has made a good faith effort to develop and submit the corrective action plan within the 30-day period but has been unable to do so; and

 

2.  The department determines that the health, safety or well-being of children will not be jeopardized as a result of granting the extension; and

 

(8)  When a program fails to submit a written proposed corrective action plan within 30 days of receiving the unacceptable test result under (a)(7)b. above, the department shall initiate action to suspend the license or permit in accordance with He-C 4001.09(i), until such time as laboratory results meeting those requirements are received by the department.

 

          (b)  Programs shall ensure that there are functional sewage disposal facilities designed to accommodate the license capacity of the program, in accordance with the following:

 

(1)  There shall be no visible sewage on the grounds;

 

(2)  There shall be flush toilets in working order connected to a sewage disposal system; and

 

(3)  Any program whose septic system is showing signs of failure, shall:

 

a.  Immediately make arrangements with a contractor licensed to evaluate and repair or replace septic systems to:

 

1.  Make temporary repairs to the septic system to correct the problem so that the program may continue to operate; or

 

2.  Make permanent repairs to the septic system or replace the septic system;

 

b.  Immediately contact the local health officer to inform him or her of the problem;

 

c. Immediately contact the department to verbally report the problem, and give the department a plan for how it will immediately provide that:

 

1.  All required bathroom units function properly; and

 

2.  Residents will not be exposed to any risks from the failed septic system;

 

d.  Within 10 days of the date that program staff first notice signs indicating that the septic system is in failure, submit to the department a written plan, which includes:

 

1.  What action has been taken to correct the failed septic system;

 

2.  The date by which that action will be completed; and

 

3.  An explanation of how the program will ensure that the requirements in (b) (3) c. 1. and 2. above will continue to be met until repair or replacements are completed; and

 

e.  Request an extension to d. above which the department shall grant if additional time is necessary to develop a written plan and the safety and well-being of the residents is maintained.

 

          (c)  Programs shall ensure that in each building in which residents reside, for every 4 residents there shall be one bathroom unit that is accessible to residents and equipped with:

 

(1)  An operable door; and

 

(2)  A properly functioning sink, toilet, and shower or tub.

 

          (d)  Programs shall maintain bathroom facilities in accordance with the following:

 

(1)  At least once each day and whenever visibly soiled, sinks, toilets, commodes, foot stools, potty chairs, and adapters shall be cleaned to remove visible dirt and sanitized;

 

(2)  Toilet paper, individual cloth or paper towels, and individual bar or liquid soap shall be available and accessible to residents and staff;

 

(3)  Bathrooms shall have a means of outside ventilation; and

 

(4)  Bathroom floors and other surfaces shall be cleaned at least weekly, and more often when obviously soiled.

 

          (e)  In addition to the requirements for toilets set forth in (c) above, programs that serve residents younger than 3 years of age shall:

 

(1)  Provide additional child size toilets, adult toilets with adapters, or potty chairs to meet the needs of such residents;

 

(2)  Place potty chairs within easy access to a toilet and sink to allow program staff to proceed to the toilet to empty the potty chair and proceed to the hand washing sink after toileting without having to open doors or gates, or have physical contact with other residents;

 

(3)  Not place potty chairs or commodes in food preparation areas or food service areas; and 

 

(4)  Empty and sanitize each potty-chair and commode receptacle after each use.

 

          (f)  Programs serving diapered residents and residents who are not toilet trained shall have a designated diaper changing area that:

 

(1)  Is not located in kitchens, food preparation or food service areas, or on surfaces where food is prepared or served;

 

(2)  Is located adjacent to or in close proximity to a hand washing sink to allow access for hand washing without having to open doors or have physical contact with other residents;

 

(3)  Has a non-porous, washable surface, which shall be sanitized after each diaper change and used exclusively for diaper changing;

 

(4)  Contains a foot-activated receptacle for disposal of soiled disposable diapers and cleansing articles; and

 

(5)  Is equipped with a sink used for adult and resident hand washing before or after diaper changing or toileting.

 

Source.  #2664, eff 3-30-84, EXPIRED: 3-30-90

 

New.  #8581, eff 4-20-06, EXPIRED: 4-20-06

 

New.  #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14; ss by #10705, eff 10-23-14; ss by #13151, eff 12-30-20

 

          He-C 4001.19  Requirements for Program Staff.

 

          (a)  Program staff shall:

 

(1)  Relate with residents in a professional, respectful manner; and

 

(2)  Have the ability to identify the needs and problems of the children and possess skill in planning and implementing services of the program.

 

          (b)  The program director or designee shall, for each staff person who is responsible for the care, supervision, or treatment of residents, have on file available for review by the department documentation of job qualifications such as:

 

(1)  All required education, such as a diploma, transcripts, certificates, or degrees; and

 

(2)  All required training and experience, as set forth on an application form or resume.

 

          (c)  For the purposes of this section, the field of human services shall include residential care, education, social work, mental health, law enforcement, psychology, sociology, pastoral counseling, theology, juvenile justice, medical services, corrections, substance abuse, social services, recreation, or a related field.

 

          (d)  The department shall accept the following education and training for program staff:

 

(1)  Credit courses in human services, offered by a regionally accredited college or university, toward meeting pre-service and in-service training requirements;

 

(2)  Non-credit courses in human services, which are offered by a regionally accredited college or university, toward meeting pre-service and in-service training requirements at a ratio of 12 contact hours equal one credit; and

 

(3) Conference sessions, workshops, non-credit correspondence courses or other non-credit distance learning courses related to human services, that are open to individuals working in the residential child care field or to the public or both, and are presented by an instructor who has at least a bachelor’s degree in human services or the subject area in which he or she is teaching, at a ratio of 12 contact hours equals one credit.

 

          (e)  The program director shall meet at least one of the following pre-service training and education options:

 

(1) 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

 

(2)  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.

 

          (f)  Direct care staff shall be at least 21 years of age, have a high school diploma, high school equivalency certificate, or general equivalency diploma, and meet one of the following pre-service training and education requirements:

 

(1)  An associate’s or higher degree with a minimum of 12 credits in the field of human services, or other field related to residential care, awarded by a regionally accredited college or university;

 

(2)  The equivalent of 2 years of full-time experience working with children, either as a paid employee or volunteer;

 

(3)  Any combination of college credits in human services and experience with children that total 2 years, as follows:

 

a.  Two years of full-time college shall equal 60 credits;

 

b.  Two years of full-time employment shall equal 3000 hours; and

 

c.  One credit shall equal 50 hours of experience; or

 

(4)  Documentation of 7 years of parenting experience.

 

          (g)  When an applicant for a direct care staff member does not meet one of the provisions in (f) above:

 

(1)  An agreement shall be on file, signed, and dated by the individual and the program director or designee, which includes a written plan for:

 

a.  Attaining 12 credits in human services within 2 years from the date that the individual begins working as a direct care staff, with documentation on file of the completion of 3 credits every 6 months, beginning on the date of hire;

 

b.  How the program will supervise the individual while they are working on acquiring the required 12 credits; and

 

c.  Maintaining current documentation of earned credits on file in the individual’s personnel file; and

 

(2)  No more than 30% of staff shall be hired under the provisions of (g)(1)a. above.

 

          (h)  A child care assistant, intern, or volunteer shall:

 

(1)  Be at least 18 years of age;

 

(2)  Work at all times under the supervision of an on-duty staff person who meets at least the minimum qualifications for the position of direct care staff;

 

(3)  Not be responsible for the care or supervision of residents including treatment, discipline, physical intervention, counseling, or administration of medication; and

 

(4)  Not be included in the staff to child ratio.

 

          (i)  Supervision as referenced in (h) above shall require that a staff person who meets at least the minimum qualifications of direct care staff shall at all times have:

 

(1)  Knowledge of and accountability for the activity and whereabouts of the child care interns, child care assistants, or volunteers and the residents with whom he or she is working; or

 

(2)  The ability to either see or hear the child care intern, child care assistant, or volunteer and the residents with whom he or she is working.

 

          (j)  The exception to (i) above shall be that the program director or designee may at his or her discretion, authorize a specific child care assistant, intern, or volunteer to be responsible for one or more residents during time limited, specific activities, either indoors or outdoors, including off premises.

 

          (k)  Prior to having contact with residents or food, personnel shall receive a tour of and orientation to the program that includes the following:

 

(1)  The program’s complaint procedures;

 

(2)  The duties and responsibilities of the position;

 

(3)  The medical emergency procedures;

 

(4)  The emergency and evacuation procedures;

 

(5)  The infection control procedures;

 

(6)  The program confidentiality requirements;

 

(7)  Grievance procedures for both staff and residents;

 

(8)  The procedures for food safety for personnel involved in preparation, serving, and storing of food, as applicable;

 

(9)  The policies required in He-C 4001.14(a); and

 

(10)  The mandatory reporting requirements including RSA 161-F:46 and RSA 169-C:29.

 

          (l)  No new direct care staff shall be solely responsible for residents in care until he or she has completed the orientation required above.

 

          (m)  The licensee shall provide all personnel with an annual continuing education or in-service education training, which at a minimum contains the following:

 

(1)  The licensee’s infection control program;